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A rapidly growing round mass in the gallbladder: Hong Ja Kim, Tae Hoon Lee; Clin Endosc 2023;56(1):132-134. Published online January 16, 2023; DOI: https://doi.org/10.5946/ce.2022.298

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Reviews

Role of radiofrequency ablation in advanced malignant hilar biliary obstruction: Mamoru Takenaka, Tae Hoon Lee; Clin Endosc 2023;56(2):155-163. Published online January 16, 2023; DOI: https://doi.org/10.5946/ce.2022.218

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Malignant hilar biliary obstruction (MHO), an aggressive perihilar biliary obstruction caused by cholangiocarcinoma, gallbladder cancer, or other metastatic malignancies, has a poor prognosis. Surgical resection is the only curative treatment for biliary malignancies. However, the majority of patients with MHO cannot undergo surgery on presentation because of an advanced inoperable state or a poor performance state due to old age or comorbid diseases. Therefore, palliative biliary drainage is mandatory to improve symptomatic jaundice and the quality of life. Among the drainage methods, endoscopic biliary drainage is the current standard for palliation of unresectable advanced MHO. In addition, combined with endoscopic drainage, additional local ablation therapies, such as photodynamic therapy or radiofrequency ablation (RFA), have been introduced to prolong stent patency and survival. Currently, RFA is commonly used as palliative therapy, even for advanced MHO. This literature review summarizes recent studies on RFA for advanced MHO.

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Qi Chen, Nai-Jian Ge, Yu-Liang Li, Ming Huang, Wen-Hui Li, Dong Lu, Ning Wei, Peng-Hua Lv, Jian-Fei Tu, Cheng-Jian He, Wu-Jie Wang, Rong Ding, Bo Peng, Xue-Jun Wang, Fu-An Wang, Guang-Yu Zhu, Yong Wang, Li Chen, Jie Min, Jin-He Guo, Gao-Jun Teng, Jian Lu
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Surgical Management of Biliary Strictures
Nitin N. Katariya
Digestive Disease Interventions.2025;[Epub] CrossRef
Biliary metallic stent combined with radioactive 125I seeds strands for malignant hilar obstruction
Milan Sigdel, Chengzhi Zhang, Rongna Hou, Mengyao Song, Zhanguo Sun, Dechao Jiao
BMC Cancer.2025;[Epub] CrossRef
Percutaneous endobiliary radiofrequency ablation with stent placement in type IV hilar cholangiocarcinoma: A prospective comparison with stent placement alone
Kun Yung Kim, Chang Jin Yoon, Jae Hwan Lee, Chong-Ho Lee, Jin-Hyeok Hwang, Jaihwan Kim
European Journal of Radiology.2024; 176: 111516. CrossRef
Intraductal ablation therapy for malignant biliary obstruction
Qiyu Zhang, Yanchao Dong, Hongtao Niu
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Metastatic Cholangiocarcinoma Presenting as Colonic Obstruction
Yianni Protopapadakis, Kevin Lamm, Joseph Baber
ACG Case Reports Journal.2023; 10(12): e01238. CrossRef
Is endoscopic radiofrequency ablation plus stent placement superior to stent placement alone for the treatment of malignant biliary obstruction? A systematic review and meta-analysis
Chenming Liu, Jiaming Dong, Yuxing Liu, Siyuan Zhang, Ruanchang Chen, Haijun Tang
Journal of International Medical Research.2023;[Epub] CrossRef

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Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE): Moon Jae Chung, Se Woo Park, Seong-Hun Kim, Chang Min Cho, Jun-Ho Choi, Eun Kwang Choi, Tae Hoon Lee, Eunae Cho, Jun Kyu Lee, Tae Jun Song, Jae Min Lee, Jun Hyuk Son, Jin Suk Park, Chi Hyuk Oh, Dong-Ah Park, Jeong-Sik Byeon, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun, Ho Soon Choi, Chan Guk Park, Joo Young Cho; Clin Endosc 2021;54(2):161-181. Published online March 24, 2021; DOI: https://doi.org/10.5946/ce.2021.069

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Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in 8 categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.

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Role of Endoscopic Ultrasound in the Management of Pancreatic Cancer
Balaji Musunuri, Shiran Shetty
Indian Journal of Surgical Oncology.2024; 15(S2): 269. CrossRef
Endoscopic Ultrasound (EUS) guided biopsy of healthy pig pancreas: Towards the histological diagnosis of chronic pancreatitis.
Julio Iglesias-García, Yessica Domínguez-Novoa, Héctor Lazare-Iglesias, Antonio González-Cantalapiedra, Ihab Abdulkader-Nallib, Óscar Varela-López, José Lariño-Noia, Enrique Domínguez-Muñoz
Revista Española de Enfermedades Digestivas.2024;[Epub] CrossRef
Endoscopic ultrasound-guided tissue acquisition for personalized treatment in pancreatic adenocarcinoma
Sang Myung Woo
Clinical Endoscopy.2023; 56(2): 183. CrossRef
Pancreatic duct lavage cytology combined with a cell-block method for patients with possible pancreatic ductal adenocarcinomas, including pancreatic carcinoma in situ
Hiroaki Kusunose, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Hideyuki Anan, Kazuki Endo, Haruka Okano, Masaya Oikawa, Takashi Tsuchiya, Takashi Sawai, Yutaka Noda, Kei Ito
Clinical Endoscopy.2023; 56(3): 353. CrossRef
Anesthesia care provider sedation versus conscious sedation for endoscopic ultrasound–guided tissue acquisition: a retrospective cohort study
Sneha Shaha, Yinglin Gao, Jiahao Peng, Kendrick Che, John J. Kim, Wasseem Skef
Clinical Endoscopy.2023; 56(5): 658. CrossRef
Endoscopic ultrasound-guided tissue acquisition and gene panel testing for pancreatic cancer
Kentaro SUDO, Emiri KITA, Akiko TSUJIMOTO, Kazuyoshi NAKAMURA, Akiko ODAKA, Makiko ITAMI, Sana YOKOI, Hiroshi ISHII
Suizo.2022; 37(1): 8. CrossRef
Impact of rapid on-site evaluation on diagnostic accuracy of EUS-guided fine-needle aspiration of solid pancreatic lesions: experience from a single center
Irem Guvendir, Itir Ebru Zemheri, Kamil Ozdil
BMC Gastroenterology.2022;[Epub] CrossRef
Endoscopic Ultrasound Guided Fine Needle Aspiration and Biopsy for Pancreatic Disease
Kwang Hyuck Lee
The Korean Journal of Pancreas and Biliary Tract.2021; 26(4): 241. CrossRef

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Commentary

Can Contrast-Enhanced Harmonic Endoscopic Ultrasonography Differentiate Malignancy from Benign Disease?: Tae Hoon Lee; Clin Endosc 2018;51(1):5-7. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2018.016

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Citations

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Diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography in predicting the malignancy potential of submucosal tumors: a systematic review and meta-analysis
Yong-tao Yang, Neng Shen, Fei Ao, Wei-qing Chen
Surgical Endoscopy.2020; 34(9): 3754. CrossRef
Current Status of Endoscopic Ultrasound Techniques for Pancreatic Neoplasms
Yousuke Nakai, Naminatsu Takahara, Suguru Mizuno, Hirofumi Kogure, Kazuhiko Koike
Clinical Endoscopy.2019; 52(6): 527. CrossRef

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Review

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

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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.

Citations

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Clinical application of ERCP concurrent laparoscopic cholecystectomy in the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones
Jiang-Bo Shen, Peng-Cheng Chen, Jin-Gen Su, Qing-Chun Feng, Pei-Dong Shi
Heliyon.2024; 10(10): e31022. 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
Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones
Hirokazu Saito, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Haruo Imamura, Ikuo Matsushita, Tatsuyuki Kakuma, Shuji Tada
Clinical Endoscopy.2022; 55(2): 263. CrossRef
Management of difficult or failed biliary access in initial ERCP: A review of current literature
Qinghai Chen, Peng Jin, Xiaoyan Ji, Haiwei Du, Junhua Lu
Clinics and Research in Hepatology and Gastroenterology.2019; 43(4): 365. CrossRef
Comparison of efficacy and safety of transpancreatic septotomy, needle-knife fistulotomy or both based on biliary cannulation unintentional pancreatic access and papillary morphology
Jun Wen, Tao Li, Yi Lu, Li-Ke Bie, Biao Gong
Hepatobiliary & Pancreatic Diseases International.2019; 18(1): 73. CrossRef
Wire-guided biliary cannulation: a comprehensive approach to a set of techniques
Vincenzo Cennamo, Marco Bassi, Stefano Landi, Cecilia Binda, Carlo Fabbri, Stefania Ghersi, Antonio Gasbarrini
European Journal of Gastroenterology & Hepatology.2019; 31(11): 1299. CrossRef
TRANSPAPILLARY ENDOSCOPIC SURGERY: COMPLICATIONS AND PREVENTION OF THEIR DEVELOPMENT
P N Romashchenko, A A Filin, N A Maistrenko, A A Fekliunin, E S Zherebtsov
Bulletin of the Russian Military Medical Academy.2019; 21(1): 54. CrossRef
Modified transprepancreatic septotomy reduces postoperative complications after intractable biliary access
Henggao Zhong, Xiaohong Wang, Lihua Yang, Lin Miao, Guozhong Ji, Zhining Fan
Medicine.2018; 97(1): e9522. CrossRef

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Original Article

Usefulness of the Forrest Classification to Predict Artificial Ulcer Rebleeding during Second-Look Endoscopy after Endoscopic Submucosal Dissection: Duk Su Kim, Yunho Jung, Ho Sung Rhee, Su Jin Lee, Yeong Geol Jo, Jong Hwa Kim, Jae Man Park, Il-Kwun Chung, Young Sin Cho, Tae Hoon Lee, Sang-Heum Park, Sun-Joo Kim; Clin Endosc 2016;49(3):273-281. Published online March 4, 2016; DOI: https://doi.org/10.5946/ce.2015.086

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Background
/Aims: Delayed post-endoscopic submucosal dissection (ESD) bleeding (DPEB) is difficult to predict and there is controversy regarding the usefulness of prophylactic hemostasis during second-look endoscopy. This study evaluated the risk factors related to DPEB, the relationship between clinical outcomes and the Forrest classification, and the results of prophylactic hemostasis during second-look endoscopy.
Methods
Second-look endoscopy was performed on the day after ESD to check for recent hemorrhage or potential bleeding and the presence of artificial ulcers in all patients.
Results
DPEB occurred in 42 of 581 patients (7.2%). Multivariate analysis determined that a specimen size ≥40 mm (odds ratio [OR], 3.03; p=0.003), and a high-risk Forrest classification (Forrest Ib+IIa+IIb; OR, 6.88; p<0.001) were risk factors for DPEB. DPEB was significantly more likely in patients classified with Forrest Ib (OR, 24.35; p<0.001), IIa (OR, 12.91; p<0.001), or IIb (OR, 8.31; p<0.001) ulcers compared with Forrest III ulcers. There was no statistically significant difference between the prophylactic hemostasis and non-hemostasis groups (Forrest Ib, p=0.938; IIa, p=0.438; IIb, p=0.397; IIc, p=0.773) during second-look endoscopy.
Conclusions
The Forrest classification of artificial gastric ulcers during second-look endoscopy seems to be a useful tool for predicting delayed bleeding. However, routine prophylactic hemostasis during second-look endoscopy seemed to not be useful for preventing DPEB.

Citations

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Response
Thomas K.L. Lui
Gastrointestinal Endoscopy.2024; 99(4): 664. CrossRef
Outcome of Gastric Fundus and Pylorus Botulinum Toxin A Injection in Obese Patients Class I–II with Normal Pyloric Orifice Structure: A Retrospective Analysis
Murat Ferhat Ferhatoglu, Abdulcabbar Kartal, Ali Ilker Filiz, Abut Kebudi
Bariatric Surgical Practice and Patient Care.2022; 17(3): 148. CrossRef
Forrest Classification for Bleeding Peptic Ulcer: A New Look at the Old Endoscopic Classification
Hsu-Heng Yen, Ping-Yu Wu, Tung-Lung Wu, Siou-Ping Huang, Yang-Yuan Chen, Mei-Fen Chen, Wen-Chen Lin, Cheng-Lun Tsai, Kang-Ping Lin
Diagnostics.2022; 12(5): 1066. CrossRef
Performance Comparison of the Deep Learning and the Human Endoscopist for Bleeding Peptic Ulcer Disease
Hsu-Heng Yen, Ping-Yu Wu, Pei-Yuan Su, Chia-Wei Yang, Yang-Yuan Chen, Mei-Fen Chen, Wen-Chen Lin, Cheng-Lun Tsai, Kang-Ping Lin
Journal of Medical and Biological Engineering.2021; 41(4): 504. CrossRef
Prevention of bleeding in the early postoperative period after intraluminal stomach resection: results of a prospective randomized study
S.G. Shapovalyants, R.V. Plakhov, M.V. Bordikov, E.V. Gorbachev, I.V. Zhitareva, E.D. Fedorov
Endoskopicheskaya khirurgiya.2020; 26(5): 5. CrossRef
Risk factors for delayed bleeding by onset time after endoscopic submucosal dissection for gastric neoplasm
Hyeong Seok Nam, Cheol Woong Choi, Su Jin Kim, Hyung Wook Kim, Dae Hwan Kang, Su Bum Park, Dae Gon Ryu
Scientific Reports.2019;[Epub] CrossRef
Effectiveness of Autologous Platelet-Rich Plasma for the Healing of Ulcers after Endoscopic Submucosal Dissection
Eunju Jeong, In kyung Yoo, Ozlem Ozer Cakir, Hee Kyung Kim, Won Hee Kim, Sung Pyo Hong, Joo Young Cho
Clinical Endoscopy.2019; 52(5): 472. CrossRef
Bleeding in patients who underwent scheduled second-look endoscopy 5 days after endoscopic submucosal dissection for gastric lesions
Koichi Izumikawa, Masaya Iwamuro, Tomoki Inaba, Shigenao Ishikawa, Kenji Kuwaki, Ichiro Sakakihara, Kumiko Yamamoto, Sakuma Takahashi, Shigetomi Tanaka, Masaki Wato, Hiroyuki Okada
BMC Gastroenterology.2018;[Epub] CrossRef
Continuous esomeprazole infusion versus bolus administration and second look endoscopy for the prevention of rebleeding in children with a peptic ulcer
Oana Belei, Laura Olariu, Maria Puiu, Cristian Jinca, Cristina Dehelean, Tamara Marcovici, Otilia Marginean
Revista Española de Enfermedades Digestivas.2018;[Epub] CrossRef
Role of second‐look endoscopy and prophylactic hemostasis after gastric endoscopic submucosal dissection: A systematic review and meta‐analysis
Eun Hye Kim, Se Woo Park, Eunwoo Nam, Chang Soo Eun, Dong Soo Han, Chan Hyuk Park
Journal of Gastroenterology and Hepatology.2017; 32(4): 756. CrossRef
Second-Look Endoscopy after Endoscopic Submucosal Dissection: Can We Obtain Valuable Information?
Hye Kyung Jeon, Gwang Ha Kim
Clinical Endoscopy.2016; 49(3): 212. CrossRef

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Case Report

Endoscopic Extraction of Biliary Fascioliasis Diagnosed Using Intraductal Ultrasonography in a Patient with Acute Cholangitis: Ji Su Ha, Hyun Jong Choi, Jong Ho Moon, Yun Nah Lee, Jae Woong Tae, Moon Han Choi, Tae Hoon Lee, Sang-Woo Cha; Clin Endosc 2015;48(6):579-582. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.579

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Fasciola hepatica infection may result in biliary obstruction with or without cholangitis in the chronic biliary phase. Because clinical symptoms and signs of F. hepatica are similar to other biliary diseases that cause bile duct obstruction, such as stones or bile duct malignancies, that are, in fact, more common, this condition may not be suspected and diagnosis may be overlooked and delayed. Patients undergoing endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the evaluation of bile duct obstruction may be incidentally detected with the worm, and diagnosis can be confirmed by extraction of the leaf-like trematode from the bile duct. Intraductal ultrasonography (IDUS) can provide high-resolution cross-sectional images of the bile duct, and is useful in evaluating indeterminate biliary diseases. We present a case of biliary fascioliasis that was diagnosed using IDUS and managed endoscopically in a patient with acute cholangitis.

Citations

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A Curious Case of Walking Cholangitis in a Nonendemic Region: Hepatobiliary Fascioliasis
Anupam Kumar Singh, Jahnvi Dhar, Saroj Kant Sinha, Jayanta Samanta
ACG Case Reports Journal.2025; 12(5): e01700. CrossRef
An Update on the Pathogenesis of Fascioliasis: What Do We Know?
Melinda Tanabe, Maria Caravedo, A White, Miguel Cabada
Research and Reports in Tropical Medicine.2024; Volume 15: 13. CrossRef
Fascioliasis: Image Findings, Diagnosis, and Treatment
Jae Seung Lee
Clinical Ultrasound.2024; 9(1): 18. CrossRef
Parasitic Diseases of Upper Gastrointestinal Tract
Heung Up Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2024; 24(2): 127. CrossRef
Endoscopic Diagnosis of Biliary Fascioliasis in Non-endemic Region
Shankar Roy, Abhishek Mewara, Rajesh Gupta, Surinder Singh Rana
Digestive Diseases and Sciences.2023; 68(9): 3476. CrossRef
Fasciola Hepatica Induced Hepatic Abscess Treated with Triclabendazole
Hyun Joon Park, Gil-Soon Choi, Minjung Jung, Sang Uk Lee
The Korean Journal of Gastroenterology.2021; 77(1): 39. CrossRef
Pancréas parasitaire
M. Wallon, F. Bailly, F. Peyron
EMC - Hépatologie.2021; 36(3): 1. CrossRef
Biliary Fascioliasis in Chronic Calcific Pancreatitis Presenting with Ascending Cholangitis and Biliary Stricture
Tanawat Pattarapuntakul, Bancha Ovartlarnporn, Worapot Rojsanga, Thanaidpon Yungyoo
Case Reports in Gastroenterology.2019; 13(3): 438. CrossRef
Obstructive jaundice of a parasitic etiology
M.� Antonia Remacha ., M� Pilar Goñi , Jesus Espinel
Revista Española de Enfermedades Digestivas.2018;[Epub] 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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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

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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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The therapeutic effect of balloon dilatation with different duration for biliary duct calculi
Zhi Yuan Yu, Chen Liang, Shi Yu Yang, Xu Zhang, Yan Sun
Journal of Minimal Access Surgery.2022; 18(3): 327. CrossRef
The ballooning time in endoscopic papillary balloon dilation for removal of bile duct stones
Qiang Wang, Luyao Fu, Tao Wu, Xiong Ding
Medicine.2021; 100(11): e24735. CrossRef
Nouveautés dans la prise en charge des calculs biliaires à l’UEGW 2015
E. Bories, C. Lefort
Acta Endoscopica.2016; 46(1-2): 20. CrossRef
Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis?
Toshio Fujisawa, Koichi Kagawa, Kantaro Hisatomi, Kensuke Kubota, Atsushi Nakajima, Nobuyuki Matsuhashi
World Journal of Gastroenterology.2016; 22(26): 5909. CrossRef
Is the Balloon Dilation Duration in Endoscopic Papillary Balloon Dilation (EPBD) Related to the Occurrence of Post-EPBD Pancreatitis?
Dong Uk Kim
Clinical Endoscopy.2015; 48(1): 6. CrossRef

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Review

Bilateral Metallic Stenting in Malignant Hilar Obstruction: Tae Hoon Lee, Jong Ho Moon, Sang-Heum Park; Clin Endosc 2014;47(5):440-446. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.440

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Endoscopic palliative biliary drainage is considered as a gold standard treatment in advanced or inoperable hilar cholangiocarcinoma. Also, metal stents are preferred over plastic stents in patients with >3 months life expectancy. However, the endoscopic intervention of advanced hilar obstruction is often more challenging and complex than that of distal malignant biliary obstructions. In this literature review, we describe the issues commonly encountered during endoscopic unilateral (single) versus bilateral (multiple) biliary stenting for malignant hilar obstruction. Also, we provide technical guidance to improve the technical success rates and patient outcomes, focusing on bilateral metallic stenting techniques such as stent-in-stent or side-by-side deployment.

Citations

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Long slim versus conventional self-expandable metallic stent in bilateral endoscopic side-by-side deployment for unresectable malignant hilar biliary obstruction
Ling Xing, Yan-ting Liu, Xin Ye, Tian-tian Wang, Jun Wu, Ming-xing Xia, Bing Hu, Dao-jian Gao
Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Side‐by‐side placement of fully covered metal stents versus conventional 7F plastic stents in malignant hilar biliary obstruction: Prospective randomized controlled trial
Woo Hyun Paik, Min Kyu Jung, Dong Uk Kim, Tae Jun Song, Min Jae Yang, Young Hoon Choi, Joo Seong Kim, Min Woo Lee, Jin Ho Choi, Sang Hyub Lee
Digestive Endoscopy.2024; 36(4): 473. CrossRef
Suprapapillary stenting for malignant hilar obstruction: Is it feasible in the West?
Netanel F. Zilberstein, Neal A. Mehta
Gastrointestinal Endoscopy.2023; 98(2): 222. CrossRef
Endoscopic re‐intervention after stent‐in‐stent versus side‐by‐side bilateral self‐expandable metallic stent deployment
Tomohisa Iwai, Mitsuhiro Kida, Kosuke Okuwaki, Hiroshi Yamauchi, Toru Kaneko, Rikiya Hasegawa, Masafumi Watanabe, Takahiro Kurosu, Hiroshi Imaizumi, Wasaburo Koizumi
Journal of Gastroenterology and Hepatology.2022; 37(6): 1060. CrossRef
Feasibility and Safety of Endoluminal Radiofrequency Ablation as a Rescue Treatment for Bilateral Metal Stent Obstruction Due to Tumor Ingrowth in the Hilum: A Pilot Study
Hoonsub So, Chi Hyuk Oh, Tae Jun Song, Hyun Woo Lee, Jun Seong Hwang, Sung Woo Ko, Dongwook Oh, Do Hyun Park, Sang Soo Lee, Dong-Wan Seo, Sung Koo Lee, Myung-Hwan Kim
Journal of Clinical Medicine.2021; 10(5): 952. CrossRef
Fully covered metal biliary stents: A review of the literature
Robert Lam, Thiruvengadam Muniraj
World Journal of Gastroenterology.2021; 27(38): 6357. CrossRef
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Case Report

Electrohydraulic Lithotripsy of an Impacted Enterolith Causing Acute Afferent Loop Syndrome: Young Sin Cho, Tae Hoon Lee, Soon Oh Hwang, Sunhyo Lee, Yunho Jung, Il-Kwun Chung, Sang-Heum Park, Sun-Joo Kim; Clin Endosc 2014;47(4):367-370. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.367

Abstract PDF PubReader ePub

Afferent loop syndrome caused by an impacted enterolith is very rare, and endoscopic removal of the enterolith may be difficult if a stricture is present or the normal anatomy has been altered. Electrohydraulic lithotripsy is commonly used for endoscopic fragmentation of biliary and pancreatic duct stones. A 64-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy presented with acute, severe abdominal pain for a duration of 2 hours. Initially, he was diagnosed with acute pancreatitis because of an elevated amylase level and pain, but was finally diagnosed with acute afferent loop syndrome when an impacted enterolith was identified by computed tomography. We successfully removed the enterolith using direct electrohydraulic lithotripsy conducted using a transparent cap-fitted endoscope without complications. We found that this procedure was therapeutically beneficial.

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Review

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.

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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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Focused Review Series: Endoscopic Sedation Revisited: Principles and Practice

Endoscopic Sedation: From Training to Performance: Tae Hoon Lee, Chang Kyun Lee; Clin Endosc 2014;47(2):141-150. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.141

Abstract PDF PubReader ePub

Adequate sedation and analgesia are considered essential requirements to relieve patient discomfort and pain and ultimately to improve the outcomes of modern gastrointestinal endoscopic procedures. The willingness of patients to undergo sedation during endoscopy has increased steadily in recent years and standard sedation practices are needed for both patient safety and successful procedural outcomes. Therefore, regular training and education of healthcare providers is warranted. However, training curricula and guidelines for endoscopic sedation may have conflicts according to varying legal frameworks and/or social security systems of each country, and well-recognized endoscopic sedation training systems are not currently available in all endoscopy units. Although European and American curricula for endoscopic sedation have been extensively developed, general curricula and guidelines for each country and institution are also needed. In this review, an overview of recent curricula and guidelines for training and basic performance of endoscopic sedation is presented based on the current literature.

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R Bortolussi, P Zotti, M Matovic, A Morabito, C Bertuzzi, M Caserta, F Fabiani, A Fracasso, C Santantonio, C Zanier, A Roscetti, J Polesel, D Gussetti, S Bedin, AM Colussi, D Fantin
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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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Case Report

Endoscopic Removal of a Proximally Migrated Metal Stent during Balloon Sweeping after Stent Trimming: Nam Jun Cho, Tae Hoon Lee, Sang-Heum Park, Han Min Lee, Kyung Hee Hyun, Suck-Ho Lee, Il-Kwun Chung, Sun-Joo Kim; Clin Endosc 2013;46(4):418-422. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.418

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Placement of a self-expanding metal stent (SEMS) is an effective method for palliation of a malignant biliary obstruction. However, metal stents can cause various complications, including stent migration. Distally migrated metal stents, particularly covered SEMS, can be removed successfully in most cases. Stent trimming using argon plasma coagulation may be helpful in difficult cases despite conventional methods. However, no serious complications related to the trimming or remnant stent removal method have been reported due to the limited number of cases. In particular, proximal migration of a remnant fragmented metal stent after stent trimming followed by balloon sweeping has not been reported. We report an unusual case of proximal migration of a remnant metal stent during balloon sweeping following stent trimming by argon plasma coagulation. The remnant metal stent was successfully removed with rotation technique using a basket and revised endoscopically.

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Technical Tips and Issues of Biliary Stenting, Focusing on Malignant Hilar Obstruction: Tae Hoon Lee; Clin Endosc 2013;46(3):260-266. Published online May 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.3.260

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Although there is no survival advantage, inoperable hilar cholangiocarcinoma managed by palliative drainage may benefit from symptomatic improvement. In general, biliary drainage is divided into endoscopic or percutaneous approaches and surgical drainage. Plastic or metal stent is the most preferred device for palliative drainage in endoscopic approach. Considering cost-effectiveness, use of metallic stent is preferred than plastic stents in patients with more than 3 months of life expectancy with inoperable malignant biliary obstruction. In patients with unresectable malignant hilar obstruction, the endoscopic approach with biliary stent placement by experts has been considered as the treatment of choice. However, the endoscopic management of hilar obstruction is often more challenging and complex than distal malignant biliary obstructions. There is still a lack of clear consensus on the use of plastic versus metal stents and unilateral versus bilateral drainage since the decision should be made under many grounds such as the volume of liver drainage more than 50%, life expectancy, and expertise of the facility.

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