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Jong Ho Moon - One of the best experts on this subject based on the ideXlab platform.

  • prospective randomized trial of a new multibending versus conventional ultra slim endoscope for Peroral Cholangioscopy without device or endoscope assistance with video
    Gastrointestinal Endoscopy, 2020
    Co-Authors: Jong Ho Moon, Takao Itoi, Hyun Jong Choi, Torsten Beyna, Horst Neuhaus
    Abstract:

    Background and Aims Currently available Peroral Cholangioscopy (POC) is a duodenoscopy-assisted procedure that does not involve directly inserting an endoscope into the biliary tree. A prototype multibending (MB) ultra-slim endoscope has been developed as a dedicated cholangioscope to overcome the technical difficulties of direct POC. In this study, we evaluated the efficacy of the new MB ultra-slim endoscope compared with a conventional ultra-slim endoscope for free-hand insertion of an endoscope into the bile duct for direct POC without the assistance of accessories. Methods Ninety-two patients with biliary disease requiring diagnostic and/or therapeutic direct POC were assigned randomly to groups examined using an MB ultra-slim endoscope (MB group, n=46) versus a conventional ultra-slim endoscope (conventional group, n=46). The primary outcome was the technical success of free-hand insertion of the endoscope during direct POC, defined as successful insertion of the endoscope through the ampulla of Vater and advancement of the endoscope up to the bifurcation or to the obstructed segment of the biliary tree without any accessories within 15 minutes. Results Free-hand biliary insertion of the endoscope for direct POC was technically successful in 41 patients (89.1%) in the MB group, which was significantly higher than the rate (14 patients, 30.4%) in the conventional group (P  Conclusions Free-hand biliary insertion of the MB ultra-slim endoscope showed a high technical success rate without severe adverse events and effectively decreased procedure time compared with a conventional ultra-slim endoscope. Direct POC using the MB ultra-slim endoscope can be used for novel diagnostic and therapeutic procedures of the biliary tree without the assistance of another endoscope or accessory. (Clinical trial registration number: NCT02189421.)

  • tissue acquisition for diagnosis of biliary strictures using Peroral Cholangioscopy or endoscopic ultrasound guided fine needle aspiration
    Endoscopy, 2019
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Background  Although endoscopic retrograde cholangiopancreatography (ERCP) is a first-line diagnostic modality for suspected malignant biliary stricture (MBS), the diagnostic yield of ERCP-based tissue sampling is insufficient. Peroral Cholangioscopy-guided forceps biopsy (POC-FB) and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) are evolving as reliable diagnostic procedures for inconclusive MBS. This study aimed to evaluate the usefulness of a diagnostic approach using POC-FB or EUS-FNAB according to the stricture location in patients with suspected MBS. Methods  Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with transpapillary forceps biopsy (TPB) was performed initially. When malignancy was not confirmed by TPB, POC-FB using a SpyGlass direct visualization system or direct POC using an ultraslim endoscope was performed for proximal strictures, and EUS-FNAB was performed for distal strictures as a follow-up biopsy. Results  Among a total of 181 patients, initial TPB showed malignancy in 122 patients, and the diagnostic accuracy of initial TPB was 71.8 % (95 % confidence interval [CI] 65.3 % – 78.4 %]. Of the 59 patients in whom TPB was negative for malignancy, 32 had proximal biliary strictures and underwent successful POC. The remaining 27 patients had distal strictures and underwent successful EUS-FNAB. The accuracy of malignancy detection using POC-FB for proximal biliary strictures and EUS-FNAB for distal biliary strictures was 93.6 % (95 %CI 84.9 %−100 %) and 96.3 % (95 %CI 89.2 %−100 %), respectively. The overall diagnostic accuracy for the combination of TPB with either POC-FB for proximal strictures and EUS-FNAB for distal strictures was 98.3 % (95 %CI 95.9 %−100 %) and 98.4 % (95 %CI 95.3 %−100 %), respectively. Conclusions  An approach using POC-FB or EUS-FNAB according to the stricture location may be useful in the diagnosis of suspected MBS.

  • Tissue acquisition for diagnosis of biliary strictures using Peroral Cholangioscopy or endoscopic ultrasound-guided fine-needle aspiration.
    Endoscopy, 2018
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Although endoscopic retrograde cholangiopancreatography (ERCP) is a first-line diagnostic modality for suspected malignant biliary stricture (MBS), the diagnostic yield of ERCP-based tissue sampling is insufficient. Peroral Cholangioscopy-guided forceps biopsy (POC-FB) and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) are evolving as reliable diagnostic procedures for inconclusive MBS. This study aimed to evaluate the usefulness of a diagnostic approach using POC-FB or EUS-FNAB according to the stricture location in patients with suspected MBS. Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with transpapillary forceps biopsy (TPB) was performed initially. When malignancy was not confirmed by TPB, POC-FB using a SpyGlass direct visualization system or direct POC using an ultraslim endoscope was performed for proximal strictures, and EUS-FNAB was performed for distal strictures as a follow-up biopsy. Among a total of 181 patients, initial TPB showed malignancy in 122 patients, and the diagnostic accuracy of initial TPB was 71.8 % (95 % confidence interval [CI] 65.3 % - 78.4 %]. Of the 59 patients in whom TPB was negative for malignancy, 32 had proximal biliary strictures and underwent successful POC. The remaining 27 patients had distal strictures and underwent successful EUS-FNAB. The accuracy of malignancy detection using POC-FB for proximal biliary strictures and EUS-FNAB for distal biliary strictures was 93.6 % (95 %CI 84.9 %-100 %) and 96.3 % (95 %CI 89.2 %-100 %), respectively. The overall diagnostic accuracy for the combination of TPB with either POC-FB for proximal strictures and EUS-FNAB for distal strictures was 98.3 % (95 %CI 95.9 %-100 %) and 98.4 % (95 %CI 95.3 %-100 %), respectively. An approach using POC-FB or EUS-FNAB according to the stricture location may be useful in the diagnosis of suspected MBS. © Georg Thieme Verlag KG Stuttgart · New York.

  • direct Peroral Cholangioscopy for diagnosis of bile duct lesions using an i scan ultraslim endoscope a pilot study
    Endoscopy, 2017
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Background and study aims I-SCAN is a computed virtual chromoendoscopy (CVC) system designed to enhance surface and vascular patterns. In this study, we evaluated the usefulness of direct Peroral Cholangioscopy (POC) using I-SCAN compared with a conventional white-light image (WLI) to diagnose bile duct lesions. Patients and methods Patients with mucosal lesions in the bile duct detected during direct POC were enrolled prospectively. The quality of endoscopic visualization and the visual diagnosis were assessed using I-SCAN and WLI modes, respectively, during direct POC. Results A total of 20 patients (9 malignant and 11 benign lesions) underwent I-SCAN to evaluate lesions in the bile duct using direct POC. The quality of endoscopic visualization using direct POC with I-SCAN was significantly higher than that of WLI for surface structure (P = 0.04), surface microvascular architecture (P = 0.01), and margins (P = 0.02). Overall diagnostic accuracy of the visual diagnosis was not different between I-SCAN and WLI (90.0 % vs. 75.0 %; P = 0.20). Conclusion Direct POC using CVC by I-SCAN seems to be helpful for evaluating mucosal lesions of the bile duct, without the interference from bile. Clinical trial registration: UMIN000021009

  • Direct Peroral Cholangioscopy for diagnosis of bile duct lesions using an I-SCAN ultraslim endoscope: a pilot study.
    Endoscopy, 2017
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Background and study aims I-SCAN is a computed virtual chromoendoscopy (CVC) system designed to enhance surface and vascular patterns. In this study, we evaluated the usefulness of direct Peroral Cholangioscopy (POC) using I-SCAN compared with a conventional white-light image (WLI) to diagnose bile duct lesions. Patients and methods Patients with mucosal lesions in the bile duct detected during direct POC were enrolled prospectively. The quality of endoscopic visualization and the visual diagnosis were assessed using I-SCAN and WLI modes, respectively, during direct POC. Results A total of 20 patients (9 malignant and 11 benign lesions) underwent I-SCAN to evaluate lesions in the bile duct using direct POC. The quality of endoscopic visualization using direct POC with I-SCAN was significantly higher than that of WLI for surface structure (P = 0.04), surface microvascular architecture (P = 0.01), and margins (P = 0.02). Overall diagnostic accuracy of the visual diagnosis was not different between I-SCAN and WLI (90.0 % vs. 75.0 %; P = 0.20). Conclusion Direct POC using CVC by I-SCAN seems to be helpful for evaluating mucosal lesions of the bile duct, without the interference from bile. UMIN000021009. © Georg Thieme Verlag KG Stuttgart · New York.

Hyun Jong Choi - One of the best experts on this subject based on the ideXlab platform.

  • prospective randomized trial of a new multibending versus conventional ultra slim endoscope for Peroral Cholangioscopy without device or endoscope assistance with video
    Gastrointestinal Endoscopy, 2020
    Co-Authors: Jong Ho Moon, Takao Itoi, Hyun Jong Choi, Torsten Beyna, Horst Neuhaus
    Abstract:

    Background and Aims Currently available Peroral Cholangioscopy (POC) is a duodenoscopy-assisted procedure that does not involve directly inserting an endoscope into the biliary tree. A prototype multibending (MB) ultra-slim endoscope has been developed as a dedicated cholangioscope to overcome the technical difficulties of direct POC. In this study, we evaluated the efficacy of the new MB ultra-slim endoscope compared with a conventional ultra-slim endoscope for free-hand insertion of an endoscope into the bile duct for direct POC without the assistance of accessories. Methods Ninety-two patients with biliary disease requiring diagnostic and/or therapeutic direct POC were assigned randomly to groups examined using an MB ultra-slim endoscope (MB group, n=46) versus a conventional ultra-slim endoscope (conventional group, n=46). The primary outcome was the technical success of free-hand insertion of the endoscope during direct POC, defined as successful insertion of the endoscope through the ampulla of Vater and advancement of the endoscope up to the bifurcation or to the obstructed segment of the biliary tree without any accessories within 15 minutes. Results Free-hand biliary insertion of the endoscope for direct POC was technically successful in 41 patients (89.1%) in the MB group, which was significantly higher than the rate (14 patients, 30.4%) in the conventional group (P  Conclusions Free-hand biliary insertion of the MB ultra-slim endoscope showed a high technical success rate without severe adverse events and effectively decreased procedure time compared with a conventional ultra-slim endoscope. Direct POC using the MB ultra-slim endoscope can be used for novel diagnostic and therapeutic procedures of the biliary tree without the assistance of another endoscope or accessory. (Clinical trial registration number: NCT02189421.)

  • tissue acquisition for diagnosis of biliary strictures using Peroral Cholangioscopy or endoscopic ultrasound guided fine needle aspiration
    Endoscopy, 2019
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Background  Although endoscopic retrograde cholangiopancreatography (ERCP) is a first-line diagnostic modality for suspected malignant biliary stricture (MBS), the diagnostic yield of ERCP-based tissue sampling is insufficient. Peroral Cholangioscopy-guided forceps biopsy (POC-FB) and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) are evolving as reliable diagnostic procedures for inconclusive MBS. This study aimed to evaluate the usefulness of a diagnostic approach using POC-FB or EUS-FNAB according to the stricture location in patients with suspected MBS. Methods  Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with transpapillary forceps biopsy (TPB) was performed initially. When malignancy was not confirmed by TPB, POC-FB using a SpyGlass direct visualization system or direct POC using an ultraslim endoscope was performed for proximal strictures, and EUS-FNAB was performed for distal strictures as a follow-up biopsy. Results  Among a total of 181 patients, initial TPB showed malignancy in 122 patients, and the diagnostic accuracy of initial TPB was 71.8 % (95 % confidence interval [CI] 65.3 % – 78.4 %]. Of the 59 patients in whom TPB was negative for malignancy, 32 had proximal biliary strictures and underwent successful POC. The remaining 27 patients had distal strictures and underwent successful EUS-FNAB. The accuracy of malignancy detection using POC-FB for proximal biliary strictures and EUS-FNAB for distal biliary strictures was 93.6 % (95 %CI 84.9 %−100 %) and 96.3 % (95 %CI 89.2 %−100 %), respectively. The overall diagnostic accuracy for the combination of TPB with either POC-FB for proximal strictures and EUS-FNAB for distal strictures was 98.3 % (95 %CI 95.9 %−100 %) and 98.4 % (95 %CI 95.3 %−100 %), respectively. Conclusions  An approach using POC-FB or EUS-FNAB according to the stricture location may be useful in the diagnosis of suspected MBS.

  • Tissue acquisition for diagnosis of biliary strictures using Peroral Cholangioscopy or endoscopic ultrasound-guided fine-needle aspiration.
    Endoscopy, 2018
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Although endoscopic retrograde cholangiopancreatography (ERCP) is a first-line diagnostic modality for suspected malignant biliary stricture (MBS), the diagnostic yield of ERCP-based tissue sampling is insufficient. Peroral Cholangioscopy-guided forceps biopsy (POC-FB) and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) are evolving as reliable diagnostic procedures for inconclusive MBS. This study aimed to evaluate the usefulness of a diagnostic approach using POC-FB or EUS-FNAB according to the stricture location in patients with suspected MBS. Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with transpapillary forceps biopsy (TPB) was performed initially. When malignancy was not confirmed by TPB, POC-FB using a SpyGlass direct visualization system or direct POC using an ultraslim endoscope was performed for proximal strictures, and EUS-FNAB was performed for distal strictures as a follow-up biopsy. Among a total of 181 patients, initial TPB showed malignancy in 122 patients, and the diagnostic accuracy of initial TPB was 71.8 % (95 % confidence interval [CI] 65.3 % - 78.4 %]. Of the 59 patients in whom TPB was negative for malignancy, 32 had proximal biliary strictures and underwent successful POC. The remaining 27 patients had distal strictures and underwent successful EUS-FNAB. The accuracy of malignancy detection using POC-FB for proximal biliary strictures and EUS-FNAB for distal biliary strictures was 93.6 % (95 %CI 84.9 %-100 %) and 96.3 % (95 %CI 89.2 %-100 %), respectively. The overall diagnostic accuracy for the combination of TPB with either POC-FB for proximal strictures and EUS-FNAB for distal strictures was 98.3 % (95 %CI 95.9 %-100 %) and 98.4 % (95 %CI 95.3 %-100 %), respectively. An approach using POC-FB or EUS-FNAB according to the stricture location may be useful in the diagnosis of suspected MBS. © Georg Thieme Verlag KG Stuttgart · New York.

  • direct Peroral Cholangioscopy for diagnosis of bile duct lesions using an i scan ultraslim endoscope a pilot study
    Endoscopy, 2017
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Background and study aims I-SCAN is a computed virtual chromoendoscopy (CVC) system designed to enhance surface and vascular patterns. In this study, we evaluated the usefulness of direct Peroral Cholangioscopy (POC) using I-SCAN compared with a conventional white-light image (WLI) to diagnose bile duct lesions. Patients and methods Patients with mucosal lesions in the bile duct detected during direct POC were enrolled prospectively. The quality of endoscopic visualization and the visual diagnosis were assessed using I-SCAN and WLI modes, respectively, during direct POC. Results A total of 20 patients (9 malignant and 11 benign lesions) underwent I-SCAN to evaluate lesions in the bile duct using direct POC. The quality of endoscopic visualization using direct POC with I-SCAN was significantly higher than that of WLI for surface structure (P = 0.04), surface microvascular architecture (P = 0.01), and margins (P = 0.02). Overall diagnostic accuracy of the visual diagnosis was not different between I-SCAN and WLI (90.0 % vs. 75.0 %; P = 0.20). Conclusion Direct POC using CVC by I-SCAN seems to be helpful for evaluating mucosal lesions of the bile duct, without the interference from bile. Clinical trial registration: UMIN000021009

  • Direct Peroral Cholangioscopy for diagnosis of bile duct lesions using an I-SCAN ultraslim endoscope: a pilot study.
    Endoscopy, 2017
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Background and study aims I-SCAN is a computed virtual chromoendoscopy (CVC) system designed to enhance surface and vascular patterns. In this study, we evaluated the usefulness of direct Peroral Cholangioscopy (POC) using I-SCAN compared with a conventional white-light image (WLI) to diagnose bile duct lesions. Patients and methods Patients with mucosal lesions in the bile duct detected during direct POC were enrolled prospectively. The quality of endoscopic visualization and the visual diagnosis were assessed using I-SCAN and WLI modes, respectively, during direct POC. Results A total of 20 patients (9 malignant and 11 benign lesions) underwent I-SCAN to evaluate lesions in the bile duct using direct POC. The quality of endoscopic visualization using direct POC with I-SCAN was significantly higher than that of WLI for surface structure (P = 0.04), surface microvascular architecture (P = 0.01), and margins (P = 0.02). Overall diagnostic accuracy of the visual diagnosis was not different between I-SCAN and WLI (90.0 % vs. 75.0 %; P = 0.20). Conclusion Direct POC using CVC by I-SCAN seems to be helpful for evaluating mucosal lesions of the bile duct, without the interference from bile. UMIN000021009. © Georg Thieme Verlag KG Stuttgart · New York.

Sang Heum Park - One of the best experts on this subject based on the ideXlab platform.

  • tissue acquisition for diagnosis of biliary strictures using Peroral Cholangioscopy or endoscopic ultrasound guided fine needle aspiration
    Endoscopy, 2019
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Background  Although endoscopic retrograde cholangiopancreatography (ERCP) is a first-line diagnostic modality for suspected malignant biliary stricture (MBS), the diagnostic yield of ERCP-based tissue sampling is insufficient. Peroral Cholangioscopy-guided forceps biopsy (POC-FB) and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) are evolving as reliable diagnostic procedures for inconclusive MBS. This study aimed to evaluate the usefulness of a diagnostic approach using POC-FB or EUS-FNAB according to the stricture location in patients with suspected MBS. Methods  Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with transpapillary forceps biopsy (TPB) was performed initially. When malignancy was not confirmed by TPB, POC-FB using a SpyGlass direct visualization system or direct POC using an ultraslim endoscope was performed for proximal strictures, and EUS-FNAB was performed for distal strictures as a follow-up biopsy. Results  Among a total of 181 patients, initial TPB showed malignancy in 122 patients, and the diagnostic accuracy of initial TPB was 71.8 % (95 % confidence interval [CI] 65.3 % – 78.4 %]. Of the 59 patients in whom TPB was negative for malignancy, 32 had proximal biliary strictures and underwent successful POC. The remaining 27 patients had distal strictures and underwent successful EUS-FNAB. The accuracy of malignancy detection using POC-FB for proximal biliary strictures and EUS-FNAB for distal biliary strictures was 93.6 % (95 %CI 84.9 %−100 %) and 96.3 % (95 %CI 89.2 %−100 %), respectively. The overall diagnostic accuracy for the combination of TPB with either POC-FB for proximal strictures and EUS-FNAB for distal strictures was 98.3 % (95 %CI 95.9 %−100 %) and 98.4 % (95 %CI 95.3 %−100 %), respectively. Conclusions  An approach using POC-FB or EUS-FNAB according to the stricture location may be useful in the diagnosis of suspected MBS.

  • Tissue acquisition for diagnosis of biliary strictures using Peroral Cholangioscopy or endoscopic ultrasound-guided fine-needle aspiration.
    Endoscopy, 2018
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Although endoscopic retrograde cholangiopancreatography (ERCP) is a first-line diagnostic modality for suspected malignant biliary stricture (MBS), the diagnostic yield of ERCP-based tissue sampling is insufficient. Peroral Cholangioscopy-guided forceps biopsy (POC-FB) and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) are evolving as reliable diagnostic procedures for inconclusive MBS. This study aimed to evaluate the usefulness of a diagnostic approach using POC-FB or EUS-FNAB according to the stricture location in patients with suspected MBS. Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with transpapillary forceps biopsy (TPB) was performed initially. When malignancy was not confirmed by TPB, POC-FB using a SpyGlass direct visualization system or direct POC using an ultraslim endoscope was performed for proximal strictures, and EUS-FNAB was performed for distal strictures as a follow-up biopsy. Among a total of 181 patients, initial TPB showed malignancy in 122 patients, and the diagnostic accuracy of initial TPB was 71.8 % (95 % confidence interval [CI] 65.3 % - 78.4 %]. Of the 59 patients in whom TPB was negative for malignancy, 32 had proximal biliary strictures and underwent successful POC. The remaining 27 patients had distal strictures and underwent successful EUS-FNAB. The accuracy of malignancy detection using POC-FB for proximal biliary strictures and EUS-FNAB for distal biliary strictures was 93.6 % (95 %CI 84.9 %-100 %) and 96.3 % (95 %CI 89.2 %-100 %), respectively. The overall diagnostic accuracy for the combination of TPB with either POC-FB for proximal strictures and EUS-FNAB for distal strictures was 98.3 % (95 %CI 95.9 %-100 %) and 98.4 % (95 %CI 95.3 %-100 %), respectively. An approach using POC-FB or EUS-FNAB according to the stricture location may be useful in the diagnosis of suspected MBS. © Georg Thieme Verlag KG Stuttgart · New York.

  • direct Peroral Cholangioscopy for diagnosis of bile duct lesions using an i scan ultraslim endoscope a pilot study
    Endoscopy, 2017
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Background and study aims I-SCAN is a computed virtual chromoendoscopy (CVC) system designed to enhance surface and vascular patterns. In this study, we evaluated the usefulness of direct Peroral Cholangioscopy (POC) using I-SCAN compared with a conventional white-light image (WLI) to diagnose bile duct lesions. Patients and methods Patients with mucosal lesions in the bile duct detected during direct POC were enrolled prospectively. The quality of endoscopic visualization and the visual diagnosis were assessed using I-SCAN and WLI modes, respectively, during direct POC. Results A total of 20 patients (9 malignant and 11 benign lesions) underwent I-SCAN to evaluate lesions in the bile duct using direct POC. The quality of endoscopic visualization using direct POC with I-SCAN was significantly higher than that of WLI for surface structure (P = 0.04), surface microvascular architecture (P = 0.01), and margins (P = 0.02). Overall diagnostic accuracy of the visual diagnosis was not different between I-SCAN and WLI (90.0 % vs. 75.0 %; P = 0.20). Conclusion Direct POC using CVC by I-SCAN seems to be helpful for evaluating mucosal lesions of the bile duct, without the interference from bile. Clinical trial registration: UMIN000021009

  • Direct Peroral Cholangioscopy for diagnosis of bile duct lesions using an I-SCAN ultraslim endoscope: a pilot study.
    Endoscopy, 2017
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Background and study aims I-SCAN is a computed virtual chromoendoscopy (CVC) system designed to enhance surface and vascular patterns. In this study, we evaluated the usefulness of direct Peroral Cholangioscopy (POC) using I-SCAN compared with a conventional white-light image (WLI) to diagnose bile duct lesions. Patients and methods Patients with mucosal lesions in the bile duct detected during direct POC were enrolled prospectively. The quality of endoscopic visualization and the visual diagnosis were assessed using I-SCAN and WLI modes, respectively, during direct POC. Results A total of 20 patients (9 malignant and 11 benign lesions) underwent I-SCAN to evaluate lesions in the bile duct using direct POC. The quality of endoscopic visualization using direct POC with I-SCAN was significantly higher than that of WLI for surface structure (P = 0.04), surface microvascular architecture (P = 0.01), and margins (P = 0.02). Overall diagnostic accuracy of the visual diagnosis was not different between I-SCAN and WLI (90.0 % vs. 75.0 %; P = 0.20). Conclusion Direct POC using CVC by I-SCAN seems to be helpful for evaluating mucosal lesions of the bile duct, without the interference from bile. UMIN000021009. © Georg Thieme Verlag KG Stuttgart · New York.

  • a newly modified access balloon catheter for direct Peroral Cholangioscopy by using an ultraslim upper endoscope with videos
    Gastrointestinal Endoscopy, 2016
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Moon Han Choi, Sang Heum Park
    Abstract:

    Background and Aims Direct Peroral Cholangioscopy (POC) by using an ultraslim upper endoscope has been increasingly applied for diagnosis and treatment of diverse biliary diseases. Recently, an intraductal balloon catheter has been used commonly to guide the flexible ultraslim endoscope. However, accessibility into the bile duct remains a limitation of the procedure. The aim of this study was to evaluate the feasibility and success rate of an intraductal balloon-guided direct POC by using an ultraslim endoscope with a newly modified 5F balloon catheter. Methods In total, 36 patients with biliary obstruction were included prospectively for a direct POC by using an ultraslim endoscope with a newly modified intraductal 5F balloon catheter. The main outcome measure was technical success, defined as successful advancement of the ultraslim endoscope into the obstructed segment of the biliary tree or the bifurcation. Secondary outcomes were mean time for the total procedure, intubation into the common bile duct and advancement up to the target site after intubation of the ultraslim endoscope, technical success rates of diagnostic and therapeutic interventions, and adverse events. Results The intraductal balloon-guided direct POC using a newly modified 5F balloon catheter was completed successfully in 35 of 36 patients (97.2%). The mean times for total procedure, intubation into the distal common bile duct, and advancement up to the obstructed bile duct segment were 27.3 ± 7.2, 2.2 ± 0.5, and 0.8 ± 0.4 minutes, respectively. In total, 49 interventions were performed in 35 patients, excluding 1 patient in whom we failed to perform direct POC. Technical success of the interventions was achieved with 44 of 49 procedures (89.8%). No adverse events, including cholangitis, were observed. Conclusions A newly modified 5F balloon catheter seemed to facilitate performing intraductal balloon-guided direct POC for direct visual examination of the bile duct in patients with biliary obstruction. Continued development of endoscopes and accessories are expected to further improve the performance of direct POC.

Toshio Tsuyuguchi - One of the best experts on this subject based on the ideXlab platform.

  • Peroral Cholangioscopy for the Diagnosis of Biliary Tract Diseases
    Advanced Therapeutic Endoscopy for Pancreatico-Biliary Diseases, 2017
    Co-Authors: Toshio Tsuyuguchi, Harutoshi Sugiyama, Yuji Sakai, Naoya Kato
    Abstract:

    Peroral Cholangioscopy permits direct visualization and tissue sampling of indeterminate biliary lesions and treats difficult bile duct stones. Accurate differential diagnosis is essential in the planning of therapy, can avoid unnecessary surgery in cases of benign disease, and aids in assessing the potential resectability of tumors. The main indication of Cholangioscopy is diagnosis of indeterminate biliary strictures, because brushing cytology and biopsies are limited by relative low sensitivity. Standard Peroral Cholangioscopy is a mother-baby system. The newly developed video Peroral cholangioscope (CHF-B260: Olympus, Japan) can provide not only high-resolution digital images but also narrowband imaging which may identify neoplasm. Mother-baby scope system has not gained widespread acceptance, because of its fragility and the need for two skillful endoscopists. To overcome this disadvantage, single-operator system (SpyGlass: Boston Scientific, USA) was developed and used frequently. Recently, direct Peroral Cholangioscopy (DC) by using an ultraslim video scope has been reported. Compared to standard mother-baby system, DC has relatively large working channel and durability but technical difficulty in the insertion into the bile duct. In addition, intrahepatic bile duct exploration is arduous task for DC. A meta-analysis of SpyGlass Cholangioscopy showed that targeted biopsies under cholangioscope cannot improve diagnostic power compared to conventional brush cytology and biopsies. Therefore better visualization is essential for improving sensitivity of malignant biliary strictures. In this chapter, we reviewed Peroral Cholangioscopy, focusing on diagnosis of the biliary tract diseases.

  • potential role of Peroral Cholangioscopy for preoperative diagnosis of cholangiocarcinoma
    Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2012
    Co-Authors: Harutoshi Sugiyama, Toshio Tsuyuguchi, Yuji Sakai, Masayuki Ohtsuka, Masaru Miyazaki, Osamu Yokosuka
    Abstract:

    Background/Purpose: We evaluated the utility of Peroral Cholangioscopy (POCS) for preoperative diagnosis of cholangiocarcinoma. Methods: POCS was performed to assess the horizontal extension of the carcinoma. We compared the results of assessment with those of histologic analysis of 44 surgically resected specimens. Results: Cholangiocarcinoma types were described as filling defects and strictures in 16 and 28 patients, respectively, using cholangiography. Endoscopic retrograde cholangiography (ERC) identified tumor extension in 5 and 15 patients with filling defects (31.25%) and strictures (53.57%), respectively. ERC+POCS identified tumor extension in 15 and 16 patients with filling defects (93.75%) and strictures (60.71%), respectively. ERC+POCS was significantly useful for patients with filling defects compared with ERC alone (P=0.002). ERC+POCS was not significantly useful for patients with strictures compared with ERC alone. Conclusions: POCS is a useful preoperative examination modality for assessing tumor extension in cholangiocarcinoma patients, especially in those with filling defects.

  • long term follow up after Peroral Cholangioscopy directed lithotripsy in patients with difficult bile duct stones including mirizzi syndrome an analysis of risk factors predicting stone recurrence
    Surgical Endoscopy and Other Interventional Techniques, 2011
    Co-Authors: Toshio Tsuyuguchi, Harutoshi Sugiyama, Yuji Sakai, Takeshi Ishihara, Osamu Yokosuka
    Abstract:

    Background Peroral Cholangioscopy-directed lithotripsy (PC-directed lithotripsy) has been successfully used for the treatment of difficult bile duct stones, including Mirizzi syndrome (MS). However, long-term outcome and risk factors for stone recurrence after PC-directed lithotripsy have not yet been elucidated. The aim of this study was to assess the outcomes of long-term follow-up after PC-directed lithotripsy and to clarify risk factors predicting stone recurrence.

  • Long-term follow-up after Peroral Cholangioscopy-directed lithotripsy in patients with difficult bile duct stones, including Mirizzi syndrome: an analysis of risk factors predicting stone recurrence
    Surgical Endoscopy, 2011
    Co-Authors: Toshio Tsuyuguchi, Harutoshi Sugiyama, Yuji Sakai, Takeshi Ishihara, Osamu Yokosuka
    Abstract:

    Background Peroral Cholangioscopy-directed lithotripsy (PC-directed lithotripsy) has been successfully used for the treatment of difficult bile duct stones, including Mirizzi syndrome (MS). However, long-term outcome and risk factors for stone recurrence after PC-directed lithotripsy have not yet been elucidated. The aim of this study was to assess the outcomes of long-term follow-up after PC-directed lithotripsy and to clarify risk factors predicting stone recurrence. Methods One hundred twenty-two consecutive patients with difficult bile duct stones, including MS type II (McSherry classification system), were included in the study. Results Successful stone removal was achieved in 117 (95.9%) of the 122 patients treated with PC-directed lithotripsy. Of these 117 patients, reliable follow-up information for a median period of 5.5 years (range = 0.19–16.6) was obtained for 111 patients (94.9%) in whom stone type was classified into one of the following three categories: (1) MS type II (47 patients); (2) impacted stones (45 patients); and (3) large stones (≥20 mm in short diameter, 19 patients). Bile duct stone recurrence was observed in 18 patients (16.1%), of whom 4 had MS type II, 9 had impacted stones, and 5 had large stones. Statistical analysis showed that dilated bile duct diameter greater than or equal to 20 mm was the only risk factor for stone recurrence. Conclusions PC-directed lithotripsy used for the treatment of difficult bile duct stones, including MS type II and impacted stones, and is found to be safe at long-term follow-up. Dilated bile duct diameter is the only risk factor for stone recurrence. Careful follow-up is indispensable, particularly for patients with dilated bile ducts.

  • The successful use of Peroral Cholangioscopy for the diagnosis and treatment of the biliary tract lesions and giant bile duct stones in a 76-year-old man.
    Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2009
    Co-Authors: Yuji Sakai, Toshio Tsuyuguchi, Harutoshi Sugiyama, Takeshi Ishihara, Kaoru Miyakawa, Shin Yasui, Tatsuya Fujimoto, Hiroaki Shimizu, Masaru Miyazaki
    Abstract:

    We encountered a case in whom Peroral Cholangioscopy was useful for the diagnosis and treatment of irregular biliary tract mucosa and giant bile duct stones. Peroral Cholangioscopy seems to improve the diagnosis of biliary tract diseases and allow internal treatment. The proper diagnosis of biliary tract diseases may be further confirmed by the concomitant use of narrow band imaging and this endoscopic technology.

Bong Min Ko - One of the best experts on this subject based on the ideXlab platform.

  • Therapeutic role of direct Peroral Cholangioscopy using an ultra-slim upper endoscope
    Journal of Hepato-Biliary-Pancreatic Sciences, 2011
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Bong Min Ko
    Abstract:

    Introduction Peroral Cholangioscopy provides direct visualization of the bile duct and facilitates diagnostic procedures and therapeutic intervention. The currently available mother–baby scope system is not widely used because of its disadvantages. Direct Peroral Cholangioscopy (POC) with a regular, ultra-slim, upper endoscope can provide a valuable and economic solution for evaluating bile duct lesions, although its therapeutic role in biliary tract disease is uncertain. We assessed the usefulness of direct POC with an ultra-slim endoscope for therapeutic application in patients with biliary diseases. Methods Several new techniques and accessories allow therapeutic intervention under direct POC using an ultra-slim upper endoscope with a larger, 2-mm working channel. Intracorporeal laser or electrohydraulic lithotripsy under direct POC is a main therapeutic intervention for patients with bile duct stones resistant to conventional endoscopic procedures. Tumor ablation therapy such as photodynamic therapy and argon plasma coagulation may be performed under direct POC. Direct POC can be applied to guide biliary interventions such as guidewire placement, stone removal, and migrated stent retrieval, using diverse accessories. Conclusion Direct POC with an ultra-slim upper endoscope allows therapeutic intervention for patients with biliary diseases. Enhancements of the endoscope and specialized accessories are expected to expand the therapeutic role of direct POC.

  • therapeutic role of direct Peroral Cholangioscopy using an ultra slim upper endoscope
    Journal of Hepato-biliary-pancreatic Sciences, 2011
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Bong Min Ko
    Abstract:

    Introduction Peroral Cholangioscopy provides direct visualization of the bile duct and facilitates diagnostic procedures and therapeutic intervention. The currently available mother–baby scope system is not widely used because of its disadvantages. Direct Peroral Cholangioscopy (POC) with a regular, ultra-slim, upper endoscope can provide a valuable and economic solution for evaluating bile duct lesions, although its therapeutic role in biliary tract disease is uncertain. We assessed the usefulness of direct POC with an ultra-slim endoscope for therapeutic application in patients with biliary diseases.

  • clinical feasibility of direct Peroral Cholangioscopy guided photodynamic therapy for inoperable cholangiocarcinoma performed by using an ultra slim upper endoscope with videos
    Gastrointestinal Endoscopy, 2011
    Co-Authors: Hyun Jong Choi, Bong Min Ko, Jong Ho Moon, Young Koog Cheon, Ri A Song, Sang Heum Park
    Abstract:

    Background Photodynamic therapy (PDT) has emerged as a promising palliative treatment for inoperable cholangiocarcinoma. Cholangioscopy-guided PDT can be useful for identification of tumor margins, determination of the appropriate location for placement of the diffuser, and evaluation of the patient's response to therapy. Objective To evaluate the feasibility of PDT under direct Peroral Cholangioscopy (POC) by using an ultra-slim upper endoscope in patients with inoperable cholangiocarcinoma. Design Prospective, observational, pilot study. Setting Single tertiary-care referral center. Patients This study involved 9 patients with inoperable extrahepatic cholangiocarcinoma. Intervention Photofrin II was administered intravenously 48 hours before PDT. Additional PDT was performed up to 48 hours after the initial application of therapy. A successful direct POC–guided PDT was defined as advancement of the endoscope into the distal margin of the tumor and maintenance of endoscope position until PDT was completed. Main Outcome Measurements The clinical feasibility, usefulness, and complications of direct POC for PDT. Results Seventeen sessions of direct POC for PDT were performed in 9 patients. PDT was performed successfully in 15 of 17 sessions (88.2%) and 7 of 9 patients (77.8%). Biliary drainage under direct POC, if necessary after PDT, was possible in 100% of patients (7/7). Follow-up direct POC confirmed significant tumor ablation after PDT in 5 patients. One patient reported mild skin redness; no major procedure-related complications were observed. Limitations Small sample size, pilot study. Conclusion Direct POC–guided PDT by using an ultra-slim upper endoscope seems to be both feasible and safe in select patients with inoperable extrahepatic cholangiocarcinoma.

  • Clinical feasibility of direct Peroral Cholangioscopy–guided photodynamic therapy for inoperable cholangiocarcinoma performed by using an ultra-slim upper endoscope (with videos)
    Gastrointestinal Endoscopy, 2011
    Co-Authors: Hyun Jong Choi, Bong Min Ko, Jong Ho Moon, Young Koog Cheon, A. Ri Song, Sang Heum Park
    Abstract:

    Background Photodynamic therapy (PDT) has emerged as a promising palliative treatment for inoperable cholangiocarcinoma. Cholangioscopy-guided PDT can be useful for identification of tumor margins, determination of the appropriate location for placement of the diffuser, and evaluation of the patient's response to therapy. Objective To evaluate the feasibility of PDT under direct Peroral Cholangioscopy (POC) by using an ultra-slim upper endoscope in patients with inoperable cholangiocarcinoma. Design Prospective, observational, pilot study. Setting Single tertiary-care referral center. Patients This study involved 9 patients with inoperable extrahepatic cholangiocarcinoma. Intervention Photofrin II was administered intravenously 48 hours before PDT. Additional PDT was performed up to 48 hours after the initial application of therapy. A successful direct POC–guided PDT was defined as advancement of the endoscope into the distal margin of the tumor and maintenance of endoscope position until PDT was completed. Main Outcome Measurements The clinical feasibility, usefulness, and complications of direct POC for PDT. Results Seventeen sessions of direct POC for PDT were performed in 9 patients. PDT was performed successfully in 15 of 17 sessions (88.2%) and 7 of 9 patients (77.8%). Biliary drainage under direct POC, if necessary after PDT, was possible in 100% of patients (7/7). Follow-up direct POC confirmed significant tumor ablation after PDT in 5 patients. One patient reported mild skin redness; no major procedure-related complications were observed. Limitations Small sample size, pilot study. Conclusion Direct POC–guided PDT by using an ultra-slim upper endoscope seems to be both feasible and safe in select patients with inoperable extrahepatic cholangiocarcinoma.

  • direct Peroral Cholangioscopy using an ultra slim upper endoscope for the treatment of retained bile duct stones
    The American Journal of Gastroenterology, 2009
    Co-Authors: Jong Ho Moon, Hyun Jong Choi, Bong Min Ko, Su Jin Hong, Young Koog Cheon, Chan Sup Shim
    Abstract:

    Direct Peroral Cholangioscopy Using an Ultra-Slim Upper Endoscope for the Treatment of Retained Bile Duct Stones