Pub Date : 2024-01-31DOI: 10.15279/kpba.2024.29.1.9
Jin Lee, E. Hong, Kyung Joo Lee, Se Woo Park, Dong Hee Koh
Background/Aim: Reactive oxygen species (ROS) are associated with the growth and invasion of malignant tumors. Ursodeoxycholic acid (UDCA) was proven to block the EGFR-MAPK signaling pathway and epithelial-mesenchymal transition (EMT) in bile duct cancer (BDC) cells. This study was performed to determine the effect of UDCA on ROS activity in BDC cells.Methods: Human extrahepatic BDC cells were cultured. MTT assays evaluated cell viability, and ROS assay kit measured ROS. The western blot assays measured the expression levels of various target proteins. SiRNA was used for silencing of specific genes, and shRNA was used for over-expression of specific genes.Results: UDCA suppressed DCA-induced production of peroxide and ROS, inhibited expression of PRX2, phosphorylated STAT3 and SOD2, and decreased expression of NOX2 and NOX4 in BDC cells. PRX2 and STAT3 were involved in inhibiting EMT by UDCA. UDCA restored the expression of catalase inhibited by DCA in BDC cells. Furthermore, overexpression of NOX4 using shRNA offset the antineoplastic effect of UDCA in BDC cells.Conclusions: UDCA suppresses the production of ROS and enhances the elimination of ROS, inhibiting STAT3 and PRX2 associated with EMT in BDC cells. Accordingly, UDCA contributes to inhibiting the growth and invasiveness of BDC cells via suppression of ROS activity and EMT.
{"title":"Ursodeoxycholic Acid Suppresses Epithelial-Mesenchymal Transition via Inhibition of Reactive Oxygen Species in Bile Duct Cancer Cells","authors":"Jin Lee, E. Hong, Kyung Joo Lee, Se Woo Park, Dong Hee Koh","doi":"10.15279/kpba.2024.29.1.9","DOIUrl":"https://doi.org/10.15279/kpba.2024.29.1.9","url":null,"abstract":"Background/Aim: Reactive oxygen species (ROS) are associated with the growth and invasion of malignant tumors. Ursodeoxycholic acid (UDCA) was proven to block the EGFR-MAPK signaling pathway and epithelial-mesenchymal transition (EMT) in bile duct cancer (BDC) cells. This study was performed to determine the effect of UDCA on ROS activity in BDC cells.Methods: Human extrahepatic BDC cells were cultured. MTT assays evaluated cell viability, and ROS assay kit measured ROS. The western blot assays measured the expression levels of various target proteins. SiRNA was used for silencing of specific genes, and shRNA was used for over-expression of specific genes.Results: UDCA suppressed DCA-induced production of peroxide and ROS, inhibited expression of PRX2, phosphorylated STAT3 and SOD2, and decreased expression of NOX2 and NOX4 in BDC cells. PRX2 and STAT3 were involved in inhibiting EMT by UDCA. UDCA restored the expression of catalase inhibited by DCA in BDC cells. Furthermore, overexpression of NOX4 using shRNA offset the antineoplastic effect of UDCA in BDC cells.Conclusions: UDCA suppresses the production of ROS and enhances the elimination of ROS, inhibiting STAT3 and PRX2 associated with EMT in BDC cells. Accordingly, UDCA contributes to inhibiting the growth and invasiveness of BDC cells via suppression of ROS activity and EMT.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"358 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140472184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.15279/kpba.2024.29.1.25
M. Park, Jiyoun Kim, Sagong Min, Kangkook Lee, Ji Yeon Lee, Kwang Bum Cho
Hemorrhagic cholecystitis (HC) is a rare form of cholecystitis that may be caused by the progression of either calculous or acalculous cholecystitis, which has been reported sporadically as case reports. Acalculous cholecystitis is often diagnosed late and can be fulminant. HC without gallstones also can have a poor prognosis and be linked to a high mortality rate. Therefore, early detection, hemodynamic monitoring, and prompt treatment are essential to treat bleeding in cholecystitis. We report a case of hemorrhagic acalculous cholecystitis discovered during the examination and point-of-care ultrasound in a patient with pyogenic spondylodiscitis. The patient was referred with a chief complaint of liver dysfunction without bleeding tendencies or risk factors. Ultrasound revealed focal gallbladder wall irregularity, intraluminal membranes, and non-shadowing non-layering intraluminal echoes. Extravascular contrast leakage was exhibited on the computed tomography scan. The patient underwent emergency percutaneous drainage and subsequent cholecystectomy before developing major complications.
{"title":"Hemorrhagic Acalculous Cholecystitis in Pyogenic Spondylodiscitis Patient","authors":"M. Park, Jiyoun Kim, Sagong Min, Kangkook Lee, Ji Yeon Lee, Kwang Bum Cho","doi":"10.15279/kpba.2024.29.1.25","DOIUrl":"https://doi.org/10.15279/kpba.2024.29.1.25","url":null,"abstract":"Hemorrhagic cholecystitis (HC) is a rare form of cholecystitis that may be caused by the progression of either calculous or acalculous cholecystitis, which has been reported sporadically as case reports. Acalculous cholecystitis is often diagnosed late and can be fulminant. HC without gallstones also can have a poor prognosis and be linked to a high mortality rate. Therefore, early detection, hemodynamic monitoring, and prompt treatment are essential to treat bleeding in cholecystitis. We report a case of hemorrhagic acalculous cholecystitis discovered during the examination and point-of-care ultrasound in a patient with pyogenic spondylodiscitis. The patient was referred with a chief complaint of liver dysfunction without bleeding tendencies or risk factors. Ultrasound revealed focal gallbladder wall irregularity, intraluminal membranes, and non-shadowing non-layering intraluminal echoes. Extravascular contrast leakage was exhibited on the computed tomography scan. The patient underwent emergency percutaneous drainage and subsequent cholecystectomy before developing major complications.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140470662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.15279/kpba.2024.29.1.35
Min Jae Yang, Se Woo Park, Jae-Hee Cho
{"title":"Mechanistic Loop Resolution Strategy for Short-Type Single-Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Roux-en-Y Reconstruction","authors":"Min Jae Yang, Se Woo Park, Jae-Hee Cho","doi":"10.15279/kpba.2024.29.1.35","DOIUrl":"https://doi.org/10.15279/kpba.2024.29.1.35","url":null,"abstract":"","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"359 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140471186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.15279/kpba.2024.29.1.31
Jae Sin Lee, Jong Yul Lee
Ketamine is an anesthetic agent for diagnostic and surgical procedures. However, it can produce dissociative anesthesia and induce hallucinations. Therefore, it tends to be abused as a recreational drug. Chronic ketamine use can cause numerous adverse effects including ketamine-induced chlangiopathy and ulcerative cystitis. Ketamineinduced cholangiopathy has been reported since the 1980s and most cases were found in Western countries and South Asia. Here, we report the first case of ketamineinduced cholangiopathy in Korea. Owing to increasing recreational drug use among Koreans, ketamine-induced cholangiopathy should be considered in the differential diagnosis in young patients with cholangitis of unknown etiology.
{"title":"The First Case Report of Ketamine-Induced Cholangiopathy in Korea","authors":"Jae Sin Lee, Jong Yul Lee","doi":"10.15279/kpba.2024.29.1.31","DOIUrl":"https://doi.org/10.15279/kpba.2024.29.1.31","url":null,"abstract":"Ketamine is an anesthetic agent for diagnostic and surgical procedures. However, it can produce dissociative anesthesia and induce hallucinations. Therefore, it tends to be abused as a recreational drug. Chronic ketamine use can cause numerous adverse effects including ketamine-induced chlangiopathy and ulcerative cystitis. Ketamineinduced cholangiopathy has been reported since the 1980s and most cases were found in Western countries and South Asia. Here, we report the first case of ketamineinduced cholangiopathy in Korea. Owing to increasing recreational drug use among Koreans, ketamine-induced cholangiopathy should be considered in the differential diagnosis in young patients with cholangitis of unknown etiology.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"319 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140473441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.15279/kpba.2024.29.1.1
E. Lee
Endoscopic sphincterotomy (EST) is a basic procedure for pancreatobiliary endoscopy and is currently widely performed as a standard procedure for the treatment of various pancreatobiliary diseases worldwide. Later, in 1982, endoscopic papillary balloon dilation (EPBD) was introduced as an alternative to EST, and EPBD is known to reduce the risk of bleeding and perforation compared to EST. In order to safely and effectively perform EST and EPBD procedures, it is essential to select an appropriate target for the procedure, as well as to understand and familiarize with the anatomical structure of the duodenal papilla, related instruments, and basic techniques of EST and EPBD.
内镜下括约肌切开术（EST）是胰胆管内镜检查的基本程序，目前作为治疗各种胰胆管疾病的标准程序在全世界广泛开展。后来，1982 年内镜乳头气囊扩张术（EPBD）作为EST 的替代手术被引入，与 EST 相比，EPBD 可降低出血和穿孔的风险。为了安全有效地进行EST和EPBD手术，必须选择合适的手术目标，了解并熟悉十二指肠乳头的解剖结构、相关器械以及EST和EPBD的基本技术。
{"title":"Endoscopic Sphincterotomy and Endoscopic Papillary Balloon Dilation to Do It Safely","authors":"E. Lee","doi":"10.15279/kpba.2024.29.1.1","DOIUrl":"https://doi.org/10.15279/kpba.2024.29.1.1","url":null,"abstract":"Endoscopic sphincterotomy (EST) is a basic procedure for pancreatobiliary endoscopy and is currently widely performed as a standard procedure for the treatment of various pancreatobiliary diseases worldwide. Later, in 1982, endoscopic papillary balloon dilation (EPBD) was introduced as an alternative to EST, and EPBD is known to reduce the risk of bleeding and perforation compared to EST. In order to safely and effectively perform EST and EPBD procedures, it is essential to select an appropriate target for the procedure, as well as to understand and familiarize with the anatomical structure of the duodenal papilla, related instruments, and basic techniques of EST and EPBD.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"165 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140477585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.15279/kpba.2024.29.1.20
Renandha Septaryan Yustira, A. Nugroho, Renaningtyas Tambun, I. D. Mulyanto, Esther Eunike, Kenny Wijaya Sutanto
Cat-scratch disease (CSD) is a bacterial infection which primarily transmitted to humans through scratches, bites, or licks from infected cats. Even though CSD is generally a mild condition, atypical symptoms may appear and must be distinguished from other diseases. We encountered a 57-year-old woman who presented with intermittent pain in the right upper quadrant and epigastric part of the abdomen, and had lost 11 kg within a few months. She never had a cat and did not recall being scratched by a cat. Radiologic examinations strongly suggest a malignant bile duct tumor, thus liver resection was done. However, the result of histopathology was a CSD. At follow-up, the patient was stable and also showed improvement in her general condition. Hence, proper preoperative examinations of the patients are crucial in order to avoid excessive or inadequate treatment.
{"title":"Atypical Presentation of Cat-Scratch Disease Mimicking Malignancy: A Case Report","authors":"Renandha Septaryan Yustira, A. Nugroho, Renaningtyas Tambun, I. D. Mulyanto, Esther Eunike, Kenny Wijaya Sutanto","doi":"10.15279/kpba.2024.29.1.20","DOIUrl":"https://doi.org/10.15279/kpba.2024.29.1.20","url":null,"abstract":"Cat-scratch disease (CSD) is a bacterial infection which primarily transmitted to humans through scratches, bites, or licks from infected cats. Even though CSD is generally a mild condition, atypical symptoms may appear and must be distinguished from other diseases. We encountered a 57-year-old woman who presented with intermittent pain in the right upper quadrant and epigastric part of the abdomen, and had lost 11 kg within a few months. She never had a cat and did not recall being scratched by a cat. Radiologic examinations strongly suggest a malignant bile duct tumor, thus liver resection was done. However, the result of histopathology was a CSD. At follow-up, the patient was stable and also showed improvement in her general condition. Hence, proper preoperative examinations of the patients are crucial in order to avoid excessive or inadequate treatment.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"41 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140477568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.15279/kpba.2023.28.3.53
Jin-Seok Park, Seok-min Jeong
Pancreatic cystic neoplasms (PCNs) are precursors of pancreatic cancer, and the rate of their incidental detection has gradually increased recently with a reported prevalence from 2.4 to 13.5%. However, accurate diagnosis can be challenging because PCNs have morphologies ranging from benign to malignant disease, and as for other cancers, precise and timely management of premalignant PCN is essential to prevent malignant transformation. Endoscopic ultrasound (EUS) is a useful tool for the differential diagnosis PCN and treatment decision-making because its imaging features predict malignant transformation. However, its performance is suboptimal, and its accuracy for differentiating mucinous pancreatic cysts and other PCNs is only 65-75%, which has increased interest in the application of artificial intelligence (AI). AI has already provided tools that have improved diagnostic accuracies for many cancers, including colon, lung, and breast cancer, and recent studies have shown AI has the potential to differentiate mucinous and non-mucinous tumors and stratify the malignant potentials of PCNs. This article provides a review of the literature on EUS-based AI studies of PCNs.
{"title":"Endoscopic Ultrasound-Based Artificial Intelligence Diagnosis of Pancreatic Cystic Neoplasms","authors":"Jin-Seok Park, Seok-min Jeong","doi":"10.15279/kpba.2023.28.3.53","DOIUrl":"https://doi.org/10.15279/kpba.2023.28.3.53","url":null,"abstract":"Pancreatic cystic neoplasms (PCNs) are precursors of pancreatic cancer, and the rate of their incidental detection has gradually increased recently with a reported prevalence from 2.4 to 13.5%. However, accurate diagnosis can be challenging because PCNs have morphologies ranging from benign to malignant disease, and as for other cancers, precise and timely management of premalignant PCN is essential to prevent malignant transformation. Endoscopic ultrasound (EUS) is a useful tool for the differential diagnosis PCN and treatment decision-making because its imaging features predict malignant transformation. However, its performance is suboptimal, and its accuracy for differentiating mucinous pancreatic cysts and other PCNs is only 65-75%, which has increased interest in the application of artificial intelligence (AI). AI has already provided tools that have improved diagnostic accuracies for many cancers, including colon, lung, and breast cancer, and recent studies have shown AI has the potential to differentiate mucinous and non-mucinous tumors and stratify the malignant potentials of PCNs. This article provides a review of the literature on EUS-based AI studies of PCNs.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128668068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.15279/kpba.2023.28.3.76
Ah Reum Kim, J. Hwang, B. Yoo, Jin Hong Kim, M. Yang
Clearance of a difficult biliary stone can be obtained using various interventional techniques such as endoscopic sphincterotomy followed by endoscopic papillary large balloon dilation, mechanical lithotripsy, peroral cholangioscopy-assisted intraductal electrohydraulic/laser lithotripsy, temporary plastic stent insertion, percutaneous transhepatic cholangioscopy-guided lithotripsy, and extracorporeal shock wave lithotripsy. We hereby describe the successful endoscopic treatment using various currently available interventional techniques in a case with multiple difficult common bile duct stones. Furthermore, we discuss the countermeasures to overcome the hurdles of each procedure.
{"title":"Successful Endoscopic Treatment of Difficult Common Bile Duct Stones Using Various Interventional Techniques: A Case Report","authors":"Ah Reum Kim, J. Hwang, B. Yoo, Jin Hong Kim, M. Yang","doi":"10.15279/kpba.2023.28.3.76","DOIUrl":"https://doi.org/10.15279/kpba.2023.28.3.76","url":null,"abstract":"Clearance of a difficult biliary stone can be obtained using various interventional techniques such as endoscopic sphincterotomy followed by endoscopic papillary large balloon dilation, mechanical lithotripsy, peroral cholangioscopy-assisted intraductal electrohydraulic/laser lithotripsy, temporary plastic stent insertion, percutaneous transhepatic cholangioscopy-guided lithotripsy, and extracorporeal shock wave lithotripsy. We hereby describe the successful endoscopic treatment using various currently available interventional techniques in a case with multiple difficult common bile duct stones. Furthermore, we discuss the countermeasures to overcome the hurdles of each procedure.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130791889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.15279/kpba.2023.28.3.67
Se Hee Lee, Woohyun Cho, Min Yang
Hyperamylasemia and hyperlipidemia occur when the amounts of amylase and lipase that enter the blood overweigh the kidney and liver reticuloendothelial system clearance of the enzymes. In normal homeostasis, most of these enzymes are excreted from the apical membrane of the acinar cells into the ductal system of the gland. However, in pathological conditions, this apical exocytosis is blocked, and the leakage of these enzymes at the basolateral membrane is increased. Therefore, these enzymes are released into the bloodstream. Many different pancreatic pathologies and Gullo syndrome can cause this type of leakage in the pancreas. This mechanism can also cause basolateral leakage in other organs that secrete amylase and lipase. In small bowel inflammatory conditions, amylase and lipase are absorbed through the inflamed mucosa and introduced into the bloodstream due to increased vascular permeability. Regardless of the enzymes that enter the blood circulation, several kidney and liver diseases prevent the excretion and metabolism of serum amylase and lipase. When the amylase and lipase are combined with immunoglobulins, they escape normal glomerular filtration due to the development of macroenzymes and accumulate in the blood. These situations related to the clearance of the enzymes are also crucial mechanisms of serum enzyme elevation that should not be overlooked.
{"title":"Approach to Hyperamylasemia and Hyperlipasemia","authors":"Se Hee Lee, Woohyun Cho, Min Yang","doi":"10.15279/kpba.2023.28.3.67","DOIUrl":"https://doi.org/10.15279/kpba.2023.28.3.67","url":null,"abstract":"Hyperamylasemia and hyperlipidemia occur when the amounts of amylase and lipase that enter the blood overweigh the kidney and liver reticuloendothelial system clearance of the enzymes. In normal homeostasis, most of these enzymes are excreted from the apical membrane of the acinar cells into the ductal system of the gland. However, in pathological conditions, this apical exocytosis is blocked, and the leakage of these enzymes at the basolateral membrane is increased. Therefore, these enzymes are released into the bloodstream. Many different pancreatic pathologies and Gullo syndrome can cause this type of leakage in the pancreas. This mechanism can also cause basolateral leakage in other organs that secrete amylase and lipase. In small bowel inflammatory conditions, amylase and lipase are absorbed through the inflamed mucosa and introduced into the bloodstream due to increased vascular permeability. Regardless of the enzymes that enter the blood circulation, several kidney and liver diseases prevent the excretion and metabolism of serum amylase and lipase. When the amylase and lipase are combined with immunoglobulins, they escape normal glomerular filtration due to the development of macroenzymes and accumulate in the blood. These situations related to the clearance of the enzymes are also crucial mechanisms of serum enzyme elevation that should not be overlooked.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124129793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.15279/kpba.2023.28.3.81
Ji Hun Woo, Junyeol Kim, J. Choi, Joo-Wan Kang, W. Paik, J. Ryu, Yong-Tae Kim, S. Lee
Biliary stent removal can cause hemobilia due to injury to the adjacent vessel, but it is rarely reported. If significant hemobilia occurs during stent removal, samesession covered self-expandable metal stent (CSEMS) insertion may be useful as a rescue or bridge therapy before angiography. Here, we report two cases of lifethreatening hemobilia following stent removal successfully treated by CSEMS. The first case was a Klatskin tumor bismuth type IV patient who required biliary stenting for resolving malignant biliary obstruction. The second case was a hepatocellular carcinoma patient who had undergone multiple transarterial chemoembolization and required biliary stents for liver abscess. In this situation, inserting a CSEMS at a higher level than the expected bleeding site and recognizing stenting as a temporary therapy with its limitations are important. Also, it is crucial to consider pre-procedural imaging in high-risk patients, and perform post-procedural imaging to evaluate for ongoing bleeding or vascular abnormalities.
{"title":"Two Cases of Life-Threatening Hemobilia Following Removal of Biliary Stents Treated with Covered Self-Expandable Metal Stents","authors":"Ji Hun Woo, Junyeol Kim, J. Choi, Joo-Wan Kang, W. Paik, J. Ryu, Yong-Tae Kim, S. Lee","doi":"10.15279/kpba.2023.28.3.81","DOIUrl":"https://doi.org/10.15279/kpba.2023.28.3.81","url":null,"abstract":"Biliary stent removal can cause hemobilia due to injury to the adjacent vessel, but it is rarely reported. If significant hemobilia occurs during stent removal, samesession covered self-expandable metal stent (CSEMS) insertion may be useful as a rescue or bridge therapy before angiography. Here, we report two cases of lifethreatening hemobilia following stent removal successfully treated by CSEMS. The first case was a Klatskin tumor bismuth type IV patient who required biliary stenting for resolving malignant biliary obstruction. The second case was a hepatocellular carcinoma patient who had undergone multiple transarterial chemoembolization and required biliary stents for liver abscess. In this situation, inserting a CSEMS at a higher level than the expected bleeding site and recognizing stenting as a temporary therapy with its limitations are important. Also, it is crucial to consider pre-procedural imaging in high-risk patients, and perform post-procedural imaging to evaluate for ongoing bleeding or vascular abnormalities.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117344746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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