Clinical Endoscopy

Case Reports

Esophageal Stricture Caused by the Ingestion of Undissolved Picosulfate Powder: Daehyun Kim, Byungha Cho, Jong Wook Choi, Ki Bae Kim, Seon Mee Park; Clin Endosc 2021;54(1):122-126. Published online March 16, 2020; DOI: https://doi.org/10.5946/ce.2019.206

Picosulfate solution is widely used as a small volume bowel cleansing agent and is considered to be effective and relatively safe. A case of a 75-year-old woman ingested picosulfate powder and drank a small volume of water, subsequently experienced severe burning pain in the chest. Endoscopy was performed and showed a submucosal hemorrhage and exudative ulcers at the mid to lower esophagus. At 2 weeks, her symptoms improved with conservative treatment. However, liquid food dysphagia developed 11 weeks after ingestion. A follow-up endoscopy revealed multiple esophageal strictures, which were treated with a fully covered metal stent and esophageal balloon dilation. Consequently, the esophageal strictures improved after one year. As this case demonstrates, detailed information about picosulfate powder ingestion after dissolving it in more than 200 mL of water should be presented to patients to avoid esophageal injury.

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Citric acid/magnesium oxide/sodium picosulfate

Reactions Weekly.2021; 1868(1): 140. CrossRef

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

Abstract PDF

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

Citations

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

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Papillary Cannulation Facilitated by Submucosal Saline Injection into an Intradiverticular Papilla: Kanglock Lee, Ji Wook Choi, Yunhyeong Lee, Joung-Ho Han, Seon Mee Park; Clin Endosc 2019;52(1):83-86. Published online June 12, 2018; DOI: https://doi.org/10.5946/ce.2018.060

Abstract PDF

Endoscopic retrograde cholangiopancreatography (ERCP) of the intradiverticular papilla with its invisible orifice remains challenging. Several techniques have been introduced to evert the papillary opening to facilitate cannulation. A 79-year-old woman with bile duct stones underwent ERCP, which revealed that the papilla was located inside a large diverticulum and tended to rotate inward with a trial of papillary cannulation. Submucosal papillary injection of 3 cc of normal saline was performed at 3 and 9 o’clock. Eversion and fixation of a papilla in the diverticulum with this technique allowed selective cannulation of the biliary tree. Stones were retrieved after endoscopic papillary balloon dilation without complications. She had an uneventful post-procedural course. Our findings suggest that submucosal saline injection technique is safe and effective for selective cannulation and can be recommended when cannulation is very difficult because of an intradiverticular papilla.

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Impact of Periampullary Diverticulum on ERCP Outcomes and Recurrence of Common Bile Duct Stones
Xiaoxi Xie, Yanni Li, Yonghao Chen, Chong Geng, Yaoyu Guo, Xiao Li, Chunhui Wang
Digestive Diseases and Sciences.2026; 71(2): 681. CrossRef
Biliary cannulation techniques: Optimizing success and minimizing risk
Aryan Jain, Mayur Pabba, Aditya Jain, Savita Madhankumar, Sahib Singh, Saurabh Chandan, Muhammad Khalid Hasan, Mustafa A Arain
World Journal of Gastrointestinal Endoscopy.2026;[Epub] CrossRef
Two-devices-in-one-channel method: a challenging cannulation of intradiverticular major papilla
Renato Medas, Eduardo Rodrigues-Pinto, Pedro Pereira, Guilherme Macedo
VideoGIE.2024; 9(3): 141. CrossRef
Periampullary submucosal saline injection to facilitate intradiverticular papillary biliary cannulation
Jad P. AbiMansour, Ryan J. Law
VideoGIE.2024; 9(8): 368. CrossRef
Endoclip-Assisted Cannulation for a Hidden Duodenal Papilla: Three Cases
Il Soon Jung, Ki Bae Kim, Jun Su Lee, Joung-Ho Han, Seon Mee Park
The Korean Journal of Pancreas and Biliary Tract.2024; 29(4): 167. CrossRef
A “One Accessory and One Guidewire-in-One Channel” Technique in a Patient with Billroth II Anastomosis
Kook Hyun Kim, Sung Bum Kim, Tae Nyeun Kim
Clinical Endoscopy.2021; 54(1): 139. CrossRef
Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: An Overview of Advanced Techniques
Brian M. Fung, Teodor C. Pitea, James H. Tabibian
EMJ Hepatology.2021; : 73. CrossRef
Make mission impossible successful: clip-with-line traction facilitates difficult pancreatic duct cannulation in a patient with duodenal duplication
Wei-hui Liu, Zhao-shen Li, Dong Wang
Endoscopy.2020; 52(09): E346. CrossRef

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

Abstract PDF

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

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A hidden cause of pancreatitis in a child with a previous choledochal cyst resection – Diving for pearls in bile duct remnant
F. Pereira Correia, C. Nunes, M. Ravara, F. Bordalo Ferreira, A. Mendes, G. Alexandrino, L. Carvalho Lourenço, D. Horta
Endoscopy.2023; 55(S 02): S22. CrossRef
Choledochal cysts – state of the art
Thanh Liem Nguyen, V. S. Cheremnov, Yu. A. Kozlov
Russian Journal of Pediatric Surgery.2021; 25(1): 37. CrossRef

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Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping: Keunmo Kim, Eun Bee Kim, Yong Hyeok Choi, Youngmin Oh, Joung-Ho Han, Seon Mee Park; Clin Endosc 2017;50(2):202-205. Published online September 13, 2016; DOI: https://doi.org/10.5946/ce.2016.112

Abstract PDF

Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP). We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL) and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm ovalshaped perforation was found at the lateral duodenal wall. We repaired the perforation by sequentially performing double EBL and endoclipping. The first EBL was performed at the proximal edge of the perforation orifice, and two-thirds of the perforation were repaired. The second EBL, which also included the contents covered under the first EBL, repaired the defect almost completely. Finally, to account for the possible presence of a residual perforation, an endoclip was applied at the distal end of the perforation. The detection and closure of the perforation were completed within 10 minutes. We suggest that double EBL is an effective method for closure.

Citations

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Endoscopic treatment of ERCP-related duodenal perforation
Nicole Evans, James L. Buxbaum
Techniques in Gastrointestinal Endoscopy.2019; 21(2): 83. CrossRef

11,553 View
192 Download
2 Web of Science
1 Crossref

Review

Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations: Seon Mee Park; Clin Endosc 2016;49(4):376-382. Published online July 29, 2016; DOI: https://doi.org/10.5946/ce.2016.088

Abstract PDF

The management strategy for endoscopic retrograde cholangiopancreatography-related duodenal perforation can be determined based on the site and extent of injury, the patient’s condition, and time to diagnosis. Most cases of perivaterian or bile duct perforation can be managed with a biliary stent or nasobiliary drainage. Duodenal wall perforations had been treated with immediate surgical repair. However, with the development of endoscopic devices and techniques, endoscopic closure has been reported to be a safe and effective treatment that uses through-the-scope clips, ligation band, fibrin glue, endoclips and endoloops, an over-the-scope clipping device, suturing devices, covering luminal stents, and open-pore film drainage. Endoscopic therapy could be instituted in selected patients in whom perforation was identified early or during the procedure. Early diagnosis, proper conservative management, and effective endoscopic closure are required for favorable outcomes of non-surgical management. If endoscopic treatment fails, or in the cases of clinical deterioration, prompt surgical management should be considered.

Citations

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Gastrointestinal Perforations During Endoscopy: Recognition and Management
Matthew T. Moyer, Brandon Rodgers, Rushin Brahmbhatt, Michael Deutsch
Gastrointestinal Endoscopy Clinics of North America.2026; 36(2): 279. CrossRef
Approach to the Patient with a Gastrointestinal Perforation
Fredy Nehme, Phillip S. Ge
Gastrointestinal Endoscopy Clinics of North America.2026; 36(2): 301. CrossRef
Endoscopic Duodenal Stenting for Iatrogenic Stapfer Type I Duodenal Perforation: An Alternative to Surgical Repair
Ishraq Joarder, Shukria Ahmadi, Fahd Jowhari
Cureus.2025;[Epub] CrossRef
Endoscopic retrograde cholangiopancreatography—related duodenal perforations in the modern era of advanced endoscopy
Scot M. Lewey
Gastrointestinal Endoscopy.2025; 102(1): 106. CrossRef
ERCP-induced perforation: review and revisit after half a century
Abdel Rahman A. A. Al Manasra, Zaid Mesmar, Tarek Manasreh, Hanan M . Hammouri, Anas Husein, Khaled Jadallah, Mohammed Bani hani, Niazy Abu Farsakh, Shatha K. Shahwan, Doaa Al-qaoud, Jehad Fataftah
F1000Research.2024; 12: 612. CrossRef
Stapfer I and II duodenal perforations after endoscopic procedures: how surgical delay impacts outcomes
Quentin Chenevas-Paule, Anaïs Palen, Marc Giovannini, Jacques Ewald, Jean Philippe Ratone, Fabrice Caillol, Solène Hoibian, Yanis Dahel, Olivier Turrini, Jonathan Garnier
Surgical Endoscopy.2024; 38(11): 6614. CrossRef
ERCP-induced perforation: review and revisit after half a century
Abdel Rahman A. A. Al Manasra, Zaid Mesmar, Tarek Manasreh, Hanan M . Hammouri, Anas Husein, Khaled Jadallah, Mohammed Bani hani, Niazy Abu Farsakh, Shatha K. Shahwan, Doaa Al-qaoud, Jehad Fataftah
F1000Research.2023; 12: 612. CrossRef
Traitement instrumental endoscopique des pathologies biliaires intra- et extrahépatiques
A. Hedjoudje, F. Prat
EMC - Hépatologie.2023; 38(3): 1. CrossRef
Fully covered self-expandable metal stent for intraprocedural or late-diagnosed Type-II endoscopic retrograde cholangiopancreatography-related perforations
Osman Bozbiyik, Bartu Cetin, Tufan Gumus, Fatih Tekin, Alper Uguz
BMC Gastroenterology.2022;[Epub] CrossRef
Clinical analysis of 45 cases of perforation were identified during endoscopic retrograde cholangiopancreatography procedure
Yin-Shui Miao, Yuan-Yuan Li, Bo-Wen Cheng, Yan-Fang Zhan, Sheng Zeng, Xiao-Jiang Zhou, You-Xiang Chen, Nong-Hua Lv, Guo-Hua Li
Frontiers in Medicine.2022;[Epub] CrossRef
AGA Clinical Practice Update on Endoscopic Management of Perforations in Gastrointestinal Tract: Expert Review
Jeffrey H. Lee, Prashant Kedia, Stavros N. Stavropoulos, David Carr-Locke
Clinical Gastroenterology and Hepatology.2021; 19(11): 2252. CrossRef
Evaluation of complications after endoscopic retrograde cholangiopancreatography using a short type double balloon endoscope in patients with altered gastrointestinal anatomy: a single‐center retrospective study of 1,576 procedures
Mitsuo Tokuhara, Masaaki Shimatani, Toshiyuki Mitsuyama, Masataka Masuda, Takashi Ito, Sachi Miyamoto, Norimasa Fukata, Hideaki Miyoshi, Tsukasa Ikeura, Makoto Takaoka, Katsuyasu Kouda, Kazuichi Okazaki
Journal of Gastroenterology and Hepatology.2020; 35(8): 1387. CrossRef
Retracted: Endoscopic Treatment of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforations
Ding Shi, Jian feng Yang, Yong pan Liu
Journal of Laparoendoscopic & Advanced Surgical Techniques.2019; 29(3): 385. CrossRef
Duodenal perforation after the cutting an ENPD tube in a patient with pancreatic cancer and acute suppurative pancreatic ductitis
Akihisa OHNO, Nao FUJIMORI, Kazuhide MATSUMOTO, Katsuhito TERAMATSU, Yu TAKAMATSU, Masami MIKI, Takehiro TAKAOKA, Takamasa OONO
Suizo.2019; 34(1): 30. CrossRef
Endoscopic treatment of ERCP-related duodenal perforation
Nicole Evans, James L. Buxbaum
Techniques in Gastrointestinal Endoscopy.2019; 21(2): 83. CrossRef
Endoscopic management of iatrogenic gastrointestinal perforations
Kan Wang, Jihao Shi, Linna Ye
Laparoscopic, Endoscopic and Robotic Surgery.2019; 2(2): 41. CrossRef
The Management of Duodenal Perforation: Change Over Time. A Case Series and Literature Review
Amit Nehra, Rajesh Godara
Hellenic Journal of Surgery.2019; 91(5-6): 159. CrossRef
A Case of Unresolved and Worsening Retroperitoneal Abscess
Raghav Bansal, Mohamed Barakat, Soohwan Chun, Sonam Rosberger, Joel Baum, Melik Tiba
Case Reports in Gastrointestinal Medicine.2018; 2018: 1. CrossRef
On the feasibility of the computational modelling of the endoluminal vacuum-assisted closure of an oesophageal anastomotic leakage
Ester Comellas, Facundo J. Bellomo, Iván Rosales, Luis F. del Castillo, Ricardo Sánchez, Pau Turon, Sergio Oller
Royal Society Open Science.2018; 5(2): 171289. CrossRef
Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies
Paul R. Tarnasky, Prashant Kedia
International Journal of Gastrointestinal Intervention.2017; 6(1): 37. CrossRef
A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system
Roberto Cirocchi, Michael Denis Kelly, Ewen A. Griffiths, Renata Tabola, Massimo Sartelli, Luigi Carlini, Stefania Ghersi, Salomone Di Saverio
The Surgeon.2017; 15(6): 379. CrossRef

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Original Articles

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

Abstract PDF

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

Citations

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

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

Abstract PDF

Background/Aims

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

Methods

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

Results

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

Conclusions

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

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Endoscopic biliary drainage in patients with surgically altered anatomy: the Street multicenter study
Aurelio Mauro, Giuseppe Vanella, Vincenzo Giorgio Mirante, Alessandro Fugazza, Cecilia Binda, Luca Elli, Edoardo Forti, Roberto Di Mitri, Debora Berretti, Helga Bertani, Mariangela Delliponti, Federico Desideri, Virginia Ferretti, Roberto Grassia, Roberto
Gastrointestinal Endoscopy.2026; 103(1): 111. CrossRef
Usefulness of the clip-with-line method for difficult biliary cannulation in Billroth II gastrectomy
Shiyu Ou, Caijie Xu, Zhixin Chen, Zhongzhuan Li, Ling Du
European Journal of Gastroenterology & Hepatology.2026; 38(4): 517. CrossRef
A “One Accessory and One Guidewire-in-One Channel” Technique in a Patient with Billroth II Anastomosis
Kook Hyun Kim, Sung Bum Kim, Tae Nyeun Kim
Clinical Endoscopy.2021; 54(1): 139. CrossRef
Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction: An esophagogastroduodenoscope or a colonoscope?
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Takuto Hikichi, Hiromasa Ohira
World Journal of Gastrointestinal Endoscopy.2020; 12(8): 220. CrossRef
Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review
Tae Young Park, Tae Jun Song
World Journal of Gastroenterology.2019; 25(24): 3091. CrossRef
Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article
Rabbinu Rangga Pribadi, Abdul Aziz Rani, Murdani Abdullah
Journal of Digestive Diseases.2019; 20(12): 631. CrossRef
Endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: Outcomes and potential factors affecting technical failure
Jia-Su Li, Duo-Wu Zou, Zhen-Dong Jin, Jie Chen, Xin-Gang Shi, Zhao-Shen Li, Feng Liu
Saudi Journal of Gastroenterology.2019; 25(6): 355. CrossRef
Endoscopic Management of Difficult Bile Duct Stones
Murad Aburajab, Kulwinder Dua
Current Gastroenterology Reports.2018;[Epub] CrossRef
Forward-viewing endoscope for ERCP in patients with Billroth II gastrectomy: a systematic review and meta-analysis
Tae Young Park, Chang Seok Bang, Sang Hyeon Choi, Young Joo Yang, Suk Pyo Shin, Ki Tae Suk, Gwang Ho Baik, Dong Joon Kim, Jai Hoon Yoon
Surgical Endoscopy.2018; 32(11): 4598. CrossRef
Self-expandable metal stents for choledocholithiasis in Billroth II gastrectomy patients
Min-Gui Han, Eunae Cho, Chang-Hwan Park, Chung-Hwan Jun, Seon-Young Park
Hepatobiliary & Pancreatic Diseases International.2018; 17(6): 546. CrossRef
Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations
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Diagnostic Accuracy of the Initial Endoscopy for Ampullary Tumors: Hee Seung Lee, Jong Soon Jang, Seungho Lee, Myeong Ho Yeon, Ki Bae Kim, Jae Geun Park, Joo Young Lee, Mi Jin Kim, Joung-Ho Han, Rohyun Sung, Seon Mee Park; Clin Endosc 2015;48(3):239-246. Published online May 29, 2015; DOI: https://doi.org/10.5946/ce.2015.48.3.239

Abstract PDF

Background/Aims

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

Methods

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

Results

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

Conclusions

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

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Yu. G. Starkov, A. I. Vagapov, S. V. Dzhantukhanova, R. D. Zamolodchikov
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S Shen, X Zhang, D Tang, J H Zhu, Y Cao, X Wang, J Yao, Q Zhan, W J Li, L Wang
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Shushi YAMAMOTO, Toshikazu SAKAI, Kenjiro MIYOSHI, Takaharu ITAMI, Mishio DANJOU, Wang HSINCHEN, Yuji HAMAMOTO, Eunryel NAM, Mitsuhiro ISAKA, Shidow TORISU
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Endoscopic Management of Ampullary Adenomas: A Comprehensive Review
Minh Thu T. Nguyen, Ruchir Paladiya, Dushyant Singh Dahiya, Murali Dharan
Journal of Clinical Medicine.2025; 14(10): 3532. CrossRef
The Brescia International Multidisciplinary Consensus Guidelines on the Optimal Pathology Assessment and Multidisciplinary Pathways of Non‐Pancreatic Neoplasms in and Around the Ampulla of Vater (PERIPAN)
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Il Sang Shin, Yun Nah Lee, Jong Ho Moon
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Xin Chen, Jie Huang, Xiaoli Chen, Qingqing Luo, Min Gao, Jiaguo Wu, Xingkang He, Jincheng Wang
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29 Crossref

Case Reports

Abdominal Compartment Syndrome in Severe Acute Pancreatitis Treated with Percutaneous Catheter Drainage: Soonyoung Park, Seungho Lee, Hyo Deok Lee, Min Kim, Kyeongmin Kim, Yusook Jeong, Seon Mee Park; Clin Endosc 2014;47(5):469-472. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.469

Abstract PDF

Acute pancreatitis is one of the main causes of intra-abdominal hypertension (IAH). IAH contributes to multiple physiologic alterations and leads to the development of abdominal compartment syndrome (ACS) that induces multiorgan failure. We report a case of ACS in a patient with severe acute pancreatitis. A 44-year-old man who was admitted in a drunk state was found to have severe acute pancreatitis. During management with fluid resuscitation in an intensive care unit, drowsy mentality, respiratory acidosis, shock requiring inotropes, and oliguria developed in the patient, with his abdomen tensely distended. With a presumptive diagnosis of ACS, abdominal decompression through percutaneous catheter drainage was performed immediately. The intraperitoneal pressure measured with a drainage catheter was 31 mm Hg. After abdominal decompression, the multiorgan failure was reversed. We present a case of ACS managed with percutaneous catheter decompression.

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Mark Tokarev, Ivan Semenenko, Alina Zelenskaia, Baina Komiyukova, Viacheslav Shibitov
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International Association of Pancreatology Revised Guidelines on Acute Pancreatitis 2025: Supported and Endorsed by the American Pancreatic Association, European Pancreatic Club, Indian Pancreas Club, and Japan Pancreas Society
Andrea Párniczky, Alexandra Mikó, Aliye Uc, Anand Narayan Singh, Anshuman Elhence, Ashok Saluja, Atsushi Masamune, Barham K. Abu Dayyeh, Brian Davidson, Charles Mel Wilcox, Chris Forsmark, David Whitcomb, Deepak Gunjan, Dhiraj Yadav, Djuna Cahen, D. Nages
Pancreatology.2025; 25(6): 770. CrossRef
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Subhash Chander, Marco A. Bracamonte, Newton B. Neidert, Samuel I. Garcia
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Rita Jacobs, Robert D. Wise, Ivan Myatchin, Domien Vanhonacker, Andrea Minini, Michael Mekeirele, Andrew W. Kirkpatrick, Bruno M. Pereira, Michael Sugrue, Bart De Keulenaer, Zsolt Bodnar, Stefan Acosta, Janeth Ejike, Salar Tayebi, Johan Stiens, Colin Cord
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10 Crossref

A Case of Choledocholithiasis and Intestinal Malrotation in an Adolescent with Repaired Gastroschisis: Byung Chul Kim, Ki Bae Kim, Eui Joong Kim, Soonyoung Park, Dong-Hwa Lee, Eun Bee Kim, Hee Bok Chae, Seon Mee Park; Clin Endosc 2014;47(2):201-204. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.201

Abstract PDF

Most infants with repaired gastroschisis develop normally and remain in good health. About 10% of patients with gastroschisis have other malformations. We report a case of choledocholithiasis and intestinal malrotation in an adolescent with repaired gastroschisis. A 17-year-old girl presented with fever, jaundice, and abdominal pain. She had undergone an operation to repair gastroschisis at birth. Physical examination revealed icteric sclera, a tight abdominal wall, and a longitudinal surgical scar at the midline. An abdominal computed tomography scan revealed a round calcifying lesion near the pancreas and a midline-positioned liver and gallbladder. Absence of the retroperitoneal duodenum and the anterior and left-sided position of the superior mesenteric vein compared with the superior mesenteric artery were observed. Results of abarium examination revealed intestinal malrotation. Endoscopic retrograde cholangiopancreatography revealed diffuse dilatation of the biliary trees and a malpositioned gallbladder. A single stone was removed by using a basket. The clinical symptoms improved after the patient underwent endoscopic retrograde cholangiopancreatography.

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Delayed Presentation of Malrotation after Infancy: A Systematic Review Based on Clinical Presentations, Associated Anomalies, Diagnosis, and Management
Charu Sharma, Nitinkumar Bhajandas Borkar, C. Ashwin, Chandrasen Sinha
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Unusual Aspect of a Choledocholithiasis
Matthias Breidert, Markus Weber, Stefan Wildi
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7,443 View
55 Download
1 Web of Science
2 Crossref

Erratum

Erratum: 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(4):453-453. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.453; Corrects: Clin Endosc 2012;45(2):155

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Original Article

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

Abstract PDF

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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Noticement

Noticement: Comparison of Midazolam Alone versus Midazolam Plus Propofol during Endoscopic Submucosal Dissection: Young Shim Cho, Euikeun Seo, Jung-Ho Han, Soon Man Yoon, Hee Bok Chae, Seon Mee Park, Sei Jin Youn; Clin Endosc 2012;45(1):108-108. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.108; Retracts: Clin Endosc 2011;44(1):22

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Conscious sedation using propofol versus midazolam in cirrhotic patients during upper GI endoscopy: A comparative study
Essam A Wahab, Emad F Hamed, Hanan S Ahmad, Sameh M Abdel Monem, Talaat Fathy
JGH Open.2019; 3(1): 25. CrossRef

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Original Article

Comparison of Midazolam Alone versus Midazolam Plus Propofol during Endoscopic Submucosal Dissection: Young Shim Cho, Euikeun Seo, Jung-Ho Han, Soon Man Yoon, Hee Bok Chae, Seon Mee Park, Sei Jin Youn; Clin Endosc 2011;44(1):22-26. Published online September 30, 2011; DOI: https://doi.org/10.5946/ce.2011.44.1.22; Retraction in: Clin Endosc 2012;45(1):108

8,580 View
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