Clinical Endoscopy

Original Article

Usefulness of Percutaneous Transhepatic Cholangioscopic Lithotomy for Removal of Difficult Common Bile Duct Stones: Jae Hyung Lee, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Su Bum Park, Suk Hun Kim, Ung Bae Jeon; Clin Endosc 2013;46(1):65-70. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.65

Background/Aims

Approximately 5% to 10% of common bile duct (CBD) stones are difficult to remove by conventional endoscopic methods. Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) can be an alternative method for this condition, but is not well established yet. The aim of this study was to evaluate the clinical efficacy and safety of PTCSL for removal of difficult CBD stones.

Methods

This study is a retrospective review of 34 consecutive patients who underwent unsuccessful removal of CBD stones using conventional endoscopic methods between December 2008 and July 2010 and were subsequently treated using PTCSL.

Results

Among 443 patients with CBD stones, 34 patients (7.8%) failed to achieve stone removal using conventional endoscopic methods. Of these 34 patients, 33 were treated using PTCSL. In all 33 cases (100%), complete stone removal was achieved using PTCSL. Most complications (15/17, 88.2%) were mild and transient. Major complications occurred in two patients (6.1%) who experienced hemobilia, and percutaneous transhepatic biliary drainage tract disruption, respectively; which were fully recovered without mortality.

Conclusions

Despite prolonged hospital stay and temporary decline of quality of life, PTCSL is an effective and safe method in the management of difficult CBD stones, especially in patients with difficulty in approaching the affected bile duct.

Citations

Citations to this article as recorded by

Risk factors for postoperative stone formation in pediatric choledochal cysts: a study of 457 cases
Sujin Gang, Pyeong Hwa Kim, Hyunhee Kwon, Hee Mang Yoon, Jung-Man Namgoong
Scientific Reports.2025;[Epub] CrossRef
Colangioscopia asistida mediante abordaje transparietohepático en el manejo de las hepatolitiasis
Ana Belén Martín Arnau, Antonio Molera Espelt, Jordi Villaba Auñon, Santiago Sánchez-Cabús
Cirugía Española.2024; 102(11): 599. CrossRef
Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures
Easton Neitzel, Jack Stearns, Jessica Guido, Kaiden Porter, Jed Whetten, Luke Lammers, Eric vanSonnenberg
Abdominal Radiology.2024; 49(11): 4074. CrossRef
Percutaneous transhepatic cholangioscopy in the management of hepatolithiasis
Ana Belén Martín Arnau, Antonio Molera Espelt, Jordi Villaba Auñon, Santiago Sánchez-Cabús
Cirugía Española (English Edition).2024; 102(11): 599. CrossRef
Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Common Bile Duct Stones: Endoscopic Management of Difficult Common Bile Duct Stones
Eunae Cho, Dong Kee Jang, Seong-Hun Kim, Dong Uk Kim
The Korean Journal of Pancreas and Biliary Tract.2024; 29(4): 135. CrossRef
Evidence-based clinical practice guidelines for cholelithiasis 2021
Naotaka Fujita, Ichiro Yasuda, Itaru Endo, Hiroyuki Isayama, Takuji Iwashita, Toshiharu Ueki, Kenichiro Uemura, Akiko Umezawa, Akio Katanuma, Yu Katayose, Yutaka Suzuki, Junichi Shoda, Toshio Tsuyuguchi, Toshifumi Wakai, Kazuo Inui, Michiaki Unno, Yoshifu
Journal of Gastroenterology.2023; 58(9): 801. CrossRef
Percutaneous transhepatic cholangioscopic lithotripsy: A useful technique in the management of difficult biliary stones
Thandalam K. Anand, Pandurangan Basumani, Ramakrishnan Ravi
Indian Journal of Gastroenterology.2023; 42(6): 857. CrossRef
Percutaneous biliary stone clearance: is there still a need? A 10-year single-centre experience
Y. Kilic, A. Graham, N.P. Tait, D. Spalding, P. Vlavianos, L.R. Jiao, A. Alsafi
Clinical Radiology.2022; 77(2): 130. CrossRef
A propensity score matching study between conventional and soft fiber-optic choledochoscope guided percutaneous transhepatic cholangioscopic lithotripsy for treatment of cholelithiasis
Hao Jin, Min Cui
Langenbeck's Archives of Surgery.2022; 407(2): 675. CrossRef
Successful Removal of a Difficult Common Bile Duct Stone by Percutaneous Transcholecystic Cholangioscopy
Hyunsuk Lee, Sang Hyub Lee, Gunn Huh, Yeji Kim, Saebeom Hur, Moonhaeng Hur, Minwoo Lee, Byeongyun Ahn
Clinical Endoscopy.2022; 55(2): 297. CrossRef
The Use of Palliative Endoscopic Ultrasound-guided Enterostomy to Treat Small Bowel Obstruction in Two Patients with Advanced Malignancies
Ji Hong Oh, Seung Goun Hong
The Korean Journal of Medicine.2022; 97(3): 191. CrossRef
Ultra-mini Percutaneous Hepatolithotomy in Patients With Large and Multiple Hepatolithiasis
Ahmet Öztürk, Mehmet Giray Sönmez, Süleyman Bakdik, Gökhan Ecer, Nurullah Altinkaya, Hüseyin Ataseven, Faruk Aksoy
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2021; 31(1): 76. CrossRef
One-step percutaneous transhepatic cholangioscopic lithotripsy in patients with choledocholithiasis
Ping Wang, Haisu Tao, Chengcheng Liu, Xinghua Zhou, Beiwang Sun, Canhua Zhu, Kun Li, Zhaoshan Fang
Clinics and Research in Hepatology and Gastroenterology.2021; 45(2): 101477. CrossRef
Minimally invasive management of traumatic biliary fistula in the setting of gastric bypass
Molly Mounsey, Jessica Martinolich, Olatoye Olutola, Marcel Tafen
BMJ Case Reports.2021; 14(4): e238002. CrossRef
Percutaneous Transhepatic Laser Lithotripsy for Biliary Stones in Patients with Altered Biliary Anatomy
Jacob Indu, Vikrama Amitha Kheda, Deepak Bolbandi, Sanjay Govil, Ravisankar Bhat
Journal of Clinical Interventional Radiology ISVIR.2021; 05(03): 177. CrossRef
Review of the Endoscopic, Surgical and Radiological Techniques of Treating Choledocholithiasis in Bariatric Roux-en-Y Gastric Bypass Patients and Proposed Management Algorithm
Qiuye Cheng, Amy Hort, Peter Yoon, Ken Loi
Obesity Surgery.2021; 31(11): 4993. CrossRef
Choledochoscopy: An update
Tsinrong Lee, Thomas Zheng Jie Teng, Vishal G Shelat
World Journal of Gastrointestinal Endoscopy.2021; 13(12): 571. CrossRef
Сholangioscopy. Initial Experience of the Center
Т.В. Маевская, Ю.В. Слободин
Евразийский онкологический журнал.2021; (4): 348. CrossRef
One‐Step Multichannel Percutaneous Transhepatic Cholangioscopic Lithotripsy Applied in Bilateral Hepatolithiasis
Haisu Tao, Ping Wang, Beiwang Sun, Kun Li, Canhua Zhu
World Journal of Surgery.2020; 44(5): 1586. CrossRef
Percutaneous removal of biliary stones post‐liver transplant in a pediatric patient: Case report and review of the literature
Taryn J. Rohringer, Jessica H. Hannick, Armando Lorenzo, Yaron Avitzur, Michael Temple, Dimitri A. Parra
Pediatric Transplantation.2020;[Epub] CrossRef
Tratamiento de la coledocolitiasis mediante CPRE e instrumentación a través de un tubo en T
Robin Germán Prieto Ortíz, Arturo Iván Duarte Osorio, Pablo García Echeverri, Hernan Ballén Parraga
Revista Colombiana de Gastroenterología.2020; 35(3): 382. CrossRef
The Light at the End of the Tunnel
Rufaat Mando, Darrel Ceballos, Manoj Kumar, Osama Abdul-Rahim, Meir Mizrahi
ACG Case Reports Journal.2019; 6(7): e00113. CrossRef
A comparative evaluation of treatment methods for bile duct stones after hepaticojejunostomy between percutaneous transhepatic cholangioscopy and peroral, short double-balloon enteroscopy
Koichiro Tsutsumi, Hironari Kato, Shuntaro Yabe, Sho Mizukawa, Hiroyuki Seki, Yutaka Akimoto, Daisuke Uchida, Kazuyuki Matsumoto, Takeshi Tomoda, Naoki Yamamoto, Shigeru Horiguchi, Hirofumi Kawamoto, Hiroyuki Okada
Therapeutic Advances in Gastroenterology.2017; 10(1): 54. CrossRef
Traitement instrumental non chirurgical des pathologies biliaires intra- et extrahépatiques
A. Vienne, F. Prat
EMC - Hépatologie.2014; 29(1): 1. CrossRef
Interventional biliary radiology: current state-of-the-art and future directions
Andrew Shawyer, Mark D Goodwin, Robert N Gibson
Imaging in Medicine.2013; 5(6): 525. CrossRef
Percutaneous Approach for Removal of Difficult Common Bile Duct Stones
Ji Kon Ryu
Clinical Endoscopy.2013; 46(1): 3. CrossRef
A modified Rendezvous ERCP technique in duodenal diverticulum
Mehmet Odabasi
World Journal of Gastrointestinal Endoscopy.2013; 5(11): 568. CrossRef

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Special Issue Articles of IDEN 2012

Highlights of Pancreatobiliary Endoscopy in International Digestive Endoscopy Network 2012: How Much Has It Advanced?: Seok Ho Dong; Clin Endosc 2012;45(3):297-298. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.297

Abstract PDF PubReader ePub: The pancreatobiliary organ is composed of one of the most complicated structures and complex physiological functions among other digestive organs in our body. This is why endoscopic procedure in pancreaticobiliary system requires rather complicated techniques. In International Digestive Endoscopy Network (IDEN) 2012, many interesting pancreatobiliay endoscopy related topics were presented. Basic procedures like endoscopic papillary balloon dilation (EPBD), advanced techniques like endoscopic necrosectomy, prevention and management of post-ERCP pancreatitis, and spyglass system are reviewed in this highlight summary.

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Original Article

Short-term Clinical Outcomes Based on Risk Factors of Recurrence after Removing Common Bile Duct Stones with Endoscopic Papillary Large Balloon Dilatation: Jung Ho Kim, Yeon Suk Kim, Dong Kyu Kim, Min Su Ha, Young Jun Lee, Jong Joon Lee, Sang Jin Lee, In Sik Won, Yang Suh Ku, Yun Soo Kim, Ju Hyun Kim; Clin Endosc 2011;44(2):123-128. Published online December 31, 2011; DOI: https://doi.org/10.5946/ce.2011.44.2.123

Abstract PDF PubReader ePub

Background/Aims

Recurrence is an important late complication of endotherapy of bile duct stones. Endoscopic papillary large balloon dilation (EPLBD) can be used as an alternative method of removing difficult bile duct stones. The aim of this study was to evaluate short term clinical outcomes after removing common bile duct (CBD) stones using EPLBD.

Methods

A retrospective review was performed based on the medical records of 141 patients who received EPLBD, with or without endoscopic sphincterotomy, between September 2008 and February 2010. Of these, 50 patients, were enrolled in the study. Clinical and endoscopic parameters were analyzed to identify risk factors for CBD stones recurrence.

Results

Male:Female ratio was 22:28 (mean age, 67.4±14.4 years). Recurrence rate was 24.0% (12/50). Mean follow-up period was 10.8±4.5 months. Nineteen (38.0%) had a history of surgery and 20 (40.0%) were comorbid with periampullary diverticula. Mean diameters of the stones and CBD were 13.8±4.3 mm and 20.1±7.2 mm, respectively. In univariate analysis, large CBD stones (≥12 mm) and angulated CBD (angle ≤145°) were identified as the significant predictors of recurrence. In multivariate analysis, angulated CBD (angle ≤145°) was the significant independent risk factor for recurrence.

Conclusions

Close follow-up seems necessary in patients with angulated CBD (angle ≤145°).

Citations

Citations to this article as recorded by

Endoscopic Papillary Large Balloon Dilatation With or Without Endoscopic Sphincterotomy in the Treatment of Common Bile Duct Stones
Jia Wang, Lichao Cao, Kuijin Xue, Peng Qi, Qingdong Mao, Mingjuan Cui, Hui Ju, Baoguo He, Bin Cao
Digestive Diseases and Sciences.2025; 70(2): 478. CrossRef
Eyelid and Parotid Gland Metastasis of Colorectal Cancer Demonstrated by 18F-FDG PET/CT
Mehmet Samsum, Nur Aydinbelge Dizdar, Alev Cinar, Ozlem Ozmen
Clinical Nuclear Medicine.2025;[Epub] CrossRef
Recurrence of common bile duct stones after endoscopic clearance and its predictors: A systematic review
Marko Kozyk, Suprabhat Giri, Sidharth Harindranath, Manan Trivedi, Kateryna Strubchevska, Rakesh Kumar Barik, Sridhar Sundaram
DEN Open.2024;[Epub] CrossRef
Modern Management of Common Bile Duct Stones: Breakthroughs, Challenges, and Future Perspectives
Yanguang Sha, Zhilin Wang, Rongmei Tang, Ke Wang, Chen Xu, Guangbin Chen
Cureus.2024;[Epub] CrossRef
Risk factors and management of primary choledocholithiasis: a systematic review
Jie Zhang, Xiaofeng Ling
ANZ Journal of Surgery.2021; 91(4): 530. CrossRef
Efficacy and safety of conversion of percutaneous cholecystostomy to endoscopic transpapillary gallbladder stenting in high-risk surgical patients
Hyung Ku Chon, Chan Park, Dong Eun Park, Tae Hyeon Kim
Hepatobiliary & Pancreatic Diseases International.2021; 20(5): 478. CrossRef
Alterations of the Bile Microbiome in Recurrent Common Bile Duct Stone
Cheng Ye, Wence Zhou, Hui Zhang, Long Miao, Gen Lv, Abdelwahab Omri
BioMed Research International.2020;[Epub] CrossRef
Clinical Impact of Common Bile Duct Angulation for Recurrence of Bile Duct Stones
Se Woo Park
The Korean Journal of Gastroenterology.2020; 76(4): 177. CrossRef
Clinical Impact of Common Bile Duct Angulation on the Recurrence of Common Bile Duct Stone: A Meta-analysis and Review
Seongyul Ryu, Ik Hyun Jo, Seonhoo Kim, Yeon-Ji Kim, Woo Chul Chung
The Korean Journal of Gastroenterology.2020; 76(4): 199. CrossRef
Causes associated with recurrent choledocholithiasis following therapeutic endoscopic retrograde cholangiopancreatography: A large sample sized retrospective study
Feng Deng, Mi Zhou, Ping-Ping Liu, Jun-Bo Hong, Guo-Hua Li, Xiao-Jiang Zhou, You-Xiang Chen
World Journal of Clinical Cases.2019; 7(9): 1028. CrossRef
Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation
Takao Itoi, Shomei Ryozawa, Akio Katanuma, Yoshinobu Okabe, Hironori Kato, Jun Horaguchi, Takayoshi Tsuchiya, Takuji Gotoda, Naotaka Fujita, Kenjiro Yasuda, Yoshinori Igarashi, Kazuma Fujimoto
Digestive Endoscopy.2018; 30(3): 293. CrossRef
Mid‐term outcome of endoscopic sphincterotomy combined with large balloon dilation
Fumihide Itokawa, Takao Itoi, Atsushi Sofuni, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Junko Umeda, Reina Tanaka, Ryosuke Tonozuka, Mitsuyoshi Honjyo, Fuminori Moriyasu, Kazuhiko Kasuya, Akihiko Tsuchida
Journal of Gastroenterology and Hepatology.2015; 30(1): 223. CrossRef
Which Is the Better Treatment for the Removal of Large Biliary Stones? Endoscopic Papillary Large Balloon Dilation versus Endoscopic Sphincterotomy
Woo Hyun Paik, Ji Kon Ryu, Jin Myung Park, Byeong Jun Song, Jaihwan Kim, Joo Kyung Park, Yong-Tae Kim
Gut and Liver.2014; 8(4): 438. CrossRef
Endoscopic papillary balloon dilation for difficult common bile duct stones: Our experience
Maddalena Zippi
World Journal of Clinical Cases.2013; 1(1): 19. CrossRef

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The Usefulness of Endoscopic Ultrasonography in the Diagnosis of Common Bile Duct Stones: Sung Soo You, M.D., Eun Young Kim, M.D., Jong Woon Cheon, M.D., Chang Jin Seo, M.D., Ja Kyoung Cho, M.D., Hyung Keun Ha, M.D., Jin Tae Jung, M.D., Joong Goo Kwon, M.D.,Chang Hyeong Lee, M.D. and Ho Gak Kim, M.D.; Korean J Gastrointest Endosc 2005;30(5):249-256. Published online May 30, 2005

Abstract PDF: Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosis and treatment of common bile duct stones (CBDS). However it is associated with some complications. Endoscopic ultrasonography (EUS) is an efficient diagnostic tool for CBDS with better accuracy than ultrasonography (USG) or computed tomography (CT) and lower complication rate than ERCP. We evaluated the diagnostic usefulness of EUS in suspicious CBDS. Methods: From Oct. 2001 to Mar. 2004, 84 patients with the suspicion of CBDS, without definite evidence on CT and/or USG were evaluated with EUS. The reports were reviewed retrospectively. Results: Patients were 38 males, 46 females with mean age of 56 years old. CBDS were found in 25 (29.8%) patients. In the diagnosis of CBDS undetected in CT and/or USG, EUS gave 96% sensitivity, 96.6% specificity, 92.3% positive predictive value and 98.3% negative predictive value. When CBDS were found in EUS, the average sizes of CBD and CBDS were 8.8 mm (4∼16.7) and 6.4 mm (3.3∼9.1) respectively. Diagnostic ERCP was avoided in 54 (64.3%). EUS provided additional diagnosis such as gallbladder stones, gallbladder cancer, ampullary cancer and adenoma. No complication was associated with EUS. Conclusions: EUS is reasonably safe and accurate procedure in detecting CBDS. EUS may possibly replace diagnostic ERCP in CBDS. (Korean J Gastrointest Endosc 2005;30:249⁣256)

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총담관 결석의 내시경적 치료 성적 ( Results of Endoscopic Treatment in Common Bile Duct Stones ): Korean J Gastrointest Endosc 2000;20(3):191-197. Published online November 30, 1999

Abstract PDF: Background
/Aims: Common bile duct stones are the most common among bile duct diseases. In the past, common bile duct stones were considered a surgically operable disease, but is now considered a medical disease due to the advancement of endoscopy and endoscopic techniques. The aim of this study was to determine the results of endoscopic treatment of common bile duct stones. Methods: Removal of primary or secondary common bile duct stones were attempted by peroral or percutaneous endoscopy. The common bile duct stones were diagnosed by ultrasonography or cholangiography. As a primary approach route, the peroral transpapillary endoscopic approach was tried. On the other hand, percutaneous common bile duct stone removal was attempted if the patient already had a percutaneous route, peroral transpapillary approaches failed, or if conditions for endoscopy were unfavorable. Results: The study subjects consisted of 196 patients; 96 males and 100 females. The mean age was 61.8 years. A total of 272 endoscopic stone removal were attempted in 196 patients. Of the 272, peroral approaches were conducted 241 times for 183 patients, and percutaneous approaches were performed 31 times for 12 patients. The success rate of the first treatment modality to remove the common bile duct stones was 90.3% (176/195). The overall success rate of endoscopic common bile duct stones removal was 100%. Conclusions: In all patients, the common bile duct stones were removed successfully by endoscopy, and thus supporting the shift of recognizing common bile duct stones as a medical rather than surgical discase.

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내시경적 역행성 담췌관 조영술로 진단에 실패한 총담관결석에 대한 초음파내시경의 유용성 ( Diagnostic Utility of Endoscopic Ultrasonograpy (EUS) for Common Bile Duct (CBD) Stones not Confirmed by Endoscopic Retrograde Cholangiopancreatography (ERCP) ): Korean J Gastrointest Endosc 1999;19(3):394-401. Published online November 30, 1998

Abstract PDF: Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the best imaging procedure for the diagnosis of common bile duct (CBD) stones. But the difficulties of diagnosis are mostly due to problems involving cannulation, microlithiasis and pancreatitis etc. The diagnostic utility of endoscopic ultrasonography (EUS) for the diagnosis of CBD stones not detected by ERCP was retrogradely assessed in 8 patients. Methods: All the patients (N=98) underwent ERCP, and in the case where CBD stones were not confirmed by ERCP, EUS was performed. Final diagnosis was determined by ERCP with an endoscopic sphincterotomy (EST) or operative exploration. Results: 98 patients with CBD stones were studied. The first ERCP successfully imaged CBD stones in 90 patients and an EST was performed in 84 patients. In 6 patients, stones were removed through operative exploration. ERCP images were incomplete or of poor quality in 8 patients. EUS images were excellent or good in all 8 cases, where ERCP was ineffective. Factors associated with incomplete results for CBD stones included; inability to cannulate the ampulla of Vater (N=1), nonvisualized CBD (N=4), microlithiasis (N=2), and association with the periampullary fistula (N=1). The second ERCP and EST successfully confirmed the diagnosis of CBD stones in 6 patients. In 2 patients, operative exploration was needed to confirm the diagnosis of CBD stones. Conclusions: An EUS appears to be an accurate and useful diagnostic tool for assessing CBD stones in cases where an ERCP was ineffective. (Korean J Gastrointest Endosc 19: 394∼401, 1999)

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원저 : 담도 췌장 ; 담도계 담석과 십이지장 유두 주위부 게실과의 관계 ( Original Articles : Biliary Tract & Pancreas ; The Relationship between Biliary Calculi and Juxtapapillary Duodenal Diverticuli ): Korean J Gastrointest Endosc 1997;17(4):507-512. Published online November 30, 1996

Abstract PDF: Background
/Amins: Juxtapapillary duodenal diverticuli are often associated with biliary stones. The aim of this study was to investigate the prevalence of juxtapapillary duodenal diverticuli in biliary stones. Methods: Three hundred and thirteen patients underwent endoscopic retrograde cholangiopancreatography were studied prospectively. Results: Seventy-five patients had juxtapapillary duodennl diverticuli(24%). The occurrence of diver- ticuli increased with age and more commomly in female patients. The prevalence of diver- ticulii was higher in patients with commom bile duct stones(35.6% vs 17.6%; P 0.002) and gallbladder stones(33.3% vs 17.6%; P=0,001) than in patients without biliary stones (17.6%). Conclusions: We conclude that biliary stones are associated with juxtapapillary diverticuli. (Korean J Gastrointest Endosc 17: 507-512, 1997)

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원저 : 담도 췌장 ; 복강경 담낭 절제술에 있어서 내시경적 역행성 담췌관 조영술의 역할 ( Original Articles : Biliary Tract & Pancreas ; The Role of Endoscopic Retrograde Cholangiopancreatography in Laparoscopic Cholecystectomy ): Korean J Gastrointest Endosc 1997;17(1):15-22. Published online November 30, 1996

Abstract PDF: Background
/Aims: Perioperative endoscopic retrograde cholangiopancreatography (ERCP) and en copic sphincterotomy (EST) offer the ability to remove common bile duct (CBD) stones and it ean make laparoscopic cholecystectcqny possible instead of open cholecystectomy. Although ERCP accurately detects CBD stones, the associated financial costs and potential morbidity argue against its indiscriminate use. Thus, we undertook the current retrospective study to analyze our own experience in the identification of preoperative indicators of CBD stones in patients managed by laparoscopic cholecystectomy. Methods: Between October 1994 and October 1996, 503 laparoscopic cholecystectomy were performed at Samsung Medical Center. We analyzed the value of serum biochemical tests and findings of ultrasonography in patients ted by laparoscopic cholecystectomy. Results: A total of 117 patients underwent perigperative ERCP; 113 patients underwent preoperative ERCP with 2/113 (1.8%) failing to cannulate the ampulla; 21 patients (18.0%) had choledocholithiasis; and all patients with CBD stones were cleared by EST without major complications. The indication of ERCP for prediction of CBD stones were categorized as 4 groups; abnormal liver function tests (LFT) and duct dilatation in ultrasonography 61.9% (13/22), only abnormal liver function tests 13.6% (6/44), only duct dilatation in ultrasonography 5,9% (1/17), and normal liver function tests with normal findings in ultrasonopaphy 2.9% (1/35) in this study. In patients with CBD stones, there was no significant difference to predict CBD stones in total bilirubin, alkaline phosphatase, and alanine aminotransferase. Gallstone pancreatitis patients who had hyperamylasemia and abnornal LFT that were resolved or resolving before ERCP revealed no CBD stones (0/10, 0%). Conclusions: ERCP before laparoscopic cholecystectomy is needed in selected patients who have abnormal liver function and/or CBD dilatation on ultrasonography. Gallstone pancreatitis that is resalving or resolved clinically may not require preoperative ERCP. ERCP with EST and laparoscopic cholecystectomy is a safe and effective method for the management of symptomatic eholelithiasis and choledocholithiasis. (Korean J Gastrointest Endosc 17: 15~22, 1997)

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원저 : 악성종양에 의한 폐쇄성황달 및 폐쇄 상하부에 담관결석이 동반된 환자에서 Coil형 팽창성금속도관 ( Endocoil ) 삽관을 통한 치료 ( Original Articles : Successful Management by a New Self-expandable and Removable Metallic Coil Stent Insertion in a Case with Malignant Obstructive Jaundice Associated with CBD Stones at Below and Above the Stricture ): Korean J Gastrointest Endosc 1994;14(4):402-408. Published online November 30, 1993

Abstract PDF: Endoscopic retrograde biliary drainge is a useful method of palliative treatment of malignant biliary obstruction with respect to safety, rapidity in decompression of obstruction. However, despite of efforts to prolong patency of the stents, the main long term complication of current-widely used plastic endoprosthesis is to tendency for the stents to become clogged by sludge leading to recurrent jaundice and cholangitis, finally, obstruction of stents. Recently, in an effort to improve the patency of stent, variety of self-expandable metallic endoprosthesis have developed and which can be compressed into and inserted through small lumen catheter with large-bored lumen in expandable state. However, most of these open mesh of self-expandable stents allows tumor in growth which causes reobstruction, and additionally it is nearly impossible to retrieve the inserted prosthesis. Recently developed coil metal stent(Endocoil, Intent Co.), which, unlikely other previous metallic stent, has possibility of retrieving prosthesis and prevention of tumor ingrowth. We experienced a case of 52-year old male sufferd from malignant biliary obstruction due to recurrence of cancer at peripancreatic lymph nodes and combined with common bile duct stones on both proximal and distal side of the stricture, in whom Endocoil was implanted with sucessful decompression of obstruction and simultaneous removal of biliary stones located at both side of stricture.

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