Clinical Endoscopy

Original Articles

Efficacy of double half-pigtail plastic stents for endoscopic biliary drainage of acute calculous cholangitis: Toshitaka Sakai, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Hidehito Sumiya, Jun Horaguchi, Masaya Oikawa, Takashi Tsuchiya, Yutaka Noda, Kei Ito; Clin Endosc 2025;58(6):898-908. Published online November 11, 2025; DOI: https://doi.org/10.5946/ce.2025.134

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Plastic stent placement is required when biliary stones cannot be completely removed during the initial endoscopic retrograde cholangiopancreatography (ERCP). Although double half-pigtail plastic stents (DHPs) help prevent stent migration, their clinical utility has not yet been evaluated.
Methods
We retrospectively reviewed data from 221 patients who underwent DHP placement for acute calculous cholangitis (ACC) between January 2015 and March 2024. Patient without complete stone removal during initial ERCP were included. Clinical success, adverse events, recurrent biliary obstruction (RBO), and time to RBO (TRBO) were compared in 21 patients treated with straight plastic stents (STs) under similar conditions.
Results
Clinical success was achieved in 99% of patients in the DHP group and 95% of the ST group (p=0.13). Adverse event rates were comparable between groups. During follow-up, the DHP group had significantly lower stent occlusion (2% vs. 20%, p<0.01) and migration rates (4% vs. 15%, p=0.02), leading to a lower RBO rate (5% vs. 35%, p<0.01). The median TRBO was significantly longer in the DHP group (585 vs. 247 days, p<0.01).
Conclusions
DHPs had comparable efficacy to STs, with significantly fewer stent-related adverse events. This may be a potential option for biliary drainage in ACC.

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Incidence and risk factors for recurrence of common bile duct stones in patients undergoing endoscopic extraction without prophylactic biliary stenting and subsequent cholecystectomy: a retrospective study in Japan: Hidehito Sumiya, Takahisa Ogawa, Shinsuke Koshita, Yoshihide Kanno, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Kei Ito; Clin Endosc 2026;59(1):124-131. Published online October 24, 2025; DOI: https://doi.org/10.5946/ce.2025.081

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Background
/Aims: In patients undergoing endoscopic extraction of common bile duct stones (CBDs) and subsequent cholecystectomy, CBDs sometimes recur during the preoperative and perioperative periods. In this study, the incidence and risk factors for CBDs recurrence were investigated.
Methods
A total of 245 patients (mean age: 66 years; 138 men) who underwent cholecystectomy within 180 days of CBDs extraction between October 2017 and June 2023 were included. Recurrence was defined as the detection of the CBDs during the preoperative or perioperative period using imaging modalities such as computed tomography or re-endoscopic retrograde cholangiopancreatography, regardless of the presence of cholangitis.
Results
CBDs recurrence occurred in 4.1% of the patients (10/245). The median time to recurrence was 40 days. Preoperative recurrence was observed in nine patients, and only one patient had postoperative recurrence. Multivariate analysis identified cystic duct stones as the only significant risk factor for CBDs recurrence (hazard ratio, 15.6; 95% confidence interval, 3.7–66; p<0.001).
Conclusions
The risk of CBDs recurrence after endoscopic extraction during the pre and perioperative periods is high in patients with cystic duct stones. Prophylactic biliary stenting may be considered in high-risk patients.

Citations

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Balancing surgical timing and risk stratification to prevent recurrent common bile duct stones after bile duct clearance
Sung Bum Kim
Clinical Endoscopy.2026; 59(1): 76. CrossRef
Biliary Fistula at the Margin of Liver Caused by New Common Bile Duct Stones after Hepatectomy: A Case Report and Literature Review of Bile Leakage after Liver Surgery
勇李
Asian Case Reports in Emergency Medicine.2026; 14(01): 113. CrossRef

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Endoscopic removal of common bile duct stones in nonagenarians: a tertiary center experience: Mustafa Jalal, Amaan Khan, Sijjad Ijaz, Mohammed Gariballa, Yasser El-Sherif, Amer Al-Joudeh; Clin Endosc 2023;56(1):92-99. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2022.020

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Background
/Aims: There are few studies assessed the efficacy and mortality of endoscopic retrograde cholangiopancreatography (ERCP) for the removal of common bile duct (CBD) stones in the elderly aged ≥90 years. We aimed to assess the safety and efficacy of endoscopic removal of CBD stones in nonagenarians.
Methods
We retrospectively reviewed ERCP reports for CBD stone removal. The endoscopic and therapeutic outcomes were collected. The length of stay (LOS), the total number of adverse events, and mortality rate were compared between groups.
Results
A total of 125 nonagenarians were compared with 1,370 controls (65–89 years old individuals). The mean LOS for nonagenarians was significantly higher than in controls (13.6 days vs. 6.5 days). Completed intended treatment was similar in the nonagenarians and controls (89.8% and 89.5%, respectively). The overall complication rate did not differ between the groups. However, nonagenarians had a higher incidence of post-ERCP pneumonia (3.9%). None of the nonagenarians were readmitted to the hospital within 7 days. Four nonagenarians (3.2%) and 25 (1.8%) controls died within 30 days.
Conclusions
Advanced age alone did not affect the decision to perform the procedure. However, prompt diagnosis and treatment of post-ERCP pneumonia in nonagenarians could improve the outcomes and reduce mortality.

Citations

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Risk factors for post‐endoscopic retrograde cholangiopancreatography complications in very elderly patients aged 90 years or older—No additional risk
Daisuke Manabe, Toshihiko Arizumi, Hitoshi Aoyagi, Koichiro Abe, Shinya Kodashima, Yoshinari Asaoka, Takatsugu Yamamoto, Atsushi Tanaka
Geriatrics & Gerontology International.2025; 25(1): 54. CrossRef
Is endoscopic retrograde cholangiopancreatography safe for centenarians?
Filippo Antonini, Durante Donnarumma, Tiziana Buono
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Outcomes of Therapeutic Endoscopic Retrograde Cholangiopancreatography in Elderly Patients (≥80 Years) with Choledocholithiasis: A Comprehensive Meta-Analysis
Liping Wang, Zhihua Chen
Digestive Diseases.2025; 43(6): 718. CrossRef
Efficacy and Safety of Electrohydraulic Lithotripsy Using Peroral Cholangioscopy under Endoscopic Retrograde Cholangiopancreatography Guidance in Older Adults: A Single-Center Retrospective Study
Koji Takahashi, Hiroshi Ohyama, Yuichi Takiguchi, Yu Sekine, Shodai Toyama, Nana Yamada, Chihei Sugihara, Motoyasu Kan, Mayu Ouchi, Hiroki Nagashima, Yotaro Iino, Yuko Kusakabe, Kohichiroh Okitsu, Izumi Ohno, Naoya Kato
Medicina.2023; 59(4): 795. CrossRef

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Case Report

Successful Removal of a Difficult Common Bile Duct Stone by Percutaneous Transcholecystic Cholangioscopy: Hyunsuk Lee, Sang Hyub Lee, Gunn Huh, Yeji Kim, Saebeom Hur, Moonhaeng Hur, Minwoo Lee, Byeongyun Ahn; Clin Endosc 2022;55(2):297-301. Published online May 4, 2021; DOI: https://doi.org/10.5946/ce.2020.301

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Common bile duct (CBD) stones are prevalent in 11% to 21% of patients with gallstones and can cause various clinical manifestations, from biliary colic to biliary sepsis. The treatment of choice is endoscopic retrograde cholangiopancreatography, but approximately 5% to 10% of CBD stones are difficult to remove using these conventional endoscopic methods. Although percutaneous transhepatic cholangioscopy and lithotripsy can be used as an alternative, it can be technically demanding and risky if the intrahepatic duct is not dilated. We report a case of a large CBD stone that was successfully removed using percutaneous transcholecystic cholangioscopy.

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PERcutaneous transhepatic CHOLangioscopy using a new single‐operator short cholangioscope (PERCHOL): European feasibility study
Enrique Pérez‐Cuadrado‐Robles, Simon Phillpotts, Michiel Bronswijk, Claudio Cim Conrad, Cecilia Binda, Laurent Monino, Kirill Basiliya, Marcus Hollenbach, Apostolis Papaefthymiou, Hadrien Alric, Lucille Quénéhervé, Alessandro Di Gaeta, Mathieu Pioche, Ari
Digestive Endoscopy.2024; 36(6): 719. CrossRef
Cholangioscopy as a rescue for a post-cholecystectomy adherent stone formed around a migrated surgical clip in the common bile duct
Chukwunonso Ezeani, Samuel O. Igbinedion, Kwabena Asafo-Agyei, Erik A. Holzwanger, Sultan Mahmood, Mandeep S. Sawhney, Tyler M. Berzin, Moamen Gabr, Douglas K. Pleskow
VideoGIE.2024; 9(5): 241. CrossRef
Colangioscopia percutánea utilizando SpyGlass Discover para el manejo de coledocolitiasis difícil en anatomía alterada: reporte de caso
V. Sánchez-Cerna, G. Araujo-Almeyda, J. Aliaga-Ramos, T. Reyes-Mugruza, W. Celedonio-Campos
Revista de Gastroenterología de México.2024; 89(3): 451. CrossRef
Percutaneous cholangioscopy utilizing SpyGlass Discover for difficult-to-treat choledocholithiasis in an altered anatomy: A case report
V. Sánchez-Cerna, G. Araujo-Almeyda, J. Aliaga-Ramos, T. Reyes-Mugruza, W. Celedonio-Campos
Revista de Gastroenterología de México (English Edition).2024; 89(3): 451. CrossRef

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Original Articles

Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis: Jake S. Jacob, Michelle E. Lee, Erin Y. Chew, Aaron P. Thrift, Robert J. Sealock; Clin Endosc 2021;54(2):269-274. Published online November 6, 2020; DOI: https://doi.org/10.5946/ce.2020.100

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines.
Methods
We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis.
Results
Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity for choledocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis.
Conclusions
The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers an improved risk stratification tool.

Citations

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Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography for Bile Duct Stones—Avoiding the Avoidable
Stefan Chiriac, Catalin Sfarti, Horia Minea, Sebastian Zenovia, Irina Girleanu, Laura Huiban, Cristina Muzica, Adrian Rotaru, Remus Stafie, Robert Nastasa, Ermina Stratina, Bogdan Mihnea Ciuntu, Raluca Avram, Anca Trifan
Biomedicines.2026; 14(1): 91. CrossRef
Unnecessary ERCPs: Is Spontaneous Stone Passage the Sole Determinant?
Dimitrios I. Ziogas, Theodoros A. Voulgaris, Ance Volkanovska, Aliki Stamou, Georgios Kranidiotis, Gerasimos Stefanidis, Paraskevas Gkolfakis, Ioannis A. Vezakis, Gjorgi Deriban, Meri Trajkovska, Konstantinos Triantafyllou, Antonios Vezakis, Ioannis S. Pa
Medicina.2026; 62(3): 548. CrossRef
Approach to biliary tree clearance in pediatric patients undergoing cholecystectomy: insights from a tertiary hospital
Tal Weiss, Yael Dreznik, Maya Paran, Dragan Kravarusic
Pediatric Surgery International.2025;[Epub] CrossRef
Endoscopic retrograde cholangiopancreatography, endoscopic papillary balloon dilation, and laparoscopic hepatectomy for intra- and extrahepatic bile duct stones
Zhi-Liang Chen, Hong Fu
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Performance of Diagnostic Guidelines in the Evaluation of Choledocholithiasis in Patients With Acute Biliary Presentation: A Systematic Review and Meta‐Analysis
Henry C. K. Kwok, Fransiska R. M. Falconer, Alain C. Vandal, Andrew G. Hill, Andrew D. Maccormick
World Journal of Surgery.2025; 49(8): 2153. CrossRef
Rendimiento diagnóstico de las Guías de la Sociedad Americana de Endoscopia Gastrointestinal 2019 para coledocolitiasis
Diego David de la Peña Castro, Javier del Bosque Cárdenas, Ana Isabel Padilla García
Cirujano General.2025; 47(2): 82. CrossRef
Balancing Endoscopy and Surgery in Choledocholithiasis: A 12-Year Real-World Analysis From a Brazilian Tertiary University Hospital
Otávio B Ceribeli, Philipe F Tafner, Martinho A Gestic, Murillo P Utrini, Francisco Callejas-Neto, Everton Cazzo
Cureus.2025;[Epub] CrossRef
The role of AI models in enhancing choledocholithiasis diagnosis: A systematic review and meta‑analysis
Panagiotis Doukas, Sotirios Doukas, Arkady Broder
Experimental and Therapeutic Medicine.2025; 30(6): 1. CrossRef
Endoscopic ultrasound avoids diagnostic ERCP among the ASGE high-risk group – Experience in an Asian population
Weng-Fai Wong, Yu-Ting Kuo, Ming-Lun Han, Hsiu-Po Wang
Journal of the Formosan Medical Association.2024; 123(3): 374. CrossRef
Rendimiento diagnóstico de la endosonografía biliopancreática en pacientes con riesgo intermedio de coledocolitiasis
Lázaro Antonio Arango Molano, Andrés Sánchez Gil, Claudia Patricia Diaz Tovar, Andrés Valencia Uribe, Christian Germán Ospina Pérez, Pedro Eduardo Cuervo Pico, Rodrigo Alberto Jiménez Gómez
Revista de Gastroenterología del Perú.2024; 44(1): 8. CrossRef
ASGE Predictors for the Diagnosis of Choledocholithiasis: Validation in a Public Hospital of Merida, Yucatan, México
Richard Camilo Aguirre-Sanchez, Abraham Hernan-Herrera-Sanchez, Carlos Enrique Perez-Osorio, Maria Fidelia Cardenas-Marrufo
The International Journal of Gastroenterology and Hepatology Diseases.2024;[Epub] CrossRef
Predictors of Choledocholithiasis in Cholecystectomy Patients and Their Cutoff Values and Prediction Model in Korea in Comparison with the 2019 ASGE Guidelines
Jung Hun Woo, Hwanhyi Cho, Kihyun Ryu, Young Woo Choi, Sanghyuk Lee, Tae Hee Lee, Dae Sung Kim, In Seok Choi, Ju Ik Moon, Seung Jae Lee
Gut and Liver.2024; 18(6): 1060. CrossRef
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Sultan Abdulwadoud Alshoabi, Abdulkhaleq Ayedh Binnuhaid, Halah Fuad Muslem, Abdullgabbar M. Hamid, Fahad H. Alhazmi, Faisal A. Alrehily, Abdulaziz A. Qurashi, Osamah M. Abdulaal, Abdullah F. Alshamrani, Awatif M. Omer
Diseases.2024; 12(12): 333. CrossRef
Suspected common bile duct stones: reduction of unnecessary ERCP by pre-procedural imaging and timing of ERCP
Christina J. Sperna Weiland, Evelien C. Verschoor, Alexander C. Poen, Xavier J. M. N. Smeets, Niels G. Venneman, Abha Bhalla, Ben J. M. Witteman, Hester C. Timmerhuis, Devica S. Umans, Jeanin E. van Hooft, Marco J. Bruno, P. Fockens, Robert C. Verdonk, Jo
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Low Detection Rates of Bile Duct Stones During Endoscopic Treatment for Highly Suspected Bile Duct Stones with No Imaging Evidence of Stones
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Effect of Frailty on the Management of Suspected Choledocholithiasis
Katherine C. Bergus, Rondi B. Gelbard, Sara Scarlet, Shruthi Srinivas, Brett M. Tracy
The American Surgeon™.2023; 89(7): 3104. CrossRef
Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis
Andy Silva-Santisteban, Ishani Shah, Madhuri Chandnani, Vaibhav Wadhwa, Leo Tsai, Abraham F. Bezuidenhout, Tyler M. Berzin, Douglas Pleskow, Mandeep Sawhney
Endoscopy International Open.2023; 11(06): E599. CrossRef
ERCP findings provide further justification for a “surgery-first” mindset in choledocholithiasis
Gloria Sanin, Gabriel Cambronero, James Patterson, Maggie Bosley, Aravindh Ganapathy, Carl Wescott, Lucas Neff
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Dynamic changes in liver function tests do not correctly reclassify patients at risk of choledocholithiasis beyond ASGE 2019 criteria
Tatiana Ramírez-Peña, Rómulo Darío Vargas-Rubio, Carlos Ernesto Lombo, Luis Miguel Rodríguez-Hortua, Oscar Mauricio Muñoz-Velandia
Therapeutic Advances in Gastrointestinal Endoscopy.2023;[Epub] CrossRef
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Yun Nah Lee, Jong Ho Moon
Clinical Endoscopy.2021; 54(2): 147. CrossRef

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Single-Stage Endoscopic Stone Extraction and Cholecystectomy during the Same Hospitalization: Toshiaki Terauchi, Hiroharu Shinozaki, Satoshi Shinozaki, Yuichi Sasakura, Masaru Kimata, Junji Furukawa, Alan Kawarai Lefor, Yoshiro Ogata, Kenji Kobayashi; Clin Endosc 2019;52(1):59-64. Published online October 5, 2018; DOI: https://doi.org/10.5946/ce.2018.107

Abstract PDF PubReader ePub

Background
/Aims: The clinical impact of single-stage endoscopic stone extraction by endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy during the same hospitalization remains elusive. This study aimed to determine the efficacy and safety of single-stage ERCP and cholecystectomy during the same hospitalization in patients with cholangitis.
Methods
We retrospectively reviewed the medical records of 166 patients who underwent ERCP for mild to moderate cholangitis due to choledocholithiasis secondary to cholecystolithiasis from 2012 to 2016.
Results
Complete stone extraction was accomplished in 92% of patients (152/166) at the first ERCP. Among 152 patients who underwent complete stone extraction, cholecystectomy was scheduled for 119 patients (78%). Cholecystectomy was performed during the same hospitalization in 89% of patients (106/119). We compared two groups of patients: those who underwent cholecystectomy during the same hospitalization (n=106) and those who underwent cholecystectomy during a subsequent hospitalization (n=13). In the delayed group, cholecystectomy was performed about three months after the first ERCP. There were no significant differences between the groups in terms of operative time, rate of postoperative complications, and interval from cholecystectomy to discharge.
Conclusions
Single-stage endoscopic stone extraction is recommended in patients with mild to moderate acute cholangitis due to choledocholithiasis. The combination of endoscopic stone extraction and cholecystectomy during the same hospitalization is safe and feasible.

Citations

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Safety and efficacy of single-stage endoscopic stone removal and the timing of ERCP for acute cholangitis: a multicenter study
Zhi An, Jiawei Chen, Zi Yan, Chaoqun Han, Jun Fang, Qiu Zhao
BMC Gastroenterology.2026;[Epub] CrossRef
RECURRENT BILIARY EVENTS IN PATIENTS, WHO UNDERWENT ENDOSCOPIC LITHOEXTRACTION DUE TO OBSTRUCTIVE JAUNDICE
S. V. Dolzhkovyi
World of Medicine and Biology.2022; 18(79): 59. CrossRef
Destiny for Rendezvous: Is Cholecysto/Choledocholithiasis Better Treated with Dual- or Single-Step Procedures?
S. Vaccari, M. Minghetti, A. Lauro, M. I. Bellini, A. Ussia, S. Khouzam, I. R. Marino, M. Cervellera, V. D’Andrea, V. Tonini
Digestive Diseases and Sciences.2022; 67(4): 1116. CrossRef
Application of ERCP Procedures in Choledocholithiasis with Duodenal Stenosis Patients
Yuyan Shi, Jinghon Zhong, Jianbo Zhou, Qifeng Song, Zhaoqi Dong
Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef
Choledocholithiasis without cholecystolithiasis, after endoscopic retrograde cholangiopancreatography follow-up without cholecystectomy
Bahtiyar MUHAMMEDOĞLU, Eyüp PİRCANOĞLU, Serkan TORUN
Konuralp Tıp Dergisi.2021; 13(1): 68. CrossRef
Comparison of the safety and efficacy of single-stage endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy versus two-stage ERCP followed by laparoscopic cholecystectomy six-to-eight weeks later: A randomized controlled trial
Bahtiyar Muhammedoğlu, Ilhami Taner Kale
International Journal of Surgery.2020; 76: 37. CrossRef
Single-Stage Endoscopic Stone Extraction and Cholecystectomy during the Same Hospitalization: What is the Optimal Strategy for Patients with Choledocholithiasis and Cholelithiasis?
Tae Yoon Lee
Clinical Endoscopy.2019; 52(1): 5. CrossRef

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Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study: Ruchir Patel, Meghraj Ingle, Dhaval Choksi, Prateik Poddar, Vikas Pandey, Prabha Sawant; Clin Endosc 2017;50(6):592-597. Published online August 9, 2017; DOI: https://doi.org/10.5946/ce.2017.010

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US).
Methods
All patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP.
Results
We included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach.
Conclusions
EUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications.

Citations

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Unnecessary ERCPs: Is Spontaneous Stone Passage the Sole Determinant?
Dimitrios I. Ziogas, Theodoros A. Voulgaris, Ance Volkanovska, Aliki Stamou, Georgios Kranidiotis, Gerasimos Stefanidis, Paraskevas Gkolfakis, Ioannis A. Vezakis, Gjorgi Deriban, Meri Trajkovska, Konstantinos Triantafyllou, Antonios Vezakis, Ioannis S. Pa
Medicina.2026; 62(3): 548. CrossRef
The utility of endoscopic ultrasound in detecting missed common bile duct stones
Mahmoud Farouk, Mona Kaddah, Hussein H. Okasha, Katarzyna M. Pawlak, Gaurav Muktesh, Petko Karagyozov, Michał Żorniak, Mohammed Tag-Adeen, Elsayed Ghoneem, Rasha M.M. Ahmed, Mahmoud Alansary, Khaled Ragab, Ramy El-Hendawy, Adnan A. Mohamed
Al-Azhar Assiut Medical Journal.2025; 23(2): 317. CrossRef
Rendimiento diagnóstico de la endosonografía biliopancreática en pacientes con riesgo intermedio de coledocolitiasis
Lázaro Antonio Arango Molano, Andrés Sánchez Gil, Claudia Patricia Diaz Tovar, Andrés Valencia Uribe, Christian Germán Ospina Pérez, Pedro Eduardo Cuervo Pico, Rodrigo Alberto Jiménez Gómez
Revista de Gastroenterología del Perú.2024; 44(1): 8. CrossRef
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
Low Detection Rates of Bile Duct Stones During Endoscopic Treatment for Highly Suspected Bile Duct Stones with No Imaging Evidence of Stones
Hirokazu Saito, Hajime Iwasaki, Hisashi Itoshima, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Masayoshi Uehara, Ikuo Matsushita, Tatsuyuki Kakuma, Shuji Tada
Digestive Diseases and Sciences.2023; 68(5): 2061. CrossRef
Diagnostic accuracy of endoscopic ultrasound in evaluation of patients with obstructive jaundice: single-center experience
Shereen Abou Bakr, Hagar Elessawy, Sameh Ghaly, Muhammed Abo Elezz, Ahmed Farahat, Mariam Salah Zaghloul
Egyptian Liver Journal.2022;[Epub] CrossRef
Endoscopic ultrasound avoids adverse events in high probability choledocholithiasis patients with a negative computed tomography
Meng-Ying Lin, Chun-Te Lee, Ming-Tsung Hsieh, Ming-Ching Ou, Yao-Shen Wang, Meng-Chieh Lee, Wei-Lun Chang, Bor-Shyang Sheu
BMC Gastroenterology.2022;[Epub] CrossRef
Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones
Mohamed Eissa, Hussein Hassan Okasha, Mohamed Abbasy, Ahmed Kamal Khamis, Abeer Abdellatef, Mohamed Akl Rady
World Journal of Gastrointestinal Endoscopy.2022; 14(9): 564. CrossRef
Az endoszkópos ultrahangvizsgálat diagnosztikus érzékenysége epeúti kövesség gyanúja esetén
Bánk Keczer, Zsolt Dubravcsik, Attila †Szepes, László Madácsy, Attila Szijártó, István Hritz
Orvosi Hetilap.2022; 163(10): 400. CrossRef
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Li-Ming Xu, Duan-Min Hu, Wen Tang, Shao-Hua Wei, Wei Chen, Guang-Qiang Chen
World Journal of Clinical Cases.2019; 7(21): 3615. CrossRef
Can Endoscopic Ultrasonography Prevent Unnecessary Endoscopic Retrograde Cholangiopancreatography in Patients with High and Intermediate Likelihood of Choledocholithiasis?
Eui Joo Kim, Jae Hee Cho
Clinical Endoscopy.2017; 50(6): 518. CrossRef

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Case Report

Diffuse-Type Caroli Disease with Characteristic Central Dot Sign Complicated by Multiple Intrahepatic and Common Bile Duct Stones: Moon Joo Hwang, Tae Nyeun Kim; Clin Endosc 2017;50(4):400-403. Published online June 20, 2017; DOI: https://doi.org/10.5946/ce.2016.150

Abstract PDF PubReader ePub

Caroli disease (CD) is a rare congenital malformation of the liver characterized by non-obstructive, segmental, cystic dilatation of the intrahepatic bile ducts (IHDs). The clinical course is usually asymptomatic for the first 5–20 years, and symptoms may seldom occur throughout the patient’s life. Bile stagnation leads to recurrent episodes of cholangitis, stone formation, or liver abscesses, and biliary cirrhosis usually occurs years later. Here we report on a 42-year-old man diagnosed with diffuse-type CD with a characteristic central dot sign, who had multiple intrahepatic and common bile duct (CBD) stones. CBD stones were treated successfully with endoscopic retrograde cholangiopancreatography (ERCP).

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Review

An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications: Hyun Woo Lee, Najmul Hassan Shah, Sung Koo Lee; Clin Endosc 2017;50(5):451-463. Published online April 17, 2017; DOI: https://doi.org/10.5946/ce.2016.139

Abstract PDF PubReader ePub

Biliary complications are the most common post-liver transplant (LT) complications with an incidence of 15%–45%. Furthermore, such complications are reported more frequently in patients who undergo a living-donor LT (LDLT) compared to a deceased-donor LT (DDLT). Most post-LT biliary complications involve biliary strictures, bile leakage, and biliary stones, although many rarer events, such as hemobilia and foreign bodies, contribute to a long list of related conditions. Endoscopic treatment of post-LT biliary complications has evolved rapidly, with new and effective tools improving both outcomes and success rates; in fact, the latter now consistently reach up to 80%. In this regard, conventional endoscopic retrograde cholangiopancreatography (ERCP) remains the preferred initial treatment. However, percutaneous transhepatic cholangioscopy (PTCS) is now central to the management of endoscopy-resistant cases involving complex hilar or multiple strictures with associated stones. Many additional endoscopic tools and techniques—such as the rendezvous method, magnetic compression anastomosis (MCA), and peroral cholangioscopy (POCS)—combined with modified biliary stents have significantly improved the success rate of endoscopic management. Here, we review the current status of endoscopic treatment of post-LT biliary complications and discuss conventional as well as the aforementioned new tools and techniques.

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Original Articles

Sensitivity and Specificity of Magnetic Resonance Cholangiopancreatography versus Endoscopic Ultrasonography against Endoscopic Retrograde Cholangiopancreatography in Diagnosing Choledocholithiasis: The Indonesian Experience: Dadang Makmun, Achmad Fauzi, Hamzah Shatri; Clin Endosc 2017;50(5):486-490. Published online February 28, 2017; DOI: https://doi.org/10.5946/ce.2016.159

Abstract PDF PubReader ePub

Background
/Aims: Biliary stone disease is one of the most common conditions leading to hospitalization. In addition to endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) are required in diagnosing choledocholithiasis. This study aimed to compare the sensitivity and specificity of EUS and MRCP against ERCP in diagnosing choledocholithiasis.
Methods
This retrospective study was conducted after prospective collection of data involving 62 suspected choledocholithiasis patients who underwent ERCP from June 2013 to August 2014. Patients were divided into two groups. The first group (31 patients) underwent EUS and the second group (31 patients) underwent MRCP. Then, ERCP was performed in both groups. Sensitivity, specificity, and diagnostic accuracy of EUS and MRCP were determined by comparing them to ERCP, which is the gold standard.
Results
The male to female ratio was 3:2. The mean ages were 47.25 years in the first group and 52.9 years in the second group. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for EUS were 96%, 57%, 87%, 88%, and 80% respectively, and for MRCP were 81%, 40%, 68%, 74%, and 50%, respectively.
Conclusions
EUS is a better diagnostic tool than MRCP for diagnosing choledocholithiasis.

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Az endoszkópos ultrahangvizsgálat diagnosztikus érzékenysége epeúti kövesség gyanúja esetén
Bánk Keczer, Zsolt Dubravcsik, Attila †Szepes, László Madácsy, Attila Szijártó, István Hritz
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22 Crossref

Twenty-Second versus Sixty-Second Dilation Duration in Endoscopic Papillary Balloon Dilation for the Treatment of Small Common Bile Duct Stones: A Prospective Randomized Controlled Multicenter Trial: Byoung Wook Bang, Tae Hoon Lee, Tae Jun Song, Joung-Ho Han, Hyun Jong Choi, Jong Ho Moon, Chang-Il Kwon, Seok Jeong; Clin Endosc 2015;48(1):59-65. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.59

Abstract PDF PubReader ePub

Background/Aims

Endoscopic papillary balloon dilation (EPBD) has been advocated as an alternative therapy to endoscopic sphincterotomy for the treatment of common bile duct (CBD) stones. However, there is no established consensus on the optimal balloon dilation duration (BDD). We prospectively evaluated the efficacy and post-endoscopic retrograde cholangiopancreatography (ERCP) complications between the 20- and 60-second EPBD groups.

Methods

A total of 228 patients with small CBD stones (≤12 mm) were randomly assigned to undergo EPBD with a 20- or 60-second duration at six institutions. We evaluated baseline patient characteristics, endoscopic data, clinical outcomes, and procedure-related complications. In addition, we analyzed risk factors for postprocedural pancreatitis.

Results

CBD stones were removed successfully in 107 of 109 patients (98.1%) in the 20-second group and in 112 of 119 patients (94.1%) in the 60-second group (p=0.146). Post-ERCP pancreatitis developed in seven patients (6.4%) in the 20-second group and nine patients (7.5%) in the 60-second group (p=0.408). In multivariate analysis, contrast dye injection into the pancreatic duct is a significant risk factor for post-EPBD pancreatitis.

Conclusions

Based on the data showing that there were no significant differences in safety and efficacy between the two BDD groups, 20 seconds of BDD may be adequate for treatment of small CBD stones with EPBD.

Citations

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Comparative efficacy of balloon dilatation duration on patients with choledocholithiasis: a Bayesian network meta-analysis and systematic review
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Case Report

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

Abstract PDF PubReader ePub

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

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Delayed Presentation of Malrotation after Infancy: A Systematic Review Based on Clinical Presentations, Associated Anomalies, Diagnosis, and Management
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Journal of Indian Association of Pediatric Surgeons.2024; 29(5): 417. CrossRef
Unusual Aspect of a Choledocholithiasis
Matthias Breidert, Markus Weber, Stefan Wildi
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Role of Multidetector Computerized Tomography (MDCT) in Identification of Common Bile Duct Stone: Comparison with ERCP: Dong Il Kim, M.D., Hong Sik Lee, M.D., Jin Nam Kim, M.D., Sung Woo Jung, M.D., Ja Seol Koo, M.D., Hyung Joon Yim, M.D., Yoon Tae Jeen, M.D., Hoon Jai Chun, M.D., Soon Ho Um, M.D., Sang Woo Lee, M.D., Jai Hyun Choi, M.D., Chang Duck Kim, M.D., Seung Hwa Le; Korean J Gastrointest Endosc 2007;35(4):235-242. Published online October 30, 2007

Abstract PDF: Background
/Aims: MDCT, which provides high resolution and various reconstructing images, has recently become widely available and is a promising tool for imaging the bile duct with precision. In order to evaluate the diagnostic value of multidetector computerized tomography (MDCT) for a common bile duct (CBD) stone, this study compared the diagnostic accuracy of MDCT with that of ERCP. Methods: The medical records of the patients undergoing both MDCT and ERCP consecutively from June 2006 to January 2007 were retrospectively reviewed. One hundred and sixty four patients (164 cases) were enrolled in this study. The final diagnoses were based mainly on the ERCP findings. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MDCT and ERCP for choledocholithiasis were identified and compared. Results: Of the 164 cases, 47 cases were diagnosed with choledocholithiasis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for choledocholithiasis were 89.4%, 98.3%, 95.5%, 95.8%, 95.7% in MDCT and 97.9%, 99.1%, 97.9%, 99.1%, 98.8% in ERCP, respectively. There were no statistically significant differences in the diagnostic accuracy between the two methods (p=0.206). Conclusions: MDCT has high sensitivity and specificity for diagnosing stones in the bile duct and should be performed in preference to ERCP in patients suspected of having choledocholithiasis. (Korean J Gastrointest Endosc 2007;35:235-242)

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Usefulness of Endoscopic Ultrasonography for Diagnosing Choledocholithiasis in Patients with Gallbladder Stones: Ja Seol Koo, M.D., Hong Sik Lee, M.D., Sung Woo Jung, M.D., Woo Sik Han, M.D., Jong Sup Lee, M.D., Hyung Joon Yim, M.D., Sang Woo Lee, M.D., Jai Hyun Choi, M.D., Chang Duck Kim, M.D. and Ho Sang Ryu, M.D.; Korean J Gastrointest Endosc 2007;35(4):228-234. Published online October 30, 2007

Abstract PDF: Background
/Aims: CBD stones (CBDS) are generally thought to originate from the gallbladder. Recently, EUS appears to be the best imaging method for making the diagnosis of CBDS. We conducted this study to evaluate the role of EUS for detecting CBDS in patients with gallbladder stones (GBS) and to determine the parameters for predicting CBDS. Methods: From April 2003 to March 2005, 117 GBS patients were enrolled. The patients' clinical and laboratory findings and the radiologic findings of US, EUS, CT and ERCP were reviewed. The sensitivity, specificity, PPV and NPV of EUS for detecting CBDS were evaluated by using ERCP and intraoperative CBD exploration as the gold standard for diagnosing CB. Results: A total 117 patients received EUS and no complications were encountered. After performing ERCP and/or intraoperative exploration, 62 of the patients were examined for determining the presence or absence of CBDS. EUS shows 95% sensitivity and 95% specificity for identifying CBDS. The overall agreement between EUS and ERCP was 94.8%. The patients with CBDS were older than those without CBDS. Fever, jaundice and cholangitis were more prevalent in the patients with CBDS. The results of liver function tests were elevated more frequently in the patients with CBDS (p＜0.05). Conclusions: EUS is an accurate and minimally invasive method for diagnosing CBDS. Evaluating CBD in patients with gallstones is selectively recommended according to clinical and laboratory findings. (Korean J Gastrointest Endosc 2007;35:228-234)

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The Roles of Endoscopic Sphincterotomy and Cholecystectomy in Acute Biliary Pancreatitis: Ji Bong Jeong, M.D.*, Ji Kon Ryu, M.D., Joo Kyung Park, M.D., Won Jae Yoon, M.D., Sang Hyub Lee, M.D., Jin-Hyeok Hwang, M.D.^†, Jun Kyu Lee, M.D.^‡, Yong-Tae Kim, M.D. and Yong Bum Yoon, M.D.; Korean J Gastrointest Endosc 2006;33(3):152-158. Published online September 30, 2006

Abstract PDF: Background
/Aims: Stone removal can prevent recurrence of acute biliary pancreatitis. This study examined the natural course of acute biliary pancreatitis and compared the results obtained using endoscopic sphincterotomy (EST) and cholecystectomy. In addition, the incidence and risk factors associated with acute cholecystitis were estimated when a cholecystectomy had not been performed. Methods: The medical records of 113 patients diagnosed with acute biliary pancreatitis in Seoul National University Hospital from January 1990 to April 2005 were reviewed retrospectively. Results: Twenty-five patients received no specific treatment of which 15 (60.0%) experienced a recurrence during a mean follow-up period of 36.0 months. Fifty-two patients received EST only and did not experience a recurrence during a mean follow-up of 29.8 months. Thirty-six patients underwent a cholecystectomy, and 1 (2.8%) patient experienced a second attack during a follow-up of 35.2 months. The clinical factors predictive of pancreatitis recurrence in patients without treatment could not be identified. Acute cholecystitis developed in 7 out of 77 (9.1%) patients who did not receive a cholecystectomy during a mean follow-up period of 33.3 months, and patients with both gallbladdor and common bile duct stones were found to be more prone to a recurrence. Conclusions: Sixty percent of patients with acute biliary pancreatitis without treatment experienced a second attack, which could be prevented by EST. A cholecystectomy is not always necessary as a routine treatment after EST for preventing pancreatitis, and is recommended for patients with both visible gallbladdor and common bile duct stones at the time of the first attack. (Korean J Gastrointest Endosc 2006;33:152⁣158)

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Successful Removal of Common Bile Duct Stone Using Endoscopic Papillary Balloon Dilation (EPBD), in A 28-month-old Child with Down's Syndrome: Jee Heon Kang, M.D., Do Hyun Park, M.D., Jeung Hoon Park, M.D., Myung Ho Oh, M.D.*, Seung Hyo Han, M.D., Hyoung Su Ahn, M.D., Yong Ha Lee, M.D., Sang-Heum Park, M.D., Suck-Ho Lee, M.D., Il-Kwun Chung, M.D., Hong-Soo Kim, M.D. and Sun-Joo Kim, M.D.; Korean J Gastrointest Endosc 2006;33(2):125-129. Published online August 30, 2006

Abstract PDF: Although cholelithiasis is an uncommon condition in infants, a recent study documented the increasing detection of this disorder. This increase may be explained by the wide use and improvement in abdominal ultrasound. Choledocholithiasis with cholestatic jaundice in infants usually requires therapeutic intervention, even though the incidence of spontaneous resolution has been reported to be higher in infants than adults. Choledocholithiasis in children has traditionally been managed surgically with open common duct exploration. Recently, endoscopic stone removal was accepted as a standard therapy in pediatric choledocholithiasis. We report a case of the successful removal of common bile duct stone using endoscopic papillary balloon dilation (EPBD), in a 28-month-old infant with Down's syndrome. (Korean J Gastrointest Endosc 2006;33:125⁣129)

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Endoscopic Sphincterotomy Plus Endoscopic Papillary Large Balloon Dilatation for Large Bile Duct Stones: Seoung Joon Hwang, M.D., Young Gyun Kim, M.D., Kyu Chul Lee, M.D., Myung Kwan Ji, M.D.*, Hyun Soo Kim, M.D.*, Soon Goo Baik, M.D.*, Kuen Man Lee, M.D., Jin Hyuck Chang, M.D., Min Su Kim, M.D., Yong Han Paik, M.D., Se Joon Lee, M.D., Hyo Jin Park, M.D., Kw; Korean J Gastrointest Endosc 2006;32(3):184-189. Published online March 30, 2006

Abstract PDF: Background
/Aims: The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy (EST) is successful in 80∼90% of cases but it often requires a prolonged time and repeated trials. This study investigated the utility of a combined endoscopic papillary large balloon dilatation (EPLBD) and a mid-incision of an EST (m-EST) method for the removal of large CBD stones. Methods: Thirty patients with large CBD stones were enrolled in this study. EPLBD was carried out using the one-step inflation of a 15∼18 mm diameter balloon after m-EST. Results: The maximum stone diameter was 21.62±5.38 mm. Twelve patients had more than 4 stones, 7 patients had 2 stones, and the remainder had a single large stone. Complete ductal clearance was achieved in all patients. After the procedure, the serum amylase and/or lipase levels were elevated in 3 patients (13.3%). However, there was no episode of true pancreatitis. Minor bleeding was encountered in only one patient (3.3%), and was easily controlled by an endoscopic epinephrine injection. The procedure was carried out safely in 6 patients with periampullary diverticulum. No perforation or mortality was encountered. Conclusions: Combined EPLBD and m-EST is a safe and effective method, and may be a good alternative treatment for removing large CBD stones. (Korean J Gastrointest Endosc 2006;32:184⁣189)

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Forecasting and Retreatment of Unsuccessful Endoscopic Mechanical Lithotripsy in Patients with Difficult Bile Duct Stones: Sang Hyub Lee, M.D., Joo Kyung Park, M.D., Won Jae Yoon, M.D., Jun Kyu Lee, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D. and Yong Bum Yoon, M.D.; Korean J Gastrointest Endosc 2005;31(6):374-382. Published online December 30, 2005

Abstract PDF: Background
/Aims: Endoscopic removal of a bile duct stone becomes more difficult with increasing stone size. The endoscopic mechanical lithotripsy is frequently used to overcome this problem. However, it is necessary to predict its outcome and determine the optimal treatment when it does fail. This study examined the predictors and optimal treatment for an unsuccessful endoscopic mechanical lithotripsy. Methods: One hundred and twenty five patients who underwent endoscopic mechanical lithotripsy, were retrospectively evaluated. Various predictive factors and procedure-related complications were analyzed. In addition, the clinical outcome of retreatment for unsuccessful endoscopic mechanical lithotripsy was evaluated. Results: Endoscopic mechanical lithotripsy was successful in 97 patients (77.6%). An impacted stone(s), stone size (≥30 mm) and stone size/bile duct diameter (＞1.0) were significant factors forecasting failure, with an estimated odds ratio 26.67, 5.94 and 5.99, respectively. More frequent complications related with the failure were not observed. When the procedure did fail, all were retreated successfully with various modalities including surgery. Despite the short hospitalization period, non-surgical treatment had a similar clinical outcome to that of surgery. Conclusions: An impacted stone, stone size (≥ 30 mm) or stone size/bile duct diameter (＞1.0) in difficult choledocholithiasis are indicators of unsuccessful endoscopic mechanical lithotripsy. Alternative non-surgical treatment might be considered to manage difficult choledocholithiasis when endoscopic mechanical lithotripsy fails. (Korean J Gastrointest Endosc 2005;31:374⁣382)

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Two Cases of Hemobilia Associated with Common Bile Duct Stones: Jeong Ki Kim, M.D., Kwang Hyun Ko, M.D., Hyeuk Park, M.D., Hong Youp Choi, M.D., Sung Pyo Hong, M.D., Seong Gyu Hwang, M.D., Pil Won Park, M.D. and Gyu Sung Rim, M.D.; Korean J Gastrointest Endosc 2005;30(3):178-181. Published online March 31, 2005

Abstract PDF: Hemobilia is a disease caused by injury or conditions that cause the abnormal communication between intrahepatic blood vessels and biliary tract, resulting in leakage of blood into the biliary tract. In the past, trauma had been the most common cause of hemobilia. However, with the increasing invasive procedures in the hepatobiliary tract, iatrogenic origin has become the major cause of hemobilia. Also, non-traumatic etiologies of hemobilia include vascular malformation such as aneurysm, gallstone, inflammation, biliary tumor, hepatocellular carcinoma and coagulopathy. Among these non-traumatic etiologies, choledocholithiasis is a rare cause of hemobilia. The authors have experienced two cases of hemobilia caused by choledocholithiasis, which was diagnosed by abdominal ultrasonography, abdominal CT and duodenoscopy. Both patients were treated by the endoscopic sphincterotomy and stone removal with basket. (Korean J Gastrointest Endosc 2005;30:178⁣182)

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A Case of Common Bile Duct Stone Caused by Foreign Body in Patient with Adenoma of the Ampulla of Vater: Ju Hyun Park, M.D., Sun Mi Lee, M.D., Jun Hyok Oh, M.D., Sang Youn Hwang, M.D., Seong Hun Lee, M.D., Tae Oh Kim, M.D., Seong Ook Lee, M.D., Won Il Park, M.D., Suk Kim, M.D.*, Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and; Korean J Gastrointest Endosc 2005;30(2):114-117. Published online February 27, 2005

Abstract PDF: Choledocholithiasis caused by a foreign body is rare. The most common type of foreign body in the common bile duct is a residual object from previous surgery such as a metal clip or suture material. Foreign body may enter the biliary system after choledochointestinal anastomosis or endoscopic sphincterotomy. Rarely, penetrating missile fragment or gunshot shrapnel account for another type of foreign body. We experienced a case of common bile duct (CBD) stone caused by foreign meterial in 75-years-old women who had a plant foreign body in the common bile duct. She had no past history of abdominal surgery or penetrating trauma. The foreign body and stone were successfully extracted with Dormia basket after the endoscopic sphincterotomy. (Korean J Gastrointest Endosc 2005;30: 114⁣117)

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A Case of Biliary Obstruction Secondary to Shrapnel: Jeong Sik Kim, M.D., Seong Kyu Park, M.D., Yun Oh Bae, M.D., Jin Ho Kim, M.D.,; Korean J Gastrointest Endosc 2003;26(4):236-239. Published online April 30, 2003

Abstract PDF: Obstructive jaundice primarily results from choledocholithiasis, neoplasm, inflammation and infection such as primary sclerosing cholangitis, postsurgical stricture, AIDS cholangiopathy, extrinsic compression of the biliary trees. However, obstructive jaundice secondary to foreign bodies is rare. Especially, shrapnel induced biliary obstruction is very rare and has never been reported in Korea. We report a patient who had biliary obstruction due to metal shrapnel. He had shrapnel injury 52 year ago during the Korean War. For a long time, he had had no symptoms. He was admitted to our hospital for epigastric pain and jaundice. Abdominal CT scan showed a metallic foreign body in the common bile duct. The patient underwent ERCP, and the shrapnel and several stones were successfully extracted with a basket. (Korean J Gastrointest Endosc 2003;26:236⁣239)

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내시경적 유두괄약근 절개술을 이용한 간외담관결석 제거 후 결석 재발에 영향을 미치는 인자 ( Factor Influencing the Recurrence of CBD Stones after an Endoscopic Sphincteromy ): Korean J Gastrointest Endosc 1999;19(4):581-587. Published online November 30, 1998

Abstract PDF: Background
/Aims: Long term results of an endoscopic sphincterotomy (EST) have still been poorly estimated. The aim of this study was to assess late complications of EST. Methods: The rate of late complications were retrospectively evaluated in with 91 patients (mean age, 59.1 years; range, 28∼86 years; M：F, 44：47), who underwent EST for choledocholithiasis. Results: Forty six patients (50.5%) had their gallbladder in situ, and 45 patients (49.5%) underwent cholecystectomy. Early complications (＜30 days) such as hemorrhage, pancreatitis, and perforation occurred in 7 patients (7.7%). During a mean period of 53.4 months (range, 24∼134 months), 26 patients (28.0%) developed late complications, including a recurrence of CBD stones in 20 patients (22.0%) (8-gallbladder in situ, 12-cholecystectomized). An univariate analysis of risk factors for stone recurrence revealed dilated ducts, stone sizes, and stone numbers which were not related with stone recurrence. The history of choledocholithotomy with cholecystectomy was significantly related to stone recurrence. Conclusions: After EST for bile duct stones, late complications occurred in a significant proportion of patients and it was determined that a history of choledocholithotomy with cholecystectomy was significantly correlated with stone recurrence. (Korean J Gastrointest Endosc 19: 581∼587, 1999)

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담낭결손을 동반한 총담관 대장루 1 예 ( A Case of Choledochocolonic Fistula Combined with Absence of Gallbladder ): Korean J Gastrointest Endosc 1999;19(3):481-485. Published online November 30, 1998

Abstract PDF: The enterobiliary fistulas are mostly spontaneous and are caused by biliary disease associated with calculi. Review of many series shows that the most common variety of enterobiliary fistulas is a cholecystoduodenal fistula followed by cholecystocolic, cholecystogastric and choledochoduodenal fistula in that order. But very few cases of choledochocolonic fistulae have been reported. We report a case of choledocholithiasis combined with the absence of gallbladder leading to a choledochocolonic fistula, which was confirmed by endoscopic retrograde cholangiography and abdominal exploration in a 63- year-old male patient with complaint of right upper abdominal pain. (Korean J Gastrointest Endosc 19: 481∼485, 1999)

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원저 : 담도 췌장 ; 십이지장 유두주위 게실과 담석의 연관성 ( Original Articles : Biliary Tract & Pancreas ; Association of Periampullary Diverticula with Primary Choledocholithiasis but not with Secondary Choledocholithiasis ): Korean J Gastrointest Endosc 1997;17(4):501-506. Published online November 30, 1996

Abstract PDF: Background
/Aims: Several endoscopie studies found an association between periam- puilary diverticula and biliary calculi, however, the results of the reports are inconsistent when considering the anatomical location of the stones. The aims of our study are to evaluate the association between periampullary diverticula and gallstones according to their location iand to clarify the origin of the common bile duct stones by analyzing the composition of the stones. Methods: During a period of 10 months, 611 of 632 consecutive cases of endoscopic retrograde cholangiopancreatography(ERCP) were prospectively en- rolled. The data of periampullary diverticula and gallstones were analyzed according to the location of the stones. The stones available were initially grouped on the basis of their grass marphology and cross-sectional appearance, and finally analyzed by quantitative infrared spectroscopy. (Korean J Gastrointest Endosc 17: 501-506, 1997) (continue)

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원저 : 담도 췌장 ; 간외담관 담석증에서의 초음파내시경의 진단적 유용성 ( Original Articles : Biliary Tract & Pancreas ; Effectiveness of Endoscopic Ultrasonography in Detecting the Extrahepatic Choledocholithiasis ): Korean J Gastrointest Endosc 1997;17(1):23-31. Published online November 30, 1996

Abstract PDF: Backgroud/Aims: Ultrasonography is the easiest, fastest procedure for the diagnosis of choledocholithiasis, but the diagnostic failure are mostly because of the intrapancreatic level of this condition and the absence of bile duct dillatation. Endoscopic ultrasonography is a promising procedure for the diagnosis of extrahepatic cholestasis due to noninvasiveness and accuracy in the digestive gas interposition. The aim of this study was to prospectively compare the diagnostic accuracy of endoscopie ultrasonography with abdominal ultrasonography and endoscopic retrograde cholangiography in 66 patients with suspected choledocholithiasis. Methods: All of the patients had abdominal ultrasonography, endoscopic ultrasonography ~and endoscopie retrograde cholangiography within 72 hours and final diagnosis was determined by endoseopic retrograde cholangiography with sphincterotomy. Results: (l) Choledocholithiasis was confirmed in 45 patients: Thirteen patients had nondilated common bile ducts and 20 patients had stones with diamerer < 1 cm. (2) Endoscopic ultrasonography was more sensitive(95.5%) than abdominal ultrasonography (44.4%: P<0.0001) and similar to endoscopic retrograde cholangiography (97.8%). Specificity was same as 100% in 3 diagnostic tools. (3) Endoscopic ultrasonography was superior to abdommal ultrasonography for the diagnosis of choledocholithiasis with nondilated common bile duct(100% vs 15.3%, P<0.0001) and with less than 1cm sized small stone(100% vs 10.0%, P<0.0001). Endoscopic ultrasonography results did not depend on stone diameter or common bile duct dilatation. Conclusions: Endoscopic ultrasonography could be an accurate and safe diagnostic tool for the diagnosis of choledocholithiasis and could be promising especially in the cases with difficult cannulation of bile duct and gal1 stone pancreatitis. (Korean J Gastrointest Endosc 17: 23-31, 1997)

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원저 : 담도 췌장 ; 담낭 담석으로 인한 복강경 담낭절제술시 총담관결석 동반 유무의 예측과 치료 ( Original Articles : Biliary Tract & Pancreas ; Prediction and Management of Choledocholithiasis in Patients Undergoing Laparoscopic Cholecystectomy due to Cholelithiasis ): Korean J Gastrointest Endosc 1997;17(5):632-639. Published online November 30, 1996

Abstract PDF: Background
/Aims: Endoscopic retrograde cholangiopancreatography(ERCP) or operative cholangiography is the procedure to demonstrate and remove stones of the biliary tree in patients undergoing laparoscopic cholecystectomy(LC) due to cholelithiasis. However, ERCP or operative cholangiography is an invasive procedure. The next question then is when and for what indication should ERCP or operative cholangiography be performed. The aims of this study were to assess whether prediction of common bile duct(CBD) stones by the noninvasive method such as liver function test and/or clinical findings is possible, and to investigate which method is more adequate for removal of CBD stones found on ERCP or operative cholangiography. Methods: A total 207 patients with symptomatic cholelithiasis scheduled for LC were enrolled from September 1993 to August 1996. Patients who were already found to have either extrahepatic or intrahepatic biliary stones on sonogram were excluded. Patients were classified into risk group and non-risk group. Patients who belong to the risk group were those having CBD dilatation by ultrasonography, history of jaundice or cholangitis, gallstone pancreatitis, or elevated transaminases. (Korean J Gastrointest Endosc 17: 632-639, 1997) (continue)

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증례 : 담도 췌장 ; 결석을 동반한 간외담관 기형 1예 ( Case Reports : Biliary Tract & Pancreas ; A Rare Case of Extrahepatic Bile Duct Anomaly Associated with Multiple Stones ): Korean J Gastrointest Endosc 1996;16(6):1023-1028. Published online November 30, 1995

Abstract PDF: Congenital anomaly of the extrahepatic biliary system is relatively common, especially vascular variations are much more frequent than anatomic variations. The normal anatomical structure is encountered in only 35 percent of individuals, many of these variations have little or no clinical improtance, but some cases induce symptoms and signs or may lead to incorrect diagnosis and inappropriate management. These are very important to correct diagnosis of biliary variations observed during ultrasonography, cholangiography and endoscopic retrograde cholangiopancreatography(ERCP) and to accurate management by surgeon or endoscopist since accidental section or ligation of aberrant structures can lead to serious complications. We experienced a very rare case of extrahepatic bile duct anomaly confirmed by ERCP. The right and left extrahepatic ducts were connected at the level of the pancreatic segment of the common bile duct and the cystic duct drains to the right extrahepatic duct. There were several stones in the distal portion of the left extrahepatic duct and gallbladder. (Korean J Gastrointeet Endosc 16: 1023-1028, 1996)

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원저 : 식도 위장관 ; 십이지장 유두주위 게실의 임상적 특성 ( Original Articles : Esophagus , Stomach & Intestine ; Clinical Characteristics of Periampullary Diverticulum ): Korean J Gastrointest Endosc 1996;16(6):937-944. Published online November 30, 1995

Abstract PDF: Background
/Aims: Periampuilary diverticulum has been known to be associated with various bilio-pancreatic diseases such as choledocholithiasis and disturbs performing selective cannuiation of ERCP and EST. This present study aims to investigate anatomical morphology of periampullary diverticulum and to determine whether periampullary diverticulurn influences difficulty and complication performing of ERCP and to analyse the relationship between periampullary diverticulum and choledocholithiasis. Methods: We reviewed records of chart and diverticular pictures in 1389 cases of underwent ERCP and evaluated the incidence, size, direction, location of periampullary diverticulum and its influence against performing of ERCP and investigated its relationship with bilio-pancreatic diseases such as choledocholithiasis. (Korean J Gastrointest 16: 937~944, 1996) (continue..)

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원저 : 담도 췌장 ; 내시경적 담관결석 제거술의 임상적 고찰 ( Original Articles : Biliary Tract & Pancreas ; Endoscopic Removal of Bile Duct Stones ): Korean J Gastrointest Endosc 1995;15(4):697-703. Published online November 30, 1994

Abstract PDF: From January 1988 to December 1994, endoscopic sphincterotomy with stone extraction was attempted in 395 patients with common duct stones at Yeungnam University Hospital. Endoscopic sphincterotomy was successful in 389 patients(98.5 %), and clearance of the duct was achieved in 364 patients with an overall success rate of 92.2%. After sphincterotomy, stone extraction by basket or balloon was undertaken in 298 patients without lithotripsy, and stones could be extracted after fragmentation of stones in 19 patients. In 47 patients, stones were passed into duo denum spontaneously. There were 6 cases of sphincterotomy failure due to large periampullary diverticulum or previous gastrojejunostomy. In patients with success ful sphincterotomy, endoscopic stone extraction was failed in 25 cases due to 14 large stones, 5 bile duct strictures, 4 impacted stones, and 2 cases of technical fail ure. Complications were developed in 13 patients(3.3%); 8 pancreatitis and 5 bleedings. All of them were improved with medical therapy only. Despite relatively high success rate and low complications of the endoscopic management of choledocholithiasis, there were significant difficulties in removing large stones. Developement of more effective and inexpensive methods of lithotripsy, and the search for rapidly effective solvent dissolving stones were needed. (Kor J Gastrointest Endosc 15: 697-703, 1995)

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원저 : 내시경적 유두부 괄약근 절개술 123예의 임상적 고찰 ( Original Articles : 128 Cases of Endoscopic Sphincterotomy ( EST ) ): Korean J Gastrointest Endosc 1994;14(2):190-195. Published online November 30, 1993

Abstract PDF: Endoscopic sphincterotomy(EST) is now an established therapeutic procedure for various disorder of the pailla of Vater, the biliary tract, and the pancreas. From November 1992 to September l993, 123 cases of E.S.T were performed in our hospital. The success rate of EST was 97.8%, and choledocholithiasis was the indication for EST in 63. 4% of cases. Among 78 cases of choledocholithiasis, 47 cases were presence of gall bladder with stone (16 cases) or without stone (31 cases), especially 46 cases were assisted with needle type papillotome and 23 cases were assisted with guidewire. EST hae relatively low complications and is the therapy of choice for choledocholithiasis and various diisease of biliary tract. Guidewire assisted stanard papillotome probable reduce the use of needle type papillotome in the difficult cases that EST with pull type papillotome was impossible.

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