Percutaneous transhepatic cholangioscopic intervention in the management of complete membranous occlusion of bilioenteric anastomosis: report of two cases.

Postoperative biliary stricture is a relatively rare but serious complication of biliary surgery. Although Rouxen-Y hepaticojejunostomy or choledochojejunostomy are well-established and fundamental therapeutic approaches, their postoperative morbidity and mortality rates have been reported to be up to 33% and 13%, respectively. Recent studies suggest that percutaneous transhepatic intervention is an effective and less invasive therapeutic modality compared with traditional surgical treatment.

Natural History and Prognostic Factors of Advanced Cholangiocarcinoma without Surgery, Chemotherapy, or Radiotherapy: A Large-Scale Observational Study.

Background/aims: We aimed to evaluate survival time and prognostic factors in patients with advanced unresectable cholangiocarcinoma who have not received surgery, chemotherapy, or radiotherapy.

Methods: A total of 1,377 patients, who were diagnosed with primary cholangiocarcinoma between 1996 and 2002, were reviewed retrospectively according to the following inclusion criteria: histologically proven primary adenocarcinoma arising from the bile-duct epithelium, advanced unresectable stages, no severe comorbidity that can affect survival time, and no history of surgery, chemotherapy, or radiotherapy.

Results: Of the 1,377 cases reviewed, 330 patients complied with the inclusion criteria and were thus eligible to participate in this study; 203 had intrahepatic cholangiocarcinoma and 127 had hilar cholangiocarcinoma.

Endoscopic ultrasound guided fine needle aspiration biopsy in diagnosis of pancreatic and peripancreatic lesions: a single center experience in Korea.

Background/aims: Although endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has been introduced and its use has been increasing in Korea, there have not been many reports about its performance. The aim of this study was to assess the utility of EUS-FNA without on-site cytopathologist in establishing the diagnosis of solid pancreatic and peripancreatic masses from a single institution in Korea.

Methods: Medical records of 139 patients who underwent EUS-FNA for pancreatic and peripancreatic solid mass in the year 2007, were retrospectively reviewed.

EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage (with videos).

Background: Currently, percutaneous drainage is the first treatment of choice for hepatic abscesses because of its high success and low mortality rates compared with other surgical procedures. However, percutaneous drainage of hepatic abscesses in the caudate lobe or gastrohepatic space may be difficult.

Objective: The aim of this study was to determine the technical feasibility and clinical implication of EUS-guided drainage for hepatic abscesses not accessible to percutaneous biliary drainage.

IgG4 immunostaining of duodenal papillary biopsy specimens may be useful for supporting a diagnosis of autoimmune pancreatitis.

Background: Autoimmune pancreatitis (AIP) is now considered to be part of an immunoglobulin G4 (IgG4)-related systemic fibroinflammatory disease.

Objective: We evaluated whether IgG4 immunostaining of duodenal papillary biopsy specimens is useful for supporting a diagnosis of AIP.

Design: A prospective study.

The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses.

Objectives: A large-caliber needle such as a 19-gauge needle may help overcome the limitations of a 22-gauge needle by acquiring a larger amount of tissue sample. However, there has been no well-designed comparative study for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with a 19-gauge aspiration needle. We conducted this study to compare the diagnostic accuracy of EUS-FNA using a 19-gauge aspiration needle with that using a 22-gauge aspiration needle in patients with solid pancreatic/peripancreatic mass.

Course of choledochal cysts according to the type of treatment.

Objective: To compare natural course and treatment results of various types of choledochal cysts.

Material And Methods: Complication rate in treated (T) and natural course in not treated (NT) patients with choledochal cysts were compared. The level of bilioenteric anastomosis after cyst resection was categorized and their post-procedure courses were analyzed.

The antioxidant and chemopreventive potentialities of Mosidae (Adenophora remotiflora) leaves.

Our study focused on the antioxidant activities of Mosidae leaf ethanol extract (MLE) and included measurements of reducing power, total phenolic compounds, DPPH radical scavenging activity, and hydroxyl radical scavenging activity. In order to determine whether or not MLE evidences any chemopreventive activities, experimental lung metastasis was induced via the i.v.

EUS-guided cholecystoenterostomy with single-step placement of a 7F double-pigtail plastic stent in patients who are unsuitable for cholecystectomy: a pilot study (with video).

Background: Although the definitive therapy of acute cholecystitis is cholecystectomy, nonsurgical treatment such as percutaneous cholecystostomy could be indicated in patients who are unsuitable candidates for cholecystectomy. EUS-guided cholecystoenterostomy with a plastic stent and/or nasobiliary drainage has been proposed as an alternative effective treatment for these patients.

Objective: We conducted this study to evaluate the technical feasibility, safety, usefulness, and follow-up results of EUS-guided cholecystoenterostomy with single-step placement of a plastic stent for patients with acute cholecystitis who are unsuitable candidates for cholecystectomy.

EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP (with videos).

Background: Percutaneous transhepatic biliary drainage (PTBD) may be the last resort for an occluded biliary metal stent when the ERCP was unsuccessful.

Objective: Because an EUS-guided biliary drainage has been proposed as an effective alternative for PTBD after a failed ERCP, we conducted this study to determine the feasibility and usefulness of an EUS-guided hepaticogastrostomy (EUS-HG) with a fully covered self-expandable metal stent (FCSEMS) for an occluded biliary metal stent after a failed ERCP.

Design: A case study.

The combined measurement of total serum IgG and IgG4 may increase diagnostic sensitivity for autoimmune pancreatitis without sacrificing specificity, compared with IgG4 alone.

Objectives: Until now, there was no international consensus on the diagnostic criteria for autoimmune pancreatitis (AIP). As for serologic criteria, the HISORt criteria use elevated immunoglobulin (Ig) G4 alone, whereas the Asian diagnostic criteria include elevations of total IgG or IgG4, or the presence of autoantibodies. This study was mainly aimed at determining whether the combined measurement of total IgG and IgG4 could increase the diagnostic sensitivity for AIP while maintaining specificity, compared with IgG4 alone.

Updates in the treatment of gallstones.

For the treatment of symptomatic gallbladder stones, laparoscopic cholecystectomy is the procedure of choice. However, open cholecystectomy is advisable in some situations, and a new technique - natural-orifice transluminal endoscopic surgery - has been described recently. In addition, nonsurgical approaches have also been used in patients with gallbladder stones.

Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience.

Background/purpose: Both curative resection and minimized in-hospital mortality offer the only chance of long-term survival in patients with hilar cholangiocarcinoma. The reported resectability rates for hilar cholangiocarcinoma have increased by virtue of combined major hepatectomy, but this procedure is technically demanding and still associated with a significant morbidity and mortality that must be carefully balanced against the chances of long-term survival.

Methods: Between January 2001 and December 2008, 350 patients with hilar cholangiocarcinoma underwent exploration for the purpose of potentially curative resection, of whom 302 (86.

Spinal Cord Stimulation for Intractable Visceral Pain due to Chronic Pancreatitis.

Pain caused by chronic pancreatitis is medically intractable and resistant to conventional interventional or surgical treatment. We report a case of spinal cord stimulation (SCS) for intractable pain due to chronic pancreatitis. The patient had a history of nonalcoholic chronic pancreatitis and multiple emergency room visits as well as repeated hospitalization including multiple nerve block and morphine injection for 3 years.

Utility of 18F-FDG PET/CT for differentiation of autoimmune pancreatitis with atypical pancreatic imaging findings from pancreatic cancer.

Objective: This study was conducted to evaluate the clinical usefulness of PET/CT in differentiating autoimmune pancreatitis from pancreatic cancer.

Materials And Methods: To differentiate autoimmune pancreatitis from pancreatic cancer, we analyzed the cases of 17 patients with autoimmune pancreatitis and atypical pancreatic imaging findings who underwent integrated PET/CT. The PET/CT findings on the 17 patients with autoimmune pancreatitis were compared with those of 151 patients with pancreatic cancer.

Differences in pancreatic immunohistochemical staining profiles of TGF-beta1, MMP-2, and TIMP-2 between autoimmune and alcoholic chronic pancreatitis.

Objectives: Tumor growth factor beta (TGF-beta) is an immunosuppressive cytokine and has been implicated in a variety of disease processes, including those in autoimmune disease. Tumor growth factor beta is also involved in fibrosis by regulating matrix metalloproteinases (MMPs) and the tissue inhibitor of MP (TIMP). The purpose of this study was to compare the expression patterns of TGF-beta1, MMP-2, and TIMP-2 between autoimmune chronic pancreatitis (AIP) and alcoholic chronic pancreatitis (ACP) by immunohistochemical staining of pancreatic tissue specimens.

EC-18, a synthetic monoacetyldiacylglyceride, inhibits hematogenous metastasis of KIGB-5 biliary cancer cell in hamster model.

EC-18 (monoacetyldiacylglyceride) stimulates T cell production of IL-2, IL-4, IL-12, IFN-gamma, and GM-CSF in vitro. To study the effects of these cytokines stimulated by EC-18 on cancer cells, we applied hamster biliary cancer model, a difficult cancer to treat. Cancer (KIGB-5) cells were given intravenously to produce hematogenous metastatic lung lesions which were treated with EC-18 at 10, 25, and 50 mg/kg/day respectively.

Prognostic factors and predictive model in patients with advanced biliary tract adenocarcinoma receiving first-line palliative chemotherapy.

Background: Advanced biliary tract adenocarcinoma (BTA) has been a rare but fatal cancer. If unresectable, palliative chemotherapy improved the quality and length of life, but to the authors' knowledge, prognostic factors in such patients have not been well established to date. In the current study, prognostic factors were investigated in patients with advanced BTA receiving first-line palliative chemotherapy.

EUS-guided biliary drainage with one-step placement of a fully covered metal stent for malignant biliary obstruction: a prospective feasibility study.

Objectives: Endoscopic ultrasound (EUS)-guided biliary drainage (EUSBD) with plastic stents has been introduced as an alternative to percutaneous transhepatic biliary drainage (PTBD) in cases of biliary obstruction when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful. Although self-expandable metallic stents with a larger diameter might offer long-lasting patency compared with plastic stents, to date, EUSBD with one-step placement of a fully covered self-expandable metal stent (FCSEMS) has not been evaluated. We conducted this study to determine the feasibility and usefulness of EUSBD with one-step placement of FCSEMS.

Newly designed stent for endoscopic bilateral stent-in-stent placement of metallic stents in patients with malignant hilar biliary strictures: multicenter prospective feasibility study (with videos).

Background: Endoscopic management of malignant hilar biliary strictures is difficult even for an experienced endoscopist. Moreover, endoscopic placement of bilateral metal stents is considered very difficult and complicated.

Objective: We explored the feasibility and efficacy of the placement of a newly designed metal stent for an endoscopic bilateral stent-in-stent procedure for the management of malignant hilar biliary strictures.

Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy.

Objective: To assess the effect of ipsilateral hepatic vein embolization (HVE) performed after portal vein embolization (PVE) on liver regeneration.

Summary Background Data: PVE induces shrinkage of the embolized lobe and compensatory enlargement of the non-embolized lobe, but it does not always induce sufficient liver regeneration. There was no effective method to accelerate liver regeneration in addition to PVE yet.

Histologic influence of paclitaxel-eluting covered metallic stents in a canine biliary model.

Background: Metallic stents for malignant biliary obstruction are susceptible to occlusion by tumor ingrowth or overgrowth. Paclitaxel-eluting metallic stents (PEMSs), however, may prevent occlusion from tumor ingrowth.

Objective: We evaluated the safety of PEMSs in a canine biliary model by analyzing tissue reactions by histologic examination.

[Clinical characteristics and malignant predictive factors of pancreatic neuroendocrine tumors].

Background/aims: Neuroendocrine tumors (NET) of the pancreas are rare. Its prognosis is better than pancreas adenocarcinoma due to the slow growth, however, malignant NET of the pancreas are observed. The purposes of this study were to evaluate the clinical characteristics and to find the predictive factors of NET which are associated with malignancy and survival.

Yield of EUS-guided FNA on the diagnosis of pancreatic/peripancreatic tuberculosis.

Background: Pancreatic/peripancreatic tuberculosis (TB) is a very rare clinical entity, even in countries with high incidences of TB. The diagnosis of pancreatic/peripancreatic TB with EUS-guided FNA (EUS-FNA) remains a diagnostic challenge because of limitations of the endoscopists' expertise on this condition.

Objective: This study evaluated the yield and usefulness of EUS-FNA in patients with pancreatic/peripancreatic TB.