Prirnary sclerosing cholangitis, a chronic progressive cholestatic hepatobiliary disorder of unknown etiology, is characterized by inflammation, scarring and obliteration of bile duct leading to biliary cirrhosis and liver failure. Because histologic finding has only a limited role in the diagnosis, the gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricutre or beading. The natural history is extremely variable. We report two cases of primary sclerosing cholangitis diagnosed by repeated endoscopic retrograde cholangiographies. They were followed up for 7 and 2 years, respectively.
Bile Ducts ; Cholangiography ; Cholangitis, Sclerosing* ; Cicatrix ; Diagnosis ; Inflammation ; Liver Cirrhosis, Biliary ; Liver Failure ; Natural History

Collagenous colitis is an uncommon condition charaeterized clinically by diarrhea and weight loss and histologically by thickening of the subepithelial collagen band with chromic inflammation. Laboratory tests of blood, urine and stool, and colonscopic findings are usually normal. The etiology of collagenous colitis is unknown. We report a case of collagenous colitis improved after treatment with sulfasalazine with review of literatures.
Colitis, Collagenous* ; Collagen* ; Diarrhea ; Inflammation ; Sulfasalazine ; Weight Loss

Approximately one-third of patients with Crohn's disease do not respond to conventional treatments, and some experience significant adverse effects, such as serious infections and lymphoma, and many patients require surgery due to complications. Increasing evidence suggests that specific changes in the composition of gut microbiota, termed as dysbiosis, are a common feature in patients with inflammatory bowel disease (IBD). Dysbiosis can lead to activation of the mucosal immune system, resulting in chronic inflammation and the development of mucosal lesions. Recently, fecal microbiota transplantation, aimed at modifying the composition of gut microbiota to overcome dysbiosis, has become a potential alternative therapeutic option for IBD. Herein, we present a patient with Crohn's colitis in whom biologic therapy failed previously, but clinical remission and endoscopic improvement was achieved after a single fecal microbiota transplantation infusion.
Biological Therapy ; Colitis ; Crohn Disease* ; Dysbiosis ; Fecal Microbiota Transplantation* ; Gastrointestinal Microbiome ; Humans ; Immune System ; Inflammation ; Inflammatory Bowel Diseases ; Lymphoma

Obstructive disorders of the biliary trees include occlusions of the bile duct lumen by stones, intrinsic disorders of the bile ducts, and extrinsic compressions. The most common biliary cause of obstructive jaundice is the presence of stones. Intrinsic disorders of the bile ducts may be inflammatory, infectious, or neoplastic. And significant enlargement of adjacent lymph nodes due to metastatic tumors or lymphoma can occasionally obstruct the extrahepatic bile ducts. But obstructive jaundice produced by periportal tuberculous lymphadenitis with no evidence of pulmonary tuberculosis is very rare. We report a case of tuberculous lymphadenitis causing obstructive jaundice with a mass around mid common bile duct on abdominal sonogram, CT scan and ERCP, and it was confirmed by an exploratory laparotomy.
Bile Ducts ; Bile Ducts, Extrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Jaundice, Obstructive* ; Laparotomy ; Lymph Nodes ; Lymphoma ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node* ; Tuberculosis, Pulmonary

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography(ERCP) or operative cholangiography is the procedure to demonstrate and remove stones of the biliary tree in patients undergoing laparoscopic cholecystectomy(LC) due to cholelithiasis. However, ERCP or operative cholangiography is an invasive procedure. The next question then is when and for what indication should ERCP or operative cholangiography be performed. The aims of this study were to assess whether prediction of common bile duct(CBD) stones by the noninvasive method such as liver function test and/or clinical findings is possible, and to investigate which method is more adequate for removal of CBD stones found on ERCP or operative cholangiography. METHODS: A total 207 patients with symptomatic cholelithiasis scheduled for LC were enrolled from September 1993 to August 1996. Patients who were already found to have either extrahepatic or intrahepatic biliary stones on sonogram were excluded. Patients were classified into risk group and non-risk group. Patients who belong to the risk group were those having CBD dilatation by ultrasonography, history of jaundice or cholangitis, gallstone pancreatitis, or elevated transaminases. RESULTS: 54 cases were confirmed to have CBD stones by preoperative ERCP(49 cases) and operative cholangiography(5 cases). Detection rate of CBD stones in risk group was 26.8%(22.2% in CBD dilatation, 50.0% in jaundice, 42.9% in history of cholangitis, and 0% in history gallstone pancreatitis or elevated transaminase). Detection rate of CBD stones in non-risk group was 7.7%. All of 12 patients who had CBD stones were successfully removed(10 with preoperative endoscopic removal, 1 with postoperative endoscopic removal, and 1 with CBD exploration). CONCLUSIONS: Jaundice or cholangitis need the preoperative ERCP and, if stones are found, they can be revoved endoscopically. CBD dilatation may be an indication for operative cholangiography rather than preoperative ERCP, and, if CBD stones were found, they can be revoved by laparoscopic CBD exploration or postoperative ERCP. But history of gallstone pancreatitis, elevated transaminases, or patients with no risk factors may not need preoperative ERCP or operative cholangiography considering the cost-effectiveness or possible morbidity.
Bile ; Biliary Tract ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy, Laparoscopic* ; Choledocholithiasis* ; Cholelithiasis* ; Dilatation ; Gallstones ; Humans ; Jaundice ; Liver Function Tests ; Pancreatitis ; Risk Factors ; Transaminases ; Ultrasonography

Endoscopic retrograde cholangiography has now evolved into a highly sophisticated diagnostic and therapeutic tool in patients with hepatobiliary-pancreatic disorders. However, this procedure is associated with risks of significant complications such as cholangitis, pancreatitis, hemorrhage, and perforation which have been widely recognized. Hepatic subcapsular biloma is a very rare and less recognized complication of this procedure. Recently, we experienced a case of hepatic subcapsular biloma, developed after endoscopic removal of choledocholithiasis, managed with percutaneous drainage procedure and endoscopic stenting, and report with a review of literature.
Cholangiography* ; Cholangitis ; Choledocholithiasis ; Drainage ; Hemorrhage ; Humans ; Pancreatitis ; Stents

BACKGROUND: Conventional endoscopic sphincterotomy with papillotome(CES) is an established method of management for patients with biliary obstruction from various causes. However, an alternative treatment to CES must be considered when antecedent cholangiagraphy is unsuccessful or when cannulatian with the conventional papillotome fails. The needle-knife papillotomy(NKP) is one of the alternative methods to CES. Recently, it has been suggested that NKP can be used to achieve diagnostic cholangiography. But NKP is controversial because results from studies assessing its efficacy and safety are conflicting. The current study was undertaken to assess retrospectively the efficacy and safety of NKP and CES. METHODS: All enrolled patients(CES group 113, NKP group 105) underwent ERCP between September 1993 and August 1996 at Korea Univeisity Guro Hospital. NKP for cannulation was used only when biliary tract disease was suspected but deep canulation failed inspite of several attempts. The efficacy and safety of NKP and CES were evaluated according to the rate of success of performing purposes(removal of common bile duct stones, inser tion of endoscopic nasobiliary drainage or endoprosthesis, treatment of sphincter of Oddi dysfunction, and cannulation) and complications(bleeding, perforation, pancreatitis). RESULTS: 1. Overall success rates of performing purposes were 92.9% in CES group(removal of common bile duct stones 95.2%, insertion of endoscopic nasobiliary drainage or endoprosthesis 84.6%, treatment of sphincter of Oddi dysfunction 100%) and 80.0% in NKP group(removal of common bile duct stone 86.7%, insertion of endoscopic nasobiliary drainage or endoprosthesis 80.6%, treatment of SO dysfunction 100%, cannulation 70.6%). The success rate of CES was significantly higher than that of NKP(p=0.04). 2. The morbidity rate of NKP was 10.5%(8 bleeding cases, 1 perforation case, 2 pancreatitis cases) but was not significantly different from that of rate for CES 8.0%(9 bleeding dases). 19 patients with complications recovered uneventfully with conservative treatment. Only 1 patient(ampullary carcinoma) undertwent operation due to severe bleeding after NKP. There was no procedure-related mortality in both groups. CONCLUSION: NKP is an effective endoscopic tool allowing successful endoscopic sphincterotomy when conventional technique fails. And, in carefully selelected cases, NKP is a useful aid for a successful diagnostic cholangiograph.
Biliary Tract Diseases ; Catheterization ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Drainage ; Hemorrhage ; Humans ; Korea ; Mortality ; Pancreatitis ; Retrospective Studies ; Sphincter of Oddi Dysfunction ; Sphincterotomy, Endoscopic*

Gastric volvulus is torsion of the stomach axis accompanied by obstruction and/or strangulation. It is a very rare condition, but it is considered a clinical emergency when it occurs acutely. Acute gastric volvulus requires an early diagnosis and prompt surgical treatment because a delayed diagnosis may lead to gastric obstruction, ischemia and necrosis. We experienced two cases of acute gastric volvulus due to diaphragmatic hernia and the patients were successfully treated with surgery. Here, we report on these two cases with the review of the reported literature on 26 adult cases of gastric volvulus in South Korea.
Adult ; Axis, Cervical Vertebra ; Delayed Diagnosis ; Early Diagnosis ; Emergencies ; Hernia, Diaphragmatic ; Humans ; Ischemia ; Necrosis ; Republic of Korea ; Stomach ; Stomach Volvulus

Esophageal retrograde peristalsis is known to be absent normally. This rare finding, if it happens, usually suggests a possibility that proximal ends of the manometric catheter are connected to the pressure transducers in a reverse order. We report a case showing repeated retrograde peristalsis during an esophageal manometric examination due to an inadventently hooked catheter in the esophagus during insertion. We suggest that if a retrograde peristalsis is repeatedly observed during a manometric session, an erroneous recording due to a hooked catheter in the esophageal lumen should be considered as one possibility.
Catheters* ; Esophagus* ; Peristalsis* ; Transducers, Pressure

Ampullary adenoma is a benign neoplasm with malignant potential that arises from the glandular epithelium of the ampulla of Vater. When the tumor is confined to the ampulla, abdominal sonogram and CT scan can show dilatation of the common bile duct or pancreatic duct, but the mass itself may not be seen. And even biopsies are done, the confirmation of malignant change is frequently missed, and it may be impossible to assess the presence of carcinoma in situ or invasive carcinoma without complete exicision of the lesion. So complete surgical resection is recommended because of extensive growth of the ampullary adenoma and its malignant potential. Recently, we experienced a case of about 0.8 x 1.0 cm sized tumor of the ampulla of Vater that was diagnosed as villous adenoma on endoscopic biopsy, and malignant change was found on resected surgical specimen.
Adenoma ; Adenoma, Villous* ; Ampulla of Vater* ; Biopsy ; Carcinoma in Situ ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Dilatation ; Epithelium ; Pancreatic Ducts ; Tomography, X-Ray Computed