Clinical Endoscopy

Original Article

The efficacy of a novel integrated outside biliary stent and nasobiliary drainage catheter system for acute cholangitis: a single center pilot study: Naosuke Kuraoka, Tetsuro Ujihara, Hiromi Kasahara, Yuto Suzuki, Shun Sakai, Satoru Hashimoto; Clin Endosc 2023;56(6):795-801. Published online April 11, 2023; DOI: https://doi.org/10.5946/ce.2022.289

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Endoscopic biliary drainage is the gold standard treatment for cholangitis. The two methods of biliary drainage are endoscopic biliary stenting and nasobiliary drainage. A novel integrated outside biliary stent and nasobiliary drainage catheter system (UMIDAS NB stent; Olympus Medical Systems) was recently developed. In this study, we evaluated the efficacy of this stent in the treatment of cholangitis caused by common bile duct stones or distal bile duct strictures.
Methods
We conducted a retrospective pilot study by examining the medical records of patients who required endoscopic biliary drainage for cholangitis due to common bile duct stones or distal bile duct strictures, and who were treated with a UMIDAS NB stent, between December 2021 and July 2022.
Results
Records of 54 consecutive patients were reviewed. Technical and clinical success rates were 47/54 (87.0%) and 52/54 (96.3%), respectively. Adverse events were observed in 12 patients, with six patients experiencing pancreatitis as an adverse event, following endoscopic retrograde cholangiopancreatography (ERCP). Regarding late adverse events, five cases of biliary stent migration into the bile duct were observed. Disease-related death occurred in one patient.
Conclusions
The outside-type UMIDAS NB stent is an efficacious new method for biliary drainage and can be applied to many indications.

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Systematic Review and Meta-analysis

Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis: Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Jijo Varghese, Sridhar Sundaram; Clin Endosc 2023;56(2):169-179. Published online February 15, 2023; DOI: https://doi.org/10.5946/ce.2022.282

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)–guided tissue acquisition from pancreatic lesions.
Methods
A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-TA in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis.
Results
Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52–0.90) and strict criteria (OR, 0.58; 95% CI, 0.46–0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76–1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents.
Conclusions
The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

Citations

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Comparison of standard vs auxiliary (contrast or elastography) endoscopic ultrasound-guided fine needle aspiration/biopsy in solid pancreatic lesions: A meta-analysis
Mitali Madhumita Rath, Prajna Anirvan, Jijo Varghese, Tara Prasad Tripathy, Ranjan K Patel, Manas Kumar Panigrahi, Suprabhat Giri
World Journal of Methodology.2025;[Epub] CrossRef
Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
Abhirup Chatterjee, Jimil Shah
Diagnostics.2023; 14(1): 78. CrossRef

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Focused Review Series: Endoscopic Management for Biliary Stricture after Liver Transplantation

Unilateral Versus Bilateral Biliary Drainage for Post-Transplant Anastomotic Stricture: Jin Ho Choi, Woo Hyun Paik; Clin Endosc 2020;53(3):255-260. Published online May 22, 2020; DOI: https://doi.org/10.5946/ce.2020.079

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Living donor liver transplantation is the most common type of liver transplantation in Asia. Post-transplant biliary stricture is frequent in living donor liver transplantation, and endoscopic management is considered to be the treatment of choice. However, endoscopic management is still challenging in patients who undergo right lobe living donor liver transplantation because of the anatomical alteration. In this article, we reviewed the recently updated results for proper endoscopic biliary drainage in post-living donor liver transplantation anatomical biliary stricture and compared unilateral and bilateral drainage.

Citations

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Digital single-operator cholangioscopy for difficult anastomotic biliary strictures in living donor liver transplant recipients after failure of standard ERCP: SPYPASS-2 study (with videos)
In Rae Cho, Sang Hyub Lee, Joongyu Kang, Junyeol Kim, Tae Seung Lee, Myeong Hwan Lee, Min Woo Lee, Jin Ho Choi, Woo Hyun Paik, Ji Kon Ryu, Yong-Tae Kim, Suk Kyun Hong, YoungRok Choi, Nam-Joon Yi, Kwang-Woong Lee, Kyung-Suk Suh
Gastrointestinal Endoscopy.2025; 101(5): 979. CrossRef
Development of novel biliary metal stent with coil-spring structure and its application in vivo swine biliary stricture model
In Rae Cho, Sang Hyub Lee, Jin Ho Choi, Namyoung Park, Min Woo Lee, Joo Seong Kim, Seok Jeong, Don Haeng Lee, Tae-Won Jeong, Byoung-Yun Ki, Woo Hyun Paik, Ji Kon Ryu, Yong-Tae Kim
Frontiers in Oncology.2023;[Epub] CrossRef

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Original Article

Efficacy of Nasobiliary Tubes and Biliary Stents in Management of Patients with Bile Leak after Liver Transplantation: A Systematic Review: Ali Raza, Anam Omer, Sara Iqbal, Vineet Gudsoorkar, Pramoda Koduru, Kumar Krishnan; Clin Endosc 2019;52(2):159-167. Published online March 29, 2019; DOI: https://doi.org/10.5946/ce.2018.118

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Background
/Aims: Bile leak is one of the most common complications of liver transplantation. The treatment options for bile leaks include conservative management, surgical re-intervention, percutaneous drainage and endoscopic drainage. We aimed to perform a systematic review to identify the efficacy of endoscopic treatment in the resolution of post-transplant bile leaks. Methods: Two independent reviewers performed systematic literature search in PubMed, ISI Web of Science, grey literature and relevant references in May 2017. Human studies in English with documented post-liver transplant bile leaks were included. Results: Thirty-four studies were included in the final analysis. The pooled efficacy of biliary stents for the resolution of post-transplant bile leaks was 82.43% compared with 87.15% efficacy of nasobiliary tubes. The efficacy of biliary stents was lower for anastomotic leaks (69.23%) compared to T-tube (90.9%) or cut-surface/ cystic duct stump related leaks (92.8%). Similarly, the efficacy of nasobiliary tube was also lower for anastomotic leaks (58.33%) compared to T-tube or cut-surface related leaks (100%). Conclusions: In this systematic review, the overall efficacy was 82.43% in biliary stent group, and 87.15% in nasobiliary tube group. Both biliary stent and nasobiliary tube were more effective in managing non-anastomotic leaks compared to anastomotic leaks.

Citations

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Application of percutaneous biliary drainage in the treatment of post-operative bile leakage after liver rupture: A case report
Jinlong Chen, Zhikuan Wang, Lixin Zhang, Xi Chen, Yuanyuan Liu, Hong Chen, Xiaoqiang Tong, Yanchao Dong
Journal of Minimal Access Surgery.2025; 21(2): 200. CrossRef
Lesson learnt from 60 years of liver transplantation: Advancements, challenges, and future directions
Eyad Gadour
World Journal of Transplantation.2025;[Epub] CrossRef
Optimal timing of endoscopic biliary drainage for bile duct leaks: A multicenter, retrospective, clinical study
De-Xin Chen, Kai-Xuan Fang, Sheng-Xin Chen, Sen-Lin Hou, Gui-Hai Wen, Hai-Kun Yang, Da-Peng Shi, Qing-Xin Lu, Ya-Qi Zhai, Ming-Yang Li
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
A nomogram for prediction of ERCP success in patients with bile duct leaks: a multicenter study
De-xin Chen, Sheng-xin Chen, Sen-lin Hou, Gui-hai Wen, Hai-kun Yang, Da-peng Shi, Qing-xin Lu, Ya-qi Zhai, Ming-yang Li
Surgical Endoscopy.2024; 38(5): 2465. CrossRef
Complications in Post-Liver Transplant Patients
Carlotta Agostini, Simone Buccianti, Matteo Risaliti, Laura Fortuna, Luca Tirloni, Rosaria Tucci, Ilenia Bartolini, Gian Luca Grazi
Journal of Clinical Medicine.2023; 12(19): 6173. CrossRef
Nasobiliary drainage: an effective treatment for pruritus in cholestatic liver disease
Wafaa Ahmed, Rebecca Jeyaraj, David Reffitt, John Devlin, Abid Suddle, John Hunt, Michael A Heneghan, Phillip Harrison, Deepak Joshi
Frontline Gastroenterology.2022; 13(5): 416. CrossRef
A case of combined use of endoscopic drainage and percutaneous drainage for traumatic liver injury type III b
Shigekuni Okumura, Jun Oda, Yousuke Minami, Masaru Hirayama, Kennta Aida
Journal of the Japanese Society of Intensive Care Medicine.2021; 28(3): 210. CrossRef
Biliary Complications Following Adult Deceased Donor Liver Transplantation: Risk Factors and Implications at a High-volume US Center
Abraham J. Matar, Katie Ross-Driscoll, Lisa Kenney, Hannah K. Wichmann, Joseph F. Magliocca, William H. Kitchens
Transplantation Direct.2021; 7(10): e754. CrossRef
The Need for a Better-Designed Study of the Outcomes of Endoscopic Management of Bile Leak
Hyung Ku Chon, Eun Ji Shin, Seong-Hun Kim
Clinical Endoscopy.2020; 53(6): 633. CrossRef

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Case Report

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 PubReader ePub

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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Review

Endoscopic Management of Anastomotic Strictures after Liver Transplantation: Dong Wook Lee, Hyeong Ho Jo, Juveria Abdullah, Michel Kahaleh; Clin Endosc 2016;49(5):457-461. Published online September 30, 2016; DOI: https://doi.org/10.5946/ce.2016.130

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Endoscopic treatment of biliary strictures involving plastic stent placement has been used widely. The use of self-expandable metal stents (SEMSs) has been described for anastomotic strictures following liver transplantation (LT). This review aimed to assess and compare the efficacy of plastic stents with SEMS in LT patients. Information was retrieved regarding technical success, stricture resolution, the number of endoscopic retrograde cholangiography procedures, follow-up, immediate, and late complications. Eight studies involving plastic stents had a stricture resolution rate of 84.5%, with the rates ranging from 63% to 100%. These rates are comparable with the stricture resolution rate of 75% determined from six studies that involved 236 patients who received metal stents and the rates ranged from 53% to 81%. The observed success rate for metal stents used to manage post-LT anastomotic biliary strictures was below the reported rate for multiple plastic stents. Hence, the currently available metal stents should not be offered for the management of post-LT anastomotic biliary strictures.

Citations

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Less is more: The use of single biodegradable stenting to treat biliary anastomotic strictures in pediatric liver transplantation
Jesús Quintero Bernabeu, Javier Juamperez Goñi, Maria Mercadal Hally, Cristina Padrós Fornieles, Mauricio Larrarte King, José Andrés Molino Gahete, Anna Coma Muñoz, Iratxe Diez Miranda, Mercedes Pérez Lafuente, Ramon Charco Torra, Ernest Hidalgo Llompart
Liver Transplantation.2024;[Epub] CrossRef
Long-Term Results of Endoscopic Metal Stenting for Biliary Anastomotic Stricture after Liver Transplantation
Aymeric Becq, Alexis Laurent, Quentin De Roux, Cristiano Cremone, Hugo Rotkopf, Yann Le Baleur, Farida Mesli, Christophe Duvoux, Aurélien Amiot, Charlotte Gagniere, Nicolas Mongardon, Julien Calderaro, Daniele Sommacale, Alain Luciani, Iradj Sobhani
Journal of Clinical Medicine.2023; 12(4): 1453. CrossRef
Endoskopisches Management von Gallengangskomplikationen nach Leberchirurgie
Martha M. Kirstein, Torsten Voigtländer
Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie.2022; 147(04): 398. CrossRef
Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience
Wafaa Ahmed, Dave Kyle, Amardeep Khanna, John Devlin, David Reffitt, Zeino Zeino, George Webster, Simon Phillpotts, Robert Gordon, Gareth Corbett, William Gelson, Manu Nayar, Haider Khan, Matthew Cramp, Jonathan Potts, Waleed Fateen, Hamish Miller, Bharat
Therapeutic Advances in Gastroenterology.2022;[Epub] CrossRef
Incidents and risk factors of biliary complications after orthotropic liver transplantation
Samir Zeair, Robert Stasiuk, Labib Zair, Marta Wawrzynowicz-Syczewska, Anita Rybicka, Elżbieta Grochans, Arkadiusz Kazimierczak
Medicine.2021; 100(34): e26994. CrossRef
Biliary complications in recipients of living donor liver transplantation: A single-centre study
Reginia Nabil Guirguis, Ehab Hasan Nashaat, Azza Emam Yassin, Wesam Ahmed Ibrahim, Shereen A Saleh, Mohamed Bahaa, Mahmoud El-Meteini, Mohamed Fathy, Hany Mansour Dabbous, Iman Fawzy Montasser, Manar Salah, Ghada Abdelrahman Mohamed
World Journal of Hepatology.2021; 13(12): 2081. CrossRef
Management of Post-Transplant Anastomotic Stricture Using Self-Expandable Metal Stent
Dong Wook Lee, Kazuo Hara
Clinical Endoscopy.2020; 53(3): 261. CrossRef
A unique type of fully covered metal stent for the management of post liver transplant biliary anastomotic strictures
Ben Warner, Phillip Harrison, Muhammad Farman, John Devlin, David Reffitt, Yasser El-Sherif, Shirin E. Khorsandi, Andreas Prachalias, Miriam Cortes Cerisuelo, Krish Menon, Wayel Jassem, Parthi Srinivasan, Hector Vilca-Melendez, Michael Heneghan, Nigel Hea
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A. V. Shabunin, I. Yu. Korzheva, G. M. Chechenin, S. S. Lebedev, P. A. Drozdov, O. S. Zhuravel, S. A. Astapovich
Almanac of Clinical Medicine.2020; 48(3): 171. CrossRef
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James F. Crismale, Jawad Ahmad
Gastrointestinal Endoscopy Clinics of North America.2019; 29(2): 237. CrossRef
Endoscopic management of anastomotic stricture after living-donor liver transplantation
Dong Wook Lee, Jimin Han
The Korean Journal of Internal Medicine.2019; 34(2): 261. CrossRef
Efficacy of Nasobiliary Tubes and Biliary Stents in Management of Patients with Bile Leak after Liver Transplantation: A Systematic Review
Ali Raza, Anam Omer, Sara Iqbal, Vineet Gudsoorkar, Pramoda Koduru, Kumar Krishnan
Clinical Endoscopy.2019; 52(2): 159. CrossRef
Endoscopic management of biliary strictures post-liver transplantation
Ahmed Akhter, Patrick Pfau, Mark Benson, Anurag Soni, Deepak Gopal
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Gastrointestinal Endoscopy.2018; 87(2): 501. CrossRef
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Sanjaya K. Satapathy, Imran Sheikh, Bilal Ali, Fazal Yahya, Mehmet Kocak, Laxmi Babu Parsa, James D. Eason, Jason M. Vanatta, Satheesh P. Nair
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Clinical Endoscopy.2016; 49(6): 502. CrossRef

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Focused Review Series: Past, present and futures of gastrointestinal stents

Development of Biliary and Enteral Stents by the Korean Gastrointestinal Endoscopists: Chan Sup Shim, Jin Hong Kim, Gene Hyun Bok; Clin Endosc 2016;49(2):113-123. Published online March 9, 2016; DOI: https://doi.org/10.5946/ce.2016.039

Abstract PDF PubReader ePub

Stenting in the gastrointestinal tract is a common procedure used for palliation of obstruction in the enteral and biliary tract. Today, stenting of malignant and benign strictures is performed at almost every major tertiary hospital in Korea. Moreover, Korea has become a major global supplier of cutting edge technology in the field of self-expanding metal stents. However, the history of stenting in Korea is relatively short and was far behind that of other nations such as Japan and Germany. The authors are humbled and gratified to have been able to observe the development and application of these stents in Korea, first hand. In this article, the authors review the overall history of stenting with a specific focus on the development of stenting in Korea. The development of esophageal, gastroduodenal, biliary, and colonic stents in Korea are reviewed in this article from a chronological and historical point of view, and a personal account of some of the significant moments of stent development in Korea are described.

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Fracture of self-expandable metallic stent inserted for unresectable gastric cancer at the esophagogastric junction: successful retrieval of distal fragment by gastrotomy
Masaaki Urade, Daiki Kimura, Toshifumi Shinbo, Shinichiro Hirokawa
Clinical Journal of Gastroenterology.2022; 15(2): 351. CrossRef
Early malfunction of a biliary self-expandable metal stent with an antireflux valve
Sang Hoon Kim, Chi Hyuk Oh, Jae Min Lee, Seong Ji Choi, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen, Hoon Jai Chun, Hong Sik Lee, Chang Duck Kim
Medicine.2020; 99(16): e19750. CrossRef

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Current Status of Biliary Metal Stents: Hyeong Seok Nam, Dae Hwan Kang; Clin Endosc 2016;49(2):124-130. Published online February 25, 2016; DOI: https://doi.org/10.5946/ce.2016.023

Abstract PDF PubReader ePub

Many advances have been achieved in biliary stenting over the past 30 years. Endoscopic stent placement has become the primary management therapy to relieve obstruction in patients with benign or malignant biliary tract diseases. Compared with plastic stents, a self-expandable metallic stent (SEMS) has been used for management in patients with malignant strictures because of a larger lumen and longer stent patency. Recently, SEMS has been used for various benign biliary strictures and leaks. In this article, we briefly review the characteristics of SEMS as well as complications of stent placement. We review the current guidelines for managing malignant and benign biliary obstructions. Recent developments in biliary stenting are also discussed.

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Focused Review Series: Updates on Gastrointestinal and Pancreaticobiliary Stents

Update on Pancreatobiliary Stents: Stent Placement in Advanced Hilar Tumors: Sung Ill Jang, Dong Ki Lee; Clin Endosc 2015;48(3):201-208. Published online May 29, 2015; DOI: https://doi.org/10.5946/ce.2015.48.3.201

Abstract PDF PubReader ePub

Palliative drainage is the main treatment option for inoperable hilar cholangiocarcinoma to improve symptoms, which include cholangitis, pruritus, high-grade jaundice, and abdominal pain. Although there is no consensus on the optimal method for biliary drainage due to the paucity of large-scale randomized control studies, several important aspects of any optimal method have been studied. In this review article, we discuss the liver volume to be drained, stent type, techniques to insert self-expanding metal stents, and approaches for proper and effective biliary drainage based on previous studies and personal experience.

Citations

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Correlation between liver volume drainage and clinical success after endoscopic biliary drainage of hilar malignant obstruction
Jennifer Nakamura Ruas, Ernesto Quaresma Mendonça, Luciano Lenz, Gustavo Andrade de Paulo, Ricardo Uemura Sato, José Jukemura, Ulysses Ribeiro Junior, Fauze Maluf-Filho, Bruno Costa Martins
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3D-printed versatile biliary stents with nanoengineered surface for anti-hyperplasia and antibiofilm formation
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Mohammad Bilal, Martin L. Freeman
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Gang Chen, Mei Zhang, Yu-Guo Sheng, Fang Yang, Zhong-Qi Li, Tong-Gang Liu, Yu-Fei Fu
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Zhong-Ke Chen, Wei Zhang, Yuan-Shun Xu, Yu Li
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Fei Teng, Yu-Tao Xian, Jia Lin, Yu Li, An-Le Wu
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Yu-Fei Fu, Wen-Jie Zhou, Yi-Bing Shi, Wei Cao, Chi Cao
Abdominal Radiology.2019; 44(8): 2900. CrossRef
Self-Expanded Metallic Stent Insertion for Hilar Cholangiocarcinoma: Comparison of Unilateral and Bilateral Stenting
Xue Yin, Dong-Mei Li, Fang Yang, Tong-Gang Liu, Feng-Fei Xia, Yu-Fei Fu
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Placement of a Newly Designed Y-Configured Bilateral Self-Expanding Metallic Stent for Hilar Biliary Obstruction: A Pilot Study
Dechao Jiao, Kai Huang, Ming Zhu, Gang Wu, Jianzhuang Ren, Yanli Wang, Xinwei Han
Digestive Diseases and Sciences.2017; 62(1): 253. CrossRef
Unilateral versus bilateral stent insertion for malignant hilar biliary obstruction
Gang Chang, Feng-Fei Xia, Hong-Fu Li, Su Niu, Yuan-Shun Xu
Abdominal Radiology.2017; 42(11): 2745. CrossRef
Optimizing palliation of malignant hilar strictures by the use of endobiliary stents
Jeffery J. Easler, Stuart Sherman, Gregory A. Coté
Gastrointestinal Endoscopy.2017; 86(5): 828. CrossRef
Palliative treatment with radiation-emitting metallic stents in unresectable Bismuth type III or IV hilar cholangiocarcinoma
Jian Lu, Jin-He Guo, Hai-Dong Zhu, Guang-Yu Zhu, Yong Wang, Qi Zhang, Li Chen, Chao Wang, Tian-Fan Pan, Gao-Jun Teng
ESMO Open.2017; 2(4): e000242. CrossRef
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Review

Endoscopic Stent Placement in the Palliation of Malignant Biliary Obstruction: Jin Hong Kim; Clin Endosc 2011;44(2):76-86. Published online December 31, 2011; DOI: https://doi.org/10.5946/ce.2011.44.2.76

Abstract PDF PubReader ePub

Biliary drainage with biliary stent placement is the treatment of choice for palliation in patients with malignant biliary obstruction caused by unresectable neoplasms. In such patients, the endoscopic approach can be initially used with percutaneous radiological intervention. In patients with unresectable malignant distal bile duct obstructions, endoscopic biliary drainage with biliary stent placement has now become the main and least invasive palliative modality, which has been proven to be more effective in >80% of cases with lower morbidity than surgery, and perhaps may provide a survival benefit. In patients with unresectable malignant hilar obstruction, the endoscopic approach for biliary drainage with biliary stent placement has also been considered as the treatment of choice. There is still a lack of clear consensus on the use of covered versus uncovered metal stents in malignant distal bile duct obstructions and plastic versus metal stents and unilateral versus bilateral drainage in malignant hilar obstructions.

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Endoscopic Ultrasound-Guided Antegrade Stent Placement in Patients with Failed ERCP as a Modality of Preoperative and Palliative Biliary Drainage
Sridhar Sundaram, Kiran Mane, Prachi Patil, Raosaheb Rathod, Aadish Kumar Jain, Unique Tyagi, Shaesta Mehta
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Contemporary advances in the endoscopic management of cholangiocarcinoma: a review of accomplished milestones and prospective opportunities
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Development of novel biliary metal stent with coil-spring structure and its application in vivo swine biliary stricture model
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Frontiers in Oncology.2023;[Epub] CrossRef
Role of radiofrequency ablation in advanced malignant hilar biliary obstruction
Mamoru Takenaka, Tae Hoon Lee
Clinical Endoscopy.2023; 56(2): 155. CrossRef
Percutaneous transhepatic duodenal drainage is good option for afferent loop syndrome for obstructive colorectal cancer patient with history of Billroth's operation II: A case report of a rare postoperative complication
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Case Report

A Primary Repair with Hemoclips and Fibrin Glue Injection in Biliary Stent Induced Duodenal Perforation: Ki Won Kim, M.D., Tae Hoon Lee, M.D., Sang-Heum Park, M.D., Bum Suk Son, M.D., Sae Hwan Lee, M.D., Suck-Ho Lee, M.D., Il-Kwun Chung, M.D. and Sun-Joo Kim, M.D.; Korean J Gastrointest Endosc 2011;42(6):437-441. Published online May 25, 2011

Abstract PDF: Duodenal perforations caused by biliary prostheses are uncommon, but they are potentially life threatening and require immediate treatment. Here we describe an unusual case of duodenal perforation induced by a plastic biliary stent. It masqueraded as a case of cholecystitis and combined systemic upset with a localized peritonitis and fever. Primary endoscopic closure by hemoclips was difficult due to the position of the lateral wall and the complexity of aligning the perforation with the endoscope. To approximate the perforated hole and adherent hemoclips, glue injection and sprayings were successfully performed under cap-fitted endoscopy. The patient recovered without additional complications.

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Spontaneous Biloma Caused by Pancreatic Cancer and Treated by Endoscopic Biliary Stenting: Ji Young Park, M.D., Jin Lee, M.D., Soon Jae Lee, M.D., Se Ah Kwon, M.D., Dong Hee Koh, M.D., Min Ho Choi, M.D., Hyun Joo Jang, M.D. and Sea Hyub Kae, M.D.; Korean J Gastrointest Endosc 2011;42(3):190-194. Published online March 28, 2011

Abstract PDF: Biloma is a rare disorder, and is defined as an abnormal extrahepatic or intrahepatic collection of bile within a defined capsular space. The common causes of biloma are iatrogenic and trauma. Spontaneous biloma, especially caused by pancreatic cancer, is very rare. An 86-year-old man was admitted with abdominal pain and fever. The patient denied a history of abdominal surgery, endoscopic retrograde cholangiography, or trauma. Abdominal computed tomography demonstrated a huge collection of fluid in the left lobe of the liver, dilatation of the intra and proximal common bile duct, and a heterogeneous enhancing mass in the pancreatic head portion. Percutaneous drainage under ultrasound guidance was performed, and the fluid analysis was compatible with biloma. A plastic stent was endoscopically inserted into the common bile duct to treat continuous drainage of the fluid despite percutaneous drainage. We report a case of biloma developed spontaneously in a patient with pancreatic cancer and successfully treated by endoscopic biliary stenting. (Korean J Gastrointest Endosc 2011;42:190-194)

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A Case of Bleeding from a Periampullary Duodenal Varix that Developed after Biliary Metal Stent Placement in a Patient with Pancreatic Cancer: Chung Hwon Lee, M.D.*, Seok Jeong, M.D.* and Don Haeng Lee, M.D.*^,†; Korean J Gastrointest Endosc 2008;37(1):76-81. Published online July 30, 2008

Abstract PDF: Duodenal varices bleed less commonly than gastro-esophageal varices in patients with portal hypertension. However, if there is no stigmata of recent esophageal or gastric variceal bleeding, clinicians should suspect the presence of an extra gastro-esophageal site of variceal bleeding. Duodenal variceal bleeding can be difficult to diagnose and treat. Therefore, the bleeding may be life threatening in most cases and has a poor prognosis. We experienced a case of variceal bleeding that developed in a patient with far advanced pancreatic cancer after placement of a self- expanding metal stent into a strictured bile duct via the peroral and transpapillary route. The patient had a duodenal varix near the major papilla and the bleeding was treated with an injection of Histoacryl^Ⱂ. We thought the bleeding of the periampullary varix resulted from injury due to exposure to the free end of the alloy wires in the distal portion of the inserted biliary metal stent. (Korean J Gastrointest Endosc 2008;37:76-81)

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Endoscopic Bilateral Metal Stent Placement with a Y-Configured Dual Stent for Advanced Hilar Carcinoma: Jong Ho Hwang, M.D.*, Dae Hwan Kang, M.D., Sang Yong Lee, M.D.*, Kyung Yeob Kim, M.D., Jae Sup Eum, M.D., Ji Young Kim, M.D., Do Hoon Kim, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Geun Am Song, M.D. and Mong Cho, M.D.; Korean J Gastrointest Endosc 2008;36(1):7-13. Published online January 30, 2008

Abstract PDF: Background
/Aims: Palliative endoscopic or percutaneous internal drainage is widely used for treating hilar cholangiocarcinoma. Yet unilateral biliary drainage does not completely improve jaundice and it can induce acute cholangitis by the undrained contrast media. To investigate this technique's technical and clinical effectiveness, a newly devised Y-configured dual stent was used for treating advanced hilar malignancies. Methods: From May, 2005 to May, 2007, 20 hilar malignancies (men: women=9:11, age=70.5 yr) that were not suitable for surgical resection were included in this study. For bilateral metal stent placement, a biliary stent with a wide open central mesh was first inserted. After this, another stent without a hole was inserted into the contralateral hepatic duct through the open central mesh of the first stent. Results: Bilateral metal stent insertion was done in 14 of 20 patients. Among the 14 patients in whom bilateral stents were successfully placed, the rate of functional success was 100%. There were no early complications. As a late complication, stent occlusion occurred in 4 of 14 patients (28.5%), and one of these patients had a plastic stent inserted. The other 3 patients were treated with percutaneous transhepatic biliary drainage. The median stent patency period was 231 days. Conclusions: The bilateral metal stent method using the Y stent is safe and effective for bilateral biliary drainage in patients with unresectable hilar malignancies. (Korean J Gastrointest Endosc 2008;36:7-13)

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Sigmoidoscopic Removal of Migrated Plastic Biliary Stents: Chang Nyol Paik, M.D., Jong Young Choi, M.D., Jae Myung Park, M.D., Yu Kyung Cho, M.D., In Seok Lee, M.D., Sang Woo Kim, M.D., Myung Gyu Choi, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2007;34(6):343-345. Published online June 30, 2007

Abstract PDF: Endoscopic retrograde biliary drainage is a well-established, minimally invasive procedure for treating biliary obstructions caused by malignant or benign diseases. Al though there is a low rate of complications with biliary stenting, late complications of stent migration can occur, occasionally resulting in bowel inflammation, obstruction or perforation. We report a case of a migrated biliary stent that induced an obstruction of the colon following ERBD in the stricture of hepatic ducts after a liver transplant, and was removed endoscopically.

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The Clinical Efficacy of Percutaneous Bilateral Internal Drainage in Advanced Hilar Malignancy by T-Configured Dual Stent Placement: Comparison with Unilateral Endoscopic Stent Placement: Joo Ho Lee, M.D., Sang Yong Lee, M.D., Jung Hyun Lee, M.D., Hyo Jin Jung, 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., Mong Cho, M.D., Suk Kim, M.D.*, Chang Won Kim, M.D.* and Suk Hong Lee, M.D.*; Korean J Gastrointest Endosc 2006;33(2):85-93. Published online August 30, 2006

Abstract PDF: Background
/Aims: Endoscopic or percutaneous internal drainage is a well-established palliative treatment for unresectable biliary tumors. Previous studies dealing with the unilateral versus bilateral liver lobe drainage have reported inconsistent results. This study evaluated the clinical efficacy of bilateral drainage with a newly designed T configured dual stent (T-stent) placement. Methods: From 2001 to 2004, 46 hilar malignancies, which were not suitable for endoscopic retrograde biliary drainage (ERBD) on MR cholangiography were treated with the percutaneous placement of two self-expandable metallic endoprostheses in a T configuration through a single transhepatic access. The outcomes were examined retrospectively. The hilar malignancies, which were drained by unilateral ERBD were also reviewed. Results: The 46 hilar malignancies drained by a T stent included a cholangiocarcinoma (n=36), gallbladder cancer (n=6), and metastatic cancer (n=4). Procedure related cholangitis occurred in 3 out of 46 patients (6.5%). The mean survival and stent patency times were 256 and 194 days, respectively. The 34 hilar malignancies drained by unilateral ERBD included cholangiocarcinoma (n=29), gallbladder cancer (n=3), and pancreatic cancer (n=2). Procedure related cholangitis occurred in 7 out of 34 patients (20.6%). The mean survival and stent patency times were 292 and 186 days, respectively. There were no statistically significant differences in the cholangitis frequency, survival and stent patency between the two groups. The frequency of cholangitis, mean survival and patency time in Klatskin tumors, which were drained by the T-stent (n=36) and ERBD (n=29), were compared. There were no significant differences in survival and stent patency time. Conclusions: T-configured dual stent placement can be used effectively in advanced biliary hilar malignancies. It can be used as a safe palliative drainage method in advanced hilar tumors, which are not suitable for ERBD. (Korean J Gastrointest Endosc 2006;33:85⁣93)

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A Case of Iatrogenic Bronchobiliary Fistula: Hee Bok Chae, M.D., Ki Won Moon, M.D., Sang Seok Bae, M.D., Seon Mee Park, M.D., Sei Jin Youn, M.D., Il Hun Bae, M.D.*, Jae Woon Choi, M.D.^†and Jun Ho Wang, M.D.^‡; Korean J Gastrointest Endosc 2004;28(3):151-155. Published online March 31, 2004

Abstract PDF: Bronchobiliary fistula is a rare condition. It is defined by the presence of a passage between the biliary tract and the bronchial tree. Many conditions can give rise to the developement of such a communication. The patient was a 71-year-old man who had obstructive jaundice due to liver mass. At first, we inserted an uncovered metallic stent for biliary drainage. However, the bile duct was perforated due to the trapping of a catheter in the distal end of the deployed stent. The operation was performed immediately, but only the sump draingage was placed in the retroperitoneum because the perforation site could not be found. After 20 days from the procedure, the patient complained of bilioptysis because of a bronchobiliary fistula. We inserted a covered stent into the previous uncovered metallic stent. Bilioptysis rapidly resolved after the successful procedure. We report a case of iatrogenic bronchobiliary fistula which was managed by endoscopic biliary stenting. (Korean J Gastrointest Endosc 2004;28:151⁣155)

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The Usefulness of Endoscopic Retrograde Biliary Drainage Using Plastic: Seung Jai Yoon, M.D., Sung Tae Ryu, M.D., Ju Hyun Suh, M.D., Seok Jeong, M.D.,; Korean J Gastrointest Endosc 2003;26(4):205-209. Published online April 30, 2003

Abstract PDF: Background
/Aims: Endoscopic sphincterotomy is considered the primary option for treatment of common bile duct (CBD) stones. In some cases, however, complete stone removal is difficult or even impossible. Endoscopic retrograde biliary drainage (ERBD) has been suggested to be an alternative treatment in such cases or in patients with high surgical risks. In this study, we evaluated the effectiveness of ERBD using a plastic stent for treatment of CBD stones. Methods: From Mar. 1996 to Aug. 1999, ERBD was performed in 12 patients with CBD stones. Indications for ERBD were old age in 4, a large perivater diverticulum in 4, refusal of surgery in 2, bleeding risk and biliary stricture in 1 each. Nine had one of the significant associated medical conditions. Results: Six of the 12 patients were symptom-free at the time of evaluation (mean 32.9 months). Of the remaining 6 patients, 3 had operation, 1 had a successful endoscopic stone removal, 1 had a stent exchange, and 1 was lost to follow-up at 26 months. Thus, overall success rate of ERBD for treatment of CBD stones was 75% (9/12). Median symptom-free duration was 41 months (range 18∼59 months). Conclusions: In view of its relatively high success rate and long-term effect, ERBD is an alternative modality for treatment of CBD stones, especially in patients with high surgical risks. (Korean J Gastrointest Endosc 2003;26:205⁣209)

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악성 완전 담도협착에서의 경피적 세침천자술에 의한 경피적 내시경적 담도배액술 ( Percutaneous Endoscopic Biliary Stenting (PEBS) Using the Percutaneous Fine Needle Puncture Method in Malignant Complete Biliary Obstruction ): Korean J Gastrointest Endosc 2000;20(2):154-157. Published online November 30, 1999

Abstract PDF: Nonsurgical drainage of malignant obstructive jaundice is an interesting alternative to surgical drainage in the palliative treatment of pancreaticobiliary neoplasms. Biliary drainage by endoprosthesis is as effective and better supported than percutaneous external drainage, but more difficult to control. Endoscopic retograde biliary drainage (ERBD) is a safe and effective biliary drainage procedure, and is indicated with malignant obstructive jaundice in patients on whom endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) can be performed. A nonoperative method of palliation was used in patients with malignant obstructive jaundice, in whom a biliary endoprosthesis could not be placed endoscopically due to complete obstruction of the bile duct. A guide wire was manipulated through the lesion by a percutaneous transhepatic route, after puncturing the tumor by a fine needle, and retrieved from the duodenum through an endoscope. A stent was then passed through the endoscope over the guide wire across the stricture.

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직장 자궁내막증: 증례보고 및 국내문헌 고찰 ( Rectal Endometriosis: A Case Report of with a Clinical Analysis of Other Cases Reported in Related Korean Literature ): Korean J Gastrointest Endosc 1999;19(4):667-674. Published online November 30, 1998

Abstract PDF: Hemobilia is defined as a hemorrhage in the biliary tract and is most commonly associated with accidental or iatrogenic trauma. A case is herein reported of hemobilia developed in a hepatic artery aneurysm after biliary stenting was performed in patient with cholangiocarcinoma. A 63-year-old man was admitted with melena and had history of cholangiocarcinoma with an intraductal biliary stent. A hepatic artery angiography revealed two pseudoaneurysms at the common hepatic artery and right hepatic artery. Transarterial embolization with gelfoam was successfully received and hemobilia was not developed later. (Korean J Gastrointest Endosc 19: 671∼675, 1999)

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원저 : 담도 췌장 ; 내시경적 제거가 곤란한 총담관결석 환자에서 영구적 담관배액술의 효과 ( Original Articles : Biliary Tract & Pancreas ; Long-Term Effect of Permanent Biliary Stenting for Endoscopically Unextractable Common Bile Duct Stone(s) ): Korean J Gastrointest Endosc 1998;18(1):40-50. Published online November 30, 1997

Abstract PDF: Background
/Aims: Endoscopic sphincterotomy(EST) has become a well-established therapeutic modality for common bile duct stone(s). EST and subsequent stone extraction, including mechanical lithotripsy, can clear bile duct in 85% to 95% of patients. Other therapeutic modalities which have been developed to enhance bile duct clearance including extracorporeal shock-wave lithotripsy, electrohydraulic or laser lithotripsy, and chemical dissolution are high cost, not yet widely available especially in community hospital, yet to be perfected, or still under clinical evaluation. The use of biliary stenting has been proposed as an alternative therapy for patients at high risk for surgery. We carried out this prospective, controlled study to evaluate the long-term effect of biliary stenting for endoscopically unextractable common bile duct stone(s). Methods: Of the 233 patients with common bile duct stone(s) admitted at Gil Hospital from Jan. 1995 to Dec. 1996, the stent group were 14 patients with retained comrnon bile duct stone(s) in which 7Fr polyethylene biliary stent was placed with the proximal end above the stone and the distal end in the duodenum. The control group were 6 patients with common bile duct stone(s) not treated, because of patients refusal of surgical or endoscopic management. Follow-up was achieved by direct interview and telephone, and consisted of prospective analysis of all complications that occured during long-term follow-up period. Complication rates in the both groups were compared using chi-square test and cumulative complication-free rates were calculated by Kaplan-Meier analysis. (Korean J Gastrointest Kndosc 18: 40-50, 1~998) (continue)

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

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

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