No abstract available.

Choledocholithiasis carries a risk of developing biliary obstruction, acute cholangitis, and pancreatitis. Therefore, removal is recommended even in asymptomatic patients. Endoscopic retrograde cholangiopancreatography (ERCP) is regarded as the standard of treatment for choledocholithiasis nowadays. However, ERCP can accompany severe complications such as bleeding, ERCP-associated pancreatitis, cholangitis, and perforations. It is important for endoscopists to know how to remove choledocholithiasis effectively while minimizing adverse events. In this review, we will go over the technical aspects and various accessories to effectively remove choledocholithiasis.

Acute pancreatitis is a sudden inflammatory disease that could be developed into a fatal condition. Traditional dogma was to rest the pancreas by fasting. However, evidence shows the benefits of early enteral feeding resulting in a shorter hospital stay, improved mortality, multi-organ failure, systemic infections, and the need for operative interventions. Clinicians should encourage enteral feeding as soon as possible even in severe acute pancreatitis if there are no contraindications. An immediate solid diet could be attempted. Regarding tube feeding, the nasojejunal tube did not show superiority to the nasogastric tube. Different formulas and probiotics need more investigation. Guidelines are against using prophylactic antibiotics, but Korean centers still report overuse of antibiotics. However, there is still a debate about using prophylactic antibiotics in severe acute pancreatitis. Broad-spectrum antibiotics should be initiated when an infection is suspected. In conclusion, enteral nutritional support and optimal use of antibiotics are the keys to the management of acute pancreatitis.

Acute pancreatitis is a sudden inflammatory disease that could be developed into a fatal condition. Traditional dogma was to rest the pancreas by fasting. However, evidence shows the benefits of early enteral feeding resulting in a shorter hospital stay, improved mortality, multi-organ failure, systemic infections, and the need for operative interventions. Clinicians should encourage enteral feeding as soon as possible even in severe acute pancreatitis if there are no contraindications. An immediate solid diet could be attempted. Regarding tube feeding, the nasojejunal tube did not show superiority to the nasogastric tube. Different formulas and probiotics need more investigation. Guidelines are against using prophylactic antibiotics, but Korean centers still report overuse of antibiotics. However, there is still a debate about using prophylactic antibiotics in severe acute pancreatitis. Broad-spectrum antibiotics should be initiated when an infection is suspected. In conclusion, enteral nutritional support and optimal use of antibiotics are the keys to the management of acute pancreatitis.

Gastric outlet obstruction is a major symptom in patients with advanced pancreatic cancer. Endoscopic intervention is often challenging in severe strictures because the guidewire cannot pass beyond the stricture. Sometimes, the air itself cannot pass beyond the stricture, which can result in a severely distended stomach. Such a stomach is vulnerable to excessive air insertion or mechanical stress during endoscopic procedures, and endoscopists may encounter a higher rate of complications. Gastric perforation is rare but could be fatal. However, endoscopic management can show a favorable result if the perforation is noticed early. The authors report a case of the perforation of a gastric tear during duodenal stent insertion in a patient with a gastric outlet obstruction.

The guidewire is an essential accessory in ERCP. Although rare, guidewires can cause complications, such as subcapsular hepatic hematoma, perforation, knotting, fracture, and impaction, during ERCP. This report describes a guidewire impaction during the endoscopic treatment of a patient with symptomatic chronic pancreatitis. The methods used to treat guidewire impaction are not well known. In the present case, the impacted guidewire was retrieved by inserting another guidewire and dilating the space adjacent to it. Endoscopists should check for the free movement of the guidewire before stent deployment. Additionally, it is important to ask for help from experienced senior staff to overcome any challenges during the procedure. In conclusion, endoscopists should be aware of the possibility of a guidewire impaction during ERCP.

Biliary-colonic fistula is a rare complication after hepatic resection. We present at a case of asymptomatic biliary-colonic fistula that developed 6 months after hepatectomy in a 73-year old female patient. She had been undergoing endoscopic treatment for a postoperative bile leakage, and the fistula was found by follow-up endoscopic retrograde cholangiopancreatography (ERCP). The fistula was formed between the right posterior segmental duct and the colon, and it was closed by colonoscopic clipping under fluoroscopic guidance. There was no recurrence at the 6-week follow-up ERCP.
Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Colon ; Colonoscopy ; Female ; Fistula ; Follow-Up Studies ; Hepatectomy ; Humans ; Recurrence

Up to 15% of acute pancreatitis can develop to acute necrotizing pancreatitis characterized by necrosis of the pancreas parenchyma and/or the peripancreatic tissue. It is associated with high rates of morbidity and mortality compared to interstitial edematous pancreatitis. A collection of fluid and necrotic tissue is called acute necrotic collections (ANC) and may form an enhancing wall consisting of reactive tissue after 4 weeks, which is called walled-off necrosis (WON). ANC and WON could be either sterile or infected. WON is often complex and septated, and when it gets infected or causes other serious complications, drainage or resection is indicated. The traditional approach is to surgically remove all the infected necrotic tissue, but this invasive approach carries high rates of complications and death. The recent advance of percutaneous and/or endoscopic approaches has enabled a stepup method for the management of necrotizing pancreatitis. Herein, the authors focused on the endoscopic and percutaneous approaches for the care of patients with necrotizing pancreatitis.
Drainage ; Endoscopy ; Humans ; Methods ; Mortality ; Necrosis ; Pancreas ; Pancreatitis ; Pancreatitis, Acute Necrotizing

Serous cystic neoplasm (SCN) represents 10–16% of cystic pancreatic lesions, first classified by Compagno and Oertel at 1978. In contrast to mucinous cystic neoplasm or intraductal papillary mucinous neoplasm of pancreas which have malignant potential, SCN is thought to be exclusively benign as solitary lesion in nearly all cases. There has been rare reported association between the SCN and pancreatic ductal adenocarcinoma, and few cases were documented their coexistence. In this report, we present the case of SCN of the pancreas with literature review in which synchronous pancreatic ductal adenocarcinoma and pancreatic intraepithelial neoplasm coexist together.

Pancreatic adenocarcinoma is one of the cancers with the poorest prognosis, and its incidence has gradually increased to become the 9th most common cancer in Korea in 2016. Surgical resection is the only treatment option to improve the cure and longterm survival rate. Unfortunately, only 10% to 20% of all pancreatic cancer patients present with resectable disease, because of common symptoms are rarely noticeable in its early stages and disease progress very quickly. Unresectable pancreatic cancer can be divided into locally advanced pancreatic cancer (LAPC) and metastatic disease. Pancreatic cancer with distant metastasis accounts for about 40–60% of the total pancreatic cancer and systemic chemotherapy is considered as standard treatment. LAPC is observed in 30–40%, defined as the tumor surrounding major blood vessels (especially, celiac artery and superior mesenteric artery) more than 180° without distant metastasis which cannot be completely removed by surgery. Standard treatment for LAPC has not yet been established, and chemotherapy and radiotherapy have mainly been used, but in most cases, response to these therapeutic options has been limited. As imaging techniques, endoscopic devices and procedures have recently been developed and the role of local endoscopic therapies for LAPC has expanded. This article provides an overview of local endoscopic treatment for LAPC such as injection therapy, radiofrequency ablation (RFA), irreversible electroporation (IRE), radiotherapy and drug-delivery stent insertion.