담관결석 제거를 위한 내시경 유두부 거대풍선확장술에 대한 고찰

Abstract

ABSTRACT

Endoscopic papillary large balloon dilation for retrieval of choledocholithiasis

Kim Seok-Won Advisor: Prof. Kim Young-Dae M.D.,Ph.D. Department of Medicine Graduate School of Chosun University

Background : Endoscopic sphincterotomy(EST) is widely used in retrieval of stones in common bile duct. And endoscopic papillary balloon dilation(EPBD) has been alternative to EST. EPBD appears to be associated with increased risk of pancreatitis and decreased risk of bleeding. With larger stone, endoscopic balloon dilation with conventional balloon(6-8mm) was reported as less effective for extraction of stone. Endoscopic papillary large balloon dilation(EPLBD) involves endoscopic biliary sphincterotomy followed by balloon dilation using 12-20mm balloon to remove large or difficult stones from the common bile duct. EPLBD would theoretically combine advantage of sphincterotomy and balloon dilation by increasing efficacy at stone retraction while minimizing complication.

Aim : This study evaluate complications of EPLBD for retrieval of choledocholithiasis.

Method : 103 patients diagnosed with choledocholithiasis between January 2009 and September 2011 by computed tomography or endoscopic retrograde cholangiopancreatography(ERCP). They were retrospectively evaluated stone removal rate and complication such as bleeding, post- procedure pancreatitis, perforation and asymptomatic hyperamylasemia.

Result : Total 103 patients were performed EPLBD or EST for retrieval of common bile duct stones. 39 cases were performed EST and 64 cases were performed EPLBD. Common bile duct(CBD) stones removal rate in the initial session of endoscopic retrograde cholangiopancreatography(ERCP) was similar (82% vs 81% p=0.767) between EST and EPLBD. In the aspect of complications any clinically significant episodes of perforation and bleeding was not developed. There was no statistical difference in post-procedure pancreatitis(7.6% vs 3.1%, p=0.295) and development of asymptomatic hyperamylasemia(23.4% vs 30.7%, p=0.412) between EST and EPLBD.

Conclusion : Unlike EPBD, EPLBD does not appear to be associated with a higher risk of post-ERCP pancreatitis, probably because the pancreatic orifice is not effaced with significant force during biliary balloon dilation after EST. EPLBD appears to be reasonable option for removal of large or difficult common bile duct stones.

Key word : Endoscopic papillary large balloon dilation, endoscopic sphincterotomy, endoscopic retrograde cholangiopancreatography, choledocholithiasis