Clinical Endoscopy

Original Article

Prophylactic endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis induced after metallic stent placement for malignant biliary strictures: a retrospective study in Japan: Fumisato Kozakai, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Kei Ito; Clin Endosc 2024;57(5):647-655. Published online May 17, 2024; DOI: https://doi.org/10.5946/ce.2023.284

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Background
/Aims: Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement.
Methods
Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included.
Results
Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p<0.05). Adverse events occurred for 7 patients (23.3%: acute pancreatitis in 7; non-obstructive cholangitis in 1; perforation of the cystic duct in 1 with an overlap), all of which improved with conservative treatment. No patients developed AC when the GBS placement was successful, whereas 25 of the 128 patients (19.5%) without a prophylactic GBS developed AC during the median follow-up period of 357 days (p=0.043). In the multivariable analysis, GBS placement was a significant factor in preventing AC (hazard ratio, 0.61; 95% confidence interval, 0.37–0.99; p=0.045).
Conclusions
GBS may contribute to the prevention of AC after SEMS placement for malignant biliary strictures.

Citations

Citations to this article as recorded by

Risk Factors for Cholecystitis After Self-expandable Metallic Stent Placement for Malignant Distal Biliary Obstruction
Hashem Albunni, Azizullah Beran, Nwal Hadaki, Mark A. Gromski, Mohammad Al-Haddad
Journal of Clinical Gastroenterology.2025;[Epub] CrossRef
Risk factors for infection following particle stent placement in obstructive jaundice patients: A retrospective analysis
Gang Wang, Rui Qi
Current Problems in Surgery.2025; 67: 101775. CrossRef
Technical challenges and safety of prophylactic gallbladder stenting with metallic biliary stenting
Masood Muhammad Karim, Om Parkash
Clinical Endoscopy.2024; 57(6): 841. CrossRef

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Case Report

Single-pigtail plastic stent made from endoscopic nasobiliary drainage tubes in endoscopic ultrasound-guided gallbladder drainage: a retrospective case series: Koichi Soga; Clin Endosc 2024;57(2):263-267. Published online April 4, 2023; DOI: https://doi.org/10.5946/ce.2022.213

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Technical failure of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is often attributed to device failure. To rectify this problem, we developed a single-pigtail plastic stent (SPPS) for EUS-GBD. We retrospectively reviewed the cases of four patients who underwent EUS-GBD for acute cholecystitis. To prepare the SPPS, a 7.5-Fr endoscopic nasobiliary drainage tube was cut to an appropriate length. The use of SPPS during EUS-GBD was successful from both technical and clinical standpoints. The SPPS spontaneously detached 57 days after the procedure in patient 4 and 412 days after the procedure in patient 1. Patient 1 developed cholecystitis after 426 days and was managed with antibiotics. The other three patients did not develop any complications after surgery. In conclusion, we designed a new SPPS dedicated to EUS-GBD and established its technical feasibility and clinical effectiveness.

Citations

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Endoscopic ultrasound-guided retrieval of a migrated plastic stent from a pelvic abscess
Koichi Soga, Yuto Suzuki, Fuki Hayakawa, Takeshi Fujiwara, Yo Fujimoto, Ikuhiro Kobori, Masaya Tamano
Endoscopy.2024; 56(S 01): E870. CrossRef
Usefulness of inserting a modified single‐pigtail plastic stent into a metallic stent in endoscopic ultrasound-guided gallbladder drainage
Koichi Soga
Endoscopy.2023; 55(S 01): E1081. CrossRef

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Original Articles

The feasibility of percutaneous transhepatic gallbladder aspiration for acute cholecystitis after self-expandable metallic stent placement for malignant biliary obstruction: a 10-year retrospective analysis in a single center: Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Masayuki Hijioka, Ken Kawabe, Naohiko Harada, Makoto Nakamuta, Takamasa Oono, Yoshihiro Ogawa; Clin Endosc 2022;55(6):784-792. Published online October 21, 2022; DOI: https://doi.org/10.5946/ce.2021.244

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Background
/Aims: Patients with acute cholecystitis (AC) after metallic stent (MS) placement for malignant biliary obstruction (MBO) have a high surgical risk. We performed percutaneous transhepatic gallbladder aspiration (PTGBA) as the first treatment for AC. We aimed to identify the risk factors for AC after MS placement and the poor response factors of PTGBA.
Methods
We enrolled 401 patients who underwent MS placement for MBO between April 2011 and March 2020. The incidence of AC was 10.7%. Of these 43 patients, 37 underwent PTGBA as the first treatment. The patients’ responses to PTGBA were divided into good and poor response groups.
Results
There were 20 patients in good response group and 17 patients in poor response group. Risk factors for cholecystitis after MS placement included cystic duct obstruction (p<0.001) and covered MS (p<0.001). Cystic duct obstruction (p=0.003) and uncovered MS (p=0.011) demonstrated significantly poor responses to PTGBA. Cystic duct obstruction is a risk factor for cholecystitis and poor response factor for PTGBA, whereas covered MS is a risk factor for cholecystitis and an uncovered MS is a poor response factor of PTGBA for cholecystitis.
Conclusions
The onset and poor response factors of AC after MS placement were different between covered and uncovered MS. PTGBA can be a viable option for AC after MS placement, especially in patients with covered MS.

Citations

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Endeavors to prevent stent malfunction: new insights into the risk factors for recurrent biliary obstruction
Sung-Jo Bang
Clinical Endoscopy.2024; 57(1): 56. CrossRef
Endoscopic Ultrasound-Guided Naso-gallbladder Drainage Using a Dedicated Catheter for Acute Cholecystitis After Transpapillary Metal Stent Placement for Malignant Biliary Obstruction
Tadahisa Inoue, Rena Kitano, Mayu Ibusuki, Kazumasa Sakamoto, Satoshi Kimoto, Yuji Kobayashi, Yoshio Sumida, Yukiomi Nakade, Kiyoaki Ito, Masashi Yoneda
Digestive Diseases and Sciences.2023; 68(12): 4449. CrossRef
The writing on the wall: self-expandable stents for endoscopic ultrasound-guided hepaticogastrostomy?
Hyung Ku Chon, Shayan Irani, Tae Hyeon Kim
Clinical Endoscopy.2023; 56(6): 741. CrossRef
How should a therapeutic strategy be constructed for acute cholecystitis after self-expanding metal stent placement for malignant biliary obstruction?
Mamoru Takenaka, Masatoshi Kudo
Clinical Endoscopy.2022; 55(6): 757. CrossRef

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Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis using Two Gallbladder Stents (Dual Gallbladder Stenting): Zain A Sobani, Sergio A. Sánchez-Luna, Tarun Rustagi; Clin Endosc 2021;54(6):899-902. Published online May 31, 2021; DOI: https://doi.org/10.5946/ce.2021.023

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Background
/Aims: Endoscopic transpapillary gallbladder drainage (ETPGBD) is gaining popularity for the management of acute cholecystitis (AC) in high-risk patients. However, the stents placed during the procedure are not immune to obstruction. Here we describe a novel technique of stenting with two transpapillary stents and evaluate its technical feasibility, safety, and efficacy in AC.
Methods
A retrospective analysis of all patients undergoing ETPGBD using dual stents for AC at our institution between November 1, 2017 and August 31, 2020 was conducted. We abstracted patient data to evaluate technical and clinical success, adverse events, and long-term outcomes. Two stents were placed either during the index procedure or during an interval procedure performed 4–6 weeks after the index procedure.
Results
A total of 21 patients underwent ETPGBD with dual stenting (57.14% male, mean age: 62.14±17.21 years). The median interval between the placement of the first and the second stents was 37 days (range: 0–226 days). Technical and clinical success rates were 100%, with a recurrence rate of 4.76% (n=1) and adverse event rate of 9.52% (n=2) during a mean follow-up period of 471.74±345.64 days (median: 341 days, range: 55–1084 days).
Conclusions
ETPGBD with dual gallbladder stenting is a safe and effective technique for long-term gallbladder drainage in non-surgical candidates. Larger controlled studies are needed to validate our findings for the widespread implementation of this technique.

Citations

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Endoscopic Transpapillary Gallbladder Drainage With 2 Stents Versus 1 Stent Reduces Reinterventions: A Multicenter Study
James D. Haddad, Natalie Wilson, Vijay S. Are, Shawn L. Shah, Danny Issa, Tarek Sawas, Mohammad Bilal, Thomas Tielleman
Techniques and Innovations in Gastrointestinal Endoscopy.2025; 27(1): 150899. CrossRef
Endoscopic Gallbladder Drainage EUS LAMS vs. ERCP Trans-papillary Drainage
Maham Hayat, Yasi Xiao, Mustafa A. Arain, Dennis Yang
Current Gastroenterology Reports.2025;[Epub] CrossRef
Endoscopic Gallbladder Drainage: A Comprehensive Review on Indications, Techniques, and Future Perspectives
Edoardo Troncone, Rosa Amendola, Alessandro Moscardelli, Elena De Cristofaro, Pasquale De Vico, Omero Alessandro Paoluzi, Giovanni Monteleone, Manuel Perez-Miranda, Giovanna Del Vecchio Blanco
Medicina.2024; 60(4): 633. CrossRef
Approaches to Cholecystitis: Surgical, Endoscopic, and Percutaneous Management
Nicole Cherng, Ikechukwu Achebe, Mason Winkie, Julie Thomann, Eric Then, Neil B. Marya
Journal of Intensive Care Medicine.2024;[Epub] CrossRef
Interval cholecystectomy following drainage procedures for acute cholecystitis: percutaneous transhepatic vs endoscopic transpapillary gallbladder drainage
Morihiro Katsura, Kazuhide Matsushima, Takashi Kato, Christine Isabella Bent, Tadao Kubota, Tomiaki Kubota, Masafumi Ie
Journal of Gastrointestinal Surgery.2024; 28(11): 1912. CrossRef
Long-Term Impact of Endoscopic Gallbladder Stenting for Calculous Cholecystitis in Poor Surgical Candidates: A Multi-center Comparative Study
Tadahisa Inoue, Yuta Suzuki, Michihiro Yoshida, Itaru Naitoh, Fumihiro Okumura, Rena Kitano, Kenichi Haneda, Kazuki Hayashi, Masashi Yoneda
Digestive Diseases and Sciences.2023; 68(4): 1529. CrossRef
Intermediate- to long-term outcomes of endoscopic transpapillary gallbladder stenting in patients with gallstone-related disease: a 10-year single-center experience
Wiriyaporn Ridtitid, Natee Faknak, Panida Piyachaturawat, Nicha Teeratorn, Yingluk Sritunyarat, Phonthep Angsuwatcharakon, Parit Mekaroonkamol, Pradermchai Kongkam, Rungsun Rerknimitr
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Percutaneous Cystic Duct Interventions and Drain Internalization for Calculous Cholecystitis in Patients Ineligible for Surgery
Courtney Sperry, Asad Malik, Allison Reiland, Bartley Thornburg, Rajesh Keswani, Muhammed Sufyaan Ebrahim Patel, Aziz Aadam, Anthony Yang, Ezra Teitelbaum, Riad Salem, Ahsun Riaz
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Jad P. AbiMansour, Ryan J. Law, Andrew C. Storm, Vinay Chandrasekhara
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Assessment of Gallbladder Drainage Methods in the Treatment of Acute Cholecystitis: A Literature Review
Dorotea Bozic, Zarko Ardalic, Antonio Mestrovic, Josipa Bilandzic Ivisic, Damir Alicic, Ivan Zaja, Tomislav Ivanovic, Ivona Bozic, Zeljko Puljiz, Andre Bratanic
Medicina.2023; 60(1): 5. CrossRef
Long-Term Outcomes of Endoscopic Gallbladder Drainage for Cholecystitis in Poor Surgical Candidates: An Updated Comprehensive Review
Tadahisa Inoue, Michihiro Yoshida, Yuta Suzuki, Rena Kitano, Fumihiro Okumura, Itaru Naitoh
Journal of Clinical Medicine.2021; 10(21): 4842. CrossRef
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Jad AbiMansour, Ryan Law
Clinical Endoscopy.2021; 54(6): 783. CrossRef

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Case Report

Minimally Invasive Approach Using Digital Single-Operator Peroral Cholangioscopy-Guided Electrohydraulic Lithotripsy and Endoscopic Nasogallbladder Drainage for the Management of High-Grade Mirizzi Syndrome: Hyung Ku Chon, Chan Park, Tae Hyeon Kim; Clin Endosc 2021;54(6):930-934. Published online February 18, 2021; DOI: https://doi.org/10.5946/ce.2021.015

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Mirizzi syndrome is a rare complication of gallbladder disease that can be difficult to treat. In particular, endoscopic treatment often fails because of the inability to access or to capture the impacted cystic duct stone. We report a case of Mirizzi syndrome grade III that was successfully managed by digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage and interval laparoscopic cholecystectomy. Based on our experience, digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage is a feasible minimally invasive approach for the management of high-grade Mirizzi syndrome.

Citations

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Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques
Edoardo Troncone, Michelangela Mossa, Pasquale De Vico, Giovanni Monteleone, Giovanna Del Vecchio Blanco
Medicina.2022; 58(1): 120. CrossRef
Endoscopic management of cystic duct stones and Mirizzi’s syndrome: experience at an academic medical center
Rishi Pawa, Robert Dorrell, Swati Pawa
Endoscopy International Open.2022; 10(01): E135. CrossRef
Mirizzi Syndrome Type IV Successfully Treated with Peroral Single-operator Cholangioscopy-guided Electrohydraulic Lithotripsy: A Case Report with Literature Review
Hirokazu Kawai, Toshifumi Sato, Masaaki Natsui, Kotaro Watanabe, Ryosuke Inoue, Mayuki Kimura, Kazumi Yoko, Syun-ya Sasaki, Masashi Watanabe, Taku Ohashi, Akihiro Tsukahara, Norio Tanaka, Yoshihisa Tsukada
Internal Medicine.2022; 61(23): 3513. CrossRef
Quality of life of treated patients with Mirizi syndrome
F. M. Pavuk
Klinicheskaia khirurgiia.2021; 88(1-2): 69. CrossRef
A Stone in Remnant Cystic Duct Causing Mirizzi Syndrome Following Laparoscopic Cholecystectomy
Min Jae Yang, Do Hyun Park
Clinical Endoscopy.2021; 54(5): 777. CrossRef

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Reviews

Practical Approaches for High-Risk Surgical Patients with Acute Cholecystitis: The Percutaneous Approach versus Endoscopic Alternatives: Rungsun Rerknimitr, Khanh Cong Pham; Clin Endosc 2020;53(6):678-685. Published online January 9, 2020; DOI: https://doi.org/10.5946/ce.2019.186

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In high-risk surgical patients with acute cholecystitis who are not candidates for early laparoscopic cholecystectomy, gallbladder (GB) drainage is an alternative treatment option. Percutaneous transhepatic gallbladder drainage (PTGBD) is a recommended first line intervention because of its high efficacy and feasibility in most centers. However, with the advent of endoscopic accessories and technology, endoscopic GB drainage has been chosen as a more favorable choice by endoscopists. Endoscopic transpapillary gallbladder drainage (ETGBD) can be performed under either fluoroscopic or peroral cholangioscopic guidance via endoscopic retrograde cholangiopancreatography by the transpapillary placement of a long double-pigtail stent. In a patient with common bile duct stones, this procedure is accompanied with stone removal. ETGBD is especially useful for acute cholecystitis patients who are contraindicated for PTGBD or those with severe coagulopathy, thrombocytopenia, and abnormal anatomy. Moreover, the advantage of ETGBD is its preservation of the external GB structure. Thereby it would not disturb the future cholecystectomy. Recently, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using plastic, fully covered metallic, or lumen-apposing metal stents transmurally has emerged as a modality for GB drainage with higher technical and clinical success rates. EUS-GBD can provide a more permanent GB drainage than PTGBD and ETGBD.

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Federico Coccolini, Eugenio Cucinotta, Andrea Mingoli, Mauro Zago, Gaia Altieri, Alan Biloslavo, Roberto Caronna, Ismail Cengeli, Enrico Cicuttin, Roberto Cirocchi, Luigi Cobuccio, Gianluca Costa, Valerio Cozza, Camilla Cremonini, Giovanni Del Vecchio, Gi
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Maria Arechederra, Maria Rullán, Daniel Oyón, Matias A. Ávila, Jesús M. Urman, Carmen Berasain
Exploration of Digestive Diseases.2024; : 5. 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
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Single-Session Endoscopic Ultrasound–Directed Transgastric Endoscopic Retrograde Cholangiopancreatography and Simultaneous Endoscopic Ultrasound–Guided Transmural Gallbladder Drainage in Choledocholithiasis and Acute Cholecystitis After Unsuccessful Lapar
Azhar Hussain, Vishnu Charan Suresh Kumar, Hafiz Muzaffar Akbar Khan
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Markus Zachäus, Michael Bartels, Andreas Flade, Andreas Schubert-Hartmann, Regina Lamberts, Alireza Sepehri-Shamloo, Ulrich Paul Halm
Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie.2023; 148(02): 140. CrossRef
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Hayato Yamahata, Minoru Yabuta, Mahbubur Rahman
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Guido Costamagna
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Wiriyaporn Ridtitid, Thanawat Luangsukrerk, Panida Piyachaturawat, Nicha Teeratorn, Phonthep Angsuwatcharakon, Pradermchai Kongkam, Rungsun Rerknimitr
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Hayato Kurihara, Francesca M. Bunino, Alessandro Fugazza, Enrico Marrano, Giulia Mauri, Martina Ceolin, Ezio Lanza, Matteo Colombo, Antonio Facciorusso, Alessandro Repici, Andrea Anderloni
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Yunxiao Lyu, Ting Li, Bin Wang, Yunxiao Cheng, Liang Chen, Sicong Zhao
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Takumi Habu, Akihiro Sako, Kotaro Nishida, Koichi Komatsu, Keiichi Arakawa, Takehito Maruyama, Shigeo Aoki, Hideyuki Mishima, Yuichi Matsui
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Current Status in the Treatment of Acute Cholecystitis Patients Receiving Antithrombotic Therapy: Is Endoscopic Drainage Feasible?- A Systematic Review: Ryota Sagami, Kenji Hayasaka, Hidefumi Nishikiori, Hideaki Harada, Yuji Amano; Clin Endosc 2020;53(2):176-188. Published online January 9, 2020; DOI: https://doi.org/10.5946/ce.2019.177

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The bleeding complication risk of surgery or percutaneous transhepatic gallbladder drainage (PTGBD) may increase in patients with acute cholecystitis receiving antithrombotic therapy (ATT). Endoscopic gallbladder drainage (EGBD) may be recommended for such patients. English articles published between 1991 and 2018 in peer-reviewed journals that discuss cholecystectomy, PTGBD, and EGBD in patients with ATT or coagulopathy were reviewed to assess the safety of the procedures, especially in terms of the bleeding complication. There were 8 studies on cholecystectomy, 3 on PTGBD, and 1 on endoscopic transpapillary gallbladder drainage (ETGBD) in patients receiving ATT. With respect to EGBD, 28 studies on ETGBD (including 1 study already mentioned above) and 26 studies on endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) were also analyzed. The overall bleeding complication rate in patients with ATT who underwent cholecystectomy was significantly higher than that in patients without ATT (6.5% [23/354] vs. 1.2% [26/2,224], p<0.001). However, the bleeding risk of cholecystectomy and PTGBD in patients receiving ATT was controversial. The overall technical success, clinical success, and bleeding complication rates of ETGBD vs. EUS-GBD were 84% vs. 96% (p<0.001), 92% vs. 97% (p<0.001), and 0.65% vs. 2.1% (p=0.005), respectively. One patient treated with ETGBD experienced bleeding complication among 191 patients with bleeding tendency. ETGBD may be an ideal drainage procedure for patients receiving ATT from the viewpoint of bleeding, although EUS-GBD is also efficacious.

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Jacquelyn Chi Ying Fok, Anthony Yuen Bun Teoh, Shannon Melissa Chan
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DEN Open.2025;[Epub] CrossRef
Pseudoaneurysmal rupture with massive bleeding following endoscopic ultrasound-guided gallbladder drainage using an electrocautery-enhanced lumen-apposing metal stent
Kyong Joo Lee, Se Woo Park, Dong Hee Koh
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Acute cholecystitis management in high-risk, critically ill, and unfit-for-surgery patients: the Italian Society of Emergency Surgery and Trauma (SICUT) guidelines
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Elective Cholecystectomy After Endoscopic Gallbladder Stenting for Acute Cholecystitis: A Propensity Score Matching Analysis
Shinjiro Kobayashi, Kazunari Nakahara, Saori Umezawa, Keisuke Ida, Atsuhito Tsuchihashi, Satoshi Koizumi, Junya Sato, Keisuke Tateishi, Takehito Otsubo
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Markus Zachäus, Michael Bartels, Andreas Flade, Andreas Schubert-Hartmann, Regina Lamberts, Alireza Sepehri-Shamloo, Ulrich Paul Halm
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Original Article

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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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
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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
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Case Report

A Rare Fatal Bile Peritonitis after Malposition of Endoscopic Ultrasound-Guided 5-Fr Naso-Gallbladder Drainage: Tae Hyung Kim, Hyun Jin Bae, Seung Goun Hong; Clin Endosc 2020;53(1):97-100. Published online September 3, 2019; DOI: https://doi.org/10.5946/ce.2019.032

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Endoscopic ultrasound (EUS)-guided gallbladder (GB) drainage has recently emerged as a more feasible treatment than percutaneous transhepatic GB drainage for acute cholecystitis. In EUS-guided cholecystostomies in patients with distended GBs without pericholecystic inflammation or prominent wall thickening, a needle puncture with tract dilatation is often difficult. Guidewires may slip during the insertion of thin and flexible drainage catheters, which can also cause the body portion of the catheter to be unexpectedly situated and prolonged between the GB and intestines because the non-inflamed distended GB is fluctuant. Upon fluoroscopic examination during the procedure, the position of the abnormally coiled catheter may appear to be correct in patients with a distended stomach. We experienced such an adverse event with fatal bile peritonitis in a patient with GB distension suggestive of malignant bile duct stricture. Fatal bile peritonitis then occurred. Therefore, the endoscopist should confirm the indications for cholecystostomy and determine whether a distended GB is a secondary change or acute cholecystitis.

Citations

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Incidence and management of cystic duct perforation during endoscopic transpapillary gallbladder drainage for acute cholecystitis
Kazunari Nakahara, Junya Sato, Ryo Morita, Yosuke Michikawa, Keigo Suetani, Yosuke Igarashi, Akihiro Sekine, Shinjiro Kobayashi, Takehito Otsubo, Fumio Itoh
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Original Article

Endoscopic Ultrasonography-Guided Gallbladder Drainage as a Treatment Option for Acute Cholecystitis after Metal Stent Placement in Malignant Biliary Strictures: Fumisato Kozakai, Yoshihide Kanno, Kei Ito, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Toji Murabayashi, Keisuke Yonamine, Yujiro Kawakami, Yuki Fujii, Kazuaki Miyamoto, Yutaka Noda; Clin Endosc 2019;52(3):262-268. Published online March 15, 2019; DOI: https://doi.org/10.5946/ce.2018.183

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Background
/Aims: It is often difficult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliary strictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) for acute cholecystitis.
Methods
The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January 2011 and August 2018 were retrospectively evaluated. The procedural outcomes of percutaneous transhepatic gallbladder drainage (PTGBD) with tube placement (n=11 cases) and aspiration (PTGBA) (n=27 cases) during the study period were evaluated as a reference.
Results
The technical success and clinical effectiveness rates of EUS-GBD were 90% (9/10) and 89% (8/9), respectively. Severe bile leakage that required surgical treatment occurred in one case. Acute cholecystitis recurred after stent dislocation in 38% (3/8) of the cases. Both PTGBD and PTGBA were technically successful in all cases without severe adverse events and clinically effective in 91% and 63% of the cases, respectively.
Conclusions
EUS-GBD after MS placement was a feasible option for treating acute cholecystitis. However, it was a rescue technique following the established percutaneous intervention in the current setting because of the immature technical methodology, including dedicated devices, which need further development.

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Review

Current Status of Endoscopic Gallbladder Drainage: Joey Ho Yi Chan, Anthony Yuen Bun Teoh; Clin Endosc 2018;51(2):150-155. Published online November 17, 2017; DOI: https://doi.org/10.5946/ce.2017.125

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The gold standard for treatment of acute cholecystitis is laparoscopic cholecystectomy. However, cholecystectomy is often not suitable for surgically unfit patients who are too frail due to various co-morbidities. As such, several less invasive endoscopic treatment modalities have been developed to control sepsis, either as a definitive treatment or as a temporizing modality until the patient is stable enough to undergo cholecystectomy at a later stage. Recent developments in endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with endoscopic ultrasound (EUS)-specific stents having lumen-apposing properties have demonstrated potential as a definitive treatment modality. Furthermore, advanced gallbladder procedures can be performed using the stents as a portal. With similar effectiveness as percutaneous transhepatic cholecystostomy and lower rates of adverse events reported in some studies, EUS-GBD has opened exciting possibilities in becoming the next best alternative in treating acute cholecystitis in surgically unfit patients. The aim of this review article is to provide a summary of the various methods of gallbladder drainage (GBD) with particular focus on EUS-GBD and the many new prospects it allows.

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Original Articles

Clinical Value of Contrast-Enhanced Harmonic Endoscopic Ultrasonography in the Differential Diagnosis of Pancreatic and Gallbladder Masses: Galam Leem, Moon Jae Chung, Jeong Youp Park, Seungmin Bang, Si Young Song, Jae Bock Chung, Seung Woo Park; Clin Endosc 2018;51(1):80-88. Published online September 20, 2017; DOI: https://doi.org/10.5946/ce.2017.044

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Background
/Aims: Recent studies have revealed that contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) is beneficial in the differential diagnosis of malignant neoplasms of the pancreas and gallbladder from benign masses, in terms of the evaluation of microvasculature and real-time perfusion. In this study, we aimed to prove the clinical value of CEH-EUS in the differential diagnosis of pancreatic and gallbladder masses by direct comparison with that of conventional EUS.
Methods
We reviewed the sonographic images and medical information of 471 patients who underwent conventional EUS and CEH-EUS for the diagnosis of pancreatic and gallbladder masses at a single medical center (Severance Hospital, Seoul, Korea) between March 2010 and March 2016.
Results
The enhancement pattern of CEH-EUS of the pancreatic solid masses showed higher sensitivity and specificity in differentiating pancreatic adenocarcinoma and neuroendocrine tumors (82.0% and 87.9% for pancreatic adenocarcinoma and 81.1% and 90.9% for neuroendocrine tumors, respectively), and the area under the receiver operating characteristic curves was higher than that of conventional EUS. The enhancement texture of CEH-EUS of the gallbladder masses showed a higher sensitivity in differentiating malignant masses than that of conventional EUS; however, the difference between the areas under the receiver operating characteristic curves was not statistically significant.
Conclusions
CEH-EUS can complement conventional EUS in the diagnosis of pancreatic and gallbladder masses, in terms of the limitations of the latter.

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Endoscopic Gallbladder Drainage for Acute Cholecystitis: Jessica Widmer, Paloma Alvarez, Reem Z. Sharaiha, Sonia Gossain, Prashant Kedia, Savreet Sarkaria, Amrita Sethi, Brian G. Turner, Jennifer Millman, Michael Lieberman, Govind Nandakumar, Hiren Umrania, Monica Gaidhane, Michel Kahaleh; Clin Endosc 2015;48(5):411-420. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.411

Abstract PDF PubReader ePub

Background/Aims

Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage.

Methods

Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued.

Results

During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%).

Conclusions

Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.

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Case Reports

Ectopic Opening of the Common Bile Duct into the Duodenal Bulb Accompanied with Cholangitis and Gallbladder Cancer: A Report of Two Cases: Jae Min Lee, Hong Jun Kim, Chang Yoon Ha, Hyun Ju Min, Hyunjin Kim, Tae Hyo Kim, Woon Tae Jung, Ok Jae Lee; Clin Endosc 2015;48(3):260-264. Published online May 29, 2015; DOI: https://doi.org/10.5946/ce.2015.48.3.260

Abstract PDF PubReader ePub

An ectopic opening of the common bile duct (CBD) into the duodenal bulb is a very rare congenital anomaly of the biliary system, which may cause recurrent duodenal ulcer or biliary diseases such as choledocholithiasis and cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in the diagnosis of this anomaly. We report two such cases: one in a 61-year-old man and the other in a 57-year-old man. In the first case, this anomaly caused acute cholangitis with multiple CBD stones, which were successfully treated by ERCP. In the second case, abdominal computed tomography showed pneumobilia, which was further evaluated using ERCP. Besides, this patient was diagnosed with an ectopic opening of the CBD associated with gallbladder cancer. We report these unusual cases and review the relevant medical literature.

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Kazuaki Hashimoto, Tsukasa Ihara, Yuichiro Maruyama, Shinichi Tomisaki, Hiroshi Harada
Surgical Case Reports.2024;[Epub] CrossRef
Ectopic Opening of the Common Bile Duct Accompanied by Duodenal Ulcer
Jin Hee Noh
The Korean Journal of Gastroenterology.2024; 84(3): 138. CrossRef
Ectopic ampulla with cholangitis: A case report
Kiran Shankar, Vikas Pemmada, Parvesh Kumar Jain
International Journal of Gastrointestinal Intervention.2024; 13(4): 133. CrossRef
Ectopic Opening of the Bile Duct Into the Duodenal Bulb: Complications of Biliary Drainage
James Yang, Rohit Agrawal, Constantine Melitas, Brian Boulay, Josi Herren, Ronald Gaba, Edward Villa
ACG Case Reports Journal.2023; 10(2): e00973. CrossRef
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Viliam Masaryk, Frank Meyer, Uwe Will
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Ectopic papilla of Vater in the pylorus presenting with cholangitis: A case report with literature review
Taha Alkarboly, Dana T. Gharib, Karzan M. Salih, Shevan M. Mustafa, Abdulwahid M. Salih, Fahmi H. Kakamad
International Journal of Surgery Case Reports.2022; 93: 106887. CrossRef
Efficacy and safety of therapeutic ERCP in patients with ectopic papilla of Vater
Junbo Hong, Weiping Pan, Wei Zuo, Anjiang Wang, Liang Zhu, Xiaodong Zhou, Xiaojiang Zhou, Guohua Li, Zhijian Liu, Pi Liu, Hao Zhen, Yong Zhu, Jiuhong Ma, Jianhui Yuan, Xu Shu, Yin Zhu, Nonghua Lu, Youxiang Chen
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Li Lian Kuan, John Isherwood, Cristina Pollard, Ashley Dennison
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Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: Diagnosis and Therapeutic Management and Considerations for Timing of Surgery and Duration of Follow-up After Initial Endoscopic Retrograde Cholangiopancreatography
Bahtiyar Muhammedoğlu
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A Case of Biliary Cast Developed in a Patient with Long-Standing Biliary Sludge: Ja Won Koo, Na Eun Jang, Hong Joo Lee, Kwang Ro Joo, Jae Myung Cha, Hyun Phil Shin, Joung Il Lee, Sung-Jig Lim; Clin Endosc 2013;46(1):98-101. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.98

Abstract PDF PubReader ePub

Development of biliary casts is very unusual, especially in patients who have not undergone liver transplantation. Variable causes of biliary cast formation in nonliver transplantation patients have been suggested. However, stasis of bile flow and/or gallbladder hypocontractility is known to eventually result in the promotion of biliary sludge and subsequent cast formation. Here we present one case of biliary cast syndrome, which developed in a nonliver transplant patient who had biliary sludge for a long period of time, providing evidence that long-standing biliary sludge may lead to cast formation.

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A Case of Biliary Cast Syndrome with Cholangiocarcinoma-like Lesion in a Patient with No History of Liver Transplantation
Sa-Hong Jo, Ho-Cheol Choi, Sung-Eun Park, Jin-Il Moon, Jung-Ho Won, Jae-Boem Na, Yang-Won Kim, Won-Jeong Yang, Byeong-Ju Koo, Jae-Kyeong Ahn, Seong-Je Kim
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2 Web of Science
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A Case of Neuroendocrine Carcinoma of the Gallbladder That Was Diagnosed by Endoscopy: Hyon A Lee, M.D., Hong Joo Kim, M.D., Mi Yeon Jung, M.D. and Dong Seok Shin, M.D.; Korean J Gastrointest Endosc 2011;42(6):424-427. Published online June 6, 2011

Abstract PDF: A neuroendocrine carcinoma mostly occurs in gastrointestinal tract, lung and pancreas. The gallbladder is an uncommon organ occurring a neuroendocrine carcinoma and it is difficult to diagnose before operation of gallbladder. It is not definitely established to natural course and treatment owing to its rare occurrence. A 71-year-old woman was hospitalized with intermittent abdominal pain and nausea. Abdominal computed tomography showed multiple masses of gallbladder obstructing biliary tract, and she was suspected of carcinoma of gallbladder infiltrating a common bile duct in endoscopic ultrasonography. She took a biopsy through endoscopic retrograde cholangiopancreatography (ERCP) and was diagnosed with a neuroendocrine carcinoma of gallbladder. We report a case of a neuroendocrine carcinoma of gallbladder confirmed by endoscopic biopsy, with a review of literature.

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Two Cases of Xanthogranulomatous Cholecystitis and Gallbladder Cancer with Hemobilia: Jong Kyu Kwon, M.D., Dae Jin Kim, M.D., Hyun Uk Ryu, M.D., Soo Hwan Seol, M.D., Byung Sik Hwang, M.D., Jong Hun Park, M.D.^* and Kyung Rak Son, M.D.^†; Korean J Gastrointest Endosc 2011;42(6):428-432. Published online June 4, 2011

Abstract PDF: Hemobilia is a rare upper gastrointestinal (GI) bleeding phenomenon usually caused by trauma but may occur due to various liver and pancreatobiliary diseases. Causes related to gallbladder disease include vascular disorders, malignancy, polyps, heterotopic GI mucosa, acalculous inflammation, and most commonly gallstones. Most cases are treated with a cholecystectomy. If hemobilia is detected, efforts must be made to exclude malignancy because hemobilia develops from both benign and malignant disease. Particularly in gallbladder disease with hemobilia, the possibility of gallbladder carcinoma should be considered. We report two cases of hemoblia by endoscopic retrograde cholangiopancreatography and duodenoscopy, with a review of the literature. The first case was xanthoglanulomatous cholesystitis and the second case was gallbladder cancer disclosed by cholecystectomy.

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A Case of Acute Cholecystitis with a Perforation Complicating Endoscopic Retrograde Cholangiopancreatography: Seung Hee Ryu, M.D., Myung Hwan Noh, M.D., Ji Sun Han, M.D., Su Mi Woo, M.D., Byung Geun Kim, M.D., Chien Ter Hsing, M.D., So Young Park, M.D. and Joon Mo Kim, M.D.; Korean J Gastrointest Endosc 2011;42(3):185-189. Published online March 28, 2011

Abstract PDF: The incidence of acute cholecystitis complicating endoscopic retrograde Cholangiopancreatography (ERCP) is rarely reported at 0.2% but is usually associated with a cystic duct obstruction caused by gallstones, gallbladder polyps, or cancer. However, acute cholecystitis with a gallbladder perforation after ERCP without a history of cystic duct obstruction can develop very rarely and has not yet been reported in Korea. We report a case of acute cholecystitis with gallbladder perforation and aggravation of a pancreatic pseudocyst after diagnostic ERCP in a man with a pancreatic cystic lesion. He has been successfully cured using only percutaneous transhepatic gallbladder drainage and antibiotics with no surgery. (Korean J Gastrointest Endosc 2011;42:185-189)

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A Case of Acute Pancreatitis Caused by the Necrotic Tissue of Gallbladder Cancer: Hoe Hoon Chung, M.D., Seok Ho Dong, M.D., Jaejun Sim, M.D., Jae Young Jang, M.D., Hyo Jong Kim, M.D., Byung Ho Kim, M.D., Young Woon Chang, M.D. and Rin Chang, M.D.; Korean J Gastrointest Endosc 2011;42(2):131-134. Published online February 28, 2011

Abstract PDF: The most common cause of acute pancreatitis is gallstones. However, idiopathic causes comprise about 10 to 15% of all cases of acute pancreatitis. Biliary sludge is thought to be a cause of idiopathic acute pancreatitis and mainly via obstruction of the common bile duct. Cholesterol polyps of the gallbladder, cholesterolosis and hemobilia can be associated with biliary pain. Fragments of the gallbladder polyps and blood clots can lead to acute pancreatitis in a way similar to that of biliary sludge. Yet it has never been reported that the necrotic tissue of gallbladder cancer can lead to acute pancreatitis. Herein, we report on the case of a 52-year-old man with acute pancreatitis that was caused by the necrotic tissue of gallbladder cancer. The necrotic tissue in the bile duct was revealed on endoscopic retrograde cholangiopancreatography (ERCP). The patient was successfully treated by laparoscopic cholecystectomy along with liver segmentectomy. (Korean J Gastrointest Endosc 2011;42:131-135)

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A Case of Tubular Adenoma of the Common Hepatic Duct Accompanied with Gallbladder Carcinoma: Jun Ho Choi, M.D., Tae Hoon Lee, M.D., Sang-Heum Park, M.D., Yun Suk Shim, M.D., Chang Kyun Lee, M.D., Suck-Ho Lee, M.D., Sun-Joo Kim, M.D. and Hyun-Deuk Cho, M.D.*; Korean J Gastrointest Endosc 2010;40(6):396-400. Published online June 30, 2010

Abstract PDF: Biliary adenoma is rarely found in the biliary tract, and there are currently few reported cases of tubular adenoma. Biliary adenoma most often occurs on the duodenal ampulla and the next most common site is on the common bile duct. Because the clinical signs, symptoms and the laboratory findings of these lesions may be similar to malignant biliary diseases, it is difficult to differentiate benign biliary adenoma from malignancy. Therefore, the diagnosis of these tumors tends to be delayed and physicians usually make the pathologic confirmation after a surgical operation. We experienced a case of the simultaneous occurrence of tubular adenoma of the common hepatic duct and gallbladder carcinoma, and all this was diagnosed and treated with common hepatic duct resection and a Roux-en-Y hepaticojejunostomy operation. To the best of our knowledge, this is the first report of biliary tubular adenoma accompanied with gallbladder carcinoma arising from tubulovillous adenoma. (Korean J Gastrointest Endosc 2010;40:396-400)

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Primary Squamous Cell Carcinoma of the Gallbladder Forming a Cholecystogastric Fistula: Chang Jae Lee, M.D. and Jinsook Jung, M.D.*; Korean J Gastrointest Endosc 2010;40(4):285-289. Published online April 30, 2010

Abstract PDF: The most common type of gallbladder cancer is adenocarcinoma. Primary squamous cell carcinoma of the gallbladder is a rare and aggressive disease. It is responsible for up to 1.7% of the malignant neoplasms of the gallbladder. It characteristically presents with invasive growth, a low tendency towards lymph node metastasis and a high incidence of local infiltration and hepatic metastasis, presenting a worse prognosis than adenocarcinoma of the gallbladder. Cases of gallbladder cancer forming a fistula to the stomach are also rare. We experienced a case of primary squamous cell carcinoma of the gallbladder which formed a fistula to the stomach. (Korean J Gastrointest Endosc 2010;40:285-289)

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A Case of a Double Gallbladder with Common Bile Duct Stones: Nark-Soon Park, M.D., Hong Sik Lee, M.D., Ji Hoon Kim, M.D., Dong Hun Lee, M.D., Eun Sun Kim, M.D., Young Jin Kim, M.D., Eun Bum Park, M.D., Jin Nam Kim, M.D., Ja Seol Koo, M.D., Sang Woo Lee, M.D., Jae Hyun Choi, M.D., Chang Duck Kim, M.D. and Ho Sang Ry; Korean J Gastrointest Endosc 2007;35(5):369-372. Published online November 30, 2007

Abstract PDF: A double or bilobed gallbladder is a rare congenital anomaly, occurring at a rate of 1/4,000∼5,000. We encountered a case of a double gallbladder that was diagnosed by an endoscopic retrograde cholangiogram. In view of the paucity of this anomaly, we report the case of a patient with a double gallbladder (Y duplication) accompanied by a common bile duct (CBD) stone. We also discuss the characteristics, classification, embryology and treatment of the double gallbladder. (Korean J Gastrointest Endosc 2007;35:369-372)

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A Case of Esophageal Obstruction Caused by an Ingested Canine Gallbladder: Jong In Yang, M.D., Ji Won Kim, M.D.*, Kook Lae Lee, M.D.*, Jung Mook Kang, M.D., Yong Jin Jung, M.D.*, Ji Bong Jeong, M.D.* and Byung Kwan Kim, M.D.*; Korean J Gastrointest Endosc 2007;34(3):143-145. Published online March 30, 2007

Abstract PDF: Endoscopic intervention is a very important and effective tool for evaluating and treating an esophageal foreign body. The size of a cystic foreign body filled with liquid can be reduced by needle puncture and fluid spillage. We report a rare case of an acute total obstruction of the esophagus by an ingested canine gallbladder that was removed by endoscopic intervention. (Korean J Gastrointest Endosc 2007;34:143⁣145)

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Percutaneous Transhepatic Gallbladder Stenting for Acute Cholecystitis after Palliative Metallic Biliary Stenting: Hwal Suk Cho, M.D., Sun Mi Lee, M.D., Chan Won Park, M.D., Ji Young Kim, M.D., Do Hoon Kim, M.D., Kee Tae Park, M.D., Tae Oh Kim, M.D., Jeong Heo, M.D., Gwang Ha Kim, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.; Korean J Gastrointest Endosc 2006;33(5):322-325. Published online November 30, 2006

Abstract PDF: Metallic biliary stenting to relieve a malignant biliary obstruction can cause a cystic duct obstruction and acute cholecystitis. Percutaneous transhepatic cholecystostomy is often performed in patients with a limited life expectancy but can have a significant impact on the quality of life. Percutaneous transhepatic gallbladder stenting (PTGS) was performed across the cystic duct via the cholecystostomy tube tract to allow the removal of the cholecystostomy tube. The patient remained asymptomatic for 7 months after PTGS. In conclusion, PTGS across the cystic duct may be considered a treatment option in selected patients who develop acute cholecystitis after palliative metallic biliary stenting. (Korean J Gastrointest Endosc 2006;33: 322⁣325)

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A Case of Mucin-hypersecreting Gallbladder Papillary Carcinoma Manifested as Obstructive Jaundice: Ji Hoon Jung, M.D., Myung-Hwan Kim, M.D., Sang Su Lee, M.D., Chang Hee Jung, M.D., Ji Young Lee, M.D., Dong Wan Seo, M.D., Sung Goo Lee, M.D. and Gyung Yeop Gong, M.D.*; Korean J Gastrointest Endosc 2006;32(3):235-237. Published online March 30, 2006

Abstract PDF: Biliary papillomatosis (BP) is a rare disease that is classified as either the mucin-hypersecreting type or nonmucin-secreting type. Typical papillomas of the biliary tree mainly involve intrahepatic bile ducts or both intra- and extrahepatic bile ducts. The isolated involvement of the extrahepatic bile duct is rare, and there is no report of BP confined to the gallbladder in Korea. We report a case of a 50-year-old man who developed obstructive jaundice due to hypersecreted mucin from papillomas of the gallbladder. (Korean J Gastrointest Endosc 2006;32:235⁣238)

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Comparative Cholangiocytotoxicity between Ioxithalamate and Iopromide with Short-term Exposure: Young Min Ju, M.D., Sung Koo Lee, M.D., Myung Hwan Kim, M.D., Dong Wan Seo, M.D., Sang Soo Lee, M.D., Jae Myung Cha, M.D., Eun Kwang Choi, M.D. and Seok Won Jung, M.D.; Korean J Gastrointest Endosc 2006;32(2):101-108. Published online February 27, 2006

Abstract PDF: Background
/Aims: In a previous study examining long- term exposure to contrast media, high-osmolar ionic contrast media were reported to be more cytotoxic to gallbladder epithelial cells than low-osmolar nonionic contrast media. However, biliary epithelial cells are rarely exposed to contrast media for such long periods in clinical practice. This study compared the cytotoxicity of two types of contrast media to gallbladder epithelial cells exposed for a short-term. Methods: Ioxithalamate and iopromide were tested, and dog gallbladder epithelial cells were used as the test cells. The cells were exposed to the two contrast agents with increasing iodine concentration and osmolality for 30 minutes. The number of cells, aneuploidy and supernatant LDH activities were measured each day. Results: The growth of cells exposed to the two contrast media was significantly reduced but there was no difference between the two contrast media at the same iodine concentration. The level of cell lysis measured by the supernatant LDH activities before the triton X-100 treatment was similar with the two contrast media. No aneuploidy fraction was detected in any of the cell groups treated with the two contrast media for 5 days. Conclusions: In contrast to previous results, high-osmolar ionic and low-osmolar nonionic contrast media with short- term exposure were found to have a similar cytotoxicity to biliary epithelial cells. (Korean J Gastrointest Endosc 2006;32:101⁣108)

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A Case of Limy Bile Associated with Cholangitis and Calcified Gallbladder: Gyu Yup Hwang, M.D., Anna Kim, M.D., Sang Jeong Yoon, M.D., Sung Hee Jung, M.D., Byeong Seong Ko, M.D., Hyeon Woong Yang, M.D. and Byung Min John, M.D.; Korean J Gastrointest Endosc 2005;31(1):58-61. Published online July 30, 2005

Abstract PDF: Limy bile is characterized by excessive precipitation of calcium carbonate, and generally preceded by gallbladder obstruction. Three case reports have been found in the domestic literatures. It is rare that limy bile syndrome associates cholangitis or calcified gallbladder. We report the case of a patient with limy bile, located in the gallbladder, common bile duct, and intrahepatic duct, with association of calcified gallbladder. This case showed characteristic radiologic and endoscopic findings. The patient was treated by endoscopic sphincterotomy and laparoscopic cholecystectomy. (Korean J Gastrointest Endosc 2005;31:58⁣61)

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Endosonographic Findings Useful in the Differentiation between Malignant and Benign Causes of Thickened Gallbladder Wall: Don Lee, M.D., Sung Koo Lee, M.D., Myung-Hwan Kim, M.D., Dong Wan Seo, M.D., Sang Soo Lee, M.D., Young Il Min, M.D. and Jung-Sun Kim, M.D.*; Korean J Gastrointest Endosc 2005;30(1):12-18. Published online January 30, 2005

Abstract PDF: Background
/Aims: The early diagnosis of possible cancer in thickened gallbladder wall is very important. This study was aimed to confirm the usefulness of endoscopic ultrasonography in differential diagnosis of gallbladder cancer in thickened gallbladder wall, and to find out the findings of endoscopic ultrasonography which favor malignancy. Methods: We reviewed 67 cases of patients who underwent cholecystectomies and who also showed thickened gallbladder wall in their preoperative endoscopic ultrasonography. According to the post-surgical pathologic diagnosis, the cases were classified into malignant and benign diseases, and they were statistically compared with several findings of endoscopic ultrasonography of thickened gallbladder wall. Results: Pathologic diagnosis included 10 cancers and 57 benign diseases. The sensitivity (90%) and specificity (98%) of endoscopic ultrasonography for diagnosis of gallbladder cancer were superior to those of other techniques. Wall thickness, associations of gallstones, loss or preservation of layered structure and irregularity of inner surface of thickened wall were significant variables in the differential diagnosis between malignant and benign causes of thickened gallbladder wall (p＜0.05). Conclusions: Endoscopic ultrasonography is useful to diagnose gallbladder cancer within thickened wall. Loss of layered structure and irregular inner surface of thickened wall are independent predictive factor of gallbladder cancer. (Korean J Gastrointest Endosc 2005;30: 12⁣18)

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A Case of Hemobilia due to Gallbladder Carcinoma: Heok Soo Ahn, M.D., Byoung Sik Mun, M.D., So Ri Kim, M.D., Soo Teik Lee, M.D. and Seung Ok Lee, M.D.; Korean J Gastrointest Endosc 2003;27(3):171-174. Published online September 30, 2003

Abstract PDF: Gallbladder carcinoma is an uncommon neoplasm, and hemobilia caused by this disease is rare. We present a case of hemobilia in a patient with gallbladder carcinoma, which was recognized at forward duodenoscopy. A 42-year-old man visited our hospital due to intermmittent right upper quadrant pain. Duodenoscopy revealed blood clots with bile juice around the ampulla of Vater and the second portion of the duodenum. Endoscopic ultrasonography for the gallbladder showed a dumbell-shaped mass with a homogenous internal echogenicity on the body of the gallbladder. MR cholangiography showed a lobulated mass with low-signal intensity in the T1-weighted and T2-weighted images. Subsequently, laparoscopic cholecystectomy with regional lymph node dissection was performed, and adenocarcinoma was confirmed.

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췌담관 합류 이상과 담관 낭종이 동반된 담낭암 1예 ( Gallbladder Cancer Associated with an Anomalous Union of the Pancreaticobiliary Duct and a Choledochal Cyst ): Korean J Gastrointest Endosc 2000;20(2):137-140. Published online November 30, 1999

Abstract PDF: An anomalous pancreaticobiliary ductal union is a rare anomaly occurring in the biliary tract. This anomaly has been implicated as a cause of choledochal cysts, bile duct and gallbladder carcinoma, and recurrent pancreatitis. A case is herein reported of a 63 year-old woman who suffered from gallbladder cancer associated with a choledochal cyst and an anomalous pancreaticobiliary union. (Korean J Gastrointest Endosc 2000;20:137 140)

1,656 View
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