Endoscopic Ultrasound-guided Pancreatic Pseudocyst Drainage without Fluoroscopy / 대한췌담도학회지

BACKGROUND/AIMS: Pancreatic pseudocyst is a common complication of acute and chronic pancreatitis. Endoscopy ultrasound (EUS)-guided drainage includes multiple steps and requires many resources such as a linear echoendoscope and a fluoroscopy room, which may not be available at all medical centers. We aimed to evaluate the efficacy and safety of EUS-guided pancreatic pseudocyst drainage without fluoroscopy. METHODS: This retrospective study analyzed 10 patients who had undergone EUS-guided transmural drainage of pancreatic pseudocyst without use of fluoroscopy at the Pusan National University Hospital between January 2009 and December 2016. Drainage was performed via a transgastric approach and one or two 7 Fr double-pigtail stents were inserted. RESULTS: The technical success rate was 100% and the clinical success rate was 80%. In two patients, clinical success was not achieved and additional percutaneous catheter drainage was done. Therefore, pseudocysts in all the patients were treated successfully without surgical drainage. However, there were three adverse events in three patients: bleeding, infection, and stent migration in each respective patient. During the median follow-up period of 36.5 months, there was no recurrence of pseudocysts in any of the patients. CONCLUSIONS: EUS-guided transmural drainage of pseudocyst drainage without use of fluoroscopy is a technically feasible, safe, and effective procedure for the treatment of pancreatic pseudocyst.

A Case of Giant Fibrovascular Polyp of the Esophagus, Treated Successfully by Endoscopic Resection / 대한소화기학회지

Fibrovascular polyps are rare benign intraluminal tumors that usually arise from the cervical esophagus. These often present as very large sized pedunculated polyps and cause symptoms including dysphagia and respiratory distress. Generally, large polyps are surgically excised, while endoscopic resection is limited to smaller polyps. Herein, we present a giant fibrovascular polyp of the esophagus treated successfully by endoscopic resection.

A Common Bile Duct Web in Association with Bile Duct Stone Treated with Balloon Dilatation / 대한췌담도학회지

Bile duct web is very rare disease and it's etiology is controversial. Some webs are occurred in the presence of chronic inflammation, frequently associated with bile duct stone, but others are thought to be congenital. Many patients with bile duct web are asymptomatic, but they sometimes present symptom of biliary obstruction and cholangitis. It can be diagnosed by endoscopic retrograde cholangiopancreatogram, typically appearing as thin and shelf like radiolucent ring. We report a case of the common bile duct web with bile duct stones diagnosed by Endoscopic retrograde cholangiopancreatography (ERCP) in a 65-year-old man. The patient was treated by balloon dilatation successfully.

A Case of Intrahepatic Bile Duct Sarcoma; Misdiagnosed with Liver Abscess Combined with Intrahepatic Ductal Stone / 대한췌담도학회지

Sarcoma is rare malignant tumor originated from mesenchymal stem cells that can differentiate to soft tissue and bone. Therefore sarcoma can be arised from any regions in human body. However, the incidence of bile duct sarcoma is extremely rare in adults. Obstructive jaundice is the most common presentation in the patients, but there're no specific symptoms or signs. Also it can be misdiagnosed with other tumors or benign lesions in computed tomography or ultrasonography. For these reasons, it is hard to diagnose and manage. We present a case of intrahepatic bile duct sarcoma misdiagnosed with liver abscess in 70 year-old female with literature review.

New-Onset Malignant Pleural Effusion after Abscess Formation of a Subcarinal Lymph Node Associated with Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration / 결핵및호흡기질환

We present a case of an unusual infectious complication of a ruptured mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which led to malignant pleural effusion in a patient with stage IIIA non-small-cell lung cancer. EBUS-TBNA was performed in a 48-year-old previously healthy male, and a mediastinal abscess developed at 4 days post-procedure. Video-assisted thoracoscopic surgery was performed for debridement and drainage, and the intraoperative findings revealed a large volume pleural effusion that was not detected on the initial radiographic evaluation. Malignant cells were unexpectedly detected in the aspirated pleural fluid, which was possibly due to increased pleural permeability and transport of malignant cells originating in a ruptured subcarinal lymph node from the mediastinum to the pleural space. Hence, the patient was confirmed to have squamous cell lung carcinoma with malignant pleural effusion and his TNM staging was changed from stage IIIA to IV.