• Clinical Endoscopy
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• v.57 no.1
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• pp.122-127
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• 2024

Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.9
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• pp.4487-4490
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• 2016

Background: Methylation at cg 16941656 of FRY is exclusively found in normal pancreatic tissue and has been proven to be specific for pancreatic-in-origin among several adenocarcinomas. Here, we investigated methylated DNA in the bile as a biomarker to differentiate the cause of obstruction between pancreatic cancer and benign causes. Materials and Methods: Bile samples of 45 patients with obstructive jaundice who underwent ERCP were collected and classified into pancreatic cancer (group 1) and benign causes (group 2) in 24 and 21 patients, respectively. DNA was extracted from bile and bisulfite modification was performed. After, methylation in cg 16941656 of FRY was identified by real-time PCR, with beta-actin used as a positive control. Results: Methylated DNA was identified in 10/24 (41.67%) and 1/21 (4.8%) of cases in groups 1 and 2, respectively (P= 0.012). The sensitivity, specificity, positive predictive value and negative predictive value to differentiate pancreatic cancer from benign causes were 42%, 95%, 91%, and 59%, respectively. Conclusions: Detecting a methylation at cg 16941656 of FRY in bile has high specificity, with an acceptable positive likelihood rate, and may therefore be helpful in distinguish pancreatic cancer from benign strictures.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.2 no.2
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• pp.262-266
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• 1999

Obstruction of the extrahepatic bile ducts is the most common cause of conjugated hyperbilirubinemia in early infancy. More than 90% of such obstructive lesions are accounted for by extrahepatic biliary atresia. A rare lesion is obstruction of the common duct by impacted, thickened secretions and bile. Bile plug syndrome is defined as extrahepatic obstruction of the bile ducts by bile sludge in term infants without anatomic abnormalities, congenital chemical defects of bile, or hepatocellular lesions. Obstruction of extrahepatic ducts by plugs of biliary material apperas to be due to the inspissation and precipitation of bile and mucus within the lumen of the ducts. Cholestasis and precipitation of bile develop in association with abnormal composition of bile in cystic fibrosis, hepatocellular damage, prolonged erythroblastic jaundice, altered biliary dynamics with total parenteral nutrition, gut dysfunction, diuretic therapy, exchange transfusions and perinatal hemolysis. In those cases, the term inspissated bile syndrome is used. The clinical and laboratory findings in bile plug syndrome are identical to those observed in biliary atresia and choledochal cyst. The diagnosis can be suspected based on the findings of clinical and laboratory examinations together with hepatobiliary imaging, ultrasonography, radionuclide scan and liver biopsy. We experienced a case of spontaneous resolution of bile plug syndrome in a 4-year-old girl. We report this case with brief review related literatures.

• Journal of Digestive Cancer Reports
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• v.7 no.1
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• pp.18-21
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• 2019

Serine protease inhibitor Kazal-type 1 (SPINK1) is a gene expressed from pancreatic acinar cell which its mutation is known to be associated with chronic pancreatitis (CP) and pancreatic cancer. We report a case of a 47-years-old female with nausea and weight loss with yellow discoloration of skin. Initial imaging and endoscopic study led us to an impression of chronic pancreatitis with pancreatic cancer with common bile-duct dilation. Biopsy result was confirmed with pancreatic adenocarcinoma and additional imaging revealed lymph node and bone metastasis. Our genetic analysis revealed 194+2T>C mutation of SPINK1. Biliary obstruction was successfully decompressed by stent insertion and underwent chemotherapy and radiotherapy. Although there is accumulating evidence of association between SPINK1 mutation and CP, the relationship between SPINK1 mutation and pancreatic cancer in CP patient is an emerging concept. Genetic analysis should be considered in patients with young age especially when diagnosed with both CP and pancreatic cancer.

• Journal of Digestive Cancer Research
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• v.6 no.1
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• pp.32-35
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• 2018

Non-Hodgkin's lymphoma is known to be a rare and unusual cause of biliary obstruction. We report a case of biliary obstruction that a 25-year-old male showed icteric sclera and yellow discoloration of his skin caused by metastasis of non-Hodgkin lymphoma. Initial imaging & endoscopic work-up led us to an impression of either cholangiocarcinoma or IgG4-related disease, yet the pathological results weren't diagnostic. Through our thorough re-examination, we found a 5cm sized round, fixed, non-tender sternal mass, and additional imaging studies were suggestive of lymphoma, which was also consistent with the results of incisional chest wall biopsy. Biliary obstruction by lymphoma was successfully treated by endoscopic plastic stent insertion procedure and chemotherapy. Although it is widely accepted that lymphoma accounts for very few portion of malignant biliary obstruction, due to the fact that lymphoma and cholangiocarcinoma are often indistinguishable, careful diagnostic approach should be done.

• Biomolecules & Therapeutics
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• v.31 no.6
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• pp.674-681
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• 2023

Bile pigment, bilirubin, and biliverdin concentrations may change as a results of biliary tract cancer (BTC) altering the mechanisms of radical oxidation and heme breakdown. We explored whether changes in bile pigment components could help distinguish BTC from benign biliary illness by evaluating alterations in patients with BTC. We collected bile fluid from 15 patients with a common bile duct stone (CBD group) and 63 individuals with BTC (BTC group). We examined the bile fluid's bilirubin, biliverdin reductase (BVR), heme oxygenase (HO-1), and bacterial taxonomic abundance. Serum bilirubin levels had no impact on the amounts of bile HO-1, BVR, or bilirubin. In comparison to the control group, the BTC group had considerably higher amounts of HO-1, BVR, and bilirubin in the bile. The areas under the curve for the receiver operating characteristic curve analyses of the BVR and HO-1 were 0.832 (p<0.001) and 0.891 (p<0.001), respectively. Firmicutes was the most prevalent phylum in both CBD and BTC, according to a taxonomic abundance analysis, however the Firmicutes/Bacteroidetes ratio was substantially greater in the BTC group than in the CBD group. The findings of this study showed that, regardless of the existence of obstructive jaundice, biliary carcinogenesis impacts heme degradation and bile pigmentation, and that the bile pigment components HO-1, BVR, and bilirubin in bile fluid have a diagnostic significance in BTC. In tissue biopsies for the diagnosis of BTC, particularly for distinguishing BTC from benign biliary strictures, bile pigment components can be used as additional biomarkers.

• Journal of Yeungnam Medical Science
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• v.7 no.2
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• pp.197-202
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• 1990

Mechanical obstruction of the common hepatic duct includes the following causes ; choledocholithiasis, sclerosis, cholangitis, pancreatic carcinoma, cholangiocarcinoma, postoperative stricture, primary hepatic duct carcinoma, enlarged cystic duct lymph nodes, and metastatic nodal involvement of the porta hepatis. Partial mechanical obstruction of the common hepatic duct caused by impaction of stones and inflammation surrounding the vicinity of the neck of the gallbladder had been reported on the "syndrome del conducto hepatico" in 1948 by Mirizzi. Nowadays, this disease was named by Mirizzi syndrome. Mirizzi syndrome is a rare entity of common hepatic duct obstruction that results from an inflammatory response secondary to a gallstone impacted in the cystic duct or neck of the gallbladder. It results from an almost parallel course and low insertion of the cystic duct into the common hepatic duct. In a varient of Mirizzi's syndrome, the cause of the common hepatic duct obstruction was a primary cystic duct carcinoma rather than gallstone disease. A 71-year-old man was admitted with a four-day history of right upper quadrant abdominal pain. Past medical history was unremarkable. On physical examination, the patient had a temperature of $38^{\circ}C$, icteric sclera and right upper quadrant tenderness. Pertinent laboratory findings included WBC 18,000/$cm^2$;albumin 2.6g/dl(normal 3.9-5.1) ; SGOT 183u/L(normal 0-50) ; SGPT167u/L(normal 0-65) ; bilirubin, 8.2mg/dl(normal 0-1) with the direct bilirubin, 4.4mg/dl(normal 0-0.4). Ultrasonography revealed a dilated extrahepatic biliary tree. ERCP showed that the superior margin was angular and more consistent with a calculus causing partial CHD obstruction(Mirizzi syndrome). At surgery a diseased gallbladder containing calculi was found. In addition, there was two calculi partially eroding through the proximal portion of the cystic duct and compressing the common hepatic duct. A cholecystectomy and excision of common bile duct was performed, with Roux-en-Y hepaticojejunostomy. The postoperative course was uneventful.

• Journal of the Korean Society of Radiology
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• v.81 no.4
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• pp.1013-1018
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• 2020

Ascariasis is an intestinal disease caused by Ascaris lumbricoides. Most patients with ascariasis are asymptomatic; however, the presence of many larvae in the bowel can cause gastrointestinal complications, such as intestinal obstruction, obstructive jaundice, cholangitis, cholecystitis, and pancreatitis. Herein, we report a case of ascariasis presenting as hematoma and active bleeding in the sigmoid mesocolon of a 74-year-old man on computed tomography (CT). Sigmoid colon perforation was also detected on follow-up CT. Laparoscopic low anterior resection was performed; there was a large hematoma in the sigmoid mesocolon. Roundworms were microscopically identified in the mesenteric adipose tissue. The clinical and CT findings of this unusual presentation of ascariasis revealed serial complications during parasite migration from the intestinal lumen to the peritoneal cavity.

• Journal of the Korean Society of Radiology
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• v.84 no.6
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• pp.1350-1360
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• 2023

Purpose To evaluate the factors that predict symptomatic dislodgement of a percutaneous transhepatic biliary drainage (PTBD) catheter in patients with malignant biliary obstruction. Materials and Methods This retrospective study included 572 patients with malignant biliary obstruction who underwent 733 PTBD catheter insertions between January 2010 and February 2015. The duration of catheter placement, approach site, location of the catheter tip, insertion angle, presence of a closed-loop pigtail, and tube diameter were evaluated. Results During the follow-up period, 224 PTBD catheter dislodgements (30.56%) were observed in 157 patients. Among them, 146 (19.92%) were symptomatic. The mean duration from catheter insertion until dislodgement was 32 days (range: 1-233 days). Male (odds ratio [OR]: 1.636, 95% confidence interval [CI]: 1.131-2.367, p = 0.009), right-sided approach (OR: 1.567, 95% CI: 1.080-2.274, p = 0.018), increased insertion angle (OR: 1.015, 95% CI: 1.005-1.026, p = 0.005), and incomplete closed-loop pigtail formation (OR: 1.672, 95% CI: 1.098-2.545, p = 0.016) were independent factors predictive of symptomatic dislodgement of a PTBD catheter. Conclusion Factors predictive of symptomatic catheter dislodgement included male sex, a right-sided approach, increased insertion angle, and incomplete closed-loop pigtail formation.

• The Korean Journal of Nuclear Medicine
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• v.5 no.1
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• pp.49-64
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• 1971

The radioactive $^{131}I$-rose bengal serial scintiphotography was performed in 62 patients with the hepatobiliary diseases and in 20 normal subjects. This approach permitted visualization of the hepatic uptake of $^{131}I$-rose bengal from the circulation and its excretion into the biliary trees and the intestines. In some of these patients, gallbladder function was examined, using eggs as a gallbladder constrictor. The time of maximum hepatic uptake was well correlated to the conventional biochemical liver function tests. In addition to $^{131}I$-rose bengal scintiphotography, $^{198}Au$-colloid scintiphotography was also performed to make comparison of these two tests. The results obtained were as follows: 1. In normal subjects, the maximum hepatic uptake of $^{131}I$-rose bengal occurred at $23{\pm}2.9$ minutes, the initial hepatic excretion at $34{\pm}5.1$ minutes, the visualization of the gallbladder at $29{\pm}5.7$ minutes and the intestinal visualization at $54{\pm}25.8$ minutes. The radioactivity in the gallbladder decreased to $10.7{\pm}5.0%$ one hour after the ingestion of eggs. 2. In the patients with cirrhosis of the liver, there was a delayed and decreased hepatic uptake. The maximun hepatic upake occurred at $43{\pm}12.9$ minutes. The differences in the results of uptake between the cirrhotic and the normal group were statistically significant. The initial hepatic excretion occurred at $60{\pm}18.5$ minutes and had tendency of delaying compared with the normal controls. The gallbladder was visualized in 13 of 16 cases (81%) and its visualization occurred at $49{\pm}14.6$ minutes with a tendency to be delayed compared with the normal controls. The intestinal visualization occurred at $63{\pm}15.8$ minutes and its delaying tendency was somewhat more prominent. 3. In patients with hepatitis, the maximum hepatic uptake occurred at $59{\pm}21.4$ minutes and was significantly delayed. The initial hepatic excretion occurred at $82{\pm}34.3$ minutes and the results revealed a delaying tendency. The gallbladder was visualized in 15 of 20 cases (75%) at $57{\pm}18.7$ minutes, which was significantly delayed. The Intestinal visualization was noted in all cases with marked delay. 4. In patients with obstructive jaundice, the maximum hepatic uptake was noted at $83{\pm}14.7$ minutes, showing the most significant delay. The hepatic excretion into biliary trees and intestines was not entirely noted in all cases except the only one case with gallbladder visualization. 5. In patients with cholelithiasis, the maximum hepatic upake and the initial hepatic excretion were slightly delayed with mean times of $39{\pm}11.2\;and\;48{\pm}17.1$ minutes respectively. The visualization of the gallbladder was demonstrated in 10 of 17 cases (59%) and occurred at $52{\pm}25.6$ minutes with a slight delay. The intestinal visualization occurred at $67{\pm}47.7$ minutes and was slightly delayed. $^{131}I$-rose bengal in the gallbladder remained high, $49.3{\pm}21.3%$, which suggested quantitatively decreased power of gallbladder constriction. 6. The time of the maximum hepetic uptake was correlated well to BSP retention and serum alkaline phosphatase ativity. However, the maximum hepatic uptake had no definite correlation with serum albumin, serum globulin, TTT, serum cholesterol, SGPT or SGOT. 7. In the diagnosis of the hepatobiliary diseases with jaundice, $^{131}I$-rose bengel serial scintiphotography has proved to be more useful than $^{198}Au$-colloid scintiphotography. With these results, it could be justified that $^{131}I$-rose bengal scintiphotography is an excellent diagnostic aid for dynamic hepatobiliary function studies in the clinical practice.