Usefullness of J-turn,pull-release method for intubation of bile duct without accessory in DPOC = Usefullness of J-turn,pull-release method for intubation of bile duct without accessory in DPOC

다국어 초록 (Multilingual Abstract)

Background and Study Aims: The Direct peroral cholangioscopy (POC) using an ultraslim endoscope provides endoscopic visualization of the biliary trees with following major advantages, high quality endoscopic images, a working channel and economical benefit. Despite of these advantages, an accessory usually is required to insert into the bile duct because of acute angle between the duodenum and bile duct and loop formation in stomach. But it has been reported that the intubation without an accessory was possible, so we carried out the study for how to be successful intubation without any accessories under the direct POC. Patients and Methods: From April 2014 to June 2015, we carried out the direct POC using ultraslim endoscope without any accessories in patients who had large or hard stone. Ultraslim endoscopy (Olympus GIF-XP260N) was used for choledochoscopy. Before POC, the orifice of major papilla should be widened enough by EST or EPBD. First, entering the 2nd portion of duodenum, the scope was shortened by right turn, pulling method. Second, it was deflected up (J-turn) carefully and positioned in front of the major papilla. Then pull it slowly toward the major papilla. When the tip of scope reached at papilla orifice, release the J-turn by down regulation of endoscopy with advancing the scope into the bile duct simultaneously. After entering the common bile duct, we performed stone fragmentation with EHL. If the scope could not reach the stone, balloon catheter was used for advancing the scope. Finally the stones were extracted by ERCP. Results: DPOC using an ultraslim endoscope without an accessory was successfully performed in 21 of the 29 (24 for impacted CBD stone, 4 mirrizi syndrome, 1 IHD stone) patients. No significant procedure- related complications such as bleeding, pancreatitis, perforation except one air embolism was noted. Conclusions: Despite of limitation for advancing endoscopy to upper CBD and IHBD, POC using J-turn, pull-release method is considered for successful maneuver for intubation of bile duct. We reported 21 successful cases by this method, further cases are needed to evaluate the effectiveness and safety of this method.