총수담관 결석의 진단에 있어서 내시경적 역행성 담췌관 조영술과 초음파 내시경의 비교
Endoscopic Ultrasonography Versus Endoscopic Retrograde Cholangiopancreatography for the Diagnosis of Choledocholithiasis
최윤미, 김해성, 안승익, 이건영, 홍기천, 최선근, 허윤석, 김세중, 우제홍, 신석환, 김형길,
소속 상세정보
최윤미 ( Choe Yun-Mee )
인하대학교 의과대학 외과학교실
김해성 ( Kim Hae-Sung )
인하대학교 의과대학 외과학교실
안승익 ( Ahn Seung-Ick )
인하대학교 의과대학 외과학교실
이건영 ( Lee Kun-Young )
인하대학교 의과대학 외과학교실
홍기천 ( Hong Kee-Chun )
인하대학교 의과대학 외과학교실
최선근 ( Choi Sun-Keun )
인하대학교 의과대학 외과학교실
허윤석 ( Heo Yoon-Seok )
인하대학교 의과대학 외과학교실
김세중 ( Kim Sei-Joong )
인하대학교 의과대학 외과학교실
우제홍 ( Woo Ze-Hong )
인하대학교 의과대학 외과학교실
신석환 ( Shin Suk-Hwan )
인하대학교 의과대학 외과학교실
김형길 ( Kim Hyung-Gil )
인하대학교 의과대학 내과학교실
KMID : 0371320030640040327
Abstract
PURPOSE: In order to reduce the rate of conversion to an open cholecystectomy, and to avoid the retention of bile duct stones, it is important to detect a choledocholithiasis prior to a laparoscopic cholecystectomy. The aim of this study was to compare the diagnostic accuracy of endoscopic ultrasonography (EUS) with endoscopic retrograde cholangiopancreatography (ERCP) in 150 patients who had an intraoperative cholangiography and choledochotomy with a choledocholithiasis performed.
METHODS: Between January 2001 and February 2002, 150 patients who underwent an ERCP or EUS performed preoperatively and a cholecystectomy with intraoperative cholangiography or choledochotomy consecutively performed at the Inha University Hospital were reviewed.
RESULTS: An ERCP was performed in 119 patients, and an EUS was carried out in 67 patients. Thirty six patients had both performed. The ERCP failed in 17cases (14.3%). The EUS identified the bile duct in all cases. There were five ERCP related complications (3 pancreatitis, 2 cholangitis), but no complications were encountered when using EUS. In 62 patients (41.3%), a choledocholithiasis was found. ERCP had a sensitivity of 89.5%, a specificity of 84.4%, a positive predictive value of 87.8%, and a negative predictive value of 86.4%. EUS showed a sensitivity of 88.9%, a specificity of 84.7%, a positive predictive value of 66.7%, and a negative predictive value of 95.3%. Concordance of ERCP and EUS was obtained in 90% of cases.
CONCLUSIONS: EUS appears to be safer, more comfortable, and, as accurate as an ERCP detecting a choledocholithiasis.
키워드
초음파내시경;내시경적 역행성 담췌관 조영술;총수담관 결석
EUS;ERCP;Choledocholithiasis
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