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Original Articles
Puncture angle on an endoscopic ultrasound image is independently associated with unsuccessful guidewire manipulation of endoscopic ultrasound-guided hepaticogastrostomy: a retrospective study in Japan
Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Kazuhide Matsumoto, Masatoshi Murakami, Katsuhito Teramatsu, Keijiro Ueda, Masayuki Hijioka, Akira Aso, Yoshihiro Ogawa
Clin Endosc 2024;57(5):656-665.   Published online July 26, 2024
DOI: https://doi.org/10.5946/ce.2023.244
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is performed globally, the procedure remains challenging. Guidewire manipulation is the most difficult step, and there are few reports on the factors associated with unsuccessful guidewire manipulation. This study aimed to assess the significance of the puncture angle on EUS images and identify the most effective guidewire rescue method for patients with unsuccessful guidewire manipulation.
Methods
We retrospectively enrolled 115 patients who underwent EUS-HGS between May 2016 and April 2022 at two centers. The puncture angle between the needle and the intrahepatic bile duct was measured through EUS movie records.
Results
Guidewire manipulation was unsuccessful in 28 patients. Receiver operating characteristic (ROC) curves identified an optimal puncture angle cutoff value of 85° (cutoff value, 85°; area under the ROC curve, 0.826; sensitivity, 85.7%; specificity, 81.6%). Multivariate analysis demonstrated that a puncture angle <85° was a significant risk factor for unsuccessful guidewire manipulation (odds ratio, 19.8; 95% confidence interval, 6.42–61.5; p<0.001). Among the 28 unsuccessful cases, 24 patients (85.7%) achieved successful guidewire manipulation using various rescue methods.
Conclusions
The puncture angle observed on EUS is crucial for guidewire manipulation. A puncture angle of <85° was associated with unsuccessful guidewire manipulation.
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Outcomes of partially covered self-expandable metal stents with different uncovered lengths in endoscopic ultrasound-guided hepaticogastrostomy: a Japanese retrospective study
Takeshi Okamoto, Takashi Sasaki, Tsuyoshi Takeda, Tatsuki Hirai, Takahiro Ishitsuka, Manabu Yamada, Hiroki Nakagawa, Takafumi Mie, Takaaki Furukawa, Akiyoshi Kasuga, Masato Ozaka, Naoki Sasahira
Clin Endosc 2024;57(4):515-526.   Published online May 10, 2024
DOI: https://doi.org/10.5946/ce.2023.142
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO).
Methods
Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared.
Results
Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS.
Conclusions
No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

Citations

Citations to this article as recorded by  
  • Migration of covered expandable metal stents after endoscopic ultrasound-guided hepaticogastrostomy: stent covering versus stent design?
    Todd H. Baron
    Clinical Endoscopy.2024; 57(4): 471.     CrossRef
  • 2,201 View
  • 177 Download
  • 1 Web of Science
  • 1 Crossref
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Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of patients with biliary tract cancer, especially with intrahepatic cholangiocarcinoma
Takafumi Yanaidani, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Nobumasa Mizuno, Sho Ishikawa, Masanori Yamada, Tsukasa Yasuda
Clin Endosc 2024;57(3):384-392.   Published online February 15, 2024
DOI: https://doi.org/10.5946/ce.2023.139
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a standard diagnostic method for biliary tract cancer (BTC), and samples obtained in this manner may be used for comprehensive genomic profiling (CGP). This study evaluated the utility of EUS-TA for CGP in a clinical setting and determined the factors associated with the adequacy of CGP in patients with BTC.
Methods
CGP was attempted for 105 samples from 94 patients with BTC at the Aichi Cancer Center, Japan, from October 2019 to April 2022.
Results
Overall, 77.1% (81/105) of the samples were adequate for CGP. For 22-G or 19-G fine-needle biopsy (FNB), the sample adequacy was 85.7% (36/42), which was similar to that of surgical specimens (94%, p=0.45). Univariate analysis revealed that 22-G or larger FNB needle usage (86%, p=0.003), the target primary lesions (88%, p=0.015), a target size ≥30 mm (100%, p=0.0013), and number of punctures (90%, p=0.016) were significantly positively associated with CGP sample adequacy.
Conclusions
EUS-TA is useful for CGP tissue sampling in patients with BTC. In particular, the use of 22-G or larger FNB needles may allow for specimen adequacy comparable to that of surgical specimens.

Citations

Citations to this article as recorded by  
  • Is genomic analysis possible in a tissue acquired via endoscopic ultrasound-guided fine-needle biopsy in cholangiocarcinoma?
    Jonghyun Lee, Sung Yong Han
    Clinical Endoscopy.2024; 57(3): 332.     CrossRef
  • Utility of Transpapillary Biopsy and Endoscopic Ultrasound-Guided Tissue Acquisition for Comprehensive Genome Profiling of Unresectable Biliary Tract Cancer
    Soma Fukuda, Susumu Hijioka, Yoshikuni Nagashio, Daiki Yamashige, Daiki Agarie, Yuya Hagiwara, Kohei Okamoto, Shin Yagi, Yasuhiro Komori, Masaru Kuwada, Yuta Maruki, Chigusa Morizane, Hideki Ueno, Nobuyoshi Hiraoka, Kiichiro Tsuchiya, Takuji Okusaka
    Cancers.2024; 16(16): 2819.     CrossRef
  • Endoscopic Ultrasound and Intraductal Ultrasound in the Diagnosis of Biliary Tract Diseases: A Narrative Review
    Akiya Nakahata, Yasunobu Yamashita, Masayuki Kitano
    Diagnostics.2024; 14(18): 2086.     CrossRef
  • 2,587 View
  • 71 Download
  • 3 Web of Science
  • 3 Crossref
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The efficacy of a novel integrated outside biliary stent and nasobiliary drainage catheter system for acute cholangitis: a single center pilot study
Naosuke Kuraoka, Tetsuro Ujihara, Hiromi Kasahara, Yuto Suzuki, Shun Sakai, Satoru Hashimoto
Clin Endosc 2023;56(6):795-801.   Published online April 11, 2023
DOI: https://doi.org/10.5946/ce.2022.289
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic biliary drainage is the gold standard treatment for cholangitis. The two methods of biliary drainage are endoscopic biliary stenting and nasobiliary drainage. A novel integrated outside biliary stent and nasobiliary drainage catheter system (UMIDAS NB stent; Olympus Medical Systems) was recently developed. In this study, we evaluated the efficacy of this stent in the treatment of cholangitis caused by common bile duct stones or distal bile duct strictures.
Methods
We conducted a retrospective pilot study by examining the medical records of patients who required endoscopic biliary drainage for cholangitis due to common bile duct stones or distal bile duct strictures, and who were treated with a UMIDAS NB stent, between December 2021 and July 2022.
Results
Records of 54 consecutive patients were reviewed. Technical and clinical success rates were 47/54 (87.0%) and 52/54 (96.3%), respectively. Adverse events were observed in 12 patients, with six patients experiencing pancreatitis as an adverse event, following endoscopic retrograde cholangiopancreatography (ERCP). Regarding late adverse events, five cases of biliary stent migration into the bile duct were observed. Disease-related death occurred in one patient.
Conclusions
The outside-type UMIDAS NB stent is an efficacious new method for biliary drainage and can be applied to many indications.
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Comparison of tube-assisted mapping biopsy with digital single-operator peroral cholangioscopy for preoperative evaluation of biliary tract cancer
Tsuyoshi Takeda, Takashi Sasaki, Takafumi Mie, Takeshi Okamoto, Chinatsu Mori, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Clin Endosc 2022;55(4):549-557.   Published online July 20, 2022
DOI: https://doi.org/10.5946/ce.2021.227
AbstractAbstract PDFPubReaderePub
Background
/Aims: Digital single-operator cholangioscopy (DSOC)-guided mapping biopsy (DMB) and tube-assisted mapping biopsy (TMB) are two techniques used for preoperative evaluation of biliary tract cancer (BTC). However, data regarding the diagnostic performance of these techniques are limited.
Methods
We retrospectively examined consecutive patients with BTC who underwent either technique at our institution between 2018 and 2020. We evaluated the technical success rate, adequate tissue acquisition rate, and diagnostic performance of these techniques for the evaluation of lateral spread of BTC.
Results
A total of 54 patients were included in the study. The technical success rate of reaching the target sites was 95% for DMB and 100% for TMB. The adequate tissue acquisition rate was 61% for DMB and 69% for TMB. The adequate tissue acquisition rate was low, especially for target sites beyond the secondary biliary radicles. The sensitivity of DMB alone was 39%, which improved to 65% when combined with visual impression. Experts demonstrated a higher negative predictive value and diagnostic accuracy with respect to both DSOC visual impression and DMB for the evaluation of lateral spread of BTC compared to trainees.
Conclusions
Adequate tissue acquisition rates were similar between the two techniques. Since DMB requires expertise, TMB may be an acceptable option when DSOC is unavailable or when DSOC expertise is limited.

Citations

Citations to this article as recorded by  
  • Endoscopic evaluation of indeterminate biliary strictures: Cholangioscopy, endoscopic ultrasound, or both?
    Raymond S. Y. Tang
    Digestive Endoscopy.2024; 36(7): 778.     CrossRef
  • Cholangioscopy for biliary diseases
    Aymeric Becq, Adil Soualy, Marine Camus
    Current Opinion in Gastroenterology.2023; 39(2): 67.     CrossRef
  • 2,802 View
  • 181 Download
  • 2 Web of Science
  • 2 Crossref
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Laser-cut-type versus braided-type covered self-expandable metallic stents for distal biliary obstruction caused by pancreatic carcinoma: a retrospective comparative cohort study
Koh Kitagawa, Akira Mitoro, Takahiro Ozutsumi, Masanori Furukawa, Yukihisa Fujinaga, Kenichiro Seki, Norihisa Nishimura, Yasuhiko Sawada, Kosuke Kaji, Hideto Kawaratani, Hiroaki Takaya, Kei Moriya, Tadashi Namisaki, Takemi Akahane, Hitoshi Yoshiji
Clin Endosc 2022;55(3):434-442.   Published online October 28, 2021
DOI: https://doi.org/10.5946/ce.2021.161
AbstractAbstract PDFPubReaderePub
Background
/Aims: Covered self-expandable metallic stents (CMSs) are widely used for malignant distal biliary obstructions (MDBOs) caused by pancreatic carcinoma. This study compared the efficacy and safety of the laser-cut-type and braided-type CMSs.
Methods
To palliate MDBOs caused by pancreatic carcinoma, the laser-cut-type CMSs was used from April 2014 to March 2017, and the braided-type CMSs was used from April 2017 to March 2019. The tested self-expandable metallic stents were equipped with different anti-migration systems.
Results
In total, 47 patients received CMSs for MDBOs (24 laser-cut type, 23 braided-type). The time to recurrent biliary obstruction (TRBO) was significantly longer in the braided-type CMSs (p=0.0008), and the median time to stent dysfunction or patient death was 141 and 265 days in the laser-cut-type CMSs and braided-type CMSs, respectively (p=0.0023). Stent migration was the major cause of stent dysfunction in both groups, which occurred in 37.5% of the laser-cut-type CMSs and 13.0% of the braidedtype CMSs. There were no differences in the survival duration between the groups.
Conclusions
The TRBO was significantly longer for the braided-type CMSs with an anti-migration system than for the laser-cuttype. Stent migration tended to be less frequent with the braided-type CMSs than with the laser-cut-type CMSs.

Citations

Citations to this article as recorded by  
  • Braided-type stent versus laser-cut-type stent for patients with unresectable distal malignant biliary obstruction: a randomized controlled trial
    Sho Hasegawa, Takamitsu Sato, Satoru Shinoda, Yusuke Kurita, Tomoki Ogata, Shinichi Nihei, Shin Yagi, Kunihiro Hosono, Itaru Endo, Noritoshi Kobayashi, Kensuke Kubota, Atsushi Nakajima
    Gastrointestinal Endoscopy.2024; 99(5): 739.     CrossRef
  • Removal of Duckbill‐type laser‐cut anti‐reflux metal stents: Clinical evaluation and in vitro study
    Yuto Yamada, Takashi Sasaki, Tsuyoshi Takeda, Takeshi Okamoto, Takafumi Mie, Chinatsu Yonekura, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Takahisa Matsuda, Yoshinori Igarashi, Naoki Sasahira
    DEN Open.2023;[Epub]     CrossRef
  • Comparable Efficacy of Laser-Cut and Braided Self Expanding Metallic Biliary Stent: A Systematic Review and Meta-Analysis
    Priyadarshini Loganathan, Saurabh Chandan, Babu P. Mohan, Shreyas Saligram, Douglas G. Adler
    Digestive Diseases and Sciences.2023; 68(9): 3756.     CrossRef
  • Evaluation of the mechanical properties of current biliary self-expandable metallic stents: axial and radial force, and axial force zero border
    Wataru Yamagata, Toshio Fujisawa, Takashi Sasaki, Rei Ishibashi, Tomotaka Saito, Shuntaro Yoshida, Shizuka No, Kouta Inoue, Yousuke Nakai, Naoki Sasahira, Hiroyuki Isayama
    Clinical Endoscopy.2023; 56(5): 633.     CrossRef
  • Covered self-expandable metal stents for distal biliary obstruction from pancreatic carcinoma: what type of stent is preferred?
    Hideyuki Shiomi, Ryota Nakano, Shogo Ota
    Clinical Endoscopy.2022; 55(3): 369.     CrossRef
  • 3,577 View
  • 286 Download
  • 5 Web of Science
  • 5 Crossref
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Review
Endoscopic Evaluation of Biliary Strictures: Current and Emerging Techniques
Roy Huynh, Corinne Owers, Christopher Pinto, Thuy-My Nguyen, Titus Kwok
Clin Endosc 2021;54(6):825-832.   Published online May 27, 2021
DOI: https://doi.org/10.5946/ce.2021.048
AbstractAbstract PDFPubReaderePub
The diagnosis of biliary strictures in clinical practice can be challenging. Discriminating between benign and malignant biliary strictures is important to prevent the morbidity and mortality associated with incorrect diagnoses. Missing a malignant biliary stricture may delay surgery, resulting in poor prognostic outcomes. Conversely, it has been demonstrated that approximately 20% of patients who undergo surgery for suspected biliary malignancies have a benign etiology on histopathology. Traditional tissue sampling using endoscopic retrograde cholangiography does not always produce a definitive diagnosis, with a considerable proportion of cases remaining as indeterminate biliary strictures. Recent advances in endoscopic techniques have the potential to improve the diagnostic and prognostic accuracy of biliary strictures.

Citations

Citations to this article as recorded by  
  • Diagnostic value of new biliary biopsy cannulae for malignant bile duct strictures via endoscopic retrograde cholangiopancreatography pathway
    Meng-Qi Zhuang, Cheng Zheng, Wei-Wei Xie, Lin Xu, Jia-Li Wu, Dao-Quan Zhang, Yuan-Gan Chen, Sen-Sen Niu, Xiang Zhan, Yu-Bao Zhou
    Asian Journal of Surgery.2024; 47(1): 471.     CrossRef
  • Nightmare of straight-type plastic stent migration into the peripheral bile duct: what is my savior?
    Yun Chae Lee, Shayan Irani, Hyung Ku Chon
    Clinical Endoscopy.2024; 57(1): 134.     CrossRef
  • Case report: The diagnostic dilemma of indeterminate biliary strictures: report on two cases with a literature review
    Chunyan Meng, Jing Wang, Peipei Zhang, Bo Wang
    Frontiers in Oncology.2024;[Epub]     CrossRef
  • The additional value of the combined use of EUS and ERCP for the evaluation of unclear biliary strictures
    Eszter Bényei, Antonio Molinaro, Per Hedenström, Riadh Sadik
    Scandinavian Journal of Gastroenterology.2024; 59(8): 980.     CrossRef
  • The Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound Connection: Unity Is Strength, or the Endoscopic Ultrasonography Retrograde Cholangiopancreatography Concept
    Claudio Giovanni De Angelis, Eleonora Dall’Amico, Maria Teresa Staiano, Marcantonio Gesualdo, Mauro Bruno, Silvia Gaia, Marco Sacco, Federica Fimiano, Anna Mauriello, Simone Dibitetto, Chiara Canalis, Rosa Claudia Stasio, Alessandro Caneglias, Federica Me
    Diagnostics.2023; 13(20): 3265.     CrossRef
  • Biliary Tree Diagnostics: Advances in Endoscopic Imaging and Tissue Sampling
    Matteo Ghisa, Angelo Bellumat, Manuela De Bona, Flavio Valiante, Marco Tollardo, Gaia Riguccio, Angelo Iacobellis, Edoardo Savarino, Andrea Buda
    Medicina.2022; 58(1): 135.     CrossRef
  • Increasing the Yield: When More Is Better
    Kevin D. Platt, Allison R. Schulman
    American Journal of Gastroenterology.2022; 117(5): 729.     CrossRef
  • 4,941 View
  • 260 Download
  • 7 Web of Science
  • 7 Crossref
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Original Article
Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis
Jake S. Jacob, Michelle E. Lee, Erin Y. Chew, Aaron P. Thrift, Robert J. Sealock
Clin Endosc 2021;54(2):269-274.   Published online November 6, 2020
DOI: https://doi.org/10.5946/ce.2020.100
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines.
Methods
We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis.
Results
Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity for choledocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis.
Conclusions
The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers an improved risk stratification tool.

Citations

Citations to this article as recorded by  
  • Endoscopic ultrasound avoids diagnostic ERCP among the ASGE high-risk group – Experience in an Asian population
    Weng-Fai Wong, Yu-Ting Kuo, Ming-Lun Han, Hsiu-Po Wang
    Journal of the Formosan Medical Association.2024; 123(3): 374.     CrossRef
  • Rendimiento diagnóstico de la endosonografía biliopancreática en pacientes con riesgo intermedio de coledocolitiasis
    Lázaro Antonio Arango Molano, Andrés Sánchez Gil, Claudia Patricia Diaz Tovar, Andrés Valencia Uribe, Christian Germán Ospina Pérez, Pedro Eduardo Cuervo Pico, Rodrigo Alberto Jiménez Gómez
    Revista de Gastroenterología del Perú.2024; 44(1): 8.     CrossRef
  • ASGE Predictors for the Diagnosis of Choledocholithiasis: Validation in a Public Hospital of Merida, Yucatan, México
    Richard Camilo Aguirre-Sanchez, Abraham Hernan-Herrera-Sanchez, Carlos Enrique Perez-Osorio, Maria Fidelia Cardenas-Marrufo
    The International Journal of Gastroenterology and Hepatology Diseases.2024;[Epub]     CrossRef
  • Suspected common bile duct stones: reduction of unnecessary ERCP by pre-procedural imaging and timing of ERCP
    Christina J. Sperna Weiland, Evelien C. Verschoor, Alexander C. Poen, Xavier J. M. N. Smeets, Niels G. Venneman, Abha Bhalla, Ben J. M. Witteman, Hester C. Timmerhuis, Devica S. Umans, Jeanin E. van Hooft, Marco J. Bruno, P. Fockens, Robert C. Verdonk, Jo
    Surgical Endoscopy.2023; 37(2): 1194.     CrossRef
  • Low Detection Rates of Bile Duct Stones During Endoscopic Treatment for Highly Suspected Bile Duct Stones with No Imaging Evidence of Stones
    Hirokazu Saito, Hajime Iwasaki, Hisashi Itoshima, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Masayoshi Uehara, Ikuo Matsushita, Tatsuyuki Kakuma, Shuji Tada
    Digestive Diseases and Sciences.2023; 68(5): 2061.     CrossRef
  • Effect of Frailty on the Management of Suspected Choledocholithiasis
    Katherine C. Bergus, Rondi B. Gelbard, Sara Scarlet, Shruthi Srinivas, Brett M. Tracy
    The American Surgeon™.2023; 89(7): 3104.     CrossRef
  • Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis
    Andy Silva-Santisteban, Ishani Shah, Madhuri Chandnani, Vaibhav Wadhwa, Leo Tsai, Abraham F. Bezuidenhout, Tyler M. Berzin, Douglas Pleskow, Mandeep Sawhney
    Endoscopy International Open.2023; 11(06): E599.     CrossRef
  • ERCP findings provide further justification for a “surgery-first” mindset in choledocholithiasis
    Gloria Sanin, Gabriel Cambronero, James Patterson, Maggie Bosley, Aravindh Ganapathy, Carl Wescott, Lucas Neff
    Surgical Endoscopy.2023; 37(11): 8714.     CrossRef
  • Dynamic changes in liver function tests do not correctly reclassify patients at risk of choledocholithiasis beyond ASGE 2019 criteria
    Tatiana Ramírez-Peña, Rómulo Darío Vargas-Rubio, Carlos Ernesto Lombo, Luis Miguel Rodríguez-Hortua, Oscar Mauricio Muñoz-Velandia
    Therapeutic Advances in Gastrointestinal Endoscopy.2023;[Epub]     CrossRef
  • National adherence to the ASGE-SAGES guidelines for managing suspected choledocholithiasis: An EAST multicenter study
    Brett M. Tracy, Benjamin K. Poulose, Cameron W. Paterson, April E. Mendoza, Apostolos Gaitanidis, Jonathan M. Saxe, Andrew J. Young, Martin D. Zielinski, Carrie A. Sims, Rondi B. Gelbard
    Journal of Trauma and Acute Care Surgery.2022; 92(2): 305.     CrossRef
  • Accuracy of SAGES, ASGE, and ESGE criteria in predicting choledocholithiasis
    Kinzang Wangchuk, Pongsakorn Srichan
    Surgical Endoscopy.2022; 36(10): 7233.     CrossRef
  • Evaluation of the American Society of Gastrointestinal Endoscopy 2019 and the European Society of Gastrointestinal Endoscopy guidelines' performances for choledocholithiasis prediction in clinically suspected patients: A retrospective cohort study
    Suppadech Tunruttanakul, Borirak Chareonsil, Kotchakorn Verasmith, Jayanton Patumanond, Chatchai Mingmalairak
    JGH Open.2022; 6(6): 434.     CrossRef
  • Test Performance Characteristics of Dynamic Liver Enzyme Trends in the Prediction of Choledocholithiasis
    Yang Lei, B. Lethebe, Erin Wishart, Fateh Bazerbachi, B. Elmunzer, Nirav Thosani, James Buxbaum, Yen-I Chen, Sydney Bass, Martin Cole, Christian Turbide, Darren Brenner, Steven Heitman, Rachid Mohamed, Nauzer Forbes
    Journal of Clinical Medicine.2022; 11(15): 4575.     CrossRef
  • Criterios ASGE 2010 frente a 2019 para coledocolitiasis en pacientes llevados a colangiopancreatografía retrógrada endoscópica
    Ana María Lourido Gamboa, Guillermo Vallejo Vallecilla, Jesús Eduardo Díaz Realpe, Katheryn Daniela Lagos Castro, Juan David Guzmán Sandoval, Angela María Merchán Galvis
    Revista colombiana de Gastroenterología.2022; 37(4): 362.     CrossRef
  • Optimal Predictive Criteria for Common Bile Duct Stones: The Search Continues
    Yun Nah Lee, Jong Ho Moon
    Clinical Endoscopy.2021; 54(2): 147.     CrossRef
  • 5,990 View
  • 307 Download
  • 14 Web of Science
  • 15 Crossref
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Review
Review of Simultaneous Double Stenting Using Endoscopic Ultrasound-Guided Biliary Drainage Techniques in Combined Gastric Outlet and Biliary Obstructions
Hao Chi Zhang, Monica Tamil, Keshav Kukreja, Shashideep Singhal
Clin Endosc 2020;53(2):167-175.   Published online August 13, 2019
DOI: https://doi.org/10.5946/ce.2019.050
AbstractAbstract PDFPubReaderePub
Concomitant malignant gastric outlet obstruction and biliary obstruction may occur in patients with advanced cancers affecting these anatomical regions. This scenario presents a unique challenge to the endoscopist in selecting an optimal management approach. We sought to determine the efficacy and safety of endoscopic techniques for treating simultaneous gastric outlet and biliary obstruction (GOBO) with endoscopic ultrasound (EUS) guidance for biliary drainage. An extensive literature search for peer-reviewed published cases yielded 6 unique case series that either focused on or included the use of EUS-guided biliary drainage (EUS-BD) with simultaneous gastroduodenal stenting. In our composite analysis, a total of 51 patients underwent simultaneous biliary drainage through EUS, with an overall reported technical success rate of 100% for both duodenal stenting and biliary drainage. EUS-guided choledochoduodenostomy or EUS-guided hepaticogastrostomy was employed as the initial technique. In 34 cases in which clinical success was ascribed, 100% derived clinical benefit. The common adverse effects of double stenting included cholangitis, stent migration, bleeding, food impaction, and pancreatitis. We conclude that simultaneous double stenting with EUS-BD and gastroduodenal stenting for GOBO is associated with high success rates. It is a feasible and practical alternative to percutaneous biliary drainage or surgery for palliation in patients with associated advanced malignancies.

Citations

Citations to this article as recorded by  
  • Endoscopic Management of Malignant Biliary Obstruction
    Woo Hyun Paik, Do Hyun Park
    Gastrointestinal Endoscopy Clinics of North America.2024; 34(1): 127.     CrossRef
  • Long‐term outcomes of endoscopic double stenting using an anti‐reflux metal stent for combined malignant biliary and duodenal obstruction
    Takashi Sasaki, Tsuyoshi Takeda, Yuto Yamada, Takeshi Okamoto, Chinatsu Mori, Takafumi Mie, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
    Journal of Hepato-Biliary-Pancreatic Sciences.2023; 30(1): 144.     CrossRef
  • A Systematic Review of Endoscopic Treatments for Concomitant Malignant Biliary Obstruction and Malignant Gastric Outlet Obstruction and the Outstanding Role of Endoscopic Ultrasound-Guided Therapies
    Giacomo Emanuele Maria Rizzo, Lucio Carrozza, Dario Quintini, Dario Ligresti, Mario Traina, Ilaria Tarantino
    Cancers.2023; 15(9): 2585.     CrossRef
  • EUS-guided gallbladder drainage using a lumen-apposing metal stent as rescue treatment for malignant distal biliary obstruction: a large multicenter experience
    Cecilia Binda, Andrea Anderloni, Alessandro Fugazza, Arnaldo Amato, Germana de Nucci, Alessandro Redaelli, Roberto Di Mitri, Luigi Cugia, Valeria Pollino, Raffaele Macchiarelli, Benedetto Mangiavillano, Edoardo Forti, Mario Luciano Brancaccio, Roberta Bad
    Gastrointestinal Endoscopy.2023; 98(5): 765.     CrossRef
  • Choledochoduodenostomy Versus Hepaticogastrostomy in Endoscopic Ultrasound-guided Drainage for Malignant Biliary Obstruction: A Meta-analysis and Systematic Review
    Kejie Mao, Binbin Hu, Feng Sun, Kaiming Wan
    Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2022; 32(1): 124.     CrossRef
  • Efficacy and safety of endoscopic duodenal stent versus endoscopic or surgical gastrojejunostomy to treat malignant gastric outlet obstruction: systematic review and meta-analysis
    Rajesh Krishnamoorthi, Shivanand Bomman, Petros Benias, Richard A. Kozarek, Joyce A. Peetermans, Edmund McMullen, Ornela Gjata, Shayan S. Irani
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Focused Review Series: Current Status of Image-Enhanced Endoscopy (IEE)
Role of Image-Enhanced Endoscopy in Pancreatobiliary Diseases
Yun Nah Lee, Jong Ho Moon, Hyun Jong Choi
Clin Endosc 2018;51(6):541-546.   Published online November 30, 2018
DOI: https://doi.org/10.5946/ce.2018.203
AbstractAbstract PDFPubReaderePub
Recent advances in cholangiopancreatoscopy technology permit image-enhanced endoscopy (IEE) for pancreatobiliary diseases. There are limitations in endoscopy performance and in the study of the clinical role of IEE in bile duct or pancreatic duct diseases. However, currently available IEEs during cholangiopancreatoscopy including traditional dye-aided chromoendoscopy, autofluorescence imaging, narrow-band imaging, and i-Scan have been evaluated and reported previously. Although the clinical role of IEE in pancreatobiliary diseases should be verified in future studies, IEE is a useful promising tool in the evaluation of bile duct or pancreatic duct mucosal lesions.

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    Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
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Original Article
Usefulness of Endoscopic Transpapillary Tissue Sampling for Malignant Biliary Strictures and Predictive Factors of Diagnostic Accuracy
Hiroki Tanaka, Shimpei Matsusaki, Youichirou Baba, Yoshiaki Isono, Tomohiro Sase, Hiroshi Okano, Tomonori Saito, Katsumi Mukai, Tetsuya Murata, Hiroki Taoka
Clin Endosc 2018;51(2):174-180.   Published online August 31, 2017
DOI: https://doi.org/10.5946/ce.2017.082
AbstractAbstract PDFPubReaderePub
Background
/Aims: It is sometimes difficult to distinguish between malignant and benign biliary strictures using imaging studies alone, and pathological diagnosis is necessary. The aim of this study was to determine the usefulness of endoscopic transpapillary tissue sampling and factors predictive of diagnostic accuracy.
Methods
From April 2008 to December 2014, 136 patients underwent endoscopic transpapillary tissue sampling for malignant biliary strictures. The cytological and histological findings were reported as negative, suspicious, or positive. Suspicious and positive findings were defined as pathologically positive.
Results
The sensitivity was 65.0% for forceps biopsy, 49.5% for brush cytology, 46.2% for bile aspiration cytology, and 21.9% for endoscopic nasobiliary drainage cytology. The combination of these procedures improved the sensitivity (72.8%). Endoscopic transpapillary tissue sampling was more sensitive for lesions of biliary origin (91.4%) than for extrabiliary lesions (66.3%). In surgical cases, the sensitivity for tumors with an infiltrative growth pattern (53.3%) was significantly lower than for a tumor with an expanding or intermediate growth pattern (87.5%).
Conclusions
Combining procedures can improve diagnostic accuracy. It may be possible to predict the sensitivity of endoscopic transpapillary tissue sampling by evaluating the etiology and tumor growth pattern using preoperative imaging studies.

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    Hyun Jik Lee, Kwang Bum Cho
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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
AbstractAbstract PDFPubReaderePub
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
AbstractAbstract PDFPubReaderePub
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: Past, present and futures of gastrointestinal stents
Basic Knowledge about Metal Stent Development
Seok Jeong
Clin Endosc 2016;49(2):108-112.   Published online March 22, 2016
DOI: https://doi.org/10.5946/ce.2016.029
AbstractAbstract PDFPubReaderePub
Biliary self-expandable metal stents (SEMS), a group of non-vascular stents, have been used in the palliative management of biliary obstruction around the world. However, there are still unmet needs in the clinical application of biliary SEMS. Comprehensive understanding of the SEMS is required to resolve the drawbacks and difficulties of metal stent development. The basic structure of SEMS, including the materials and knitting methods of metal wires, covering materials, and radiopaque markers, are discussed in this review. What we know about the physical and mechanical properties of the SEMS is very important. With an understanding of the basic knowledge of metal stents, hurdles such as stent occlusion, migration, and kinking can be overcome to develop more ideal SEMS.

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  • Spontaneous Common Bile Duct Perforation Treated with Placement of Metal Stent
    Dong Hoon Yang, Sang Wook Park, Hyeung Chul Moon, Kyoung Wan You, Seo Joon Eun, Seung Ki Moon, Choel Min Bak, Shin Hyoung Jo
    Korean Journal of Pancreas and Biliary Tract.2016; 21(4): 222.     CrossRef
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Mechanisms of Biliary Plastic Stent Occlusion and Efforts at Prevention
Chang-Il Kwon, Glen A. Lehman
Clin Endosc 2016;49(2):139-146.   Published online March 22, 2016
DOI: https://doi.org/10.5946/ce.2016.024
AbstractAbstract PDFPubReaderePub
Biliary stenting via endoscopic retrograde cholangiopancreatography has greatly improved the quality of patient care over the last 30 years. Plastic stent occlusion limits the life span of such stents. Attempts to improve plastic stent patency duration have mostly failed. Metal stents (self-expandable metal stents [SEMSs]) have therefore replaced plastic stents, especially for malignant biliary strictures. SEMS are at least 10 times more expensive than plastic stents. In this focused review, we will discuss basic mechanisms of plastic stent occlusion, along with a systematic summary of previous efforts and related studies to improve stent patency and potential new techniques to overcome existing limitations.

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Special Issue Article of IDEN 2013
Functional Self-Expandable Metal Stents in Biliary Obstruction
Chang-Il Kwon, Kwang Hyun Ko, Ki Baik Hahm, Dae Hwan Kang
Clin Endosc 2013;46(5):515-521.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.515
AbstractAbstract PDFPubReaderePub

Biliary stents are widely used not only for palliative treatment of malignant biliary obstruction but also for benign biliary diseases. Each plastic stent or self-expandable metal stent (SEMS) has its own advantages, and a proper stent should be selected carefully for individual condition. To compensate and overcome several drawbacks of SEMS, functional self-expandable metal stent (FSEMS) has been developed with much progress so far. This article looks into the outcomes and defects of each stent type for benign biliary stricture and describes newly introduced FSEMSs according to their functional categories.

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Case Report
A Case of Biliary Cast Developed in a Patient with Long-Standing Biliary Sludge
Ja Won Koo, Na Eun Jang, Hong Joo Lee, Kwang Ro Joo, Jae Myung Cha, Hyun Phil Shin, Joung Il Lee, Sung-Jig Lim
Clin Endosc 2013;46(1):98-101.   Published online January 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.1.98
AbstractAbstract PDFPubReaderePub

Development of biliary casts is very unusual, especially in patients who have not undergone liver transplantation. Variable causes of biliary cast formation in nonliver transplantation patients have been suggested. However, stasis of bile flow and/or gallbladder hypocontractility is known to eventually result in the promotion of biliary sludge and subsequent cast formation. Here we present one case of biliary cast syndrome, which developed in a nonliver transplant patient who had biliary sludge for a long period of time, providing evidence that long-standing biliary sludge may lead to cast formation.

Citations

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  • Intensive Care Unit–Related Cholangiopathy-Induced Biliary Cast Syndrome Without Liver Transplantation: A Rare Entity
    Fnu Vikash, Sindhu Vikash, Sammy Ho, Donald Kotler, Sunny Patel
    ACG Case Reports Journal.2024; 11(2): e01269.     CrossRef
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    Sa-Hong Jo, Ho-Cheol Choi, Sung-Eun Park, Jin-Il Moon, Jung-Ho Won, Jae-Boem Na, Yang-Won Kim, Won-Jeong Yang, Byeong-Ju Koo, Jae-Kyeong Ahn, Seong-Je Kim
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    Reza Dabiri, Hamid Asadzadeh Aghdae, Hasan Rajabalinia, Amir Houshang Mohammad Alizadeh
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  • 49 Download
  • 2 Web of Science
  • 3 Crossref
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An Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: The Clinical Features and Endoscopic Treatment
Sang Soo Lim, M.D., Hong Ja Kim, M.D., Du San Baik, M.D., Ki Chul Shin, M.D., Il Han Song, M.D., Young Woo Choi, M.D.*, Jung Ho Han, M.D. and Sang Heum Park, M.D.
Korean J Gastrointest Endosc 2010;40(1):16-21.   Published online January 30, 2010
AbstractAbstract PDF
Background
/Aims: An ectopic opening of the common bile duct (CBD) into the duodenal bulb is known to cause biliary tract diseases or peptic ulcer. Yet such a case is extremely rare and the clinical significance of this malformation has not yet been clarified.
Methods
Ten patients with an ectopic opening in the duodenal bulb and who were treated at 4 hospitals in the Chungcheong province area were enrolled. Their clinical and radiographic features and the treatment for their combined biliary diseases were retrospectively analysed.
Results
The mean age of the ten patients was 73 years (range: 38∼84 years, 8 men, 2 women) Eight of 10 patients had clinical signs and symptoms (RUQ abdominal pain: 5, epigastric pain: 3, fever: 3, Melena: 1). The two patients without symptoms were incidentally found to have an ectopic orifice during the evaluation for bile duct dilatation and a regular health check-up, respectively. Nine had duodenal ulcer scars or bulb deformities. Four had active duodenal ulcers and one of them had bleeding from the active duodenal ulcer, which was treated by endoscopic sclerotheraphy. Six of the 10 patients (60%) had biliary tract diseases (CBD stones: 4, cholangitis without CBD stone: 1, IHD stone: 1). Cholangiography was used for evaluation in 9 patients, and it showed dilatation of the CBD or IHD in 7 (78%), a tapered common bile duct at the distal CBD in 7 (78%) and a hook-shaped distal CBD in 8 (89%). Six patients' biliary tract diseases were treated endoscopically (ERCP: 4, PTCS: 2). Duodenal perforation occurred in 1 (10%), who was successfully managed by medical treatment.
Conclusions
An ectopic opening of the CBD in the duodenal bulb is frequently associated with recurrent duodenal ulcer and biliary tract disease. Combined biliary tract disease can be successfully treated endoscopically. (Korean J Gastrointest Endosc 2010;40:16-21)
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Endoscopic Biliary Stenting in Patients with Malignant Biliary Obstruction
Hyung Wook Kim, M.D. and Dae Hwan Kang, M.D.
Korean J Gastrointest Endosc 2009;39(1):1-7.   Published online July 30, 2009
AbstractAbstract PDF
Cholangiocarcinoma has an extremely poor prognosis and the majority of patients have an incurable disease at the time of presentation. These patients should be offered palliative drainage management. The aims of palliation are to prevent cholangitis or bile peritonitis in the course of follow-up or chemotherapy, and to preserve the functional volume of the liver as much as possible. Endoscopic or percutaneous drainage has become increasingly important in the palliative care of patients with unresectable cholangiocarcinoma. Compared to the percutaneous approach, endoscopic biliary stenting is less invasive, more comfortable, and results in a reduced hospital stay. Therefore, endoscopic biliary stenting should be considered the first-line therapy for jaundice palliation in unresectable cholangiocarcinoma. (Korean J Gastrointest Endosc 2009;39:1-7)
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A Comparison of Covered Expandable Metal Stent and Uncovered Expandable Metal Stent for the Management of Distal Malignant Biliary Obstruction
Won Jae Yoon, M.D., Kwang Hyuck Lee, M.D., Jun Kyu Lee, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D., Woo Jin Lee, M.D.* and Yong Bum Yoon, M.D.
Korean J Gastrointest Endosc 2005;30(5):257-261.   Published online May 30, 2005
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Background
/Aims: Covered self-expandable metal stents (CEMS) were developed to overcome tumor ingrowth which is a problem of uncovered EMS (UEMS). However, the efficacy of CEMS is controversial, and CEMS have problems such as migration and development of cholecystitis. Methods: We evaluated 77 cases of endoscopic retrograde biliary drainage using EMS for unresectable distal malignant biliary obstruction in a retrospective setting. Polyurethane-covered Wallstents were used on 36 patients and uncovered Wallstents were used on 41 patients. Early complications and stent patency were analyzed. The end points of this study were stent obstruction or death of the patient. Results: Stent migration occurred in three of the CEMS group and one of the UEMS group. Cholecystitis occurred in one of the CEMS group but in none of the UEMS group. Acute pancreatitis and bleeding did not occur in both groups. Stent occlusion occurred after a mean of 271 days in the CEMS group and 263 days in the UEMS group. Conclusions: Stent patency was comparable between covered and uncovered Wallstent. A large-scale prospective randomized study is needed to evaluate the efficacy and indication of covered Wallstent. (Korean J Gastrointest Endosc 2005;30:257⁣261)
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Endoscopic Retrograde Cholangiopancreatography in Thirty-four Children
Sung Hee Jung, M.D., Kyung Mo Kim, M.D.*, Dong Wan Seo, M.D., Bo Hwa Choi, M.D.*, Chong Hyun Yoon, M.D., Ji Yeol Yoon, M.D., Jung Ho Kim, M.D., Sung Koo Lee, M.D., Myung Hwan Kim, M.D. and Young Il Min, M.D.
Korean J Gastrointest Endosc 2003;26(6):418-425.   Published online June 30, 2003
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Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is being used with increasing frequency as a diagnostic and therapeutic tool in children with suspected disorders of the pancreaticobiliary tract. We reviewed ERCPs performed in children and investigated clinical indications and usefulness of ERCP. Methods: A total of 80 ERCPs were performed in 34 patients (age: 17 months∼15 yrs) at Asan Medical Center from 1994 to 2001. Adult side-viewing duodenoscope, Olympus JF or TJF, was used for all procedures. General anesthesia was used in 73% of the patients, whereas intravenous sedation was employed in the remainder. Results: Cannulation was successful in 77 attempts (96%). ERCP was commonly indicated for the evaluation of pancreatic disease (18 cases) such as acute pancreatitis (4), recurrent pancreatitis (4), chronic pancreatitis (9), and non-resolving acute pancreatitis (1). Biliary tract diseases (15 cases) were common bile duct stones (4), choledochal cyst (8), and traumatic or nontraumatic common bile duct stricture (3). Therapeutic ERCP (n=20) included sphincterotomy (55.9%), insertion of stents (12%), and removal of common bile duct stones or pancreatic duct stones with balloon or basket (32%). The complications were developed in 12 out of 80 attempts (15%) and resolved with medical management. Conclusions: ERCP seems to be a useful and relatively safe procedure in the evaluation of pancreaticobiliary disorders in children and also can be used for nonoperative treatment of these diseordrs. (Korean J Gastrointest Endosc 2003;26:418⁣425)
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원저 : 악성 담도 폐쇄에서 금속 배액관 삽입 후 강내 방사선 치료의 효과 ( The Efficacy of Intraluminal Radiotherapy after Metallie Stent Insertion in Malignant Biliary Tract Obstruction )
Korean J Gastrointest Endosc 2000;20(6):449-455.   Published online November 30, 1999
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Background
/Aims: Inoperable malignant biliary tract obstructions (MBTO) are best palliated by drainage procedures followed by radiation therapy. In order to administer high doses in a short time to the central part of the tumor, internal radiotherapy has been proposed for a palliative goa1. The aim of this study is to investigate the effect of intraluminal radiotherapy (ILRT) to the stent patency and patients survival time after expandable metallic stent insertion in MBTO. Methods: Between August 1996 and July 1998, 28 patients (17 females, 11 males, average age 61.4 years) with inoperable MBTO were provided with percutaneous transhepatic biliary drainage (12 patients; bile duct cancer, 8 patients; pancreatic head cancer, 4 patients; gallbladder cancer; 4 patients; lymph node metastasis from stomach cancer). The 14 patients were treated by only metallic stent. The other 14 patients were treated by metallic stent insertion and followed by ILRT. The ILRT was done by iridium-192 (mean dosage 23.3 Gray, 5 fractions). Results: There were no significant differences in the two groups regarding age, sex, type of disease, and location of the obstruction. The patients tolerated ILRT well. Conclusions: The ILRT after expandable metallic stent was safe and effective in stent patency and the patient's surviva1 time in inopcrable MBTO. (Korean J Gastrointest Endosc 2000;20:449-455)
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악성 폐쇄성 황달환자에서 코일형 (EndocoilTM) 금속배액관과 플라스틱 배액관의 비교 (Randomised Trial of Coil (EndocoilTM) Stent Versus Plastic Stent in Malignant Biliary Tract Obstruction)
Korean J Gastrointest Endosc 1999;19(2):235-241.   Published online November 30, 1998
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Background
/Aims: Endoscopic stent placement has become accepted palliative therapy for malignant biliary tract obstruction (MBTO). The main problem of plastic stent are the clogging or migration. The new self expandable super-elastic metallic coil stent (Endo-coilTM, Instent Inc.) is claimed to allow large lumen and prolong biliary-stent patency. In a prospective randomised trial, we compared the efficacy and frequency of stent dysfunction of EndocoilTMand plastic stent (PercuflexR, Microvasive Co.). Method: Bet-ween Aug. 1994 and Mar. 1995, we assigned 29 patients (21 males and 8 females, mean age 63 years) with unresectable MBTO due to cancer of bile duct (17), pancreas (6) periampullary (3), gallbladder (2) and perichoedochal LN (1). Thirteen of patients under-went EndocoilTMstents (24 Fr) and other 16 patients underwent plastic stents (12 Fr) insertion via transpapillary route. Successful insertion of stents was attained all cases and no serious complication occured. Results: All patients with EndocoilTM stents and 11 (68%) patients with plastic stents were relieved completely from jaundice (T. bilirubon <3.0 mg/dl). There was no differences in decreasement of bilirubin between two groups after 7 days and 30 days after stents insertion. Median patency of the stents was significantly prolonged in patients with EndocoilTM stents compared with those with plastic stents(205 days vs 92 days). The stent dysfunction was noted 2 cases (15%) in EndocoilTM due to tumor ingrowth. In contrast, stent dysfunction was occured in 10 cases (62%) of plastic stents due to clogging (7 cases) and migration (3 cases). The patients' overall median survival was not different significantly between two groups (EndocoilTM250 days vs plastic 196 days). Conclusions: Both ndocoilTMand plastic stents offer effective bile drainage in MBTO. However EndocoilTM stents may be more effective for providing longer periods of drainage due to lower frequency of stent dysfuction than plastic stents. (Korean J Gastrointest Endosc 19: 235 ∼241, 1999)
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원저 : 담도 췌장 ; 췌담도계 질환에서 관내 내시경 ( Intraductal endoscope ) 의 유용성 ( Original Articles : Biliary Tract & Pancreas ; Usefulness of Intraductal Endoscopy for Pancreaticobiliary Disease )
Korean J Gastrointest Endosc 1997;17(1):32-40.   Published online November 30, 1996
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Background
/Aims: The aim of this study was to evaluate the usefulness of intraductal endoscopy in pancreaticobiliary tract disease by means of percutaneous cholangioscopy(PCS), peroral cholangioscopy(POCS) and peroral pancteatoscopy(POPS). Methods: PCS was performed in 33 patients, including 24 patients with biliary tract stones, and 8 patients with malignant biliary tract disease, and one with villous adenoma of common bile duct(CBD), POCS was performed in 5 patients, including two with cholangiocarcinoma, two with icteric hepatoma and one with benign stenosis of bile duct. POPS performed in 6 patients, ineluding 3 patients with chronic pancreatitis, two with pancreatic cancer and one with mucinous ductal ectasia. Results: 1. Complete removal of the stones was achieved in 22 of 24 patie~nts(91.7%). 2. Accuracy rate of forceps biopsy in PCS was achieved 13 fo 14 patients(92.9%). 3. Success rate of therapeutic PCS was 100%. 4. Accuracy rate of forceps biopsy in POCS was achieved 3 of 5 patients(60%). 5. Diagnostic gain of POPS was achieved 5 of 6 patients(83.3%). 6. There was no serious complications with only mild complications in 3 patients, including mild bleeding in 2 patients and cholangitis in only one. Conclusions: Intraductal endoscopy of biliary tract, including PCS and POCS were useful diagnostic and therapeutic methods with advantages of direct visualization of intraductal disease and POPS using ultrathin pancreatoscope could provide direct assessment of the pancreatic duct. (Korean J Gastrointest Endosc 17: 32-40, 1997)
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