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Background/aims: The patterns of quantitative hepatobiliary scintigraphy for bilioenteric anastomoses have not been objectively defined. This study was undertaken to establish the patterns of quantitative hepatobiliary scintigraphy in the patients with bilioenteric anastomoses performed for repair of postcholecystectomy benign biliary strictures., Methodology: 37 patients with bilioenteric anastomosis (Study group) and 10 postcholecystectomy healthy subjects (Controls) underwent quantitative hepatobiliary scintigraphy. Study group patients were further categorized into: Group A (n=27) - normal clinical and biochemical parameters, and Group B (n=10) - abnormal clinical and/or biochemical parameters. On scintigraphy, time of maximal activity and time of clearance of half of the activity was calculated at the liver parenchyma and hepatic hilum. Time of appearance of activity in the intestine was also recorded., Results: There was no significant difference in the scintigraphic parameters between Group A and Controls except for earlier appearance of activity in the intestines (p=0.036) in Group A. In Group B there was significant increase in the time of clearance of half of the activity at the liver parenchyma and hepatic hilum compared to Controls (p=0.003 and 0.036 respectively), and at the liver parenchyma compared to Group A (p=0.002)., Conclusions: Quantitative hepatobiliary scintigraphic patterns in patients with bilioenteric anastomosis were similar to those of postcholecystectomy controls. Patients with abnormal biochemical parameters had significant delay in clearance of activity. Significance of these scintigraphic patterns in this subset of patients can be determined only on long-term follow-up.

Endoscopic nasobiliary drainage may cause undue stress, such as pharyngeal discomfort. We converted external drainage to internal drainage by cutting the external drainage tube with endoscopically available scissor forceps. Endoscopic nasobiliary drainage tubes were cut in the vicinity of the papilla using scissor forceps in 4 patients. The drainage tube was successfully cut in all patients. The tube was left for short-term internal drainage in 3 patients until the operation or endoscopic treatment was performed. The remaining patient with pancreatic head cancer was followed as an outpatient and the tube stent was occluded 62 days after cutting. Although further studies using a larger number of patients are needed, our procedure is thought to be beneficial to patients undergoing endoscopic nasobiliary drainage.

The case of a 57-year-old woman with a benign biliary stricture is described. Radiological examinations showed granularly elevated lesions in the common hepatic duct and severe stenosis at the hepatic hilum. Under a tentative diagnosis of hepatic hilar bile duct cancer, the patient underwent extended right hepatectomy with bile duct resection. However, pathological and immunohistochemical studies revealed a benign stricture with remarkable formation of lymph follicles with germinal centers, which could be termed "follicular cholangitis". This is the first case report of this uncommon presentation of inflammatory changes of the bile duct. Its etiology was unknown, and more investigation is encouraged to clarify its relationship to systemic disorders and malignancies. As difficulty remains in discriminating between benign and malignant strictures by nonsurgical modalities at present, surgical resection without complications provides a feasible approach to such a benign lesion.

In patients with chronic pancreatitis, surgical therapy is indicated for intractable pain. There is no definite opinion about the diameter of the pancreatic duct when deciding the necessity for some forms of surgery. In some patients with a small-caliber duct, ductal decompression is also necessary for the relief of refractory pain. Ultrasound-guided needle puncture provides an easy approach for opening the dilated duct, but in the case of a small-caliber duct, needle puncture alone is insufficient. Insertion of a guide-wire into the duct can secure the ductal cavity, even if the duct is not markedly dilated. Using this technique, with or without intravenous administration of secretin, we have performed longitudinal ductal opening in some patients with chronic pancreatitis. We describe our reliable technique for opening of a small pancreatic duct, and the results we obtained in our series.

This is a case presentation of a 14-year-old boy with the radiological diagnosis of cholangiocarcinoma occluding the hepatic duct bifurcation. His only symptom at presentation was jaundice and further workup confirmed a mass at the porta hepatis. Surgical treatment resulted in a resection of the hepatic bifurcation tumor with a final pathological diagnosis of a carcinoid tumor of the hepatic duct bifurcation. To our knowledge, this is only the second case presented of a resected carcinoid tumor in adolescence. In this communiqué we present the above case and review of the world literature of biliary neuroendocrine tumors.

Background/aims: To report our experience on palliative management of malignant biliary obstruction with percutaneous placement of metallic stents., Methodology: During a 3-year period 20 patients with malignant biliary obstruction were treated with percutaneous insertion of metallic biliary endoprostheses., Results: Stent placement was successful in 19 patients, with significant improvement of jaundice in 18 patients. 17 patients have died up to date. In this group survival was 4-324 days (mean: 107 days) and mean stent primary and secondary patency 94.3 and 97.4 days, respectively. Three patients are alive with a follow-up from 20-195 days. Mean secondary patency is 65.3 days (20-134 days). We encountered serious complications in 4 patients (20%). Thirty-day mortality was 15%, while procedural mortality was 10%. Four patients presented 13-120 days (mean: 71.5 days) after the procedure with stent reocclusion (reocclusion rate: 20%)., Conclusions: The procedure is relatively easy and safe to perform, yields excellent palliation of the patient's symptomatology and, therefore, contributes substantially to the maintenance of good quality of life of the patient with malignant biliary obstruction.

A 24 year-old woman complained of obstructive jaundice 24 days after blunt abdominal trauma due to a traffic accident. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a stricture, 15 mm in length, at the common bile duct associated with upper bile duct dilatation. Jaundice was reduced by percutaneous transhepatic cholangio-drainage (PTCD). A 7 Fr-sized PTCD tube was exchanged for a larger-sized catheter for percutaneous transhepatic cholangioscopy expecting gradual dilatation of the stricture. Following the confirmation of satisfactory dilatation of the stricture, the catheter was removed. There was no recurrence of jaundice 16 months later in a follow-up study.

A case of a 51-year-old man, who presented with cholestatic jaundice due to common bile duct compression produced by primary retroperitoneal fibrosis, is reported. The patient was operated on two years earlier because of hydronephrosis, when the disease was diagnosed. Cholangiopancreatography revealed a "double duct sign", disclosing another benign cause for this radiographic sign, that once was considered to be pathognomonic of pancreas cancer. The bile duct stricture was managed by the insertion of an endoscopic endoprosthesis. This is the first report of jaundice due to Ormond's disease and the third, due to retroperitoneal fibrosis.

In adults, congenital stricture of the common hepatic duct that does not cause jaundice is very rare. In this report we present a case of a congenital web occluding the common hepatic duct at the level of the bifurcation that was diagnosed by endoscopic retrograde cholangiography.