Clinical Endoscopy

Clinical outcomes of permanent stenting with endoscopic ultrasound gallbladder drainage: Eisuke Suzuki, Yuji Fujita, Kunihiro Hosono, Yuji Koyama, Seitaro Tsujino, Takuma Teratani, Atsushi Nakajima, Nobuyuki Matsuhashi; Clin Endosc 2023;56(5):650-657. Published online April 5, 2023; DOI: https://doi.org/10.5946/ce.2022.190

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Background
/Aims: Endoscopic ultrasound gallbladder drainage (EUS-GBD) is gaining attention as a treatment method for cholecystitis. However, only a few studies have assessed the outcomes of permanent stenting with EUS-GBD. Therefore, we evaluated the clinical outcomes of permanent stenting using EUS-GBD.
Methods
This was a retrospective, single-center cohort study. The criteria for EUS-GBD at our institution are a high risk for surgery, inability to perform surgery owing to poor performance status, and inability to obtain consent for emergency surgery. EUS-GBD was performed using a 7-Fr double-pigtail plastic stent with a dilating device. The primary outcomes were the recurrence-free rate of cholecystitis and the late-stage complication-avoidance rate. Secondary outcomes were technical success, clinical success, and procedural adverse events.
Results
A total of 41 patients were included in the analysis. The median follow-up period was 168 (range, 10–1,238) days. The recurrence-free and late-stage complication-avoidance rates during the follow-up period were 95% (38 cases) and 90% (36 cases), respectively. There were only two cases of cholecystitis recurrence during the study period.
Conclusions
EUS-GBD using double-pigtail plastic stent was safe and effective with few complications, even in the long term, in patients with acute cholecystitis.

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Revolutionizing outcomes: endoscopic ultrasound-guided gallbladder drainage using innovative electrocautery enhanced-lumen apposing metal stents for high-risk surgical patients
Hyung Ku Chon, Yun Chae Lee, Tae Hyeon Kim, Seung Ok Lee, Seong-Hun Kim
Scientific Reports.2024;[Epub] CrossRef

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Successful removal of remnant cystic duct stump stone using single-operator cholangioscopy-guided electrohydraulic lithotripsy: two case reports: Sung Hyeok Ryou, Hong Ja Kim; Clin Endosc 2023;56(3):375-380. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2021.273

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Cholecystectomy is the best method for treating gallstone diseases. However, 10%–30% of patients who undergo a cholecystectomy continue to complain of upper abdominal pain, dyspepsia, or jaundice—this is referred to as postcholecystectomy syndrome. Cystic duct stump stones are a troublesome cause of postcholecystectomy syndrome. Conventionally, surgery is mainly performed to remove cystic duct stump stones. However, repeated surgery can cause complications, such as postoperative bleeding, biliary injury, and wound infection. As an alternative method of surgery, endoscopic retrograde cholangiopancreatography is sometimes used to remove cystic duct stump stones, although the success rate is not high due to technical difficulties. Recently, peroral cholangioscopy, which can directly observe the bile duct, has been suggested as an alternative method. We report two cases in which a cystic duct stump stone was successfully removed via a single-operator cholangioscopy, after failure with an endoscopic retrograde cholangiopancreatography.

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Clinical perspectives on post-cholecystectomy syndrome: a narrative review
Changjin Nam, Jun Suh Lee, Ji Su Kim, Tae Yoon Lee, Young Chul Yoon
Annals of Medicine.2025;[Epub] CrossRef
Holmium Laser Lithotripsy in the Management of Difficult Biliary and Cystic Ductal Stones – A Case Series
Amit Kumar, Harindra Kumar Goje, Nimesh Kumar Tarway, Vivek Hande
Journal of Marine Medical Society.2024;[Epub] CrossRef
Laparoscopic management of remnant gall bladder with stones: Lessons from a tertiary care centre's experience
Gilbert Samuel Jebakumar, Jeevanandham Muthiah, Loganathan Jayapal, R. Santhosh Kumar, Siddhesh Tasgaonkar, K.S. Santhosh Anand, J.K.A. Jameel, Sudeepta Kumar Swain, K.J. Raghunath, Prasanna Kumar Reddy, Tirupporur Govindaswamy Balachandar
Laparoscopic, Endoscopic and Robotic Surgery.2024; 7(1): 27. CrossRef
A remnant cystic duct presenting as a duodenal subepithelial tumor
Gwang Ha Kim, Dong Chan Joo
Clinical Endoscopy.2024; 57(2): 268. CrossRef

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Outcomes of Endoscopic Management among Patients with Bile Leak of Various Etiologies at a Tertiary Care Center: Suprabhat Giri, Sridhar Sundaram, Harish Darak, Sanjay Kumar, Shobna Bhatia; Clin Endosc 2020;53(6):727-734. Published online August 21, 2020; DOI: https://doi.org/10.5946/ce.2020.017

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Background
/Aims: Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions such as ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line management for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies other than post-cholecystectomy injury are extremely limited.
Methods
We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care center and who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution without extravasation of the contrast medium during the second ERCP conducted after 6 weeks.
Results
In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in 34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP, sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65 (91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis of bile leak and ERCP.
Conclusions
Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.

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Postoperative Bile Leak in Liver Hydatid Cyst: When to Intervene?
Krishna Rao Gurana, Mukteshwar Dasari, Vijay Kumar Sharma, Julie Shah, Abhijit Chandra
Journal of West African College of Surgeons.2025;[Epub] CrossRef
A critical appraisal of the ISGLS definition of biliary leakage after liver resection
Svenja Sliwinski, Jan Heil, Josephine Franz, Hanan El Youzouri, Michael Heise, Wolf O. Bechstein, Andreas A. Schnitzbauer
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Progress in ERCP Treatment of Biliary Complications in Patients with Hepatic Echinococcosis
燕泽林
Advances in Clinical Medicine.2023; 13(03): 4013. CrossRef
Diagnosis and Management of Bile Leaks after Severe Liver Injury: A Trauma Association of Canada (TAC) Multicenter Study
Morgan Schellenberg, Chad G. Ball, Natthida Owattanapanich, Brent Emigh, Patrick B. Murphy, Bradley Moffat, Brett Mador, Andrew Beckett, Jennie Lee, Emilie Joos, Samuel Minor, Matt Strickland, Kenji Inaba
Journal of Trauma and Acute Care Surgery.2022;[Epub] CrossRef
Postoperative bile leakage caused by intrahepatic duct injury during right hemicolectomy
Jaram Lee, Ook Song, Hyeong-Min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Medicine.2021; 100(46): e27877. CrossRef
The Need for a Better-Designed Study of the Outcomes of Endoscopic Management of Bile Leak
Hyung Ku Chon, Eun Ji Shin, Seong-Hun Kim
Clinical Endoscopy.2020; 53(6): 633. CrossRef

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A New Technique of Endoscopic Transpapillary Gallbladder Drainage Combined with Intraductal Ultrasonography for the Treatment of Acute Cholecystitis: Ryota Sagami, Kenji Hayasaka, Tetsuro Ujihara, Ryotaro Nakahara, Daisuke Murakami, Tomoyuki Iwaki, Satoshi Suehiro, Yasushi Katsuyama, Hideaki Harada, Yuji Amano; Clin Endosc 2020;53(2):221-229. Published online November 5, 2019; DOI: https://doi.org/10.5946/ce.2019.099

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Background
/Aims: Endoscopic transpapillary gallbladder drainage (ETGBD) is useful for the treatment of acute cholecystitis; however, the technique is difficult to perform. When intraductal ultrasonography (IDUS) is combined with ETGBD, the orifice of the cystic duct in the common bile duct may be more easily detected in the cannulation procedure. The aim of this study was to evaluate the efficacy of ETGBD with IDUS compared with that of ETGBD alone.
Methods
A total of 100 consecutive patients with acute cholecystitis requiring ETGBD were retrospectively recruited. The first 50 consecutive patients were treated using ETGBD without IDUS, and the next 50 patients were treated using ETGBD with IDUS. Through propensity score matching analysis, we compared the clinical outcomes between the groups. The primary outcome was the technical success rate.
Results
The technical success rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (92.0% vs. 76.0%, p=0.044). There was no significant difference in procedure length between the two groups (74.0 min vs. 66.7 min, p=0.310). The complication rate of ETGBD with IDUS was significantly higher than that of ETGBD without IDUS (6.0% vs. 0%, p<0.001); however, only one case showed an IDUS technique-related complication (pancreatitis).
Conclusions
The assistance of IDUS may be useful in ETGBD.

Citations

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Endoscopic management of acute cholecystitis in high‐risk surgical patients: A comprehensive review article
Akinori Maruta, Takuji Iwashita, Kensaku Yoshida, Shogo Shimizu, Masahito Shimizu
DEN Open.2026;[Epub] CrossRef
Usefulness of a One‐step Semi‐deployment Flushing and Stenting Technique in Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis (With Video)
Yuki Kawasaki, Jun Ushio, Hisaki Kato, Kazuya Sumi, Yuki Shibata, Norihiro Nomura, Junichi Eguchi, Takayoshi Ito, Haruhiro Inoue
DEN Open.2026;[Epub] CrossRef
The Success Rate Is Lower but Completion Rate of Laparoscopic Cholecystectomy Is higher in Endoscopic Transpapillary Gallbladder Drainage than Percutaneous Gallbladder Drainage for Acute Cholecystitis
Toshiro Masuda, Hiroshi Takamori, Ken-ichi Ogata, Katsuhiro Ogawa, Kenji Shimizu, Ryuichi Karashima, Hidetoshi Nitta, Katsutaka Matsumoto, Tetsuya Okino, Hideo Baba
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(4): 413. CrossRef
The Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound Connection: Unity Is Strength, or the Endoscopic Ultrasonography Retrograde Cholangiopancreatography Concept
Claudio Giovanni De Angelis, Eleonora Dall’Amico, Maria Teresa Staiano, Marcantonio Gesualdo, Mauro Bruno, Silvia Gaia, Marco Sacco, Federica Fimiano, Anna Mauriello, Simone Dibitetto, Chiara Canalis, Rosa Claudia Stasio, Alessandro Caneglias, Federica Me
Diagnostics.2023; 13(20): 3265. CrossRef
Strategy Comparison of Endoscopic Ultrasound-Guided Gallbladder Drainage to Percutaneous Transhepatic Gallbladder Drainage, Following Failed Emergent Endoscopic Transpapillary Gallbladder Drainage
Ryota Sagami, Kazuhiro Mizukami, Takao Sato, Hidefumi Nishikiori, Kazunari Murakami
Journal of Clinical Medicine.2023; 12(22): 7034. CrossRef
Accuracy of Endoscopic Transpapillary Gallbladder Drainage with Liquid-Based Cytology for Gallbladder Disease
Soichiro Kawahara, Takeshi Tomoda, Hironari Kato, Toru Ueki, Yutaka Akimoto, Ryo Harada, Tomohiro Toji, Hiroyuki Okada
Digestion.2022; 103(2): 116. CrossRef
The anatomy of the cystic duct and its association with cholelithiasis: MR cholangiopancreatographic study
Shallu Garg, Usha Dutta, Sreedhara B. Chaluvashetty, Kimavat Hemanth Kumar, Naveen Kalra, Daisy Sahni, Anjali Aggarwal
Clinical Anatomy.2022; 35(7): 847. CrossRef
Bouncing off the balloon: A new trick for selective cystic duct cannulation
Rishabh Gulati, Tarun Rustagi
Journal of Hepato-Biliary-Pancreatic Sciences.2021;[Epub] CrossRef
Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis
Zain A. Sobani, Christina Ling, Tarun Rustagi
Digestive Diseases and Sciences.2021; 66(5): 1425. CrossRef
Akute Cholezystitis bei hohem OP-Risiko: sonografische und endoskopische Therapieoptionen
Manuela Götzberger, Natascha Nüssler, Barbara Braden, Christoph F. Dietrich, Thomas Müller
Zeitschrift für Gastroenterologie.2021; 59(09): 983. CrossRef
Editors' Choice of Noteworthy Clinical Endoscopy Publications in the First Decade
Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
Clinical Endoscopy.2021; 54(5): 633. CrossRef
A case in which repositioning based on intraductal ultrasonography was useful for trans-papillary gallbladder drainage
Teruaki Miyauchi, Kenji Shimura
Progress of Digestive Endoscopy.2021; 99(1): 135. CrossRef
Intraductal Ultrasonography Can Enhance the Success of Endoscopic Transpapillary Gallbladder Drainage in Patients with Acute Cholecystitis
Clement Chun Ho Wu, Christopher Jen Lock Khor
Clinical Endoscopy.2020; 53(2): 114. CrossRef

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An Incidentally Detected Remnant Cystic Duct Carcinoma during the Evaluation of a Duodenal Submucosal Tumor (SMT) Lesion: Jung Ho Bae, M.D., Gwang Ha Kim, M.D., Jin Hyun Park, M.D., Bong Eun Lee, M.D., Jae Sup Eum, M.D., Dae Hwan Kang, M.D., Do Youn Park, M.D.* and Geun Am Song, M.D.; Korean J Gastrointest Endosc 2008;36(6):401-404. Published online June 30, 2008

Abstract PDF: Carcinoma of the cystic duct remnant is a rare disease. We report a case of a remnant cystic duct carcinoma in a male patient who had undergone cholecystectomy for cholecystolithiasis 20 years previously. A 53-yr-old man visited our hospital for the evaluation of a submucosal tumor on the duodenum. During the evaluation, we detected a mass in the cystic duct remnant by the use of endoscopic ultrasonography. Based on the pathology, the mass was confirmed as a carcinoma of the cystic duct remnant by intraductal ultrasonography and an intraductal biopsy. (Korean J Gastrointest Endosc 2008;36:401-405)

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A Case of Acute Pancreatitis Associated with Aberrant Cystic Duct Opening into the Right Hepatic Duct: Kyung-Phil Kang, M.D. and Won-Chung Choi, M.D.; Korean J Gastrointest Endosc 2006;33(3):187-190. Published online September 30, 2006

Abstract PDF: Congenital anomalies of the pancreaticobiliary structure may go undetected until adulthood, and they can be the cause of unexplained jaundice, abdominal pain, nausea and vomiting. In addition to such associated disease, as cholangitis, gallstone, cholangiocarcinoma and pancreatitis, recognition of these variant anatomies is clinically important for planning surgery and for preventing inadvertent surgical injury. Although congenital abnormalities and variations of the biliary ducts are common, and variations in the drainage and course of the cystic duct are also frequently seen, variation of the cystic duct opening into the right hepatic duct is rare; further, it is important to avoid erroneous ligation of the hepatic duct during surgery. We report here on a case of aberrant cystic duct opening into the right hepatic duct along with acute pancreatitis. (Korean J Gastrointest Endosc 2006;33:187⁣190)

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A Case of Cystic Duct Carcinoma with Hepatic Duct Invasion: Chang Hyun Lee, M.D., Youn Joo Kim, M.D., Woo Hyun Paik, M.D., Jae Kyung Lee, M.D., Goh Eun Chung, M.D., Sang Hyup Lee, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D., Yong Bum Yoon, M.D., Dong Chul Kim, M.D.*, Se Hyung Kim, M.D.^† and Jin Young Jan; Korean J Gastrointest Endosc 2006;33(3):178-182. Published online September 30, 2006

Abstract PDF: A primary carcinoma of the cystic duct is extremely rare, accounting for 2.6% of all biliary carcinomas. However, the prognosis is better than other biliary carcinomas. The median survival is 20.4 months. In Korea, three cases have been reported and there is no case where a pre-operative MRI has been performed. We report a case of a primary carcinoma of the cystic duct with hepatic duct invasion, which presented as a painless right upper quadrant mass, that was diagnosed by MRCP in a pre-operative situation. (Korean J Gastrointest Endosc 2006;33:178⁣182)

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증례 : 유두부로 개구하는 담낭관 급성 췌장염 - 증례보고 - ( Cystic Duct Insertion at the Ampulla of Vater and Acute Pancreatitis - A Case Report - ): Korean J Gastrointest Endosc 2000;20(6):496-498. Published online November 30, 1999

Abstract PDF: The two most common causes of acute pancreatitis are alcohol and cholelithiasis. Acute recurrent pancreatitis can result from a variety of abnormalities involving the terminal end of the distal choledochus, pancreatic duct, ampulla of Vater and the major duodenal papilla, which in turn may include a papillary stenosis, periampullary neoplasm, choledochocele, sphincter of Oddi dysfunction, and pancreatic ductal adenocarcinoma. Recently a case of recurrent acute pancreatitis associated with aberrant cystic duet insertion at the ampulla of Vater was experienced. Biliary-pancreatic reflux was speculated to be the mechanism responsible for causing this anomalous, recurrent, acute pancreatitis. Another case of acute pancreatitis associated with aberrant cystic duct insertion at the ampulla of Vater was also experienced in a 29-year-old man, 1Jnlike the previous report, our case showed cholestatic features on the initial blood chemistry. An endoscopic retrograde cholangiopancre-atography performed after recovry revealed only aberrant cystic duct insertion at the ampulla of Vater. This anomaly also seems to have played a role in causing acute pancreatitis in this patient. This interesting case is herein reported with a review of the relevant literature. (Korean J Gastrointest Endosc 2000;20:496-498)

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담낭관 저위합류의 임상적 의의 ( Clinical Significance of Low Junction of the Cystic Duct ): Korean J Gastrointest Endosc 1999;19(5):747-755. Published online November 30, 1998

Abstract PDF: Background
/Aims: Recently, similar to the anomalous union of the pancreatobiliary duct (AUPBD), a low junction of the cystic duct (LJCD) was reported to be associated with the carcinogenesis of the gall bladder (GB) and other pancreatobiliary diseases. This study was designed to evaluate the clinical significance of the LJCD. Methods: In this study all cases were performed ERCP. Three hundred and twenty two cases were selected due to their clear identification of the union area between the bile duct and the pancreatic duct, inserted area of the cystic duct, and the duodenal opening of the bile duct. The LJCD was defined that the cystic duct joins the distal bile duct between the upper margin of the pancreas and the duodenal opening of the bile duct. AUPBD was defined as a common channel greater than 15 mm in length. The clinical data was divided into four groups-normal biliary anatomy (Group 1), AUPBD (Group 2), LJCD (Group 3), and combined with AUPBD and LJCD (Group 4), and then analyzed. Results: The mean age of the subjects was 56.6 with 183 male and 139 female cases. Among 322 cases, there were 7.1% (23 of 322) of AUPBD, 11.2% (36 of 322) of LJCD and 0.6% (2 of 322) of combined with AUPBD and LJCD. The clinical symptoms and the laboratory findings of the subjects were no statistical significance among the groups. The incidence of CBD stones was 27.3% (88 of 322) of the patients; 25.3% (66 of 261) of Group 1, 21.7% (5 of 23) of Group 2, 47.2% (17 of 36) of Group 3, and were significantly higher in Group 3 than Group 1 & Group 3 (p=0.038). However, the incidence of GB stones and cystic duct stones was no statistical significance among the groups. Malignant diseases of the biliary trees were 9.65% (31 of 322) of the patients; 6.8% (18 of 261) of Group 1, 26% (6 of 23) of Group 2, 13.8% (5 of 36) of Group 3, and were closely correlated with AUPBD (p＜0.001) and LJCD (p=0.017). Conclusions: LJCD is relatively common in patients undergoing ERCP and closely correlated with the CBD stones and the malignacies of the biliary system. However its role in these condition is uncertain and needs to be further investigated. (Korean J Gastrointest Endosc 19: 747∼755, 1999)

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원저 : 담도 췌장 ; 담낭관결석의 내시경적 치료 ( Original Articles : Biliary Tract & Pancreas ; Endoscopic Treatment with ESWL of Impacted Cystic Duct Stones ): Korean J Gastrointest Endosc 1998;18(6):863-871. Published online November 30, 1997

Abstract PDF: Background
/Aims: The established treatment for cystic duct stones is surgery, but nonoperative removal of gallstones through percutaneous cholecystostomy can also be a useful procedure in patients at high risk for surgery. Conventional methods using endoscopic or percutaneous stone extraction usually fail due to the inability to access or capture the cystic duct stones in the narrow, long, spiral portion of the cystic duct, especially in impacted cases. As a result stone fragmentation is required during endoscopic stone removal. It is impossible for an electrohydraulic lithotripsy (EHL) to gain access to the stones, due to the rigid distal metal tip of the lithotripter and the narrowness of the long, spiral cystic duct. Using extracorporeal shockwave lithotripsy (ESWL) to disintegrate gallstones is a more effective method for removal of cystic duct stones. Experiences of endoscopic treatment for cystic duct stones of patients with high risk for surgery were reviewed, and conclusions are included in this study. Methods: Patient records of endoscopic management of cystic duct stones between January, 1994 and December, 1997, were reviewed for methods and results of treatment. Most of the patients had undergone lithotripsy followed by percutaneous transhepatic cholecystostomy. (Korean J Gastrointest Endosc 18: 863-871, 1998) (continue)

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

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

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증례 : 담도 췌장 ; 담낭 이중조영술이 진단에 유용했던 만성 담낭염 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case af Chronic Cholecystitis Diagnosed with Double Contrast Study of the Gallbladder ): Korean J Gastrointest Endosc 1998;18(1):117-121. Published online November 30, 1997

Abstract PDF: The combined diagnostic modalities using abdominal ultrasound, endoscopic ultrasound and endascopic retrograde cholangiopancreatogram are useful for the diagnosis of gall bladder disease. But, these diagnostic methods have limitations for the detection of early flat-type gallbladder cancer. To cope with these problems, double contrast study of gallbladder disease is being recently used to diagnose the flat-type cancer of gallbladder in Japan. Herein we report a case of chronic cholecystitis confirmed histologically and assisted by double contrast method of gallbladder, which was diagnosed as a gallbladder polyp by abdominal sonogram at first. The method requires the cystic duct cannulation and placement of the catheter to the gallbladder. And then Barium sulfate and CO2 are injected through the catheter. The patient didnt experience any complication during and after this procedure except for hyperamylasemia. After the simple cholecystectomy, he improved completely. In conclusion, double contrast study of gallbladder can be useful in the diagnosis of the gallbladder disease and compensate for the other dignostic tools. (Korean J Gastrointest Endosc 18: 117-121, 1998)

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원저 : 담도 췌장 ; 내시경적 역행성 담관 조영술에 의한 담낭관 - 간외담관 접합부의 변형과 기형에 관한 연구 ( Original Articles : Biliary Tract & Pancreas ; Clinical Significances of Variants and Anomalies of Cystico - Hepatic Junction by Endoscopic Retrograde Cholangiography ): Korean J Gastrointest Endosc 1997;17(3):351-361. Published online November 30, 1996

Abstract PDF: Background
/Aims: The biliary tract often shows various morphologic abnormalities. Thus various anomalies and variations of the cystic duct have been extensively studied via cadeveric or intraoperative dissections and operative cholangiograms. The knowledge of the junction of cystic and common hepatic duct is essential for endoscopic management of biliary tract disease. But no large series identifying this critical cystico-hepatic junction(CHJ) by duodenoscopy has been reported, Methods: To know the anomaly and variant of CHJ and to evaluate its clinical significence, we retrospectively reviewed 434 cases of endoscopic retrograde cholangiography performed at Korea University Hospital from 1992 through 1993. The CHJ was categorized as lateral or medial only for unequivocal angulation in that direction, and spiral when there is overlap of the CHJ with the bile duct in the posteroanterior view. The CHJ was further modified as parallel if the course of the two ducts was closely adherent for 1 cm or more. In addition to identifying the radial takeoff, the level of the CHJ along the length of the extrahepatic biliary tree was determined. The distance from the ampulla to the junction was divided by the distance from the ampulla to the bifurcation and expressed as proximal, middle, distal, respectively. (Korean J Gastrointest Endosc 17: 351-361, 1997) (continue)

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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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