Pub Date : 2021-04-30DOI: 10.15279/KPBA.2021.26.3.209
K. Lee
1) 췌장낭종 Springer (Johns Hopkins University) 연구팀에서 췌장 낭종으로 수술은 받은 환자 436명의 데이터를 수집하여 지도학습(supervised learning) 방식으로 AI ‘컴프시스트 (CompCyst)’를 훈련시켰다. 이 방법은 multivariate organization of combined alterations (MOCA) 알고리즘을 이용하여 임상 양상, 영상 검사, 낭종의 단백질 분석, DNA 돌연변이, 염색체 변이들의 정보 분석방법을 학습시켰다. 이후 AI 진단법 컴프시스트로 다른 췌장 낭종 환자 426명을 대상으로 퇴원해야 하는 환자(양성), 경과 관찰이 필요한 환자, 수술해야 하는 환자 3단계로 분류하였다. Received dec. 22, 2020 Revised Jan. 8, 2021 Accepted Jan. 11, 2021
{"title":"Application of Artificial Intelligence in Diagnosis of Pancreaticobiliary Diseases","authors":"K. Lee","doi":"10.15279/KPBA.2021.26.3.209","DOIUrl":"https://doi.org/10.15279/KPBA.2021.26.3.209","url":null,"abstract":"1) 췌장낭종 Springer (Johns Hopkins University) 연구팀에서 췌장 낭종으로 수술은 받은 환자 436명의 데이터를 수집하여 지도학습(supervised learning) 방식으로 AI ‘컴프시스트 (CompCyst)’를 훈련시켰다. 이 방법은 multivariate organization of combined alterations (MOCA) 알고리즘을 이용하여 임상 양상, 영상 검사, 낭종의 단백질 분석, DNA 돌연변이, 염색체 변이들의 정보 분석방법을 학습시켰다. 이후 AI 진단법 컴프시스트로 다른 췌장 낭종 환자 426명을 대상으로 퇴원해야 하는 환자(양성), 경과 관찰이 필요한 환자, 수술해야 하는 환자 3단계로 분류하였다. Received dec. 22, 2020 Revised Jan. 8, 2021 Accepted Jan. 11, 2021","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123448655","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 : 2021-04-30DOI: 10.15279/KPBA.2021.26.2.67
E. Lee, H. Chon, Ju Sang Park, S. Yi, Dong Wook Lee, C. Park, Kwang Bum Cho
To date, there is no standardization of the endoscopi c retrograde cholangiopancreatography (ERCP) room setting regarding with the size, equipment or space arrangement. Therefore, the authors visited 11 tertiary hospitals that recently remodeled or newly designed the ERCP room to analyze and identify their advantages and disadvantages. The ERCP room should have enough space for equipments including fluoroscopy, endoscopy, electrosurgical unit, preparation table and for patient movement. The EUS room does not require an independent space unless it is a very large scale hospital, and the ERCP room can be shared. Considering the pros and cons of each equipment, adequate fluoroscopic device should be selected depending on the hospital circumstance. Expensive equipment for X-ray fluoroscopy system is not necessarily good, and it is necessary to install equipment suitable for each hospital situation by understanding the advantages and disadvantages of fluoroscopy. For prevention of ERCP-related radiation hazard, both endoscopist and assistants should wear radiation-blocking apron, thyroid protectors, and lead glasses. Furthermore, a shield that can block radiation between the endoscopist and the patient should be installed to protect high-energy scattered waves. One-way direction should be designed to prevent cross infection when moving the endoscopic equipment from the ERCP to the cleaning room. If possible, it is recommended to keep a cardiopulmonary resuscitation cart in the ERCP room.
{"title":"ERCP Room Setting: What Doctors Starting ERCP Need to Know","authors":"E. Lee, H. Chon, Ju Sang Park, S. Yi, Dong Wook Lee, C. Park, Kwang Bum Cho","doi":"10.15279/KPBA.2021.26.2.67","DOIUrl":"https://doi.org/10.15279/KPBA.2021.26.2.67","url":null,"abstract":"To date, there is no standardization of the endoscopi c retrograde cholangiopancreatography (ERCP) room setting regarding with the size, equipment or space arrangement. Therefore, the authors visited 11 tertiary hospitals that recently remodeled or newly designed the ERCP room to analyze and identify their advantages and disadvantages. The ERCP room should have enough space for equipments including fluoroscopy, endoscopy, electrosurgical unit, preparation table and for patient movement. The EUS room does not require an independent space unless it is a very large scale hospital, and the ERCP room can be shared. Considering the pros and cons of each equipment, adequate fluoroscopic device should be selected depending on the hospital circumstance. Expensive equipment for X-ray fluoroscopy system is not necessarily good, and it is necessary to install equipment suitable for each hospital situation by understanding the advantages and disadvantages of fluoroscopy. For prevention of ERCP-related radiation hazard, both endoscopist and assistants should wear radiation-blocking apron, thyroid protectors, and lead glasses. Furthermore, a shield that can block radiation between the endoscopist and the patient should be installed to protect high-energy scattered waves. One-way direction should be designed to prevent cross infection when moving the endoscopic equipment from the ERCP to the cleaning room. If possible, it is recommended to keep a cardiopulmonary resuscitation cart in the ERCP room.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125990012","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 : 2019-10-31DOI: 10.15279/kpba.2019.24.4.163
J. Yoon
Common bile duct stones (CBDS) are estimated to be present in 10–20% of individuals with symptomatic gallstones. Most patients with gallstones remain asymptomatic throughout their lifetime, but 10–25% of them may develop biliary pain or complications including pain, jaundice, infection and acute pancreatitis, with an annual risk of about 2–3% for symptomatic disease and 1–2% for major complications. The primary treatment, endoscopic retrograde cholangio-pacreatography (ERCP), is minimally invasive but associated with adverse events in 6% to 15% of patients. Therefore, exact evaluation of CBDS is important in patients with gallstones. Clinicians are therefore confronted with a number of potentially valid options such as endoscopic ultrasonography versus magnetic retrograde cholangiopancreatography in order to diagnose suspected CBDS. The aim of this review for evaluation of patients suspected of common bile duct stone is to provide practical advice on how to manage patients with CBDS. It considers diagnostic strategies in patients with suspected CBDS, as well as the different therapeutic options available for CBDS.
{"title":"Evaluation of Patients Suspected of Common Bile Duct Stone","authors":"J. Yoon","doi":"10.15279/kpba.2019.24.4.163","DOIUrl":"https://doi.org/10.15279/kpba.2019.24.4.163","url":null,"abstract":"Common bile duct stones (CBDS) are estimated to be present in 10–20% of individuals with symptomatic gallstones. Most patients with gallstones remain asymptomatic throughout their lifetime, but 10–25% of them may develop biliary pain or complications including pain, jaundice, infection and acute pancreatitis, with an annual risk of about 2–3% for symptomatic disease and 1–2% for major complications. The primary treatment, endoscopic retrograde cholangio-pacreatography (ERCP), is minimally invasive but associated with adverse events in 6% to 15% of patients. Therefore, exact evaluation of CBDS is important in patients with gallstones. Clinicians are therefore confronted with a number of potentially valid options such as endoscopic ultrasonography versus magnetic retrograde cholangiopancreatography in order to diagnose suspected CBDS. The aim of this review for evaluation of patients suspected of common bile duct stone is to provide practical advice on how to manage patients with CBDS. It considers diagnostic strategies in patients with suspected CBDS, as well as the different therapeutic options available for CBDS.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125097021","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 : 2019-10-31DOI: 10.15279/kpba.2019.24.4.159
J. H. Lee
The increasing discovery of pancreatic cystic neoplasm is a recent trend because of the widespread use and development of imaging techniques. Physicians have to recognize the different characteristics of the cystic neoplasms so that a determination may be selected regarding the potential for malignancy. Appropriate evaluation of pancreatic cystic lesion includes a multidisciplinary approach involving gastroenterologists with experience in endoscopic ultrasound, radiologist, and pancreatic surgeons. The selective approach is important in management of this neoplasm with minimizing incorrect diagnosis and unnecessary surgery. Considering the characteristic features of pancreatic cystic neoplasm, the clinical decision should be tailored according to needs and conditions of the individual patients
{"title":"Surgical Indications and Postsurgical Follow-up Strategy for Pancreatic Cystic Neoplasm","authors":"J. H. Lee","doi":"10.15279/kpba.2019.24.4.159","DOIUrl":"https://doi.org/10.15279/kpba.2019.24.4.159","url":null,"abstract":"The increasing discovery of pancreatic cystic neoplasm is a recent trend because of the widespread use and development of imaging techniques. Physicians have to recognize the different characteristics of the cystic neoplasms so that a determination may be selected regarding the potential for malignancy. Appropriate evaluation of pancreatic cystic lesion includes a multidisciplinary approach involving gastroenterologists with experience in endoscopic ultrasound, radiologist, and pancreatic surgeons. The selective approach is important in management of this neoplasm with minimizing incorrect diagnosis and unnecessary surgery. Considering the characteristic features of pancreatic cystic neoplasm, the clinical decision should be tailored according to needs and conditions of the individual patients","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124613301","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 : 2019-10-31DOI: 10.15279/kpba.2019.24.4.137
K. Jang
Pancreas cystic neoplasm is a relatively common disease. However, its’ pathologic diagnosis is not easy. The most frequent problem is low cellularity when compared to another organ cytology or biopsy material. Considering the procedure and anatomic difficulty, it is not uncommon to observe a low cellular smear or scanty volume of cells in the biopsy specimen. In this case, the molecular pathology test, including nextgeneration sequencing, may be helpful. If pathologist can identify some mutation in cells or cystic fluid, differential diagnosis of cystic neoplasm may be possible. These are KRAS and GNAS, VHL, and CTNNB1 mutation in mucinous cystic neoplasm, intraductal papillary-mucinous neoplasm, serous cystic neoplasm, and solid pseudopapillary neoplasm, respectively. The next-generation sequencing is an emerging molecular test that can detect multiple biomarkers for diagnosis, including pancreas cystic neoplasm. It has been reported that next-generation sequencing test can be applied for differential diagnosis of pancreas cystic neoplasm. However, these molecular pathology tests were not all-around; it needs to be properly managed with pathologist’s quality control. It should be remembered that even if it goes through quality control, it may show a failure rate of around 30%. Despite the advances in molecular methods of high techniques, it should be remembered that the most important thing in pathologic diagnosis of pancreas cystic neoplasm is an endoscopist’s skill and pathologist’s expertise those provide adequate specimen and accurate diagnosis.
{"title":"Recent Update in Pathologic Diagnosis for Pancreatic Cystic Neoplasm","authors":"K. Jang","doi":"10.15279/kpba.2019.24.4.137","DOIUrl":"https://doi.org/10.15279/kpba.2019.24.4.137","url":null,"abstract":"Pancreas cystic neoplasm is a relatively common disease. However, its’ pathologic diagnosis is not easy. The most frequent problem is low cellularity when compared to another organ cytology or biopsy material. Considering the procedure and anatomic difficulty, it is not uncommon to observe a low cellular smear or scanty volume of cells in the biopsy specimen. In this case, the molecular pathology test, including nextgeneration sequencing, may be helpful. If pathologist can identify some mutation in cells or cystic fluid, differential diagnosis of cystic neoplasm may be possible. These are KRAS and GNAS, VHL, and CTNNB1 mutation in mucinous cystic neoplasm, intraductal papillary-mucinous neoplasm, serous cystic neoplasm, and solid pseudopapillary neoplasm, respectively. The next-generation sequencing is an emerging molecular test that can detect multiple biomarkers for diagnosis, including pancreas cystic neoplasm. It has been reported that next-generation sequencing test can be applied for differential diagnosis of pancreas cystic neoplasm. However, these molecular pathology tests were not all-around; it needs to be properly managed with pathologist’s quality control. It should be remembered that even if it goes through quality control, it may show a failure rate of around 30%. Despite the advances in molecular methods of high techniques, it should be remembered that the most important thing in pathologic diagnosis of pancreas cystic neoplasm is an endoscopist’s skill and pathologist’s expertise those provide adequate specimen and accurate diagnosis.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125161977","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 : 2019-10-31DOI: 10.15279/kpba.2019.24.4.147
J. Choi, S. Lee
The accurate diagnosis of pancreatic cystic lesions (PCLs) is important because they determine the strategy of treatment or follow-up. Endoscopic ultrasound (EUS) has been widely used in diagnosis and treatment of PCLs. EUS can be used to obtain additional information in the case of an indeterminate cyst on computed tomography or magnetic resonance imaging, or in case of showing a worrisome feature. Contrastenhanced EUS showed highly accurate for differential diagnosing of non-neoplastic cysts from neoplastic cyst, and it also useful for distinguishing mural nodules from mucin. EUS-guided fine needle aspiration can be used to analyze cytology, chemistry, and molecular markers in cystic fluid if there is insufficient evidence for the diagnosis by non-invasive modalities. Needle-based confocal laser endomicroscopy allows real time diagnosis of PCLs with good accuracy during EUS-guided fine needle aspiration by subcellular level imaging. Through-the-needle cystoscopy or through-the-needle forceps biopsy are also attempted in these days but the evidence for its effectiveness is insufficient. EUS-guided ablation procedures are emerging as a minimally invasive therapeutic methods for unmet needs in dichotomous treatment policy for PCLs. Large long-term follow-up observational studies have been reported on the feasibility and efficacy of EUS-guided ablation for PCLs with ethanol or in combination with chemoagent. Further study for the actual treatment effects or real clinical benefit would be needed. The use of EUS in the diagnosis and treatment of PCLs is expected to make much progress in the future.
{"title":"Endoscopic Ultrasound-based Approach in the Diagnosis and Treatment for Pancreatic Cystic Lesions","authors":"J. Choi, S. Lee","doi":"10.15279/kpba.2019.24.4.147","DOIUrl":"https://doi.org/10.15279/kpba.2019.24.4.147","url":null,"abstract":"The accurate diagnosis of pancreatic cystic lesions (PCLs) is important because they determine the strategy of treatment or follow-up. Endoscopic ultrasound (EUS) has been widely used in diagnosis and treatment of PCLs. EUS can be used to obtain additional information in the case of an indeterminate cyst on computed tomography or magnetic resonance imaging, or in case of showing a worrisome feature. Contrastenhanced EUS showed highly accurate for differential diagnosing of non-neoplastic cysts from neoplastic cyst, and it also useful for distinguishing mural nodules from mucin. EUS-guided fine needle aspiration can be used to analyze cytology, chemistry, and molecular markers in cystic fluid if there is insufficient evidence for the diagnosis by non-invasive modalities. Needle-based confocal laser endomicroscopy allows real time diagnosis of PCLs with good accuracy during EUS-guided fine needle aspiration by subcellular level imaging. Through-the-needle cystoscopy or through-the-needle forceps biopsy are also attempted in these days but the evidence for its effectiveness is insufficient. EUS-guided ablation procedures are emerging as a minimally invasive therapeutic methods for unmet needs in dichotomous treatment policy for PCLs. Large long-term follow-up observational studies have been reported on the feasibility and efficacy of EUS-guided ablation for PCLs with ethanol or in combination with chemoagent. Further study for the actual treatment effects or real clinical benefit would be needed. The use of EUS in the diagnosis and treatment of PCLs is expected to make much progress in the future.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126384885","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 : 2019-10-31DOI: 10.15279/kpba.2019.24.4.175
Seok Jeong
Endoscopic papillary balloon dilation (EPBD) and endoscopic papillary large balloon dilation (EPLBD) have been performed all around the world over several decades for the treatment of common bile duct stone. EPBD using small dilation balloon catheter can preserve sphincter of Oddi function and reduce the recurrence rate of bile duct stone compared to endoscopic sphincterotomy (EST). EPBD is a procedure with low risk of bleeding, which is appropriate for patients with coagulopathy, hepatic cirrhosis, end-stage of renal disease, and surgically altered anatomy such as Billroth II gastrectomy and periampullary diverticulum. However, it has a higher risk of postprocedure pancreatitis than EST. EPLBD using large balloon catheter (12 mm or more of diameter) is proper for more than 10 mm of common bile duct stone. The advantages of EPLBD are reduced need for mechanical lithotripsy with decreased procedure time and radiation exposure time irrespective of the precedence of EST. EPLBD also requires fewer endoscopic retrograde cholangiopancreatography sessions and is more costeffective. The incidence of post-procedure pancreatitis is lower in EPLBD than EST. If EPBD and EPLBD are done under the guidelines, these would be safe and effective and may be alternatives to EST for common bile duct stone.
{"title":"Endoscopic Papillary Balloon Dilation/Endoscopic Papillary Large Balloon Dilation","authors":"Seok Jeong","doi":"10.15279/kpba.2019.24.4.175","DOIUrl":"https://doi.org/10.15279/kpba.2019.24.4.175","url":null,"abstract":"Endoscopic papillary balloon dilation (EPBD) and endoscopic papillary large balloon dilation (EPLBD) have been performed all around the world over several decades for the treatment of common bile duct stone. EPBD using small dilation balloon catheter can preserve sphincter of Oddi function and reduce the recurrence rate of bile duct stone compared to endoscopic sphincterotomy (EST). EPBD is a procedure with low risk of bleeding, which is appropriate for patients with coagulopathy, hepatic cirrhosis, end-stage of renal disease, and surgically altered anatomy such as Billroth II gastrectomy and periampullary diverticulum. However, it has a higher risk of postprocedure pancreatitis than EST. EPLBD using large balloon catheter (12 mm or more of diameter) is proper for more than 10 mm of common bile duct stone. The advantages of EPLBD are reduced need for mechanical lithotripsy with decreased procedure time and radiation exposure time irrespective of the precedence of EST. EPLBD also requires fewer endoscopic retrograde cholangiopancreatography sessions and is more costeffective. The incidence of post-procedure pancreatitis is lower in EPLBD than EST. If EPBD and EPLBD are done under the guidelines, these would be safe and effective and may be alternatives to EST for common bile duct stone.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"168 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134529241","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 : 2019-10-31DOI: 10.15279/kpba.2019.24.4.141
Mi-Suk Park
Pancreatic cystic neoplasm is a clinically challenging entity. Its incidence estimated up to 45% of the general population. The biological behavior ranges from benign to malignant disease. The strategy for pancreatic cystic neoplasm could be to prevent progression to pancreatic cancer while minimizing the costs. The first step for the correct management is correct diagnosis. In this paper, the radiological differential diagnosis of them will be described.
{"title":"Pancreatic Cystic Neoplasm: Radiologic Evaluation and Differential Diagnosis","authors":"Mi-Suk Park","doi":"10.15279/kpba.2019.24.4.141","DOIUrl":"https://doi.org/10.15279/kpba.2019.24.4.141","url":null,"abstract":"Pancreatic cystic neoplasm is a clinically challenging entity. Its incidence estimated up to 45% of the general population. The biological behavior ranges from benign to malignant disease. The strategy for pancreatic cystic neoplasm could be to prevent progression to pancreatic cancer while minimizing the costs. The first step for the correct management is correct diagnosis. In this paper, the radiological differential diagnosis of them will be described.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"269 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116544729","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 : 2019-10-31DOI: 10.15279/kpba.2019.24.4.182
J. H. Jun, Y. Doh, J. Jang, I. Baek, S. Jung
A 50-year-old woman visited the emergency room of Daejeon Eulji University Hospital with the primary complaint of right upper-quadrant pain. Her past medical history included a Billroth II operation with Braun anastomosis for stomach cancer. Upon physical examination, the patient had blood pressure of 100/50 mmHg, pulse rate of 116/min, respiratory rate of 18 breaths/min, and body temperature of 37.1°C. Laboratory tests indicated that the patient had a white blood cell count of 4,940/μL, hemoglobin concentration of 12.8 g/dL, platelet count of 52,000/μL, total bilirubin concentration of 1.75 mg/dL, aspartate aminotransferase level of 126 IU/L, alanine aminotransferase level of 450 IU/L, alkaline phosphatase level of 153 IU/L, amylase level of 248 U/L, lipase level of 668 U/L, and C-reactive protein level of 0.75 mg/dL. An abdominal computed tomography scan showed that the patient had biliary tree dilatation and gallbladder distension due to distal common bile duct (CBD) stones. Gallbladder stones and pericholecystic infiltration were also observed (Fig. 1). The next day, we performed endoscopic retrograde cholangiopancreatography (ERCP) for CBD stone removal. Using a cap-fitted forward-viewing endoscope (Olympus GIF Q260, Olympus Optical Co., Tokyo, Japan), the papilla was located at the 9 o’clock position (Fig. 2A). On fluoroscopy, the endoscope showed a figure 8 shape different from that in a normal Billroth II operation (Fig. 2B). We then attempted to unsuccessfully manipulate the endoscope and fix the papilla at the 12 o’clock position. To facilitate the use of a rotatable sphincterotome, the endoscope was replaced with a doublechannel endoscope (GIF-2T240, Olympus Optical Co., Tokyo, Japan) but the papilla remained at the 9 o’clock position. A sphincterotome (TRUEtome; Boston ScienReceived May 31, 2019 Revised Jun. 18, 2019 Accepted Jul. 23, 2019
{"title":"Selective Biliary Cannulation for a Papilla in the 9 o’clock Position Using Pull and Rotatable Sphincterotome","authors":"J. H. Jun, Y. Doh, J. Jang, I. Baek, S. Jung","doi":"10.15279/kpba.2019.24.4.182","DOIUrl":"https://doi.org/10.15279/kpba.2019.24.4.182","url":null,"abstract":"A 50-year-old woman visited the emergency room of Daejeon Eulji University Hospital with the primary complaint of right upper-quadrant pain. Her past medical history included a Billroth II operation with Braun anastomosis for stomach cancer. Upon physical examination, the patient had blood pressure of 100/50 mmHg, pulse rate of 116/min, respiratory rate of 18 breaths/min, and body temperature of 37.1°C. Laboratory tests indicated that the patient had a white blood cell count of 4,940/μL, hemoglobin concentration of 12.8 g/dL, platelet count of 52,000/μL, total bilirubin concentration of 1.75 mg/dL, aspartate aminotransferase level of 126 IU/L, alanine aminotransferase level of 450 IU/L, alkaline phosphatase level of 153 IU/L, amylase level of 248 U/L, lipase level of 668 U/L, and C-reactive protein level of 0.75 mg/dL. An abdominal computed tomography scan showed that the patient had biliary tree dilatation and gallbladder distension due to distal common bile duct (CBD) stones. Gallbladder stones and pericholecystic infiltration were also observed (Fig. 1). The next day, we performed endoscopic retrograde cholangiopancreatography (ERCP) for CBD stone removal. Using a cap-fitted forward-viewing endoscope (Olympus GIF Q260, Olympus Optical Co., Tokyo, Japan), the papilla was located at the 9 o’clock position (Fig. 2A). On fluoroscopy, the endoscope showed a figure 8 shape different from that in a normal Billroth II operation (Fig. 2B). We then attempted to unsuccessfully manipulate the endoscope and fix the papilla at the 12 o’clock position. To facilitate the use of a rotatable sphincterotome, the endoscope was replaced with a doublechannel endoscope (GIF-2T240, Olympus Optical Co., Tokyo, Japan) but the papilla remained at the 9 o’clock position. A sphincterotome (TRUEtome; Boston ScienReceived May 31, 2019 Revised Jun. 18, 2019 Accepted Jul. 23, 2019","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124155856","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 : 2019-10-31DOI: 10.15279/kpba.2019.24.4.168
S. Jang, D. Lee
Endoscopic sphincterotomy is performed after selective cannulation to remove the gallstone. Endoscopic sphincterotomy can cause complications such as bleeding, perforation and pancreatitis. Various types of endoscopic sphincter incision method and current generators used for incisions have been developed to reduce the incidence of such complications and increase the success rate of the procedure. In addition, guidelines for the direction and extent of endoscopic sphincterotomy and incision technique are established. The method used for the removal of gallstones after the endoscopic sphincterotomy is a method using a balloon and/or a basket. This review introduces the technical methods of endoscopic sphincterotomy and discusses the clinical indications and technical methods for representative methods of effective gallstone removal. Korean J Pancreas Biliary Tract 2019;24(4):168-174
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