Endoscopic Ultrasound Guided Fine Needle Aspiration and Biopsy for Pancreatic Disease

The endoscopic ultrasound (EUS) is a device with an ultrasound probe on the tip of endoscope. We can observe the surrounding structures outside the alimentary tract by using EUS. It is also possible to get a tissue from the pancreatic lesion for histopathologic diagnosis by using EUS. The development of devices and techniques of EUS guided tissue acquisitions made it the choice of non-operative pathologic test for pancreatic diseases. This paper describes the clinical applications of this procedure in pancreatic lesions from the recent European and Korean guidelines, including how to choose the needle, role of rapid on site evaluation, usage of stylet, suction and fanning technique, how to process acquired specimen, procedure-related complications and educations of this method.

Novel Drug Screening Platform: Tumor Organoid

Pancreatic ductal adenocarcinoma (PDAC) is known to be one of the most lethal cancers among all cancer types, with a relative 5-year survival rate of less than 8%. Currently, surgery is the only probable curative treatment for PDAC which is available for only 10-15% of the patients diagnosed with the cancer. Organoids resemble the original tissue in morphology and function with self-organizing capacity. Organoids can be cultured with high effectiveness from individual patient derived tumor tissue which makes them an extremely fitting model for translational uses and the improvement of personalized cancer medicine. Before personalized medicine based on organoids can be applied in the clinic, the improvement of drug screening platforms in terms of sensitivity and robustness is necessary.

New Stents for Endoscopic Ultrasound-Guided Procedures

Endoscopic ultrasound (EUS)-guided transmural drainage of peripancreatic fluid collection, gallbladder, bile duct, or pancreatic duct has emerged as a therapeutic option in patients with pancreatobiliary diseases. Recently, dedicated stents for EUS-guided interventions, which include lumen-apposing metal stents and modified tubular self-expanding metal stents, have been developed to improve efficacy and safety of these procedures. This article has reviewed newly developed stents for EUSguided interventions and their therapeutic outcomes.

Introduction to the Rule Book of Pancreatobiliary Endoscopy Certification

An endoscopic retrograde cholangiopancreatography (ERCP) procedure requires the highest level of difficulty among endoscopic procedures and the complications related to the procedure is relatively high, and fatal. Training in ERCP requires the development of technical, cognitive, and integrative skills well beyond those needed for standard endoscopic procedures. Therefore, a system that certifies qualifications through objective and systematic training and examination is needed to improve patient safety and quality of medical services. This manuscript introduces a set of rules that contain all the necessary matters for the certification system of pancreatic and biliary endoscopy.

Summary of Task Force Team Work to Come up with Certificate System of Pancreatobiliary Endoscopist

It has been appealed to come up with the certificate system of pancreatobiliary endoscopist from summer endoscopic retrograde cholangiopancreatography camp in 2018. All members of Policy-Quality Management Board, Educational Board, and Insurance Affaires Board had the first workshop preparing for the certificate system of pancreatobiliary endoscopist on December 8, 2018. They discussed prerequisites to the certificate system of pancreatobiliary endoscopist as well as pros and cons on the system. After trying to prepare it over half year, a task force team (TFT) set sail for the certificate system of pancreatobiliary endoscopist. Throughout one workshop and five conferences, the TFT confirmed the official name of certificate system of pancreatobiliary endoscopist and made rules and regulations on the qualification of guidance medical specialists, training hospital qualifications, acquisition, maintenance and repair of certificate, and eligibility criteria for renewal.

Bile Acid Receptors in Cholangiocyte

Bile acids are known to play a role in helping the digestion of lipid and maintenance of the bile flow. However, since the first bile acid receptor was discovered in 1999, it has been found that various bile acid receptors are present. Bile acid receptors are involved in bile acid physiology, energy metabolism, and inflammatory response. G-protein bile acid-activated receptor 1 (GPBAR1) and Sphingosine-1-phosphate receptor 2 (S1PR2) are representative bile acid receptors in cholangiocyte. They are involved in proliferation and secretion of cholangiocyte, which seem to protect cholangiocyte from the toxicity of bile acids. GPBAR1 and S1PR2 are also associated with the progression of cholangiocarcinoma.

Pancreatobiliary Endoscopy Certification System from the Perspective of Insurance Policy

Pancreatic and biliary endoscopy certified doctors perform high-level procedures and try to improve public health by maintaining professionalism. In this manuscript, I review how the certification system is reflected in the Korean National Health Insurance. In addition, we considered the impact of certified pancreatic and biliary endoscopy doctors on the public. Through this, the pancreatobiliary endoscopy certification system is to be properly established and to contribute to the improvement of public health.

Why Should We Implement a System of Endoscopic Retrograde Cholangiopancreatography Certification?

The endoscopic retrograde cholangiopancreatography (ERCP) procedure requires concentration while wearing a heavy radiation protective suit and taking the risk of radiation exposure and complications. In order to successfully perform an ERCP procedure, it is necessary to understand the target disease, as well as appropriate education and training, and a certain amount of experience in the procedure. The Korean Pancreatobiliary Association organized a promotion committee to implement the “ERCP Certification” system to maintain education and quality control of ERCP procedures. A blueprint was prepared.