• Gut and Liver
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• 제12권6호
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• pp.722-727
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• 2018

Background/Aims: Although endoscopic bilateral stent-instent placement is challenging, many recent studies have reported promising outcomes regarding technical success and endoscopic re-intervention. This study aimed to evaluate the technical accessibility of stent-in-stent placement using large cell-type stents in patients with inoperable malignant hilar biliary obstruction. Methods: Forty-three patients with inoperable malignant hilar biliary obstruction from four academic centers were prospectively enrolled from March 2013 to June 2015. Results: Bilateral stent-in-stent placement using two large cell-type stents was successfully performed in 88.4% of the patients (38/43). In four of the five cases with technical failure, the delivery sheath of the second stent became caught in the hook-cross-type vertex of the large cell of the first stent, and subsequent attempts to pass a guidewire and stent assembly through the mesh failed. Functional success was achieved in all cases of technical success. Stent occlusion occurred in 63.2% of the patients (24/38), with a median patient survival of 300 days. The median stent patency was 198 days. The stent patency rate was 82.9%, 63.1%, and 32.1% at 3, 6, and 12 months postoperatively, respectively. Endoscopic re-intervention was performed in 14 patients, whereas 10 underwent percutaneous drainage. Conclusions: Large cell-type stents for endoscopic bilateral stent-in-stent placement had acceptable functional success and stent patency when technically successful. However, the technical difficulty associated with the entanglement of the second stent delivery sheath in the hook-cross-type vertex of the first stent may preclude large cell-type stents from being considered as a dedicated standard tool for stent-in-stent placement.

• 대한한의학회지
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• 제43권3호
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• pp.195-203
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• 2022

Objectives: This study aimed to emphasize the importance of accurate and timely diagnosis of acute abdominal pain with simple radiography by reporting a case of gastrointestinal perforation. Methods: We closely observed the diagnosis and progress of acute abdominal pain after biliary stent and reviewed the outline of gastrointestinal perforation. Results: Patient diagnosed with urethral cancer metastasis to lung and peritoneum was treated with complex Korean medicinal treatments to deal with anorexia, abdominal pain, jaundice and oliguria. During hospitalization, the patient's acute abdominal pain after biliary stent was diagnosed with gastrointestinal perforation by using plain chest and abdominal radiography. Conclusion: Using simple radiography to find out the emergency diseases such as perforation in acute abdominal pain is important clinically.

• 대한의생명과학회지
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• 제19권3호
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• pp.280-283
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• 2013

Leuconostoc spp. is intrinsically resistant against vancomycin and rarely causes the infection in immunocompromised patients. In this report, we describe a fatal case of Leuconostoc lactis bacteremia in a patient with biliary tract stent insertion to resolve the biliary tract obstruction by multiple pseudocysts in the pancreatic head region. Leuconostic lactis isolated from the blood of the patients was confirmed by 16S rRNA sequencing and this isolate was susceptible against most antibiotics, including levofloxacin, penicillin, erythromycin and cefotaxime except vancomycin. The septic shock and multi-organ failure was abruptly progressed due to delayed use of adequate antibiotic. Using vancomycin as the empirical antibiotics in a bacteremic patient by Gram positive cocci, the treatment failures by the isolates with intrinsic resistance against vancomycin have to be considered. In addition, the prompt and accurate identification of Leuconostoc spp. are very important to select the adequate antibiotics.

• 한국임상수의학회지
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• 제26권1호
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• pp.48-53
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• 2009

4 년령 시쭈개 (체중 5.4 kg)가 심잡음과 운동불내성으로 내원하였다. 진단검사상 심한 폐동맥협착증으로 진단되었다 (우심실 유출로의 peak velocity of 6.4 m/s, 압력구배 165 mmHg). 본 환견은 3 cm (길이) ${\times}$ 1.5 cm (직경)의 Palmaz biliary stent를 이용하여 치료하였다. 시술후 환견의 폐동맥 협착증은 상당히 많이 개선되었다 (우심실 유출로의 of peak velocity가 3.0 m/s로 감소). 내원전 보였던 임상증상은 더 이상 보이지 않았지만 경미한 폐동맥 패쇄부전이 관찰되었다. 본 증례는 우리나라에서 최초로 시도된 스텐트를 이용한 폐동맥 협착증 증례이다.

• Clinical Endoscopy
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• 제56권5호
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• pp.633-649
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• 2023

Background/Aims: Mechanical properties (MPs) and axial and radial force (AF and RF) may influence the efficacy and complications of self-expandable metallic stent (SEMS) placement. We measured the MPs of various SEMSs and examined their influence on the SEMS clinical ability. Methods: We evaluated the MPs of 29 types of 10-mm SEMSs. RF was measured using a conventional measurement device. AF was measured using the conventional and new methods, and the correlation between the methods was evaluated. Results: A high correlation in AFs was observed, as measured by the new and conventional manual methods. AF and RF scatterplots divided the SEMSs into three subgroups according to structure: hook-and-cross-type (low AF and RF), cross-type (high AF and low RF), and laser-cut-type (intermediate AF and high RF). The hook-and-cross-type had the largest axial force zero border (>20°), followed by the laser-cut and cross types. Conclusions: MPs were related to stent structure. Hook-and-cross-type SEMSs had a low AF and high axial force zero border and were considered safest because they caused minimal stress on the biliary wall. However, the increase in RF must be overcome.

• 대한방사선협회지
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• 제29권1호
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• pp.214-214
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• 2003

• Clinical Endoscopy
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• 제56권5호
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• pp.592-593
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• 2023

• Clinical Endoscopy
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• 제56권2호
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• pp.155-163
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• 2023

Malignant hilar biliary obstruction (MHO), an aggressive perihilar biliary obstruction caused by cholangiocarcinoma, gallbladder cancer, or other metastatic malignancies, has a poor prognosis. Surgical resection is the only curative treatment for biliary malignancies. However, the majority of patients with MHO cannot undergo surgery on presentation because of an advanced inoperable state or a poor performance state due to old age or comorbid diseases. Therefore, palliative biliary drainage is mandatory to improve symptomatic jaundice and the quality of life. Among the drainage methods, endoscopic biliary drainage is the current standard for palliation of unresectable advanced MHO. In addition, combined with endoscopic drainage, additional local ablation therapies, such as photodynamic therapy or radiofrequency ablation (RFA), have been introduced to prolong stent patency and survival. Currently, RFA is commonly used as palliative therapy, even for advanced MHO. This literature review summarizes recent studies on RFA for advanced MHO.

• Clinical Endoscopy
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• 제56권4호
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• pp.521-526
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• 2023

Portobiliary fistulas are rare but may lead to life-threatening complications. Biliary plastic stent-induced portobiliary fistulas during endoscopic retrograde cholangiopancreatography have been described. Herein, we present a case of portal cavernography and recurrent hemobilia after endoscopic retrograde cholangiopancreatography in which a portobiliary fistula was detected in a patient with portal biliopathy. This likely indicates a change in clinical presentation (from bilhemia to hemobilia) after biliary drainage that was successfully treated by placement of a fully covered, self-expandable metallic stent.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제1권1호
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• pp.144-147
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• 1998

저자들은 복부 둔상 후에 발생한 담도 단독 협착을 보인 환아에서 수술적인 치료를 대신하여 내시경적 경비담도 배액술과 플라스틱 스텐트 삽입으로 증상의 호전과 2년의 추적관찰에서 재발을 보이지 않고 있는 1례를 경험하여 문헌고찰과 함께 보고하는 바이다.