Clinical Endoscopy

Editorial

Role of endoscopic ultrasound in the secondary prevention of gastric varices: Joung-Ho Han; Clin Endosc 2023;56(1):50-52. Published online January 16, 2023; DOI: https://doi.org/10.5946/ce.2022.301

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Case Reports

Pneumoperitoneum after Endoscopic Duodenal Stent Insertion in a Patient with Percutaneous Transhepatic Biliary Drainage and Biliary Stent: A Case Report: Jinwoo Choi, Min Ji Lee, Hyodeok Lee, Yook Kim, Joung-Ho Han, Seon Mee Park; Clin Endosc 2019;52(3):288-292. Published online August 29, 2018; DOI: https://doi.org/10.5946/ce.2018.128

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Early removal of a percutaneous transhepatic biliary drainage (PTBD) tube commonly causes pneumoperitoneum. However, we encountered a patient who developed pneumoperitoneum even with an indwelling PTBD tube. An 84-year-old man was admitted with type III combined duodenal and biliary obstruction secondary to metastatic bladder cancer. A biliary stent was placed using a percutaneous approach, and a duodenal stent was placed endoscopically. A large amount of subphrenic free air was detected after the procedures. Laboratory tests indicated intestinal perforation; however, peritoneal signs were absent. The patient was treated conservatively using an indwelling Levin tube. Seven days later, the massive amount of subphrenic free air disappeared. Follow-up tubography revealed unrestricted bile flow into the small intestine, and the PTBD tube was removed. Prolonged endoscopic procedures in patients with a PTBD tract communicating with the gastrointestinal tract can precipitate pneumoperitoneum. Clinicians should be careful to avoid misdiagnosing this condition as intestinal perforation.

Citations

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The characteristics of residual pneumoperitoneum after laparoscopic colorectal surgery
Sotaro Fukuhara, Hiroyuki Egi, Masatoshi Kochi, Wataru Shimizu, Yuji Takakura, Kazuhiro Taguchi, Ikki Nakashima, Yusuke Sumi, Shintaro Akabane, Koki Sato, Hisaaki Yoshinaka, Yoshifumi Teraoka, Minoru Hattori, Hideki Ohdan
Asian Journal of Endoscopic Surgery.2022; 15(2): 320. CrossRef

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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
Renato Medas, Eduardo Rodrigues-Pinto, Pedro Pereira, Guilherme Macedo
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A “One Accessory and One Guidewire-in-One Channel” Technique in a Patient with Billroth II Anastomosis
Kook Hyun Kim, Sung Bum Kim, Tae Nyeun Kim
Clinical Endoscopy.2021; 54(1): 139. CrossRef
Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: An Overview of Advanced Techniques
Brian M. Fung, Teodor C. Pitea, James H. Tabibian
EMJ Hepatology.2021; : 73. CrossRef
Make mission impossible successful: clip-with-line traction facilitates difficult pancreatic duct cannulation in a patient with duodenal duplication
Wei-hui Liu, Zhao-shen Li, Dong Wang
Endoscopy.2020; 52(09): E346. CrossRef

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Original Article

Efficacy of the Over-the-Scope Clip System for Treatment of Gastrointestinal Fistulas, Leaks, and Perforations: A Korean Multi-Center Study: Hang Lak Lee, Joo Young Cho, Jun-Hyung Cho, Jong Jae Park, Chan Gyoo Kim, Seong Hwan Kim, Joung-Ho Han; Clin Endosc 2018;51(1):61-65. Published online August 29, 2017; DOI: https://doi.org/10.5946/ce.2017.027

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Background
/Aims: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic treatment using the OTSC system in Korea.
Methods
This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure.
Results
A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures, one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the leak was achieved in 14 of 19 patients using OTSC alone.
Conclusions
The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases of anastomotic leakage after surgery.

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Shannon Melissa Chan, Kitty Kit Ying Auyeung, Siu Fung Lam, Philip Wai Yan Chiu, Anthony Yuen Bun Teoh
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Petros Stathopoulos, Malte Zumblick, Sabine Wächter, Leif Schiffmann, Thomas M. Gress, Detlef Bartsch, Guido Seitz, Ulrike W. Denzer
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Raul Eduardo Pinilla Morales, Helena Facundo Navia, Elio Fabio Sánchez Cortés, Ivette C. Jiménez Lafourie, Álvaro Eduardo Sánchez Hernández, Luis Carlos Llorente Portillo
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Chih Y. Tan, Htet A. Kyaw, Neda Farhangmehr, Cheuk‐Bong Tang, Naga V. Jayanthi
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Stephanie G. Jordan, Gregory J. Nolan
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A.V. Vodyasov, D.M. Kopaliani, P.A. Yartsev, O.Kh. Kaloeva
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LeQi Zhong, JiuDi Zhong, ZiHui Tan, YiTong Wei, XiaoDong Su, ZheSheng Wen, TieHua Rong, Yi Hu, KongJia Luo
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Case Reports

Two Cases of Plug or Stone in Remnant Intrapancreatic Choledochal Cysts Treated with Endoscopic Retrograde Cholangiopancreatography: Eunbee Kim, Min Ho Kang, Jisun Lee, Hanlim Choi, Jae-Woon Choi, Joung-Ho Han, Seon Mee Park; Clin Endosc 2017;50(5):504-507. Published online February 16, 2017; DOI: https://doi.org/10.5946/ce.2017.012

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Incomplete resection of choledochal cysts (CCs) that extend deep into the pancreas can lead to protein plug or stone formation, pancreatitis, and cholangiocarcinoma. We encountered two cases of choledocholithiasis in remnant intrapancreatic CCs (IPCCs), in which the patients exhibited symptoms after 3 and 21 years of cyst excision. A 21-year-old woman who had undergone excision of a CC, as a neonate, presented with epigastric pain. Abdominal computed tomography (CT) revealed stones inside the remnant pancreatic cyst, which were removed by endoscopic retrograde cholangiopancreatography (ERCP), and her symptoms improved. A 33-year-old woman, who underwent cyst excision 3 years ago, presented with pancreatitis. Abdominal CT showed a radiolucent plug inside the remnant pancreatic cyst. The soft, whitish plug was removed by ERCP, and the pancreatitis improved. These cases indicate that plugs and stones in CCs have the same pathogenetic mechanism, and their form depends on the time since the incomplete excision surgery.

Citations

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Choledochal cysts – state of the art
Thanh Liem Nguyen, V. S. Cheremnov, Yu. A. Kozlov
Russian Journal of Pediatric Surgery.2021; 25(1): 37. CrossRef

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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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Original Articles

Endoluminal Closure of Colon Perforation with Endoscopic Band Ligation: Technical Feasibility and Safety in an In Vivo Canine Model: Joung-Ho Han, Myounghwan Kim, Tae Hoon Lee, Hyun Kim, Yunho Jung, Seon Mee Park, Heebok Chae, Seijin Youn, Ji Yun Shin, In-Kwang Lee, Tae Soo Lee, Seok Hwa Choi; Clin Endosc 2015;48(6):534-541. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.534

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Background
/Aims: Endoscopic band ligation (EBL) is an accepted method in the management of variceal bleeding; however, there is little evidence on the safety and feasibility of EBL for the closure of bowel perforation. In this study, we aimed to evaluate the technical feasibility and efficacy of EBL in iatrogenic colon perforation by using a canine model.
Methods
We established an iatrogenic colon perforation model by using seven beagle dogs. Longitudinal 1.5- to 1.7-cm colon perforations were created with a needle knife and an insulated-tip knife, and the perforation was subsequently closed with EBL. During a 2-week follow-up period, the animals were carefully monitored and then euthanized for pathologic examination.
Results
The EBL of iatrogenic colon perforations was successful in all dogs. The mean procedure time for EBL closure with one to three bands was 191.7 seconds, and there were no immediate complications. One animal was euthanized after 3 days because of peritonitis. There were no clinical and laboratory features of sepsis or peritonitis in the remaining six animals. On necropsy, we did not find any fecal peritonitis, pericolonic abscess formation, or transmural dehiscence at the perforation site. Histopathology demonstrated inflamed granulation tissue and scar lesions replaced by fibrosis.
Conclusions
EBL might be a feasible and safe method for the management of iatrogenic colon perforations in an in vivo model.

Citations

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Endoscopic Management of Iatrogenic Colon Perforation
Yunho Jung
Clinical Endoscopy.2020; 53(1): 29. CrossRef
Endoluminal closure of an unrecognized penetrating stab wound of the duodenum with endoscopic band ligation: A case report
Dae Hoon Kim, Hanlim Choi, Ki Bae Kim, Hyo Yung Yun, Joung-Ho Han
World Journal of Clinical Cases.2019; 7(20): 3271. CrossRef
Endoscopic management of iatrogenic gastrointestinal perforations
Kan Wang, Jihao Shi, Linna Ye
Laparoscopic, Endoscopic and Robotic Surgery.2019; 2(2): 41. CrossRef
Endoscopic Band Ligation Is Able to Close Perforations Caused by Colonoscopy: A Porcine Model Study
Yidong Yang, Xianyi Lin, Siwei Tan, Xiaoli Huang, Zijun Xie, Xuan Xu, Yiming Lei, Bin Wu
Gastroenterology Research and Practice.2018; 2018: 1. CrossRef

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Efficacy and Safety of Endoscopic Papillary Balloon Dilation Using Cap-Fitted Forward-Viewing Endoscope in Patients Who Underwent Billroth II Gastrectomy: Jong Soon Jang, Seungho Lee, Hee Seung Lee, Myeong Ho Yeon, Joung-Ho Han, Soon Man Yoon, Hee Bok Chae, Sei Jin Youn, Seon Mee Park; Clin Endosc 2015;48(5):421-427. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.421

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Background/Aims

Endoscopic exploration of the common bile duct (CBD) is difficult and dangerous in patients with Billroth II gastrectomy (B-II). Endoscopic papillary balloon dilation (EPBD) via a cap-fitted forward-viewing endoscope has been reported to be an effective and safe procedure. We analyzed the technical success and complications of EPBD in patients who underwent B-II.

Methods

Thirty-six consecutive patients with B-II were enrolled from among 2,378 patients who had undergone endoscopic retrograde cholangiopancreatography in a single institute in the last 4 years. The EPBD procedure was carried out using a cap-fitted forward-viewing endoscope with 8-mm balloon catheters for 60 seconds. We analyzed the rates of CBD exploration, technical success, and complications.

Results

Afferent loop intubation was performed in all patients and selective cannulation of the bile duct was performed in 32 patients (88.9%). Complications such as transient hypoxia were observed in two patients (5.6%) and perforation, in three patients (9.7%). The perforation sites were ductal injury in two patients and one patient showed retroperitoneal air alone without symptoms. Three patients manifested different clinical courses of severe acute pancreatitis and peritonitis, transient abdominal pain, and retroperitoneal air alone. The condition of one patient improved with surgery and that of the other two patients, with conservative management.

Conclusions

Patients with perforation during EPBD in B-II showed different clinical courses. Tailored treatment strategies are necessary for improving the clinical outcomes.

Citations

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A “One Accessory and One Guidewire-in-One Channel” Technique in a Patient with Billroth II Anastomosis
Kook Hyun Kim, Sung Bum Kim, Tae Nyeun Kim
Clinical Endoscopy.2021; 54(1): 139. CrossRef
Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction: An esophagogastroduodenoscope or a colonoscope?
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Takuto Hikichi, Hiromasa Ohira
World Journal of Gastrointestinal Endoscopy.2020; 12(8): 220. CrossRef
Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review
Tae Young Park, Tae Jun Song
World Journal of Gastroenterology.2019; 25(24): 3091. CrossRef
Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article
Rabbinu Rangga Pribadi, Abdul Aziz Rani, Murdani Abdullah
Journal of Digestive Diseases.2019; 20(12): 631. CrossRef
Endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: Outcomes and potential factors affecting technical failure
Jia-Su Li, Duo-Wu Zou, Zhen-Dong Jin, Jie Chen, Xin-Gang Shi, Zhao-Shen Li, Feng Liu
Saudi Journal of Gastroenterology.2019; 25(6): 355. CrossRef
Endoscopic Management of Difficult Bile Duct Stones
Murad Aburajab, Kulwinder Dua
Current Gastroenterology Reports.2018;[Epub] CrossRef
Forward-viewing endoscope for ERCP in patients with Billroth II gastrectomy: a systematic review and meta-analysis
Tae Young Park, Chang Seok Bang, Sang Hyeon Choi, Young Joo Yang, Suk Pyo Shin, Ki Tae Suk, Gwang Ho Baik, Dong Joon Kim, Jai Hoon Yoon
Surgical Endoscopy.2018; 32(11): 4598. CrossRef
Self-expandable metal stents for choledocholithiasis in Billroth II gastrectomy patients
Min-Gui Han, Eunae Cho, Chang-Hwan Park, Chung-Hwan Jun, Seon-Young Park
Hepatobiliary & Pancreatic Diseases International.2018; 17(6): 546. CrossRef
Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations
Seon Mee Park
Clinical Endoscopy.2016; 49(4): 376. CrossRef

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Diagnostic Accuracy of the Initial Endoscopy for Ampullary Tumors: Hee Seung Lee, Jong Soon Jang, Seungho Lee, Myeong Ho Yeon, Ki Bae Kim, Jae Geun Park, Joo Young Lee, Mi Jin Kim, Joung-Ho Han, Rohyun Sung, Seon Mee Park; Clin Endosc 2015;48(3):239-246. Published online May 29, 2015; DOI: https://doi.org/10.5946/ce.2015.48.3.239

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Background/Aims

Ampullary tumors come in a wide variety of malignant forms. We evaluated the diagnostic accuracy of endoscopy for ampullary tumors, and analyzed the causes of misdiagnosis.

Methods

We compared endoscopic imaging and biopsy results to final diagnoses. Types of endoscope, numbers of biopsy specimens taken, and final diagnoses were evaluated as possible factors influencing diagnostic accuracy.

Results

Final diagnoses were 19 adenocarcinomas, 18 normal or papillitis, 11 adenomas, two adenomyomas, one paraganglioma, and one neuroendocrine tumor. The diagnostic accuracy of endoscopic imaging or the initial biopsy was identical (67.3%). At least one test was concordant with the final diagnosis in all except two cases. Compared with the final diagnosis, endoscopic imaging tended to show more advanced tumors, whereas the initial biopsy revealed less advanced lesions. The diagnostic accuracy of the initial biopsy was influenced by the type of endoscope used and the final diagnosis, but not by the number of biopsies taken.

Conclusions

Endoscopy has limited accuracy in the diagnosis of ampullary tumors. However, most cases with concordant endoscopic imaging and biopsy results are identical to the final diagnosis. Therefore, in cases where both of these tests disagree, re-evaluation with a side-viewing endoscope after resolution of papillitis is required.

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Francisco Ramos-Muñoz, Luis Carlos Hinojosa-Arco, Jorge Francisco Roldán-de la Rúa, Ana Isabel García-Salguero, Miguel Ángel Suárez-Muñoz
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Sara Teles de Campos, Marco J. Bruno
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Ming-Tse Hsu, Chi-Yi Chen, Kai-Sheng Liao, Wei-Sheng Chung, Tatsuya Toyokawa
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Ampullary Adenocarcinoma: a Mini-Review and a Case Report of a Clinically Stable Disease Patient Treated with Herbal Supplements
Khin Maung Lwin, Ye Htut Linn, Yamin Kyaw Swar Dee
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Soo Young Jang, Jin Sil Kim, Seung Yon Baek, Hye Ah Lee, Jeong Kyong Lee
Abdominal Radiology.2021; 46(7): 3128. CrossRef
Long‐term outcomes of endoscopic papillectomy for early‐stage cancer in duodenal ampullary adenoma: Comparison to surgical treatment
Jun Seong Hwang, Hoonsub So, Dongwook Oh, Tae Jun Song, Do Hyun Park, Dong‐Wan Seo, Sung Koo Lee, Myung‐Hwan Kim, Seung‐Mo Hong, Jungho Yang, Sang Soo Lee
Journal of Gastroenterology and Hepatology.2021; 36(8): 2315. CrossRef
Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Geoffroy Vanbiervliet, Marin Strijker, Marianna Arvanitakis, Arthur Aelvoet, Urban Arnelo, Torsten Beyna, Olivier Busch, Pierre H. Deprez, Lumir Kunovsky, Alberto Larghi, Gianpiero Manes, Alan Moss, Bertrand Napoleon, Manu Nayar, Enrique Pérez-Cuadrado-Ro
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Predictive factor of recurrence after endoscopic papillectomy for ampullary neoplasms
Kosuke Takahashi, Eisuke Ozawa, Ichiro Yasuda, Naohiro Komatsu, Hisamitsu Miyaaki, Ken Ohnita, Takuji Yamao, Kazuo Oba, Tatsuki Ichikawa, Kazuhiko Nakao
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Twenty-Second versus Sixty-Second Dilation Duration in Endoscopic Papillary Balloon Dilation for the Treatment of Small Common Bile Duct Stones: A Prospective Randomized Controlled Multicenter Trial: Byoung Wook Bang, Tae Hoon Lee, Tae Jun Song, Joung-Ho Han, Hyun Jong Choi, Jong Ho Moon, Chang-Il Kwon, Seok Jeong; Clin Endosc 2015;48(1):59-65. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.59

Abstract PDF PubReader ePub

Background/Aims

Endoscopic papillary balloon dilation (EPBD) has been advocated as an alternative therapy to endoscopic sphincterotomy for the treatment of common bile duct (CBD) stones. However, there is no established consensus on the optimal balloon dilation duration (BDD). We prospectively evaluated the efficacy and post-endoscopic retrograde cholangiopancreatography (ERCP) complications between the 20- and 60-second EPBD groups.

Methods

A total of 228 patients with small CBD stones (≤12 mm) were randomly assigned to undergo EPBD with a 20- or 60-second duration at six institutions. We evaluated baseline patient characteristics, endoscopic data, clinical outcomes, and procedure-related complications. In addition, we analyzed risk factors for postprocedural pancreatitis.

Results

CBD stones were removed successfully in 107 of 109 patients (98.1%) in the 20-second group and in 112 of 119 patients (94.1%) in the 60-second group (p=0.146). Post-ERCP pancreatitis developed in seven patients (6.4%) in the 20-second group and nine patients (7.5%) in the 60-second group (p=0.408). In multivariate analysis, contrast dye injection into the pancreatic duct is a significant risk factor for post-EPBD pancreatitis.

Conclusions

Based on the data showing that there were no significant differences in safety and efficacy between the two BDD groups, 20 seconds of BDD may be adequate for treatment of small CBD stones with EPBD.

Citations

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Special Issue Article of IDEN 2013

Endoscopic Treatments of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforations: Tae Hoon Lee, Joung-Ho Han, Sang-Heum Park; Clin Endosc 2013;46(5):522-528. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.522

Abstract PDF PubReader ePub

Iatrogenic duodenal perforation associated with endoscopic retrograde cholangiopancreatography (ERCP) is a very uncommon complication that is often lethal. Perforations during ERCP are caused by endoscopic sphincterotomy, placement of biliary or duodenal stents, guidewire-related causes, and endoscopy itself. In particular, perforation of the medial or lateral duodenal wall usually requires prompt diagnosis and surgical management. Perforation can follow various clinical courses, and management depends on the cause of the perforation. Cases resulting from sphincterotomy or guidewire-induced perforation can be managed by conservative treatment and biliary diversion. The current standard treatment for perforation of the duodenal free wall is early surgical repair. However, several reports of primary endoscopic closure techniques using endoclip, endoloop, or newly developed endoscopic devices have recently been described, even for use in direct perforation of the duodenal wall.

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