Original Article
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Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
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Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
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Clin Endosc 2024;57(2):226-236. Published online January 26, 2024
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DOI: https://doi.org/10.5946/ce.2023.128
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- Background
/Aims: This study aimed to compare the safety of the double-guidewire technique (DGT) with that of the conventional single-guidewire technique (SGT) in real-world situations.
Methods
A total of 240 patients with naïve papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Daegu Catholic University Medical Center between January 2021 and December 2021 were included. The primary outcome was the rate of post-ERCP pancreatitis (PEP) in the SGT and DGT groups.
Results
A total of 163 patients (67.9%) belonged to the SGT group, and 77 (32.1%) belonged to the DGT group. The rates of successful biliary cannulation were 95.7% and 83.1% in the SGT and DGT groups, respectively (p=0.002). In the study group, PEP occurred in 14 patients (5.8%). The PEP rates were not significantly different between the SGT and DGT groups (4.3% vs. 9.1%, p=0.150). In the multivariate analysis, the age of <50 years (odds ratio [OR], 9.305; 95% confidence interval [CI], 1.367–63.358; p=0.023) and hyperlipidemia (OR, 7.384; 95% CI, 1.103–49.424; p=0.039) were significant risk factors for PEP in the DGT group.
Conclusions
DGT did not increase the PEP rate in patients with naïve papilla. In addition, the age of <50 years and hyperlipidemia were significant risk factors for PEP in the DGT group.
Case Reports
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A Case of Concurrent Ampullary Adenoma and Gangliocytic Paraganglioma at the Minor Papilla Treated with Endoscopic Resection
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Jun Kwon Ko, Do Hyun Park, Hee Sang Hwang
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Clin Endosc 2019;52(4):382-386. Published online April 12, 2019
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DOI: https://doi.org/10.5946/ce.2018.198
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- A gangliocytic paraganglioma is a benign tumor of the digestive system with a very low incidence. The tumor is histopathologically characterized by a triphasic pattern consisting of epithelioid, ganglion, and spindle-shaped Schwann cells. In most cases, it occurs in the second portion of the duodenum near the ampulla of Vater. We report a case of a gangliocytic paraganglioma occurring at the minor duodenal papilla (a rare location) with a concurrent adenoma of the ampulla of Vater. Both lesions were treated simultaneously using endoscopic resection. Additionally, we have presented a literature review.
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Citations
Citations to this article as recorded by

- Estrategia de manejo quirúrgico en tumores de bajo potencial maligno de localización ampular. Presentación de un caso de paraganglioma gangliocítico
Victoria Lucas Guerrero, Anna González Costa, Andreu Romaguera Monzonis, Natalia Bejarano González, Francisco García Borobia
Cirugía Española.2021; 99(8): 621. CrossRef - Endoscopic Mucosal Resection of Adenocarcinoma at the Minor Duodenal Papilla: A Case Report and Suggestions for the Optimal Treatment Strategy
Takao Sato, Ryota Sagami, Hidefumi Nishikiori, Hiroaki Tsuji, Keiji Sato, Tsutomu Daa, Kazunari Murakami
Internal Medicine.2021; 60(16): 2593. CrossRef - Surgical management strategy in ampullary tumors with low malignant potential: Presentation of a patient with a gangliocytic paraganglioma
Victoria Lucas Guerrero, Anna González Costa, Andreu Romaguera Monzonis, Natalia Bejarano González, Francisco García Borobia
Cirugía Española (English Edition).2021; 99(8): 621. CrossRef
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Papillary Cannulation Facilitated by Submucosal Saline Injection into an Intradiverticular Papilla
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Kanglock Lee, Ji Wook Choi, Yunhyeong Lee, Joung-Ho Han, Seon Mee Park
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Clin Endosc 2019;52(1):83-86. Published online June 12, 2018
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DOI: https://doi.org/10.5946/ce.2018.060
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- 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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Citations
Citations to this article as recorded by

- 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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Acute Pancreatitis Following Endoscopic Ampullary Biopsies without Attempted Cannulation of the Ampulla of Vater
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Spyridon Michopoulos, Dimitra Kozompoli, Sparti Ntai, Georgios Kalantzis, Evanthia Zampeli, Kalliopi Petraki
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Clin Endosc 2016;49(6):575-578. Published online July 20, 2016
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DOI: https://doi.org/10.5946/ce.2016.043
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- A 51-year-old man underwent diagnostic work-up for an abnormal-appearing ampulla of Vater. Three hours after biopsy of the ampulla, the patient presented with intense symptoms suggesting acute pancreatitis, which was later confirmed with laboratory and radiographic examinations. Other causes were excluded and the acute pancreatitis was considered a procedural complication. This is a rarely reported complication that must be taken into consideration when biopsies are performed in the ampulla of Vater.
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Citations
Citations to this article as recorded by

- Readmission rate and complications following biopsy of the ampulla of Vater—A retrospective data analysis
Sam Rosella, Leonardo Zorron Cheng Tao Pu, Jonathan Ng, Kim Hay Be, Rhys Vaughan, Sujievvan Chandran, Marios Efthymiou
JGH Open.2023; 7(4): 299. CrossRef - Acute pancreatitis following endoscopic ampullary biopsy: A case report
Nidhi Mariam George, Nanda Amarnath Rajesh, Tharun Ganapathy Chitrambalam
World Journal of Gastrointestinal Endoscopy.2023; 15(8): 540. CrossRef - Endoscopic management of duodenal adenomatosis in familial adenomatous polyposis—A case‐based review
E. Soons, T. M. Bisseling, M. C. A. van Kouwen, G. Möslein, P. D. Siersema
United European Gastroenterology Journal.2021; 9(4): 461. CrossRef - Two Cases of Severe Acute Pancreatitis Following Duodenal Papillary Biopsy
Yu Ishibashi, Tomohisa Iwai, Eiji Miyata, Rikiya Hasegawa, Toru Kaneko, Koji Yamauchi, Kosuke Okuwaki, Hiroshi Imaizumi, Mitsuhiro Kida, Wasaburo Koizumi
Progress of Digestive Endoscopy.2018; 92(1): 108. CrossRef
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Focused Review Series: Advanced Endoscopic Treatment for Pancreaticobiliary Diseases
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Recent Advances in Endoscopic Papillectomy for Ampulla of Vater Tumors: Endoscopic Ultrasonography, Intraductal Ultrasonography, and Pancreatic Stent Placement
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Jimin Han, Dong Wook Lee, Ho Gak Kim
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Clin Endosc 2015;48(1):24-30. Published online January 31, 2015
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DOI: https://doi.org/10.5946/ce.2015.48.1.24
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Since it was first described nearly three decades ago, endoscopic papillectomy (EP) has been utilized as a less invasive, alternative therapy for adenoma of the major duodenal papilla. In this article, we review the recent advances in EP, especially those pertaining to endoscopic ultrasonography (EUS), intraductal ultrasonography (IDUS), and pancreatic stent placement for the prevention of postpapillectomy pancreatitis. Because EUS and IDUS have similar diagnostic accuracies, either modality can be used for the preprocedural evaluation of ampullary tumors. Nevertheless, further technical refinements are required for a more precise evaluation. Given the paucity of data on the usefulness of EUS and/or IDUS during follow-up after EP, a well-designed study is warranted. Furthermore, pancreatic stent placement appears to have a protective effect against postpapillectomy pancreatitis; however, a prospective, randomized, controlled study with a larger number of patients is needed to assess this finding. Moreover, since pancreatic stent placement after EP is not always successful, various novel techniques have been developed to ensure reliable stent placement. Despite the recent advances in EP, further technical refinements and studies are needed to confirm their efficacy.
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Citations
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- International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Clinical Endoscopy.2024; 57(2): 141. CrossRef - IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
The Korean Journal of Gastroenterology.2024; 83(6): 217. CrossRef - International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Gut and Liver.2024; 18(5): 764. CrossRef - Effect of prophylactic endoscopic clipping for prevention of delayed bleeding after endoscopic papillectomy for ampullary neoplasm: a multicenter randomized trial
Se Woo Park, Tae Jun Song, Jin Seok Park, Jae Hyuk Jun, Tae Young Park, Dong Wook Oh, Sang Soo Lee, Myung-Hwan Kim
Endoscopy.2022; 54(08): 787. CrossRef - Efficacy analysis of hemostatic spray following endoscopic papillectomy: A multicenter comparative study
Kyong Joo Lee, Tae Hoon Lee, Jae Hee Cho, Jong Jin Hyun, Sung Ill Jang, Seok Jeong, Jin‐Seok Park, Jae Kook Yang, Don Haeng Lee, Dong Ki Lee, Sang Heum Park
Journal of Gastroenterology and Hepatology.2022; 37(11): 2138. CrossRef
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Original Article
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Endosonographic Preoperative Evaluation for Tumors of the Ampulla of Vater Using Endoscopic Ultrasonography and Intraductal Ultrasonography
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Naoki Okano, Yoshinori Igarashi, Seiichi Hara, Kensuke Takuma, Itaru Kamata, Yui Kishimoto, Takahiko Mimura, Ken Ito, Yasukiyo Sumino
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Clin Endosc 2014;47(2):174-177. Published online March 31, 2014
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DOI: https://doi.org/10.5946/ce.2014.47.2.174
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- Background/Aims
In recent years, endoscopic snare papillectomy has been performed to treat tumors of the ampulla of Vater. This procedure requires accurate preoperative evaluation. In this study, we diagnosed the focal extension of such tumors by using endoscopic ultrasonography (EUS) and intraductal ultrasonography (IDUS), and examined the indications for endoscopic snare papillectomy.
MethodsThe subjects were 48 patients with a papillary tumor (13 patients, surgical resection; 35 patients, endoscopic snare papillectomy) who were evaluated preoperatively with EUS and IDUS. The tumor-node-metastasis classification was used for the endosonographic evaluation and pathological diagnosis of these tumors.
ResultsThe diagnostic accuracy of EUS was 97% for diagnosing adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 50% for pT3-4 tumors, for an overall accuracy of 85% for T-staging. The diagnostic accuracy of IDUS was 94% for adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 100% for pT3-4 tumors, for an overall accuracy of 80% for T-staging.
ConclusionsEUS and IDUS are highly capable of evaluating tumors of the ampulla of Vater preoperatively. However, these techniques are not sufficient for evaluating the focal extension of carcinomas preoperatively. Currently, endoscopic snare papillectomy is adequate for treating adenomas and pTis tumors.
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Citations
Citations to this article as recorded by

- The Role of Endoscopic Ultrasound in Ampullary Lesion Management
Caterina Stornello, Chiara Cristofori, Davide Checchin, Maria Grazia de Palo, Sabina Grillo, Giulia Peserico, Dario Quintini, Mario Gruppo, Ottavia De Simoni, Alberto Fantin
Diagnostics.2024; 14(17): 1855. CrossRef - Clinical practice guidelines for endoscopic papillectomy
Takao Itoi, Shomei Ryozawa, Akio Katanuma, Hiroki Kawashima, Eisuke Iwasaki, Shinichi Hashimoto, Kenjiro Yamamoto, Toshiharu Ueki, Yoshinori Igarashi, Kazuo Inui, Naotaka Fujita, Kazuma Fujimoto
Digestive Endoscopy.2022; 34(3): 394. CrossRef - Diagnostic accuracy of endoscopic ultrasound and intraductal ultrasonography for assessment of ampullary tumors: a meta-analysis
Xiaohua Ye, Lei Wang, Zhendong Jin
Scandinavian Journal of Gastroenterology.2022; 57(10): 1158. CrossRef - The Long-Term Outcomes of Endoscopic Papillectomy and Management of Cases of Incomplete Resection: A Single-Center Study
Shinichiro Muro, Hironari Kato, Akihiro Matsumi, Yuki Ishihara, Yosuke Saragai, Shuntaro Yabe, Saimon Takata, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Shigeru Horiguchi, Hiroyuki Okada
Journal of Gastrointestinal Surgery.2021; 25(5): 1247. CrossRef - Endoscopic papillectomy for ampullary adenoma and early adenocarcinoma: Analysis of factors related to treatment outcome and long‐term prognosis
Hiroki Kawashima, Eizaburo Ohno, Takuya Ishikawa, Tadashi Iida, Hiroyuki Tanaka, Kazuhiro Furukawa, Masanao Nakamura, Takashi Honda, Senju Hashimoto, Akihiro Itoh, Masatoshi Ishigami, Yoshiki Hirooka, Mitsuhiro Fujishiro
Digestive Endoscopy.2021; 33(5): 858. CrossRef - Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Geoffroy Vanbiervliet, Marin Strijker, Marianna Arvanitakis, Arthur Aelvoet, Urban Arnelo, Torsten Beyna, Olivier Busch, Pierre H. Deprez, Lumir Kunovsky, Alberto Larghi, Gianpiero Manes, Alan Moss, Bertrand Napoleon, Manu Nayar, Enrique Pérez-Cuadrado-Ro
Endoscopy.2021; 53(04): 429. CrossRef - Endoscopic Mucosal Resection of Adenocarcinoma at the Minor Duodenal Papilla: A Case Report and Suggestions for the Optimal Treatment Strategy
Takao Sato, Ryota Sagami, Hidefumi Nishikiori, Hiroaki Tsuji, Keiji Sato, Tsutomu Daa, Kazunari Murakami
Internal Medicine.2021; 60(16): 2593. CrossRef - Management of obstructive jaundice in patients with neoplasms of the major duodenal papilla
Yu.S. Teterin, L.R. Tigiev, P.A. Yartsev, E.V. Stepan, M.L. Rogal, Yu.D. Kulikov
Khirurgiya. Zhurnal im. N.I. Pirogova.2021; (7): 49. CrossRef - A duodenal ampullary tumor with malignant transformation of papillary polyps: a case report and literature review
Wenhui Mo, Jingjing Li, Ying Dai, Jianqing Chen, Xuanfu Xu
Journal of International Medical Research.2021;[Epub] CrossRef - Methods and outcome of the endoscopic treatment of ampullary tumors
Jan-Werner Poley, Sara Campos
Therapeutic Advances in Gastrointestinal Endoscopy.2020; 13: 263177451989978. CrossRef - Insights and updates on endoscopic papillectomy
Kenjiro Yamamoto, Eisuke Iwasaki, Takao Itoi
Expert Review of Gastroenterology & Hepatology.2020; 14(6): 435. CrossRef - A Comprehensive Approach to the Management of Benign and Malignant Ampullary Lesions: Management in Hereditary and Sporadic Settings
Donald R. Campbell, Jeffrey H. Lee
Current Gastroenterology Reports.2020;[Epub] CrossRef - Preliminary experience of hybrid endoscopic submucosal dissection by duodenoscope for recurrent laterally spreading papillary lesions
Zi-Kai Wang, Fang Liu, Yun Wang, Xiang-Dong Wang, Ping Tang, Wen Li
World Journal of Gastroenterology.2020; 26(37): 5673. CrossRef - Clinical outcomes of ampullary neoplasms in resected margin positive or uncertain cases after endoscopic papillectomy
Arata Sakai, Masahiro Tsujimae, Atsuhiro Masuda, Takao Iemoto, Shigeto Ashina, Kohei Yamakawa, Takeshi Tanaka, Shunta Tanaka, Yasutaka Yamada, Ryota Nakano, Yu Sato, Manabu Kurosawa, Takuya Ikegawa, Seiji Fujigaki, Takashi Kobayashi, Hideyuki Shiomi, Yosh
World Journal of Gastroenterology.2019; 25(11): 1387. CrossRef - Surgical method choice and coincidence rate of pathological diagnoses in transduodenal ampullectomy: A retrospective case series study and review of the literature
Feng Liu, Jia-Lin Cheng, Jing Cui, Zong-Zhen Xu, Zhen Fu, Ju Liu, Hu Tian
World Journal of Clinical Cases.2019; 7(6): 717. CrossRef - Endoscopic management of ampullary neoplasm
Sunguk Jang
International Journal of Gastrointestinal Intervention.2019; 8(3): 110. CrossRef - Comparison of postoperative early and late complications between pancreas-sparing duodenectomy and pancreatoduodenectomy
Yusuke Nakayama, Masaru Konishi, Naoto Gotohda, Yuichiro Kato, Hidetoshi Aizawa, Masashi Kudo, Satoshi Okubo, Daigoro Takahashi, Yasunori Nishida, Kazuhiko Kitaguchi, Shinichiro Takahashi
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P. Ah-Soune, J. -M. Gonzalez, A. Benezech, M. Barthet
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Ernesto Quaresma Mendonça, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura, Dalton Marques Chaves, André Kondo, Leonardo Zorrón Cheng Tao Pu, Felipe Iankelevich Baracat
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Jimin Han, Dong Wook Lee, Ho Gak Kim
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Krishnavel V. Chathadi, Mouen A. Khashab, Ruben D. Acosta, Vinay Chandrasekhara, Mohamad A. Eloubeidi, Ashley L. Faulx, Lisa Fonkalsrud, Jenifer R. Lightdale, John R. Saltzman, Aasma Shaukat, Amy Wang, Brooks D. Cash, John M. DeWitt
Gastrointestinal Endoscopy.2015; 82(5): 773. CrossRef - Endoscopic Diagnosis of Ampullary Tumors Using Conventional Endoscopic Ultrasonography and Intraductal Ultrasonography in the Era of Endoscopic Papillectomy: Advantages and Limitations
Jong Ho Moon
Clinical Endoscopy.2014; 47(2): 127. CrossRef
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Case Report
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A Case of Enteritis Cystica Profunda in the Ampulla of Vater Mimicking Choledochocele
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Kyoung Wan You, Sang Wook Park, Geum Soo Lee, Du Jin Kim, Hyeung Cheol Moon, Gun Young Hong
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Clin Endosc 2013;46(2):178-181. Published online March 31, 2013
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DOI: https://doi.org/10.5946/ce.2013.46.2.178
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Enteritis cystica profunda is a very rare disease in which a mucin-filled cystic space is surrounded partially with nonneoplastic columnar epithelium in the submucosa of the small intestine. Most of the cases are accompanied by intestinal diseases, and the disease usually occurs in the jejunum and the ileum and there has been no report of a case that occurred in the ampulla of Vater. A 58-year-old healthy female patient without any particular symptom visited the hospital to get additional examination for a mass found on the ampulla of Vater by accident. In esophagogastroduodenoscopy, a cystic mass showing a positive pillow sign was found on the ampulla of Vater. Endoscopic retrogradecholangiopancreatography was conducted as choledochocele was suspected, but no abnormality was found in the biliary system. In endoscopic ultrasonography, multiseptated cystic structures were detected in the submucosal layer of the duodenum. The lesion was resected completely through endoscopic snare polypectomy and the case was histologically diagnosed as enteritis cystica profunda.
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Citations
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- Bowel Obstruction Due to the Mesenteric Mass Being an Enteritis Cystica Profunda: A Case Report
Meshael S Albahli, Fares Ali M Aljarallah, Ali K Alshaya, Nourah Alabdulaaly, Khaled Altoukhi, Haider A Alshurafa
Cureus.2025;[Epub] CrossRef - Enteritis cystica profunda: Case report and literature review
Ricardo E. Núñez-Rocha, Felipe Girón, Mario Latiff, Carlos Eduardo Rey, Lina Rodríguez, Juan David Hernández
International Journal of Surgery Case Reports.2023; 106: 108148. CrossRef - Enteritis cystica profunda with lipoma in the second portion of the duodenum: a case report
Beom Jin Shim, Seung Keun Park, Hee Ug Park, Tae Young Park
Journal of Yeungnam Medical Science.2022; 39(1): 72. CrossRef - Ulcerated choledochocele: A case report
E. Ray-Offor, S.N. Elenwo, P.O. Igwe, C. Ngeribara
International Journal of Surgery Case Reports.2016; 28: 42. CrossRef - A Case of Enteritis Cystica Profunda Accompanied by a Lipoma in the Duodenal Bulb
Dae Sung Lee, Hae Ryong Jeong, Jin Ok Kim, Hye Jin Tae, Ho Soon Choi, Hye In Ahn, Seung Sam Paik
Korean Journal of Medicine.2014; 86(3): 314. CrossRef
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A Case of a Collision Tumor in the Ampulla of Vater with an Adenocarcinoma and a Large Cell Neuroendocrine Carcinoma
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Kang Ju, M.D., Tae Hyo Kim, M.D., Cha Young Kim, M.D., Sang Su Lee, M.D., Hong Jun Kim, M.D., Hyun Jin Kim, M.D., Woon Tae Jung, M.D. and Ok Jae Lee, M.D.
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Korean J Gastrointest Endosc 2011;42(2):127-130. Published online February 28, 2011
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- Most tumors affecting Vater's ampulla are adenocarcinomas, but a neuroendocrine carcinoma in the ampulla of Vater is extremely rare. The coexistence of these two tumors has been reported in only a few cases. Here, we report a rare case of a collision tumor of the ampulla of Vater with an adenocarcinoma and a large cell neuroendocrine carcinoma. (Korean J Gastrointest Endosc 2011;42:127-130)
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A Case of Signet-ring Cell Carcinoma of the Ampulla of Vater
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Dong Ik Kim, M.D., Sang Wook Park, M.D., Geum Soo Lee, M.D., Geyong Yun Jung, M.D., Hyun Jin Jung, M.D., Hyeung Cheol Moon, M.D., Gun Young Hong, M.D. and Yeun Keun Lim, M.D.
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Korean J Gastrointest Endosc 2010;41(4):251-254. Published online October 30, 2010
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- Signet-ring cell carcinoma of the ampulla of Vater is so rare that only 16 cases have been reported. Here we report a case of a 47-year-old man with signet-ring cell carcinoma in the ampulla of Vater. The patient was hospitalized for right upper quadrant abdominal pain and jaundice which had developed 10 days prior. Computed tomography (CT) and ultrasonography (US) revealed dilatation of the common bile duct and the intrahepatic bile duct. On duodenoscopy, a bulging mass with an irregular margin in the major papilla was noted. Histologic findings showed a signet-ring cell carcinoma. Surgical resection was not done because lymph node metastasis was noted during the operation. Hence, conservative treatment including chemotherapy and bile drainage was done. (Korean J Gastrointest Endosc 2010;41:251-254)
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A Case of Lymphoid Polyp in the Ampulla of Vater Associated with Tubulopapillary Adenoma
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Ji Ho Kim, M.D., Jei So Bang, M.D., Jong Hoon Byun, M.D., Su Hyun Yang, M.D., Sung Hoon Kim, M.D., Ji Sun Jang, M.D. and Yoon Jung Kim, M.D.*
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Korean J Gastrointest Endosc 2010;41(1):61-64. Published online July 31, 2010
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- Lymphoid polyp is a very rare disease that commonly occurs in the rectum. It is a benign, focal or diffuse lesion that typically occurs where clusters of lymphoid follicles are present. The polyp is composed of well differentiated lymphoid tissue. It can generally be differentiated from malignant lymphoma by the proliferation of normal lymphoid tissue, which has a prominent follicular pattern and a clearly defined germinal center. There have been only a few reports of lymphoid polyps of the rectum, and there have been no reports of lymphoid polyp in the ampulla of Vater. We experienced a case of lymphoid polyp in the ampulla of Vater associated with tubulopapillary adenoma, and the patient first presented with jaundice, weight loss and general weakness. (Korean J Gastrointest Endosc 2010;41:61-64)
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A Case of Ampullary Adenomyoma Associated with Dilatations of Pancreatic and Biliary Ducts
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Byung Uk Lee, M.D., Jei So Bang, M.D., Soo Hyun Yang, M.D., Ji Ho Kim, M.D., Jong Hoon Byun, M.D., Won Keun Si, M.D., Moon Hyung Lee, M.D. and Bo Kyoung Choi, M.D.
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Korean J Gastrointest Endosc 2010;40(6):391-395. Published online June 30, 2010
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- Adenomyoma is a nonneoplastic lesion that can be found anywhere in the gastrointestinal tract, but it's rarely found in the ampulla of Vater. To the best of our knowledge, it is a benign lesion, but most cases are misdiagnosed as carcinoma or adenoma by a preoperative endoscopic or radiologic procedure, and this leads to unnecessarily extensive surgical resection. We report here on a case of ampulla of Vater adenomyoma that resulted in biliary and pancreatic duct dilatation. The tumor was diagnosed by endoscopic papillectomy. (Korean J Gastrointest Endosc 2010;40:391-395)
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A Case of Transparent Cap-fitted Endoscopic Hemoclipping on a Bleeding Dieulafoy's Lesion in the Ampulla of Vater
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Hoon Sup Koo, M.D., Yong Seok Kim, M.D., Gwang Il Kim, M.D., Jung Kyung Yang, M.D., Seung Min Kim, M.D., Sang Yeol Cheon, M.D., Je Hyung Sun, M.D. and Sun Moon Kim, M.D.
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Korean J Gastrointest Endosc 2010;40(1):45-48. Published online January 30, 2010
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- Dieulafoy's lesion is a rare cause of repetitive and massive gastrointestinal bleeding, and this is characterized by an isolated arteriole protruding through a small mucosal defect. Dieulafoy's lesion is generally found in the stomach within 6 cm of the gastroesophageal junction, and usually on the lesser curvature, but many lesions have been reported in extragastric locations, including the esophagus, small bowel and rectum. A Dieulafoy's lesion in the ampulla of Vater is extremely rare, and only one such case has been reported in the Korean population. We experienced a rare case of Dieulafoy's lesion in the ampulla of Vater with massive pulsatile bleeding, and this was successfully treated by transparent cap-assisted endoscopic hemoclipping. We report here on this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2010;40:45-48)
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A Case of Bleeding on the Ampulla of Vater Due to Angiodysplasia in a Patient with End Stage Renal Disease
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Sang Bae Kim, M.D., Bu Sug Jun, M.D., Hae Bin Jung, M.D., Hyung Keun Kim, M.D., Young Suk Cho, M.D., Hyun Suk Chae, M.D., Chang Don Lee, M.D. and Sung Soo Kim, M.D.
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Korean J Gastrointest Endosc 2010;40(1):41-44. Published online January 30, 2010
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- Gastrointestinal angiodysplasia is one of the causes of acute and chronic gastrointestinal bleeding, and gastrointestinal angiodysplasia makes up 2∼6% of all the cases of upper gastrointestinal bleeding. Bleeding from the ampulla of Vater is very rare. We report here on an unusual case of bleeding from angiodysplasia at the ampulla of Vater in a 58-aged woman with end stage renal failure. This lesion was successfully treated with endoscopic argon plasma coagulation. (Korean J Gastrointest Endosc 2010;40:41-44)
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A Case of a Submucosal Ganglioneuroma of the Ampulla of Vater That Was Treated by Endoscopic Resection
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Hye Jin Cho, M.D., Jae Seon Kim, M.D., Tae Jung Yun, M.D., Seok Bae Yoon, M.D., Hyun-Seok Kang, M.D., Jae Young Moon, M.D., Jong-Jae Park, M.D. and Young-Tae Bak, M.D.
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Korean J Gastrointest Endosc 2009;39(6):393-397. Published online December 30, 2009
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- Submucosal tumors in the gastrointestinal tract are covered with a mucous membrane such as the surrounding tissue. Therefore, the use of endoscopic biopsy to diagnose submucosal tumors is not as effective as that for epithelial tumors. Although imaging tools such as ultrasonography or computed tomography have made great advances, it is still difficult to diagnose submucosal tumors before resection. The surgical resection of tumors is the most accurate diagnostic method, yet less invasive endoscopic resection has been preferred in recent years. We report herein on a rare case of ganglionueroma arising from the Ampulla of Vater and this lesion was incidentally found during performance of routine esohagogastroduodenoscopy. The lesion was diagnosed as a ganglioneuroma, and it was successfully removed through endoscopic resection. (Korean J Gastrointest Endosc 2009;39: 393-397)
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The Differential Diagnosis and Prognosis of an Ampulla of Vater Cancer with a Grossly Normal Appearance
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Ji Bong Jeong, M.D., Yong-Tae Kim, M.D.*, Yong Jin Jung, M.D., Ji Won Kim, M.D., Byung Kwan Kim, M.D., Kook Lae Lee, M.D., Ji Kon Ryu, M.D.* and Yong Bum Yoon, M.D.*
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Korean J Gastrointest Endosc 2008;37(3):185-191. Published online September 30, 2008
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- Background
/Aims: The purpose of this study was to determine the clinical parameters for a differential diagnosis between a malignant and benign stricture of the ampulla of Vater with a grossly normal appearance and to evaluate the diagnostic accuracy of the use of an endoscopic biopsy for the prognosis of ampulla of Vater cancers. Methods: Medical records and cholangiograms were retrospectively reviewed. In order to determine the clinical parameters useful for a differential diagnosis, clinical manifestations, laboratory findings and the common bile duct diameter were compared between malignant and benign strictures. The diagnostic accuracy of the use of an endoscopic biopsy and the clinical features of patients with an ampulla of Vater cancer were analyzed. The survival rate after management was also evaluated. Results: Nine patients with a benign stricture and 15 patients with a malignant stricture were included in this study. The levels of serum bilirubin, alkaline phosphatase and alanine aminotransferase were significantly higher in patients with a malignant stricture than in patients with a benign stricture (p<0.05). Of the patients who underwent surgical management, 93% had stage I or II disease. All of the patients were alive up to a mean follow-up period of 50 months. Conclusions: Liver function tests and the use of an endoscopic biopsy are useful in the differential diagnosis of a stricture of the ampulla of vater with a grossly normal appearance. Cancer patients typically present with an early stage and the prognosis is relatively good. (Korean J Gastrointest Endosc 2008;37:185-191)
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A Case of a Carcinoid Tumor of the Ampulla of Vater
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Wook Jin Lee, M.D., Myung-Hwan Kim, M.D., Hyoung-Chul Oh, M.D., Kyung Eun Kim, M.D.*, Sang Soo Lee, M.D., Dong-Wan Seo, M.D. and Sung Koo Lee, M.D.
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Korean J Gastrointest Endosc 2008;36(3):187-190. Published online March 30, 2008
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- Carcinoid tumors involving the Ampulla of Vater are very rare lesions which may result in painless jaundice. The preoperative diagnosis of a carcinoid tumor is difficult because the carcinoid tumor of the Ampulla of Vater is frequently located in the submucosa and rarely presents an ulcerative lesion on the surface mucosa. In contrast to patients with intestinal carcinoid tumors, patients with carcinoid tumor of the Ampulla of Vater are frequently free of clinical and laboratory findings that hint to the carcinoid syndrome. The natural history of this disease entity has not been well established; however, the prognosis is generally believed to be good. In this study, we report a case of a carcinoid tumor of the Ampulla of Vater with an ulcerative lesion, which was diagnosed preoperatively and treated by surgical excision. (Korean J Gastrointest Endosc 2008;36:187-191)
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An Ampulla of Vater Carcinoid Tumor that Presented with Upper Gastrointestinal Bleeding
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Jae Serk Park, M.D., Sung Jo Bang, M.D., Seok Won Jung, M.D., Sung Ho Kwon, M.D., Byung Chul Kim, M.D., Dong Ha Han, M.D., Hyun Soo Kim, M.D., Young Min Kim, M.D.*, Chang Woo Nam, M.D.† and Do Ha Kim, M.D.
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Korean J Gastrointest Endosc 2007;35(6):420-423. Published online December 30, 2007
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- A Carcinoid tumor of the ampulla of Vater is extremely rare, accounting for less than 0.3% of all gastrointestinal carcinoids. Most reported cases have arisen from the gallbladder. An ampullary carcinoid most commonly presents with jaundice or upper abdominal discomfort, and bleeding from the tumor is exceedingly rare. A diagnosis is most frequently made postoperatively due to submucosal spread of the tumor. As the metastatic potential cannot be predicted by tumor size, a Whipple pancreaticoduodenectomy rather than local excision is considered the treatment of choice. We herein report a case of a primary carcinoid tumor located at the ampulla of Vater that presented as gastrointestinal bleeding; the tumor was diagnosed by an endoscopic biopsy after a papillary sphinterotomy. (Korean J Gastrointest Endosc 2007;35:420-423)
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Two Cases of Double Papilla of Vater
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Kwang Ro Joo, M.D., Hyun Phil Shin, M.D., Hyun Jeong Kim, M.D., Jae Myung Cha, M.D., Jong Beom Park, M.D. and Joung Il Lee, M.D.
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Korean J Gastrointest Endosc 2007;34(3):170-173. Published online March 30, 2007
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- The Vaterian system consists of the common bile duct and the duct of Wirsung as they conjoin at the level of the duodenum, forming the major papilla of Vater. A double papilla of Vater with separate openings that form the bile duct and the pancreatic duct is a rare anatomic anomaly, which is observed in 0.18% of patients during endoscopic retrograde cholangiopancreatography. When a double papilla is noted, the additional problem is to determine if it is an anatomic variant or a choledochoduodenal fistula. We report two cases of a double papilla; one was associated with choledocholithiasis, and the other was identified incidentally during screening upper gastrointestinal endoscopy. (Korean J Gastrointest Endosc 2007;34:170173)
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A Case of Bleeding Due to Angiodysplasia of the Ampulla of Vater
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Jong Ryul Eun, M.D. and Byung Ik Jang, M.D.
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Korean J Gastrointest Endosc 2006;32(6):405-408. Published online June 30, 2006
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- Although angiodysplasia can be found along the whole gastrointestinal tract, it is extremely rare at the ampulla of Vater. We experienced a case of chronic bleeding due to an angiodysplasia of the major papilla. A 53-year-old man was admitted due to intermittent melena and dyspnea for approximately 4 months. Esophagogastroduodenoscopy revealed bleeding from the ampulla of Vater. A subsequent examination with side-viewing duodenoscopy revealed vascular ectasia around the orifice of the major papilla and blood oozing from this lesion. Hemostasis was successfully performed by endoscopic bipolar electrocoagulation. No further bleeding was observed and the previous vascular abnormality disappeared at the follow-up duodenoscopy. (Korean J Gastrointest Endosc 2006;32: 405408)
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A Case of Endoscopic Management of Dieulafoy's Lesion in the Ampulla of Vater
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Ki Won Hwang, M.D., Jae Hyung Lee, M.D., Joo Ho Lee, M.D., Sang Yong Lee, M.D., Tae Oh Kim, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.
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Korean J Gastrointest Endosc 2006;32(5):357-359. Published online May 30, 2006
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- Dieulafoy's lesion is an uncommon but important cause of massive upper gastrointestinal bleeding. The lesion usually occurs in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction but extragastric locations of Dieulafoy's lesion are rare. In this study, diagnosis of Dieulafoy's lesion was frequently made by endoscopy instead of surgery. Hemostasis was achieved by endoscopic treatment in more than 90% of patients. We report the successful application of endoscopic hemoclipping for treatment of active bleeding from Dieulafoy's lesion in the ampulla of Vater of the duodenum. (Korean J Gastrointest Endosc 2006;32:357360)
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A Case of Synchronous Triple Primary Cancer of Gastric Adenocarcinoma, Carcinoid Tumor of the Ampulla of Vater and Renal Cell Carcinoma
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Cheul Young Choi, M.D., Yeong Je Chae, M.D., Jong Yeop Kim, M.D., Hyun Won Shin, M.D., Min Ho Choi, M.D., Hyun Joo Jang, M.D., Chang Soo Eun, M.D., Sea Hyub Kae, M.D. and Jin Lee, M.D.
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Korean J Gastrointest Endosc 2006;32(2):136-140. Published online February 27, 2006
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- Multiple primary cancer is defined as the multiple occurrence of malignant neoplasm in the same individual. Synchronous cancers are usually defined as finding the second cancer at the same time or within a 6-month period after the diagnosis of the primary lesion, and metachronous cancers are found at more than 6 months after the initial diagnosis. Multiple primary cancers have been increasing reported on due to prolonged lifespans and the improvement of diagnostic techniques. Nevertheless, triple synchronous cancers have been regarded as a relatively rare finding. We report here on an unusual case of triple synchronous cancer of early gastric cancer, carcinoid tumor of the ampulla of Vater and renal cell carcinoma. (Korean J Gastrointest Endosc 2006;32:136 140)
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Photodynamic Therapy for Superficial Gastrointestinal Tumors
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Young Koog Cheon, M.D., Dae Hee Han, M.D., In Seop Jung, M.D., Chang Beom Ryu, M.D., Joo Young Cho, M.D., Yun Soo Kim, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.
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Korean J Gastrointest Endosc 2006;32(2):81-86. Published online February 27, 2006
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- Background
/Aims: Although photodynamic therapy (PDT) has been used for the endoscopic treatment of digestive cancer, its curative efficacy remains uncertain. This study evaluated the curative role of PDT in superficial gastrointestinal cancer. Methods: Fifteen lesions in 14 patients with a histologically proven carcinoma (early esophageal cancer 6, early gastric cancer 8, ampulla of Vater cancer 1) were injected with an intravenous hematoporphyrin derivative (2 mg/kg), and PDT was performed 48 hours later. The response to treatment was assessed by gastroscopy with biopsies. Results: The median follow-up time was 273 days (42∼1,030 days). According to the TNM stage of endoscopic ultrasonography, there were 14 T1 cases and 1 T2 case. Complete remission was observed in 13 cases after the initial and consecutive PDT. There were 2 cases of failure. The recurrence rate was 15.4% (2/13), and the median time from the initial PDT to recurrence was 349 days. Conclusions: PDT using a hematoporphyrin derivative as a photosensitizer is a safe and efficient method for treating early cancer. However, a long-term follow up period using a large population sample will be needed for confirmation. (Korean J Gastrointest Endosc 2006;32:8186)
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A Case of Synchronous Double Cancer -Klatskin's Tumor and Ampullary Adenocarcinoma-
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Beom Jae Lee, M.D., Hong Sik Lee, M.D., Jong Jin Hyun, M.D., Kyung Jin Kim, M.D., Min Jeong Kim, M.D., Rok Son Choung, M.D., Yong Sik Kim, M.D., Hyung Jun Lim, M.D., Yoon Tae Jeen, M.D., Hoon Jai Chun, M.D., Soon Ho Um, M.D., Sang Woo Lee, M.D., Jai Hyun
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Korean J Gastrointest Endosc 2005;31(6):437-442. Published online December 30, 2005
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- Multiple cancers in the extrahepatic biliary tree are relatively rare. Many such cases are a double cancer of the common bile duct and the gallbladder. We report a case of a double primary cancer that occurred synchronously at the hilum of the extrahepatic duct and the ampulla of Vater with a review of the relevant literature. A 57-year-old man was admitted to our institution after a 15 day of painless jaundice and a urine color change. Ultrasonography showed a dilation of both intrahepatic ducts. Upper endoscopy revealed a protruding ulcerative mass at the ampulla of Vater and endoscopic retrograde cholangiography showed a dilated common bile duct and a mildly dilatated pancreatic duct, but both intrahepatic bile ducts were not visualized. An upper abdominal CT scan showed a dilation of both intrahepatic bile ducts and an infiltrating mass at the bifurcation area. Magnetic resonance cholangiopanreatography showed narrowing bile duct lumen that was obstructed by the tumor at the hepatic duct bifurcation, which dilated both intrahepatic ducts. A histological examination of the ampulla of Vater revealed a well differentiated adenocarcinoma of the ampulla of Vater. The final diagnosis was a synchronous double cancer of Klatskin's tumor and an adenocarcinoma of the ampulla of Vater. (Korean J Gastrointest Endosc 2005;31:437442)
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A Case of Acute Pancreatitis Caused by Ascaris Invasion of the Common Bile Duct
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Jong Won Byun, M.D., Jae Woo Kim, M.D., Hoon Choi, M.D., Hye Jung Kim, M.D., Kyu Hong Kim, M.D., Myeong Gwan Jee, M.D., Yong Soon Park, M.D., Soon Koo Baik, M.D., Hyun Soo Kim, M.D., Sang Ok Kwon, M.D. and Seong Hyun Kim, M.D.*
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Korean J Gastrointest Endosc 2005;31(5):348-352. Published online November 30, 2005
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- Ascaris lumbricoides is the most common intestinal parasite in less-developed countries as well as in areas with poor sanitation. Highly motile mature worms may enter the ampulla of Vater and migrate to the bile or pancreatic ducts causing cholangitis, biliary stones, cholecystitis, pancreatitis and a liver abscess. The incidence of pancreatitis due to biliary ascariasis is relatively common in endemic areas, but only a few cases have been reported in Korea since 1990. A 68-year-old woman was admitted with a sudden onset of epigastric pain. She was diagnosed with acute pancreatits due to ascaris based on computed tomography, the ampulla- impacted state of the worm and an elevated serum amylase level. The patient recovered without complications after the ascaris had been extracted using grasp forceps during endoscopy. The patient also received antihelminthic therapy. We report this case with a review of the relevant literatures.(Korean J Gastrointest Endosc 2005;31:348352)
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A Case of Common Bile Duct Stone Caused by Foreign Body in Patient with Adenoma of the Ampulla of Vater
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Ju Hyun Park, M.D., Sun Mi Lee, M.D., Jun Hyok Oh, M.D., Sang Youn Hwang, M.D., Seong Hun Lee, M.D., Tae Oh Kim, M.D., Seong Ook Lee, M.D., Won Il Park, M.D., Suk Kim, M.D.*, Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and
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Korean J Gastrointest Endosc 2005;30(2):114-117. Published online February 27, 2005
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- Choledocholithiasis caused by a foreign body is rare. The most common type of foreign body in the common bile duct is a residual object from previous surgery such as a metal clip or suture material. Foreign body may enter the biliary system after choledochointestinal anastomosis or endoscopic sphincterotomy. Rarely, penetrating missile fragment or gunshot shrapnel account for another type of foreign body. We experienced a case of common bile duct (CBD) stone caused by foreign meterial in 75-years-old women who had a plant foreign body in the common bile duct. She had no past history of abdominal surgery or penetrating trauma. The foreign body and stone were successfully extracted with Dormia basket after the endoscopic sphincterotomy. (Korean J Gastrointest Endosc 2005;30: 114117)
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A Case of Gangliocytic Paraganglioma of the Ampulla of Vater Presenting as Jaundice
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Hwang Rae Chun, M.D., Chang Duck Kim, M.D., Chang Won Baeck, M.D., Sang Kyun Yu, M.D., Yong Sik Kim, M.D., Yoon Tae Jeen, M.D., Hoon Jai Chun, M.D., Hong Sik Lee, M.D., Soon Ho Um, M.D., Sang Woo Lee, M.D., Jai Hyun Choi, M.D., Ho Sang Ryu, M.D., Jung Woo
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Korean J Gastrointest Endosc 2005;30(1):47-51. Published online January 30, 2005
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- Gangliocytic paraganglioma is a rare and benign gastrointestinal tumor that usually arises in the second portion of the duodenum. Histogenesis of this tumor is yet unclear. It is incidentally found during radiographic examinations or during endoscopy looking for the cause of gastrointestinal hemorrhage, which usually manifests as mucosal ulcerations. To our knowledge, there was only one case of duodenal gangliocytic paraganglioma presenting with melena in Korea. We experienced a case of gangliocytic paraganglioma arising from the ampulla of Vater, presenting as obstructive jaundice, which was subsequently removed surgically. Thus, we report this case with a review of literatures. (Korean J Gastrointest Endosc 2005;30:4751)
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A Case of Psammomatous Carcinoid Tumor of the Ampulla of Vater
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Jon Suh, M.D., Jae Hoon Yang, M.D., Su Jin Hong, M.D., Sang Woo Cha, M.D., Jong Ho Moon, M.D., Yong Deok Cho, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D., Boo Sung Kim, M.D., Hyung Chul Kim, M.D.* and Kye Won Kwon, M.D.†
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Korean J Gastrointest Endosc 2004;28(5):262-266. Published online May 30, 2004
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- Carcinoid tumors of the ampulla of Vater are rare. The variant form of ampullary carcinoid tumors containing psammoma bodies is noted extremely rare and produces somatostatin. Obstructive jaundice is the most common presenting symptom of ampullary carcinoid tumor. It is difficult to diagnose ampullary carcinoid tumor preoperatively because of their relatively small size and submucosal location. We report a case of ampullary psammomatous carcinoid tumor and also review the literature. Deep biopsies were taken from the edges of the papillotomy wound of the protruded ampulla of Vater from a 51- year-old man. The histology was consistent with psammomatous carcinoid. 111In-octreoscan revealed an abnormal focal increased radiouptake in the infrahepatic area which suggested the presence of a somatostain producing tumor. The patient underwent a Whipple's operation. (Korean J Gastrointest Endosc 2004;28:262266)
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유두부 괄약근 절제술 후 발생한 출혈을 혈관 색전술로 치료한 증례 1예
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Korean J Gastrointest Endosc 2003;27(5):493-493. Published online November 20, 2003
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Early Diagnosis of Adenocarcinoma of the Ampulla of Vater during Treatment of Herpes Zoster
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Eun Sun Jin, M.D., Young-Woon Chang, M.D., Yong Hee Joung, M.D., Byoung Wook Lee, M.D., Yo Seb Han, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byung-Ho Kim, M.D., Joung Il Lee, M.D. and Rin Chang, M.D.
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Korean J Gastrointest Endosc 2003;27(4):263-266. Published online October 31, 2003
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- Herpes zoster infection may herald the presence of a hidden malignancy. We encountered a case of a carcinoma of the ampulla of Vater in a 72-year-old female in which the ampullary lesion was found during a work-up for excluding certain causes of Herpes zoster infection. An esophagogastroduodenoscopy showed a polypoid mass at the ampulla of Vater. A pylorus-preserving pancreaticoduodenectomy was performed and the pathology of the resected specimen confirmed well differentiated adenocarcinoma in the background of villous adenoma. The stage of the tumor was T2N0M0. This case illustrates that it may be necessary to do some diagnostic work-ups in patients with Herpes zoster infection to exclude underlying diseases. However, the extent of the work-ups should be determined in the future based on the cost-effectiveness data.
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Papillary Stenosis and Cholangitis Caused by Endoscopic Mucosal Resection of Ampullary Adenoma
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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.*
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Korean J Gastrointest Endosc 2003;27(4):249-253. Published online October 31, 2003
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- 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.