담도계 질환에 있어서 경피경간 담도경 검사의 유용성

이성구(Sung Koo Lee),최호순(Ho Soon Choi),김명환(Myung Hwan Kim),서동진(Dong Jin Suh),민영일(Young Il Min),권태원(Tae Won Kwon),이승규(Sung Gyu Lee),민병철(Byoung Chul Min) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.4

N/A Background/Aims: The development of PTCS is related to the development of percutaneous trans- hepatic biliary drainage(PTBD) technique. With the subsequent development of many new devices, PTCS is now recognized to be an indispensable diagnostic and therapeutic procedure for the management of diseases of the biliary tract. Considering the operative complications, percutaneous intervention is an attractive alternative to surgery in selected patients. We observed the usefulness of PTCS in various diseases of biliary tract. Methods: From June 1992 to January 1995, we experienced 65 cases of patients managed by PTCS. PTCS was done via dilated PTBD tract with flexible cholangioscope. 53 cases were benign biliary diseases and 12 cases were malignant diseases. Results: Indications of PTCS in benign biliary diseases were intrahepatic duct stones(42 cases), common bile duct stones(5 cases), benign stricture without stone(4 cases) and biliary stent occlusion(2 cases). In the cases of intrahepatic duct stones, complete removal of stones was achieved in 29 of 42 cases(76.2%). In the cases of choledocholithiasis, complete removal of stones was achieved in 5 of 5 patients(l00%). PTCS for benign biliary strictures with or without stones were 18 cases. 16 cases were managed by balloon dilatation and/or catheter placement and 2 cases were corrected surgically. PTCS for malignant biliary diseases were 12 cases. It was possible to differentiate benign bile duct stenosis from bile duct carcinoma by PTCS and biopsy. Two cases of bleeding during tract dilatation and PTCS and one case of sinus tract rupture were developed, but successfully managed by conservative treatment. Conclusions: Percutaneous Transhepatic Cholangioscopy (PTCS) is a safe and effective procedure for diagnosis and management of various types of biliary tract diseases. (Korean J Gastroenterol 1995;27:463 - 470)

Prognostic Factors and Adjuvant Treatments for Surgically Treated Cancers of the Biliary Tract: A Multicentre Study of the Anatolian Society of Medical Oncology (ASMO)

Unal, Olcun Umit,Oztop, Ilhan,Assoc, Tugba Kos,Turan, Nedim,Kucukoner, Mehmet,Helvaci, Kaan,Berk, Veli,Sevinc, Alper,Yildiz, Ramazan,Cinkir, Havva yesil,Tonyali, Onder,Demirci, Umut,Aktas, Bilge,Balak Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.22

Background: Biliary tract cancers are rare, and surgical resection is the standard treatment at early stages. However, reports on the benefits of adjuvant treatment following surgical resection are conflicting. This study aimed to evaluate the factors affecting survival and adjuvant treatments in patients with surgically treated biliary tract cancers. Materials and Methods: Patient clinical features, adjuvant treatments, and efficacy and prognostic factor data were evaluated. Survival analyses were performed using SPSS 15.0. Results: The median overall survival was 30.7 months (95% confidence interval [CI], 18.4-42.9 months). Median survival was 19 months (95% CI, 6-33) for patients treated with fluorouracil based chemotherapy and 53 months (95% CI, 33.2-78.8) with gemcitabine based chemotherapy(p=0.033). On univariate analysis, poor prognostic factors for survival were galbladder localization, perineural invasion, hepatic invasion, a lack of adjuvant chemoradiotherapy treatment, and a lack of lymph node dissection. On multivariate analysis, perineural invasion was a poor prognostic factor (p=0.008). Conclusions: Biliary tract cancers generally have poor prognoses. The main factors affecting survival are tumour localization, perineural invasion, hepatic invasion, adjuvant chemoradiotherapy, and lymph node dissection. Gemcitabine-based adjuvant chemotherapy is more effective than 5-fluorouracil-based chemotherapy.

The efficacy of epirubicin, cisplatin, uracil/tegafur, and leucovorin in patients with advanced biliary tract carcinoma

Park, Kyong-Hwa,Choi, In-Keun,Kim, Seok-Jin,Oh, Sang-Chul,Seo, Jae-Hong,Choi, Chul-Won,Kim, Byung-Soo,Shin, Sang-Won,Kim, Yeul-Hong,Kim, Jun-Suk Wiley Subscription Services, Inc., A Wiley Company 2005 Cancer Vol.103 No.11

<B>BACKGROUND</B><P>Advanced biliary tract carcinoma is among the most prevalent fatal diseases in Korea. However, to our knowledge, to date no effective therapeutic modality has been shown to prolong the survival of patients in the inoperable stages of this disease.</P><B>METHODS</B><P>This Phase II study was conducted to determine the efficacy and toxicity of a combined regimen of epirubicin, cisplatin, and uracil/tegafur (UFT) modulated by leucovorin in patients with advanced or recurrent biliary tract carcinoma.</P><B>RESULTS</B><P>Eleven of 40 patients (27.5%) had gallbladder carcinoma, and the remaining patients had tumors arising from other sites in the biliary tract. All patients were treated with intravenous epirubicin (50 mg/m<SUP>2</SUP> on Day 1), intravenous cisplatin (60 mg/m<SUP>2</SUP> on Day 1), oral UFT (300 mg/m<SUP>2</SUP> per day on Days 1–21), and oral leucovorin (75 mg per day on Days 1–21). Nine patients exhibited a partial response, representing 22.5% of the possible response rate (95% confidence interval [95% CI], 12.8–32.2%) based on an intention-to-treat analysis. The median survival was 34 weeks (95% CI, 20–48 weeks), and the median time to disease progression was 16 weeks (95% CI, 7–25 weeks). Neutropenia and thrombocytopenia comprised dose-limiting toxicity conditions.</P><B>CONCLUSIONS</B><P>The combination of epirubicin, cisplatin, and UFT modulated by leucovorin was active marginally in patients with advanced biliary tract carcinoma and was capable of stabilizing the disease effectively. Because it was a safe and convenient treatment modality, it may be used in outpatient care with only minor toxicity in patients with advanced malignancies of the biliary tract. Cancer 2005. © 2005 American Cancer Society.</P>

Safety Evaluation of Paclitaxel-Eluting Biliary Metal Stent with Sodium Caprate in Porcine Biliary Tract

Sung Ill Jang,Seok Jeong,Don Haeng Lee,Kun Na,Sugeun Yang,Dong Ki Lee 거트앤리버 소화기연관학회협의회 2019 Gut and Liver Vol.13 No.4

Background/Aims: Metallic stents designed to relieve malignant biliary obstruction are susceptible to occlusive tumor ingrowth or overgrowth. In a previous report, we described metallic stents covered with paclitaxel-incorporated membrane (MSCPM-I, II) to prevent occlusion from tumor ingrowth via antitumor effect. This new generation paclitaxeleluting biliary stent is further endowed with sodium caprate (MSCPM-III) for enhanced drug delivery. The purpose of this study is to examine the safety of its drug delivery system in the porcine biliary tract. Methods: MSCPM-III (10% [wt/vol] paclitaxel) and covered metal stents (CMSs) were endoscopically inserted in porcine bile ducts in vivo. Histologic biliary changes, levels of paclitaxel released, and various serum analytes (albumin, alkaline phosphate, aspartate transaminase, alanine transaminase, total protein, total bilirubin, and direct bilirubin) were assessed. Results: Based on the intensity of reactive inflammation and fibrosis, changes in porcine biliary epithelium secondary to implanted MSCPMIII were deemed acceptable (i.e., safe). Histologic features in the MSCPM-III and CMS groups did not differ significantly. In a related serum analysis, paclitaxel release from MSCPMIII stents was below the limit of detection for 28 days. Biochemical analyses were also similar for the two groups, and no evidence of hepatic or renal toxicity was found in animals receiving MSCPM-III stents. Conclusions: In a prototypic porcine trial, this newly devised metal biliary stent incorporating both paclitaxel and sodium caprate appears to be safe in the porcine bile duct.

Solitary percutaneous transhepatic biliary drainage tract metastasis after curative resection of perihilar cholangiocarcinoma

Shin Hwang,Sung-Won Jung,Jung-Man Namgoong,Sam-Youl Yoon,Gil-Chun Park,Dong-Hwan Jung,Gi-Won Song,Tae-Yong Ha,Gi-Young Ko,Dong-Wan Suh,Sung-Gyu Lee 한국간담췌외과학회 2011 한국간담췌외과학회지 Vol.15 No.3

Percutaneous transhepatic biliary drainage (PTBD) has been widely used, but it has a potential risk of tumor spread along the catheter tract. We herein present a case of solitary PTBD tract metastasis after curative resection of perihilar cholangiocarcinoma. Initially, endoscopic nasobiliary drainage was done on a 65 year-old female patient, but the cholangitis did not resolve. Thus a PTBD catheter was inserted into the right posterior duct. Right portal vein embolization was also performed. Curative surgery including right hepatectomy and bile duct resection was performed 16 days after PTBD. After 12 months, serum CA19-9 had increased gradually without any symptoms. Finally, a small right pleural metastasis was found through strict tumor surveillance for 6 months. Chemoradiation therapy was performed, but there was no response to treatment. As the tumor progressed, she complained of severe dyspnea and finally died from tumor dissemination to the chest and bones 18 months after the first detection of PTBD tract recurrence and 36 months after surgery. No intra-abdominal recurrence was found until the terminal stage. This PTBD tract recurrence was attributed to the PTBD even though it was in place for only 16 days. Although such recurrence is rare, its risk should be taken into account during follow-up of patients who have received PTBD before. (Korean J Hepatobiliary Pancreat Surg 2011;15:179-183)

Outcomes of endoscopic retrograde cholangiography and percutaneous transhepatic biliary drainage in liver transplant recipients with a Roux-en-Y biliary-enteric anastomosis

Divyanshoo Rai Kohli,Bashar A. Aqel,Nicole L. Segaran,M. Edwyn Harrison,Norio Fukami,Douglas O. Faigel,Adyr Moss,Amit Mathur,Winston Hewitt,Nitin Katariya,Rahul Pannala 한국간담췌외과학회 2023 Annals of hepato-biliary-pancreatic surgery Vol.27 No.1

Backgrounds/Aims: Data regarding outcomes of endoscopic retrograde cholangiography (ERC) in liver transplant (LT) recipients with biliary-enteric (BE) anastomosis are limited. We report outcomes of ERC and percutaneous transhepatic biliary drainage (PTBD) as first-line therapies in LT recipients with BE anastomosis. Methods: All LT recipients with Roux-BE anastomosis from 2001 to 2020 were divided into ERC and PTBD subgroups. Technical success was defined as the ability to cannulate the bile duct. Clinical success was defined as the ability to perform cholangiography and therapeutic interventions. Results: A total of 36 LT recipients (25 males, age 53.5 ± 13 years) with Roux-BE anastomosis who underwent biliary intervention were identified. The most common indications for a BE anastomosis were primary sclerosing cholangitis (n = 14) and duct size mismatch (n = 10). Among the 29 patients who initially underwent ERC, technical success and clinical success were achieved in 24 (82.8%) and 22 (75.9%) patients, respectively. The initial endoscope used for the ERC was a single balloon enteroscope in 16 patients, a double balloon enteroscope in 7 patients, a pediatric colonoscope in 5 patients, and a conventional reusable duodenoscope in 1 patient. Among the 7 patients who underwent PTBD as the initial therapy, six (85.7%) achieved technical and clinical success (p = 0.57). Conclusions: In LT patients with Roux-BE anastomosis requiring biliary intervention, ERC with a balloon-assisted enteroscope is safe with a success rate comparable to PTBD. Both ERC and PTBD can be considered as first-line therapies for LT recipients with a BE anastomosis.

Diffusion-weighted imaging of biliopancreatic disorders: correlation with conventional magnetic resonance imaging.

Lee, Nam Kyung,Kim, Suk,Kim, Gwang Ha,Kim, Dong Uk,Seo, Hyung Il,Kim, Tae Un,Kang, Dae Hwan,Jang, Ho Jin WJG Press 2012 WORLD JOURNAL OF GASTROENTEROLOGY Vol.18 No.31

<P>Diffusion-weighted magnetic resonance imaging (DWI) is a well established method for the evaluation of intracranial diseases, such as acute stroke. DWI for extracranial application is more difficult due to physiological motion artifacts and the heterogeneous composition of the organs. However, thanks to the newer technical development of DWI, DWI has become increasingly used over the past few years in extracranial organs including the abdomen and pelvis. Most previous studies of DWI have been limited to the evaluation of diffuse parenchymal abnormalities and focal lesions in abdominal organs, whereas there are few studies about DWI for the evaluation of the biliopancreatic tract. Although further studies are needed to determine its performance in evaluating bile duct, gallbladder and pancreas diseases, DWI has potential in the assessment of the functional information on the biliopancreatic tract concerning the status of tissue cellularity, because increased cellularity is associated with impeded diffusion, as indicated by a reduction in the apparent diffusion coefficient. The detection of malignant lesions and their differentiation from benign tumor-like lesions in the biliopancreatic tract could be improved using DWI in conjunction with findings obtained with conventional magnetic resonance cholagiopancreatography. Additionally, DWI can be useful for the assessment of the biliopancreatic tract in patients with renal impairment because contrast-enhanced computed tomography or magnetic resonance scans should be avoided in these patients.</P>

Clinical characteristics of patients with malignancy and long-term outcomes of surgical treatment of patients with choledochal cyst

Wung Sun Han,Hongbeom Kim,Hee Ju Sohn,Mirang Lee,Yoon Hyung Kang,Hyeong Seok Kim,Youngmin Han,Jae-Seung Kang,Wooil Kwon,Jin-Young Jang 대한외과학회 2021 Annals of Surgical Treatment and Research(ASRT) Vol.101 No.6

Purpose: There are few reports of postoperative long-term malignant risk or postoperative sequelae after surgery for choledochal cysts (CCs). This study aimed to analyze the clinical characteristics of patients with malignancy and the long-term results of operated CC. Methods: The patients who underwent surgical treatments for CC between 2003 and 2020 at Seoul National University Hospital were enrolled. Clinicopathologic factors and pre-/postoperative computed tomography or magnetic resonance imaging were reviewed. Results: Of the 153 patients, Todani classification Ic (36.6%), C-P type (43.8%) anomalous pancreaticobiliary duct union were the most common type respectively. Fourteen patients (9.2%) had biliary tract cancer and a comparison of patients with and without malignancy showed that the diameter of cyst was significantly lower in malignant patients and malignancy was observed to be significantly higher in P-C type. The incidence of long-term complications was 9.8%, and the median time interval was 30 months. The 2 most common complications were cholangitis and stricture (60.0%). There was one case of new cancer near the intrapancreatic remnant bile duct. Conclusion: Of the resected CCs, 9.2% had a combined malignancy on the biliary tracts. Long-term complications such as cholangitis, anastomotic stricture, and new cancers may occur. Therefore, continuous surveillance is required.

췌장·담도 질환에서의 성차의학

박선미 대한췌담도학회 2019 대한췌담도학회지 Vol.24 No.2

성차의학은 성과 젠더의 차이가 정상 상태, 병리기전 및 질병의 특징에 미치는 영향을 중요하게 다루고 있다. 성과 젠더의 차이를 고려해서 질병의 진단, 치료 및 예방을 한다면 개개인은 과학적 근거를 갖춘 최적화된 진료를 받을 수 있다. 여기에서는 담석증, 급성 담낭염, 급성 및 만성 췌장염, 담도 및 췌장암 등의 췌장·담도 질환에서 성과 젠더의 차이에 대하여 고찰하였다. 또한, 임상 및 전임상 연구에서 연구의 계획, 실행 및 분석에 성과 젠더분석을 반드시 포함시켜야 한다는 최근의 정책 방침과 성차의학에 관한 정보를 갖춘 웹사이트들을 소개 하였다. 이 고찰을 통하여 연구, 진료 및 의학교육 분야에서 성과 젠더의 관점을 갖추는 것이 중요하다는 점을 강조한다. Sex and gender medicine investigates the impact of sex and gender differences on normal conditions, pathogenesis, and clinical features of diseases. By considering sex and gender differences during diagnosis, treatment and prevention, a person can receive the best individualized treatment based on scientific evidence. In this review, sex and gender differences in the field of pancreatobiliary diseases are described regarding gallstones, acute cholecystitis, acute and chronic pancreatitis, and cancers of the pancreas and biliary tract. In addition, recent policy on clinical and preclinical research which states that sex and gender analysis should be included during planning, conducting, and interpretation of the researches and websites containing resources about sex and gender medicine are introduced. This review highlights the importance of considering sex and gender aspect in research, clinics, and medical education.

REVIEW : Current status of chemotherapy for the treatment of advanced biliary tract cancer

( Takashi Sasaki ),( Hiroyuki Isayama ),( Yousuke Nakai ),( Kazuhiko Koike ) 대한내과학회 2013 The Korean Journal of Internal Medicine Vol.28 No.5

Chemotherapy is indispensable for the treatment of advanced biliary tract cancer. Recently, reports regarding first-line chemotherapy have increased, and first-line chemotherapy treatment has become gradually more sophisticated. Gemcitabine and cisplatin combination therapy (or gemcitabine and oxaliplatin combination therapy) have become the standard of care for advanced biliary tract cancer. Oral f luoropyrimidines have also been shown to have good antitumor effects. Gemcitabine, platinum compounds, and oral fluoropyrimidines are now considered key drugs for the treatment of advanced biliary tract cancer. Several clinical trials using molecular targeted agents are also ongoing. Combination therapy using cytotoxic agents and molecular-targeted agents has been evaluated widely. However, reports regarding second-line chemotherapy remain limited, and it has not yet been clarified whether second-line chemotherapy can improve the prognosis of advanced biliary tract cancer. Thus, there is an urgent need to establish secondline standard chemotherapy treatment for advanced biliary tract cancer. Several problems exist when assessing the results of previous reports concerning advanced biliary tract cancer. In the present review, the current status of the treatment of advanced biliary tract cancer is summarized, and several associated problems are indicated. These problems should be solved to achieve more sophisticated treatment of advanced biliary tract cancer.