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

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

E.S.T. is performed not only for the treatment but also for the diagnosis of biliary tract diseases. E.S.T. serves as a diagnostic aid for some of biliary tract diseases which require such procedures as a peroral cholangioscopy or biopsy of the biliary duct for precise diagnosis and further differential diagnosis. The diseases of our patients were diagnosed by clinical findings and such diagnostic maneuvers as abdominal ultrasonography, intravenous cholangiography, percutaneous transhepatic chorangiography(P.T.C.), endoscopic retrograde chorangiopancreatography(E.R.C.P.), In all the two cases, abdominal ultrasonography revealed dilated extrahepatic duct, but biliary trees were not visualized at E.R.C.P. In one of the two cases, P.T.C. revealed a filling defect with dilated common bile ducts(CBD) but we could not make a differential diagnosis of CBD stone from CBD cancer. In another of the two cases, on which intravenous cholangiography was done, we could not see CBD. For the purpuse of precise diagnosis and further differential diagnosis, we performed EST and then ERCP thraugh widened papillae. With those procedures, CBD stones were shown.
Bile ; Biliary Tract Diseases ; Biopsy ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Diagnosis, Differential ; Humans ; Ultrasonography

Cystic dilatation of bile duct, so called choledochal cysts are a well documented abnormalities. Although choledochal cyst is a relatively rare disease, the number of reports have been increasing especially in tht Orient. It may be easily overlooked by the conventional diagnostic methods, such as upper gastrointestinal series, intravenous cholangiography and abdominal ultrasonogrsphy. Recent advances on diagnostic methods, such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography had been helpful in demonstrating choledochal cysts. 29 patients with choledochal cysts who had been admitted in Hanyang Universty Hospital between September l981 and August 1991 were reviewed and the clinical endoseopic and rediographic findings were discussed comparing with that from foreign literatures. (continue...)
Bile Ducts ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst* ; Dilatation ; Humans ; Rare Diseases

BACKGROUND/AIMS: The aim of this study was to evaluate the diagnostic accuracy of 64-multidetector CT (MDCT) cholangiography for determining the causes of distal common bile duct (CBD) obstruction. METHODS: Two hundred fifty consecutive patients underwent 64-MDCT for diagnosing the clinical and biochemical signs of bile duct obstruction. The causes of bile duct obstruction were assessed by the pre- and post-enhanced axial and coronal multiplanar reformation images of 64-MDCT. The results were compared with ERCP, biopsy and surgery. RESULTS: The sensitivity and specificity of MDCT for CBD stones were 96.1% and 84.9%, respectively. In seven patients, The CBD stones in 7 patients could not be detected on MDCT. Eleven patients with stones in the distal CBD, as detected on MDCT, had no stones seen on ERCP. For malignant obstruction, the sensitivity and specificity of MDCT were 97.0% and 98.6%, respectively. Three patients who were diagnosed with periampullary cancers on MDCT were disclosed to have severe papillitis on ERCP. One patient who was diagnosed with CBD stone by MDCT was disclosed to have ampullary cancer. The overall accuracy of MDCT for determining the causes of biliary obstruction was 90.5%. CONCLUSIONS: MDCT cholangiography is a non-invasive method with relatively high sensitivity and high specificity for diagnosing the causes of distal CBD obstruction.
Biopsy ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis ; Common Bile Duct ; Humans ; Papilledema ; Sensitivity and Specificity

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

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

BACKGROUND/AIMS: Endoscopic retrograde biliary drainage (ERBD) has become a standard procedure in patients with a biliary obstruction. Intraductal ultrasonography (IDUS) has emerged as a new tool for managing extrahepatic biliary diseases. IDUS-directed ERBD can be performed without conventional cholangiography (CC). The goal of this study was to assess the effectiveness and safety of IDUS-directed ERBD compared to CC-directed ERBD in patients with an extrahepatic biliary obstruction. METHODS: A total of 210 patients who had undergone IDUS-directed ERBD (IDUS-ERBD, n = 105) and CC-directed ERBD (CC-ERBD, n = 105) between October 2013 and April 2014 were analyzed retrospectively. The primary outcome measure was the procedural success rate. Secondary outcome measures included clinical outcomes, total procedure time, radiation exposure time, and overall complication rates. RESULTS: The total technical success rate of ERBD was 100% (105/105) in the IDUS-ERBD and CC-ERBD groups. Mean procedure time was slightly prolonged in the IDUS-ERBD group than that in the CC-ERBD group (32.1 ± 9.9 minutes vs. 28.4 ± 11.6 minutes, p = 0.023). Mean radiation exposure time was one-third less in the IDUS-ERBD group than that in the CC-ERBD group (28.0 ± 49.3 seconds vs. 94.2 ± 57.3 seconds, p < 0.001). No significant differences in complication rates were detected between the groups. CONCLUSIONS: IDUS-ERBD was equally effective and safe as CC-ERBD in patients with an extrahepatic biliary obstruction. Although IDUS-ERBD increased total procedure time, it significantly decreased radiation exposure.
Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage* ; Humans ; Outcome Assessment (Health Care) ; Radiation Exposure ; Retrospective Studies ; Ultrasonography