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

An occasional patient has both a pressing need for visualization of the biliary system in spite of a past history of reaction to iodinated contrast media. We report a patient, who had reacted adversely to contrast media, underwent ERCP using barium sulfate in order to opacify the biliary and pancreatic duct without side effect successfully. In conclusion, ERCP using barium sulfate as a contrast material is of value in patients who are intolerant of the iodinated contrast media.
Barium Sulfate* ; Barium* ; Biliary Tract ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde* ; Contrast Media ; Humans ; Pancreatic Ducts

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

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

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

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