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십이지장 유두부 종양의 내시경적 절제술 : 장기 추적 관찰 결과 Long-term Follow-up Results
강진경,이승근,박인서,문영명,정재복,송시영 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.5
Background/Aims: The resectability rate and prognosis of tumors of the ampulla of Vater are significantly better than for other periampullary tumors. Treatment for ampullary tumors has traditionally been surgical resection. However, endoscopic ampullectomy has been reported in patients with benign ampullary tumors. This study is being conducted to evaluate the availability of endoscopic ampullectomy. Methods: Between 1994 and 1996, 6 cases (M: F=5: 1) with ampullary tumors were treated by endoscopic ampullectomy. Clinical presentations, complications, pathologic findings, and follow-up information were reviewed. Results: Complete resection was perfomed in 5 cases. Pancreatitis after this procedure occurred in 2 cases, but were resolved by conservative care. Pathologic findings of resected specimens were adenama in 4 cases and adenocarcinoma in 2 cases. There was no recurrence in adenoma during the follow-up period (9-37 months) except in one case, which the patient was lost after 9 months. In one case with adenocarcinoma, the patient refused the operation, and consequently had the tumor recurrence 13 months later. Conclusions: Endoscopic ampullectomy was considered safe and effective treatment for removing benign ampullary tumors as well as malignant tumors, the latter of which are not considered suitable for operation.
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상부위장관 Dieulafoy 병 :임상 양상 및 내시경적 치료
강진경,박인서,문영명,이용찬,박수진,김형길,유효민 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.1
Background/Aims: Dieulafoy' s disease is an uncommon cause of recurrent massive gastrointestinal bleeding. The bleeding results from abnormally large submucosal artery , usually located on proximal stomach. Endoscopic examination reveals a small mucosal defect with an isolated protruding vessel without associated ulcer. Endoscopic treatment had recently been attempted to control the bleeding from these lesions. Methods : The clinical and endoscopic characteristics of 51 patients with gastrointestinal bleeding due to Dieulafoy' s disease were retrospectively analysed from January 1991 to July 1997 and the efficacy of endoscopic therapy of Dieulafoy' s disease was evaluated. Results : The mean age was 51.2 ±16.2 (Mean ±SD, range: 19 ∼80) years and male predominance (4.7 :1) was observed. Symptoms included: melena (45.1%); hematochezia (31.4%); melena and hematochezia (23.5%). The mean hemoglobin value was 7.5 ±2.1 g/dL. The mean transfusion requirement was 12.4 ±13.2 blood units. The diagnosis was made atial endoscopy in 72.5%. The lesion located in proximal stomach (49.0%), in mid/distal stomach (25.5%) and in duodenum (25.5%) in order. Endoscopic therapies included fibrin glue injection (FG) in 16 patients, hypertonic saline-epinephrine (1 :1,000) injection (HSE) in 15 patients, HSE+FG in 14 patients and others in 6 patients. Overall, endo-scopic trreatment was successful in achieving hemostasis in 38 (74.5%) patients; FG in 14/16 (87.6%), HSE in 12/15 (80.0%), FG HSE in 9/14 (64.3%). There was no significant difference in success rate among the endoscopic treatment modalities. Nine patients had to be operated despite the endoscopic treatments, and four patients died due to the causes other than gastrointestinal bleeding. Conclusions: Endoscopic therapy of upper gastrointestinal Dieulafoy' s disease is effective and should be employed before the surgical intervention.
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급성 췌장염에서 내시경적 역행성 담췌관 조영술의 임상적 의의
강진경,박인서,송건훈,정재복,송시영,한기준 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.3
The safety of endoscopic retrograde cholangiopancreatography(ERCP) in patients with acute pancreatitis(AP) was confirmed in the past decade. Especially in ease of acute gallstone panereatitis, early ERCP/EST(endoscopic sphincterotomy) may reduce the incidence of complications by removing gallstone which causes acute attack of pancreatitis. To assess clinical usefulness of ERCP/EST in the setting of AP, we reviewed clinical records of 58 patients with AP who had undergone ERCP /EST during the same period of admission. 1) There were thirty-four men and twenty-four women with a mean age of 51.4 (range 14-82). According to the Atlanta classification, forty-two patients were determined to have 'mild' pancreatitis, while the remaining sixteen were determined to have `severe' pancreatitis. 2) The most common indication which urged to perform ERCP was common bile duct(CBD) stones suspected by other imaging reodalities(23 cases). The next common was dilatation of CBD detected on ultrasonography in nine cases. 3) Seven patients received ERCP within 24 hours and seventeen underwent ERCP between the period of 24-72 hours after admission. Therefore 24 patients(41.4%) underuvent ERCP within 72 hours after admission. 4) The rate of visualization of either bile duct(BD) or pancreatic duct(PD) was 93.1 %. There was no significant complication attributable to the procedure itself. 5) In 8 patients(21.1%), pancreatogram revealed chronic pancreatitis. This finding was more commonly encountered in patients who were determined to have 'severe' pancreatitis. Eighteen patients(39.1%) had stones of common bile duct and this was the most common cholangiographic finding. But the incidence of CBD stone was not different between `mild' and 'severe' pancretitis groups. 6) Among various predictors of gallstone panreatitis such as elevated total blirubin, alcalin pbosphatase, gamma-glutamyl transpeptidase and suspected stones on sonography the stones found orb sonography was proceed to be the most sgnificant factor in prediction of gallstaMe pancreatitis(p=0.032). 7) EST was successfully performed in 13 patents without significant procedurerelated complication. 8) In patients who were treated for acute gallstone pancreatitis, there was no significant difference in various clinical paramlters including severity, in-hospital stay, incidence of complication and laboratory indings between the surgery group and the EST group. 9) ERCP was useful in 35 patients(60.3%) by providing diagnostic information or therapeutic modalities. The confirmation and endoscopic removal of CBD stones represented the most part of advantages. In conclusion, we have found ERCP/EST to be a safe and useful modality in both diagnostic and therapeutic aspects for patients with AP. Especially in patients with gallstone pancreatitis, ERCPIEST lave evolved into an important role by early identification and safe removal of gallstone.
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