Effective Removal Methods for Common Bile Duct Stones / 대한췌담도학회지

Choledocholithiasis carries a risk of developing biliary obstruction, acute cholangitis, and pancreatitis. Therefore, removal is recommended even in asymptomatic patients. Endoscopic retrograde cholangiopancreatography (ERCP) is regarded as the standard of treatment for choledocholithiasis nowadays. However, ERCP can accompany severe complications such as bleeding, ERCP-associated pancreatitis, cholangitis, and perforations. It is important for endoscopists to know how to remove choledocholithiasis effectively while minimizing adverse events. In this review, we will go over the technical aspects and various accessories to effectively remove choledocholithiasis.

Prognosis and Clinical Characteristics of Patients with Pancreatic Ductal Adenocarcinoma Diagnosed by Endoscopic Ultrasonography but Indeterminate on Computed Tomography

Background/Aims@#Endoscopic ultrasonography (EUS) provides high-resolution images and is superior to computed tomography (CT) scan in diagnosing small pancreatic ductal adenocarcinoma (PDAC). As a result, the use of EUS for early detection of PDAC has attracted attention. This study aimed to identify the clinical and radiological characteristics of patients with PDAC diagnosed by EUS but not found on CT scan. @*Methods@#The medical records of patients diagnosed with PDAC at 12 tertiary referral centers in Korea from January 2003 to April 2019 were reviewed. This study included patients with pancreatic masses not clearly observed on CT scan but identified on EUS. The clinical characteristics and radiological features of the patients were analyzed, and survival analysis was performed. @*Results@#A total of 83 patients were enrolled. The most common abnormal CT findings other than a definite mass was pancreatic duct dilatation, which was identified in 61 patients (73.5%). All but four patients underwent surgery. The final pathologic stages were as follows: IA (n=31, 39.2%), IB (n=8, 10.1%), IIA (n=20, 25.3%), IIB (n=17, 21.5%), III (n=2, 2.5%), and IV (n=1, 1.4%). The 5-year survival rate of these patients was 50.6% (95% confidence interval, 38.8% to 66.7%). Elevated liver function testing and R1 resection emerged as significant predictors of mortality in the multivariable Cox regression analysis. @*Conclusions@#This multicenter study demonstrated favorable long-term prognosis in patients with PDAC diagnosed by EUS but indeterminate on CT scan. EUS should be considered for patients with suspected PDAC but indeterminate on CT scan.

Endoscopic Therapy for Pancreatic Benign Neoplasms / 대한소화기암학회지

Since Endoscopic ultrasound (EUS) was introduced in the 1980s, EUS has evolved from a diagnostic tool to a therapeutic modality for patients with pancreatic neoplasms. Traditionally, treatment policy of pancreatic benign neoplasms (PBN) has been a dichotomous approach to observation or surgery. However, EUS guided treatment provides an alternative option with minimally invasiveness for patients with PBN. This review aimed to provide the role of EUS guided treatment for PBN.

Endoscopic Therapy for Pancreatic Benign Neoplasms / 대한소화기암학회지

Since Endoscopic ultrasound (EUS) was introduced in the 1980s, EUS has evolved from a diagnostic tool to a therapeutic modality for patients with pancreatic neoplasms. Traditionally, treatment policy of pancreatic benign neoplasms (PBN) has been a dichotomous approach to observation or surgery. However, EUS guided treatment provides an alternative option with minimally invasiveness for patients with PBN. This review aimed to provide the role of EUS guided treatment for PBN.

A Serous Cystic Neoplasm of the Pancreas with Synchronous Pancreatic Ductal Adenocarcinoma / 대한췌담도학회지

Serous cystic neoplasm (SCN) represents 10–16% of cystic pancreatic lesions, first classified by Compagno and Oertel at 1978. In contrast to mucinous cystic neoplasm or intraductal papillary mucinous neoplasm of pancreas which have malignant potential, SCN is thought to be exclusively benign as solitary lesion in nearly all cases. There has been rare reported association between the SCN and pancreatic ductal adenocarcinoma, and few cases were documented their coexistence. In this report, we present the case of SCN of the pancreas with literature review in which synchronous pancreatic ductal adenocarcinoma and pancreatic intraepithelial neoplasm coexist together.

Local Endoscopic Treatment of Locally Advanced Pancreatic Cancer / 대한췌담도학회지

Pancreatic adenocarcinoma is one of the cancers with the poorest prognosis, and its incidence has gradually increased to become the 9th most common cancer in Korea in 2016. Surgical resection is the only treatment option to improve the cure and longterm survival rate. Unfortunately, only 10% to 20% of all pancreatic cancer patients present with resectable disease, because of common symptoms are rarely noticeable in its early stages and disease progress very quickly. Unresectable pancreatic cancer can be divided into locally advanced pancreatic cancer (LAPC) and metastatic disease. Pancreatic cancer with distant metastasis accounts for about 40–60% of the total pancreatic cancer and systemic chemotherapy is considered as standard treatment. LAPC is observed in 30–40%, defined as the tumor surrounding major blood vessels (especially, celiac artery and superior mesenteric artery) more than 180° without distant metastasis which cannot be completely removed by surgery. Standard treatment for LAPC has not yet been established, and chemotherapy and radiotherapy have mainly been used, but in most cases, response to these therapeutic options has been limited. As imaging techniques, endoscopic devices and procedures have recently been developed and the role of local endoscopic therapies for LAPC has expanded. This article provides an overview of local endoscopic treatment for LAPC such as injection therapy, radiofrequency ablation (RFA), irreversible electroporation (IRE), radiotherapy and drug-delivery stent insertion.

Certificated System for Endoscopic Retrograde Cholangiopancreatography in Foreign Countries / 대한췌담도학회지

An endoscopic retrograde cholangiopancreatography (ERCP) is endoscopically complicated procedure which carries a higher risk of serious adverse events, and it is more challenging compared with general endoscopy. On a national basis, the accepted standards of practice in ERCP are needed to be outlined to ensure consistent clinical standards in patient management. Certificated system for general endoscopy has been implemented since 2006 in Korea. However, an established system for certification of ERCP does not exist, which requires longer training than general endoscopy. Recently, much has been reported about the need to measure and improve the quality of endoscopy services, but still the variability exists in standards used by hospitals for credentialing physicians to ERCP in Korea. There is an urgent need to settle the credentialing process to enhance practice and to protect patients, which suits our society. This article investigated the system of ERCP certification in overseas, and should be helpful to establish the standard certification system of ERCP in Korea.

The Role of Endoscopic Ultrasound in Early Detection of Pancreatic Cancer / 대한췌담도학회지

Pancreatic cancer was the 9th most common cancer in Korea in 2016, and the incidence is on the rise. Despite advances in diagnostic and therapeutic methods, 5-year survival rate of pancreatic cancer is about 11.7% in Korea, and its prognosis is very poor compared to other cancers. At present, although complete surgical resection is the most effective treatment, only less than 20% of patients are even candidates for resection because diagnosis is usually delayed. So early detection of pancreatic cancer is one of the main objective in the treatment of pancreatic cancer. Among imaging modalities, computed tomography-scan is the most widely available, and the most frequently used. However as endoscopic ultrasound (EUS) techniques have evolved and based on the results of researches that EUS is superior to computed tomography-scan in the diagnosis of small pancreatic tumor, the role of EUS in the early diagnosis of pancreatic cancer is attracting attention. Herein, the authors focused on the role of EUS in early pancreatic cancer.