| ERCP 시술과 연관된 장 천공의 임상 경과 |
| 최정식·김명환·이상수·박도현·송문희·오형철·변대근·김민경·여영선·한지민·서동완·이성구·민영일 |
| 울산대학교 의과대학 서울아산병원 내과학교실 |
| The Clinical Course of ERCP-related Bowel Perforation |
| Jung Sik Choi, M.D., Myung-Hwan Kim, M.D., Sang Soo Lee, M.D., Do Hyun Park, M.D., Moon Hee Song, M.D., Hyoung-Chul Oh, M.D., Dae Keun Pyun, M.D., Min Kyung Kim, M.D., Young Sun Yeo, M.D.,Ji Min Han, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D. and Young |
| Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea |
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| Abstract |
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Background/Aims:
The management of small-bowel perforations associated with endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic sphincterotomy (EST) is still controversial. The purpose of this study was to analyze the treatment and outcome of patients with ERCP -related perforations in a single tertiary medical center.
Methods:
Of 18,379 cases of ERCPs performed between January 1990 and December 2003, twenty-six patients (0.14%) with perforation were identified and medical chart were reviewed retrospectively.
Results:
EST were performed in 10,231 patients and perforation occurred in 18 patients. Four out of 18 patients with small-bowel perforation related to EST underwent surgical operation and the rest 14 patients recovered with conservative treatment alone. Of the rest 8 perforation patients unrelated to EST, perforation occurred during the insertion of endoscope in 7 patients and catheter manipulation in 1 patient. All but one perforations associated with mechanical injury by endoscope itself were managed with an emergent laparotomy, and the one patient with perforation related to catheter manipulation recovered with conservative treatment.
Conclusions:
A small-bowel perforation related to endoscope per se usually required a surgery, but sphincterotomy related perforations rarely did so. The prevalence and mortality rate of small-bowel perforations associated with ERCP and/or EST were 0.14% and 0%, respectively, in a single tertiary medical center. (Korean J Gastrointest Endosc 2004;29:6369) |
| Key Words:
ERCP, EST, Small-bowel perforation |
| 주요어:
ERCP, 유두 괄약근 절개술, 천공 |
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