Since endoscopic papillary large balloon dilation (EPLBD) is used to treat benign disease and as a substitute for conventional methods, such as endoscopic sphincterotomy plus endoscopic mechanical lithotripsy, we should aim for zero mortality. This review defines EPLBD and suggests guidelines for its use based on a review of published articles and our large-scale multicenter retrospective review.
Lithotripsy ; Retrospective Studies ; Sphincterotomy, Endoscopic

No abstract available.
Adult* ; Choledochal Cyst* ; Humans ; Pancreatitis* ; Sphincterotomy, Endoscopic*

Iatrogenic duodenal perforation associated with endoscopic retrograde cholangiopancreatography (ERCP) is a very uncommon complication that is often lethal. Perforations during ERCP are caused by endoscopic sphincterotomy, placement of biliary or duodenal stents, guidewire-related causes, and endoscopy itself. In particular, perforation of the medial or lateral duodenal wall usually requires prompt diagnosis and surgical management. Perforation can follow various clinical courses, and management depends on the cause of the perforation. Cases resulting from sphincterotomy or guidewire-induced perforation can be managed by conservative treatment and biliary diversion. The current standard treatment for perforation of the duodenal free wall is early surgical repair. However, several reports of primary endoscopic closure techniques using endoclip, endoloop, or newly developed endoscopic devices have recently been described, even for use in direct perforation of the duodenal wall.
Cholangiopancreatography, Endoscopic Retrograde ; Duodenum ; Endoscopy ; Sphincterotomy, Endoscopic ; Stents

Duodenal perforation associated with endoscopic retrograde cholangiopancreatography is very uncommon. However, it usually requires early diagnosis and surgical management. Perforations are commonly caused by endoscopic sphincterotomy, biliary or duodenal stent placement, guidewire-related causes, and endoscopy itself. Perforatioins can follow various clinical courses, and management depends on the cause of the perforation. Among the above causes, guidewire-induced perforation is very rare and related reports and analyses are limited. Herein we describe four cases of guidewire-induced periampullary perforation during endoscopic retrograde cholangiopancreatography, and analyze clinical characteristics and management.
Cholangiopancreatography, Endoscopic Retrograde ; Early Diagnosis ; Endoscopy ; Sphincterotomy, Endoscopic ; Stents

The endoscopic retrograde cholangiopancreatography (ERCP) has become a commonly performed endoscopic procedure in biliary pathology. ERCP is a relatively safe procedure. however, there are chance of potentially severe complications; pancreatitis, hemorrhage, infection, and perforation. Duodenal perforation, uncommon but severe complication of ERCP, occurred in less than 1% of most series. According to the related mechanism, anatomical location, and the severity of injury, three to four distinct types of perforations have been described. We experienced the barotrauma associated duodenal perforation during endoscopic hemostasis in patient with EST site bleeding. This duodenal perforation was related with excessive air inflation to maintain the patency of a lumen. Endoscopists performing ERCP should bear in mind that continued air inflation may lead to duodenal perforation.
Barotrauma ; Cholangiopancreatography, Endoscopic Retrograde ; Hemorrhage* ; Hemostasis, Endoscopic* ; Humans ; Inflation, Economic ; Pancreatitis ; Pathology ; Sphincterotomy, Endoscopic

Endoscopic sphincterotomy(EST) is now an established therapeutic procedure for various disorder of the pailla of Vater, the biliary tract, and the pancreas. From November 1992 to September l993, 123 cases of E.S.T were performed in our hospital. The success rate of EST was 97.8%, and choledocholithiasis was the indication for EST in 63. 4% of cases. Among 78 cases of choledocholithiasis, 47 cases were presence of gall bladder with stone (16 cases) or without stone (31 cases), especially 46 cases were assisted with needle type papillotome and 23 cases were assisted with guidewire. EST hae relatively low complications and is the therapy of choice for choledocholithiasis and various diisease of biliary tract. Guidewire assisted stanard papillotome probable reduce the use of needle type papillotome in the difficult cases that EST with pull type papillotome was impossible.
Biliary Tract ; Choledocholithiasis ; Needles ; Pancreas ; Sphincterotomy, Endoscopic* ; Urinary Bladder

Minimally invasive therapy is currently invaluable for the treatment of biliary stones. Clinicians should be familiar with the various endoscopic modalities that have been evolving. I reviewed the treatment of biliary stones from the common practice to pioneering procedures, and here I also briefly summarize the results of many related studies. Lithotripsy involves procedures that fragment large stones, and they can be roughly classified into two groups: intracorporeal modalities and extracorporeal shock-wave lithotripsy (ESWL). Intracorporeal modalities are further divided into mechanical lithotripsy (ML), electrohydraulic lithotripsy, and laser lithotripsy. ESWL can break stones by focusing high-pressure shock-wave energy at a designated target point. Balloon dilation after minimal endoscopic sphincterotomy (EST) is effective for retrieving large biliary stones without the use of ML. Peroral cholangioscopy provides direct visualization of the bile duct and permits diagnostic procedures or therapeutic interventions. Biliary stenting below an impacted stone is sometimes worth considering as an alternative treatment in elderly patients. This article focuses on specialized issues such as lithotripsy rather than simple EST with stone removal in order to provide important information on state-of-the-art procedures.
Aged ; Bile Ducts ; Humans ; Lithotripsy ; Lithotripsy, Laser ; Sphincterotomy, Endoscopic ; Stents

BACKGROUND/AIMS: Endoscopic sphincterotomy (EST) is a common therapeutic technique for biliary and pancreatic diseases. However, it is associated with complications such as bleeding, pancreatitis, and perforation. Automatically controlled cut system (Endocut) is known to reduce the level of hemorrhage but lead to pancreatitis. This study examined whether or not the Endocut can reduce the rate of complications of EST compared with that of the conventional blended cut current. METHODS: From September 2005 to July 2006, 519 patients were treated with EST using either Endocut (ERBE VIO 300D, 144 patients) or the conventional blended cut current (Olympus UES-30, 375 patients). Two groups were compared retrospectively for the complications of EST. RESULTS: There were no significant differences in age, gender, and the indications for EST between the two groups. Endoscopically observed bleeding and clinically evident bleeding occurred in 6.9% (10/144), 1.4% (2/144) in the Endocut group and 8.5% (31/375), 2.2% (8/375) in the conventional blended cut current group, respectively (p=0.62 and 0.58, respectively). Clinical bleeding occurred in 2 patients in the Endocut group but it was mild and easily controlled by endoscopic treatment. Mild, moderate, and severe clinical bleeding occurred in 3, 4, and 1 patient in the blended group, respectively. Pancreatitis was encountered in 6.0% (8/134) of the Endocut group and in 5.7% (21/352) of the blended group (p=0.83). Perforation only occurred in 2 patients in the blended group. CONCLUSIONS: There were a similar number of complications from EST in the Endocut and conventional blended cut current groups.
Hemorrhage ; Humans ; Pancreatic Diseases ; Pancreatitis ; Retrospective Studies ; Sphincterotomy, Endoscopic*

Periampullary diverticulum (PAD), which was frequently noticed during endocopic retrograde cholangiopancreatography (ERCP) for examination on patients with pancreaticobiliary diseases, made difficult to cannulate the duct and to perform the endoscopic sphincterotomy (EST). EST was very useful therapeutic modality for pancreaticobiliary disease, but endoscopists are always careful about EST-related complication, especially in patients with PAD. The general principle of EST was not to incise extendedly above the papillary roof, but the following endoscopic findings help to try the extended EST safely above the papillary roof. On the endoscopic examination there was reducible protrusion above papilla by contrast injection or air deflation, which had bile-colored transparency and arborescent capillary network in the usual direction of the bile duct. We have recently experienced 2 cases of extended EST in patients with PAD, who showed the endoscopic findings mentioned above and recovered without bleeding or perforation.
Bile Ducts ; Capillaries ; Diverticulum* ; Hemorrhage ; Humans ; Sphincterotomy, Endoscopic*

PURPOSE: To evaluate the CT grading of complications developing after endoscopic sphincterotomy (EST), and their clinical course. MATERIALS AND METHODS: We retrospectively evaluated CT in 19 patients in whom pancreatitis or duodenal perforation developed after EST in 594 patients. The CT grading of pancreatitis was classified as mild, moderate or severe, according to the extent of peripancreatic infiltration; duodenal perforation was classified as mild, moderate or severe grade, according to the extent of fluid collection. We attempted to correlate CT grade with the average duration of hospitalization after EST, treatment method and mortality. RESULTS: Post-EST complications detected on CT were pancreatitis (ten patients, 1.7%) and duodenal perforation (nine patients, 1.5%). In those with pancreatitis, hospitalization after EST lasted an average of nine days in mild cases (n=2), 21 days in moderate (n=1) and 41 days in severe (n=7). Nine of ten patients with pancreatitis were treated conservatively, while the other, whose grade was severe, underwent percutaneous drainage. Eight of these ten recovered; the two who died were severe grade patients, one having been treated conservatively and the other by percutaneous drainage. In patients with duodenal perforation, hospitalization after EST lasted an average of 13 days in mild cases (n=2), 16 days in moderate (n=2) and 37 days in severe (n=5). Four of nine patients with duodenal perforation were treated conservatively, while the other five (severe, four; moderate, one) underwent percutaneous drainage. One patient, graded as severe, expired, but the remaining eight rocovered. Percutaneous drainage was performed mostly in severe grade cases, and among patients thus graded, only three (3/594; 0.5%) died. CONCLUSION: CT is considered useful for predicting the clinical course and prognosis of complications occurring after EST.
Drainage ; Hospitalization ; Humans ; Mortality ; Pancreatitis ; Prognosis ; Retrospective Studies ; Sphincterotomy, Endoscopic*