Clinical Endoscopy

Review

Quality indicators in endoscopic retrograde cholangiopancreatography: a brief review of established guidelines: Zubin Dev Sharma, Rajesh Puri; Clin Endosc 2023;56(3):290-297. Published online April 11, 2023; DOI: https://doi.org/10.5946/ce.2022.210

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive endoscopic technique that has many diagnostic and therapeutic implications. It is a procedure with small but significant life-threatening complications. To ensure the best possible care, minimize complications, and improve the quality of health care, a constant review of the performance of the operator using ideal benchmark standards is needed. Hence, quality indicators are necessary. The American and European Societies of Gastrointestinal Endoscopy have provided guidelines on quality measures for ERCP, which describe the skills to be developed and training to be implemented in performing quality ERCP. These guidelines have divided the indicators into pre-procedure, intraprocedural, and post-procedure measures. The focus of this article was to review the quality indicators of ERCP.

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Advancements in Research on Challenges in Selective Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography (ERCP)
天雨张
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Development of an Automated Endoscopic Retrograde Cholangiopancreatography Quality Report Card Using an Integrated Analytics Suite
Anmol Singh, Eric Swei, Celestina Tolosa, Matthew Alverson, Todd A. Brenner, Avleen Kaur, Aida Metri, Mohammed Rifat Shaik, Nikhil Bush, Branislav Bujnak, Alexandra T. Strauss, Mouen Khashab, Eun Ji Shin, Vikesh K. Singh, Venkata S. Akshintala
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Frontiers in Surgery.2023;[Epub] CrossRef

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Original Articles

COVID-19 Rapid Antigen Test: Role in Screening Prior to Gastrointestinal Endoscopy: Ashok Dalal, Ujjwal Sonika, Manish Kumar, Roshan George, Ajay Kumar, Siddharth Srivastava, Sanjeev Sachdeva, Barjesh Chander Sharma; Clin Endosc 2021;54(4):522-525. Published online March 4, 2021; DOI: https://doi.org/10.5946/ce.2020.295

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Background
/Aims: The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19).
Methods
This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages.
Results
A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period.
Conclusions
The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.

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Intestinal Damage, Inflammation and Microbiota Alteration during COVID-19 Infection
Angela Saviano, Mattia Brigida, Carmine Petruzziello, Christian Zanza, Marcello Candelli, Maria Rita Morabito Loprete, Faiz Saleem, Veronica Ojetti
Biomedicines.2023; 11(4): 1014. CrossRef
SARS-CoV-2 (COVID-19) pneumonia patient treated with two doses of infliximab within 2 weeks for acute severe ulcerative colitis
Marouf Alhalabi, Kamal Alaa Eddin, Fadwa Ali, Ahmad Abbas
Medicine.2022; 101(4): e28722. CrossRef
Current Status of Screening Clinic due to Changes in the Reimbursement Criteria for COVID-19 Polymerase Chain Reaction Test: Case of a Hospital in Seoul
Song Lee Kim
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Rapid, point-of-care antigen tests for diagnosis of SARS-CoV-2 infection
Jacqueline Dinnes, Pawana Sharma, Sarah Berhane, Susanna S van Wyk, Nicholas Nyaaba, Julie Domen, Melissa Taylor, Jane Cunningham, Clare Davenport, Sabine Dittrich, Devy Emperador, Lotty Hooft, Mariska MG Leeflang, Matthew DF McInnes, René Spijker, Jan Y
Cochrane Database of Systematic Reviews.2022;[Epub] CrossRef
Risk-based decision-making related to preprocedural coronavirus disease 2019 testing in the setting of GI endoscopy: management of risks, evidence, and behavioral health economics
Naomi Moy, Uwe Dulleck, Ayesha Shah, Helmut Messmann, Aaron P. Thrift, Nicholas J. Talley, Gerald J. Holtmann
Gastrointestinal Endoscopy.2022; 96(5): 735. CrossRef

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Technical Reports of Endoscopic Retrograde Cholangiopancreatography Guidewires on the Basis of Physical Properties: Chang-Il Kwon, Dong Hee Koh, Tae Jun Song, Won Suk Park, Dong Hang Lee, Seok Jeong; Clin Endosc 2020;53(1):65-72. Published online August 6, 2019; DOI: https://doi.org/10.5946/ce.2019.114

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Background
/Aims: Using an appropriate guidewire can increase the success rate of selective cannulation in endoscopic retrograde cholangiopancreatography. The purpose of this technical study was to investigate the characteristics of each guidewire type and to evaluate its efficiency and rapidity of insertion.
Methods
We conducted a three-point bending test using a universal testing machine to investigate the flexibility and bending features of each guidewire. 3D-printed silicone tubes with various types of stricture and a hand-made biliary tree silicone model with six-stranded intrahepatic ducts were used to evaluate the success rate and insertion time of each guidewire.
Results
In the three-point bending test, the characteristics of each guidewire were classified. We found that the bending strengths and times were independent of shaft thickness. Using two in vitro biliary duct models, we determined that the success rate and total insertion time were better for guidewires with a resilient shaft and angled tip than for other types of guidewires (p<0.001). Although thickness of the guidewire affected the success rate (p<0.05), it did not affect the total insertion time (p≥0.05).
Conclusions
Among several types of guidewire, some factors (resilient shaft, highly flexible, and angled tip) appeared to be associated with the efficiency and rapidity of the guidewire insertion.

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Structural factors influencing the clinical performance of 0.025-inch guidewires for pancreatobiliary endoscopy: An experimental study
Takehiko Koga, Naoaki Tsuchiya, Yusuke Ishida, Takanori Kitaguchi, Keisuke Matsumoto, Makoto Fukuyama, Satoki Kojima, Norihiro Kojima, Fumihito Hirai
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Guidewire Impaction in the Main Pancreatic Duct in a Patient with Chronic Pancreatitis: A Case Report
Soyoung Kim, Hoonsub So, Seok Won Jung, Sung Jo Bang
The Korean Journal of Gastroenterology.2023; 81(1): 36. CrossRef
Efficacy of a newly developed guidewire for selective biliary access
Do Hyun Park, Joung-Ho Han, Tae Hoon Lee, Jae Kook Yang, Ji Sung Lee, Yong Hun Lee, Mamoru Takenaka, Sang-Heum Park
Scientific Reports.2023;[Epub] CrossRef
Efficacy of a Newly Developed Guidewire for Selective Biliary Cannulation: A Multicenter Randomized Controlled Trial
Sung Yong Han, Sung Ill Jang, Dong Hee Koh, Jong Hyun Lee, Dong Uk Kim, Jae Hee Cho, Kyong Joo Lee, Seong-Hun Kim, Min Je Sung, Chang-Il Kwon
Journal of Clinical Medicine.2023; 12(10): 3440. CrossRef
Comparison of Two Types of Guidewires for Malignant Hilar Biliary Obstruction by Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Trial
Sung Yong Han, Jung Wan Choe, Dong Uk Kim, Jong Jin Hyun, Joung-Ho Han, Hoonsub So, Sung Jo Bang, Dong Hee Koh, Seok Jeong
Journal of Clinical Medicine.2023; 12(10): 3590. CrossRef
Comparison of guidewires for successful cannulation of biliary stenosis and targeting of biliary branches in ERCP
Masanori Kobayashi, Hiromune Katsuda, Kazuo Ohtsuka, Ryuichi Okamoto
Endoscopy International Open.2023; 11(09): E805. CrossRef
Impact of guidewire caliber on ERCP outcomes: Systematic review and meta-analysis comparing 0.025- and 0.035-inch guidewires
Muhammad Aziz, Amna Iqbal, Zohaib Ahmed, Saad Saleem, Wade Lee-Smith, Hemant Goyal, Faisal Kamal, Yaseen Alastal, Ali Nawras, Douglas G. Adler
Endoscopy International Open.2022; 10(07): E990. CrossRef
Experimental study of loop shape using 0.025-inch ERCP guidewires (with videos)
Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Tadahiro Yamada, Masanori Yamada, Kazuya Ueshima, Jun Matsuno, Yoshitaro Yamamoto, Kazuhide Higuchi
Endoscopy International Open.2021; 09(03): E427. CrossRef
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Takeshi Ogura, Kazuhide Higuchi
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Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: Definitions, Risk Factors, and Implications
Brian M. Fung, Teodor C. Pitea, James H. Tabibian
EMJ Hepatology.2021; : 64. CrossRef
Production of ERCP training model using a 3D printing technique (with video)
Chang-Il Kwon, Yeonsun Shin, Jaeok Hong, Minje Im, Guk Bae Kim, Dong Hee Koh, Tae Jun Song, Won Suk Park, Jong Jin Hyun, Seok Jeong
BMC Gastroenterology.2020;[Epub] CrossRef
Clinical Evaluation of a Newly Developed Guidewire for Pancreatobiliary Endoscopy
Shigeto Ishii, Toshio Fujisawa, Hiroyuki Isayama, Shingo Asahara, Shingo Ogiwara, Hironao Okubo, Hisafumi Yamagata, Mako Ushio, Sho Takahashi, Hiroki Okawa, Wataru Yamagata, Yoshihiro Okawa, Akinori Suzuki, Yusuke Takasaki, Kazushige Ochiai, Ko Tomishima,
Journal of Clinical Medicine.2020; 9(12): 4059. CrossRef

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Impact of Periampullary Diverticulum on ERCP Performance: A Matched Case-Control Study: Juan E. Corral, Omar Y. Mousa, Paul T. Kröner, Victoria Gomez, Frank J. Lukens; Clin Endosc 2019;52(1):65-71. Published online August 21, 2018; DOI: https://doi.org/10.5946/ce.2018.070

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Background
/Aims: Periampullary diverticulum (PAD) is frequently encountered during endoscopic retrograde cholangiopancreatography (ERCP) and has been associated with stone formation in the bile duct. The effects of PAD on the ERCP procedure have been often debated. We aimed to compare the therapeutic success of ERCP between patients with PAD and matched controls.
Methods
We reviewed all ERCPs with findings of PAD in a national database (n=1,089) and compared them with age- and gendermatched controls in a 1:3 fashion (n=3,267). Demographics, endoscopic findings, visualization of main structures, and therapeutic success rates were compared between groups. Secondary analysis compared PAD cases and controls who had gallstone disease.
Results
The average cohort age was 68.4±14.3 years and 55.1% were male. ERCP success was similar in both groups, and no significant inter-group differences were found in the multivariate analysis. The presence of PAD did not affect the rates of sphincterotomy or visualization of main biliary structures. Secondary analysis showed similar success rates for gallstone removal between patients with PAD and controls.
Conclusions
PAD may not be considered a hinderance to ERCP success. Further research is needed to determine the best approach to cannulate the ampulla and provide endoscopic therapy for different subtypes of PAD.

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Impact of periampullary diverticulum on biliary cannulation: A retrospective cohort study
Jing Liang Ho, Aruni Seneviratna, Cherng Hann Benjamin Yip
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World Journal of Gastroenterology.2020; 26(19): 2402. CrossRef
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Bilal TOKA, Salih TOKMAK
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Murat AKAYDIN, Tamer AKAY, Metin LEBLEBİCİ
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Presence of Periampullary Diverticulum is Not a Hurdle to Successful Endoscopic Retrograde Cholangiopancreatography
Jimin Han
Clinical Endoscopy.2019; 52(1): 7. CrossRef
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Gyanprakash Ketwaroo, Waqar Qureshi
Digestive Diseases and Sciences.2019; 64(5): 1072. CrossRef

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Case Report

Papillary Cannulation Facilitated by Submucosal Saline Injection into an Intradiverticular Papilla: Kanglock Lee, Ji Wook Choi, Yunhyeong Lee, Joung-Ho Han, Seon Mee Park; Clin Endosc 2019;52(1):83-86. Published online June 12, 2018; DOI: https://doi.org/10.5946/ce.2018.060

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Endoscopic retrograde cholangiopancreatography (ERCP) of the intradiverticular papilla with its invisible orifice remains challenging. Several techniques have been introduced to evert the papillary opening to facilitate cannulation. A 79-year-old woman with bile duct stones underwent ERCP, which revealed that the papilla was located inside a large diverticulum and tended to rotate inward with a trial of papillary cannulation. Submucosal papillary injection of 3 cc of normal saline was performed at 3 and 9 o’clock. Eversion and fixation of a papilla in the diverticulum with this technique allowed selective cannulation of the biliary tree. Stones were retrieved after endoscopic papillary balloon dilation without complications. She had an uneventful post-procedural course. Our findings suggest that submucosal saline injection technique is safe and effective for selective cannulation and can be recommended when cannulation is very difficult because of an intradiverticular papilla.

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Two-devices-in-one-channel method: a challenging cannulation of intradiverticular major papilla
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Focused Review Series: Endoscopy in Children

Advanced Therapeutic Gastrointestinal Endoscopy in Children – Today and Tomorrow: Zaheer Nabi, Duvvur Nageshwar Reddy; Clin Endosc 2018;51(2):142-149. Published online December 12, 2017; DOI: https://doi.org/10.5946/ce.2017.102

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Gastrointestinal (GI) endoscopy plays an indispensable role in the diagnosis and management of various pediatric GI disorders. While the pace of development of pediatric GI endoscopy has increased over the years, it remains sluggish compared to the advancements in GI endoscopic interventions available in adults. The predominant reasons that explain this observation include lack of formal training courses in advanced pediatric GI interventions, economic constraints in establishing a pediatric endoscopy unit, and unavailability of pediatric-specific devices and accessories. However, the situation is changing and more pediatric GI specialists are now performing complex GI procedures such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography for various pancreatico-biliary diseases and more recently, per-oral endoscopic myotomy for achalasia cardia. Endoscopic procedures are associated with reduced morbidity and mortality compared to open surgery for GI disorders. Notable examples include chronic pancreatitis, pancreatic fluid collections, various biliary diseases, and achalasia cardia for which previously open surgery was the treatment modality of choice. A solid body of evidence supports the safety and efficacy of endoscopic management in adults. However, additions continue to be made to literature describing the pediatric population. An important consideration in children includes size of children, which in turn determines the selection of endoscopes and type of sedation that can be used for the procedure.

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Original Article

Endoscopic Retrograde Cholangiopancreatography in Nonagenarian Patients: Is It Really Safe?: Zain A Sobani, Daria Yunina, Anna Abbasi, Kevin Tin, Daniel Simkin, Mary Rojas, Yuriy Tsirlin, Ira Mayer, Rabin Rahmani; Clin Endosc 2018;51(4):375-380. Published online September 18, 2017; DOI: https://doi.org/10.5946/ce.2017.123

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Background
/Aims: Literature on the safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients is divided. Based on this we decided to examine the safety of ERCP in nonagenarian patients. Methods: A total of 1,389 patients, with a mean age of 63.94±19.62 years, underwent ERCP during the study period. There were 74 patients aged 90 years or older with a mean age of 92.07±1.8. Logistic regression showed that nonagenarian patients had a significantly increased odds of in-patient mortality (adjusted odds ratio [AOR]=9.6; 95% confidence interval [CI]=4, 23; p≤0.001). Charlson Comorbidity Index (CCI) ≥2 was also an independent predictor of in-patient mortality (AOR=2.4; 95% CI=1.2, 5.2; p=0.021). Age ≥90 was not associated with increased adverse events; however emergency procedures (AOR=2.4; 95% CI=1.5, 4; p<0.001) and CCI ≥2 (AOR=2.6; 95% CI=1.7, 4.0; p<0.001) were more likely to have adverse events. Conclusions: Age ≥90 and CCI ≥2 are independently associated with increased odds of in-patient mortality in patients undergoing ERCP, whereas emergency procedures and CCI ≥2 are associated with an increased adverse event rate. Caution must be exercised when considering ERCP in patients aged ≥90 years and those with a CCI ≥2

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Dong Wook Lee, Ho Gak Kim
Clinical Endoscopy.2018; 51(4): 315. CrossRef

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Review

Management of Benign and Malignant Pancreatic Duct Strictures: Enad Dawod, Michel Kahaleh; Clin Endosc 2018;51(2):156-160. Published online July 20, 2017; DOI: https://doi.org/10.5946/ce.2017.085

Abstract PDF PubReader ePub

The diagnosis and management of pancreatic strictures, whether malignant or benign, remain challenging. The last 2 decades have seen dramatic progress in terms of both advanced imaging and endoscopic therapy. While plastic stents remain the cornerstone of the treatment of benign strictures, the advent of fully covered metal stents has initiated a new wave of interest in calibrating the pancreatic duct with fewer sessions. In malignant disease, palliation remains the priority and further data are necessary before offering systematic pancreatic stenting.

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Focused Review Series: Training in Endoscopy

Training in Endoscopy: Endoscopic Retrograde Cholangiopancreatography: Jaihwan Kim; Clin Endosc 2017;50(4):334-339. Published online July 13, 2017; DOI: https://doi.org/10.5946/ce.2017.068

Abstract PDF PubReader ePub

Endoscopic retrograde cholangiopancreatography (ERCP) is a key endoscopy skill used to diagnose and treat pancreatobiliary diseases. However, its diagnostic use is decreasing in favor of other less invasive methods such as magnetic resonance cholangiopancreatography and endoscopic ultrasound. Alternatively, its use has become more important in the therapeutic area. ERCP trainees must know the anatomy and physiology of the pancreatobiliary system, several key basic skills, and complications of a successful procedure. This article briefly introduces basic ERCP knowledge, techniques, numbers necessary to achieve competency, and complications for new ERCP operators.

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Review

An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications: Hyun Woo Lee, Najmul Hassan Shah, Sung Koo Lee; Clin Endosc 2017;50(5):451-463. Published online April 17, 2017; DOI: https://doi.org/10.5946/ce.2016.139

Abstract PDF PubReader ePub

Biliary complications are the most common post-liver transplant (LT) complications with an incidence of 15%–45%. Furthermore, such complications are reported more frequently in patients who undergo a living-donor LT (LDLT) compared to a deceased-donor LT (DDLT). Most post-LT biliary complications involve biliary strictures, bile leakage, and biliary stones, although many rarer events, such as hemobilia and foreign bodies, contribute to a long list of related conditions. Endoscopic treatment of post-LT biliary complications has evolved rapidly, with new and effective tools improving both outcomes and success rates; in fact, the latter now consistently reach up to 80%. In this regard, conventional endoscopic retrograde cholangiopancreatography (ERCP) remains the preferred initial treatment. However, percutaneous transhepatic cholangioscopy (PTCS) is now central to the management of endoscopy-resistant cases involving complex hilar or multiple strictures with associated stones. Many additional endoscopic tools and techniques—such as the rendezvous method, magnetic compression anastomosis (MCA), and peroral cholangioscopy (POCS)—combined with modified biliary stents have significantly improved the success rate of endoscopic management. Here, we review the current status of endoscopic treatment of post-LT biliary complications and discuss conventional as well as the aforementioned new tools and techniques.

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Focused Review Series: EUS-Guided Therapeutic Interventions

Endoscopic Ultrasound-Guided Biliary Access, with Focus on Technique and Practical Tips: Woo Hyun Paik, Do Hyun Park; Clin Endosc 2017;50(2):104-111. Published online March 30, 2017; DOI: https://doi.org/10.5946/ce.2017.036

Abstract PDF PubReader ePub

In 1980, endoscopic ultrasound (EUS) was introduced as a diagnostic tool for evaluation of the pancreas. Since the introduction of curvilinear-array echoendoscopy, EUS has been used for a variety of gastrointestinal interventions, including fine needle aspiration, tumor ablation, and pancreatobiliary access. One of the main therapeutic roles of EUS is biliary drainage as an alternative to endoscopic retrograde biliary drainage (ERBD) or percutaneous transhepatic biliary drainage (PTBD). This article summarizes three different methods of EUS-guided biliary access, with focus on technique and practical tips.

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Endoscopic Ultrasound-Guided Biliary Drainage
Jeremy S. Nussbaum, Nikhil A. Kumta
Gastrointestinal Endoscopy Clinics of North America.2019; 29(2): 277. CrossRef
Endoscopic Ultrasound-Guided Biliary Drainage for Benign Biliary Diseases
Yousuke Nakai, Hirofumi Kogure, Hiroyuki Isayama, Kazuhiko Koike
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Relief of Obstruction in the Management of Pancreatic Cancer
Chang-Il Kwon
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Current Status of Endoscopic Ultrasound Techniques for Pancreatic Neoplasms
Yousuke Nakai, Naminatsu Takahara, Suguru Mizuno, Hirofumi Kogure, Kazuhiko Koike
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Brian R. Boulay, Simon K. Lo
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Endoscopic ultrasound–guided biliary and pancreatic duct access and intervention
Patrick Pfau
Techniques in Gastrointestinal Endoscopy.2017; 19(4): 207. CrossRef

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Original Article

Sensitivity and Specificity of Magnetic Resonance Cholangiopancreatography versus Endoscopic Ultrasonography against Endoscopic Retrograde Cholangiopancreatography in Diagnosing Choledocholithiasis: The Indonesian Experience: Dadang Makmun, Achmad Fauzi, Hamzah Shatri; Clin Endosc 2017;50(5):486-490. Published online February 28, 2017; DOI: https://doi.org/10.5946/ce.2016.159

Abstract PDF PubReader ePub

Background
/Aims: Biliary stone disease is one of the most common conditions leading to hospitalization. In addition to endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) are required in diagnosing choledocholithiasis. This study aimed to compare the sensitivity and specificity of EUS and MRCP against ERCP in diagnosing choledocholithiasis.
Methods
This retrospective study was conducted after prospective collection of data involving 62 suspected choledocholithiasis patients who underwent ERCP from June 2013 to August 2014. Patients were divided into two groups. The first group (31 patients) underwent EUS and the second group (31 patients) underwent MRCP. Then, ERCP was performed in both groups. Sensitivity, specificity, and diagnostic accuracy of EUS and MRCP were determined by comparing them to ERCP, which is the gold standard.
Results
The male to female ratio was 3:2. The mean ages were 47.25 years in the first group and 52.9 years in the second group. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for EUS were 96%, 57%, 87%, 88%, and 80% respectively, and for MRCP were 81%, 40%, 68%, 74%, and 50%, respectively.
Conclusions
EUS is a better diagnostic tool than MRCP for diagnosing choledocholithiasis.

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V.A. Kashchenko, S.I. Emelyanov, V.V. Strizheletsky, M.A. Kossovich, M.L. Tariverdiev, G.M. Rutenburg, A.A. Bogatikov, A.V. Lodygin, S.V. Gornov, F.M. Sultanova
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Focused Review Series: Pancreatobiliary endoscopy in altered gastointestinal anatomy

Endoscopic Retrograde Cholangiopancreatography in Post Gastrectomy Patients: Chang-Hwan Park; Clin Endosc 2016;49(6):506-509. Published online November 29, 2016; DOI: https://doi.org/10.5946/ce.2016.124

Abstract PDF PubReader ePub

Endoscopic retrograde cholangiopancreatography (ERCP) in post-gastrectomy patients with Billroth II (BII) reconstruction and Roux-en-Y (RY) reconstruction presents a challenge to therapeutic endoscopists. Major difficulties, including intubation to the ampulla of Vater, selective cannulation, and ampullary intervention, must be overcome in these patients. Recent data have shown that device-assisted ERCP allows for high success rates in these patients because various devices are useful for overcoming major difficulties. Therefore, good knowledge of postoperative anatomy and various devices is mandatory before performing ERCP procedures for post-gastrectomy patients.

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Single Balloon Enteroscopy-Guided Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy: Long vs. Short Type
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Journal of Digestive Diseases.2021; 22(12): 721. CrossRef
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Case Report

Conversion of Percutaneous Cholecystostomy to Endoscopic Gallbladder Stenting by Using the Rendezvous Technique: Kwangwoo Nam, Jun-Ho Choi; Clin Endosc 2017;50(3):301-304. Published online November 7, 2016; DOI: https://doi.org/10.5946/ce.2016.120

Abstract PDF PubReader ePub: We report the successful conversion of percutaneous cholecystostomy (PC) to endoscopic transpapillary gallbladder stenting (ETGS) with insertion of an antegrade guidewire into the duodenum. An 84-year-old man presented with severe acute cholecystitis and septic shock. He had significant comorbidities, and emergent PC was successfully performed. Subsequent ETGS was attempted but unsuccessful owing to difficulties with cystic duct cannulation. However, via the PC tract, the guidewire was passed antegradely into the duodenum, and ETGS with a double-pigtail plastic stent was successfully performed with the rendezvous technique. The PC tube was removed, and no recurrence was reported during the 17-month follow-up period. Conversion of PC to ETGS is a viable option in patients with acute cholecystitis who are not candidates for surgery. Antegrade guidewire insertion via the PC tract may increase the success rate of conversion and decrease the risk of procedure-related complications.

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Reviews

Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy: Tae Hoon Lee, Sang-Heum Park; Clin Endosc 2016;49(5):467-474. Published online September 19, 2016; DOI: https://doi.org/10.5946/ce.2016.103

Abstract PDF PubReader ePub

Various endoscopic techniques have been developed to overcome the difficulties in biliary or pancreatic access during endoscopic retrograde cholangiopancreatography, according to the preference of the endoscopist or the aim of the procedures. In terms of endoscopic methods, guidewire-assisted cannulation is a commonly used and well-known initial cannulation technique, or an alternative in cases of difficult cannulation. In addition, precut sphincterotomy encompasses a range of available rescue techniques, including conventional precut, precut fistulotomy, transpancreatic septotomy, and precut after insertion of pancreatic stent or pancreatic duct guidewire-guided septal precut. We present a literature review of guidewire-assisted cannulation as a primary endoscopic method and the precut technique for the facilitation of selective biliary access.

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A Review of Probe-Based Confocal Laser Endomicroscopy for Pancreaticobiliary Disease: Kunal Karia, Michel Kahaleh; Clin Endosc 2016;49(5):462-466. Published online September 19, 2016; DOI: https://doi.org/10.5946/ce.2016.086

Abstract PDF PubReader ePub

Confocal laser endomicroscopy (CLE) is a novel in vivo imaging technique that can provide real-time optical biopsies in the evaluation of pancreaticobiliary strictures and pancreatic cystic lesions (PCLs), both of which are plagued by low sensitivities of routine evaluation techniques. Compared to pathology alone, CLE is associated with a higher sensitivity and accuracy for the evaluation of indeterminate pancreaticobiliary strictures. CLE has the ability to determine the malignant potential of PCLs. As such, CLE can increase the diagnostic yield of endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, reducing the need for repeat procedures. It has been shown to be safe, with an adverse event rate of ≤1%. Published literature regarding its cost-effectiveness is needed.

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Original Article

Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure: Amy Tyberg, Jose Nieto, Sanjay Salgado, Kristen Weaver, Prashant Kedia, Reem Z. Sharaiha, Monica Gaidhane, Michel Kahaleh; Clin Endosc 2017;50(2):185-190. Published online September 19, 2016; DOI: https://doi.org/10.5946/ce.2016.030

Abstract PDF PubReader ePub

Background
/Aims: Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Rouxen-Y gastric bypass (RYGB) is challenging. Standard ERCP and enteroscopy-assisted ERCP are associated with limited success rates. Laparoscopy- or laparotomy-assisted ERCP yields improved efficacy rates, but with higher complication rates and costs. We present the first multicenter experience regarding the efficacy and safety of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) or EUS.
Methods
All patients who underwent EDGE at two academic centers were included. Clinical success was defined as successful ERCP and/or EUS through the use of lumen-apposing metal stents (LAMS). Adverse events related to EDGE were separated from ERCP- or EUS-related complications and were defined as bleeding, stent migration, perforation, and infection.
Results
Sixteen patients were included in the study. Technical success was 100%. Clinical success was 90% (n=10); five patients were awaiting maturation of the fistula tract prior to ERCP or EUS, and one patient had an aborted ERCP due to perforation. One perforation occurred, which was managed endoscopically. Three patients experienced stent dislodgement; all stents were successfully repositioned or bridged with a second stent. Ten patients (62.5%) had their LAMS removed. The average weight change from LAMS insertion to removal was negative 2.85 kg.
Conclusions
EDGE is an effective, minimally invasive, single-team solution to the difficulties associated with ERCP in patients with RYGB.

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Case Reports

Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping: Keunmo Kim, Eun Bee Kim, Yong Hyeok Choi, Youngmin Oh, Joung-Ho Han, Seon Mee Park; Clin Endosc 2017;50(2):202-205. Published online September 13, 2016; DOI: https://doi.org/10.5946/ce.2016.112

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Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP). We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL) and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm ovalshaped perforation was found at the lateral duodenal wall. We repaired the perforation by sequentially performing double EBL and endoclipping. The first EBL was performed at the proximal edge of the perforation orifice, and two-thirds of the perforation were repaired. The second EBL, which also included the contents covered under the first EBL, repaired the defect almost completely. Finally, to account for the possible presence of a residual perforation, an endoclip was applied at the distal end of the perforation. The detection and closure of the perforation were completed within 10 minutes. We suggest that double EBL is an effective method for closure.

Citations

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Endoscopic treatment of ERCP-related duodenal perforation
Nicole Evans, James L. Buxbaum
Techniques in Gastrointestinal Endoscopy.2019; 21(2): 83. CrossRef

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Mediastinal Pancreatic Pseudocysts: Krzysztof Dąbkowski, Andrzej Białek, Maciej Kukla, Janusz Wójcik, Andrzej Smereczyński, Katarzyna Kołaczyk, Tomasz Grodzki, Teresa Starzyńska; Clin Endosc 2017;50(1):76-80. Published online September 13, 2016; DOI: https://doi.org/10.5946/ce.2016.089

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Mediastinal pseudocysts are a rare complication of acute pancreatitis. Lack of uniform treatment standards makes the management of this condition a clinical challenge. We report the case of a 43-year-old patient who presented with a left pleural effusion. Pleural fluid revealed a high amylase concentration consistent with a pancreaticopleural fistula. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a disruption of the pancreatic duct with free outflow of contrast medium into the thoracic cavity. A pancreatic stent was placed. The second day after the ERCP, the patient developed septic shock and was admitted to the intensive care unit. Computed tomography (CT) revealed mediastinal pseudocysts and bilateral pleural effusions. After bilateral drainage of the pleural cavities, the patient improved clinically, and a follow-up CT scan showed that the fluid collection and pseudocysts had resolved. We discuss the optimal strategies for diagnosing and treating patients with pancreatic thoracic pseudocysts and fistulas, as well as review the management of these conditions.

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Leni Santiana, Viola Stephanie Warokko, Dikki Drajat Kusmayadi Surachman, Harry Galuh Nugraha
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Review

Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations: Seon Mee Park; Clin Endosc 2016;49(4):376-382. Published online July 29, 2016; DOI: https://doi.org/10.5946/ce.2016.088

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The management strategy for endoscopic retrograde cholangiopancreatography-related duodenal perforation can be determined based on the site and extent of injury, the patient’s condition, and time to diagnosis. Most cases of perivaterian or bile duct perforation can be managed with a biliary stent or nasobiliary drainage. Duodenal wall perforations had been treated with immediate surgical repair. However, with the development of endoscopic devices and techniques, endoscopic closure has been reported to be a safe and effective treatment that uses through-the-scope clips, ligation band, fibrin glue, endoclips and endoloops, an over-the-scope clipping device, suturing devices, covering luminal stents, and open-pore film drainage. Endoscopic therapy could be instituted in selected patients in whom perforation was identified early or during the procedure. Early diagnosis, proper conservative management, and effective endoscopic closure are required for favorable outcomes of non-surgical management. If endoscopic treatment fails, or in the cases of clinical deterioration, prompt surgical management should be considered.

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ERCP-induced perforation: review and revisit after half a century
Abdel Rahman A. A. Al Manasra, Zaid Mesmar, Tarek Manasreh, Hanan M . Hammouri, Anas Husein, Khaled Jadallah, Mohammed Bani hani, Niazy Abu Farsakh, Shatha K. Shahwan, Doaa Al-qaoud, Jehad Fataftah
F1000Research.2024; 12: 612. CrossRef
ERCP-induced perforation: review and revisit after half a century
Abdel Rahman A. A. Al Manasra, Zaid Mesmar, Tarek Manasreh, Hanan M . Hammouri, Anas Husein, Khaled Jadallah, Mohammed Bani hani, Niazy Abu Farsakh, Shatha K. Shahwan, Doaa Al-qaoud, Jehad Fataftah
F1000Research.2023; 12: 612. CrossRef
Fully covered self-expandable metal stent for intraprocedural or late-diagnosed Type-II endoscopic retrograde cholangiopancreatography-related perforations
Osman Bozbiyik, Bartu Cetin, Tufan Gumus, Fatih Tekin, Alper Uguz
BMC Gastroenterology.2022;[Epub] CrossRef
Clinical analysis of 45 cases of perforation were identified during endoscopic retrograde cholangiopancreatography procedure
Yin-Shui Miao, Yuan-Yuan Li, Bo-Wen Cheng, Yan-Fang Zhan, Sheng Zeng, Xiao-Jiang Zhou, You-Xiang Chen, Nong-Hua Lv, Guo-Hua Li
Frontiers in Medicine.2022;[Epub] CrossRef
AGA Clinical Practice Update on Endoscopic Management of Perforations in Gastrointestinal Tract: Expert Review
Jeffrey H. Lee, Prashant Kedia, Stavros N. Stavropoulos, David Carr-Locke
Clinical Gastroenterology and Hepatology.2021; 19(11): 2252. CrossRef
Evaluation of complications after endoscopic retrograde cholangiopancreatography using a short type double balloon endoscope in patients with altered gastrointestinal anatomy: a single‐center retrospective study of 1,576 procedures
Mitsuo Tokuhara, Masaaki Shimatani, Toshiyuki Mitsuyama, Masataka Masuda, Takashi Ito, Sachi Miyamoto, Norimasa Fukata, Hideaki Miyoshi, Tsukasa Ikeura, Makoto Takaoka, Katsuyasu Kouda, Kazuichi Okazaki
Journal of Gastroenterology and Hepatology.2020; 35(8): 1387. CrossRef
Retracted: Endoscopic Treatment of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforations
Ding Shi, Jian feng Yang, Yong pan Liu
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Duodenal perforation after the cutting an ENPD tube in a patient with pancreatic cancer and acute suppurative pancreatic ductitis
Akihisa OHNO, Nao FUJIMORI, Kazuhide MATSUMOTO, Katsuhito TERAMATSU, Yu TAKAMATSU, Masami MIKI, Takehiro TAKAOKA, Takamasa OONO
Suizo.2019; 34(1): 30. CrossRef
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Nicole Evans, James L. Buxbaum
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Endoscopic management of iatrogenic gastrointestinal perforations
Kan Wang, Jihao Shi, Linna Ye
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Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies
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A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system
Roberto Cirocchi, Michael Denis Kelly, Ewen A. Griffiths, Renata Tabola, Massimo Sartelli, Luigi Carlini, Stefania Ghersi, Salomone Di Saverio
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Case Report

Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion: Sung Hak Lee, Seung Goun Hong, Kyoung yong Lee, Pyung Kang Park, Sung Du Kim, Mahn Lee, Dong Wook Yu, Man Yong Hong; Clin Endosc 2016;49(3):303-307. Published online March 25, 2016; DOI: https://doi.org/10.5946/ce.2015.081

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Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.

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A rare incidence of a hepatic artery pseudoaneurysm following plastic biliary stent insertion
Toshihiko Motohara, Kensuke Yamamura, Shigenori Ueno, Hiroshi Takeno, Yasunori Nagayama, Eri Oda, Ryuichi Karashima, Nobuyuki Ozaki, Toshiro Masuda, Toru Beppu
Clinical Journal of Gastroenterology.2024; 17(2): 352. CrossRef
A Study on the Spectrum of Imaging Findings of Post-ERCP-Specific Complications: A Retrospective Descriptive Study
Ruchira Mukherji, Manoj Gopinath
Indian Journal of Radiology and Imaging.2024;[Epub] CrossRef
Delayed Hemobilia Caused by Penetration of Biliary Plastic Stent into Portal Vein
Jinhyong Kang, Yang Tae Park, Hyo Jung Kim, Jae Seon Kim
The Korean Journal of Pancreas and Biliary Tract.2022; 27(3): 135. CrossRef
Complications of endoscopic retrograde cholangiopancreatography: an imaging review
Dinesh Manoharan, Deep Narayan Srivastava, Arun Kumar Gupta, Kumble Seetharama Madhusudhan
Abdominal Radiology.2019; 44(6): 2205. CrossRef
Recurrent Bleeding from a Hepatic Artery Pseudoaneurysm after Biliary Stent Placement
Kenji Yamauchi, Daisuke Uchida, Hironari Kato, Hiroyuki Okada
Internal Medicine.2018; 57(1): 49. CrossRef
Transcatheter arterial embolization for iatrogenic bleeding after endoscopic ultrasound-guided pancreaticobiliary drainage
N.J. Lee, J.H. Shin, S.S. Lee, D.H. Park, S.K. Lee, H.-K. Yoon
Diagnostic and Interventional Imaging.2018; 99(11): 717. CrossRef
Hemobilia due to arteriobiliary fistula complicating ERCP for residual bile duct stone in a case of Mirizzi syndrome
Surendrakumar Mathur, Vinaykumar Thapar, Vasudev Chowda
Annals of Hepato-Biliary-Pancreatic Surgery.2017; 21(2): 88. CrossRef

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Original Article

The Clinical Usefulness of Simultaneous Placement of Double Endoscopic Nasobiliary Biliary Drainage: Hong Jun Kim, Sung Koo Lee, Choong Heon Ryu, Do Hyun Park, Sang Soo Lee, Dong Wan Seo, Myung-Hwan Kim; Clin Endosc 2015;48(6):542-548. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.542

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Background
/Aims: To evaluate the technical feasibility and clinical efficacy of double endoscopic nasobiliary drainage (ENBD) as a new method of draining multiple bile duct obstructions.
Methods
A total of 38 patients who underwent double ENBD between January 2004 and February 2010 at the Asan Medical Center were retrospectively analyzed. We evaluated indications, laboratory results, and the clinical course.
Results
Of the 38 patients who underwent double ENBD, 20 (52.6%) had Klatskin tumors, 12 (31.6%) had hepatocellular carcinoma, 3 (7.9%) had strictures at the anastomotic site following liver transplantation, and 3 (7.9%) had acute cholecystitis combined with cholangitis. Double ENBD was performed to relieve multiple biliary obstruction in 21 patients (55.1%), drain contrast agent filled during endoscopic retrograde cholangiopancreatography in 4 (10.5%), obtain cholangiography in 4 (10.5%), drain hemobilia in 3 (7.9%), relieve Mirizzi syndrome with cholangitis in 3 (7.9%), and relieve jaundice in 3 (7.9%).
Conclusions
Double ENBD may be useful in patients with multiple biliary obstructions.

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Case Report

Single Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients Who Underwent a Gastrectomy with Roux-en-Y Anastomosis: Six Cases from a Single Center: Jae Seung Soh, Dong-Hoon Yang, Sang Soo Lee, Seohyun Lee, Jungho Bae, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang; Clin Endosc 2015;48(5):452-457. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.452

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Patients with altered anatomy such as a Roux-en-Y anastomosis often present with various pancreaticobiliary problems requiring therapeutic intervention. However, a conventional endoscopic approach to the papilla is very difficult owing to the long afferent limb and acute angle of a Roux-en-Y anastomosis. Balloon-assisted enteroscopy can be used for endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered anatomy. We experienced six cases of Roux-en-Y anastomosis with biliary problems, and attempted ERCP using single balloon enteroscopy (SBE). SBE insertion followed by replacement with a conventional endoscope was attempted in five of six patients. The papilla was successfully approached using SBE in all cases. However, therapeutic intervention was completed in only three cases because of poor maneuverability caused by postoperative adhesion. We conclude that in patients with Roux-en-Y anastomosis, the ampulla can be readily accessed with SBE, but longer dedicated accessories are necessary to improve this therapeutic intervention.

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The Korean Journal of Pancreas and Biliary Tract.2021; 26(3): 181. CrossRef
Direct Insertion of a Short-Type Single-Balloon Enteroscope and Using a Stent Retriever to Treat Difficult Bile Duct Stones in Surgically Altered Anatomy
Takashi Sasaki, Naoki Sasahira
Clinical Endoscopy.2021; 54(6): 937. CrossRef
Single-balloon enteroscopy-assisted ERCP in patients with Roux-en-Y anatomy and choledocholithiasis: do technical improvements mean better outcomes?
Jesús Espinel Díez, María Eugenia Pinedo Ramos
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Wen-Guang Wu, Lu-Cui Qin, Xiao-Ling Song, Ming-Ning Zhao, Wen-Jie Zhang, Jun Gu, Hao Weng, Ying-Bin Liu, Yi Zhang, Chun-Ying Qu, Lei-Ming Xu, Xue-Feng Wang
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Focused Review Series: Endoscopic Disinfection in the Era of MERS

Current Issues in Duodenoscope-Associated Infections: Now Is the Time to Take Action: Junghoon Ha, Byoung Kwan Son; Clin Endosc 2015;48(5):361-363. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.361

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A duodenoscope has a very complex structure that contains many small parts which make reprocessing more challenging. The difficulty in cleaning duodenoscopes contributes to a higher risk of infection than that of conventional gastrointestinal endoscopes. However, a duodenoscope shares similar disinfection process with other gastrointestinal endoscopes. Recent outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) infections associated with duodenoscopes used for endoscopic retrograde cholangiopancreatography procedures have raised many concerns worldwide. Duodenoscope-associated infections involving CRE or other multidrug-resistant bacteria pose a great threat to patients undergoing procedures using duodenoscopes and should be dealt with a great concern. Updated guidelines regarding cleaning and disinfection of duodenoscope needs to be developed urgently to prevent transmission of infection and ensure patient safety. Meanwhile, healthcare staff should pay special attention to thorough cleaning and disinfection of duodenoscopes.

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Naiara Bussolotti Garcia, Adriana Cristina de Oliveira
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Kihyun Ryu, Sunguk Jang
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Duodenoscope-related infections: patient-ready versus single-use duodenoscopes. Is a new era for endoscopic retrograde cholangiopancreatography on the horizon?
Damiano BISOGNI, Roberto MANETTI, Luca TALAMUCCI, Michele ROSSI, Fabio STADERINI, Maurizio MORONI, Fabio CIANCHI
Minerva Surgery.2021;[Epub] CrossRef
Results of duodenoscope culture and quarantine after manufacturer-recommended cleaning process
Jacob A. Mark, Karin Underberg, Robert E. Kramer
Gastrointestinal Endoscopy.2020; 91(6): 1328. CrossRef
Elevating the standard of endoscope processing: Terminal sterilization of duodenoscopes using a hydrogen peroxide–ozone sterilizer
Vanessa Molloy-Simard, Jean-Luc Lemyre, Karine Martel, Bradley J. Catalone
American Journal of Infection Control.2019; 47(3): 243. CrossRef
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M. Phillip Fejleh, Jennifer Phan, Neil B. Marya, Stephen Kim, Zachary A. Rubin, V. Raman Muthusamy
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Duodenoscope-Associated Infections: A Literature Review and Update
Il Hwan Oh, Byoung Kwan Son
The Korean Journal of Pancreas and Biliary Tract.2018; 23(4): 145. CrossRef

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Original Article

IgG4 Levels in Bile for Distinguishing IgG4-Associated Cholangiopathy from Other Biliary Disorders: A Single Blinded Pilot Study: Udayakumar Navaneethan, Norma G. Gutierrez, Ramprasad Jegadeesan, Preethi GK Venkatesh, Earl Poptic, Madhusudhan R. Sanaka, John J. Vargo, Mansour A. Parsi; Clin Endosc 2014;47(6):555-559. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.555

Abstract PDF PubReader ePub

Background/Aims

Immunoglobulin G4 (IgG4)-associated cholangiopathy (IAC) is an inflammatory disease and may mimic primary sclerosing cholangitis (PSC), cholangiocarcinoma (CCA), or pancreatic cancer on cholangiography. We investigated whether IgG4 levels in bile aspirated during endoscopic retrograde cholangiopancreatography (ERCP) can distinguish IAC from PSC, CCA, and pancreatic cancer.

Methods

Bile was aspirated directly from the common bile duct during ERCP in patients with IAC prior to steroid therapy. For control purposes, bile was obtained from patients with PSC, CCA, pancreatic cancer, and benign biliary conditions (sphincter of oddi dysfunction/choledocholithiasis).

Results

Biliary IgG4 levels were measured in 54 patients. The median bile IgG4 levels were markedly elevated in patients with IAC (5.5 mg/dL; interquartile range [IQR], 5.1 to 15.6) as compared to patients with benign biliary conditions (0 mg/dL; IQR, 0 to 0.1; p=0.003). The median biliary IgG4 levels in PSC, CCA, and pancreatic cancer were 1.2 (IQR, 0.2 to 3.8), 0.9 (IQR, 0.2 to 3.4), and 0.2 mg/dL (IQR, 0.1 to 0.8), respectively. A cutoff value of 3.8 mg/dL distinguished IAC from PSC and CCA patients with 100% and 76.9% sensitivity and specificity, respectively.

Conclusions

The results of this pilot study suggest that measurement of biliary IgG4 levels may have clinical value in distinguishing patients with IAC from biliary disorders that can mimic IAC.

Citations

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Clinical Features, Differential Diagnosis and Treatment of IgG₄-Related Sclerosing Cholangitis
A. K. Guseva, A. V. Okhlobystin
The Russian Archives of Internal Medicine.2024; 14(2): 96. CrossRef
Review of primary sclerosing cholangitis with increased IgG4 levels
Charis D Manganis, Roger W Chapman, Emma L Culver
World Journal of Gastroenterology.2020; 26(23): 3126. CrossRef
Immunoglobulin G4-related cholangiopathy
Lucas J. Maillette de Buy Wenniger, Ulrich Beuers
Current Opinion in Gastroenterology.2015; 31(3): 252. CrossRef
Diagnosis of Immunoglobulin G4-Related Sclerosing Cholangitis
Ji Kon Ryu
Clinical Endoscopy.2014; 47(6): 476. CrossRef

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Reviews

The Management of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforation: Kwang Bum Cho; Clin Endosc 2014;47(4):341-345. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.341

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Uneventful duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is an uncommon but occasionally fatal complication. ERCP-related perforations may occur during sphincterotomy and improper manipulation of the equipment and scope. Traditionally, duodenal perforation has been treated with early surgical repair. Recently, nonoperative early endoscopic management techniques including clips or fibrin glue have been reported. In the present paper we review the literature pertaining to the treatment of perforations.

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Nathaniel Kwak, Daniel Yeoun, Fray Arroyo-Mercado, Ghassan Mubarak, Derrick Cheung, Shivakumar Vignesh
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Retracted: Endoscopic Treatment of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforations
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Complications of endoscopic retrograde cholangiopancreatography: an imaging review
Dinesh Manoharan, Deep Narayan Srivastava, Arun Kumar Gupta, Kumble Seetharama Madhusudhan
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Akihisa OHNO, Nao FUJIMORI, Kazuhide MATSUMOTO, Katsuhito TERAMATSU, Yu TAKAMATSU, Masami MIKI, Takehiro TAKAOKA, Takamasa OONO
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Daisuke Watanabe, Hiroki Hayashi, Yuki Kataoka, Tadayuki Hashimoto, Katsuro Ichimasa, Hideyuki Miyachi, Shinwa Tanaka, Takashi Toyonaga
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Kan Wang, Jihao Shi, Linna Ye
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S. G. Shapovaliyants, S. A. Budzinskiy, E. D. Fedorov, M. V. Bordikov, M. A. Zakharova
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V. L. Korobka, S. V. Tolstopyatov, A. M. Shapovalov
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Pınar YILDIZ, Tuncer TEMEL, Erkin ÖZTAŞ, Selçuk DİŞİBEYAZ
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Mohammad Saud Khan, Faisal Jamal, Zubair Khan, Abhinav Tiwari, Hermann Simo, Himani Sharma
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Ping Yue, Wen-Bo Meng, Joseph W Leung, Lei Zhang, Xiao-Liang Zhu, Hui Zhang, Hai-Ping Wang, Zheng-Feng Wang, Ke-Xiang Zhu, Long Miao, Wen-Ce Zhou, Xun Li
Chinese Medical Journal.2018; 131(19): 2346. CrossRef
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Answer
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Clinical Endoscopy.2016; 49(4): 376. CrossRef
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Hye Min Park, Min Young Do, Sei Myung Choi, Kyung Ho Yang, Chang Jae Hur, Kwang Bum Cho
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Jason Chertoff, Vikas Khullar, Lucas Burke
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Quanpeng Li, Jie Ji, Fei Wang, Xianxiu Ge, Junjie Nie, Boming Xu, Xiuhua Zhang, Guobing Jiang, Lin Miao
Oncotarget.2015; 6(19): 17847. CrossRef

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Preparation of High-Risk Patients and the Choice of Guidewire for a Successful Endoscopic Retrograde Cholangiopancreatography Procedure: Tae Hoon Lee, Young Kyu Jung, Sang-Heum Park; Clin Endosc 2014;47(4):334-340. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.334

Abstract PDF PubReader ePub

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential technique for the diagnosis and treatment of pancreatobiliary diseases. However, ERCP-related complications such as pancreatitis, cholangitis, hemorrhage, and perforation may be problematic. For a successful and safe ERCP, preprocedural evaluations of the patients and intervention-related risk factors are needed. Furthermore, in light of the recent population aging and increase in chronic cardiopulmonary diseases in Korea, precautions including endoscopic sedation and prevention of cardiopulmonary complications should be considered. In this literature review, we describe these risk factors and the use of endoscopic sedation. In addition, we reviewed the commonly available guidewires, including their materials and options, used as a basic accessory for ERCP procedures.

Citations

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Endoscopy International Open.2024; 12(05): E666. CrossRef
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Surgical Endoscopy.2023; 37(1): 421. CrossRef
Comparison of guidewires for successful cannulation of biliary stenosis and targeting of biliary branches in ERCP
Masanori Kobayashi, Hiromune Katsuda, Kazuo Ohtsuka, Ryuichi Okamoto
Endoscopy International Open.2023; 11(09): E805. CrossRef
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Advances in Clinical Medicine.2022; 12(11): 10124. CrossRef
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Cosmas Rinaldi Adithya Lesmana, Caecilia Herjuningtyas, Sri Inggriani, Yulia Estu Pratiwi, Laurentius A. Lesmana
Case Reports in Gastroenterology.2021; 15(1): 210. CrossRef
Technical Reports of Endoscopic Retrograde Cholangiopancreatography Guidewires on the Basis of Physical Properties
Chang-Il Kwon, Dong Hee Koh, Tae Jun Song, Won Suk Park, Dong Hang Lee, Seok Jeong
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Ernesto Parras Castañera, Pelayo Rodríguez López, Alberto Álvarez Delgado, Fernando Muñoz Núñez, Fernando Geijo Martínez, Antonio Velasco Guardado
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S. G. Shapovaliyants, S. A. Budzinskiy, E. D. Fedorov, M. V. Bordikov, M. A. Zakharova
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Efficacy of midazolam‐ versus propofol‐based sedations by non‐anesthesiologists during therapeutic endoscopic retrograde cholangiopancreatography in patients aged over 80 years
Su Jung Han, Tae Hoon Lee, Sang‐Heum Park, Young Sin Cho, Yun Nah Lee, Yunho Jung, Hyun Jong Choi, Il‐Kwun Chung, Sang‐Woo Cha, Jong Ho Moon, Young Deok Cho, Sun‐Joo Kim
Digestive Endoscopy.2017; 29(3): 369. CrossRef
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He-Kun Yin, Hai-En Wu, Qi-Xiang Li, Wei Wang, Wei-Lin Ou, Harry Hua-Xiang Xia
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Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy
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Case Report

Acute Duodenal Ischemia and Periampullary Intramural Hematoma after an Uneventful Endoscopic Retrograde Cholangiopancreatography in a Patient with Primary Myelofibrosis: Chang Ho Jung, Jong Jin Hyun, Dae Hoe Gu, Eul Sun Moon, Jae Seon Kim, Hong Sik Lee, Chang Duck Kim; Clin Endosc 2014;47(3):270-274. Published online May 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.3.270

Abstract PDF PubReader ePub

Acute duodenal ischemia and periampullary intramural hematoma are rare complications after endoscopic retrograde cholangiopancreatography (ERCP). A 77-year-old man with splenomegaly complained of abdominal pain caused by common bile duct (CBD) stone. After successful removal of the CBD stone without immediate complications, the patient developed intramural hematoma around the ampulla of Vater along with diffuse duodenal edema. The findings were compatible with acute intestinal ischemia, and further evaluation revealed that he had underlying primary myelofibrosis. Myeloproliferative diseases are known to be significantly associated with an increased risk of thrombohemorrhagic complications. Therefore, particular attention should be given to this group of patients when a high-risk procedure such as ERCP is performed.

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Ischemic duodenitis after endoscopic retrograde cholangiopancreatography‐related procedure
Yuki Tanisaka, Akashi Fujita, Shomei Ryozawa
Digestive Endoscopy.2022; 34(6): 1264. CrossRef
Ruptured Dissecting Intramural Duodenal Hematoma Following Endoscopic Retrograde Cholangiopancreatography
Eric Weiss, Madeline Tadley, Pak S. Leung, Mark Kaplan
ACG Case Reports Journal.2017; 4(1): e70. CrossRef

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Original Articles

Comparison between Midazolam Used Alone and in Combination with Propofol for Sedation during Endoscopic Retrograde Cholangiopancreatography: Yu Seok Kim, Myung-Hwan Kim, Seung Uk Jeong, Byung Uk Lee, Sang Soo Lee, Do Hyun Park, Dong-Wan Seo, Sung Koo Lee; Clin Endosc 2014;47(1):94-100. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.94

Abstract PDF PubReader ePub

Background/Aims

Endoscopic retrograde cholangiopancreatography (ERCP) is an uncomfortable procedure that requires adequate sedation for its successful conduction. We investigated the efficacy and safety of the combined use of intravenous midazolam and propofol for sedation during ERCP.

Methods

A retrospective review of patient records from a single tertiary care hospital was performed. Ninety-four patients undergoing ERCP received one of the two medication regimens, which was administered by a nurse under the supervision of a gastroenterologist. Patients in the midazolam (M) group (n=44) received only intravenous midazolam, which was titrated to achieve deep sedation. Patients in the midazolam pulse propofol (MP) group (n=50) initially received an intravenous combination of midazolam and propofol, and then propofol was titrated to achieve deep sedation.

Results

The time to the initial sedation was shorter in the MP group than in the M group (1.13 minutes vs. 1.84 minutes, respectively; p<0.001). The recovery time was faster in the MP group than in the M group (p=0.031). There were no significant differences between the two groups with respect to frequency of adverse events, pain experienced by the patient, patient discomfort, degree of amnesia, and gag reflex. Patient cooperation, rated by the endoscopist as excellent, was greater in the MP group than in the M group (p=0.046).

Conclusions

The combined use of intravenous midazolam and propofol for sedation during ERCP is more effective than midazolam alone. There is no difference in the safety of the procedure.

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Sedation in the Endoscopy Suite
Katherine B. Hagan, Selvi Thirumurthi, Raju Gottumukkala, John Vargo
Current Treatment Options in Gastroenterology.2016; 14(2): 194. CrossRef
Sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled study of patient-controlled propofol sedation and that given by a nurse anesthetist
Andreas Nilsson, Benjamin Grossmann, Eric Kullman, Eva Uustal, Folke Sjöberg, Lena Nilsson
Scandinavian Journal of Gastroenterology.2015; 50(10): 1285. CrossRef
Non‐radiation endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis during pregnancy
Wenming Wu, Douglas O. Faigel, Gang Sun, Yunsheng Yang
Digestive Endoscopy.2014; 26(6): 691. CrossRef
Monitored Anesthesia Care for Sedation during Endoscopic Retrograde Cholangiopancreatography
Young Duck Shin
Korean Journal of Pancreas and Biliary Tract.2014; 19(2): 59. CrossRef
Prerequisites of Colonoscopy
Kyong Hee Hong, Yun Jeong Lim
Clinical Endoscopy.2014; 47(4): 324. CrossRef

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Histological Changes in the Bile Duct after Long-Term Placement of a Fully Covered Self-Expandable Metal Stent within a Common Bile Duct: A Canine Study: Sang Soo Lee, Tae Jun Song, Mee Joo, Do Hyun Park, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim; Clin Endosc 2014;47(1):84-93. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.84

Abstract PDF PubReader ePub

Background/Aims

To date, it has been difficult to determine the optimal stenting duration of a fully covered self-expandable metal stent (FCSEMS) in a benign biliary stricture. The purpose of this study was to identify the histopathological changes in a bile duct resulting from long-term placement of a FCSEMS.

Methods

An FCSEMS was inserted into the common bile duct of 12 canines, and the animals were divided into four groups. Posteuthanasia, necropsy was performed to examine the histopathological changes in the bile ducts after 1, 3, 6, and 9 months.

Results

The results of necropsy showed that the covered membranes of the FCSEMSs were intact and easily removed from the bile ducts in 11 of the canines. Severe epithelial hyperplasia of the stented bile duct and epithelial ingrowth into the stent occurred in one animal (from the 3-month group). On histopathological examination, mild inflammatory changes were observed in the stented bile ducts, and there was no significant difference between the four groups. Among the 12 animals, five had de novo stricture.

Conclusions

An FCSEMS can be inserted into the bile duct without severe histopathological changes up until 9 months. However, a de novo stricture and severe epithelial hyperplasia relating to the stent insertion might occur.

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Antti Siiki, Juhani Sand, Johanna Laukkarinen
European Journal of Gastroenterology & Hepatology.2018; 30(8): 813. CrossRef
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Young Sik Woo, Kwang Hyuck Lee, Jong Kyun Lee, Dong Hyo Noh, Joo Kyung Park, Kyu Taek Lee, Kee-Taek Jang
Surgical Endoscopy.2016; 30(3): 1141. CrossRef
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Antti Siiki, Ralf Jesenofsky, Matthias Löhr, Isto Nordback, Minna Kellomäki, Heidi Gröhn, Joonas Mikkonen, Juhani Sand, Johanna Laukkarinen
Scandinavian Journal of Gastroenterology.2016; 51(7): 880. CrossRef
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Tae Hoon Lee, Bong Seok Jang, Min Kyo Jung, Chan Gi Pack, Jun-Ho Choi, Do Hyun Park
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Metal Stenting in Benign Biliary Strictures
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