내시경 유두괄약근 절개술과 큰 풍선 유두 확장술을 병행한 담관결석의 치료
Combined endoscopic sphincterotomy and large balloon sphincteroplasty for bile duct stones
김민경, 김명환, 이태윤, 오형철, 권승현, 한정혜, 최형오, 박수정, 김태협, 이상수, 서동완, 이성구,
소속 상세정보
김민경 ( Kim Min-Kyoung )
울산대학교 의과대학 서울아산병원 혈액종양내과
김명환 ( Kim Myung-Hwan )
울산대학교 의과대학 서울아산병원 소화기내과학교실
이태윤 ( Lee Tae-Yoon )
울산대학교 의과대학 서울아산병원 내과학교실
오형철 ( Oh Hyoung-Chul )
울산대학교 의과대학 서울아산병원 내과학교실
권승현 ( Kwon Seung-Hyun )
울산대학교 의과대학 서울아산병원 내과학교실
한정혜 ( Han Jung-Hye )
울산대학교 의과대학 서울아산병원 호흡기내과
최형오 ( Choi Hyung-Oh )
울산대학교 의과대학 서울아산병원 내과학교실
박수정 ( Park Soo-Jung )
울산대학교 의과대학 서울아산병원 호흡기내과
김태협 ( Kim Tae-Hyup )
울산대학교 의과대학 서울아산병원 내과학교실
이상수 ( Lee Sang-Soo )
울산대학교 의과대학 서울아산병원 내과학교실
서동완 ( Seo Dong-Wan )
울산대학교 의과대학 서울아산병원 내과
이성구 ( Lee Sung-Koo )
울산대학교 의과대학 서울아산병원 내과학교실
KMID : 0882420070730050474
Abstract
Background : The combined use of small endoscopic sphincterotomy (EST) followed by endoscopic papillary large balloon dilation (EPLBD) might be associated with a lower incidence of procedure-related complications such as pancreatitis, bleeding or perforation, compared to the use of EPLBD or a large EST alone. The aim of this retrospective study was to evaluate the utility of a combined EST and EPLBD method for the removal of common bile duct (CBD) stones that could not be extracted by use of an EST and conventional techniques.
Methods : Between March 2005 and September 2006, a total of 35 patients with CBD stones were enrolled. Fourteen patients had received a previous EST, and 21 patients underwent an EST. The sphincterotomy site was then dilated with a 12~18 mm diameter balloon.
Results : The average number of stones was 3.6+/-2.9 (range: 110). The average maximum stone diameter was 26.11+/-8.88 mm (range: 12~50 mm). Complete stone removal was accomplished in 31 patients (88.6%). In 9 patients (25.7%), a mechanical lithotripsy was required. No episode of true pancreatitis occurred. A procedure-related perforation occurred in one patient (2.8%) and the patient was treated with NPO and antibiotics. No procedure-related bleeding or mortality was observed. The procedure was performed safely in 9 patients (25.7%) with a periampullary diverticulum and in 14 patients (40.0%) with a previous EST.
Conclusion : Combined EST and EPLBD may be a safe and effective method, and may be a good alternative treatment for removing CBD stones that cannot be extracted by an EST and conventional techniques. However, prospective studies based on a large number of patients are needed.
키워드
Endoscopic sphincterotomy; Endoscopic papillary large balloon dilation; Common bile duct stone
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