Korean J Gastrointest Endosc > Volume 31(6); 2005 > Article
Korean Journal of Gastrointestinal Endoscopy 2005;31(6): 374-382.
난치성 담관결석 환자에 있어서 내시경 기계 쇄석술 실패의 예측 및 재치료
이상협·박주경·윤원재·이준규·류지곤·김용태·윤용범
서울대학교 의과대학 내과학교실, 간연구소
Forecasting and Retreatment of Unsuccessful Endoscopic Mechanical Lithotripsy in Patients with Difficult Bile Duct Stones
Sang Hyub Lee, M.D., Joo Kyung Park, M.D., Won Jae Yoon, M.D., Jun Kyu Lee, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D. and Yong Bum Yoon, M.D.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
Abstract

Background/Aims:
Endoscopic removal of a bile duct stone becomes more difficult with increasing stone size. The endoscopic mechanical lithotripsy is frequently used to overcome this problem. However, it is necessary to predict its outcome and determine the optimal treatment when it does fail. This study examined the predictors and optimal treatment for an unsuccessful endoscopic mechanical lithotripsy.
Methods:
One hundred and twenty five patients who underwent endoscopic mechanical lithotripsy, were retrospectively evaluated. Various predictive factors and procedure-related complications were analyzed. In addition, the clinical outcome of retreatment for unsuccessful endoscopic mechanical lithotripsy was evaluated.
Results:
Endoscopic mechanical lithotripsy was successful in 97 patients (77.6%). An impacted stone(s), stone size (≥30 mm) and stone size/bile duct diameter (>1.0) were significant factors forecasting failure, with an estimated odds ratio 26.67, 5.94 and 5.99, respectively. More frequent complications related with the failure were not observed. When the procedure did fail, all were retreated successfully with various modalities including surgery. Despite the short hospitalization period, non-surgical treatment had a similar clinical outcome to that of surgery.
Conclusions:
An impacted stone, stone size (≥ 30 mm) or stone size/bile duct diameter (>1.0) in difficult choledocholithiasis are indicators of unsuccessful endoscopic mechanical lithotripsy. Alternative non-surgical treatment might be considered to manage difficult choledocholithiasis when endoscopic mechanical lithotripsy fails. (Korean J Gastrointest Endosc 2005;31:374⁣382)
Key Words: Choledocholithiasis, Lithotripsy, Forecasting, Retreatment
주요어: 담관담석증, 쇄석술, 예측, 재치료
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