Clinical Endoscopy

Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage in hypervascular hepatocellular carcinoma: a retrospective study from Japan: Kenneth Tachi, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Ahmed Mohammed Sadek, Hossam El-Din Shaaban Mahmoud Ibrahim, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto; Received April 2, 2024 Accepted July 29, 2024 Published online November 11, 2024; DOI: https://doi.org/10.5946/ce.2024.079 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC.
Methods
This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023.
Results
A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours.
Conclusions
EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.

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Endoscopic ultrasound-guided portal vein coiling: troubleshooting interventional endoscopic ultrasonography: Shin Haba, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Akira Miyano, Daiki Fumihara, Moaz Elshair; Clin Endosc 2022;55(3):458-462. Published online November 30, 2021; DOI: https://doi.org/10.5946/ce.2021.114

Abstract PDF Supplementary Material PubReader ePub

Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) is widely performed not only as an alternative to transpapillary biliary drainage, but also as primary drainage for malignant biliary obstruction. For anatomical reasons, this technique carries an unavoidable risk of mispuncturing intrahepatic vessels. We report a technique for troubleshooting EUS-guided portal vein coiling to prevent bleeding from the intrahepatic portal vein after mispuncture during interventional EUS. EUS-HGS was planned for a 59-year-old male patient with unresectable pancreatic cancer. The dilated bile duct (lumen diameter, 2.8 mm) was punctured with a 19-gauge needle, and a guidewire was inserted. After bougie dilation, the guidewire was found to be inside the intrahepatic portal vein. Embolizing coils were placed to prevent bleeding. Embolization coils were successfully inserted under stabilization of the catheter using a double-lumen cannula with a guidewire. Following these procedures, the patient was asymptomatic. Computed tomography performed the next day revealed no complications.

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An unusual case of high gastrointestinal bleeding after Whipple surgery
E Dubois, R Geelen
Acta Gastro Enterologica Belgica.2024; 87(3): 430. CrossRef

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Retroperitoneal Synovial Sarcoma Manifested by Obstructive Jaundice in an Elderly Woman: Case Report: Dae Ho Kim, Kwang Ro Joo, Jae Myung Cha, Hyun Phil Shin, Joung Il Lee, Jae Jun Park, Hyun Soo Kim, Dal Mo Yang; Clin Endosc 2012;45(4):428-430. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.428

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Synovial sarcoma is a rare type of soft tissue sarcoma that arises in tissues containing synovial fluid, usually in the extremities. It has only rare occurrence in the retroperitoneal space. Early detection of retroperitoneal synovial sarcoma is difficult, since the retroperitoneal space is highly expandable and deeply hidden. Furthermore, the presenting symptoms are often vague and nonspecific, and are related to the pressure on adjacent structures. In this study, we present an unusual case of retroperitoneal synovial sarcoma with obstructive jaundice due to intrabiliary blood clots caused by invasion of bile duct by tumor. The obstructive jaundice was relieved through endoscopic removal of the blood clots and insertion of a biliary stent.

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Management of primary retroperitoneal synovial sarcoma: A case report and review of literature
Aikaterini Mastoraki, Dimitrios Schizas, Ioannis S Papanikolaou, George Bagias, Nikolaos Machairas, George Agrogiannis, Theodore Liakakos, Nikolaos Arkadopoulos
World Journal of Gastrointestinal Surgery.2019; 11(1): 27. CrossRef
Intrapelvic Retroperitoneal Synovial Sarcoma in a 15-Year-Old Adolescent Girl: A Case Report and Review of the Literature
Stan A. Bessems, Maarten van Heinsbergen, Paul H. Nijhuis, Kees C.P. van de Ven, Frits Aarts
Journal of Pediatric Hematology/Oncology.2019; 41(8): 627. CrossRef
Primary Monophasic Synovial Sarcoma of the Liver in a 13-Year-Old Boy
Bo Xiong, Min Chen, Feng Ye, Zhuxue Zhang, Lijuan Yin, Huifen Huang, Huijiao Chen, Hongying Zhang
Pediatric and Developmental Pathology.2013; 16(5): 353. CrossRef

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An Impacted Pancreatic Stone in the Papilla Induced Acute Obstructive Cholangitis in a Patient with Chronic Pancreatitis: Kwang-Ho Yoo, Chang-Il Kwon, Sang-Wook Yoon, Won Hee Kim, Jung Min Lee, Kwang Hyun Ko, Sung Pyo Hong, Pil Won Park; Clin Endosc 2012;45(1):99-102. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.99

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Obstructive jaundice is very rarely caused by impaction of a pancreatic stone in the papilla. We report here on a case of obstructive jaundice with acute cholangitis that was caused by an impacted pancreatic stone in the papilla in a patient with chronic pancreatitis. A 48-year-old man presented with acute obstructive cholangitis. Abdominal computed tomography with the reconstructed image revealed distal biliary obstruction that was caused by a pancreatic stone in the pancreatic head, and there was also pancreatic ductal dilatation and parenchymal atrophy of the pancreatic body and tail with multiple calcifications. Emergency duodenoscopy revealed an impacted pancreatic stone in the papilla. Precut papillotomy using a needle knife was performed, followed by removal of the pancreatic stone using grasping forceps. After additional sphincterotomy, a large amount of dark-greenish bile juice gushed out. The patient rapidly improved and he has remained well.

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Pancreatic stones causing secondary biliary obstruction: An uncommon presentation of chronic pancreatitis
Wesley C. Judy, Tom K. Lin
JPGN Reports.2024; 5(3): 414. CrossRef
The “squeezing with forceps” method for emergency endoscopic removal of an impacted pancreatic stone in the papilla of a patient on antithrombotic therapy
Sho Kitagawa, Shori Ishikawa, Keiya Okamura
Endoscopy.2023; 55(S 01): E454. CrossRef
Biliary Outlet Obstruction Due to Pancreatic Calculi in a Post-cholecystectomy Patient
Joey Almaguer, Dylan Murray, Matthew Murray, Richard Murray
Cureus.2023;[Epub] CrossRef
Ampullary Stone in Chronic Pancreatitis Causing Obstructive Jaundice and Cholangitis
Sandheep Janardhanan, Allwin James, Alagammai Palaniappan, Ramesh Ardhanari
Gastroenterology, Hepatology and Endoscopy Practice.2021; 1(2): 69. CrossRef
Ursodeoxycholic acid attenuates 5‑fluorouracil‑induced mucositis in a rat model
Seung Kim, Hoon Chun, Hyuk Choi, Eun Kim, Bora Keum, Yeon Seo, Yoon Jeen, Hong Lee, Soon Um, Chang Kim
Oncology Letters.2018;[Epub] CrossRef
Pancreatic Calculus Causing Biliary Obstruction: Endoscopic Therapy for a Rare Initial Presentation of Chronic Pancreatitis
Anurag J. Shetty, C. Ganesh Pai, Shiran Shetty, Girisha Balaraju
Digestive Diseases and Sciences.2015; 60(9): 2840. CrossRef

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Endoscopic Management of Afferent Loop Syndrome after a Pylorus Preserving Pancreatoduodenecotomy Presenting with Obstructive Jaundice and Ascending Cholangitis: Jae Kyung Kim, Chan Hyuk Park, Ji Hye Huh, Jeong Youp Park, Seung Woo Park, Si Young Song, Jaebock Chung, Seungmin Bang; Clin Endosc 2011;44(1):59-64. Published online September 30, 2011; DOI: https://doi.org/10.5946/ce.2011.44.1.59

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Afferent loop syndrome is a rare complication of gastrojejunostomy. Patients usually present with abdominal distention and bilious avomiting. Afferent loop syndrome in patients who have undergone a pylorus preserving pancreaticoduodenectomy can present with ascending cholangitis. This condition is related to a large volume of reflux through the biliary-enteric anastomosis and static materials with bacterial overgrowth in the afferent loop. Patients with afferent loop syndrome after pylorus preserving pancreaticoduodenectomy frequently cannot be confirmed as surgical candidates due to poor medical condition. In that situation, a non-surgical palliation should be considered. Herein, we report two patients with afferent loop syndrome presenting with obstructive jaundice and ascending cholangitis. The patients suffered from the recurrence of pancreatic cancer after pylorus preserving pancreaticoduodenectomy. The diagnosis of afferent loop syndrome was confirmed, and the patients were successfully treated by inserting an endoscopic metal stent using a colonoscopic endoscope.

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Percutaneous transhepatic duodenal drainage is good option for afferent loop syndrome for obstructive colorectal cancer patient with history of Billroth's operation II: A case report of a rare postoperative complication
Tung‐Yuan Chen, Chin‐Wen Hsu, Yee‐Phoung Chang, Min‐Tsung Wang, Yueh‐Jung Wu, Ching‐Hsien Wang, Kuan‐Yu Wang, Tian‐Huei Chu, Yung‐Kuo Lee
Clinical Case Reports.2023;[Epub] CrossRef
An Unusual Presentation of Obstructive Jaundice Due to Dilated Proximal Small Bowel Loops After Gastrojejunostomy: Afferent Loop Syndrome
Mahrukh Ali, Om Parkash, Jehanzeb Shahid
Cureus.2022;[Epub] CrossRef
The Use of Palliative Endoscopic Ultrasound-guided Enterostomy to Treat Small Bowel Obstruction in Two Patients with Advanced Malignancies
Ji Hong Oh, Seung Goun Hong
The Korean Journal of Medicine.2022; 97(3): 191. CrossRef
Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction
Chinatsu Yonekura, Takashi Sasaki, Takafumi Mie, Takeshi Okamoto, Tsuyoshi Takeda, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Journal of Clinical Medicine.2022; 11(21): 6357. CrossRef
Clinical management for malignant afferent loop obstruction
Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
World Journal of Gastrointestinal Oncology.2021; 13(7): 509. CrossRef
Clinical management for malignant afferent loop obstruction
Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
World Journal of Gastrointestinal Oncology.2021; 13(7): 684. CrossRef
Endoscopic Self-Expandable Metal Stent Placement for Malignant Afferent Loop Obstruction After Pancreaticoduodenectomy: A Case Series and Review
Arata Sakai, Hideyuki Shiomi, Takao Iemoto, Ryota Nakano, Takuya Ikegawa, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama
Clinical Endoscopy.2020; 53(4): 491. CrossRef
Endoscopic nasogastric tube insertion for treatment of benign afferent loop obstruction after radical gastrectomy for gastric cancer
Yuning Cao, Xiangheng Kong, Daogui Yang, Senlin Li
Medicine.2019; 98(28): e16475. CrossRef
Comparative analysis of afferent loop obstruction between laparoscopic and open approach in pancreaticoduodenectomy
Ki Byung Song, Daegwang Yoo, Dae Wook Hwang, Jae Hoon Lee, Jaewoo Kwon, Sarang Hong, Jong Woo Lee, Woo Young Youn, Kyungyeon Hwang, Song Cheol Kim
Journal of Hepato-Biliary-Pancreatic Sciences.2019; 26(10): 459. CrossRef
Metal Stent Placement in the Afferent Loop Obstructed by Peritoneal Metastases—Experience of Five Cases
Yoshihide Kanno, Tetsuya Ohira, Yoshihiro Harada, Yoshiki Koike, Taku Yamagata, Megumi Tanaka, Tomohiro Shimada, Kei Ito
Clinical Endoscopy.2018; 51(3): 299. CrossRef
Colangitis por obstrucción de asa aferente tras duodenopancreatectomía cefálica
José Ruiz Pardo, Erik Llàcer-Millán, Pilar Jimeno Griñó, Juan Ángel Fernández Hernández, Pascual Parrilla Paricio
Cirugía Española.2016; 94(2): 106. CrossRef
Cholangitis Due to Afferent Loop Obstruction After Cephalic Duodenopancreatectomy
José Ruiz Pardo, Erik Llàcer-Millán, Pilar Jimeno Griñó, Juan Ángel Fernández Hernández, Pascual Parrilla Paricio
Cirugía Española (English Edition).2016; 94(2): 106. CrossRef
An unusual cause of simultaneous common bile and pancreatic duct dilation
Puneet Chhabra, Surinder Singh Rana, Vishal Sharma, Ravi Sharma, Rajesh Gupta, Deepak Kumar Bhasin
Gastroenterology Report.2015; 3(3): 258. CrossRef
A Case of Afferent Loop Syndrome Treated by Endoscopic Metal Stent Insertion Using Two Endoscopes
Jun Jae Kim, Young Koog Cheon, Tae Yoon Lee, Chan Sup Shim
The Korean Journal of Medicine.2015; 89(4): 428. CrossRef
Acute afferent loop syndrome in the early postoperative period following pancreaticoduodenectomy
H Nageswaran, A Belgaumkar, R Kumar, A Riga, N Menezes, T Worthington, ND Karanjia
The Annals of The Royal College of Surgeons of England.2015; 97(5): 349. CrossRef
Recurrent Cholangitis by Biliary Stasis Due to Non-Obstructive Afferent Loop Syndrome After Pylorus-Preserving Pancreatoduodenectomy: Report of a Case
Yukihiro Sanada, Naoya Yamada, Masanobu Taguchi, Kazue Morishima, Naoya Kasahara, Yuji Kaneda, Atsushi Miki, Yasunao Ishiguro, Akira Kurogochi, Kazuhiro Endo, Masaru Koizumi, Hideki Sasanuma, Takehito Fujiwara, Yasunaru Sakuma, Atsushi Shimizu, Masanobu H
International Surgery.2014; 99(4): 426. CrossRef
A Case of Gastrojejunostomy under Endoscopic Ultrasound Guidance for the Treatment of Jejunal Stenosis Induced by Cholangiocarcinoma Recurrence after Pancreaticoduodenectomy
Chikashi WATASE, Junzo SHIMIZU, Masahiro MURAKAMI, Yong Kong KIM, Shoki MIKATA, Junichi HASEGAWA
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2014; 75(8): 2307. CrossRef
Electrohydraulic Lithotripsy of an Impacted Enterolith Causing Acute Afferent Loop Syndrome
Young Sin Cho, Tae Hoon Lee, Soon Oh Hwang, Sunhyo Lee, Yunho Jung, Il-Kwun Chung, Sang-Heum Park, Sun-Joo Kim
Clinical Endoscopy.2014; 47(4): 367. CrossRef

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Common Bile Duct Obstruction Caused by Tumor Thrombus after Trans-arterial Chemoembolization in a Hepatocellular Carcinoma Patient: Hoon Choi, M.D., Suk Bae Kim, M.D., Ki Chul Shin, M.D., Hyun Duk Shin, M.D., Se Young Yun, M.D., Jung Eun Shin, M.D., Hong Ja Kim, M.D. and Il Han Song, M.D.; Korean J Gastrointest Endosc 2009;38(5):299-302. Published online May 30, 2009

Abstract PDF: The jaundice in hepatocellular carcinoma patient can be found when the tumor progresses or hepatic function deteriorates. Rarely, it can be occurred when the bile duct is obstructed. The main reason of obstructive jaundice in hepatocellular carcinoma is bile duct invasion of tumor, tumor thrombus, blood clot of hemobilia and direct bile compression by tumor or metastatic lymph node. Although the tumor thrombi among them is difficult to think, prompt diagnosis and treatment should be done because the symptom and prognosis can be improved by removal of the tumor thrombus. We experienced a case of hepatocellular carcinoma patient associated with obstructive jaundice caused by tumor thrombus after transarterial chemoembolization (TACE). The tumor thrombus was removed by endoscopic retrograde cholangiopancreatography (ERCP) and confirmed as degenerated hepatocellular carcinoma cell. (Korean J Gastrointest Endosc 2009;38:299-302)

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A Case of Primary Pancreatic Lymphoma That Manifested with Acute Pancreatitis and Obstructive Jaundice: Jun Eul Hwang, M.D., Chang Hwan Park, M.D., Yong Chan Cho, M.D., Sung Kyun Kim, M.D., Hyeun Soo Kim, M.D., Sung Kyu Choi, M.D., Jong Sun Rew, M.D. and Wan Sik Lee, M.D.; Korean J Gastrointest Endosc 2009;38(3):176-178. Published online March 30, 2009

Abstract PDF: Primary pancreatic lymphoma (PPL) is a rare form of extranodal lymphoma, and this accounts for less than 0.5% of all pancreatic tumors. Differentiating PPL from pancreatic adenocarcinoma is important because the prognosis and survival of PPL is much better than those of pancreatic adenocarcinoma. Although the treatment usually consists of a combination of chemotherapy and radiation therapy, PPL patient with biliary tract or gastrointestinal obstruction should undergo biliary or gastric bypass to relieve the symptoms. Herein, we describe a case of PPL with acute pancreatitis and obstructive jaundice, and the patient was successfully managed with endoscopic retrograde pancreatic and biliary drainage. (Korean J Gastrointest Endosc 2009;38:176-179)

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A Case of the Common Bile Duct Web Treated with a Retrievable Covered Metallic Stent: Yun Sun Im, M.D., Woo Chul Chung, M.D., Kang Moon Lee, M.D., Jeong Rok Lee, M.D., Jin Dong Kim, M.D., Chang Nyol Paik, M.D., Jin Mo Yang, M.D. and Hyung Min Chin, M.D.*; Korean J Gastrointest Endosc 2008;36(3):181-186. Published online March 30, 2008

Abstract PDF: The web of the common bile duct is an extremely rare condition and is attributed to obstructive jaundice. Most cases have been found incidentally during a surgical procedure, since no specific preoperative clinical manifestations exist. Typically, the web of the biliary tree appears as a slit- or shelf-like radiolucent narrowing on a cholangiography. We experienced a case of the web of the common bile duct with obstructive jaundice in a 62 year- old female who complained of right upper quadrant pain. The patient was diagnosed via an endoscopic retrograde cholangiopancreaticography, and treated by way of a cholecystectomy, membranectomy and T-tube insertion. Four months after the surgical procedure, the patient had a recurrence of the web-like structure in the common bile duct and was subsequently treated successfully using a retrievable covered metallic stent insertion. (Korean J Gastrointest Endosc 2008;36:181-186)

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A Case of Surgical Treatment of Tuberculous Cholangitis and Lymphadenitis with Obstructive Jaundice due to Progressive Stricture of Bile Duct: Kil Hyun Kim, M.D., Yang Suh Ku, M.D., Koen Kuk Kim, M.D.*, Hyun Ok Kim, M.D., Geum Ha Kim, M.D., Kwang Il Ko, M.D., Nak So Chung, M.D., Sang Kyun Yu, M.D., Dong Kyun Park, M.D., Kwang An Kwon, M.D., Yeon Suk Kim, M.D., Yu Kyung Kim, M.D. and Ju Hyun Kim,; Korean J Gastrointest Endosc 2007;35(4):287-291. Published online October 30, 2007

Abstract PDF: Obstructive jaundice is most commonly attributed to a malignancy or stones affecting the common bile duct. Biliary tuberculosis and lymphadenitis around the periportal area have also been implicated but cases are quite rare. A 24 year old man presented with jaundice and abdominal pain for 3 days. Abdominal CT and ERCP revealed a stricture of the extrahepatic bile duct with multiple enlarged lymph nodes showing necrotic foci located at the periportal area. The colonoscopic biopsy showed evidence of M. tuberculosis. The patient was treated with ERBD insertion and oral anti-tuberculosis therapy. However, the abdominal pain recurred and there was progressive stenosis of the common bile duct. A bile duct resection with choledochojejunostomy was subsequently performed. Frozen sections revealed granulomatous inflammation with caseation necrosis, which was consistent with tuberculosis. We report a case of tuberculous cholangitis and lymphadenitis with obstructive jaundice that was managed surgically due to the progressive stricture of the bile duct. (Korean J Gastrointest Endosc 2007;35:287-291)

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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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A Case of Common Bile Duct Web Presenting with Obstructive Jaundice without Choledocholithiasis: Young Nam Kim, M.D., In Sung Moon, M.D., Seung Ki Jeong, M.D., Duck Soo Woo, M.D., Jeong Woo Park, M.D., Eun Ki Paik, M.D., Yeon Suk Kim, M.D., Dong Kyun Park, M.D., Duck Joo Choi, M.D., Yu Kyung Kim, M.D., Sun Suk Kim, M.D., Oh Sang Kwon, M.D., Moon Gi C; Korean J Gastrointest Endosc 2003;27(2):100-104. Published online August 30, 2003

Abstract PDF: Biliary web is an extremely rare disease. It has been reported about 40 cases worldwide and 7 cases in Korea. Most cases have been incidentally found at operation or autopsy because of its rare incidence and absence of specific clinical manifestations. On cholangiography, billiary web typically appears as slit like or shelf like radiolucent narrowing. We experienced a case of biliary web of the common bile duct with obstructive jaundice that was diagnosed by endoscopic retrograde cholangiopancreatography and treated by surgery in a 65 year-old male who complained of right upper quadrant pain for 4 days. We report a case of biliary web of the common bile duct with obstructive jaundice with a review of the literature. (Korean J Gastrointest Endosc 2003;27:100⁣104)

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담관낭선종에 의한 총간담관 압박으로 폐쇄성 황달이 발생한 1 예 ( A Case of Obstructive Jaundice Caused by Extrinsic Compresson of Biliary Cystadenoma of the Common Hepatic Duct ): Korean J Gastrointest Endosc 2000;21(3):756-759. Published online November 30, 1999

Abstract PDF: Biliary cystadenoma is a rare tumor that arises in the liver or, less frequently, in the extrahepatic ducts. Jaundice in patients with biliary cyst adenoma is not uncomon, but it is very rare that the jaundice is caused by tumor compression of the bile duct. A 43-year-old woman who had a huge biliary cystadenom.a occupying the left liver developed deep jaundice. Endoscopic retrograde cholangiopancreatograpy demontrated that this tumor compressed the common hepatic ducts extrinsically which caused the deep jaundice.

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악성 완전 담도협착에서의 경피적 세침천자술에 의한 경피적 내시경적 담도배액술 ( Percutaneous Endoscopic Biliary Stenting (PEBS) Using the Percutaneous Fine Needle Puncture Method in Malignant Complete Biliary Obstruction ): Korean J Gastrointest Endosc 2000;20(2):154-157. Published online November 30, 1999

Abstract PDF: Nonsurgical drainage of malignant obstructive jaundice is an interesting alternative to surgical drainage in the palliative treatment of pancreaticobiliary neoplasms. Biliary drainage by endoprosthesis is as effective and better supported than percutaneous external drainage, but more difficult to control. Endoscopic retograde biliary drainage (ERBD) is a safe and effective biliary drainage procedure, and is indicated with malignant obstructive jaundice in patients on whom endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) can be performed. A nonoperative method of palliation was used in patients with malignant obstructive jaundice, in whom a biliary endoprosthesis could not be placed endoscopically due to complete obstruction of the bile duct. A guide wire was manipulated through the lesion by a percutaneous transhepatic route, after puncturing the tumor by a fine needle, and retrieved from the duodenum through an endoscope. A stent was then passed through the endoscope over the guide wire across the stricture.

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간문맥의 해면상 변형에 의해 발생된 폐쇄성 황달 1예 ( A Case of Obstructive Jaundice Caused by Cavernous Transformation of the Portal Vein ): Korean J Gastrointest Endosc 1999;19(6):999-1004. Published online November 30, 1998

Abstract PDF: Cavernous transformation of the portal vein is a rare condition probably arising secondary to extrahepatic portal vein thrombosis or obstruction with recannalization and/or collateral veins formation to bypass the obstruction. It is believed that cavernous transformation of the portal vein is caused by a variety of diseases associated with periportal collateral development and hepatopedal flow. It is known that portal vein occlusion, which is the actual cause of cavernous transformation, has a wide variety of etiologies, such as congenital abnormalities, omphalitis, pancreatitis, various carcinoma, and liver cirrhosis. In most cases, the revealing symptom is upper gastrointestinal bleeding. Rarely, however, diagnosis is made from obstructive jaundice. Extensive collateral veins due to portal vein occlusion may compress and narrow the biliary tract. A 39-year-old man was admitted due to jaundice and abdominal discomfort for 1 month. He was confirmed to have obstructive jaundice due to collateral vessels of cavernous transformation of the portal vein. We report a case of obstructive jaundice caused by cavernous transformation of the portal vein. (Korean J Gastrointest Endosc 19: 999∼1004, 1999)

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증례 : 담도 췌장 ; 풍선 확장술로 치유된 선천성 총담관 막양구조 ( Web ) ( Case Reports : Biliary Tract & Pancreas ; A Case of a Congenital Web of the Common Bile Duct Treated with Balloon Dilatation ): Korean J Gastrointest Endosc 1998;18(3):426-431. Published online November 30, 1997

Abstract PDF: The web of the common bile duct is an extremely rare anomaly and the cause of the obstructive jaundice. We experienced a case of the congenital web of common bile duct in a 42 years old male who complained of jaundice for 10 days prior to admission without choledocholithiasis and cholangitis. An endoscopic retrograde cholangiopancreatography revealed a common bile duct web (transverse, diaphragmatic type) and the diagnosis was confirmed by an endoscopic forcep biopsy. We reported a case of the congenita1 web of the common bile duct which was treated with a stent insertion and balloon dilatation. (Korean J Gastrointest Endosc l8: 426-431, 1998)

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증례 : 담도 췌장 ; 담도경검사법 ( Cholangioscopy ) 으로 확진된 폐쇄성황달을 동반한 간세포암 3예 ( Case Reports : Biliary Tract & Pancreas ; Hepatocellular Carcinoma with Obstructive Jaundice Confirmed by Percutaneous Transhepatic Cholangioscopy ( PTCS ) and Peroral Cholangioscopy ( POCS ) ): Korean J Gastrointest Endosc 1996;16(4):681-691. Published online November 30, 1995

Abstract PDF: Jaundice associated with hepatocellular carcinoma usually occurs in the later stages due to the advanced underlying liver cirrhosis or tumor infiltration of the liver parenchyme. In the rare cases, obstructive jaundice presents as the ininitial manifestation of hepatocellular carcinoma. The possible mechanisms of bile duct obstruction associated with hepatocellular carcinoma include extrinsic compression of bile duct by extensive tumor infiltration of the liver or enlarged lymph node, direct tumor invasion of the biliary duct system, and bile duct obstruction by tumor thrombus, necrotic debris, or blood clots. We experienced three cases with hepatocellular carcinoma in whom obstructive jaundice were caused by intraductal involvement of the tumor, which were confirmed by percutaneous transhepatic cholangioscopy(PTCS) and peroral cholangioscopy(POCS). PTCS and POCS finding showed multiple, irreguarly shaped, yellowish soft tissue(chicken fat) and blood clots and, round protruded mass in the ble duct. Biopsy specimens revealed pathologically hepatocelluar carcinoma. (Korean J Gastrointest Endosc 16: 681-689, 1996)

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증례 : 담도 췌장 ; Klatskin 종양환자에서의 경피경간경종양적 접근에 의한 담도배액술 ( Case Reports : Biliary Tract & Pancreas ; Percutaneous Transhepatic Transtumoral Biliary Drainage in a Patient with Obstructive Jaundice Due to Klatskin Tumor ): Korean J Gastrointest Endosc 1996;16(3):517-525. Published online November 30, 1995

Abstract PDF: Although the endoscopic retrograde biliary drainage(ERBD) is the preferred palliative treatment for unresectable mlignant obstructive jaundice, the failure of endaprosthesis insertion occurs in 15% of the cases. Espeeially in hilar malignancy, the failure results from the inability to pass ei~ther a guide wire or a stent due to biliary stenosis or obstruction by tumorous extension. In such caae, percutaneous transhepatic biliery drainage(PTBD) can be achieved. When the tumor extends into the hilum, isolating the right and left hepatic ducts, drainage of unilateral hepatic duct will usually provide adequate palliation. However, when patients have contralateral cholangitis or jaundice fails to resolve with unilateral biliary drainage, bilateral drainage may be necessary. Compared to ERBD, the method of prolonged external biliary drainage has unwanted disadvantages. In order to achieve internal biliary drainage in case with complete obstruction of hepatic ducts due to tumor extension, percutaneous transhepatic transtumoral biliary drainage(PTTBD) could be considered. We report a case with obstructive jaundice and cholangitis due to complete obstruction of right hepatic duct and stenosis of common hepatic duct from Klatskin tumor, which was sucessfully managed by internal biliary drainage with transtumoral biliary stenting under the guidance of computed tomography. (Korean J Gastrointest Endosc 16: 517~ 523, 1996)

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원저 : Tannenbaum Stent 와 OASISTM 삽입 기구의 사용 경험 ( Original Articles : Endoscopic Application of Tannenbaum Stent with OASISTM ): Korean J Gastrointest Endosc 1995;15(2):203-211. Published online November 30, 1994

Abstract PDF: Endoscopic biliary drainage has been established as the palliative treatment of choice for malignant obstructive jaundice. But the clogging of biliary endoprosthesis has been a persistent problem faced by endoscopists over many years. Different materials, sizes, and designs have been used in efforts to overcome this problem. Recently, there are some reports that incorporating sideholes increases the risk of stent clogging, and prostheses without sideholes had significantly lower clogging compared to those with sideholes. And then Soehendra and his colleagues introduced a new design Teflon straight stent without sideholes, designated "Tan-nenbaum" (TB) stents, and reported that TB stent had significantly longer patency than Teflon pigtail stent with sideholes. When placing the TB stent, we used OASIS (One Action Stent Introduction System). This introducer enables the stent to be pre-loaded onto the distal tip of the guiding catheter and placed endoscopically in one step. By using OASIS, we reduced the duration of placing the stent in narrowed bile duct and the patients were more tolerable. Now, we report our experience of endoscopic retrograde biliary drainage by use of TB stent and OASIS" in 12 patients with obstructive jaundice due to malignancy.

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원저 : 악성 폐쇄성 황달환자에서 코일 ( coli ) 형 금속배액관 삽관술 ( Original Articles : Metallic EndoCoilTM Stent Application for Patients with Malignant Obstructive Jaundice ): Korean J Gastrointest Endosc 1995;15(1):54-62. Published online November 30, 1994

Abstract PDF: We report our experience in five patients with malignant obstructive jaundice with a new self expandable metallic stent, a coil spring made from nickel-titanium alloy. Endoscopic biliary drainage(EBD) is a safe and effective noninvasive biliary drainage method and is indicated with malignant obstructive jaundice. In order to avoid being limited by the size of the instrumentation channel of the endoscope, expandable stents have been developed. The main problems with these expandable metal stents are tumor ingrowth leading to reobstruction, migration of the stent from its original position, and epithelial trauma by the distal hard edges of the stent. The new super-elastic metallic coil stent which has a very strong radial force (EndoCoil'" stent, Instent Co.) was developed to solve the above mentioned problems. The stent which is constricted over an introducing catheter is inserted by transduodenal approach. It expands spontaneously after release to its original 8 mm diameter. During the last 6.5 rnonths, 5 stents were inserted in patients with cholangiocarcinoma, pancreatic carcinoma and cancer of the ampulla of Vater to releave jaundice. Clinical improvement was achieved in all the patients except in one who died from multiple organ metastasis. After a mean follow-up of 6 month., patients had no evidence of biliary reobstruction. Although follow-up is short, these results are encouraging, and this new metallic stent seems to have several advantages over the current commercially available ones.

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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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증례 : 폐쇄성 황달을 유발한 결핵성 림프선염 1예 ( Case Reports : A Case of Tuberculous Lymphadenitis Causing Obstructive Jaundice ): Korean J Gastrointest Endosc 1994;14(1):115-120. Published online November 30, 1993

Abstract PDF: Obstructive disorders of the biliary trees include occlusions of the bile duct lumen by stones, intrinsic disorders of the bile ducts, and extrinsic compressions. The most common biliary cause of obstructive jaundice is the presence of stones. Intrinsic disorders of the bile ducts may be inflammatory, infectious, or neoplastic. And significant enlargement of adjacent lymph nodes due to metastatic tumors or lymphoma can occasionally obstruct the extrahepatic bile ducts. But obstructive jaundice produced by periportal tuberculous lymphadenitis with no evidence of pulmonary tuberculosis is very rare. We report a case of tuberculous lymphadenitis causing obstructive jaundice with a mass around mid common bile duct on abdominal sonogram, CT scan and ERCP, and it was confirmed by an exploratory laparotomy.

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경구적 담관내시경검사로 진단된 총간관내 원발성간암의 종양색전에 의한 폐쇄성 황달 1예 ( Obstructive Jaundice Caused by the Fragment of Hepatocellular Carcinoma in the Common Hepatic Duct Confirmed by Peroral Choledochoscopy ): Korean J Gastrointest Endosc 1993;13(2):415-418. Published online November 30, 1992

Abstract PDF: The causes of jaundice in patients with hepatocellular carcinoma are usually attributed to the underlying liver diseases or extensive hepatic destruction by tumor. Obstructive jaundice by the intraluminal tumor fragment of intrahepatic and/or extrahepatic bile duct in hepatocellular carcinoma is exceedingly rare and usually diagnosed by operation or autopsy. Recently, we observed a patient in whom the fragment of tumor from the primary hepatocellular carclnoma obstructed the common hepatic duct, which was confirmed by peroral choledochoscopy. Using peroral choledochoscopy. we could see the mass located at the common hepatic duct and diagnose histologically by cytologic examination of aspirated material of common bile duct. We describe here this rare case with review the literature on primary hepatocellular carcinoma with jaundice caused by biliary obstruction.

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내시경적유두괄약근절개술없이 시행한 내시경적 비 담도배액술의 평가 ( Evaluation of the Safety , Successfullness and Effectiveness of Endoscopic Nasobiliary Drainage ( ENBD ) without Endoscopic Sphicterotomy ( EST ) ).: Korean J Gastrointest Endosc 1991;11(1):65-72. Published online January 1, 1991

Abstract PDF: Endoscopic nasobiliary drainage(ENBD) has been developed as a safe and effective noninvasive biliary drainage method for initial decompression in the benign or malignant biliary obstruction, dissolution of biliary stones by injection of litholytic agents through the tube, and proper causative diagnosis of biliary obstruction by cytologic, bacteriologic and parasite investigation of drained bile. Generally, endoscopic sphicterotomy (EST) is performed before the insertion of an ENBD tube in order to make the procedure easy and to prevent acute pancreatitis that may develop by compression of the pancreatic orifice of the inserted tube. Nevertheless, in some cases EST is difficult to perform or should not be performed due to their coagulopathy. In such cases, ENBD without EST may be necessary. To evaluate the safety, successfullness and effectiveness of ENBD without EST, ENBD without EST using 5, 6 or 7 Fr pigtail tubes were performed in 81 cases(49 malignant, 32 benign). ENBD without EST was successfully performed in 78 out of 81 cases(96.3%). This effectiveness for decompression of bile duct, evaluated by decreasing total bilirubin values, was good in 66 out of 73 casee (90. 2%). The complications of this procedure were noted in 6 out of 78 cases(7. 7%). e. g. cholangitis in 3, migration of ENBD tube in 2, acute pancreatitis in 1 case. Particularly, regardless of our concern that ENBD without EST may develop acute pancreatitis acute panereatitis was noted in only one case. In conclusion, ENBD without EST is a safe and effective method which can be applied to the cases who have benign or malignant obstructive jaundice.

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