Choledochoduodenal Fistula after Placement of Endocoil Spiral Stent for Pancreatic Head Cancer / 대한소화기내시경학회지

Retrograde endoscopic or percutaneous transhepatic bile duct drainage is the treatment of choice for palliation of malignant biliary obstruction. An expanding metal stent, Endocoil spiral stent, with strong radial force was developed to solve the problems of other metal stents which include obstruction by tumor ingrowth, migration, and epithelial trauma from the distal hard edges of the stent. A choledochoduodenal fistula is occasionally found during endoscopic retrograde cholangiopancreatiography (ERCP) or barium radiography. Cholelithiasis is suspected to be the leading cause in some endemic areas like Korea but duodenal ulcer is more common in Western countries. The case reported here is of a 78-year-old woman, suffering from vomiting, epigastric pain, and abdominal distension, who had a Endocoil spiral stent in the common bile duct (CBD) for pancreatic head cancer for 8 months. During barium radiograph, a fistulous connection between the proximal second part of duodeum and the CBD was identified.

The Evaluation and Treatment of the Obstructive Biliary Disease through the Percutaneous Transhepatic Choledocoscopy (PTCS ) / 대한소화기내시경학회지

BACKGROUND/AIMS: Obstructive jaundice is developed from the cholangiocarcinoma, biiliary tract stone, biliary benign stricture and pancreatic head cancer and is rapidly progress to cholangitis or sepsis. So early decompression, accurate diagnosis and treatment are very important. Percutaneous transhepatic choledocoscopy (PTCS) and endoscopic retrograde choledocoscopy (ERCS) have been used for evaluation of the obstructive jaundice. We performed, through the PTCS, electrohydraulic lithotripsy (EHL) for biliary tract stone rernoval, biopsy for diagnosis of biliary stric and self expandible metalic coil stent (EndocoilTM stent, Instent Co.) insertion on biliary stricture to evaluate the usefullness of PTCS in patients with obstructive jaundice. METHODS: Between Auguest 1994 and September 1995, PTCS was performed in 37 patients with obstructive jaundice. First, percutaneous transhepatic biliary drainage (PTBD) with 7Fr. drainage tube was done. Three days later, we exchainged the 7Fr. drainage tube with 16Fr.. Seven days later, through the PTCS, we performed EHL, biopsy and EndocoilTM stent insertion.

Electrohydraulic Lithotripsy(EHL) of Large Common Bile Duct Stone and Endocoil Insertion with Percutaneous Transhepatic Choledochoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Electrohydraulic lithotrypsy(EHL) under cholangioscopic control has been performed for difficult bile duct stones. The percutaneous transhepatic approach is technically easy and useful in diagnosis and treatment of bile duct obstruction and stones. Biliary stenting with self expanding metal stent is gaining increasingly wider acceptance as a palliative treatment of bile duct obstruction. METHODS: Between Sep. 1994 and Sep. 1996, EHL under choledochoscopy by percutaneous transhepatic approach was performed in 30 cases(Male: 13, Female: 17). After PTBD with 7F pig tail catheter, the percutaneous transhepatic passage was dilated over guide wire with dilaters of increasing size up to 16Fr in 3-Sdays. In one week, after fistula had been estabilished, choledochoscopy was performed. RESULTS: (1) Mean age was 61.3 years. Mean stone number was 2.5. And mean stone size was 1.6 X 2.3 cm. (2) Com.plete removal of the stone was achieved in all patients(100%). (3) There were no serious complications. (4) In six cases, Endocoils were implanted with successful decompression of obstructions and simultaneous removal of biliary stones located at both side of stricutre. CONCLUSIONS: Percutaneous transhepatic choledochoscopy is easy and safe and assists in the diagnosis and treatment of biliary stricture and the management of difficult CBD stone.