Clinical Endoscopy

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

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

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Choledochal cysts – state of the art
Thanh Liem Nguyen, V. S. Cheremnov, Yu. A. Kozlov
Russian Journal of Pediatric Surgery.2021; 25(1): 37. CrossRef

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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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A Case of Cholelithiasis with Massive Lower Gastrointestinal Bleeding: Dong Won Ahn, M.D., Sun Jung Myung, M.D., Cheol Min Shin, M.D., Su Jong Yu, M.D., Ji Won Yoo, M.D., Soo Jeong Cho, M.D., Jae Hyun Cho, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D., Yong Bum Yoon, M.D. and Jin Young Jang, M.D.*; Korean J Gastrointest Endosc 2005;31(6):432-436. Published online December 30, 2005

Abstract PDF: Cholelithiasis is a relatively common disease and can present with various clinical manifestations and complications such as no symptoms, biliary pain, acute cholecystitis, biliary pancreatitis, acute cholangitis, gallstone ileus and biliary enteric fistula. However, cholelithiasis presenting with intra-gallbladder bleeding and massive gastrointestinal bleeding are relatively rare in the worldwide literature and there have been only a few reported case studies. We present here an interesting case of a 63 year-old women with gallstone, active intra-gallbladder bleeding and massive hematochezia who underwent open cholecystectomy, resection and anastomosis of the transverse colon. This patient's pathologic evaluation revealed a finding of acute and chronic cholecystitis with marked hemorrhage and transmural fibrinoid necrosis in the transverse colon. (Korean J Gastrointest Endosc 2005;31:432⁣436)

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총담관의 편평상피세포암 1 예 ( A Case of Squamous Cell Carcinoma of the Common Bile Duct ): Korean J Gastrointest Endosc 1999;19(3):486-490. Published online November 30, 1998

Abstract PDF: A 57-year-old female with jaundice and right upper quadrant abdominal pain, was found on exploration to have squamous cell carcinoma of the common bile duct. Squamous cell carcinoma of the common bile duct is a very rare tumor, simulating adenocarcinoma in its clinical presentation and aggressiveness. Although no consistent causative factors for this tumor has been demonstrated, it has been theorized that the normal columnar epithelium of the bile duct under the influence of an inflammatory stimulus, can develop into squamous epithelium with the ongoing process leading to squamous metaplasia, and eventually carcinoma. Cholelithiasis has been implicated as a cause for bile duct cancer, which was manifested in this patient. The prognosis of this carcinoma was grave, despite all forms of surgical and medical management. A case of squamous cell carcinoma of the common bile duct is reported with a review of relevant literature. (Korean J Gastrointest Endosc 19: 486∼490, 1999)

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원저 : 담도 췌장 ; 십이지장 유두주위 게실 162예의 임상적 연구 ( Original Articles : Biliary Tract & Pancreas ; A Study of 162 Cases of Peri - Ampullary Diverticulum ): Korean J Gastrointest Endosc 1997;17(6):778-788. Published online November 30, 1996

Abstract PDF: Background
Periampullary diverticulum has been commonly discovered during endoscopic retrograde cholangiopancreatography(ERCP) in patients with various pancreaticobiliary diseases such as cholelithiasis and its clinical significance has been noted. Recently, periampullary diverticulum is known to be associated with choledocholithiasis, various pancreatobiliary diseases and intestinal symptoms. Our aims of study was to investigate characteristics of periampullary diverticulum and to determinate the positive relationship between periampullary diverticulum and choledocholithiasis, and to determinate whether periampullary diverticulum influences on the cannulation rate and complication performing ERCP and endoscopic sphincterotomy(EST). Methods: We reviewed 162 of 594 cases, which had periampullary diverticulums on ERCP during the past 6 years, and investigated size, location and number of periampullary diverticulums with special reference to the location of cholelithiasis. We also compared success rate and complication rate of ERCP and EST in cases with or without periamullary diverticulum. (Korean J Gastrointest Endosc 17: 778-788, 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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원저 : 담도 췌장 ; 급성담관염에서 응급 내시경적 경비담관 배액술 ( Original Articles : Biliary Tract & Pancreas ; Emergency Nasobiliary Drainage in Acute Suppurative Cholangitis ): Korean J Gastrointest Endosc 1997;17(3):390-395. Published online November 30, 1996

Abstract PDF: Background
/Aims: Acute suppurative cholangitis is associated with significant mortality. It is best managed by drainage of biliary tree such as endoscopic, percutaneous or surgical, We evaluated the role of emergency endoscopic nasobiliary drainage(ENBD) in the acute suppurative cholangitis. Methods: For 55 patients with acute calculous cholangitis, who did not respond to conservative management and the stone could not be removed from bile duct by endoscopic papillotomy due to poor condition or bleeding tendency, ENBD tube(7.5Fr) was inserted at proximal side of obstruction. ENBD was done at 39.4 hours (mean) after arrival to hospital. Results: ENBD was successful in all patients (100%). All patients responded with striking improvement of the abdominal pain, fever and stabilized vital signs within 3 days. After patients conditions were stabilized clinically, common bile duct stones were removed successfully by endoscopic sphincterotomy or surgery. No patients died of acute suppurative cholangitis. Conclusion: These results show that ENBD is a simple, safe, and effective measure for the initial control of acute suppurative cholangitis due to cholelithiasis, (Korean J Gastrointest Endosc 17: 390-395, 1997)

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원저 : 담낭절제술시 고식적 수술과 복강경을 통한 수술의 임상적 비교 ( Original Articles : Chinical Comparison of the Traditional Versus Laparoscopic Surgery in Cholecystectomy for Cholelithiasis ): Korean J Gastrointest Endosc 1994;14(1):64-73. Published online November 30, 1993

Abstract PDF: Laparascapic Cholecystectomy is a recentely rapidly emerged, minimally invasive procedure whereby the gallbladder is removed using laparoscopic techniques. The procedure offers the patient reduced hospital stay, faster to work, less pain, less complication, less expensiveness, and improved cosmetic results over the traditional open cholecystectomy. (continue...)

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