A Study on Normal Structures, Variations, and Anomalies of the Korean Pancreaticobiliary Ducts: Cooperative Multicenter Study / 대한소화기내시경학회지

BACKGROUND/AIMS: This study was designed to evaluate normal Korean pancreaticobiliary ducts and to assess the prevalence and pattern of variations and anomalies of theses structures. METHODS: We performed this multicenter study in which 7 university hospitals in Korea participated from March 1997 until June 1999. Total 10,243 ERCP cases were reviewed during this study period. RESULTS: 1) Maximal and midportion diameters of common bile ducts were 6.4+/-1.8 mm and 5.5+/-1.7 mm, respectively. Maximal and midportion diameters of pancreas head were 3.2+/-1.1 mm and 2.7+/-1.0 mm, respectively. Pancreaticobiliary duct diameters of subjects above the age of 40 were greater than those of subjects below the age of 40 (p<0.05). 2) The prevalence of choledochal cyst was 0.32%. The prevalence of gallbladder anomalies and anomalous union of pancreaticobiliary duct was 4.2% and 4.1%, respectively. The prevalence of pancreas divisum and annular pancreas was 0.49% and 0.05%, respectively. The most common type of pancreaticobiliary duct union was V shape (60.2%), followed by U shape (23.7%) and Y shape (16.1%). CONCLUSIONS: Understanding normal pancreaticobiliary structures and being aware of the prevalence and pattern of variations and anomalies of pancreaticobiliary structures will be helpful to diagnose and treat patients with pancreaticobiliary problems.

Sphincterotomy - Induced Hemorrhage: Prevalence, Risk Factors and Endoscopic Hemostasis / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic biliary sphincterotomy (EST)-induced hemorrhage occurs in approximately 0.5-12% of procedures. We prospectively investigated the risk factors of EST-induced hemorrhage and evaluated its safety as well as the effectiveness of endoscopic hemostasis. METHODS: One thousand three hundred and four patients, who underwent EST between July 1996 and June 1998, were enrolled. As a hemostatic treatment, epinephrine spray was initially used. If bleeding persisted, epinephrine injection was performed consecutively. In patients with exposed vessels, epinephrine injection followed by alcohol injection was given. RESULTS: EST-induced hemorrhage occurred in 136 (10.4%) patients. Types of sphincterotome (needle-knife sphincterotome, p=0.0079) and cutting speed (so-called, zipper cut, p=0.03) were revealed as significant variables for the occurrence of bleeding. Once bleeding occurred, patients with an associated ampullary lesion (impacted stone or cancer) or with coagulopathy were more likely to bleed profusely. Initial hemostasis was achieved in all patients. However, rebleeding occurred in eight patients who were initially classified in the moderate or severe bleeding group. Finally, EST-induced hemorrhage was successfully controlled in all patients after 1-3 treatment sessions (mean: 1.1 sessions). The difference in the incidence of complications between the groups with and without endoscopic hemostasis was not statistically significant. CONCLUSIONS: The use of needle-knife sphincterotome and cutting speed were independent risk factors for bleeding occurrence. Once bleeding occurred, its severity was affected by the associated ampullary lesion (impacted stone or cancer) or coagulopathy. Endoscopic hemostasis with epinephrine and/or alcohol was effective and safe in EST-induced hemorrhage.

An Intraductal Papillary Mucinous Tumors (IPMT) of the Pancreas: Clinical, Radiologie, and Pathologie Findings Acccrding to Its Subtypes / 대한소화기내시경학회지

BACKGRONDS/AIMS: Patients with a branch duct type intraductal papillary mucinous tumor (IPMT) of the pancreas with hyperplasia are suggested to be followed up without resection. The aims of this study were to compare the clinical, radiologic, and pathologic findings among the subtypes of IPMT and to find the factors that could predict a hyperplastic lesion preoperatively. METHODS: Twenty two patients with IPMT of the pancreas who underwent surgical resection were investigated. The subtypes of IPMT were classified into the main duct type (7 patients), branch duct type (6 patients), and combined type (9 patients) based on the pathologic findings of the surgical specimens. The clinical, radirologic, and pathoiogic findings of each subtype were analyzed. RESULTS: Asymptomatic patients were more common in the branch duct type of IPMT (p=0.01). The diameter of the main pancreatic duct was <7 mm in most of the branch duet types of IPMT (5/6). Hyperplastic lesions were more likely to be the branch ciuct type (5/6, p=0.01). CONCLUSIONS: A hyperplastic lesion can be predicted if a lesion is the branch duct type of IPMT with the diameter of the main pancreatic duct < 7 mm and without symptoms. Therefore, IPMT of the pancreas with these findings can be followed up without an operation.

A Case of Appendiceal Mucocele with Concominant Colon Cancer

The appendiceal mucocele is a rare disorder, usually found incidentally during ultrasonography or radiologic studies. Mucoceles of the appendix include benign or malignant disease. Both of benign cystadenoma and malignant cystadenocarcinoma are characterized by an obstructed, mucin-filled appendix displacing the cecum. We experienced a case of partial obstruction of large bowel who had a cystadenoma at appendix and a colon cancer at other site on operation field. Here in, we report a case of appendiceal mucocele and concominant colon cancer with the review of literatures.

A New Strategy to Predict the Neoplastic Polyps of the Gallbladder Based on a Scoring System Using Endoscopic Ultrasonography / 대한소화기내시경학회지

No abstract available.

Two Cases of Mucinous Ductal Ectasia of Pancreas with Normal Duodenoscopic Findings / 대한소화기내시경학회지

Fairly specific and important duodenoscopic findings for diagnosing mucinous ductal ectasia (MDE) of pancreas include a prominant ampulla, patulous ampullary orifice and extrusion of mucin through the ampulla. However, we have experienced two cases of mucinous ductal ectasia without these pathognomonic appearance of ampulla. Initially, two cases were admitted for evaluation of pancreatic multicystic lesions, and MDE was incidentally found. Their pancreatographic findings showed normal main duct and cystic dilatation confined to the branch ducts. On gross findings of surgical specimens, a duct dilatation with gelatinous mucin was localized at the uncinate process of the pancreas. Microscopically, the ductal epithelia containing mucin were lined with well-differentiated tall columnar cells showing focal hyperplastic change. We report these unusual cases of MDE with review of the literatures.

Choledochal cyst associated the with anomalous union of pancreaticobiliary duct (AUPBD) has a more grave clinical course than choledochal cyst alone

OBJECTIVE: Since choledochal cyst is frequently associated with the anomalous union of pancreaticobiliary duct (AUPBD), AUPBD has been regarded to be the etiologic factor of choledochal cyst. However, the clinical significance of AUPBD an patients with choledochal cyst has not been clearly defined. Therefore, to clarify the significance of AUPBD in choledochal cyst patients, we compared the clinical features of patients with choledochal cyst according to the presence or absence of AUPBD. METHODS: Among 52 cases which were diagnosed as choledochal cyst out of 5,037 ERCP referrals between August 1990 and December 1996, we selected 44 cases, in which the pancreaticobiliary junction was clearly visualized on cholangio-pancreaticography. These cases were divided into AUPBD-present group (n = 28) and AUPBD-absent group (n = 16). Clinical features were compared between the two groups. Furthermore, in AUPBD-present group, clinical data were also analyzed according to Kimura's classification of AUPBD. RESULTS: In our study, AUPBD was associated with choledochal cyst in 28 (64%) cases. AUPBD was found only in type I and IV according to Todani's classification of choledochal cyst. There were no significant differences between the AUPBD-present group and the AUPBD-absent group in the incidence of gallstone disease, while the incidence of acute inflammation was 93% (26/28) in the AUPBD-absent group (p < 0.01). Carcinoma developed only in the AUOBD-present group (9/28, 32%) (p < 0.05). Pancreatic disorders (i.e. pancreatic stone, pancreatitis or pancreatic cancer) occurred in 12 of 28 cases in the AUPBD-present group (43%), while only in 1 of 16 cases in the AUPBD-absent group (6%) (p < 0.05). CONCLUSION: AUPBD associated with choledochal cyst may have implications not only as a possible etiologic factor but also as an important factor that may affect the clinical course, surgical planning and prognosis. In cases with choledochal cyst, we should make an effort to evaluate the presence of AUPBD.

Endoscopic Pancreatic Duct Sphincterotomy : Indications, Technique and Safety / 대한소화기내시경학회지

BACKGROUNDS: The aim of this study was to evaluate the indications, techniqe and safety of endoscopic pancreatic duct sphincterotomy. METHODS: Fifty-four patients, 41 of whom had chronic pancreatitis, underwent endoscopic pancreatic duct sphincterotomy during a 4 year period from 1993 to 1996. We retrospectively reviewed and analyzed the results of the endoscopic pancreatic duct sphincterotomy. RESULTS: Successful endoscopic pancreatic duct sphincterotomy occurred in 52 (96%) of the cases. No mortalities resulted. Complications occurred in 4 patients (4.8%) and included pancreatitis (n=l), bleeding (n=l), cholangitis (n=1) and stenosis of the sphincterotomy site (n=1). They were successfully managed by medical or endoscopic treatment. CONCLUSIONS: Endoscopic pancreatic duct sphincterotomy was found to be a safe and feasible procedure involving a high success rate and low rates of complications. The authors conclude that endoscopic pancreatic duct sphincterotomy enlarges our endotherapeutic armamentarium and deserves additional evaluation.