1.Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping.
Keunmo KIM ; Eun Bee KIM ; Yong Hyeok CHOI ; Youngmin OH ; Joung Ho HAN ; Seon Mee PARK
Clinical Endoscopy 2017;50(2):202-205
Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP). We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL) and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm oval-shaped perforation was found at the lateral duodenal wall. We repaired the perforation by sequentially performing double EBL and endoclipping. The first EBL was performed at the proximal edge of the perforation orifice, and two-thirds of the perforation were repaired. The second EBL, which also included the contents covered under the first EBL, repaired the defect almost completely. Finally, to account for the possible presence of a residual perforation, an endoclip was applied at the distal end of the perforation. The detection and closure of the perforation were completed within 10 minutes. We suggest that double EBL is an effective method for closure.
Cholangiopancreatography, Endoscopic Retrograde
;
Cholangitis
;
Endoscopes
;
Female
;
Humans
;
Ligation*
;
Methods
2.Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy.
Clinical Endoscopy 2016;49(5):467-474
Various endoscopic techniques have been developed to overcome the difficulties in biliary or pancreatic access during endoscopic retrograde cholangiopancreatography, according to the preference of the endoscopist or the aim of the procedures. In terms of endoscopic methods, guidewire-assisted cannulation is a commonly used and well-known initial cannulation technique, or an alternative in cases of difficult cannulation. In addition, precut sphincterotomy encompasses a range of available rescue techniques, including conventional precut, precut fistulotomy, transpancreatic septotomy, and precut after insertion of pancreatic stent or pancreatic duct guidewire-guided septal precut. We present a literature review of guidewire-assisted cannulation as a primary endoscopic method and the precut technique for the facilitation of selective biliary access.
Catheterization
;
Cholangiopancreatography, Endoscopic Retrograde
;
Methods
;
Pancreatic Ducts
;
Stents
3.Percutaneous transheptic removal of biliary stones:clinical analysis of 16 cases.
Hun Kyu RYEOM ; Jae In SIM ; Auh Whan PARK ; Yong Joo KIM ; Hee Jin KIM
Journal of the Korean Radiological Society 1993;29(6):1234-1239
Percutaenous transhepatic biliary drainage (PTBD) is widely used to control cholangitis, sepsis, or jaundice caused by biliary tree obstruction. The PTBD tract can be used in percutaneous biliary stone extraction in pre-or post-operative state when ERCP is failed or operation is contraindicated. We performed 16 cases of percutaneous transhepatic biliary stone removal. Locations of biliay stones are combined intrahepatic and extrahepatic in 8 cases (50%), only extrahepati in 7 cases (44%), and only intrahepatic in 1 case (6%). The number of stones was single in 6 cases and multiple in 10 cases. Over all success rate was 81% (13/16), 93% (14/15) in extrahepatic stones and 78% (7/9) in intrahepatic stones. In 5 of 6 cases, complete stone removal was impossible due to marked tortuosity of T-tube tract or peripherally located stones, complete removal of biliary stones was achieved via a new PTBD tract. No significant pre-or post-procedure complication was occured. Percutaneous removal of biliary stones via PTBD tract is an effective and safe alternative method in difficult cases in the menagement of biliary tract stones.
Biliary Tract
;
Cholangiopancreatography, Endoscopic Retrograde
;
Cholangitis
;
Drainage
;
Jaundice
;
Methods
;
Sepsis
4.The Usefulness of Cap-assisted Endoscopic Retrograde Cholangiopancreatography for Cannulation Complicated by a Periampullary Diverticulum.
Joonhwan KIM ; Jun Soo LEE ; Eui Joo KIM ; Yeon Suk KIM ; Jae Hee CHO
The Korean Journal of Gastroenterology 2018;71(3):168-172
Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced therapeutic procedure to manage choledocholithiasis and pancreatobiliary malignancy. On occasion, ERCP failure is encountered due to difficulties in cannulation. We assessed the safety and feasibility of cap-assisted ERCP via analyzing cases in which cannulation was complicated by periampullary diverticulum. Between November 2013 and March 2014, ERCP procedures were performed in 346 patients in our tertiary medical center. Among the 73 patients who had a periampullary diverticulum, conventional ERCP failed in 5 patients due to hidden papilla (n=3) or use of tangential approach (n=2). As a rescue method, needle knife fistulotomy and selective biliary cannulation using cap-fitted forward-viewing endoscopy were successfully used in 4 patients without major complications. Based on our experience, cap-fitted forward-viewing endoscopy was relatively easy to measure the exact position of papilla and to perform biliary cannulation properly. Therefore, we recommend using cap-assisted ERCP by forward-viewing endoscopy as a useful and safe alternative to manage patients in whom cannulation is complicated by periampullary diverticulum.
Catheterization*
;
Cholangiopancreatography, Endoscopic Retrograde*
;
Choledocholithiasis
;
Diverticulum*
;
Endoscopy
;
Humans
;
Methods
;
Needles
5.Confrontational Strategy Is Essential for Being Effective Precut Papillotomy.
Gut and Liver 2015;9(4):435-436
No abstract available.
Biliary Tract Diseases/*surgery
;
Catheterization/*methods
;
Cholangiopancreatography, Endoscopic Retrograde/*methods
;
Female
;
Humans
;
Male
;
Sphincterotomy, Endoscopic/*methods
6.Evolution of gastrointestinal endoscopy in the mainland of China.
Chinese Medical Journal 2009;122(19):2220-2223
7.Which is better for unresectable malignant hilar biliary obstruction: Side-by-side versus stent-in-stent?
Itaru NAITOH ; Tadahisa INOUE ; Kazuki HAYASHI
Gastrointestinal Intervention 2018;7(2):78-84
Biliary drainage is required for the management of unresectable malignant hilar biliary obstruction (UMHBO), and endoscopic transpapillary drainage is the first-line therapy because it is less invasive. Self-expandable metallic stents (SEMSs) are superior to plastic stents because they have longer stent patency and are more cost-effective. Endoscopic bilateral SEMS placement is technically challenging compared to unilateral placement. However, recent developments in devices and techniques have facilitated bilateral SEMS placement. There are two methods for bilateral hilar SEMS placement for UMHBO: side-by-side (SBS) and stent-in-stent (SIS). Sequential SBS was commonly conducted for bilateral hilar SEMS placement. In a new and thinner delivery system that was developed for SEM placement, two SEMSs could be simultaneously inserted and deployed through the working channel. This new bilateral stenting method enabled us to accomplish simultaneous SBS placement, which increased the success rate of SBS. Insertion of the guidewire and delivery of the second SEMS through the mesh of the first SEMS is challenging in SIS. Newly designed or modified SEMSs that are suitable for SIS have been developed to overcome this challenge, and these SEMSs have facilitated SIS. Uncovered SEMS has been commonly used for hilar SEMS placement, but covered SEMS (CSEMS) is another option for hilar SEMS placement, because CSEMS prevents tumor ingrowth and allows for removal of the stent for re-intervention. Therefore, CSEMS can be used for bilateral SEMS placement in SBS. There are many methods and kinds of SEMS available for bilateral SEMS placement. However, due to lack of evidence, there is no consensus on whether SBS or SIS is optimal for bilateral hilar SEMS placement. In this review, we compared various outcomes between SBS and SIS from previous studies, to clarify which method is better for bilateral SEMS placement for UMHBO.
Cholangiopancreatography, Endoscopic Retrograde
;
Cholestasis
;
Consensus
;
Drainage
;
Klatskin Tumor
;
Methods
;
Plastics
;
Self Expandable Metallic Stents
;
Stents
8.Endoscopic Ultrasound-Guided Biliary Drainage.
Everson LA ARTIFON ; Flavio C FERREIRA ; Paulo SAKAI
Korean Journal of Radiology 2012;13(Suppl 1):S74-S82
OBJECTIVE: To demonstrate a comprehensive review of published articles regarding endoscopic ultrasound (EUS)-guided biliary drainage. MATERIALS AND METHODS: Review of studies regarding EUS-guided biliary drainage including case reports, case series and previous reviews. RESULTS: EUS-guided hepaticogastrostomy, coledochoduodenostomy and choledoantrostomy are advanced biliary and pancreatic endoscopy procedures, and together make up the echo-guided biliary drainage. Hepaticogastrostomy is indicated in cases of hilar obstruction, while the procedure of choice is the coledochoduodenostomy or choledochoantrostomy in distal lesions. Both procedures must be performed only after unsuccessful ERCPs. The indication of these procedures must be made under a multidisciplinary view while sharing information with the patient or legal guardian. CONCLUSION: Hepaticogastrostomy and coledochoduodenostomy or choledochoantrostomy are feasible when performed by endoscopists with expertise in biliopancreatic endoscopy. Advanced echo-endoscopy should currently be performed under a rigorous protocol in educational institutions.
Bile Duct Diseases/*surgery/ultrasonography
;
Cholangiopancreatography, Endoscopic Retrograde
;
Choledochostomy/methods
;
Drainage/*methods
;
Endosonography/*methods
;
Gastrostomy/methods
;
Humans
;
*Ultrasonography, Interventional
9.Post-Endoscopic Sphincterotomy Bleeding: Strategic Approach with Multiple Endoscopic Arms.
Dong Won AHN ; Seon mee PARK ; Joung Ho HAN
Korean Journal of Pancreas and Biliary Tract 2017;22(1):14-18
Endoscopic retrograde cholangiopancreatography (ERCP) is an essential method for diagnosis and treatment of various pancreatobiliary diseases and endoscopic sphincterotomy (EST) is the gateway to complete ERCP. Although techniques and instruments for EST have improved, bleeding is still the most common complication. Treatment of immediate post-EST bleeding is important because blood can interfere with subsequent procedures. Additionally, endoscopists should be cautious about delayed bleeding may cause hemobilia, cholangitis, and hemodynamic shock. Most cases of post-EST bleedings will stop spontaneously, however, endoscopic management is necessary in case of clinically significant and persistent bleeding. Various endoscopic methods including epinephrine or fibrin glue injection, electrocoagulation, hemoclipping and band ligation et al can be used through a sideviewing or forward-viewing endoscope similar to those used in hemostasis of peptic ulcer bleeding. Endoscopists who perform ERCP should use various methods of endoscopic hemostasis strategically.
Arm*
;
Cholangiopancreatography, Endoscopic Retrograde
;
Cholangitis
;
Diagnosis
;
Electrocoagulation
;
Endoscopes
;
Epinephrine
;
Fibrin Tissue Adhesive
;
Hemobilia
;
Hemodynamics
;
Hemorrhage*
;
Hemostasis
;
Hemostasis, Endoscopic
;
Ligation
;
Methods
;
Peptic Ulcer
;
Shock
;
Sphincterotomy, Endoscopic
10.Post-Endoscopic Sphincterotomy Bleeding: Strategic Approach with Multiple Endoscopic Arms.
Dong Won AHN ; Seon mee PARK ; Joung Ho HAN
Korean Journal of Pancreas and Biliary Tract 2017;22(1):14-18
Endoscopic retrograde cholangiopancreatography (ERCP) is an essential method for diagnosis and treatment of various pancreatobiliary diseases and endoscopic sphincterotomy (EST) is the gateway to complete ERCP. Although techniques and instruments for EST have improved, bleeding is still the most common complication. Treatment of immediate post-EST bleeding is important because blood can interfere with subsequent procedures. Additionally, endoscopists should be cautious about delayed bleeding may cause hemobilia, cholangitis, and hemodynamic shock. Most cases of post-EST bleedings will stop spontaneously, however, endoscopic management is necessary in case of clinically significant and persistent bleeding. Various endoscopic methods including epinephrine or fibrin glue injection, electrocoagulation, hemoclipping and band ligation et al can be used through a sideviewing or forward-viewing endoscope similar to those used in hemostasis of peptic ulcer bleeding. Endoscopists who perform ERCP should use various methods of endoscopic hemostasis strategically.
Arm*
;
Cholangiopancreatography, Endoscopic Retrograde
;
Cholangitis
;
Diagnosis
;
Electrocoagulation
;
Endoscopes
;
Epinephrine
;
Fibrin Tissue Adhesive
;
Hemobilia
;
Hemodynamics
;
Hemorrhage*
;
Hemostasis
;
Hemostasis, Endoscopic
;
Ligation
;
Methods
;
Peptic Ulcer
;
Shock
;
Sphincterotomy, Endoscopic