Clinical Application and Safety of Endoscopic Pancreatic Sphincterotomy in 339 Cases / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic pancreatic sphincterotomy (EPST) has been performed more frequently in recent years. However, it is less widely practiced than biliary sphincterotomy due to lack of firm scientific data regarding its indication and safety. The aims of this study are to evaluate EPST with regard to indications, complications, and safety. METHODS: We retrospectively reviewed and analyzed the results of EPST performed in three hundred thirty nine patients from January 2000 to April 2004.RESULTS: Complications occurred in 37 patients (10.7%) which included pancreatitis, hemorrhage, perforation, cholangitis, sepsis, and stenosis of sphincterotomy site. They were successfully managed by medical treatment. No mortalities were reported. CONCLUSIONS: EPST is a relatively safe procedure in various pancreatic diseases. Incidence of long-term complications awaits further investigations. EPST enlarges our endotherapeutic armamentarium and deserves additional evaluation.

A Case of Juxtaglomerular Cell Tumor / 대한신장학회잡지

The juxtaglomerular cell tumor is a rare benign tumor which causes surgically correctable hypertension. We report a case of hypertension caused by juxtaglomerular cell tumor in a 17-year old man. He presented with hypokalemia, metabolic alkalosis and hyperreninemic hyperaldosteronism. Renal angiography showed no evidence of renal artery stenosis. Though no mass was suspected in renal angiography, CT scan showed a well demarcated mass, 3 cm in diameter, in the upper portion of left kidney, which was resected and diagnosed to be a juxtaglomerular cell tumor. After resection of the tumor, blood pressure was normalized with resolution of hypokalemia, metabolic alkalosis and hyperreninemic hyperaldosteronism.

Endoscopic Minor Papilla Intervention in a Patient with Traumatic Ductal Leak without Pancreas Divisum / 대한소화기내시경학회지

Endoscopic treatment has been performed in a variety of pancreatic ductal diseases such as stones, strictures, sphincter stenosis, and ductal disruption and is known to be an effective therapy in some patients. Endoscopic treatment through the minor papilla is frequently done in patients with pancreas divisum. Few data are, however, available concerning endoscopic minor papilla interventions in patients without pancreas divisum but with difficult access to the main pancreatic duct at the major duodenal papilla. We present a 49-year-old man, who had pancreatic ductal leak caused by previous pancreatic surgery. He was treated by endoscopic naso-pancreatic drainage and pancreatic ductal stenting through the minor papilla, so called pancreatic rendezvous technique. Follow-up ductography after two-weeks of naso-pancreatic drainage showed no leak. This case shows that minor papillar orifice could be an alternative access for therapeutic endoscopic intervention in a patient with traumatic pancreatic ductal leak without pancreas divisum.

Non-exposed type of ampullary adenoma presenting as acute pancreatitis / 대한내과학회지

The adenoma of major duodenal pallilla is a rare cause of acute pancreatitis. Also, ampullary adenoma is known as a premalignant lesion having the potential for malignant transformation. Especially, the diagnosis of the unexposed (intramural) type of ampullary adenoma, which shows normal overlying mucosa, is known to be very difficult. We report a case of an unexposed type of ampullary adenoma presented as acute pancreatitis. On duodenoscopic examination, mucocal abnormality of the mapulla of Vater was not noted. After endoscopic sphicterotomy, a nodular mass was exposed and the tubular adeonoma was histologically confirmed with endoscopic biopsy.

Analysis of gallstones which cause biliary symptoms or complication / 대한내과학회지

BACKGROUND: Gallstone is one of the most common cause of acute abdominal pain and is increasingly managed by laparoscopic cholecystectomy. Silent gallstones are usually managed expectantly and are considered for surgery only if the characteristic biliary pain occurs. If predictors of stone-related complications such as acute cholecystitis, pancreatitis, and cholangitis can be identified, patients at high risk can be selectively referred for treatment regardless of symptoms development, while those at lower risk may be safely observed. The purpose of this study was to find out the predictors of stone-related complication or biliary pain in patients with gallbladder stones. METHODS: We collected clinical data retrospectively on patients who were diagnosed with gallstone at Asan Medical Center. Total gallstone number was classified into 1, 2~4, over 5. Diameter of the gallstones were subdivided into 20 mm. Statistical analysis was performed using SAS program (Ver 6.11). RESULTS: 918 patients (432 men and 486 women) were included in the analysis. The mean age was 54.3 years; that of men was 55 years and women was 53.8 years. Stone-related complications developed in 201 patients of acute cholecystitis, 78 patients of acute gallstone pancreatitis and 80 patients of acute cholangitis. Biliary pain was occurred in 568 patients. 658 patients were experienced cholecystectomy (158 patients open cholecystectomy and 500 patiens LLC). 377 patients were experiened ERCP, and 289 persons of that were experienced EST. Acute gallstone pancreatitis and acute cholangitis were significantly more frequent in older age and patients experiencing biliary pain. Their gallstone size was significantly smaller and the number was significantly more numerous in the univariate analysis. But, in the multiple logistic regression analysis, only age and the smallest stone size were independent risk factors. Patients who experiencing biliary pain were older and had significantly smaller and multiple gallstones in the univariate analysis. However in the multiple logistic regression analysis only age and stone number were independent variables. Acute cholecystitis was significantly more frequent in the old age group and patients with biliary pain. CONCLUSION: In the multiple logistic regression analysis, old age and small gallstones were predictors of acute gallstone pancreatitis and acute cholangitis. Old age and multiple gallstones were associated with biliary pain. Old age and biliary pain were predictors of acute cholecystitis, but the gallstone size and number were not associated in this study. We suggest that a well-designed prospective study is necessary in the future.