Perforación duodenal post-CPRE de manejo no quirúrgico: reporte de un caso / A Case Report of Non-Surgical Duodenal Perforation Following ERCP

Resumen La perforación duodenal posterior a la colangiopancreatografía retrógrada endoscópica (CPRE) es una complicación infrecuente que sucede en un 0,1%-0,6% de los casos. El manejo (quirúrgico o no quirúrgico) depende de varios factores. Presentamos el caso de una mujer que sufrió una perforación duodenal post-CPRE manejada conservadoramente con un stent biliar metálico autoexpandible (SMAE) totalmente recubierto y antibióticos, quien no requirió manejo quirúrgico.

Abstract Post-ERCP duodenal perforations occur in only 0.1 to 0.6% of ERCP cases. Whether these occurrences are managed with or without surgery depends on several factors. We report the case of a woman who had a post-ERCP duodenal perforation that was conservatively managed with a fully covered self-expanding metal stent (FCSEMS) and antibiotics who did not require surgical management.

A Case of Neuroendocrine Carcinoma of the Gallbladder That Was Diagnosed by Endoscopy / 대한소화기내시경학회지

Neuroendocrine carcinomas mostly occur in the gastrointestinal tract, lung and pancreas. The gallbladder is an uncommon organ for a neuroendocrine carcinoma and it is difficult to diagnose before gallbladder surgery. Owing to its rare occurrence its natural course and treatment are not definitely established. A 71-year-old woman was hospitalized with intermittent abdominal pain and nausea. Abdominal computed tomography showed multiple masses of the gallbladder obstructing the biliary tract. From endoscopic ultrasonography we suspected carcinoma of the gallbladder that was infiltrating a common bile duct. A biopsy was taken using endoscopic retrograde cholangiopancreatography (ERCP) and the mass was diagnosed as a neuroendocrine carcinoma of the gallbladder. Here we report a case of a neuroendocrine carcinoma of the gallbladder confirmed by endoscopic biopsy, and provide a review of the literature.

The Outcome of Laparoscopic Common Bile Duct Exploration (LCBDE) for the Choledocholithiasis that ERCP Failed to Remove

PURPOSE: With the advent of endoscopic technology, ERCP (endoscopic retrograde cholangiopancreatography)/ES (endoscopic sphincterotomy) has become the main treatment for CBD stones. However, when ERCP fails to remove CBD stones, it remains unclear whether laparoscopic treatment is an alternative or not. The aim of this study was to investigate the outcome of LCBDE for the management of difficult choledocholithiasis. METHODS: This study was a retrospective analysis of 68 LCBDE cases that were performed at the Ewha Womans University School of Medicine, Mokdong Hospital from January, 2000 to March, 2006. Group A was defined that primary LCBDE was performed without ERCP/ES. Group B was defined that secondary LCBDE was performed after ERCP/ES had failed. The operative outcomes and postoperative complications were compared between the two groups. RESULTS: Primary LCBDE was performed for 33 patients (Group A) and secondary LCBDE after failure of ERCP/ES was performed for 35 patients (Group B). No significant differences in gender, mean age and associated diseases were noted between the two groups. The stone clearance rate was 100% for both groups. There were no significant differences between the two groups for the mean operative time (201.5 min for Group A vs 188.7 min for Group B: P=0.415), the open conversion rate (9.1% vs 0%, respectively: P=0.068), the complication rate (12.1% vs 8.6%, respectively: P=0.630) and the duration of the hospital stay (14.3 days vs 11.9 days, respectively: P=0.169). The recurrence rate along with a mean follow-up of 24 months showed no significant difference between the two groups (12.1% vs 2.9%, respectively). CONCLUSION: When ERCP is impossible or stone retrieval is incomplete, LCBDE is an alternative treatment for difficult CBD stones.