A kidney containing more than 1,000 cc fluid in its collecting system is generally defined as giant hydronephrosis. A case of a 24 years old Korean male soldier having giant hydronephrosis (1,800 cc) associated with uretero-pelvic junction stricture and multiple renal stones is presented with review of literatures.
Constriction, Pathologic ; Humans ; Hydronephrosis* ; Kidney ; Male ; Military Personnel ; Young Adult

Afferent loop syndrome is a rare complication of pancreaticoduodenectomy, and the endoscopic approach is difficult due to the surgically altered anatomy. Herein, we report a case of afferent loop obstruction treated by endoscopic metal stent insertion using two endoscopes. A 57-year-old male who had undergone the Whipple operation 7 months prior for pancreatic head cancer presented with abdominal pain and jaundice. Abdominal computed tomography showed afferent loop obstruction due to recurrent metastatic pancreatic cancer. First, we attempted to insert the stent using percutaneous transhepatic approaches following percutaneous transhepatic biliary drainage, but these failed. We therefore accessed the obstruction site using a relatively thin endoscope and then exchanged this endoscope for another with a large working channel, through which the self-expandable metal stent was passed. The stent was inserted successfully. This method will increase the success rate of endoscopic treatment.
Abdominal Pain ; Afferent Loop Syndrome* ; Drainage ; Endoscopes* ; Endoscopy ; Head and Neck Neoplasms ; Humans ; Jaundice ; Male ; Middle Aged ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Stents*

A gangliocytic paraganglioma (GP) is a rare benign neuroendocrine tumor. However, its origin remains unclear. It is seen most frequently in the second portion of the duodenum. At endoscopy, a GP characteristically appears as a pedunculated nodular submucosal tumor with erosions and surface ulcers. The histological diagnosis is usually made from endoscopic biopsies showing the presence of epithelioid, spindle, and ganglion cells. We experienced a case of GP in a 38-year-old female who was referred because of a possible ampullary tumor. The endoscopic images showed a 1.5-cm, oval ampullary tumor covered with normal mucosa. An endoscopic biopsy showed chronic duodenitis. The tumor was removed by an endoscopic papillectomy. We report a case of duodenal GP that presented as a submucosal tumor that was treated with a papillectomy and review the literature.
Adult ; Biopsy ; Diagnosis ; Duodenitis ; Duodenum ; Endoscopy ; Female ; Ganglion Cysts ; Humans ; Mucous Membrane ; Neuroendocrine Tumors ; Paraganglioma* ; Ulcer

BACKGROUND/AIMS: Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Combination therapy w ith ora l udenafil and aceclofenac may reduce the occurrence of post-ERCP pancreatitis by targeting different pathophysiological mechanisms. We investigated whether combining udenafil and aceclofenac reduced the rates of post-ERCP pancreatitis. METHODS: A prospective, randomized, double-blind, placebo-controlled, multicenter study was conducted in four academic medical centers. Between January 2012 and June 2013, a total of 216 patients who underwent ERCP were analyzed for the occurrence of post-ERCP pancreatitis. Patients were determined to be at high risk for pancreatitis based on validated patient and procedure-related risk factors. RESULTS: Demographic features, indications for ERCP, and therapeutic procedures were similar in each group. There were no significant differences in the rate (15.8% [17/107] vs. 16.5% [18/109], p = 0.901) and severity of post-ERCP pancreatitis between the udenafil/aceclofenac and placebo groups. One patient in each group developed severe pancreatitis. Multivariate analyses indicated that suspected dysfunction of the sphincter of Oddi and endoscopic papillary balloon dilation without sphincterotomy were associated with post-ERCP pancreatitis. CONCLUSIONS: Combination therapy with udenafil and aceclofenac is not effective for the prevention of post-ERCP pancreatitis.
Acute Disease ; Administration, Oral ; Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage/adverse effects ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects ; Diclofenac/administration & dosage/adverse effects/*analogs & derivatives ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Pancreatitis/diagnosis/etiology/*prevention & control ; Phosphodiesterase 5 Inhibitors/*administration & dosage/adverse effects ; Prospective Studies ; Pyrimidines/*administration & dosage/adverse effects ; Republic of Korea ; Risk Factors ; Sulfonamides/*administration & dosage/adverse effects ; Treatment Outcome ; Young Adult

Acute pancreatitis can range from a mild, self-limiting disease requiring no more than supportive care, to severe disease with life-threatening complications. With the goal of providing a recommendation framework for clinicians to manage acute pancreatitis, and to contribute to improvements in national health care, the Korean Pancreatobiliary Association (KPBA) established the Korean guidelines for acute pancreatitis management in 2013. However, many challenging issues exist which often lead to differences in clinical practices. In addition, with newly obtained evidence regarding acute pancreatitis, there have been great changes in recent knowledge and information regarding this disorder. Therefore, the KPBA committee underwent an extensive revision of the guidelines. The revised guidelines were developed using the Delphi method, and the main topics of the guidelines include the following: diagnosis, severity assessment, initial treatment, nutritional support, convalescent treatment, and the treatment of local complications and necrotizing pancreatitis. Specific recommendations are presented, along with the evidence levels and recommendation grades.

BACKGROUND/AIMS: Mechanical lithotripsy is generally used when it is difficult to endoscopically remove common bile duct (CBD) stones. However, this procedure not only requires extensive experience, but it is also time consuming. Medium endoscopic sphincterotomy (medium EST) combined with endoscopic papillary large balloon dilation (EPLBD) is recently being increasingly used; therefore, the aim of this study was to evaluate the safety and effects of medium EST with EPLBD for patients with CBD stones that are difficult to remove. METHODS: 41 patients with CBD stones that were difficult to remove by conventional endoscopic methods were enrolled in this study. EPLBD was performed after medium EST. The size of the stones, the procedure time, complications and the total number of sessions needed for stone removal were analyzed. RESULTS: The mean size of the CBD stones was 18.2 +/- 7.7 mm, and the mean number of stones was 2.7. Additional mechanical lithotripsy for complete removal was required in 9.7% (4/41) of the patients. Procedure related complications occurred in 7% (3/41): bleeding in 1 case and acute pancreatitis in 2 cases. CONCLUSIONS: Medium EST with EPLBD was a safe and effective treatment modality for CBD stones that were difficult to remove. Further prospective randomized studies are needed for comparing the effectiveness and safety between conventional EST and medium EST with EPLBD for removing difficult CBD stones.
Common Bile Duct* ; Hemorrhage ; Humans ; Lithotripsy ; Pancreatitis ; Sphincterotomy, Endoscopic*

BACKGROUND/AIMS: Mechanical lithotripsy is generally used when it is difficult to endoscopically remove common bile duct (CBD) stones. However, this procedure not only requires extensive experience, but it is also time consuming. Medium endoscopic sphincterotomy (medium EST) combined with endoscopic papillary large balloon dilation (EPLBD) is recently being increasingly used; therefore, the aim of this study was to evaluate the safety and effects of medium EST with EPLBD for patients with CBD stones that are difficult to remove. METHODS: 41 patients with CBD stones that were difficult to remove by conventional endoscopic methods were enrolled in this study. EPLBD was performed after medium EST. The size of the stones, the procedure time, complications and the total number of sessions needed for stone removal were analyzed. RESULTS: The mean size of the CBD stones was 18.2 +/- 7.7 mm, and the mean number of stones was 2.7. Additional mechanical lithotripsy for complete removal was required in 9.7% (4/41) of the patients. Procedure related complications occurred in 7% (3/41): bleeding in 1 case and acute pancreatitis in 2 cases. CONCLUSIONS: Medium EST with EPLBD was a safe and effective treatment modality for CBD stones that were difficult to remove. Further prospective randomized studies are needed for comparing the effectiveness and safety between conventional EST and medium EST with EPLBD for removing difficult CBD stones.
Common Bile Duct* ; Hemorrhage ; Humans ; Lithotripsy ; Pancreatitis ; Sphincterotomy, Endoscopic*

BACKGROUND/AIMS: Endoscopic ultrasonograpy can provide detailed information about gastrointestinal wall structure and adjacent organs. However there have been few studies about submucosal lesions of the large intestine. We evaluated the usefulness of the miniature ultrasonic probe in the submucosal tumors of the large intestine. METHODS: The miniature ultrasonic probe was applied to 25 patients who had suspicious submucosal lesions of the large intestine, by barium enema or colonoscopy. We evaluated the size, internal echogenecity, border characteristics, and layer of origin of the submucosal lesions by endosonographic findings. The endosonographic images of the lesions were compared with the histologic findings. RESULTS: The lipomas (n=9) were visualized as hyperechoic masses and the carcinoids (n=7) were all hypoechoic masses in the 3rd layer. The lymphangiomas (n=6) were visualized as cystic lesions with septal structures. The granulomas (n=2) were hypoechoic or hyperechoic mass in 3rd layer. Leiomyoma (n=1) was hypoechoic mass in the 2nd layer. The overall diagnostic accuracy was 96%. CONCLUSIONS: The miniature ultrasonic probe scanning is useful in the diagnosis of submucosal lesions of the large intestine. It is also a simple and convenient procedure to assess submucosal tumors of the colon during the total colonoscopic procedure.
Barium ; Carcinoid Tumor ; Colon ; Colonoscopy ; Diagnosis ; Enema ; Granuloma ; Humans ; Intestine, Large* ; Leiomyoma ; Lipoma ; Lymphangioma ; Ultrasonics*

BACKGROUND/AIMS: To investigate the degree of cyclooxygenase-2 (COX-2) protein expression in chronic hepatitis and cirrhosis. METHODS: COX-2 protein expression was evaluated in 43 cases of chronic hepatitis and 24 cases of cirrhosis using immunohistochemical techniques. The COX-2 immunohistochemical staining score was assessed using the scoring systems of Pazirandeh et al and Qiu et al. and each scoring system was based on a sum of the parameters of staining intensity and distribution. RESULTS: The mean COX-2 expression scores in chronic hepatitis and cirrhosis were 2.5 +/- 1.3 vs. 3.3 +/- 1.1 (p = 0.008), and 3.2 +/- 2.0 vs. 4.5 +/- 1.7 (p = 0.006), respectively, based on the Pazirandeh et al. and Qiu et al. scoring systems. The percentage samples of high COX-2 expression score (4 to 5) in chronic hepatitis and cirrhosis were 16.3% vs. 45.8% (p = 0.022), and 23.3% vs. 50% (p = 0.021), respectively, based on the two scoring systems. The mean COX-2 expression scores based on the severity of hepatic fibrosis scored using Ishak's modified staging system (fibrosis score 0 to 3 vs. 4 to 6) were 2.4 +/- 1.3 vs. 3.2 +/- 1.1 (p = 0.009), and 3.1 +/- 2.0 vs. 4.3 +/- 1.8 (p = 0.009), respectively, based on the two scoring systems. CONCLUSIONS: COX-2 expression was significantly higher in liver cirrhosis group than in chronic hepatitis. COX-2 expression scores according to Ishak's staging was significantly higher in the advanced fibrosis group. COX-2 may play a role in the progression of hepatic fibrosis.
Adult ; Aged ; Cyclooxygenase 2/analysis/*physiology ; Cyclooxygenase 2 Inhibitors/therapeutic use ; Disease Progression ; Female ; Hepatitis, Chronic/enzymology ; Humans ; Immunohistochemistry ; Liver Cirrhosis/drug therapy/*enzymology ; Male ; Middle Aged

BACKGROUND/AIMS: Sustained HBV DNA reduction is necessary for biochemical remission, histological improvement, and prevention of complications. We analyzed the time taken from HBV DNA loss to viral breakthrough after antiviral treatment in patients with chronic hepatitis B (CHB). The early fall of the HBV DNA level to undetectable levels assessed really whether it is related to late breakthrough. METHODS: A total of 91 patients whose HBV DNA levels dropped below undetectable levels were chosen from lamivudine-treated 306 patients and were analyzed retrospectively. The patients were divided into 4 groups (A< or =12, 1248 wk) according to the time taken for the HBV DNA to decrease below undetectable levels. HBV DNA level was determined every 3 months. RESULTS: The mean time taken for loss of HBV DNA was 34+/-28 wk. The baseline ALT differed significantly among groups (A: 382+/-274, B: 340+/-30, C: 166+/-92, D: 54+/-100 IU/L) (p=0.007). Fifty nine of the 91 patients (64.8%) experienced viral breakthrough. The mean interval between HBV DNA loss and viral breakthrough was 65+/-40 wk and differed significantly between group A, B (82+/-43 wk) and group C, D (56+/-28 wk) (p=0.015). In multivariate analysis, only HBV DNA loss within 24 wk, was found to be independently associated with late viral breakthrough (p=0.035). Undetectable HBV DNA after 24 wk was associated with high odd ratio of 3.24 (95% CI, 1.09-9.67). CONCLUSIONS: HBV DNA loss within 24 wk after antiviral treatment could predict the late breakthrough.
Adult ; Alanine Transaminase/blood ; Antiviral Agents/therapeutic use ; Aspartate Aminotransferases/blood ; DNA, Viral/blood ; Drug Administration Schedule ; Female ; Hepatitis B virus/*isolation & purification ; Hepatitis B, Chronic/drug therapy/*virology ; Humans ; Lamivudine/therapeutic use ; Male ; Middle Aged ; Odds Ratio ; *Predictive Value of Tests ; Retrospective Studies