Clinical Endoscopy

Original Articles

Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones: Hirokazu Saito, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Haruo Imamura, Ikuo Matsushita, Tatsuyuki Kakuma, Shuji Tada; Clin Endosc 2022;55(2):263-269. Published online November 12, 2021; DOI: https://doi.org/10.5946/ce.2021.153

Background
/Aims: Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP.
Methods
This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses.
Results
Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS.
Conclusions
Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.

Citations

Citations to this article as recorded by

Advancements in Research on Challenges in Selective Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography (ERCP)
天雨张
Journal of Clinical Personalized Medicine.2024; 03(01): 100. CrossRef
The impact of transpancreatic precut sphincterotomy on the quality of ERCP in a low-volume setting
Wei-Chih Su, Chia-Chi Wang, Tsung-Hsien Hsiao, Hung-Da Chen, Jiann-Hwa Chen
Gastrointestinal Endoscopy.2024; 99(5): 747. CrossRef
Morphology of the papilla can predict procedural safety and efficacy of ERCP—a systematic review and meta-analysis
Edina Tari, Endre Botond Gagyi, Anett Rancz, Dániel Sándor Veres, Szilárd Váncsa, Péter Jenő Hegyi, Krisztina Hagymási, Péter Hegyi, Bálint Erőss
Scientific Reports.2024;[Epub] CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Hyung Ku Chon, Ki-Hyun Kim, Tae Jun Song, Dong-Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyun Chung, Jin Lee, Miyoung Choi
Gut and Liver.2024; 18(4): 564. CrossRef
Development of a Scoring System for Predicting the Difficulty of Bile Duct Cannulation and Selecting the Appropriate Cannulation Method
Taira Kuroda, Hideki Miyata, Kozue Kanemitsu-Okada, Emi Yanagihara, Hironobu Saneto, Taisei Murakami, Hirofumi Izumoto, Kei Onishi, Shogo Kitahata, Tomoe Kawamura, Ryuichiro Iwasaki, Fujimasa Tada, Eiji Tsubouchi, Atsushi Hiraoka, Tomoyuki Ninomiya
Digestive Diseases and Sciences.2024;[Epub] CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Ki-Hyun Kim, Hyung Ku Chon, Tae Jun Song, Dong Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyung Chung, Jin Lee, Miyoung Choi
The Korean Journal of Gastroenterology.2024; 84(3): 111. CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Ki-Hyun Kim, Hyung Ku Chon, Tae Jun Song, Dong Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyung Chung, Jin Lee, Miyoung Choi
The Korean Journal of Pancreas and Biliary Tract.2024; 29(4): 144. CrossRef
En face position of the major duodenal papilla using a reopenable clip during endoscopic retrograde cholangiopancreatography
Hirokazu Saito, Akiko Ikebata, Shunpei Hashigo
Digestive Endoscopy.2023;[Epub] CrossRef
Criterios 5-5-2 de canulación biliar y complicaciones post colangiopancreatografía retrógrada endoscópica: Experiencia en un hospital de referencia, Perú
Wilmer Gustavo Quiroga Purizaca, Diego Ricardo Páucar Aguilar, Jackeline Amparo Barrientos Pérez, Isamar Benyi Gutiérrez Córdova, Renato Garrido Acedo, Daniel Andrei Vargas Blácido
Revista de Gastroenterología del Perú.2023; 43(2): e1461. CrossRef
Predictive factors of difficult biliary cannulation: An experience of a tunisian tertiary center
K. Ben Abdallah, L. Hamzaoui, M. Mahmoudi, I. Cherif, A. Ben Mohamed, M. Yakoubi, A. Khsiba, M. Medhioub, M.M. Azouz
Heliyon.2022; 8(12): e12526. CrossRef

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Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them?: Sho Hasegawa, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Toshitaka Sakai, Hiroaki Kusunose, Kensuke Kubota, Atsushi Nakajima, Yutaka Noda, Kei Ito; Clin Endosc 2021;54(6):888-898. Published online May 27, 2021; DOI: https://doi.org/10.5946/ce.2020.271

Abstract PDF PubReader ePub: Background
/Aims: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because the severity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI).
Methods
A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile duct stones (CBDSs) in the ECM group.
Results
No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of the severity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severe cholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, p=0.048). In patients in the ECM group, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and 92%, respectively, for magnetic resonance cholangiopancreatography.
Conclusions
EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rate of worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need for elective EI.

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Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone: Ka Young Kim, Jimin Han, Ho Gak Kim, Byeong Suk Kim, Jin Tae Jung, Joong Goo Kwon, Eun Young Kim, Chang Hyeong Lee; Clin Endosc 2013;46(6):637-642. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.637

Abstract PDF PubReader ePub

Background/Aims

Between endoscopic sphincterotomy (ES) alone and combined endoscopic sphincterotomy and large balloon dilation (ES-LBD) groups, efficacy and long-term complications, difference in biliary stone recurrence rate, and risk factors of stone recurrence were compared.

Methods

Medical records of 222 patients who underwent ERCP for biliary stone removal were retrospectively reviewed. Patients with dilated CBD ≥11 mm and follow-up longer than 6 months were included.

Results

There were 101 patients in ES-LBD group and 121 patients in ES group. Mean follow-up duration was 25.0 (6-48) months and 13.0 (6-43) months, respectively (p=0.001). There was no difference in number of ERCP sessions, brown pigment stones, angle between mid and distal common bile duct (CBD angle) <135°, and lithotripsy rate. Complete retrieval success rate was excellent in both groups (100% vs. 99%). Early complication rate of ES-LBD and ES alone group was 4 and 4.1%, respectively (p=1.000). One patient in ES-LBD group died from delayed bleeding. Late complication rate was 5.9 and 3.3%, respectively (p=1.000). Stone recurrence rate was 6.9% and 5.8%, respectively (p=0.984). The only Independent risk factor of stone recurrence was presence of periampullary diverticulum.

Conclusions

Late complication and stone recurrence rates were similar between ES-LBD and ES alone groups.

Citations

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Usefulness of Percutaneous Transhepatic Cholangioscopic Lithotomy for Removal of Difficult Common Bile Duct Stones: Jae Hyung Lee, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Su Bum Park, Suk Hun Kim, Ung Bae Jeon; Clin Endosc 2013;46(1):65-70. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.65

Abstract PDF PubReader ePub

Background/Aims

Approximately 5% to 10% of common bile duct (CBD) stones are difficult to remove by conventional endoscopic methods. Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) can be an alternative method for this condition, but is not well established yet. The aim of this study was to evaluate the clinical efficacy and safety of PTCSL for removal of difficult CBD stones.

Methods

This study is a retrospective review of 34 consecutive patients who underwent unsuccessful removal of CBD stones using conventional endoscopic methods between December 2008 and July 2010 and were subsequently treated using PTCSL.

Results

Among 443 patients with CBD stones, 34 patients (7.8%) failed to achieve stone removal using conventional endoscopic methods. Of these 34 patients, 33 were treated using PTCSL. In all 33 cases (100%), complete stone removal was achieved using PTCSL. Most complications (15/17, 88.2%) were mild and transient. Major complications occurred in two patients (6.1%) who experienced hemobilia, and percutaneous transhepatic biliary drainage tract disruption, respectively; which were fully recovered without mortality.

Conclusions

Despite prolonged hospital stay and temporary decline of quality of life, PTCSL is an effective and safe method in the management of difficult CBD stones, especially in patients with difficulty in approaching the affected bile duct.

Citations

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Colangioscopia asistida mediante abordaje transparietohepático en el manejo de las hepatolitiasis
Ana Belén Martín Arnau, Antonio Molera Espelt, Jordi Villaba Auñon, Santiago Sánchez-Cabús
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Easton Neitzel, Jack Stearns, Jessica Guido, Kaiden Porter, Jed Whetten, Luke Lammers, Eric vanSonnenberg
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Ana Belén Martín Arnau, Antonio Molera Espelt, Jordi Villaba Auñon, Santiago Sánchez-Cabús
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Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Common Bile Duct Stones: Endoscopic Management of Difficult Common Bile Duct Stones
Eunae Cho, Dong Kee Jang, Seong-Hun Kim, Dong Uk Kim
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Evidence-based clinical practice guidelines for cholelithiasis 2021
Naotaka Fujita, Ichiro Yasuda, Itaru Endo, Hiroyuki Isayama, Takuji Iwashita, Toshiharu Ueki, Kenichiro Uemura, Akiko Umezawa, Akio Katanuma, Yu Katayose, Yutaka Suzuki, Junichi Shoda, Toshio Tsuyuguchi, Toshifumi Wakai, Kazuo Inui, Michiaki Unno, Yoshifu
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Thandalam K. Anand, Pandurangan Basumani, Ramakrishnan Ravi
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Hyunsuk Lee, Sang Hyub Lee, Gunn Huh, Yeji Kim, Saebeom Hur, Moonhaeng Hur, Minwoo Lee, Byeongyun Ahn
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Ji Hong Oh, Seung Goun Hong
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Т.В. Маевская, Ю.В. Слободин
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One‐Step Multichannel Percutaneous Transhepatic Cholangioscopic Lithotripsy Applied in Bilateral Hepatolithiasis
Haisu Tao, Ping Wang, Beiwang Sun, Kun Li, Canhua Zhu
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Taryn J. Rohringer, Jessica H. Hannick, Armando Lorenzo, Yaron Avitzur, Michael Temple, Dimitri A. Parra
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Koichiro Tsutsumi, Hironari Kato, Shuntaro Yabe, Sho Mizukawa, Hiroyuki Seki, Yutaka Akimoto, Daisuke Uchida, Kazuyuki Matsumoto, Takeshi Tomoda, Naoki Yamamoto, Shigeru Horiguchi, Hirofumi Kawamoto, Hiroyuki Okada
Therapeutic Advances in Gastroenterology.2017; 10(1): 54. CrossRef
Traitement instrumental non chirurgical des pathologies biliaires intra- et extrahépatiques
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Imaging in Medicine.2013; 5(6): 525. CrossRef
Percutaneous Approach for Removal of Difficult Common Bile Duct Stones
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26 Crossref

Special Issue Articles of IDEN 2012

Highlights of Pancreatobiliary Endoscopy in International Digestive Endoscopy Network 2012: How Much Has It Advanced?: Seok Ho Dong; Clin Endosc 2012;45(3):297-298. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.297

Abstract PDF PubReader ePub: The pancreatobiliary organ is composed of one of the most complicated structures and complex physiological functions among other digestive organs in our body. This is why endoscopic procedure in pancreaticobiliary system requires rather complicated techniques. In International Digestive Endoscopy Network (IDEN) 2012, many interesting pancreatobiliay endoscopy related topics were presented. Basic procedures like endoscopic papillary balloon dilation (EPBD), advanced techniques like endoscopic necrosectomy, prevention and management of post-ERCP pancreatitis, and spyglass system are reviewed in this highlight summary.

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Original Article

Short-term Clinical Outcomes Based on Risk Factors of Recurrence after Removing Common Bile Duct Stones with Endoscopic Papillary Large Balloon Dilatation: Jung Ho Kim, Yeon Suk Kim, Dong Kyu Kim, Min Su Ha, Young Jun Lee, Jong Joon Lee, Sang Jin Lee, In Sik Won, Yang Suh Ku, Yun Soo Kim, Ju Hyun Kim; Clin Endosc 2011;44(2):123-128. Published online December 31, 2011; DOI: https://doi.org/10.5946/ce.2011.44.2.123

Abstract PDF PubReader ePub

Background/Aims

Recurrence is an important late complication of endotherapy of bile duct stones. Endoscopic papillary large balloon dilation (EPLBD) can be used as an alternative method of removing difficult bile duct stones. The aim of this study was to evaluate short term clinical outcomes after removing common bile duct (CBD) stones using EPLBD.

Methods

A retrospective review was performed based on the medical records of 141 patients who received EPLBD, with or without endoscopic sphincterotomy, between September 2008 and February 2010. Of these, 50 patients, were enrolled in the study. Clinical and endoscopic parameters were analyzed to identify risk factors for CBD stones recurrence.

Results

Male:Female ratio was 22:28 (mean age, 67.4±14.4 years). Recurrence rate was 24.0% (12/50). Mean follow-up period was 10.8±4.5 months. Nineteen (38.0%) had a history of surgery and 20 (40.0%) were comorbid with periampullary diverticula. Mean diameters of the stones and CBD were 13.8±4.3 mm and 20.1±7.2 mm, respectively. In univariate analysis, large CBD stones (≥12 mm) and angulated CBD (angle ≤145°) were identified as the significant predictors of recurrence. In multivariate analysis, angulated CBD (angle ≤145°) was the significant independent risk factor for recurrence.

Conclusions

Close follow-up seems necessary in patients with angulated CBD (angle ≤145°).

Citations

Citations to this article as recorded by

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Yanguang Sha, Zhilin Wang, Rongmei Tang, Ke Wang, Chen Xu, Guangbin Chen
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Endoscopic Papillary Large Balloon Dilatation With or Without Endoscopic Sphincterotomy in the Treatment of Common Bile Duct Stones
Jia Wang, Lichao Cao, Kuijin Xue, Peng Qi, Qingdong Mao, Mingjuan Cui, Hui Ju, Baoguo He, Bin Cao
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Cheng Ye, Wence Zhou, Hui Zhang, Long Miao, Gen Lv, Abdelwahab Omri
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Seongyul Ryu, Ik Hyun Jo, Seonhoo Kim, Yeon-Ji Kim, Woo Chul Chung
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Feng Deng, Mi Zhou, Ping-Ping Liu, Jun-Bo Hong, Guo-Hua Li, Xiao-Jiang Zhou, You-Xiang Chen
World Journal of Clinical Cases.2019; 7(9): 1028. CrossRef
Japan Gastroenterological Endoscopy Society guidelines for endoscopic papillary large balloon dilation
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Fumihide Itokawa, Takao Itoi, Atsushi Sofuni, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Nobuhito Ikeuchi, Junko Umeda, Reina Tanaka, Ryosuke Tonozuka, Mitsuyoshi Honjyo, Fuminori Moriyasu, Kazuhiko Kasuya, Akihiko Tsuchida
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A Spontaneous Pneumobilia Observed after Severe Vomiting in a Patient with CBD Stone: Se Jin Kim, M.D., Kyoung Hoon Rhee, M.D.*, Joon Ho Wang, M.D., Jae Dong Lee, M.D., Dong Chun Seol, M.D., Seung Chan Kim, M.D. and Won Hak Kim, M.D.; Korean J Gastrointest Endosc 2008;37(5):389-392. Published online November 30, 2008

Abstract PDF: Pneumobilia almost always indicates an abnormal communication between the biliary and gastrointestinal systems. Air may occasionally enter the biliary tract in a retrograde fashion through the papilla. Transient incompetence of the sphincter of Oddi, which is produced by the passage of small biliary stones, is one rare mechanism that can explain pneumobilia. We present here a case of spontaneous pneumobilia after sphincter disruption that was presumably caused by the passage of biliary stone. A 37-year-old woman visited our hospital with the symptom of right upper quadrant pain. The pain subsided after she had an episode of severe vomiting. Plain abdominal radiography revealed that air filled the branches of the hepatic ducts, and the common bile duct had a large filling defect. We also include a review of the related literature. (Korean J Gastrointest Endosc 2008;37:389-392)

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Usefulness of Medium Incision Endoscopic Sphincterotomy with Endoscopic Papillary Balloon Dilatation for the Removal of Common Bile Duct Stones: Jeong Seon Ji, M.D., Hiun Suk Chae, M.D., Hyung Keun Kim, M.D., Young Seok Cho, M.D., Chang Wook Kim, M.D., Bo In Lee, M.D., Hwang Choi, M.D., Byung Wook Kim, M.D., Suk Won Han, M.D. and Kyu Yong Choi, M.D.; Korean J Gastrointest Endosc 2007;34(3):132-137. Published online March 30, 2007

Abstract PDF: Background
/Aims: Recent meta-analysis data has shown that there was no significant difference in the rate of overall successful stone removal between endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD). However, bleeding occurred more frequently in the EST group, and post-ERCP pancreatitis more commonly occurred in the EPBD group. Thus, we hypothesized that medium incision EST modestly combined with EPBD (m-EST⁢EPBD) could overcome the drawbacks of both techniques. Methods: Fifty eight patients who underwent m-EST⁢EPBD for removal of common bile duct stones were compared with sixty patients who underwent EST only. Medium incision EST was performed with a pure cut mode and then a 12 mm diameter balloon was used for the EPBD. Results: Complete bile duct stone clearance was achieved in 96.7% of the patients in the EST group and in 96.5% of the patients who underwent m-EST⁢EPBD (p＞0.05). There was no significant difference between the two groups for procedure-related pancreatitis. The rate for procedure- related hemorrhage was 0% in the both groups. Conclusions: m-EST⁢EPBD showed the possibility of being alternative to EST for the removal of common bile duct stone. To establish effectiveness and safety of m-EST⁢EPBD, further randomized large scaled clinical studies for comparing EST and m-EST⁢EPBD are needed. (Korean J Gastrointest Endosc 2007;34:132⁣137)

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The Usefulness of Endoscopic Ultrasonography in the Diagnosis of Common Bile Duct Stones: Sung Soo You, M.D., Eun Young Kim, M.D., Jong Woon Cheon, M.D., Chang Jin Seo, M.D., Ja Kyoung Cho, M.D., Hyung Keun Ha, M.D., Jin Tae Jung, M.D., Joong Goo Kwon, M.D.,Chang Hyeong Lee, M.D. and Ho Gak Kim, M.D.; Korean J Gastrointest Endosc 2005;30(5):249-256. Published online May 30, 2005

Abstract PDF: Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosis and treatment of common bile duct stones (CBDS). However it is associated with some complications. Endoscopic ultrasonography (EUS) is an efficient diagnostic tool for CBDS with better accuracy than ultrasonography (USG) or computed tomography (CT) and lower complication rate than ERCP. We evaluated the diagnostic usefulness of EUS in suspicious CBDS. Methods: From Oct. 2001 to Mar. 2004, 84 patients with the suspicion of CBDS, without definite evidence on CT and/or USG were evaluated with EUS. The reports were reviewed retrospectively. Results: Patients were 38 males, 46 females with mean age of 56 years old. CBDS were found in 25 (29.8%) patients. In the diagnosis of CBDS undetected in CT and/or USG, EUS gave 96% sensitivity, 96.6% specificity, 92.3% positive predictive value and 98.3% negative predictive value. When CBDS were found in EUS, the average sizes of CBD and CBDS were 8.8 mm (4∼16.7) and 6.4 mm (3.3∼9.1) respectively. Diagnostic ERCP was avoided in 54 (64.3%). EUS provided additional diagnosis such as gallbladder stones, gallbladder cancer, ampullary cancer and adenoma. No complication was associated with EUS. Conclusions: EUS is reasonably safe and accurate procedure in detecting CBDS. EUS may possibly replace diagnostic ERCP in CBDS. (Korean J Gastrointest Endosc 2005;30:249⁣256)

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내시경적 제거가 어려운 총담관 결석 환자에서 담도배액술 후의 경과 관찰: Korean J Gastrointest Endosc 2003;27(5):427-427. Published online November 20, 2003

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

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

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십이지장 유두선종의 내시경적 유두절제술 후 발생한 총담관 결석을 동반한 담도 협착 1 예 ( Biliary Stricture Associated with Common Bile Duct Stone Caused by Endoscopic Snare Papillectomy of Ampullary Adenoma ): Korean J Gastrointest Endosc 2001;23(4):259-262. Published online November 30, 2000

Abstract PDF: Neoplasms of the major duodenal papilla or the ampulla of Vater are rare but are clinically important since they are premalignant. Recently endoscopic snare papillectomy for the ampullary adenoma is being increasingly performed. The procedure is now regarded as a clinically effective treatment, however, various complications such as bleeding, perforation, colangitis, and pancreatitis have been reported. To our knowledge, biliary stricture of this case has not been reported as a complication of endoscopic snare papillectomy for ampullary adenoma. Also, secondary common bile duct stone was formed by biliary stasis associated with biliary stricture in our case. We performed the balloon dilation at the biliary stricture site and could remove the stone successfully by endoscopic method. (Korean J Gastrointest Endosc 2001;23:259-262)

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총담관 결석의 내시경적 치료 성적 ( Results of Endoscopic Treatment in Common Bile Duct Stones ): Korean J Gastrointest Endosc 2000;20(3):191-197. Published online November 30, 1999

Abstract PDF: Background
/Aims: Common bile duct stones are the most common among bile duct diseases. In the past, common bile duct stones were considered a surgically operable disease, but is now considered a medical disease due to the advancement of endoscopy and endoscopic techniques. The aim of this study was to determine the results of endoscopic treatment of common bile duct stones. Methods: Removal of primary or secondary common bile duct stones were attempted by peroral or percutaneous endoscopy. The common bile duct stones were diagnosed by ultrasonography or cholangiography. As a primary approach route, the peroral transpapillary endoscopic approach was tried. On the other hand, percutaneous common bile duct stone removal was attempted if the patient already had a percutaneous route, peroral transpapillary approaches failed, or if conditions for endoscopy were unfavorable. Results: The study subjects consisted of 196 patients; 96 males and 100 females. The mean age was 61.8 years. A total of 272 endoscopic stone removal were attempted in 196 patients. Of the 272, peroral approaches were conducted 241 times for 183 patients, and percutaneous approaches were performed 31 times for 12 patients. The success rate of the first treatment modality to remove the common bile duct stones was 90.3% (176/195). The overall success rate of endoscopic common bile duct stones removal was 100%. Conclusions: In all patients, the common bile duct stones were removed successfully by endoscopy, and thus supporting the shift of recognizing common bile duct stones as a medical rather than surgical discase.

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총담관 결석이 동반된 십이지장 구부로 분리 개구한 췌담도관 1예 ( A Case of Anomalous Termination of the Common Bile Duct and the Pancreatic Duct into the Duodenal Bulb, Associated with Common Bile Duct Stones ): Korean J Gastrointest Endosc 1999;19(6):1011-1015. Published online November 30, 1998

Abstract PDF: Usually, the papilla of Vater is located in the midportion or the distal half of the descending duodenum. Isolated cases of common bile duct termination in other sites, including the fourth portion of the duodenum, the pyloric ring, the duodenal bulb and the stomach, have been reported. A case is here in reported involving abdominal pain in the right upper quadrant area, in which an ERCP demonstrated an anomalous termination of the common bile duct and pancreatic duct into the duodenal bulb separately. This anomaly was associated with a bile duct dilatation and single common bile duct (CBD) stone. Trial of CBD stone removal during an ERCP failed. The patient's condition improved after a cholecystectomy and choledochojejunostomy. (Korean J Gastrointest Endosc 19: 1011∼1015, 1999)

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내시경적 역행성 담췌관 조영술로 진단에 실패한 총담관결석에 대한 초음파내시경의 유용성 ( Diagnostic Utility of Endoscopic Ultrasonograpy (EUS) for Common Bile Duct (CBD) Stones not Confirmed by Endoscopic Retrograde Cholangiopancreatography (ERCP) ): Korean J Gastrointest Endosc 1999;19(3):394-401. Published online November 30, 1998

Abstract PDF: Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the best imaging procedure for the diagnosis of common bile duct (CBD) stones. But the difficulties of diagnosis are mostly due to problems involving cannulation, microlithiasis and pancreatitis etc. The diagnostic utility of endoscopic ultrasonography (EUS) for the diagnosis of CBD stones not detected by ERCP was retrogradely assessed in 8 patients. Methods: All the patients (N=98) underwent ERCP, and in the case where CBD stones were not confirmed by ERCP, EUS was performed. Final diagnosis was determined by ERCP with an endoscopic sphincterotomy (EST) or operative exploration. Results: 98 patients with CBD stones were studied. The first ERCP successfully imaged CBD stones in 90 patients and an EST was performed in 84 patients. In 6 patients, stones were removed through operative exploration. ERCP images were incomplete or of poor quality in 8 patients. EUS images were excellent or good in all 8 cases, where ERCP was ineffective. Factors associated with incomplete results for CBD stones included; inability to cannulate the ampulla of Vater (N=1), nonvisualized CBD (N=4), microlithiasis (N=2), and association with the periampullary fistula (N=1). The second ERCP and EST successfully confirmed the diagnosis of CBD stones in 6 patients. In 2 patients, operative exploration was needed to confirm the diagnosis of CBD stones. Conclusions: An EUS appears to be an accurate and useful diagnostic tool for assessing CBD stones in cases where an ERCP was ineffective. (Korean J Gastrointest Endosc 19: 394∼401, 1999)

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원저 : 담도 췌장 ; 총담관 결석 제거에서 풍선을 이용한 내시경적 유두부 성형술 ( Original Articles : Biliary Tract & Pancreas ; Endoscopic Balloon Sphincteroplasty without Sphincterotomy for Removal of Common Bile Duct Stones ): Korean J Gastrointest Endosc 1998;18(3):333-339. Published online November 30, 1997

Abstract PDF: Background
The complications associated with endoscopic stone removal arise from the sphincterotomy that is performed to facilitate stone extraction. Early complications such as bleeding, perforation, pancreatitis and sepsis occur in about 10% of all patients. Moreover late complications may emerge due to the loss of the sphincter function. So the endoscopic removal of the bile duct stones without a sphincterotomy seems preferable in order to avoid the early complications related to the sphincterotomy, and may also help to preserve the function of the sphincter of Cddi. Aim: To evaluate the efficacy and safety of endoscopic balloon sphinteroplasty(EBS), we attempted to remove common bile duct stones, less than 12 mm, without sphincterotomy in 11 patients. We also investigated the effects of sphincteroplasy on the motility of sphincter of Oddi before and after EBS. Results: All patients were treated succesefully, with two patients administered sublingual nitroglycerine for the medical sphincter dilatation. Only one patient had mild abdominal pain, while the others experienced no complications. Follow-up manometric examinations showed the papillary function to be well preserved. Conclusion: This results suggested that the endoscopic balloon sphincteroplasy without sphincterotomy for the removal of small-sized stones is a useful and safe method, and its major advantage may lie in the preservation of the sphincter function. We recommend that prospective studies, preferably randomized, with clear objectives, are needed to clarify the success and safety of this technique compared to the standard sphincterotomy. (Korean J Gastrointest Endosc 18: 333-339, 1998)

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

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

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원저 : 담도 췌장 ; 담도계 담석과 십이지장 유두 주위부 게실과의 관계 ( Original Articles : Biliary Tract & Pancreas ; The Relationship between Biliary Calculi and Juxtapapillary Duodenal Diverticuli ): Korean J Gastrointest Endosc 1997;17(4):507-512. Published online November 30, 1996

Abstract PDF: Background
/Amins: Juxtapapillary duodenal diverticuli are often associated with biliary stones. The aim of this study was to investigate the prevalence of juxtapapillary duodenal diverticuli in biliary stones. Methods: Three hundred and thirteen patients underwent endoscopic retrograde cholangiopancreatography were studied prospectively. Results: Seventy-five patients had juxtapapillary duodennl diverticuli(24%). The occurrence of diver- ticuli increased with age and more commomly in female patients. The prevalence of diver- ticulii was higher in patients with commom bile duct stones(35.6% vs 17.6%; P 0.002) and gallbladder stones(33.3% vs 17.6%; P=0,001) than in patients without biliary stones (17.6%). Conclusions: We conclude that biliary stones are associated with juxtapapillary diverticuli. (Korean J Gastrointest Endosc 17: 507-512, 1997)

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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 ; 복강경 담낭 절제술에 있어서 내시경적 역행성 담췌관 조영술의 역할 ( Original Articles : Biliary Tract & Pancreas ; The Role of Endoscopic Retrograde Cholangiopancreatography in Laparoscopic Cholecystectomy ): Korean J Gastrointest Endosc 1997;17(1):15-22. Published online November 30, 1996

Abstract PDF: Background
/Aims: Perioperative endoscopic retrograde cholangiopancreatography (ERCP) and en copic sphincterotomy (EST) offer the ability to remove common bile duct (CBD) stones and it ean make laparoscopic cholecystectcqny possible instead of open cholecystectomy. Although ERCP accurately detects CBD stones, the associated financial costs and potential morbidity argue against its indiscriminate use. Thus, we undertook the current retrospective study to analyze our own experience in the identification of preoperative indicators of CBD stones in patients managed by laparoscopic cholecystectomy. Methods: Between October 1994 and October 1996, 503 laparoscopic cholecystectomy were performed at Samsung Medical Center. We analyzed the value of serum biochemical tests and findings of ultrasonography in patients ted by laparoscopic cholecystectomy. Results: A total of 117 patients underwent perigperative ERCP; 113 patients underwent preoperative ERCP with 2/113 (1.8%) failing to cannulate the ampulla; 21 patients (18.0%) had choledocholithiasis; and all patients with CBD stones were cleared by EST without major complications. The indication of ERCP for prediction of CBD stones were categorized as 4 groups; abnormal liver function tests (LFT) and duct dilatation in ultrasonography 61.9% (13/22), only abnormal liver function tests 13.6% (6/44), only duct dilatation in ultrasonography 5,9% (1/17), and normal liver function tests with normal findings in ultrasonopaphy 2.9% (1/35) in this study. In patients with CBD stones, there was no significant difference to predict CBD stones in total bilirubin, alkaline phosphatase, and alanine aminotransferase. Gallstone pancreatitis patients who had hyperamylasemia and abnornal LFT that were resolved or resolving before ERCP revealed no CBD stones (0/10, 0%). Conclusions: ERCP before laparoscopic cholecystectomy is needed in selected patients who have abnormal liver function and/or CBD dilatation on ultrasonography. Gallstone pancreatitis that is resalving or resolved clinically may not require preoperative ERCP. ERCP with EST and laparoscopic cholecystectomy is a safe and effective method for the management of symptomatic eholelithiasis and choledocholithiasis. (Korean J Gastrointest Endosc 17: 15~22, 1997)

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증례 : 담도 췌장 ; 담낭 , 담낭관 및 총담관 결석이 동반된 환자에서의 내시경적 담석제거술 ( Case Reports : Biliary Tract & Pancreas ; Endoscopic Biliary Lithotripsy in a Patient with Gallstones of Gallbladder , Cystic Duct , and Common Bile Duct ): Korean J Gastrointest Endosc 1996;16(2):268-276. Published online November 30, 1995

Abstract PDF: Endoseopic sphincterotomy(EST) has been an accepted procedure in patients with current or recurrent common bile duct stones. The success rate of sphineterotomy and of subaequent stone extraction were reported upto 90%. Percutaneous transhepatic cholecystoscopy-lithotripsy(PTCCS-L) could be one of the non-surgical treatment modalities for gallbladder stones, and has been considered as a safe, reliable and technically easy therapeutic procedure through improvement in PTCCS-L manipuiatian and through the development of new devices for this technique. PTCCS-L could be usually performed in the sgrgically high risk groups with gallbladder stones. In this report, we presented successful endoscopic biliary lithotripsy in a 60-year-old male with gallstones of gall bladder, cystic duct, and common bile duct, who was highly risk for surgery, because he has been suffered from advanced liver disease. Endoseopic sphincterotomy and stone removal with basket were done for the removal of common bile duct stones. PTCCS was performed and complete removal of gallbladder stones was achieved. Cystic duict stone was successfully removed after bougie dilation of cystic duct. There has been no recurrence of gallstones until 1 year of follow-up. (Korean J Gastrointest Endosc 16: 268~276, 1996)

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원저 : 악성종양에 의한 폐쇄성황달 및 폐쇄 상하부에 담관결석이 동반된 환자에서 Coil형 팽창성금속도관 ( Endocoil ) 삽관을 통한 치료 ( Original Articles : Successful Management by a New Self-expandable and Removable Metallic Coil Stent Insertion in a Case with Malignant Obstructive Jaundice Associated with CBD Stones at Below and Above the Stricture ): Korean J Gastrointest Endosc 1994;14(4):402-408. Published online November 30, 1993

Abstract PDF: Endoscopic retrograde biliary drainge is a useful method of palliative treatment of malignant biliary obstruction with respect to safety, rapidity in decompression of obstruction. However, despite of efforts to prolong patency of the stents, the main long term complication of current-widely used plastic endoprosthesis is to tendency for the stents to become clogged by sludge leading to recurrent jaundice and cholangitis, finally, obstruction of stents. Recently, in an effort to improve the patency of stent, variety of self-expandable metallic endoprosthesis have developed and which can be compressed into and inserted through small lumen catheter with large-bored lumen in expandable state. However, most of these open mesh of self-expandable stents allows tumor in growth which causes reobstruction, and additionally it is nearly impossible to retrieve the inserted prosthesis. Recently developed coil metal stent(Endocoil, Intent Co.), which, unlikely other previous metallic stent, has possibility of retrieving prosthesis and prevention of tumor ingrowth. We experienced a case of 52-year old male sufferd from malignant biliary obstruction due to recurrence of cancer at peripancreatic lymph nodes and combined with common bile duct stones on both proximal and distal side of the stricture, in whom Endocoil was implanted with sucessful decompression of obstruction and simultaneous removal of biliary stones located at both side of stricture.

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