Clinical Endoscopy

Safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis compared to non-cirrhosis and effect of Child-Pugh score on post-ERCP complications: a systematic review and meta-analysis: Zahid Ijaz Tarar, Umer Farooq, Mustafa Gandhi, Saad Saleem, Ebubekir Daglilar; Clin Endosc 2023;56(5):578-589. Published online May 2, 2023; DOI: https://doi.org/10.5946/ce.2023.027

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Background
/Aims: The safety of endoscopic retrograde cholangiopancreatography (ERCP) in hepatic cirrhosis and the impact of Child-Pugh class on post-ERCP complications need to be better studied. We investigated the post-ERCP complication rates in patients with cirrhosis compared with those without cirrhosis.
Methods
We conducted a literature search of relevant databases to identify studies that reported post-ERCP complications in patients with hepatic cirrhosis.
Results
Twenty-four studies comprising 28,201 patients were included. The pooled incidence of post-ERCP complications in cirrhosis was 15.5% (95% confidence interval [CI], 11.8%–19.2%; I2=96.2%), with an individual pooled incidence of pancreatitis 5.1% (95% CI, 3.1%–7.2%; I2=91.5%), bleeding 3.6% (95% CI, 2.8%–4.5%; I2=67.5%), cholangitis 2.9% (95% CI, 1.9%–3.8%; I2=83.4%), and perforation 0.3% (95% CI, 0.1%–0.5%; I2=3.7%). Patients with cirrhosis had a greater risk of post-ERCP complications (risk ratio [RR], 1.41; 95% CI, 1.16–1.71; I2=56.3%). The risk of individual odds of adverse events between cirrhosis and non-cirrhosis was as follows: pancreatitis (RR, 1.25; 95% CI, 1.06–1.48; I2=24.8%), bleeding (RR, 1.94; 95% CI, 1.59–2.37; I2=0%), cholangitis (RR, 1.15; 95% CI, 0.77–1.70; I2=12%), and perforation (RR, 1.20; 95% CI, 0.59–2.43; I2=0%).
Conclusions
Cirrhosis is associated with an increased risk of post-ERCP pancreatitis, bleeding, and cholangitis.

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The Impact of Frailty on ERCP-Related Adverse Events: Findings From a National Cohort
Umer Farooq, Zahid Ijaz Tarar, Abdallah El Alayli, Faisal Kamal, Alexander Schlachterman, Anand Kumar, David E. Loren, Thomas E. Kowalski
Techniques and Innovations in Gastrointestinal Endoscopy.2024; 26(2): 138. CrossRef
Applicability of Child-Turcotte-Pugh Score in Anticipating Post-ERCP Adverse Events in Patients With Cirrhosis
Saqr Alsakarneh, Fouad Jaber, Willie Mohammed, Mohammad Almeqdadi, Abdallah Al-Ani, Yassine Kilani, Saeed Abughazaleh, Laith Momani, Muhammad Shah Miran, Hassan Ghoz, John Helzberg, Wendell Clarkston, Mohamed Othman
Journal of Clinical Gastroenterology.2024;[Epub] CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Hyung Ku Chon, Ki-Hyun Kim, Tae Jun Song, Dong-Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyun Chung, Jin Lee, Miyoung Choi
Gut and Liver.2024; 18(4): 564. CrossRef
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY FOR THE MANAGEMENT OF CHOLEDOCHOLITHIASIS IN OLDER PATIENTS
Júlia Gardenyes, Pere Roura, Helena Vallverdú-Cartie, Judit Hermoso-Bosch, Cl�udia Roca, Mariona Espaulella, Antoni Casals, Héctor Ivo Marani, Joan Saló, Martín Galdín, Marta Gallach, Carles Leal
Revista Española de Enfermedades Digestivas.2023;[Epub] 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 Abstract Abstract PDF Supplementary Material PubReader ePub: 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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Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis: Marina Tucci Gammaro Baldavira Ferreira, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Alberto Machado da Ponte Neto, Galileu Ferreira Ayala Farias, Antônio Afonso de Miranda Neto, Pedro Victor Aniz Gomes de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(6):833-842. Published online July 1, 2021; DOI: https://doi.org/10.5946/ce.2021.052

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Background
/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients.
Methods
Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death).
Results
A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I²=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I²=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD,-0.34; 95% CI, -0.45 to -0.23; I²=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I²=51%).
Conclusions
Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.

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Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?
Florian A. Michael, Mireen Friedrich-Rust, Hans-Peter Erasmus, Christiana Graf, Olivier Ballo, Mate Knabe, Dirk Walter, Christoph D. Steup, Marcus M. Mücke, Victoria T. Mücke, Kai H. Peiffer, Esra Görgülü, Antonia Mondorf, Wolf O. Bechstein, Natalie Filma
Journal of Clinical Medicine.2023; 12(10): 3491. CrossRef
Treatment of primary sclerosing cholangitis combined with inflammatory bowel disease
You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
Intestinal Research.2023; 21(4): 420. CrossRef
Liver Transplantation for Primary Sclerosing Cholangitis (PSC) With or Without Inflammatory Bowel Disease (IBD)—A European Society of Organ Transplantation (ESOT) Consensus Statement
M. Carbone, A. Della Penna, C. Mazzarelli, E. De Martin, C. Villard, A. Bergquist, P. D. Line, J. M. Neuberger, S. Al-Shakhshir, P. J. Trivedi, U. Baumann, L. Cristoferi, J. Hov, B. Fischler, N. H. Hadzic, D. Debray, L. D’Antiga, N. Selzner, L. S. Belli,
Transplant International.2023;[Epub] CrossRef
Primary Biliary Cholangitis and Primary Sclerosing Cholangitis: Current Knowledge of Pathogenesis and Therapeutics
Ji-Won Park, Jung-Hee Kim, Sung-Eun Kim, Jang Han Jung, Myoung-Kuk Jang, Sang-Hoon Park, Myung-Seok Lee, Hyoung-Su Kim, Ki Tae Suk, Dong Joon Kim
Biomedicines.2022; 10(6): 1288. CrossRef
Use a biodegradable stent in ERCP and it will never be forgotten
Jesús García-Cano, Eva de la Santa Belda, Francisco Domper
Revista Española de Enfermedades Digestivas.2022;[Epub] CrossRef
Endoscopic stenting of dominant strictures in patients with primary sclerosing cholangitis: When, how, and for how long?
Il Sang Shin, Jong Ho Moon
Endoscopy International Open.2022; 10(09): E1169. CrossRef

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Role of Endoscopy in Primary Sclerosing Cholangitis: Purnima Bhat, Lars Aabakken; Clin Endosc 2021;54(2):193-201. Published online May 8, 2020; DOI: https://doi.org/10.5946/ce.2020.019-IDEN

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Primary sclerosing cholangitis (PSC) is a progressive disease of the bile ducts that usually results in chronic liver disease often requiring liver transplantation. Endoscopy remains crucial to the care of these patients, although magnetic resonance cholangiopancreatography has replaced endoscopic retrograde cholangiopancreatography (ERCP) as the primary imaging modality for diagnosis. For detection of dysplasia or cholangiocarcinoma, ERCP with intraductal sampling remains compulsory. Moreover, dominant strictures play an important part in the disease development, and management by balloon dilatation or stenting could contribute to long-term prognosis. In addition, endoscopy offers management for adverse events such as bile leaks and anastomotic strictures after liver transplantation. Finally, the special phenotype of inflammatory bowel disease associated with PSC as well as the frequent occurrence of portal hypertension mandates close follow-up with colonoscopy and upper endoscopy. With the emergence of novel techniques, the endoscopist remains a key member of the multidisciplinary team caring for PSC patients.

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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
Antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis
Arvid Gustafsson, Lars Enochsson, Bobby Tingstedt, Greger Olsson
JGH Open.2023; 7(1): 24. CrossRef
Primary sclerosing cholangitis—A long night's journey into day
Roger W. Chapman
Clinical Liver Disease.2022; 20(S1): 21. CrossRef

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Single-Stage Endoscopic Stone Extraction and Cholecystectomy during the Same Hospitalization: Toshiaki Terauchi, Hiroharu Shinozaki, Satoshi Shinozaki, Yuichi Sasakura, Masaru Kimata, Junji Furukawa, Alan Kawarai Lefor, Yoshiro Ogata, Kenji Kobayashi; Clin Endosc 2019;52(1):59-64. Published online October 5, 2018; DOI: https://doi.org/10.5946/ce.2018.107

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Background
/Aims: The clinical impact of single-stage endoscopic stone extraction by endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy during the same hospitalization remains elusive. This study aimed to determine the efficacy and safety of single-stage ERCP and cholecystectomy during the same hospitalization in patients with cholangitis.
Methods
We retrospectively reviewed the medical records of 166 patients who underwent ERCP for mild to moderate cholangitis due to choledocholithiasis secondary to cholecystolithiasis from 2012 to 2016.
Results
Complete stone extraction was accomplished in 92% of patients (152/166) at the first ERCP. Among 152 patients who underwent complete stone extraction, cholecystectomy was scheduled for 119 patients (78%). Cholecystectomy was performed during the same hospitalization in 89% of patients (106/119). We compared two groups of patients: those who underwent cholecystectomy during the same hospitalization (n=106) and those who underwent cholecystectomy during a subsequent hospitalization (n=13). In the delayed group, cholecystectomy was performed about three months after the first ERCP. There were no significant differences between the groups in terms of operative time, rate of postoperative complications, and interval from cholecystectomy to discharge.
Conclusions
Single-stage endoscopic stone extraction is recommended in patients with mild to moderate acute cholangitis due to choledocholithiasis. The combination of endoscopic stone extraction and cholecystectomy during the same hospitalization is safe and feasible.

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RECURRENT BILIARY EVENTS IN PATIENTS, WHO UNDERWENT ENDOSCOPIC LITHOEXTRACTION DUE TO OBSTRUCTIVE JAUNDICE
S. V. Dolzhkovyi
World of Medicine and Biology.2022; 18(79): 59. CrossRef
Destiny for Rendezvous: Is Cholecysto/Choledocholithiasis Better Treated with Dual- or Single-Step Procedures?
S. Vaccari, M. Minghetti, A. Lauro, M. I. Bellini, A. Ussia, S. Khouzam, I. R. Marino, M. Cervellera, V. D’Andrea, V. Tonini
Digestive Diseases and Sciences.2022; 67(4): 1116. CrossRef
Application of ERCP Procedures in Choledocholithiasis with Duodenal Stenosis Patients
Yuyan Shi, Jinghon Zhong, Jianbo Zhou, Qifeng Song, Zhaoqi Dong
Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef
Choledocholithiasis without cholecystolithiasis, after endoscopic retrograde cholangiopancreatography follow-up without cholecystectomy
Bahtiyar MUHAMMEDOĞLU, Eyüp PİRCANOĞLU, Serkan TORUN
Konuralp Tıp Dergisi.2021; 13(1): 68. CrossRef
Comparison of the safety and efficacy of single-stage endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy versus two-stage ERCP followed by laparoscopic cholecystectomy six-to-eight weeks later: A randomized controlled trial
Bahtiyar Muhammedoğlu, Ilhami Taner Kale
International Journal of Surgery.2020; 76: 37. CrossRef
Single-Stage Endoscopic Stone Extraction and Cholecystectomy during the Same Hospitalization: What is the Optimal Strategy for Patients with Choledocholithiasis and Cholelithiasis?
Tae Yoon Lee
Clinical Endoscopy.2019; 52(1): 5. CrossRef

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Successful Removal of a Large Common Bile Duct Stone by Using Direct Peroral Cholangioscopy and Laser Lithotripsy in a Patient with Severe Kyphosis: Song I Lee, Byung Hun Lim, Won Gak Heo, Young Jun Kim, Tae Hyeon Kim; Clin Endosc 2016;49(4):395-398. Published online March 22, 2016; DOI: https://doi.org/10.5946/ce.2015.109

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A 75-year-old woman with hypertension presented with acute suppurative cholangitis. Chest radiography revealed severe kyphosis. Abdominal computed tomography revealed a large stone impacted in the common bile duct (CBD). The patient underwent emergent endoscopic retrograde cholangiopancreatography, and cholangiography revealed a large stone (7×3 cm) in the CBD that could not be captured using a large basket. We could not use the percutaneous approach for stone fragmentation by using a cholangioscope because of severe degenerative kyphosis. Finally, we performed holmium laser lithotripsy under peroral cholangioscopy by using an ultraslim endoscope, and the large stone in the CBD was successfully fragmented and removed without complications.

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Innovation of endoscopic management in difficult common bile duct stone in the era of laparoscopic surgery
Cosmas Rinaldi Adithya Lesmana, Maria Satya Paramitha, Laurentius Adrianto Lesmana
World Journal of Gastrointestinal Endoscopy.2021; 13(7): 198. CrossRef
Endoscopic Management of Difficult Bile Duct Stones
Murad Aburajab, Kulwinder Dua
Current Gastroenterology Reports.2018;[Epub] CrossRef

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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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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
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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Cholangitis Secondary to Food Material Impaction in the Common Bile Duct through a Choledochoduodenal Fistula: Bong-Koo Kang, Sung Min Park, Byung-Wook Kim, Joon Sung Kim, Ji Hee Kim, Jeong-Seon Ji, Hwang Choi; Clin Endosc 2015;48(3):265-267. Published online May 29, 2015; DOI: https://doi.org/10.5946/ce.2015.48.3.265

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Biliary-enteric communications caused by duodenal ulcers are uncommon, and choledochoduodenal fistula (CDF) is by far the most common type. Usually in this situation, food material does not enter the common bile duct because the duodenal lumen is intact. Here, we report a case in which cholangitis occurred due to food materials impacted through a CDF. Duodenal obstruction secondary to duodenal ulcer prevented food passage into the duodenum in this case. Surgical management was recommended; however, the patient refused surgery because of poor general condition. Consequently, the patient expired with sepsis secondary to ascending cholangitis.

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Stone-Induced Purulent Choledocoduodenal Fistula Presenting with Ascending Cholangitis
Christienne Shams, Michael Cannon, Jared Bortman, Seifeldin Hakim
ACG Case Reports Journal.2018; 5(1): e60. CrossRef
Successful Conservative Treatment of a Cholecystoduodenal Fistula Caused by a Cytomegalovirus-associated Duodenal Ulcer
Hideki Mori, Moriya Zakimi, Shin Kato, Koki Yamada, Kenji Chinen, Tomiaki Kubota, Masayuki Arashiro, Susumu Shinoura, Kaoru Kikuchi
Internal Medicine.2016; 55(18): 2617. CrossRef

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Ectopic Opening of the Common Bile Duct into the Duodenal Bulb Accompanied with Cholangitis and Gallbladder Cancer: A Report of Two Cases: Jae Min Lee, Hong Jun Kim, Chang Yoon Ha, Hyun Ju Min, Hyunjin Kim, Tae Hyo Kim, Woon Tae Jung, Ok Jae Lee; Clin Endosc 2015;48(3):260-264. Published online May 29, 2015; DOI: https://doi.org/10.5946/ce.2015.48.3.260

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An ectopic opening of the common bile duct (CBD) into the duodenal bulb is a very rare congenital anomaly of the biliary system, which may cause recurrent duodenal ulcer or biliary diseases such as choledocholithiasis and cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in the diagnosis of this anomaly. We report two such cases: one in a 61-year-old man and the other in a 57-year-old man. In the first case, this anomaly caused acute cholangitis with multiple CBD stones, which were successfully treated by ERCP. In the second case, abdominal computed tomography showed pneumobilia, which was further evaluated using ERCP. Besides, this patient was diagnosed with an ectopic opening of the CBD associated with gallbladder cancer. We report these unusual cases and review the relevant medical literature.

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An operative case of gastric cancer with ectopic bile duct drainage in the lesser curvature of the stomach
Kazuaki Hashimoto, Tsukasa Ihara, Yuichiro Maruyama, Shinichi Tomisaki, Hiroshi Harada
Surgical Case Reports.2024;[Epub] CrossRef
Ectopic Opening of the Bile Duct Into the Duodenal Bulb: Complications of Biliary Drainage
James Yang, Rohit Agrawal, Constantine Melitas, Brian Boulay, Josi Herren, Ronald Gaba, Edward Villa
ACG Case Reports Journal.2023; 10(2): e00973. CrossRef
Seltene anatomische Variante im hepatobiliären System
Viliam Masaryk, Frank Meyer, Uwe Will
Die Chirurgie.2023; 94(7): 635. CrossRef
Ectopic papilla of Vater in the pylorus presenting with cholangitis: A case report with literature review
Taha Alkarboly, Dana T. Gharib, Karzan M. Salih, Shevan M. Mustafa, Abdulwahid M. Salih, Fahmi H. Kakamad
International Journal of Surgery Case Reports.2022; 93: 106887. CrossRef
Efficacy and safety of therapeutic ERCP in patients with ectopic papilla of Vater
Junbo Hong, Weiping Pan, Wei Zuo, Anjiang Wang, Liang Zhu, Xiaodong Zhou, Xiaojiang Zhou, Guohua Li, Zhijian Liu, Pi Liu, Hao Zhen, Yong Zhu, Jiuhong Ma, Jianhui Yuan, Xu Shu, Yin Zhu, Nonghua Lu, Youxiang Chen
Medicine.2020; 99(1): e18536. CrossRef
A unique case of a double common bile duct with ectopic drainage into the gastric antrum: a case report and review of the literature on double duct variants
Li Lian Kuan, John Isherwood, Cristina Pollard, Ashley Dennison
Journal of Surgical Case Reports.2020;[Epub] CrossRef
Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: Diagnosis and Therapeutic Management and Considerations for Timing of Surgery and Duration of Follow-up After Initial Endoscopic Retrograde Cholangiopancreatography
Bahtiyar Muhammedoğlu
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2019; 29(5): 399. CrossRef
Aberrant Opening of the Common Bile Duct with Precancerous Change
Min Kyu Kang, Kook Hyun Kim, Tae Nyeun Kim
The Korean Journal of Pancreas and Biliary Tract.2018; 23(1): 32. CrossRef
ERCP and Direct Cholangioscopy with Gastroscope in Patients with Ectopic Opening of the Bile Duct into the Duodenal Bulb: A Report of 3 Cases
Ji Woong Jang, Sae Hee Kim, Sung Hee Jung, Anna Kim
Korean Journal of Pancreas and Biliary Tract.2016; 21(2): 112. CrossRef

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Usefulness of Intraductal Ultrasonography in the Diagnosis of Cholangiocarcinoma and IgG4-Related Sclerosing Cholangitis: Takahiro Nakazawa, Itaru Naitoh, Kazuki Hayashi; Clin Endosc 2012;45(3):331-336. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.331

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The technique of intraductal ultrasonography (IDUS) of the bile duct with a thin-caliber probe and a ropeway system has provided excellent images of the bile duct and periductal structures and is an easy transpapillary approach. In addition, once the guide wire is inserted into the bile duct, IDUS and transpapillary biopsy after endoscopic retrograde cholangiopancreatography can be performed in a single session. Here, we review the usefulness of IDUS in the diagnosis of cholangiocarcinoma and IgG4-related sclerosing cholangitis.

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Mimickers of immunoglobulin G4-related hepatobiliary disease on biopsy
Byoung Uk Park, Hee Eun Lee, Lizhi Zhang
Seminars in Diagnostic Pathology.2024; 41(2): 95. CrossRef
IgG4-related sclerosing cholangitis overlapping with autoimmune hepatitis: Report of a case
Hongyan Li, Li Sun, David R. Brigstock, Lina Qi, Runping Gao
Pathology - Research and Practice.2017; 213(5): 565. CrossRef
Percutaneous transluminal forceps biopsy in patients suspected of having malignant biliary obstruction: factors influencing the outcomes of 271 patients
Jung Gu Park, Gyoo-Sik Jung, Jong Hyouk Yun, Byung Chul Yun, Sang Uk Lee, Byung Hoon Han, Ji Ho Ko
European Radiology.2017; 27(10): 4291. CrossRef
IgG4-related sclerosing cholangitis and chronic sclerosing sialadenitis mimicking cholangiocarcinoma and neck malignancy
Li Sun, Hong-Yan Li, David R Brigstock, Run-Ping Gao
Hepatobiliary & Pancreatic Diseases International.2017; 16(4): 443. CrossRef
Two cases of immunoglobulin G4-related sclerosing cholangitis in which transabdominal ultrasonography was useful in diagnosis and follow-up observation
Ikuhiro Kobori, Toshikuni Suda, Akihiro Nakamoto, Hiroki Saito, Osamu Okawa, Rion Sudo, Yoshinori Gyotoku, Yasumi Katayama, Masaya Tamano
Journal of Medical Ultrasonics.2016; 43(2): 271. CrossRef
IgG4-related hepatobiliary disease: an overview
Emma L. Culver, Roger W. Chapman
Nature Reviews Gastroenterology & Hepatology.2016; 13(10): 601. CrossRef
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United European Gastroenterology Journal.2016; 4(5_suppl): A1. CrossRef
Immunoglobulin G4–Related Sclerosing Cholangitis Mimicking Hilar Cholangiocarcinoma Diagnosed With Following Bile Duct Resection: Report of a Case
Atsushi Miki, Yasunaru Sakuma, Hideyuki Ohzawa, Yukihiro Sanada, Hideki Sasanuma, Alan T. Lefor, Naohiro Sata, Yoshikazu Yasuda
International Surgery.2015; 100(3): 480. CrossRef
Endoscopic diagnosis of cholangiocarcinoma: From endoscopic retrograde cholangiography to bile proteomics
Torsten Voigtländer, Tim O. Lankisch
Best Practice & Research Clinical Gastroenterology.2015; 29(2): 267. CrossRef

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Extended Spectrum-β-Lactamase or Carbapenemase Producing Bacteria Isolated from Patients with Acute Cholangitis: Ja Chung Goo, Mun Hyuk Seong, Young Kwang Shim, Hee Seung Lee, Jung-Ho Han, Kyeong Seob Shin, Jae-Woon Choi, Sei Jin Youn, Seon Mee Park; Clin Endosc 2012;45(2):155-160. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.155; Correction in: Clin Endosc 2012;45(4):453

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Background/Aims

This study assessed the antibiotic resistance organisms isolated from the blood and bile of acute cholangitis and evaluated risk factors associated with them and their impact on clinical outcomes.

Methods

The identities and antibiotic resistance profiles of bacteria isolated from 433 cases of acute cholangitis from 346 patients were analyzed. Risk factors and the outcomes of patients infected with them were assessed.

Results

Microorganisms were isolated from 266 of 419 blood cultures and 256 of 260 bile cultures. Isolates from bile and blood were identical in 71% of the cases. A total of 20 extended spectrum-β-lactamase (ESBL)-producers and 4 carbapenemase-producing organisms were isolated from blood, and 34 ESBL-producers and 13 carbapenemase-producers were isolated from bile. Sixty-four (14.8%) cases were infected with any one of these bacteria isolated from blood or bile. Risk factors associated with them in blood were nosocomial infection and prior biliary intervention. In bile, indwelling biliary device was a risk factor associated with them. Antibiotic-resistant bacteria were associated with mortality, independent of other prognostic factors.

Conclusions

ESBL or carbapenemase-producing bacteria were frequently isolated in acute cholangitis patients especially with prior biliary intervention and nosocomial infection. Isolation of antibiotic-resistant bacteria was an independent risk factor of mortality.

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An Impacted Pancreatic Stone in the Papilla Induced Acute Obstructive Cholangitis in a Patient with Chronic Pancreatitis: Kwang-Ho Yoo, Chang-Il Kwon, Sang-Wook Yoon, Won Hee Kim, Jung Min Lee, Kwang Hyun Ko, Sung Pyo Hong, Pil Won Park; Clin Endosc 2012;45(1):99-102. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.99

Abstract PDF PubReader ePub

Obstructive jaundice is very rarely caused by impaction of a pancreatic stone in the papilla. We report here on a case of obstructive jaundice with acute cholangitis that was caused by an impacted pancreatic stone in the papilla in a patient with chronic pancreatitis. A 48-year-old man presented with acute obstructive cholangitis. Abdominal computed tomography with the reconstructed image revealed distal biliary obstruction that was caused by a pancreatic stone in the pancreatic head, and there was also pancreatic ductal dilatation and parenchymal atrophy of the pancreatic body and tail with multiple calcifications. Emergency duodenoscopy revealed an impacted pancreatic stone in the papilla. Precut papillotomy using a needle knife was performed, followed by removal of the pancreatic stone using grasping forceps. After additional sphincterotomy, a large amount of dark-greenish bile juice gushed out. The patient rapidly improved and he has remained well.

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A Case of Duodenal Diverticulitis Mimicking Cholangitis: Young Lan Kwon, M.D., Kwang Bum Cho, M.D., Eun Soo Kim, M.D., Kyung Sik Park, M.D., Min Joung Kim, M.D., Kyung Hun Kim, M.D., Joung Eun Lee, M.D. and Kyung In Lee, M.D.; Korean J Gastrointest Endosc 2010;41(3):185-188. Published online September 30, 2010

Abstract PDF: The duodenum ranks second to the colon as the most common site of diverticulosis in the gastrointestinal tract with a prevalence of more than 20%. It is usually asymptomatic, and rarely requires treatments for complications, including diverticulitis, hemorrhage, and luminal obstructions. Unlike diverticulosis, duodenal diverticulitis is extremely rare. Given that the radiological appearance and clinical presentation of duodenal diverticulitis often mimic those of pancreaticobiliary neoplasms or inflammations, it is a challenge for clinicians to diagnose it correctly, which often leads to misdiagnosis and inappropriate management. Here we report a case of a 69 year-old female patient with duodenal diverticulitis, whose clinical symptoms and radiological images were similar to those of acute cholangitis. We also briefly review the literature. (Korean J Gastrointest Endosc 2010;41:185-188)

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A Case of Langerhans Cell Histiocytosis That Involved the Colon: Sang Jin Lee, M.D., Kyung-Jo Kim, M.D., Soon Man Yoon, M.D., Byong Duk Ye, M.D., Jeong-Sik Byeon, M.D., Seung-Jae Myung, M.D., Suk-Kyun Yang, M.D. and Jin-Ho Kim, M.D.; Korean J Gastrointest Endosc 2009;38(3):166-170. Published online March 30, 2009

Abstract PDF: A 34-year-old man was referred to our department for evaluation of his elevated liver function test. He was diagnosed with Langerhans cell histiocytosis 7 years ago because of recurrent pneumothorax. A CT scan showed multifocal intrahepatic duct dilatation with soft tissue infiltration in the right lobe of the liver. An ERCP showed diffuse multifocal strictures of the intrahepatic duct intervening among the normal segments of the duct. A percutaneous needle biopsy of the liver disclosed ductular proliferation, inflammatory cell infiltration and focal cholestasis. Therefore, he was diagnosed with sclerosing cholangitis. He underwent colonoscopy to evaluate for the possibility of ulcerative colitis. The colonoscopy showed erosions and erythema on the mucosa of the appendiceal orifice, another site of erosion at 35 cm from the anal verge and multiple 3~8 mm sized sessile polyps. Biopsies of the colon mucosa disclosed an infiltration of Langerhans cell histiocytosis. We report here on a very rare case of colon involvement of Langerhans cell histiocytosis. (Korean J Gastrointest Endosc 2009;38:166-170)

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A Case of an Anomalous Opening of the Common Bile Duct and Pancreatic Duct into the Duodenal Bulb, and the Patient Presented with Acute Cholangitis and Recurrent Duodenal Ulcer: Myoung Jin Cho, M.D., Mi Na Oh, M.D., Hoon Ki Baek, M.D., Ki Sung Cho, M.D., Ji Hun Kang, M.D., Young Jae Lee, M.D., Ji Woong Kim, M.D. and Jin Woong Cho, M.D.; Korean J Gastrointest Endosc 2008;37(6):459-464. Published online December 30, 2008

Abstract PDF: There are various congenital anomalies of the biliary system, but an ectopic opening of the common bile duct into the duodenal bulb is an extremely rare finding. Despite the recent improvement in the diagnosis and management of pancreatobiliary lesions, the general lack of knowledge and understanding about these variations is undoubtedly responsible for many of the problems that occur during the medical and surgical management of these lesions. We report here on a case of a 65-year-old man who had an ectopic opening of the common bile duct into the duodenal bulb, and this cause acute cholangitis with bile duct sludge, and also recurrent duodenal ulcer. In this case, we used abdomen CT, MRCP, duodenoscopy, EUS and ERCP for making the diagnosis. The cholangitis and duodenal ulcer was improved with medical therapy, and the patient was discharged without any surgical procedure. We report here on this unusual case and we include a review of the relevant medical literature. (Korean J Gastrointest Endosc 2008;37:459-463)

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A Case of Biliary Cast Syndrome with a Biliary Stricture and Suppurative Cholangitis after Liver Transplantation: Jung Pil Suh, M.D., In Seok Lee, M.D., Jae Hyuck Chang, M.D., Jung Hyun Kwon, M.D., Won Haing Hur, M.D., Si Hyun Bae, M.D., Myung Gyu Choi, M.D., In Sik Chung, M.D. and Dong Goo Kim, M.D.*; Korean J Gastrointest Endosc 2007;35(4):281-286. Published online October 30, 2007

Abstract PDF: Biliary complications after liver transplantation occur in 13∼35% of patients. Biliary cast syndrome, cast formation of biliary sludge along the bile duct, can develop in 4∼18% of liver transplant recipients, although the incidence rate is significantly decreasing due to the improvement of graft harvesting and preservation. It is very important that early diagnosis and effective management of biliary cast syndrome be performed when there is a bile duct stricture or dilatation associated with jaundice and cholangitis in the recipient after liver transplantation, due to the possibility of retransplantation and death of the patient from graft loss. We report a case of a biliary cast formed with suppurative cholangitis and extracted incidentally with a plastic biliary stent during an endoscopic procedure after cadaveric liver transplantation, in which the ERCP findings revealed a stricture at the anastomosis site of the common bile duct and cholangitis. (Korean J Gastrointest Endosc 2007;35:281-286)

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A Case of Clonorchiasis Presenting with Acute Pancreatitis and Cholangitis: Ki Sung Lee, M.D., Kyung Ho Kim, M.D., So Young Park, M.D., Chi Jun Park, M.D., Ja Young Lee, M.D., Myoung Kuk Jang, M.D., Joon Yong Park, M.D., Jin Heon Lee, M.D., Hak Yang Kim, M.D. and Jae Young Yoo, M.D.; Korean J Gastrointest Endosc 2006;32(3):231-234. Published online March 30, 2006

Abstract PDF: Clonorchiasis is a parasitic disease that is often found in Japan, Korea, China, Hong Kong as well as in countries in Southeast Asia. The disease is caused by the ingestion of infected raw freshwater fish. The clinical manifestations depend on the number of flukes in a patient, the period of infestation, and the complications. In patients with a heavy infestation, extrahepatic bile duct, the gallbladder and even the pancreas are involved. We experienced a 62-year-old man who had a history of ingestion of raw freshwater fish and presented with acute pancreatitis and cholangitis. The pancreaticobiliary-associated clonorchiasis was successfully treated with endoscopic sphincterotomy, and praziquantel. (Korean J Gastrointest Endosc 2006;32:231⁣234)

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Three Cases of Autoimmune Pancreatitis: Won Jae Yoon, M.D., Yong-Tae Kim, M.D., Yong Bum Yoon, M.D., Ji Kon Ryu, M.D., Jin-Hyeok Hwang, M.D., Hyoun Woo Kang, M.D., Su Hwan Kim, M.D., Jin Hyun Kim, M.D., Sun Whe Kim, M.D.*, Woo Ho Kim, M.D.^†, Byung Ihn Choi, M.D.^‡ and Ji Bo; Korean J Gastrointest Endosc 2004;28(1):52-59. Published online January 30, 2004

Abstract PDF: Autoimmune pancreatitis is a distinct entity with characteristic histologic, morphologic, and clinical features. It may be isolated or associated with Sjögren syndrome, primary biliary cirrhosis, primary sclerosing cholangitis, Crohn's disease and ulcerative colitis, or other immune-mediated disorders. Recent studies have reported the profiles of autoantibodies in autoimmune pancreatitis. Also a number of reports on single cases or small series of cases have been published. We report three cases of autoimmune pancreatitis; one case was associated with primary sclerosing cholangitis, which was misdiagnosed as pancreatic cancer; the other two cases were improved with steroid therapy. (Korean J Gastrointest Endosc 2004;28:52⁣59)

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Papillary Stenosis and Cholangitis Caused by Endoscopic Mucosal Resection of Ampullary Adenoma: Jung Joon Choi, M.D., Myung-Hwan Kim, M.D., Gi Deog Kim, M.D., Jung Kwon Kim, M.D., Jin Tae Park, M.D., Dong Ryeul Oh, M.D., Wook Jang Seo, M.D., Won Jang Kim, M.D., Sung Koo Lee, M.D., Young Il Min, M.D., Eun Sil Yu, M.D.* and Mi Jung Kim, M.D.*; Korean J Gastrointest Endosc 2003;27(4):249-253. Published online October 31, 2003

Abstract PDF: Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.

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70세 남자, 황달: Korean J Gastrointest Endosc 2003;26(5):315-316. Published online May 30, 2003

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A Case of Langerhans Cell Histiocytosis with Sclerosing Cholangitis: Jae Chul Hwang, M.D., Doh Hyun Kim, M.D., Eun Hee Lee, M.D., Jai Hak Jeung, M.D.,; Korean J Gastrointest Endosc 2003;26(1):56-60. Published online January 30, 2003

Abstract PDF: Langerhans cell histiocytosis is a rare disorder with abnormal proliferation of histiocytes. Besides the infiltration of a variety of organs, patients with Langerhans cell histiocytosis can develop sclerosing cholangitis, with bile duct involvement, progressive fibrosis, and cirrhosis. We report a case of Langerhans cell histiocytosis with sclerosing cholangitis. Endoscopic retrograde cholangiopancreatography revealed multiple strictures and dilatations of left intrahepatic and extrahepatic bile duct. Endoscopic biopsy of common bile duct showed diffuse infiltration of histiocytes and eosinophiles in lamina propria. Immunohistochemical stain showed positive reactions for S-100 and CD1a and a negative reaction for cytokeratin in infiltrating histiocytes. (Korean J Gastrointest Endosc 2003;26:56⁣60)

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A Case of Primary Sclerosing Cholangitis Localized at Intrahepatic Bile Duct: Woon Hyun Jun, M.D., Ho Soon Choi, M.D., Seok Woo Kang, M.D., Yun Ju Cho, M.D.,Oh Young Lee, M.D., Dong Soo Han, M.D., Yong Chul Jun, M.D., Bung Chul Yoon, M.D.,Joon Soo Hahm, M.D., Min Ho Lee, M.D., Chun Suhk Khee, M.D. and Kyung Nam Park, M.D.; Korean J Gastrointest Endosc 2001;22(4):250-254. Published online April 30, 2001

Abstract PDF: Primary sclerosing cholangitis is a cholestatic liver disease characterized by fibroobliterative inflammation of the entire biliary tree. It is a slowly progressive disease with an undulating course, resulting in biliary cirrhosis. The gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricturing and beading. We exprienced a case of primary sclerosing cholangitis by Endoscopic retrograde cholangiopancreatography (ERCP) demonstration. ERCP findings revealed multiple luminal narrowing, stricture and beaded dilatation of the intrahepatic duct. We report a case of primary sclerosing cholangitis localizing at intrahepatic bile duct, which is confused with cholangiocarcinoma. (Korean J Gastrointest Endosc 2001; 22:250⁣254)

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구연 / 포스터 : 간내 유두종에서 악성화한 유두상선암: Korean J Gastrointest Endosc 2001;22(5):376-376. Published online November 30, 2000

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원저 : 담도 췌장 ; 총담관결석에 의한 급성화농성담관염 환자에서 내시경적 역행성 담관배액술의 치료효과 ( Original Articles : Biliary Tract & Pancreas ; Biliary Stenting as an Altermative to Endoscopic Nasobiliary Drainage in Patients with Acute Calculous Suppurative Cholangitis ): Korean J Gastrointest Endosc 1997;17(6):789-800. Published online November 30, 1996

Abstract PDF: Background
/Aims: Acute calculous suppurative cholangitis(ACSC) is the most severe complication of bile duct stone(s) and carries 100% mortality if left untreated, and emergent decompression is a life-saving procedure. Endoscopic therapy such as endoscopic sphincterotomy(EST) or endoscopic nasobiliary drainage(ENBD) are well-mtablished treat- ment of choice instead of emergent surgieal or percutaneous drainages which have a high mortality or morbity, respectively. However, EST and subsequent stone removal is operator-dependent, time consuming, associated with complication rate of 6-12%, and may be inadequeate in many critically ill patients. Recently, endoscopic retrograde biliary drainage(ERBD) is suggested to be as effective in temporary biliary drainage for retained common duct stone and acute cholangitis as ENBD is, and preferred to ENBD in some reports, because ENBD can be pulled out occasionally by confused patient, more time consuming, unpleasant, a hindrance for the patient, and does not seem to be any more effective than ERBD. So, we performed this study to evaluate the role of ERBD in patient with ACSC. (Korean J Gastrointest Endosc 17: 789-800, 1997) (continue)

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증례 : 담도 췌장 ; 원발성 경화성 담관염 환자에서 MR Cholangiography 와 CT Cholangiography 의 임상적 유용성 ( Case Reports : Biliary Tract & Pancreas ; Clinical Usefulness of Magnetic Resonance Cholangiagraphy and Computed Tomography Cholangiography in Primary Sclerosing Cholangitis ): Korean J Gastrointest Endosc 1997;17(5):716-722. Published online November 30, 1996

Abstract PDF: Primary sclerosing cholangitis(PSC) is rare disease which is characterized by inflammation and obliteration of bile duct leading to biliary cirrhosis and liver failure. The cause of PSC is unknown although a number of potential etiologic factor have been investigated. The diagonsis is confirmed by typical cholangiographic demonstration with clinical features. On endoscopic retrograde cholangiopancreatography(ERCP), multifocal strictures involving both intra and extrahepatic bile ducts are most common; they were diffusely distributed, short, and annular, alternating with normal or slightly dilated segments to produce a "beaded" appearance, the "pruned-tree" appearance due to diminished arborization of the intrahepatic duct, band-like stricture, and diverticular-like outpouching(s) are seen occasionally on cholangiography, and the report of primary sclerosing cholangitis in Korea is being increased due to increased use of ERCP. Recently, magnetic resonance cholangiography(MR cholangiography) and computed tomography cholangiography(CT cholangiography) are newly developed adjunctives for evaluation of patients with biliary disease(s). We performed MR cholangiography and CT cholangiography through the nasobiliary tube in two patients with PSC, in which typical intrahepatic bile duct changes of PSC were seen as in ERCP. Now, we report MR cholangiographic and CT cholangiographic findings in patients with PSC and suggest that these radiologic studies, especially MR cholangiography, can be used as an alternative methods for serial follow-up after definite diagnosis by ERCP. (Korean J Gastrointest Endosc 17: 716-722, 1997)

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원저 : 담도 췌장 ; 급성담관염에서 응급 내시경적 경비담관 배액술 ( Original Articles : Biliary Tract & Pancreas ; Emergency Nasobiliary Drainage in Acute Suppurative Cholangitis ): Korean J Gastrointest Endosc 1997;17(3):390-395. Published online November 30, 1996

Abstract PDF: Background
/Aims: Acute suppurative cholangitis is associated with significant mortality. It is best managed by drainage of biliary tree such as endoscopic, percutaneous or surgical, We evaluated the role of emergency endoscopic nasobiliary drainage(ENBD) in the acute suppurative cholangitis. Methods: For 55 patients with acute calculous cholangitis, who did not respond to conservative management and the stone could not be removed from bile duct by endoscopic papillotomy due to poor condition or bleeding tendency, ENBD tube(7.5Fr) was inserted at proximal side of obstruction. ENBD was done at 39.4 hours (mean) after arrival to hospital. Results: ENBD was successful in all patients (100%). All patients responded with striking improvement of the abdominal pain, fever and stabilized vital signs within 3 days. After patients conditions were stabilized clinically, common bile duct stones were removed successfully by endoscopic sphincterotomy or surgery. No patients died of acute suppurative cholangitis. Conclusion: These results show that ENBD is a simple, safe, and effective measure for the initial control of acute suppurative cholangitis due to cholelithiasis, (Korean J Gastrointest Endosc 17: 390-395, 1997)

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증례 : 담도 췌장 ; 원발성 경화성 담관염에서 발생했다고 추정되는 담관암종 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Cholangiocarcinoma Suggested as Developing in the Patient with Primary Sclerosing Cholangitis ): Korean J Gastrointest Endosc 1997;17(1):99-104. Published online November 30, 1996

Abstract PDF: Primary sclerosing cholangitis is a chronic disease of unknown cause, characterized by inflammation and fibrosis of the biliary tree with diffuse multifocal stricture formation. With increasing knowledge of primary sclerosing cholangitis, it is now recognized that in the setting of inflammatory bowel disease, cholangiocarcinoma is a complication of primary sclerosing cholangitis. We recently experienced a case of 41 year old female patient who had Crohns disease associated with primary sclerosing cholangitis and cholangioearcinoma. We report a case of primary sclerosing cholangitis with cholangiocarcinoma with literature review. (Korean J Gastrointest Endosc 17: 99~104, 1997)

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증례 : 식도 위장관 ; 원발성경화성담관염 (原發性硬化性膽管炎) 을 동반한 궤양성대장염 (潰梁性大腸炎) 환자 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Primary Sclerosing Cholangitis with Ulcerative Colitis ): Korean J Gastrointest Endosc 1996;16(6):1001-1007. Published online November 30, 1995

Abstract PDF: Sclerosing cholangitis is cholestatic disease, characterized by progressive fibrotic inflammation and obliteration af intrahepatic bile ducts and extrahepatic bile ducts and sometimes associated with ulcerative colitis. The pathogenesis of this disease is not understood well. In this disease, however, have been proposed infectious agent, endotoxin of bacteria and immunological event. In Europe and U.S.A., the incidence of sclerosing cholangitis associated with ulcerative colitis was between 2,4 and 4.0 percent. The association is strongest in patients with pancolitis, with a prevalenee of 5.5 percent, compared with patients with disease confined to the distal colon, with a prevalence of 0.5 percent. But, in Korea, it has not been reported sclerosing cholangitis associated with ulcerative colitis. A 30-year old man was diagnosed as an ulcerative colitis 9 years ago and has been followed up, intermittently. Recently, he has experienced hematochezia and dizziness. Colonoscopy showed active ulcerative colitis(pancolitis), blood chemistry elevated alkaline phosphatase and y-GTP. ERCP and liver biopsy specimen revealed sclerosing cholangitis. we concluded that this case was a sclerosing cholangitis as a complication of ulcerative colitis and the first case report of primary sclerosing cholangitis with ulcerative colitis in Korea, Hence, we reported a case of primary sclerosing cholangitis with ulcerative colitis with a review of literatures. (Korean J Gastrointest Endosc 16: 1001-1o07, 1996)

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증례 : 담도 췌장 ; 원발성 경화성 담관염 2예 ( Case Reports : Biliary Tract & Pancreas ; Two Cases of Primary Sclerosing Cholangitis ): Korean J Gastrointest Endosc 1995;15(4):788-795. Published online November 30, 1994

Abstract PDF: Prirnary sclerosing cholangitis, a chronic progressive cholestatic hepatobiliary disorder of unknown etiology, is characterized by inflammation, scarring and obliteration of bile duct leading to biliary cirrhosis and liver failure. Because histologic finding has only a limited role in the diagnosis, the gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricutre or beading. The natural history is extremely variable. We report two cases of primary sclerosing cholangitis diagnosed by repeated endoscopic retrograde cholangiographies. They were followed up for 7 and 2 years, respectively. (Kor J Gastrointest Endosc 15: 788-794, 1995)

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증례 : 점액성 담도폐쇄를 일으킨 총간관의 융모성 선종 1예 ( Case Reports : Mucin - secreting Villous Adenoma of The Common Hepatic Duct Causing Mucoid Biliary Obstruction ): Korean J Gastrointest Endosc 1995;15(1):99-104. Published online November 30, 1994

Abstract PDF: Obstructive jaundice of the bile duct resulting from tumor-producing copious, thick mucin, causing ductal obstruction and dilatation, has been reported very rarely. Also, the benign bile duct neoplasm is extremely rare. We report a case of a mucin-secreting villous adenoma of common hepatic duct causing obstructive jaundice and cholangitis. The patient was a 72-year-old male and had a 3 yeared history of common hepatic mass unchanged remarkably in size. The abdominal ultrasonogram and computed tomography revealed well circumscribed, more than 2cm sized mass on the CHD and ductal dilatation. We were able to get an interesting cholangioram showing irregular, nodular, ill defined filling defect in the extrahepatic bile duct, different from US and CT findings, And it was just caused by thick, copious mucin from the tumar. This case was confirmed as mucin-secreting villous adenoma after surgery.

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