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Korean J Gastrointest Endosc > Volume 32(3); 2006 > Article
Korean Journal of Gastrointestinal Endoscopy 2006;32(3): 184-189.
내시경 유두괄약근 절개술과 큰 풍선 유두 확장술을 병용한 거대 담관결석의 치료
황성준·김영균·이규철·지명관*·김현수*·백순구*·이근만·장진혁·김민수·백용한·이세준·박효진·이관식·이상인·이동기
연세대학교 의과대학 내과학교실, *원주의과대학 내과학교실
Endoscopic Sphincterotomy Plus Endoscopic Papillary Large Balloon Dilatation for Large Bile Duct Stones
Seoung Joon Hwang, M.D., Young Gyun Kim, M.D., Kyu Chul Lee, M.D., Myung Kwan Ji, M.D.*, Hyun Soo Kim, M.D.*, Soon Goo Baik, M.D.*, Kuen Man Lee, M.D., Jin Hyuck Chang, M.D., Min Su Kim, M.D., Yong Han Paik, M.D., Se Joon Lee, M.D., Hyo Jin Park, M.D., Kw
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, *Yonsei University Wonju College of Medicine, Wonju, Korea
Abstract

Background/Aims:
The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy (EST) is successful in 80∼90% of cases but it often requires a prolonged time and repeated trials. This study investigated the utility of a combined endoscopic papillary large balloon dilatation (EPLBD) and a mid-incision of an EST (m-EST) method for the removal of large CBD stones.
Methods:
Thirty patients with large CBD stones were enrolled in this study. EPLBD was carried out using the one-step inflation of a 15∼18 mm diameter balloon after m-EST.
Results:
The maximum stone diameter was 21.62±5.38 mm. Twelve patients had more than 4 stones, 7 patients had 2 stones, and the remainder had a single large stone. Complete ductal clearance was achieved in all patients. After the procedure, the serum amylase and/or lipase levels were elevated in 3 patients (13.3%). However, there was no episode of true pancreatitis. Minor bleeding was encountered in only one patient (3.3%), and was easily controlled by an endoscopic epinephrine injection. The procedure was carried out safely in 6 patients with periampullary diverticulum. No perforation or mortality was encountered.
Conclusions:
Combined EPLBD and m-EST is a safe and effective method, and may be a good alternative treatment for removing large CBD stones. (Korean J Gastrointest Endosc 2006;32:184⁣189)
Key Words: Choledocholithiasis, Endoscopic sphincterotomy, Endoscopic papillary balloon dilatation
주요어: 담관결석, 내시경 유두괄약근 절개술, 내시경 유두 풍선 확장술
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