Selective biliary cannulation is an essential prerequisite for therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The cap-fitted forward-viewing endoscope has been used for ERCP in patients with surgically altered anatomy. In this case series, 12 patients with periampullary diverticulum underwent ERCP using the cap-assisted forward-viewing endoscope due to failure of biliary cannulation using the standard technique. Successful ERCP was achieved in all patients with no serious complications.

No abstract

A 69-year-old male visited our medical center with hematemesis. Gastrofibroscopy revealed a 4.5 cm sized fungating mass on anterior wall of gastric lower body. Biopsy specimens showed a carcinoma of neuroendocrine components with strong positive for synaptophysin stain. Because he had a metastatic neuroendocrine carcinoma with multiple metastasis of liver, we treated him with chemotherapy of etoposide and cisplatin. The primary lesion showed nearly complete response after 6th cycles of chemotherapy, however it was regrowed with chemoresistance and mutifocal lesion in stomach and liver. Endoscopic biopsy on same previous lesion revealed a poorly differentiated tubular adenocarcinoma with negative for synaptophysin. After conversion to another tumor type, the treatment outcome was progressed in spite of salvage chemotherapy for gastric adenocarcinoma. He died 17 months after diagnosis. The immunohistological change of same mass after chemotherapy suggests a possibility of other course of differentiation from common pleuripotent cells of adenocarcinoma and neuroendocrine carcinoma after chemotherapy.