RESUMO
The link between sphincter of Oddi function with biliary system (gallbladder and bile duct) diseases is considered to be very complicated. Whether routine prophylactic laparos-copic cholecystectomy should be carried out after endoscopic sphincterotomy to remove bile duct stones has been controversial worldwide. Actually, this is a very common and important clinical question which needs to be answered. The author spends a lot of time and efforts to broadly read and analyze on published articles related to this topic, and tries, from the aspects of the anatomy and function of sphincter of Oddi, the biliary diseases causing by dysfunction or discordance of sphincter of Oddi, and the impacting of artificial destruction of sphincter of Oddi on the gallbladder and bile duct of patients, to come up with an answer to this question based on scientific and medical evidence.
RESUMO
The transnasal endoscopic examination using an ultraslim upper endoscope may be more comfortable and less stressful than the peroral approach. Transnasal endoscopic retrograde cholangiopancreatography (ERCP), endoscopic nasobiliary drainage, and direct peroral cholangioscopy using an ultraslim upper endoscope have recently been reported. An 82-year-old woman with a previous history of endoscopic sphincterotomy and stone removal was admitted with acute cholangitis. Instead of conventional ERCP, we performed direct transnasal cholangioscopy (TNC) using an ultraslim upper endoscope for biliary decompression and stone removal because of her unstable vital signs. Direct TNC using an ultraslim upper endoscope may be useful in selected patients with biliary disease.