Clinical Endoscopy

Reviews

Optimal endoscopic drainage strategy for unresectable malignant hilar biliary obstruction: Itaru Naitoh, Tadahisa Inoue; Clin Endosc 2023;56(2):135-142. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2022.150

Endoscopic biliary drainage strategies for managing unresectable malignant hilar biliary obstruction differ in terms of stent type, drainage area, and deployment method. However, the optimal endoscopic drainage strategy remains unclear. Uncovered self-expandable metal stents (SEMS) are the preferred type because of their higher functional success rate, longer time to recurrent biliary obstruction (RBO), and fewer cases of reintervention than plastic stents (PS). Other PS subtypes and covered SEMS, which feature a longer time to RBO than PS, can be removed during reintervention for RBO. Bilateral SEMS placement is associated with a longer time to RBO and a longer survival time than unilateral SEMS placement. Unilateral drainage is acceptable if a drainage volume of greater than 50% of the total liver volume can be achieved. In terms of deployment method, no differences were observed in clinical outcomes between side-by-side (SBS) and stent-in-stent deployment. Simultaneous SBS boasts a shorter procedure time and higher technical success rate than sequential SBS. This review of previous studies aimed to clarify the optimal endoscopic biliary drainage strategy for unresectable malignant hilar biliary obstruction.

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Comparison of unilateral and bilateral intraductal plastic stent placement for unresectable malignant hilar biliary obstruction: A propensity score‐matched cohort analysis
Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yuhei Iwasa, Shinya Uemura, Kensaku Yoshida, Akinori Maruta, Takuji Iwashita, Ichiro Yasuda, Masahito Shimizu
Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(4): 284. CrossRef
Preoperative endoscopic biliary drainage by metal versus plastic stents for resectable perihilar cholangiocarcinoma
David M. de Jong, Timothy M. Gilbert, Lynn E. Nooijen, Eva Braunwarth, Marijana Ninkovic, Florian Primavesi, Hassan Z. Malik, Nick Stern, Richard Sturgess, Joris I. Erdmann, Rogier P. Voermans, Marco J. Bruno, Bas Groot Koerkamp, Lydi M.J.W. van Driel
Gastrointestinal Endoscopy.2024; 99(4): 566. CrossRef
TOKYO criteria 2024 for the assessment of clinical outcomes of endoscopic biliary drainage
Hiroyuki Isayama, Tsuyoshi Hamada, Toshio Fujisawa, Mitsuharu Fukasawa, Kazuo Hara, Atsushi Irisawa, Shigeto Ishii, Ken Ito, Takao Itoi, Yoshihide Kanno, Akio Katanuma, Hironari Kato, Hiroshi Kawakami, Hirofumi Kawamoto, Masayuki Kitano, Hirofumi Kogure,
Digestive Endoscopy.2024;[Epub] CrossRef
Trisectoral Metal Stenting Using Combined Stent-by-Stent and Stent-in-Stent Method for Malignant Hilar Biliary Obstruction: A Prospective Pilot Study
Tadahisa Inoue, Rena Kitano, Mayu Ibusuki, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
Digestive Diseases and Sciences.2024;[Epub] CrossRef
Research progress on biliary stents

Progress in Medical Devices.2023;[Epub] CrossRef

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Comparing palliative treatment options for cholangiocarcinoma: photodynamic therapy vs. radiofrequency ablation: Tayyaba Mohammad, Michel Kahaleh; Clin Endosc 2022;55(3):347-354. Published online May 17, 2022; DOI: https://doi.org/10.5946/ce.2021.274

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Referral to an endoscopist is often done once curative resection is no longer an option for cholangiocarcinoma management. In such cases, palliation has become the main objective of the treatment. Photodynamic therapy and radiofrequency ablation can be performed to achieve palliation, with both procedures associated with improved stent patency and survival. Despite the greatly increased cost and association with photosensitivity, photodynamic therapy allows transmission to the entire biliary tree. In contrast, radiofrequency ablation is cheaper and faster to apply but requires intraductal contact. This paper reviews both modalities and compares their efficacy and safety for bile duct cancer palliation.

Citations

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Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma
Maryam Makki, Malak Bentaleb, Mohammed Abdulrahman, Amal Abdulla Suhool, Salem Al Harthi, Marcelo AF Ribeiro Jr
World Journal of Clinical Oncology.2024; 15(3): 381. CrossRef
Endoskopisch gesteuerte Diagnostik und Therapie von Cholangiokarzinomen
Ulrike Denzer, Alexander Dechêne
Die Gastroenterologie.2023; 18(1): 16. CrossRef
Recent Updates on Local Ablative Therapy Combined with Chemotherapy for Extrahepatic Cholangiocarcinoma: Photodynamic Therapy and Radiofrequency Ablation
Tadahisa Inoue, Masashi Yoneda
Current Oncology.2023; 30(2): 2159. CrossRef
Role of radiofrequency ablation in advanced malignant hilar biliary obstruction
Mamoru Takenaka, Tae Hoon Lee
Clinical Endoscopy.2023; 56(2): 155. CrossRef
Impact of endobiliary radiofrequency ablation on survival of patients with unresectable cholangiocarcinoma: a narrative review
Elena Di Girolamo, Andrea Belli, Alessandro Ottaiano, Vincenza Granata, Valentina Borzillo, Luca Tarotto, Fabiana Tatangelo, Raffaele Palaia, Corrado Civiletti, Mauro Piccirillo, Valentina D’Angelo, Francesco Fiore, Pietro Marone, Guglielmo Nasti, Frances
Frontiers in Oncology.2023;[Epub] CrossRef
Thermal ablative therapies in the gastrointestinal tract
Hendrik Manner
Current Opinion in Gastroenterology.2023; 39(5): 370. CrossRef
Photodynamic Therapy: From the Basics to the Current Progress of N-Heterocyclic-Bearing Dyes as Effective Photosensitizers
Eurico Lima, Lucinda V. Reis
Molecules.2023; 28(13): 5092. CrossRef
Balloon‐assisted laser application for endoscopic treatment of biliary stricture
Seonghee Lim, Van Gia Truong, Seok Jeong, Jiho Lee, Byeong‐il Lee, Hyun Wook Kang
Lasers in Surgery and Medicine.2023; 55(10): 912. CrossRef
Emerging Systemic Therapies in Advanced Unresectable Biliary Tract Cancer: Review and Canadian Perspective
Vincent C. Tam, Ravi Ramjeesingh, Ronald Burkes, Eric M. Yoshida, Sarah Doucette, Howard J. Lim
Current Oncology.2022; 29(10): 7072. CrossRef

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Systematic Review and Meta-Analysis

Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis: Do Han Kim, Somashekar G. Krishna, Emmanuel Coronel, Paul T. Kröner, Herbert C. Wolfsen, Michael B. Wallace, Juan E. Corral; Clin Endosc 2022;55(2):197-207. Published online November 29, 2021; DOI: https://doi.org/10.5946/ce.2021.079

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Background
/Aims: Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliary disorders and provide guidance for treatment. This study aimed to review the technique, image classification, and diagnostic performance of confocal laser endomicroscopy (CLE).
Methods
We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of the technique, image classification, diagnostic performance, ongoing research, and limitations.
Results
Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). Needlebased CLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma, neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobserver variability are challenges for routine utilization.
Conclusions
CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs and simplifying image interpretation will promote utilization by advanced endoscopists.

Citations

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Updates in Diagnosis and Endoscopic Management of Cholangiocarcinoma
Roxana-Luiza Caragut, Madalina Ilie, Teodor Cabel, Deniz Günșahin, Afrodita Panaitescu, Christopher Pavel, Oana Mihaela Plotogea, Ecaterina Mihaela Rînja, Gabriel Constantinescu, Vasile Sandru
Diagnostics.2024; 14(5): 490. CrossRef
Endoscopic Ultrasound-Guided Needle-Based Confocal Endomicroscopy as a Diagnostic Imaging Biomarker for Intraductal Papillary Mucinous Neoplasms
Shreyas Krishna, Ahmed Abdelbaki, Phil A. Hart, Jorge D. Machicado
Cancers.2024; 16(6): 1238. CrossRef
Exploring Intestinal Permeability: Concept, Diagnosis, Connection to Bowel Disease, and Iron Deficiency
Olesja Basina, Aleksejs Derovs, Jeļena Derova, Sandra Lejniece
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences..2024; 78(4): 244. CrossRef
American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: summary and recommendations
Larissa L. Fujii-Lau, Nirav C. Thosani, Mohammad Al-Haddad, Jared Acoba, Curtis J. Wray, Rodrick Zvavanjanja, Stuart K. Amateau, James L. Buxbaum, Audrey H. Calderwood, Jean M. Chalhoub, Nayantara Coelho-Prabhu, Madhav Desai, Sherif E. Elhanafi, Douglas S
Gastrointestinal Endoscopy.2023; 98(5): 685. CrossRef
In Vivo Click Chemistry Enables Multiplexed Intravital Microscopy
Jina Ko, Kilean Lucas, Rainer Kohler, Elias A. Halabi, Martin Wilkovitsch, Jonathan C. T. Carlson, Ralph Weissleder
Advanced Science.2022;[Epub] CrossRef
Endoscopic ultrasound-guided tissue acquisition: Needle types, technical issues, and sample handling
Woo Hyun Paik
International Journal of Gastrointestinal Intervention.2022; 11(3): 96. CrossRef

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Original Article

Survival Benefit of Intraductal Radiofrequency Ablation for Malignant Biliary Obstruction: A Systematic Review with Meta-Analysis: Byung Hyo Cha, Myoung-Jin Jang, Sang Hyub Lee; Clin Endosc 2021;54(1):100-106. Published online January 15, 2021; DOI: https://doi.org/10.5946/ce.2020.254

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Background
/Aims: Cholangiocarcinoma (CCA) is a rare but aggressive disease with a poor survival. Recent trials have shown improved survival with intraductal radiofrequency ablation (RFA) therapy. We performed a systematic review with meta-analysis to determine the survival benefit of endoscopic RFA for unresectable extrahepatic CCA with malignant biliary obstruction (MBO).
Methods
A systematic search from 1970 to 2020 was performed in MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials. gov. We selected eligible studies reporting relative risks, hazard ratios (HRs), or odds ratios, adjusted by controlling for confounding factors of survival rate and stent patency duration, among patients with extrahepatic CCA with MBO treated with RFA with stent insertion or stent insertion only.
Results
A total of eight trials (three randomized and five nonrandomized) with a total of 420 patients were included in the metaanalysis. Pooled overall survival analysis favored RFA treatment with stent insertion (HR, 0.47; 95% confidence interval [CI], 0.34– 0.64; I²=47%; p=0.09); however, no significant difference was found in the duration of stent patency between the groups (HR, 0.79; 95% CI, 0.57–1.09; I²=7%; p=0.36).
Conclusions
RFA therapy with stent insertion may confer a survival benefit compared with stent insertion only in patients with CCA and MBO.

Citations

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Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis
Matheus de Oliveira Veras, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Guilherme Henrique Peixoto de Oliveira, Rômulo Sérgio Araújo Gomes, Davi Lucena Landim, Felipe Giacobo Nunes, Tomazo Antônio Prince Franzini, Marcos Eduardo Lera dos Santos, W
Endoscopy International Open.2024; 12(01): E23. CrossRef
Reply to Chandrasekhara and Aggarwal
Matheus de Oliveira Veras, Diogo Turiani Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura
Endoscopy International Open.2024; 12(05): E640. CrossRef
Consensus statements on endoscopic radiofrequency ablation for malignant biliary strictures

Journal of Digestive Diseases.2024; 25(1): 2. CrossRef
The Impact of Radiofrequency Ablation on Survival Outcomes and Stent Patency in Patients with Unresectable Cholangiocarcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Daniele Balducci, Michele Montori, Francesco Martini, Marco Valvano, Federico De Blasio, Maria Eva Argenziano, Giuseppe Tarantino, Antonio Benedetti, Emanuele Bendia, Marco Marzioni, Luca Maroni
Cancers.2024; 16(7): 1372. CrossRef
Impact of temperature-controlled endobiliary radiofrequency ablation for inoperable hilar cholangiocarcinoma: A propensity score–matched analysis
Il Sang Shin, Jong Ho Moon, Yun Nah Lee, Jun Ho Myeong, Tae Hoon Lee, Jae Kook Yang, Young Deok Cho, Sang-Heum Park
Endoscopy International Open.2024; 12(04): E535. CrossRef
Percutaneous endobiliary radiofrequency ablation and stent placement for unresectable malignant biliary obstruction: a propensity score matching retrospective study
Wei Cui, Jing-Zhi Huang, Qi Wang, Feng Shi, Qing Gou, Xiao-Ming Chen, Jing Zhang, Jia-Ping Li, Rongde Xu
BMC Gastroenterology.2024;[Epub] CrossRef
Biliary stents for active materials and surface modification: Recent advances and future perspectives
Yuechuan Li, Kunshan Yuan, Chengchen Deng, Hui Tang, Jinxuan Wang, Xiaozhen Dai, Bing Zhang, Ziru Sun, Guiying Ren, Haijun Zhang, Guixue Wang
Bioactive Materials.2024; 42: 587. CrossRef
Chinese national clinical practice guideline on diagnosis and treatment of biliary tract cancers
Xu’an Wang, Yongrui Bai, Ningli Chai, Yexiong Li, Enqiang Linghu, Liwei Wang, Yingbin Liu
Chinese Medical Journal.2024;[Epub] CrossRef
Feasibility and safety of trans-biliary cryoablation: Preclinical evaluation of a novel flexible cryoprobe
Chao Zhang, Linzhong Zhu, Shousheng Tang, Jukun Wang, Yu Li, Xin Chen, Chunjing Bian, Dongbin Liu, Guokun Ao, Tao Luo
Cryobiology.2023; 111: 40. CrossRef
Efficacy and Safety of Radiofrequency Ablation Plus Stent Versus Stent-alone Treatments for Malignant Biliary Strictures
Hayat Khizar, Yufei Hu, Yanhua Wu, Kamran Ali, Junaid Iqbal, Muhammad Zulqarnain, Jianfeng Yang
Journal of Clinical Gastroenterology.2023; 57(4): 335. 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
In-stent radiofrequency ablation with uncovered metal stent placement for tumor ingrowth/overgrowth causing self-expandable metal stent occlusion in distal malignant biliary obstruction: multicenter propensity score–matched study
Namyoung Park, Min Kyu Jung, Eui Joo Kim, Woo Hyun Paik, Jae Hee Cho
Gastrointestinal Endoscopy.2023; 97(4): 694. CrossRef
ACG Clinical Guideline: Diagnosis and Management of Biliary Strictures
B. Joseph Elmunzer, Jennifer L. Maranki, Victoria Gómez, Anna Tavakkoli, Bryan G. Sauer, Berkeley N. Limketkai, Emily A. Brennan, Elaine M. Attridge, Tara J. Brigham, Andrew Y. Wang
American Journal of Gastroenterology.2023; 118(3): 405. CrossRef
Effect of radiofrequency ablation in addition to biliary stent on overall survival and stent patency in malignant biliary obstruction: an updated systematic review and meta-analysis
Zahid Ijaz Tarar, Umer Farooq, Mustafa Gandhi, Ghulam Ghous, Saad Saleem, Faisal Kamal, Zaid Imam, Laith Jamil
European Journal of Gastroenterology & Hepatology.2023; 35(6): 646. CrossRef
Impact of endobiliary radiofrequency ablation on survival of patients with unresectable cholangiocarcinoma: a narrative review
Elena Di Girolamo, Andrea Belli, Alessandro Ottaiano, Vincenza Granata, Valentina Borzillo, Luca Tarotto, Fabiana Tatangelo, Raffaele Palaia, Corrado Civiletti, Mauro Piccirillo, Valentina D’Angelo, Francesco Fiore, Pietro Marone, Guglielmo Nasti, Frances
Frontiers in Oncology.2023;[Epub] CrossRef
Endoluminal radiofrequency ablation in patients with malignant biliary obstruction: a randomised trial
Jana Jarosova, Lea Zarivnijova, Ivana Cibulkova, Jan Mares, Peter Macinga, Alzbeta Hujova, Premysl Falt, Ondrej Urban, Jan Hajer, Julius Spicak, Tomas Hucl
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Chenming Liu, Jiaming Dong, Yuxing Liu, Siyuan Zhang, Ruanchang Chen, Haijun Tang
Journal of International Medical Research.2023;[Epub] CrossRef
Intraductal Therapies for Cholangiocarcinoma
Abhishek Agnihotri, David E. Loren
Techniques and Innovations in Gastrointestinal Endoscopy.2022; 24(2): 200. CrossRef
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David M. de Jong, Jeska A. Fritzsche, Amber S. Audhoe, Suzanne S. L. Yi, Marco J. Bruno, Rogier P. Voermans, Lydi M. J. W. van Driel
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Surgical Oncology Clinics of North America.2021; 30(3): 491. CrossRef

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Review

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

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

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The additional value of the combined use of EUS and ERCP for the evaluation of unclear biliary strictures
Eszter Bényei, Antonio Molinaro, Per Hedenström, Riadh Sadik
Scandinavian Journal of Gastroenterology.2024; 59(8): 980. CrossRef
Antibiotic prophylaxis and its effect on postprocedural adverse events in endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis
Arvid Gustafsson, Lars Enochsson, Bobby Tingstedt, Greger Olsson
JGH Open.2023; 7(1): 24. CrossRef
Primary sclerosing cholangitis—A long night's journey into day
Roger W. Chapman
Clinical Liver Disease.2022; 20(S1): 21. CrossRef

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Original Article

Inside Plastic Stents versus Metal Stents for Treating Unresectable Malignant Perihilar Biliary Obstructions: A Retrospective Comparative Study: Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Toji Murabayashi, Fumisato Kozakai, Jun Horaguchi, Yutaka Noda, Kei Ito; Clin Endosc 2020;53(6):735-742. Published online March 4, 2020; DOI: https://doi.org/10.5946/ce.2020.003

Abstract PDF PubReader ePub

Background
/Aims: The aim of this study was to evaluate outcomes of inside plastic stents (iPSs) versus those of metal stents (MSs) for treating unresectable perihilar malignant obstructions.
Methods
For all patients who underwent endoscopic suprapapillary placement of iPS(s) or MS(s) as the first permanent biliary drainage for unresectable malignant perihilar obstructions between January 2014 and August 2019, clinical outcomes using iPSs (n=20) and MSs (n=85), including clinical efficacy, adverse events, and time to recurrence of biliary obstruction (RBO), were retrospectively evaluated.
Results
There were no differences in clinical effectiveness (95% for the iPS group vs. 92% for the MS group, p=1.00). Procedure-related adverse events, including pancreatitis, acute cholangitis, acute cholecystitis, and death, were observed for 8% of the MS group, although no patient in the iPS group developed such adverse events. The median time to RBO was 561 days (95% confidence interval, 0–1,186 days) for iPSs and 209 days (127–291 days) for MSs, showing a significant difference (p=0.008).
Conclusions
Time to RBO after iPS placement was significantly longer than that after MS placement. IPSs, which are removable, unlike MSs, were an acceptable option.

Citations

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Fumimasa Tomooka, Koh Kitagawa, Akira Mitoro, Yukihisa Fujinaga, Norihisa Nishimura, Tadashi Namisaki, Takemi Akahane, Kosuke Kaji, Shohei Asada, Shinya Sato, Jun‐Ichi Hanatani, Hitoshi Mori, Yuki Motokawa, Tomihiro Iwata, Hiroki Kachi, Yui Osaki, Hitoshi
DEN Open.2025;[Epub] CrossRef
Endoscopic nasobiliary drainage versus endoscopic biliary stenting for preoperative biliary drainage in patients with malignant hilar biliary obstruction: Propensity score‐matched multicenter comparative study
Hirotoshi Ishiwatari, Takanori Kawabata, Hiroki Kawashima, Yousuke Nakai, Shin Miura, Hironari Kato, Hideyuki Shiomi, Nao Fujimori, Takeshi Ogura, Osamu Inatomi, Kensuke Kubota, Toshio Fujisawa, Mamoru Takenaka, Hiroshi Mori, Kensaku Noguchi, Yuki Fujii,
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Comparison of unilateral and bilateral intraductal plastic stent placement for unresectable malignant hilar biliary obstruction: A propensity score‐matched cohort analysis
Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yuhei Iwasa, Shinya Uemura, Kensaku Yoshida, Akinori Maruta, Takuji Iwashita, Ichiro Yasuda, Masahito Shimizu
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A Novel Method of Calculating the Drained Liver Volume Using a 3D Volume Analyzer for Biliary Drainage of Unresectable Malignant Hilar Biliary Obstruction
Naoto Imagawa, Mitsuharu Fukasawa, Shinichi Takano, Satoshi Kawakami, Yoshimitsu Fukasawa, Hiroyuki Hasegawa, Natsuhiko Kuratomi, Shota Harai, Naruki Shimamura, Dai Yoshimura, Shoji Kobayashi, Takashi Yoshida, Mitsuaki Sato, Yuichiro Suzuki, Nobuyuki Enom
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Partial Stent-in-Stent Method with an Uncovered Self-Expandable Metallic Stent for Unresectable Malignant Hilar Bile Duct Obstruction
Takuya Shimosaka, Yohei Takeda, Taro Yamashita, Yuta Seki, Shiho Kawahara, Takayuki Hirai, Noriyuki Suto, Yuri Sakamoto, Wataru Hamamoto, Hiroki Koda, Takumi Onoyama, Kazuya Matsumoto, Kazuo Yashima, Hajime Isomoto, Naoyuki Yamaguchi
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Hirotoshi Ishiwatari, Junya Sato, Hiroki Sakamoto, Takuya Doi, Hiroyuki Ono
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Safety and efficacy of biliary suprapapillary metal and plastic stents in malignant biliary obstruction: a systematic review and meta-analysis
Saqr Alsakarneh, Mahmoud Y. Madi, Fouad Jaber, Kamal Hassan, Yassine Kilani, Omar Al Ta’ani, Dushyant Singh Dahiya, Amir H. Sohail, Laith Numan, Mohammad Bilal, Wissam Kiwan
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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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Endoscopic retrograde stent drainage therapies for malignant biliary obstruction: the distal opening of stent location above or across the duodenal papilla? A systematic review and meta-analysis
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Scandinavian Journal of Gastroenterology.2023; 58(9): 1071. CrossRef
Suprapapillary placement of plastic versus metal stents for malignant biliary hilar obstructions: a multicenter, randomized trial
Yoshihide Kanno, Kei Ito, Kazunari Nakahara, Shinya Kawaguchi, Yoshiharu Masaki, Toru Okuzono, Hironari Kato, Masaki Kuwatani, Shotaro Ishii, Toji Murabayashi, Sho Hasegawa, Masatsugu Nagahama, Yuji Iwashita, Yosuke Michikawa, Shuzo Terada, Yujiro Kawakam
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Review

The Role of Peroral Cholangioscopy in Evaluating Indeterminate Biliary Strictures: Nasim Parsa, Mouen A. Khashab; Clin Endosc 2019;52(6):556-564. Published online July 16, 2019; DOI: https://doi.org/10.5946/ce.2019.011

Abstract PDF PubReader ePub

Biliary strictures are considered indeterminate when the initial radiologic evaluation and endoscopic retrograde cholangiopancreatography with brush cytology and/or forceps biopsy do not reveal diagnostic findings. Evaluation of these strictures is challenging and often requires a multidisciplinary approach and multiple procedures. Peroral cholangioscopy allows direct visualization of these lesions and targeted tissue acquisition using miniature biopsy forceps. In the past decade, there have been significant improvements in the field of cholangioscopy. These advances have allowed higher-quality image acquisition, easy setup, operation by a single operator, easy maneuverability, and excellent targeted tissue sampling performance. However, the interpretation of cholangioscopic visual findings remains challenging. In this review, we discuss the role of peroral cholangioscopy in the evaluation of indeterminate biliary strictures.

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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.

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Focused Review Series: Advanced Endoscopic Treatment for Pancreaticobiliary Diseases

Endoscopic Ablation Therapy for Biliopancreatic Malignancies: Jason Roque, Shiaw-Hooi Ho, Nageshwar Reddy, Khean-Lee Goh; Clin Endosc 2015;48(1):15-19. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.15

Abstract PDF PubReader ePub

Biliopancreatic malignancies such as cholangiocarcinoma (CCA) has notoriously been diagnosed late. As such most therapy have been palliative in nature. Cholangioscopy allows for an earlier diagnosis to be made. Brachytherapy with the insertion of catheter with iridium-132 seeds, percutaneously or through endoscopic retrograde cholangiopancreatography (ERCP) was the earliest ablative techniques used. It has been shown to have a beneficial effect only in prolonging survival. Photodynamic therapy (PDT) has also been used for several years. stenting with PDT versus stenting alone for unresectable CCA showed a marked survival benefit with the addition of PDT. However the most exciting endoscopic ablative modality appears to be intraductal radiofrequency ablation using the Habib catheter and device. Several case series have shown the effectiveness of this technique in ablating tumors. This technique is evolving and coupled with early diagnosis of CCA through cholangioscopy will allow for a curative therapy. The crux to the effective treatment of early cancerous lesions in the bile or pancreatic duct is the early diagnosis of such lesions. Effective endoscopic ablative therapy is now available with the advent of radiofrequency ablation probes that can be passed through the duodenoscope via ERCP.

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Review

Bilateral Metallic Stenting in Malignant Hilar Obstruction: Tae Hoon Lee, Jong Ho Moon, Sang-Heum Park; Clin Endosc 2014;47(5):440-446. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.440

Abstract PDF PubReader ePub

Endoscopic palliative biliary drainage is considered as a gold standard treatment in advanced or inoperable hilar cholangiocarcinoma. Also, metal stents are preferred over plastic stents in patients with >3 months life expectancy. However, the endoscopic intervention of advanced hilar obstruction is often more challenging and complex than that of distal malignant biliary obstructions. In this literature review, we describe the issues commonly encountered during endoscopic unilateral (single) versus bilateral (multiple) biliary stenting for malignant hilar obstruction. Also, we provide technical guidance to improve the technical success rates and patient outcomes, focusing on bilateral metallic stenting techniques such as stent-in-stent or side-by-side deployment.

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Tadahisa Inoue, Fumihiro Okumura, Itaru Naitoh, Shigeki Fukusada, Kenta Kachi, Takanori Ozeki, Kaiki Anbe, Hiroyasu Iwasaki, Takashi Mizushima, Yuji Kobayashi, Norimitsu Ishii, Kiyoaki Ito, Hiromu Kondo, Kazuki Hayashi, Masashi Yoneda, Hitoshi Sano
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Itaru Naitoh, Takahiro Nakazawa, Tesshin Ban, Fumihiro Okumura, Atsuyuki Hirano, Hiroki Takada, Shozo Togawa, Kazuki Hayashi, Katsuyuki Miyabe, Shuya Shimizu, Hiromu Kondo, Yuji Nishi, Michihiro Yoshida, Hiroaki Yamashita, Shuichiro Umemura, Yasuki Hori,
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Eun Young Kim, Kwang An Kwon, Il Ju Choi, Ji Kon Ryu, Ki Baik Hahm
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Original Article

Photodynamic Therapy in Unresectable Cholangiocarcinoma: Not for the Uncommitted: Jayant P. Talreja, Marisa DeGaetani, Kristi Ellen, Timothy Schmitt, Monica Gaidhane, Michel Kahaleh; Clin Endosc 2013;46(4):390-394. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.390

Abstract PDF PubReader ePub

Background/Aims

Photodynamic therapy (PDT) in unresectable cholangiocarcinoma has been associated with improved survival. We report a single tertiary care center experience over the past 6 years.

Methods

Fifty-five patients with unresectable cholangiocarcinoma received PDT between 2004 and 2010. Plastic stents were placed after PDT to prevent cholangitis.

Results

Twenty-seven patients (49%) showed Bismuth type IV, 22 (41%) showed Bismuth type III, and six (10%) showed Bismuth type I and II. Twenty patients (37%) received chemotherapy and radiation therapy, five (9%) received chemotherapy only; and one (2%) received radiation therapy only. Mean number of PDT sessions was 1.9±1.5 sessions (range, 1 to 9). Mean survival duration was 293±266 days (median, 190; range, 25 to 1,332). PDT related complications included three (5%) facial burn, three (5%) photosensitivity, and two (3%) rash. Kaplan-Meier analysis comparing the survival means of patients who received PDT and chemotherapy/radiation therapy (median survival 257 days; 95% confidence interval [CI], 166 to 528) versus who received PDT only (median survival 183 days; 95% CI, 129 to 224) showed no significant difference (log-rank p=0.20).

Conclusions

PDT has a measurable impact on survival in unresectable cholangiocarcinoma but requires aggressive stenting posttherapy.

Citations

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Photodynamic Therapy (PDT), Radiofrequency Ablation (RFA) With Biliary Stents in Palliative Treatment of Unresectable Extrahepatic Cholangiocarcinoma
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Efficacy and safety of photodynamic therapy for unresectable cholangiocarcinoma: A meta-analysis
Yi Lu, Lei Liu, Jia-chuan Wu, Li-ke Bie, Biao Gong
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Biliary Tumor Ablation with Photodynamic Therapy and Radiofrequency Ablation
Ioana Smith, Michel Kahaleh
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The Role of Endoscopy in the Diagnosis and Management of Cholangiocarcinoma
Ajaypal Singh, Uzma D. Siddiqui
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Role of photodynamic therapy and intraductal radiofrequency ablation in cholangiocarcinoma
Janaki Patel, Nada Rizk, Michel Kahaleh
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Impact of Radiofrequency Ablation on Malignant Biliary Strictures: Results of a Collaborative Registry
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Digestive Diseases and Sciences.2015; 60(7): 2164. CrossRef
Randomised phase II trial of photodynamic therapy plus oral fluoropyrimidine, S-1, versus photodynamic therapy alone for unresectable hilar cholangiocarcinoma
Do Hyun Park, Sang Soo Lee, So Eun Park, Jae Lyun Lee, Jun Ho Choi, Hee Jung Choi, Ji Woong Jang, Hyoung Jung Kim, Jun Bum Eum, Dong-Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Jung Bok Lee
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Is There Any Evidence for a Role of Local Treatment in Cholangiocarcinoma?
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Visceral Medicine.2014; 30(4): 254. CrossRef

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Focused Review Series: Photodynamic Therapy

Current Status of Photodynamic Therapy for Bile Duct Cancer: Tae Yoon Lee, Young Koog Cheon, Chan Sup Shim; Clin Endosc 2013;46(1):38-44. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.38

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The most common form in bile duct cancers is a highly desmoplastic cancer with a growth pattern characterized by periductal extension and infiltration. The prognosis of bile duct cancers, especially hilar cholangiocarcinoma, is limited by tumor spread along the biliary tree leading to refractory obstructive cholestasis, cholangitis, and liver failure. Although biliary endoprosthesis improves occlusion rates and reduces the number of therapeutic interventions, median survival time is not ameliorated. Photodynamic therapy (PDT) is a local photochemical tumor treatment that consists of a photosensitizing agent in combination with laser irradiation of a distinct wavelength. Tumor ablation with PDT combined with biliary stenting reduces cholestasis and significantly improves median survival time in selected patients with bile duct cancers.

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Extrahepatic cholangiocarcinoma: Current status of endoscopic approach and additional therapies
Alina Ioana Tantau, Alina Mandrutiu, Anamaria Pop, Roxana Delia Zaharie, Dana Crisan, Carmen Monica Preda, Marcel Tantau, Voicu Mercea
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Investigated spectral-fluorescent properties of endogenous porphyrins of the wild boar hepatobiliary system optimize the diagnostics and treatment of cholangiocarcinoma with FD and PDT
Artem Shiryaev, Polina Alekseeva, Kanamat Efendiev, Dmitry Yakovlev, Arkadii Moskalev, Elizaveta Kozlikina, Pavel Kharnas, Igor Reshetov, Vladimir Levkin, Victor Loschenov
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Dmitry V. Yakovlev, Dina S. Farrakhova, Artem A. Shiryaev, Kanamat T. Efendiev, Maxim V. Loschenov, Liana M. Amirkhanova, Dmitry O. Kornev, Vladimir V. Levkin, Igor V. Reshetov, Victor B. Loschenov
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Carlo Felix Maria Jung, Julie Lavole, Maximilien Barret, Einas Abou Ali, Lola-Jade Palmieri, Solene Dermine, Amélie Barré, Stanislas Chaussade, Romain Coriat
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Luciano Tarantino, Giuseppina Busto, Aurelio Nasto, Riccardo Aurelio Nasto, Paolo Tarantino, Raffaele Fristachi, Luigi Cacace, Sara Bortone
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Site-specific conjugation of single domain antibodies to liposomes enhances photosensitizer uptake and photodynamic therapy efficacy
M. Broekgaarden, R. van Vught, S. Oliveira, R. C. Roovers, P. M. P. van Bergen en Henegouwen, R. J. Pieters, T. M. Van Gulik, E. Breukink, M. Heger
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Case Report

One Case of Common Bile Duct Cancer Mimicking Cystic Neoplasm of the Pancreas, Arising 9 Years after Excision of a Choledochal Cyst: Sang Wook Park, Sang Hyub Lee, Young Ook Eum, Hong Sang Oh, Donghyeon Lee, Eunhyo Jin, Kwanghyun Chung, Jin-Hyeok Hwang; Clin Endosc 2012;45(4):435-439. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.435

Abstract PDF PubReader ePub

A 42-years-old woman had undergone operation for cholecochal cyst with gallbladder cancer 9 years ago. Pathology revealed a polypoid mass in the gallbladder with liver infiltration as poorly differentiated adenocarcinoma. Computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasound showed a newly developed suspected solid nodule in the peripheral portion of cystic lesion in the pancreas head. She underwent a pylorus preserving pancreaticoduodenectomy for the suspected mucinous cystic neoplasm of the pancreas. Pathology revealed poorly differentiated adenocarcinoma. The remnant choledochal cyst had developed to cholangiocarcinoma, which mimicked cystic neoplasm of the pancreas.

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Carcinoma of the Papilla of Vater after Diversion Operation for Pancreaticobiliary Maljunction
Takahiro Yamanaka, Kenichiro Araki, Norihiro Ishii, Mariko Tsukagoshi, Takamichi Igarashi, Akira Watanabe, Norio Kubo, Hiroyuki Kuwano, Ken Shirabe
Case Reports in Gastroenterology.2017; 11(2): 265. CrossRef
Treatment and outcomes of adults with remnant intrapancreatic choledochal cysts
Hong-Tian Xia, Tao Yang, Bin Liang, Jian-Ping Zeng, Jia-Hong Dong
Surgery.2016; 159(2): 418. CrossRef

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Special Issue Articles of IDEN 2012

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

Abstract PDF PubReader ePub

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

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Two cases of immunoglobulin G4-related sclerosing cholangitis in which transabdominal ultrasonography was useful in diagnosis and follow-up observation
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UEG Week 2016 Oral Presentations

United European Gastroenterology Journal.2016; 4(5_suppl): A1. CrossRef
Immunoglobulin G4–Related Sclerosing Cholangitis Mimicking Hilar Cholangiocarcinoma Diagnosed With Following Bile Duct Resection: Report of a Case
Atsushi Miki, Yasunaru Sakuma, Hideyuki Ohzawa, Yukihiro Sanada, Hideki Sasanuma, Alan T. Lefor, Naohiro Sata, Yoshikazu Yasuda
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Torsten Voigtländer, Tim O. Lankisch
Best Practice & Research Clinical Gastroenterology.2015; 29(2): 267. CrossRef

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The Long-term Outcome and Predictors for Increased Survival after PDT for Hilar Cholangiocarcinoma: Ji Ho Ahn, M.D., Young Koog Cheon, M.D., Young Deok Cho, M.D., Hyun Jong Choi, M.D., Jong Ho Moon, M.D., Tae Hoon Lee, M.D., Sang Heum Park, M.D. and Chan Sup Shim, M.D.*; Korean J Gastrointest Endosc 2011;42(1):6-10. Published online January 30, 2011

Abstract PDF

Background/Aims: Photodynamic therapy (PDT) has a promising effect on nonresectable cholangiocarcinoma (CC) but its long term data is not yet available. This study examined the long term outcome and factors associated with increased survival after performing PDT for hilar cholangiocarcinoma.

Methods: A list of 393 patients with a diagnosis of hilar CC was retrieved from the database of Soonchunhyang University Hospital (Seoul, Korea) and these patients were seen from January 1, 2001, to April 1, 2010. We retrospectively reviewed the records of 74 patients who underwent PDT in addition to biliary stenting with/without chemoradiation.

Results: The median overall survival from the date of diagnosis to death or to the last follow-up was 11.7 months (range: 2.2∼78.4). After performing PDT, a complete remission was observed in 1.3% (1/74) of the patients who had a superficial depth of tumor without lymph node involvement. On multivariate analysis using the Cox regression model, increasing the time to treatment after the diagnosis was a statistically significant predictor of shorter survival after PDT [Odds ratio: 3.25, 95% confidence interval (CI): 1.90∼4.71, p=0.034].

Conclusions: Although PDT does not prevent progression of CC, it appears to control the cholestasis. The early treatment of PDT after the diagnosis showed a survival benefit for patients with advanced hilar CC. (Korean J Gastrointest Endosc 2011;42:6-10)

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A Preliminary Study on the Usefullness of a Zilver Stent for Bilateral Stenting in Patients with Advanced Hilar Cholangiocarcinoma: Jae Sup Eum, M.D., Dae Hwan Kang, M.D. and Cheol Woong Choi, M.D.; Korean J Gastrointest Endosc 2008;36(6):354-360. Published online June 30, 2008

Abstract PDF: Background
/Aims: Hilar cholangiocarcinomas have an extremely poor prognosis. Although endoscopic bilateral metal stenting with the "stent in stent" technique using a Y stent is currently employed to treat patients with an unresectable hilar cholangiocarcinoma, this method has limited application in cases of tight strictures. Furthermore, insertion of stents into the Y stent side (first stent side) is problematic in cases of tumor recurrence. We evaluated the clinical efficacy of the use of endoscopic bilateral metal stenting with the Zilver stent. Methods: Seven patients with an unresectable Bismuth type III or IV hilar cholangiocarcinoma were included in this study. For endoscopic bilateral metal stenting, we first inserted a Y stent with a central wide-open mesh. The Zilver stent was placed into the contralateral hepatic duct through the central portion of the Y stent. Results: Both technical and functional success was achieved in seven patients (100%). The early complication rate was 0%, and late complications due to tumor recurrence occurred in 2 out of 7 (28.6%) patients. These patients were managed by the placement of additional stents or with the use of percutaneous transhepatic biliary drainage. Conclusions: We suggest that a combination technique using Y and Zilver stents improves bilateral stenting for patients with advanced hilar cholangiocarcinoma and facilitates stent reinsertion in cases of tumor recurrence. (Korean J Gastrointest Endosc 2008; 36:354-360)

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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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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 Clonorchiasis Presenting as Common Hepatic Duct Mass: Choul Woong Hwang, M.D., Byung Wook Lim, M.D., Ung Ryu, M.D., Jong Hoon Kim, M.D., Hye Yeon Park, M.D., Kyung Il Park, M.D., Sung Moon Jung, M.D., Kyung-Ah Kim, M.D., Jeon Ho Yang, M.D., June Sung Lee, M.D., Young Soo Moon, M.D., Young Bin Jeon, M.D.*, Sa; Korean J Gastrointest Endosc 2005;31(4):268-272. Published online October 30, 2005

Abstract PDF: The liver fluke, Clonorchis sinensis is an important human parasite and is endemic in Eastern Asia including Korea, China, and Japan. Patients acquire the infestation by eating raw or undercooked freshwater fish. Radiologic examinations usually reveal dilated peripheral intrahepatic bile ducts and normal extrahepatic bile duct. The diagnosis of clonorchiasis may sometimes be difficult and a presentation as an obstructive mass at the common hepatic duct is a rare event. Here we report a case of clonorchiasis of 54-year- old woman presented with epigastric pain. Endoscopic retrograde cholangiography revealed a mass at the common hepatic duct with dilatation of the intrahepatic ducts mimicking cholangiocarcinoma. Using an endoscopic basket, muddy, sludge-like materials were extracted through the papillary orifice. We report this case with a review of literatures. (Korean J Gastrointest Endosc 2005;31:268⁣272)

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구연 / 담췌 : 58 세 남자 , 황달: Korean J Gastrointest Endosc 2001;22(5):321-322. Published online November 30, 2000

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간문부 담관암의 담도내 종적 침윤 평가에 있어 자기공명 담관조영술과 경피경간 담도경 성적의 비교: Korean J Gastrointest Endosc 2001;23(5):318-318. Published online November 30, 2000

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Mucin-hypersecreting Cholangiocarcinoma: Korean J Gastrointest Endosc 2000;20(5):411-411. Published online November 30, 1999

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췌장의 점액 생산성 종양과 유사한 점액 생산성 담도암 8예 ( Eight Cases of Mucin-hypersecreting Cholangiocarcinoma Similar to Intraductal Papillary Mucinous Tumor of the Pancreas ): Korean J Gastrointest Endosc 2000;20(1):33-40. Published online November 30, 1999

Abstract PDF: Background
/Aims: Mucin-hypersecreting cholangiocarcinoma is very similar to intraductal papillary mucinous tumor (IPMT) of the pancreas. But this disease is rare and its clinicopathologic features are not well known. The purposes of this study are to report our experience of eight patients with the tumor and to analyze the characteristics of its clinical, radiological and pathological finding. Methods: Eight patients (3 men and 5 women, mean age 52 years) were diagnosed as having a mucin-hypersecreting cholangiocarcinoma among 4,570 cases of ERCP from 1995 to 1998. Results: Recent or previous attacks of biliary pain or acute cholangitis were elicited in most of the patients. CT showed diffuse intra- and extra-hepatic duct dilatation in all patients and suspicious ill-defined mass shadow in 2 out of 8 patients. On cholangioscopic examination, a papillary mass or minute mucosal lesion was found in the dilated bile duct containing thick viscid mucin. Eight patients were recommended an operation and curative resection was performed in seven patients. Histologically, well-differentiated adenocarcinoma in the background of benign hyperplasia and adenoma was documented in all patients. Conclusions: Mucin- hypersecreting cholangiocarcinoma may be characterized by exceedingly similarity to IMPT of the pancreas in clinical, radiological and pathological features. Further investigation is needed for detailed information such as natural history and outcome. (Korean J Gastrointest Endosc 2000;20:33~40)

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경피경간 담도배액관을 따라 피부로 전이된 담도암 1예 ( Subcutaneous Implantation Metastasis of a Cholangiocarcinoma of the Bile Duct after Percutaneous Transhepatic Biliary Drainage (PTBD) ): Korean J Gastrointest Endosc 1999;19(5):837-842. Published online November 30, 1998

Abstract PDF: Percutaneous transhepatic biliary catheterization (PTC) has not only been increasingly used in the localization of benign and malignant lesions, but it is also considered rapid, safe and effective method to establish internal and external drainage for decompression of biliary obstructions. Infections and granulomas at the catheter entry site can occasionally develop, but are easily managed. However, such technique, when used both for obtaining malignant cells for diagnosis and for percutaneous decompression of the biliary tract can exposure the patient at risk for dissemination of the tumor along the catheter tract. This rare complication has been observed in a patient who underwent percutaneous transhepatic biliary drainage (PTBD) for malignant biliary tract obstruction. Although tumor cell seeding along the catheter tract is a very rare complication, we think that PTBD should be avoided when curative resection is planned. (Korean J Gastrointest Endosc 19: 837∼842, 1999)

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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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증례 : 식도 위장관 ; 간내 담석이 위치한 부위와 다른 부위에 병발된 간내 담관암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Intrahepatic Cholangiocarcinoma Developed in a Remote Region from the Site of Hepatolithiasis ): Korean J Gastrointest Endosc 1998;18(6):968-975. Published online November 30, 1997

Abstract PDF: An association of hepatolithiasis and cholangiocarcinoma is thought to be rare, with a rate reported to be 2.36%-10%. Most of the cholangiocarcinomas concurrent with intrahepatic stones are found in the vicinity of the hepatolithiasis, and the diagnosis of intrahepatic cholangiocarcinoma in cases with hepatolithiasis is very difficult to detect preoperatively in spite of recent developments in techniques of imaging studies. Recently, the development of cholangiocarcinoma was reportd even after the complete removal of the hepatic stones. Thus, bile stasis and bacterial infecton appear to be important causative factors causing cholangiocarcinoma rather than the stone itself. A rare case is reported on intrahepatic cholangiocarcinoma developed in a remote region from the site of the hepatolithiasis. Therefore, the possible presence of cholangiocarcinoma should always be considered and sought during the diagnosis and treatment of hepatolithiasis. (Korean J Gastrointest Endosc 18: 968-973, 1998)

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증례 : 식도 위장관 ; 반복적인 담관염으로 나타난 점액 생성 담관암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Mucin - producing Cholangiocarcinoma in the Patient with Recurrent Cholangitis ): Korean J Gastrointest Endosc 1998;18(6):957-962. Published online November 30, 1997

Abstract PDF: Free-floating tumor debris or mucobilia as a cauae of intermittent obstruction has been described infrequently. A middle aged woman with intermittent jaundice caused by abundant mucus from an intrahepatic mucinous cholangiocarcinoma is presented. Symptoms of juandice, midepigastric pain and fever developed despited an intitial cholecystectomy and common bile duct stone extraction using endoscopic retrograde cholangography (ERCP). Intraductal mucin was diagnosed through on ERCP and confirmed intraoperatively and pathologically as the cause of the obstructive juandice. The patient remained asymptomatic and without evidence of disease for more than 2 years postoperatively. Description is presented of the patient who was admitted presented with recurrent cholangitis caused by profuse secretion of mucus by mucin-producing cholangiocaricnoma, with a review of relevant literature. (Korean J Gastrointest Endosc 18: 957-962, 1998)

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증례 : 담도 췌장 ; 담낭관의 하부접합과 연관된 원발성 중복종양 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Double Primary Cancer Associated with a Low Junction of the Cystic Duct ): Korean J Gastrointest Endosc 1998;18(4):630-636. Published online November 30, 1997

Abstract PDF: Recently it has been discovered that anomalous union of pancreaticobiliary duct (AUPBD) may play an important role in the pathogenesis of bile duct cancer. Similar to this fact, there were a few reports on the clinical significance of the low junction of the cystic duct (LJCD). LJCD refers to the situation whereby the cystic duct enters the common duct at a low position between the upper margin of the pancreas and the duodenal opening of the bile duct. The pathogenetic mechanism in LJCD is similar to AUPBD in that the pancreatic juice refluxes to the bile duct, mixes with biles, and then generates the mutagens, which act as inflammatory substances and carcinogens on the epithelium of the bile duct. A 51-year-old male who experienced dyspepsia was hospitalized due to his abnormally functioning liver and dilated common bile duct. We confirmed primary cholangiocarcinoma on the common hepatic duct and gallbladder carcinoma associated with LJCD by ERCP and pathologic review of surgical specimen. We report a case of synchronous type double primary cancer associated with LJCD with a brief review of the literatures. (Korean J Gastrointest Endosc 18: 630-636, 1997)

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증례 : 담도 췌장 ; 담관 점막 및 점막하를 따라 담낭 및 총간관으로 전이된 총 담관암 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Common Bile Duct Cancer with Mucosal and Submucosal Spread to Gallbladder and Common Hepatic Duct ): Korean J Gastrointest Endosc 1997;17(6):872-877. Published online November 30, 1996

Abstract PDF: Cholangiocarcinoma is a form of adenocarcinoma arising from the intrahepatic or extra- hepatic biliary epithelium. Apparent predisposing factors include some chronic hepato- biliary parasitic infsttations, congenital anomalies with ectatic ducts, sclerosing cholangitis and chronic ulcerative colitis and occupational exposure to possible biliary tract carcinogens. Patients with cholangiocarcinoma usually present with biliary obstruction, painless jaundice, pruritus, weight loss and acholic stools. Because the obstructing process is gradua1, the cholangiocarcinoma is often far advanced by the time it presents clinically. The diagnosis is most frequently made by cholangiography following ultrasound demonstration of dilated intrahepatic bile ducts. We report a case of common bile duct cancer spreading to gallbladder and common hepatic duct along the biliary mucosal epitherium and submucosal tissue in 68-year-old female patient along with a review of literature. (Korean J Gastrointest Endosc 17: 872-877, 1997)

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

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

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