| 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 |
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| Abstract |
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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;32:184189) |
| Key Words:
Choledocholithiasis, Endoscopic sphincterotomy, Endoscopic papillary balloon dilatation |
| 주요어:
담관결석, 내시경 유두괄약근 절개술, 내시경 유두 풍선 확장술 |
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