A Killian-Jamieson diverticulum (KJD) is an unfamillar and unusual cervical esophageal diverticulum. This diverticulum originates on the anterolateral aspect of the esophagus through the Killian-Jamieson's area that is formed between cricopharyngeal muscle and the lateral to longitudinal esophageal muscle. Recently, we experienced a patient who was found outpouching lesion on lateral side of left esophagus on the duodenoscopy. Then, a barium esophagography performed and in left lateral position demonstrated a left-sided diverticulum with a frontal projection, highly suggestive of a KJD. There are two ways of surgical approach to manage the KJD. First is external approach, another one is endoscopic approach. In common, external approach has been recommended for the treatment of KJD because of concern of nerve injury. We present a case of KJD that underwent external approach and sternocleidomastoid muscle flap in the management of KJD.
Barium ; Diverticulum* ; Diverticulum, Esophageal ; Duodenoscopy ; Esophagus* ; Humans

The risk of complications associated with endoscopic procedures, including bleeding and perforation, tends to increase due to the magnification of the therapeutic endoscopic spectrum. In cases of duodenal perforation, surgical closure is the treatment of choice; however, there have been some cases in which the nonsurgical treatment of an iatrogenic duodenal perforation during an endoscopic procedure was effected via endoscopic clipping closure. Here, we report two cases of successful endoscopic clipping closure of an iatrogenic duodenal perforation occur ring during a duodenoscopy insertion for ERCP and endoscopic mucosal resection for the treatment of duodenal adenoma.
Adenoma ; Cholangiopancreatography, Endoscopic Retrograde ; Duodenoscopy ; Hemorrhage

Ectopic pancreas is commonly located at stomach, duodenum and jejunum. It is a relatively rare entity and is usually of no clinical importance which especially is a very rare source of massive upper gastrointestinal bleeding. We have recently experienced a case of an ectopic pancreas in the second portion of the duodenum which was proven to be a source of massive gastrointestinal bleeding by duodenoscopy and was confirmed by surgical exploration.
Duodenoscopy ; Duodenum* ; Esophagus* ; Hemorrhage* ; Intestines* ; Jejunum ; Pancreas* ; Stomach*

The recent development of endoscopic retrograde cholangiopancreatography (ERCP) now permits the collection of pure human pancreatic secretions via duodenoscopic cannulation. Study objectives are evaluation of exocrine pancreatic function and analysis of pure pancreatic juice collected by use of ERCP technique in subjects without pancreatic disease. From March to July 1993, we performed ERCP and collection of pure pancreatic juice in 10 patients without evidence of pancreatic disease. (continue...)
Catheterization* ; Cholangiopancreatography, Endoscopic Retrograde ; Duodenoscopy ; Humans ; Pancreatic Diseases ; Pancreatic Juice*

Neuroendocrine tumors (NET) of the major duodenal papilla are rare and the natural history of this disease is not clear. We experienced a case in a 31-year-old male. Duodenoscopy revealed an enlarged major duodenal papilla with central umbilication and nodularity. Endoscopic ultrasonography (EUS) demonstrated a 3-cm hypoechoic mass that was confined to the submucosa. A biopsy led to the diagnosis of a grade 1 NET. The patient refused surgery, so we performed an endoscopic papillectomy. The tumor was removed completely. The resected specimen confirmed the diagnosis of a well-differentiated NET and all resection margins were negative. Surgical resection is currently considered to be the gold standard for the treatment of a large NET of the major duodenal papilla; however, endoscopic resection is a possible treatment modality for patients at high surgical risk or who are reluctant to undergo surgery.
Adult ; Ampulla of Vater* ; Biopsy ; Diagnosis ; Duodenoscopy ; Endosonography ; Humans ; Male ; Natural History ; Neuroendocrine Tumors*

Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both biliary and duodenal self-expandable metal stent placement is necessary to palliate their symptoms, but it was difficult to cross two metal stents. Recently, endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) was reported to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simultaneous duodenal metal stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered metal stent was placed across the duodenal stricture, EUS-CDS was performed. The second case was a 63-year-old man who previously had a covered metal stent placed for malignant biliary obstruction. After removing the previously placed metal stent, EUS-CDS was performed. Then, a duodenal covered metal stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from stent occlusion. EUS-CDS combined with duodenal metal stent placement may be an ideal treatment strategy in patients with pancreatic cancer with both duodenal and biliary malignant obstruction.
Aged ; Choledochostomy ; Constriction, Pathologic ; Diet ; Duodenal Obstruction ; Duodenoscopy ; Humans ; Middle Aged ; Pancreatic Neoplasms ; Stents

No abstract available.
Adult ; Carcinoid Tumor/*diagnosis/pathology ; Chromogranins/metabolism ; Duodenal Neoplasms/*diagnosis/pathology ; Duodenoscopy ; Humans ; Male

Intramural duodenal hematoma (IDH) is a rare complication of pancreatitis. We report a unique case of IDH caused by acute gallstone pancreatitis in a 37-year-old man. The patient presented with hematemesis and sudden exacerbation of upper abdominal pancreatic pain. An abdominal computed tomography scan showed an intramural hyperdense hematoma and symmetric thickening of the duodenal wall along with peripancreatic inflammation and gallbladder stones. A duodenoscopy also revealed a bloody edematous duodenal wall with a narrow lumen due to IDH. The patient recovered fully from the acute pancreatitis and IDH without pancreaticoduodenectomy using conservative management and a subsequent cholecystectomy.
Cholecystectomy ; Duodenoscopy ; Duodenum ; Gallbladder ; Gallstones ; Hematemesis ; Hematoma ; Humans ; Inflammation ; Pancreaticoduodenectomy ; Pancreatitis

The incidence of retroperitoneal abscess with fistula formation after acute pancreatitis is rare, but the mortality rate for patients with this condition is very high. The standard treatment for this condition has been surgical removal and drainage. However, recent studies have shown that percutaneous catheter drainage or noninvasive endoscopic abscess drainage with using endoscopic ultrasonography is effective and safe for the treatment of pancreatic and peripancreatic abscess. A retroperitoneal abscess with duodenal fistula that developed after acute pancreas and its endoscopic treatment has never been reported on in Korea. We experienced a 45-year-old man who had been treated for acute pancreatitis at other hospital, and he was then referred to our hospital and diagnosed as having a retroperitoneal abscess with fistula, which communicated with the third portion of duodenum, as assessed by abdominal CT and duodenoscopy. So we treated him with endoscopic double-pigtailed stent insertion through the fistulous tract and we drained the abscess. Endoscopic drainage may be a suitable alternative for the management of the retroperitoneal abscess with fistula that develops after acute pancreatitis.
Abscess ; Catheters ; Drainage ; Duodenoscopy ; Duodenum ; Endosonography ; Fistula ; Humans ; Incidence ; Korea ; Middle Aged ; Pancreas ; Pancreatitis ; Stents

Metastasis of renal cell carcinoma to the ampulla of Vater is a rare occurrence. We report a case of acute recurrent pancreatitis caused by metastasis of renal cell carcinoma to the ampulla of Vater. The patient manifested acute recurrent pancreatitis 10 years after a nephrectomy for renal cell carcinoma and was presumed to have obstructive pancreatitis secondary to an ampullary mass. Duodenoscopy revealed an ampullary mass, and the patient was finally diagnosed with metastatic renal cell carcinoma. With insertion of a pancreatic stent via endoscopic retrograde cholangiopancreatography, the acute pancreatitis was resolved. When an ampullary mass is observed in a patient with a history of renal cell carcinoma, the possibility of ampullary metastasis of the renal cell carcinoma should be considered, as this is a potential etiology of acute recurrent pancreatitis.
Ampulla of Vater ; Carcinoma, Renal Cell ; Cholangiopancreatography, Endoscopic Retrograde ; Duodenoscopy ; Humans ; Neoplasm Metastasis ; Nephrectomy ; Pancreatitis ; Stents