RESUMEN
An endoscopic retrograde cholangiopancreatography (ERCP) procedure requires the highest level of difficulty among endoscopic procedures and the complications related to the procedure is relatively high, and fatal. Training in ERCP requires the development of technical, cognitive, and integrative skills well beyond those needed for standard endoscopic procedures. Therefore, a system that certifies qualifications through objective and systematic training and examination is needed to improve patient safety and quality of medical services. This manuscript introduces a set of rules that contain all the necessary matters for the certification system of pancreatic and biliary endoscopy.
RESUMEN
Choledochocele is the least common type of choledochal cyst. Choledochocele has a potential for carcinogenesis, but only a handful of cases with concurrent ampullary carcinoma have been reported. We recently experienced a case of choledochocele with tubulovillous adenoma with focal high-grade dysplasia, which was successfully and completely resected en bloc via endoscopic papillectomy. Prior to endoscopic papillectomy, the endoscopic ultrasonography was able to accurately diagnose the ampullary tumor arising in choledochocele. Herein, we would like to report this case and discuss the potential of malignant transformation and the usefulness of endoscopic ultrasonography in choledochocele.
RESUMEN
Background/Aims@#Using an appropriate guidewire can increase the success rate of selective cannulation in endoscopic retrograde cholangiopancreatography. The purpose of this technical study was to investigate the characteristics of each guidewire type and to evaluate its efficiency and rapidity of insertion. @*Methods@#We conducted a three-point bending test using a universal testing machine to investigate the flexibility and bending features of each guidewire. 3D-printed silicone tubes with various types of stricture and a hand-made biliary tree silicone model with six-stranded intrahepatic ducts were used to evaluate the success rate and insertion time of each guidewire. @*Results@#In the three-point bending test, the characteristics of each guidewire were classified. We found that the bending strengths and times were independent of shaft thickness. Using two in vitro biliary duct models, we determined that the success rate and total insertion time were better for guidewires with a resilient shaft and angled tip than for other types of guidewires (p<0.001). Although thickness of the guidewire affected the success rate (p<0.05), it did not affect the total insertion time (p≥0.05). @*Conclusions@#Among several types of guidewire, some factors (resilient shaft, highly flexible, and angled tip) appeared to be associated with the efficiency and rapidity of the guidewire insertion.
RESUMEN
Idiopathic hypereosinophilic syndrome (IHS) can be diagnosed when prolonged eosinophilia and organ involvement are evident without specific etiologic factors. Budd-Chiari syndrome (BCS) is hepatic venous outflow obstruction, regardless of the cause or level of obstruction. Budd-Chiari syndrome associated with idiopathic hypereosinophic syndrome seems to be very rare, and only a few reports of such cases have been published. We experienced a 27-years-old man presented as BCS associated with idiopathic hypereosinophilic syndrome. Liver pathology revealed sinosoidal dilation, extravasated red blood cells and some degree of fibrosis. Liver sonogram, CT and inferior venocavogram didn't show visualization of hepatic vein and a short segmental narrowing of IVC. We present a case of BCS associated with IHS with review of literatures.