A choledochocele is a benign cyst-like herniation of the intramural segment of the distal common bile duct protruding into the duodenal lumen. Cholangiography is essential to demonstrate a choledochocele. Because choledochoceles are often associated with characteristic structual alterations of the papilla of Vater and the peripapillary area, ERCP is helpful in demonstrating a choledochocele. We present the clinical, endoscopic and radiographic (ERCP) findings in a patient with choledochocele.
Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst* ; Common Bile Duct ; Humans

A choledochocele is a benign cyst-like herniation of the intramural segment of the distal common bile duct protruding into the duodenal lumen. Cholangiography is essential to demonstrate a choledochocele. Because choledochoceles are often associated with characteristic structual alterations of the papilla of Vater and the peripapillary area, ERCP is helpful in demonstrating a choledochocele. We present the clinical, endoscopic and radiographic (ERCP) findings in a patient with choledochocele.
Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst* ; Common Bile Duct ; Humans

Endoscopic retrograde cholangiopancreatography(ERCP) procedures are more difficult in patients who have undergone partial gastrectomy with Billroth II anastomosis. Because its altered anatomical relationship. the endoscopist is presented with additional problems: (i) Dfficulties in entering the afferent loop, depending on the surgical techiques used. (ii) The endoscope may be too sort to reach the papillary region unless the loops are suecessfully straightened out. (iii) Difficulties in passing the ligament of Treitz, especially in patients with Braun's anastomosis, (iv) Problems in cannulating the papilla and especially the common bile duct from a reversed position. (v) Problems in carrying out a papillotomy in a correct position. We attempted endoscopic sphincterotomy in 3 opatients previously subjected to gastrectomy with needle knife, and succeeded in 2 of them. In the two patients, successful billary drainage was achieved. And one patients with Billroth II gastrectomy, presented with CBD stone and cholangit, was successfully treated with endoscopic stone retriveial. The patient with a Billroth-II operation may unergo endscopic diagnostic as well as therapeutic procedures with a high rate of success, and can be suitable candidates for ERCP and endoscopic sphincterotomy
Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Drainage ; Endoscopes ; Gastrectomy* ; Gastroenterostomy* ; Humans ; Ligaments ; Needles ; Sphincterotomy, Endoscopic

BACKGROUND: Various studies on the prediction of common bile duct (CBD) stones through preoperative or operative cholangiography have been reported. When CBD stones were suspected due to preoperative screening factors, endoscopic retrograde cholangiopancreatography was done as a first choice and operative cholangiography could be omitted. We want to know the indications of selective cholangiography and the significance of routine operative cholangiography during a simple cholecystectomy. METHODS: The cases of 134 patients who received on open cholecystectomy between Jan. 1995 and Sept. 1997 were reviewed. Twenty-even (27) cases of a choledocholithotomy without cholangiography were discarded from this study. Our cases were divided into two groups: group I included 9 patients who had CBD Stones, which was pathologicaly confirmed by operative cholangiography, and group II included 98 patients who had no CBD Stones, which pathologicaly confirme by operative cholangiography. The predictability of pathologic CBD. was calculated by the factors as the total bilirubin, alkaline phosphatase, AST, ALT, GGT, CBD. diameter by sonography. According to the number of positive screening factors, 3 grades of scoring were imposed in each case. Grade I was the case where 0- screening factor was positive, grade II was the case where 2 screening factors were positive, and grade III was the case where 3 or more screening factors were positive. RESULTS: Eighty-ive (85) cases were grade I, 6 cases were grade II, and 16 cases were grade III. In grade I, only one case had asymptomatic CBD stones, and the negative predictability was 98.8%. In grade II, there were no CBD lesions, and the negative predictability was 100%. In grade III, there were 8 cases of pathologic CBD lesions, and the negative predictability was 50%. CONCLUSIONS: Precise prediction of CBD lesions before a cholecystectomy is of value in deciding whether or not to perform an operative cholangiography. In our study, we graded the patients according to 5 non-nvasive screening factors. In grade I cases, the negative predictability of 98.8% was acceptable for omitting the operative cholangiography. In grade II cases, the negative predictability was 100%, but in these cases, there was the possibility of pathologic CBD Stones. Hence, in these cases, an operative cholangiography may be done, depending on the surgeon's decision. In grade III cases, an operative cholangiography or a preoperative ERCP. is mandatory.
Alkaline Phosphatase ; Bilirubin ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Common Bile Duct ; Humans ; Mass Screening

PURPOSE: MR cholangiography(MRC) in patients with obstructive biliary diseases was evaluated in order to compare its role with that of ERCP or PTC. MATERIALS AND METHODS: Twenty consecutive patients with obstructive biliary and peribiliary diseases (Eleven biliary and peribiliary carcinomas, seven intrahepatic stone diseases and seven extrahepatic stone diseases) were included and ERCP(16 ccases) or PTC(four cases) was performed in all twenty cases. Non-breasth-hold, heavily T2-weighted, fast spin echo MRC was carried out and 2-D axial, coronal images and 3-D images with maximum intensity projection protocol were obtained. We regarded ERCP or PTC as thegold standard and then comparedn MRC with ERCP of PTC retrospectively. RESULTS: In 11 patients with biliary and peribiliary carcinomas, the level of obstruction was depicted in nine cases(83%) on MRC and in six of seven cases(86%) on ERCP. The causes of obstruction were demonstrated in eight cases(73%) on MRC and in six of seven cases(86%) on ERCP. On MRC, Seven cases(64%) revealed similar findings to ERCP or PTC. Of seven cases of EHD and seven of IHD stone diseases, EHD stones were detected in six cases(86%) on MRC and in seven cases (100%) on ERCP,IHD stones were detected in four cases(57%) on MRC and in five cases(71%) on ERCP. 2D-MRC was superior to 3D-MRCin the detection of stones. The extent and grade of ductal dilatiation was accurately revealed in six cases(86%)on MRC and in seven cases(100%) on ERCP of EHD stones, in six cases(86%) on MRC and in three cases(43%) on ERCP of IHD stones. Six cases(86%) of EHD stones and two cases(29%) of IHD stones revealed similar findings between MRCand ERCP. CONCLUSION: MRC findings were similar to those of ERCP or PTC in the evaluation of malignant biliary diseases or extrahepatic stone diseases and was valuable in their diagnoses. In the evaluation of intrahepaticstone diseases, MRC demonstrated dilated peripheral IHDs with stones more difinitely than ERCP but in the detection its accuracy was low. Further studies may therefore be needed.
Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Humans ; Imaging, Three-Dimensional ; Retrospective Studies

PURPOSE: In order to reduce the rate of conversion to an open cholecystectomy, and to avoid the retention of bile duct stones, it is important to detect a choledocholithiasis prior to a laparoscopic cholecystectomy. The aim of this study was to compare the diagnostic accuracy of endoscopic ultrasonography (EUS) with endoscopic retrograde cholangiopancreatography (ERCP) in 150 patients who had an intraoperative cholangiography and choledochotomy with a choledocholithiasis performed. METHODS: Between January 2001 and February 2002, 150 patients who underwent an ERCP or EUS performed preoperatively and a cholecystectomy with intraoperative cholangiography or choledochotomy consecutively performed at the Inha University Hospital were reviewed. RESULTS: An ERCP was performed in 119 patients, and an EUS was carried out in 67 patients. Thirty six patients had both performed. The ERCP failed in 17cases (14.3%). The EUS identified the bile duct in all cases. There were five ERCP related complications (3 pancreatitis, 2 cholangitis), but no complications were encountered when using EUS. In 62 patients (41.3%), a choledocholithiasis was found. ERCP had a sensitivity of 89.5%, a specificity of 84.4%, a positive predictive value of 87.8%, and a negative predictive value of 86.4%. EUS showed a sensitivity of 88.9%, a specificity of 84.7%, a positive predictive value of 66.7%, and a negative predictive value of 95.3%. Concordance of ERCP and EUS was obtained in 90% of cases. CONCLUSIONS: EUS appears to be safer, more comfortable, and, as accurate as an ERCP detecting a choledocholithiasis.
Bile Ducts ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Choledocholithiasis* ; Diagnosis* ; Endosonography* ; Humans ; Pancreatitis ; Sensitivity and Specificity

Choledochal web is an extremely rare disease and it is frequently associated with bile duct stone that causes biliary obstruction and cholangitis. Most cases of choledochal web have been found incidentally during a surgical procedure or on autopsy because of its rare incidence and the absence of specific clinical manifestations. Yet making an early diagnosis has become feasible with the development of radiologic studies. All twelve cases of choledochal web, reported in Korea, were located in the extrahepatic duct, and were diagnosed with an operation, endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. We report here on a case of intrahepatic choledochal web that was well visualized by percutaneous transhepatic choledochoscopy and it was treated with balloon dilatation.
Autopsy ; Bile Ducts ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Dilatation ; Early Diagnosis ; Incidence ; Korea ; Rare Diseases

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most useful diagnostic tool in biliary and pancreatic disease. However, ERCP cannot be performed successfully in all patients. Cannulation failure is the most common cause of failure of ERCP. Mechanical pathologies, such as peri-Vater diverticulum, cancer of the papilla of Vater, and impacted stone were the common causes of cannulation failure. We experienced two cases of carcinoma of the papilla of Vater in whom cholangiography and insertion of the nasobiliary tube were performed througth an artificial choledoehoduodenal fistula made by a needle type diathermy knife, beacuse cannulation to the duct was failed due to the tumor.
Catheterization ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Diathermy ; Diverticulum ; Fistula* ; Humans ; Needles ; Pancreatic Diseases ; Pathology

The usefulness of microscopic examination of pure bile directly collected from the biliary tract during endoscopic retrograde cholangiography and without hormonal stimulation was evaluated in 86 patients. Cholesterol monohydrate crystal and/or calcium bilirubinate granule were observed in the bile of 64% of GB stones, 88% of CBD stones and l00% of IHD stones. But only 4% of non stone control group were positive crystals examinations. According to this results, microscopic examinations:of bile samples collected during endoscopic retrograde cholangiography exhibited a sensitivity and a specificity for cholelithiasis recognition of 82.3% and 95.8%, respectively, with a positive and negative predictive value of 98.1% and 67.6%, respectively. We conclude that microscopic bile examinations of bile samples collected during ERC is useful to investigate in patients with suspected cholelithiasis.
Bile* ; Biliary Tract ; Bilirubin ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Cholelithiasis ; Cholesterol ; Gallstones ; Humans ; Sensitivity and Specificity

A double gallbladder is a condition that arises during the fetal period due to the abnormal differentiation of presumptive gallbladder cells, which causes two separate gallbladders, each with their own cystic duct. Most cases are diagnosed incidentally during surgery. Detailed preoperative investigations (ultrasound, oral cholecystography, intravenous cholangiography, CT, ERCP and MRCP) are required for an accurate preoperative diagnosis before considering a cholecystectomy to avoid inadvertent damage to the biliary ductal system and to overlook the second gallbladder during surgery. A total cholecystectomy, with removal of both gallbladders, should be the appropriate treatment for a double gallbladder to avoid complications and a reoperation. We report a patient with an accessory gallbladder, originating from right hepatic duct, and also discuss the characeristics of this rare anomaly.
Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystography ; Cystic Duct ; Diagnosis ; Gallbladder* ; Hepatic Duct, Common* ; Humans ; Reoperation