Ghrelin's second life - World Journal of Gastroenterology

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Figure 4 Endoscopic balloon dilation using a large balloon and mechanical lithotripsy. The balloon was inflated gradually to a diameter of 15 mm across the papilla and the ballooning was sustained for 60 s, and the bezoar basket captured the stone completely. The stone was fragmented by mechanical lithotripsy using a bezoar basket. Figure 5 Follow-up endoscopic retrograde cholangiopancreatogram disclosed remnant stone fragments. Figure 6 Remnant stone fragments were extracted by the basket and balloon occluded cholangiogram showed complete duct clearance. was fully recovered and discharged on the 11 th day of hospitalization. DISCUSSION Since ML was first introduced by Riemann et al [6] for the retrieval of CBD stones, ML has been the method of WJG|www.wjgnet.com Chung HJ et al . Choledocholithiasis treated by bezoar basket choice in cases of large or impacted stones. Additionally, in cases with concomitant narrowing of the distal CBD from which it is impossible to remove stones by EST, ML is the simplest, most cost-effective, and safe procedure [1-5] . For large stones > 1 cm, there are several therapeutic options other than ML. Endoluminal electrohydraulic lithotripsy (EHL) via the peroral or percutaneous route [3,7,8] , extracorporeal shockwave lithotripsy (ESWL) [1,3] , laser lithotripsy [9] , and stenting [10,11] are nonoperative options, especially for elderly patients and patients at high surgical risk. ESWL, EHL and laser lithotripsy yield similar success rates of 80%-95% and may be used in combination. These techniques are not available at all treatment facilities, thus, the selection of a specific treatment option may differ between institutions or physicians. There have been some studies of EHL using balloon catheters under fluoroscopy [7] and single-operator duodenoscope-assisted cholangioscopy-guided EHL [8] . These are complex and very labor-intensive procedures. ESWL usually requires multiple sessions and an additional endoscopic procedure for complete stone retrieval [1] . The placement of biliary stents is used as an immediate management option to prevent cholangitis or stone impaction [5] , and for retrieval in choledocholithiasis patients who are intractable to the usual lithotripsy option, or have a high surgical risk [6,11] . However, recent studies have shown high rates of late morbidity and mortality after long-term stenting. Temporary use of self-expandable metallic stents combined with EHL has been reported for avoiding long-term stent placement in patients with intractable CBD stones [11] . Large stones (2.5 cm or 2.8 cm in diameter), or hard concretions, often make ML cumbersome or even impossible [3] . Indeed, a stone size > 2.8 cm is associated with lithotripsy failure [12] . Another study has shown that impacted stones, as well as stone size only, is a predictive factor for stone extraction failure, especially in cases where the bile duct is not dilated adequately to accommodate a large stone [5] . In our case, the stone was oversized (4 cm) and dilation of the bile duct was not sufficient to capture the stone using a basket for ML. Other retrieval modalities, such as EHL, and laser lithotripsy, were not promptly available. Also, ESWL was not indicated because the stone was radiolucent. Therefore, we selected a 6-cm diameter bezoar basket to grasp the large stone completely for ML. We performed endoscopic papillary large balloon dilation (EPLBD) without EST before ML for easy removal of the large stone. Several reports have shown the efficacy of EPLBD for treatment of large bile duct stones [13-15] . Most studies have carried out EST followed by EPLBD, but some groups have attempted stone extraction by EPLBD alone without EST [16] . The preceding EST has a lower risk of pancreatitis that the pancreatic orifice is separated from the biliary orifice after EST and it may result in balloon dilation forces away from the pancreatic duct [15] . In our opinion, preceding EST before EPLBD may not play a role in the guidance of balloon 3329 July 7, 2012|Volume 18|Issue 25|
Chung HJ et al . Choledocholithiasis treated by bezoar basket dilation because the direction of ballooning by the inflating catheter is always radial. Therefore, our case had LBS only without a previous EST. In conclusion, ML using a gastric bezoar basket was safe and effective for the retrieval of a CBD stone, which was extraordinarily large. The bezoar basket is not a newly designed device, but an existing tool originally used for the removal of bezoars. This is believed to be the first published attempt to retrieve a giant and intractable bile duct stone and should be considered as an alternative nonoperative option for the management of difficult CBD stones. REFERENCES 1 Binmoeller KF, Brückner M, Thonke F, Soehendra N. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy 1993; 25: 201-206 2 McHenry L, Lehman G. Difficult bile duct stones. Curr Treat Options Gastroenterol 2006; 9: 123-132 3 Hochberger J, Tex S, Maiss J, Hahn EG. Management of difficult common bile duct stones. Gastrointest Endosc Clin N Am 2003; 13: 623-634 4 Leung JW, Tu R. Mechanical lithotripsy for large bile duct stones. Gastrointest Endosc 2004; 59: 688-690 5 Garg PK, Tandon RK, Ahuja V, Makharia GK, Batra Y. Predictors of unsuccessful mechanical lithotripsy and endoscopic clearance of large bile duct stones. Gastrointest Endosc 2004; 59: 601-605 6 Riemann JF, Seuberth K, Demling L. Mechanical lithotripsy of common bile duct stones. Gastrointest Endosc 1985; 31: 207-210 7 Moon JH, Cha SW, Ryu CB, Kim YS, Hong SJ, Cheon YK, Cho YD, Kim YS, Lee JS, Lee MS, Shim CS, Kim BS. Endoscopic treatment of retained bile-duct stones by using a balloon catheter for electrohydraulic lithotripsy without cholangioscopy. Gastrointest Endosc 2004; 60: 562-566 WJG|www.wjgnet.com 8 Farrell JJ, Bounds BC, Al-Shalabi S, Jacobson BC, Brugge WR, Schapiro RH, Kelsey PB. Single-operator duodenoscope-assisted cholangioscopy is an effective alternative in the management of choledocholithiasis not removed by conventional methods, including mechanical lithotripsy. Endoscopy 2005; 37: 542-547 9 Prat F, Fritsch J, Choury AD, Frouge C, Marteau V, Etienne JP. Laser lithotripsy of difficult biliary stones. Gastrointest Endosc 1994; 40: 290-295 10 Katsinelos P, Galanis I, Pilpilidis I, Paroutoglou G, Tsolkas P, Papaziogas B, Dimiropoulos S, Kamperis E, Katsiba D, Kalomenopoulou M, Papagiannis A. The effect of indwelling endoprosthesis on stone size or fragmentation after long-term treatment with biliary stenting for large stones. Surg Endosc 2003; 17: 1552-1555 11 Mizukami Y, Saito H, Obara T, Arisato S, Nakano Y, Sakurai Y, Izawa T, Kohgo Y. Temporary use of an accuflex stent for unextractable common bile duct stones. J Gastroenterol Hepatol 2000; 15: 680-683 12 Cipolletta L, Costamagna G, Bianco MA, Rotondano G, Piscopo R, Mutignani M, Marmo R. Endoscopic mechanical lithotripsy of difficult common bile duct stones. Br J Surg 1997; 84: 1407-1409 13 Ersoz G, Tekesin O, Ozutemiz AO, Gunsar F. Biliary sphincterotomy plus dilation with a large balloon for bile duct stones that are difficult to extract. Gastrointest Endosc 2003; 57: 156-159 14 Attasaranya S, Cheon YK, Vittal H, Howell DA, Wakelin DE, Cunningham JT, Ajmere N, Ste Marie RW, Bhattacharya K, Gupta K, Freeman ML, Sherman S, McHenry L, Watkins JL, Fogel EL, Schmidt S, Lehman GA. Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series. Gastrointest Endosc 2008; 67: 1046-1052 15 Maydeo A, Bhandari S. Balloon sphincteroplasty for removing difficult bile duct stones. Endoscopy 2007; 39: 958-961 16 Chan HH, Lai KH, Lin CK, Tsai WL, Wang EM, Hsu PI, Chen WC, Yu HC, Wang HM, Tsay FW, Tsai CC, Chen IS, Chen YC, Liang HL, Pan HB. Endoscopic papillary large balloon dilation alone without sphincterotomy for the treatment of large common bile duct stones. BMC Gastroenterol 2011; 11: 69 S- Editor Cheng JX L- Editor A E- Editor Zheng XM 3330 July 7, 2012|Volume 18|Issue 25|
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World Journal of Gastroenterology W
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Phillip S Oates, Perth Ross C Smith
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Deepak N Amarapurkar, Mumbai Abhiji
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Trine Olsen, Tromsø Eyvind J Pauls
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Conor P Delaney, Cleveland Sharon D
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S Contents EDITORIAL TOPIC HIGHLIGH
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Contents ACKNOWLEDGMENTS APPENDIX A
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Verhulst PJ et al . Ghrelin and glu
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Online Submissions: http://www.wjgn
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Ishikawa T. Zinc during interferon
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Sitarz R et al . Gastroenterostoma
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Sitarz R et al . Gastroenterostoma
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Morais TC et al . Gastrointestinal
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Song MJ et al . Usefulness of PET/C
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A Sensitivity B Sensitivity C Sensi
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Bae GS et al . Anti-inflammatory ef
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B Myeloperoxidase activity (U/mg pr
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A Time (h) - 1 3 6 NJ4 B Relative H
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A C Time (h) - 1 3 6 NJ4-2 B Relati
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A Collagen staining (fold change) C
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CCl4/YGJ CCl4-13 wk CCl4-7 wk Contr
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CCl4/YGJ CCl4-13 wk CCl4-7 wk Contr
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liver and have potent proliferative
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A 8 wk 9 wk 10 wk 13 wk CCl4/YGJ CC
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Cheng JC. A Chinese Herbal Decoctio
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Singh R, Neo EN, Nordeen N, Shanmug
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etter patient tolerance with regard
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Key words: Intestinal alkaline phos
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Molnár K et al . iAP in pediatric
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Chung WC et al . Ulcer after gastre
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Yang HY et al . Early resection of
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indicate a later timing for radical
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Zhao WC, Zhang HB, Yang N, Fu Y, Qi
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level, or rapid enlargement of lesi
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Table 3 Area under the receiver ope
Page 111 and 112: Zhao WC et al . Prognostic factors
Page 113 and 114: Online Submissions: http://www.wjgn
Page 116 and 117: mV 0 2 4 6 8 cpm FD patients are sh
Page 118 and 119: COMMENTS Background Gastric motilit
Page 120 and 121: thirds partial hepatectomy (PH) in
Page 122: A Serum ALT (U/L) C Serum alkaline
Page 126 and 127: REFERENCES 1 Schibler U. Circadian
Page 132 and 133: positive patients were found to hav
Page 134: Online Submissions: http://www.wjgn
Page 140: 21 Tosolini M, Kirilovsky A, Mlecni
Page 147 and 148: Diao TJ et al . NO and hepatopulmon
Page 149 and 150: Gallegos M et al . Lymphogranuloma
Page 151 and 152: Gallegos M et al . Lymphogranuloma
Page 155 and 156: A Hadžić N et al . Diagnosis in B
Page 157 and 158: Hadžić N et al . Diagnosis in BAA
Page 159: A B Chung HJ et al . Choledocholith
Page 165 and 166: Instructions to authors ISSN and EI
Page 167 and 168: Instructions to authors AIM (no mor
Page 169 and 170: Instructions to authors Guidelines
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