National Survey Regarding the Management of Difficult Bile Duct Stones in South Korea
Yoon Suk Lee,
Tae Joo Jeon,
Woo Hyun Paik,
Dong-Won Ahn,
Kwang Hyun Chung,
Byoung Kwan Son,
Tae Jun Song,
Sung-Hoon Moon,
Eaum Seok Lee,
Jae Min Lee,
Seung Bae Yoon,
Chang Nyol Paik,
Yun Nah Lee,
Jin-Seok Park,
Dong Wook Lee,
Sang Wook Park,
Hyung Ku Chon,
Kwang Bum Cho,
Chang Hwan Park,
on behalf of the Committee of Policy and Quality Management in Korean Pancreatobiliary Association
Affiliations
Yoon Suk Lee
Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
Tae Joo Jeon
Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
Woo Hyun Paik
Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Dong-Won Ahn
Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
Kwang Hyun Chung
Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
Byoung Kwan Son
Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
Tae Jun Song
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Sung-Hoon Moon
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
Eaum Seok Lee
Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
Jae Min Lee
Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
Seung Bae Yoon
Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Chang Nyol Paik
Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
Yun Nah Lee
Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
Jin-Seok Park
Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
Dong Wook Lee
Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
Sang Wook Park
Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
Hyung Ku Chon
Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
Kwang Bum Cho
Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
Chang Hwan Park
Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
on behalf of the Committee of Policy and Quality Management in Korean Pancreatobiliary Association
Background/Aims: This study aimed to investigate the patterns of preferred endoscopic procedure types and techniques for managing difficult common bile duct (CBD) stones in South Korea. Methods: The Committee of Policy and Quality Management of Korean Pancreatobiliary Association (KPBA) conducted a survey containing 19 questions. Both paper and online surveys were carried out; with the paper survey being conducted during the 2019 Annual Congress of KPBA and the online survey being conducted through Google Forms from April 2020 to February 2021. Results: The response rate was approximately 41.3% (86/208). Sixty-two (73.0%) worked at tertiary hospitals or academic medical centers, and 60 (69.7%) had more than 5 years of endoscopic retrograde cholangiopancreatography experience. The preferred size criteria for large CBD stones were 15 mm (40.6%), 20 mm (31.3%), and 30 mm (4.6%). For managing of large CBD stones, endoscopic papillary large balloon dilation after endoscopic sphincterotomy was the most preferred technique (74.4%). When performing procedures in those with bleeding diathesis, 64 (74.4%) respondents favored endoscopic papillary balloon dilation (EPBD) alone or EPBD with small endoscopic sphincterotomy. Fifty-five respondents (63.9%) preferred the doubleguidewire technique when faced with difficult bile duct cannulation in patients with periampullary diverticulum. In surgically altered anatomies, cap-fitted forward viewing endoscopy (76.7%) and percutaneous transhepatic cholangioscopy (48.8%) were the preferred techniques for Billroth-II anastomosis and total gastrectomy with Roux-en-Y anastomosis, respectively. Conclusions: Most respondents showed unifying trends for the management of difficult CBD stones. The current practice patterns could be used as basic data for clinical quality improvements in the management of difficult CBD stones.
