Jaundice is one of the poor prognostic factors in the patient with hepatocellular carcinoma (HCC). In HCC patients, the most common cause of jaundice is liver parenchymal dysfunction and jaundice due to biliary obstruction is relatively rare. However, it is clinically important because biliary obstruction can be treated effectively with biliary drainage procedure and by that quality of life and survival of the patient can be improved. It is important to identify the mechanism and location of the bile duct obstruction for an appropriate management of the biliary obstruction. Endoscopic retrograde biliary drainage (ERBD) has commonly been selected as the first-line treatment. However, percutaneous transhepatic biliary drainage or endoscopic ultrasound guided biliary drainage also can be used when the endoscopic approach is impossible or when ERBD fails. Between two types of stents - plastic or self-expandable metal, there is no definitive evidence about which one is superior. Stent type should be selected according to the characteristics of obstruction and expected survival of patient.
Carcinoma, Hepatocellular* ; Cholestasis ; Cholestasis, Extrahepatic ; Disease Management ; Drainage ; Humans ; Jaundice ; Jaundice, Obstructive* ; Liver ; Plastics ; Quality of Life ; Stents ; Ultrasonography

Transpancreatic septotomy is known to improve the success rate of selective bile duct cannulation in endoscopic retrograde cholangiopancreatography. Recent retrospective study reported that transpancreatic septotomy is more effective and safer than needle knife sphincterotomy. Herein, we report a case of patient with gallstone pancreatitis who suffered from intramural duodenal hematoma after transpancreatic septotomy that caused obstruction of the duodenum and hypovolemic shock. The intramural hematoma improved after conservative management. The rare adverse event such as intramural duodenal hematoma seems to be considered after transpancreatic septotomy, especially when acute pancreatitis is accompanied.
Bile Ducts ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde* ; Duodenum ; Gallstones ; Hematoma* ; Humans ; Needles ; Pancreatitis ; Retrospective Studies ; Shock

Nontraumatic spontaneous intramural hematoma is an infrequent complication of the use of oral anticoagulants. The most commonly affected site is the jejunum followed by ileum and duodenum. The symptoms can vary depending on the location and size of hematoma. Patients with intramural hematoma usually present with abdominal pain, nausea and vomiting, but rarely present with hematuria, pancreatitis, cholangitis. An obstructive jaundice and acute cholecystitis has not been reported as a secondary cause of duodenal intramural hematoma in Korea so far. Here, we report spontaneous duodenal intramural hematoma caused by anticoagulant therapy that associated with transient obstructive jaundice and acute cholecystitis in a 79-year-old man, which was successfully managed conservative management. In addition, we reviewed reports of intramural hematoma with literature review.
Abdominal Pain ; Aged ; Ampulla of Vater* ; Anticoagulants ; Cholangitis ; Cholecystitis ; Cholecystitis, Acute* ; Duodenum ; Hematoma* ; Hematuria ; Humans ; Ileum ; Jaundice, Obstructive* ; Jejunum ; Korea ; Nausea ; Pancreatitis ; Vomiting

Among complications of choledochal cysts, malignant transformation is most concerning and management of choledochal cyst now includes complete cyst excision, whenever possible. In cases of choledochal cyst associated with pancreaticobiliary maljunction like our case, cholecystectomy along with the resection of dilatated bile duct and the biliary diversion are generally performed. However, incomplete cyst excision can result in malignant transformation within the remnant cyst. We present the case of cholangiocarcinoma arising from remnant intrapancreatic cyst 15 years after choledochal cyst excision in a patient with Todani type 1 choledochal cyst associated with pancreaticobiliary maljunction. We learn from the case that a careful long-term follow-up is needed in patients with choledochal cysts if residual cyst is remained after excision.
Bile Ducts ; Cholangiocarcinoma* ; Cholecystectomy ; Choledochal Cyst* ; Follow-Up Studies ; Humans ; Pancreatic Cyst

A 46-year-old female with abnormal radiologic finding was diagnosed with pancreatic neuroendocrine tumor and multiple hepatic metastasis. Molecular targeted therapy (everolimus) and two times of transarterial chemoembolizations (TACE) were performed before pylorus-preserving pancreaticoduodenectomy (PPPD). After 2nd TACE and PPPD, grade 2 pancreatic neuroendocrine tumor was pathologically confirmed. Four times of additional TACE was done. After size increase of several probable hepatic metastasis in the both lobes of liver, laparoscopic left lateral sectionectomy of liver was performed. After two and half years of left lateral sectionectomy, 7th TACE was performed and the patients have survived without further disease progression. This case suggests that patients with pancreatic neuroendocrine tumor and hepatic metastasis can be treated by TACE, primary tumor resection, surgery for liver metastasis and molecular targeted therapy. Therefore, aggressive multidisciplinary approaches need to be considered for long term survival of patients with pancreatic neuroendocrine tumor with hepatic metastasis.
Disease Progression ; Female ; Humans ; Liver ; Middle Aged ; Molecular Targeted Therapy ; Neoplasm Metastasis ; Neuroendocrine Tumors* ; Pancreas ; Pancreaticoduodenectomy

BACKGROUND/AIM: The aim of this study was to evaluate the stability and simplicity of papillary balloon dilatation by retrospectively analyzing the results of performing concurrent papillary balloon dilatation in conjunction with percutaneous transhepatic biliary drainage (PTBD) in the patients with biliary obstruction due to common bile duct stones or a tumor who were difficult to treat with an endoscopic approach. METHODS: We retrospectively analyzed a total of 21 patients who were treated through a percutaneous transhepatic biliary approach after they were diagnosed with biliary obstruction due to a tumor and biliary stones in a single medical institution for four years from 2012 to 2015. RESULTS: Sixteen out of 21 patients (76.2%) underwent percutaneous transhepatic biliary drainage and papillary balloon dilatation. For 5 patients (23.8%) in whom it was difficult to perform the procedure simultaneously due to the patient's poor overall condition such as pancreatitis and septic shock, papillary balloon dilatation was performed 5-8 days after biliary drainage. Nineteen of 21 patients (90.5%) were successfully treated by a single procedure without residual stones or restenosis, but in two patients, stones were removed two times and three times. CONCLUSIONS: The use of a percutaneous transhepatic biliary approach to patients in whom endoscopy cannot be performed is considered safe and effective. In addition, unless the procedure is specifically contraindicated, the use of papillary balloon dilatation performed simultaneously with PTBD can reduce patient inconvenience and procedure frequency.
Common Bile Duct ; Dilatation* ; Drainage* ; Endoscopy ; Gallstones ; Humans ; Pancreatitis ; Retrospective Studies ; Shock, Septic

BACKGROUND/AIM: Adenocarcinoma arising from the ampulla of Vater is a rare disease and has limited data regarding outcome of palliative chemotherapy. We investigated the efficacy and safety of capecitabine plus oxaliplatin (XELOX) in patients with advanced ampullary adenocarcinoma. METHODS: From October 2006 to January 2014, we retrospectively analyzed 28 patients with advanced ampullary adenocarcinoma treated by XELOX regimen at single institution. All the patients had histologically confirmed stage IV or recurrent ampullary adenocarcinoma. XELOX was administered in outpatient clinic every 3 weeks according to the following protocol: oral administration of capecitabine 750 mg/m² twice a day on days 1-14 and intravenous injection of oxaliplatin 130 mg/m² on day 1. RESULTS: With follow-up of median 24.6 months (range 4.0–78.0 months), median progression-free survival (PFS) was 4.8 months (range 0.7–26.1 months), and median overall survival (OS) was 11.9 months (range 2.0–36.0 months). One patient (4%) achieved complete response and 5 patients (18%) showed partial response. There were no significant differences for PFS and OS according to response by chemotherapy. The most common grade 3 adverse events in patients were nausea and vomiting (10.7%). There was no treatment-related mortality. CONCLUSIONS: XELOX regimen is well tolerated and show moderate activity against advanced ampullary adenocarcinoma.
Adenocarcinoma* ; Administration, Oral ; Ambulatory Care Facilities ; Ampulla of Vater* ; Antineoplastic Agents ; Capecitabine* ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Injections, Intravenous ; Mortality ; Nausea ; Rare Diseases ; Retrospective Studies ; Vomiting

Autoimmune pancreatitis is a rare type of chronic pancreatitis. Unlike chronic pancreatitis caused by other causes, autoimmune pancreatitis is characterized by a dramatic response to corticosteroid and immunomodulator therapy. Two most widely used drugs for treatment of autoimmune pancreatitis are corticosteroid and immunomodulators. Corticosteroid is the first line drug for autoimmune pancreatitis and used for remission induction. Remission induction rate of corticosteroid therapy is more than 90%, but relapse rate is approximately 30%. Centers in Japan and Republic of Korea prefer low-dose corticosteroid for maintenance. On the other hand, centers in North America and Europe prefer immunomodulators for maintenance. In the future, well-designed studies on methods to decrease relapse rate of autoimmune pancreatitis and effective use of immunomodulators are needed.
Adrenal Cortex Hormones ; Autoimmune Diseases ; Drug Therapy ; Europe ; Hand ; Immunologic Factors ; Japan ; North America ; Pancreatitis* ; Pancreatitis, Chronic ; Recurrence ; Remission Induction ; Republic of Korea

Although asymptomatic bile duct dilatation was commonly found in clinical practice due to the development of imaging devices and frequent health screening examination, it is sometimes difficult to distinguish between normal and abnormal. In evaluating the cause of bile duct dilatation, comprehensive approach should be accompanied, instead of determining by using any one of imaging modalities. Before diagnosing bile duct dilatation, physiologic changes due to aging and history of biliary operation might be considered. The acceptable range for normal diameter of bile duct is 7-8 mm in transabdominal ultrasonography and less than 10 mm in cholangiography. However, the diameter of bile duct in elderly is acceptable up to 10 mm and 12 mm, respectively. Among patients with incidentally found bile duct dilation, further additional image studies are required to confirm the cause of bile duct dilatation in case of presence of symptom and abnormal liver function test. Meanwhile, the truly asymptomatic patient with normal liver enzyme profiles should be followed closely with clinical and laboratory follow-up to help decide whether any additional imaging would be appropriate.
Aged ; Aging ; Bile Ducts* ; Bile* ; Cholangiography ; Dilatation* ; Endosonography ; Follow-Up Studies ; Humans ; Liver ; Liver Function Tests ; Mass Screening ; Ultrasonography

Health care screening is becoming more popular in Korea as more people are interested in well-being and health. However, there are controversies regarding usefulness of screening. Tumor markers are frequently measured in the health care screening. As a result, many patients end up visiting physicians because of incidentally found increased levels of tumor markers. Carbohydrate antigen (CA) 19-9 is the single most useful tumor marker for pancreatic cancer. Although CA 19-9 is useful for predicting prognosis and evaluating treatment response for pancreatic cancer, CA 19-9 is less useful for screening of pancreatic cancer because of low incidence of pancreatic cancer.
Biomarkers ; Biomarkers, Tumor ; CA-19-9 Antigen ; Delivery of Health Care ; Early Detection of Cancer ; Humans ; Incidence ; Korea ; Mass Screening ; Pancreatic Neoplasms ; Prognosis