Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy (appointed a Task Force to develope medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on indication for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies.

Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It can be a life-threatening condition if it is not recognized early. Patients with severe cholangitis may present with hypotension, and mental status changes. The most frequent causes of acute cholangitis are biliary calculi, benign biliary stricture, and malignancy. The most common pathogens isolated are gram-negative bacteria (Escherichia coli , followed by Klebsiella species and Enterobacter species). A diagnosis of acute cholangitis requires evidence of systemic inflammation, cholestasis, and imaging with biliary obstruction. Imaging studies may consist of ultrasound, computed tomography, magnetic resonance cholangiopancreatography, and/or endoscopic ultrasound. The mainstay of treatment consists of fluid resuscitation, antibiotics, and biliary drainage. Penicillin/β-lactamase, third-generation cephalosporin, or carbapenem are all acceptable choices for first-line treatment. In patients with severe cholangitis, biliary drainage should be performed within 24 hours. Patients with severe acute cholangitis require urgent (within 24 hours) biliary decompression. Endoscopic retrograde cholangiopancreatography remains the preferred modality for biliary drainage. In conclusion, acute cholangitis is mostly treatable when recognized and treated early. Recognizing and initiating early treatment leads to markedly decreased patient morbidity and mortality.

The term cholangiocarcinoma (CC) refers to all tumors arising from bile duct epithelium. CCs are characterized by their rarity, difficulty in diagnosis, and overall poor prognosis. This leads to a paucity of data from which to define the natural history and optimal treatment regimens. Currently, surgical resection remains the only potentially curative treatment, but many patients develop recurrence. In addition, a limited number of patients can be candidates for curative resection at diagnosis. Therefore, chemotherapy is inevitable choice for the treatment of advanced CC. Gemcitabine plus cisplatin (GP) is considered a standard option for advanced biliary cancer. A randomized phase III trial (ABC-02 trial) showed the superiority of gemcitabine plus cisplatin over gemcitabine alone. Treatment with nab-paclitaxel plus gemcitabine-cisplatin prolonged median progression-free survival and overall survival vs. those reported for historical controls treated with gemcitabine-cisplatin alone in a phase II study of 60 patients with locally advanced unresectable or metastatic biliary tract cancer. Recent data of the ABC-06 trial has provided slight evidence for the use of second-line chemotherapy after progression on cisplatin plus gemcitabine combination. Other active regimens, that could be considered in patients who include have disease progression while receiving GP and who retain an adequate performance status, includes capecitabine plus cisplatin, liposomal irinotecan plus leucovorin-modulated fluorouracil and a fluoropyrimidine alone. We herein review recent published data regarding the use of palliative chemotherapies in CC patients, with a particular focus on novel cytotoxic agents.

Background/Aim: The aim of this study was to compare clinical features of hypertriglyceridemia-induced acute pancreatitis (HTGAP) with those of biliary acute pancreatitis (BAP) and alcoholic acute pancreatitis (AAP), respectively. Methods: Medical records of patients with acute pancreatitis (AP) who were admitted to our institution from January 2014 to December 2018 were retrospectively reviewed. Disease severity and local complications were evaluated according to the 2012 Revised Atlanta Classification. Systemic complications were evaluated according to the Modified Marshall Scoring System. Results: Of the total 610 patients with AP, those with BAP, AAP, and HTGAP were 310 (50.8%), 144 (23.6%), and 17 (2.8%), respectively. Compared with BAP, HTGAP showed higher proportion of moderately severe acute pancreatitis (MSAP) (64.7% vs. 28.1%, p<0.001) and severe acute pancreatitis (SAP) (17.6% vs. 5.5%, p <0.001). And HTGAP showed more local complications (76.5% vs. 26.8%, p<0.001) and higher recurrence rate (52.9% vs. 6.5%, p <0.001), but there was no significant difference in systemic complications (23.5% vs. 11.6%, p =0.140). Contrarily, there was no significant difference between HTGAP and AAP with respect to disease severity (64.7% vs. 63.9% in MSAP and 17.6% vs. 6.9% in SAP, p =0.181), local complications (76.5% vs. 67.4%, p =0.445), recurrence rate (52.9% vs. 32.6%, p =0.096), and systemic complications (23.5% vs. 11.5%, p =0.233). Conclusions: HTGAP showed higher disease severity, more local complications, and higher recurrence rate than BAP. However, there was no significant difference in clinical features between HTGAP and BAP.