As the average life expectancy in Korea continues to rise, the number of elderly patients with pancreatobiliary disease is also expected to increase. Thus, it has been important to perform safe and quality-controlled endoscopic retrograde cholangiopancreatography in nowadays. However, there has been no standard educational programs of endoscopic retrograde cholangiopancreatography and quality control system, so Korean Pancreatobiliary Association has a plan to make credentialing organizations especially for pancreatobiliary certification. In this article, we would like to discuss the suitable framework and practical problems about the process and renewal of pancreatobiliary certification system.

No abstract availble
Carcinoma, Hepatocellular/*pathology ; Humans ; Liver Neoplasms/*pathology ; Neoplasm Staging ; Prognosis

With the advances in the imaging techniques, it is now possible to more accurately diagnose and stage pancreatic cancer. However, there is no uniform definition of "borderline resectable pancreatic cancer (BRPC)" and consensus on this terminology has not been reached yet. Although there has been much progress in the therapeutic strategies for pancreatic cancer, the optimal treatment scheme for BRPC is still under debate. In order to overcome these problems, prospective studies using multidisciplinary approaches are warranted. This article is intended to review the currently available definitions and management of BRPC. Promising novel ablative methods that are used as local treatments for locally advanced pancreatic cancer are also introduced. In the near future, these ablative methods might prove to be invaluable for those with BRPC.
Consensus ; Pancreatic Neoplasms*

Cardiopulmonary complications of endoscopic retrograde cholangiopancreatography are rare, but they can cause serious morbidity and even possibly lead to death. Complications include cardiovascular events such as cardiac arrhythmias, hypotension and myocardiac infarction and respiratory-related complications like respiratory depression, hypoxia and aspiration. In many cases, these complications are a direct or indirect consequence of elderly or at-risk patients, and these problems may also arise from medications used for sedation and analgesia. Careful evaluation for high-risk patients before procedure and close cardiopulmonary monitoring during and after procedure should be warranted to reduce complications.
Aged ; Analgesia ; Anoxia ; Arrhythmias, Cardiac ; Cholangiopancreatography, Endoscopic Retrograde ; Humans ; Hypotension ; Infarction ; Respiratory Insufficiency

Cardiopulmonary complications of endoscopic retrograde cholangiopancreatography are rare, but they can cause serious morbidity and even possibly lead to death. Complications include cardiovascular events such as cardiac arrhythmias, hypotension and myocardiac infarction and respiratory-related complications like respiratory depression, hypoxia and aspiration. In many cases, these complications are a direct or indirect consequence of elderly or at-risk patients, and these problems may also arise from medications used for sedation and analgesia. Careful evaluation for high-risk patients before procedure and close cardiopulmonary monitoring during and after procedure should be warranted to reduce complications.
Aged ; Analgesia ; Anoxia ; Arrhythmias, Cardiac ; Cholangiopancreatography, Endoscopic Retrograde ; Humans ; Hypotension ; Infarction ; Respiratory Insufficiency

Pancreatic cystic neoplasms are becoming increasingly frequent, presenting a number of challenges in clinical practice. While several guidelines have been published to address these, they are largely composed of expert opinions based on relatively low-level evidence. Their recommendations are similar in general, but there are many differences in detail. Pancreatic neoplasms have differing malignant potential, based on the histologic type and clinical and radiological features of the cysts. It is necessary to stratify the malignancy risk of each cyst, using proper evaluation methods, and to manage it appropriately, with surgical resection or surveillance. In addition, risks associated with surgical resection, costs associated with long-term follow-up, and patient discomfort and anxiety must be considered in the proper management of pancreatic cystic neoplasms. In this review, we introduce four recently published guidelines.
Anxiety ; Expert Testimony ; Follow-Up Studies ; Humans ; Pancreatic Cyst ; Pancreatic Neoplasms

A duodenoscope is complex instrument with an elevator and an elevator wire channel which are difficult to access and not readily amenable to cleaning and disinfection. Lapses in endoscope reprocessing have been regarded as a major cause of duodenoscope-associated transmission of infection. However, recent outbreaks of carbapenem-resistant Enterobacteriaceae or other multidrug-resistant organisms have emerged in spite of proper adherence to the manufacturer's reprocessing instructions. It is the time to reestablish reprocessing protocol appropriate for duodenoscope and revise a new design of duodenoscope that makes reprocessing easier in order to prevent cross-transmission of infection by duodenoscope. This manuscript reviews current state of duodenoscope-associated infections, recent measures from the United States government agencies and its limitations, and future strategies to prevent duodenoscope-associated infections.
Disease Outbreaks ; Disinfection ; Duodenoscopes ; Elevators and Escalators ; Endoscopes ; Enterobacteriaceae ; United States Government Agencies

Hypertriglyceridemia is an important cause of acute pancreatitis, and its symptoms are similar to those of pancreatitis of other causes. Moreover, the possibility of recurrence renders accurate diagnosis critical, and treatment, lifestyle modifications, and education should be performed simultaneously. For treatment during the acute phase of the disease, insulin or plasmapheresis can be combined with modalities used for acute pancreatitis of other causes; fibrate administration is recommended. In addition, hypertriglyceridemia-induced acute pancreatitis requires daily management, such as continuous administration of lipid-lowering agents, and lifestyle modifications are needed even after completion of acute-phase treatment.

Pancreatic cystic neoplasms are becoming increasingly frequent, presenting a number of challenges in clinical practice. While several guidelines have been published to address these, they are largely composed of expert opinions based on relatively low-level evidence. Their recommendations are similar in general, but there are many differences in detail. Pancreatic neoplasms have differing malignant potential, based on the histologic type and clinical and radiological features of the cysts. It is necessary to stratify the malignancy risk of each cyst, using proper evaluation methods, and to manage it appropriately, with surgical resection or surveillance. In addition, risks associated with surgical resection, costs associated with long-term follow-up, and patient discomfort and anxiety must be considered in the proper management of pancreatic cystic neoplasms. In this review, we introduce four recently published guidelines.

Hypertriglyceridemia is an important cause of acute pancreatitis, and its symptoms are similar to those of pancreatitis of other causes. Moreover, the possibility of recurrence renders accurate diagnosis critical, and treatment, lifestyle modifications, and education should be performed simultaneously. For treatment during the acute phase of the disease, insulin or plasmapheresis can be combined with modalities used for acute pancreatitis of other causes; fibrate administration is recommended. In addition, hypertriglyceridemia-induced acute pancreatitis requires daily management, such as continuous administration of lipid-lowering agents, and lifestyle modifications are needed even after completion of acute-phase treatment.