분할췌에서 장기간 스텐트 삽입 후 췌관 변화가 동반된 증례와 췌관스텐트 폐색의 미세구조 분석 = A Case of the Pancreatic Duct Change after a Long-term Pancreatic Stenting in Pancreas Divisum and the Fine Structural Analysis of Occluded Pancreatic Polyethylene Stent

다국어 초록 (Multilingual Abstract)

The pancreatic duct stenting is now recognized as the treatment option for a number of pancreatic disorders. Although the stent-induced ductal changes may result, there is little information regarding the frequency of these stent-induced changes in chronic pancreatitis. Pancreatic stents may occlude with time, but there is only little information available on the nature of the clogging process. Although a short-term efficacy of endoscopic pancreatic duct stenting has been proved, the long-term efficacy continues to be controversial. The aim of this study was to report a case of chronic pancreatitis with pancreatolith after the incidental long-term pancreatic stenting for 3 years due to a pancreas divisum with acute pancreatitis. Also, this study described the analysis of the ultrastructural changes in the surface of an occluded pancreatic stent. A scanning and transmission electron microscopy showed an amorphous protein matrix in whole stent that arranged as a network in some areas but arranged as the layers in other areas. A variable number of bacteria of mixed species, calcium carbonate or calcium oxalate crystal, round leukocyte were scattered in the protein matrix. The yeast and plant material were seen in some part of the stent as well.

참고문헌 (Reference)

1 "quantification in pancreatic juice by enzyme-linked immunosorbent assay and comparison with other methods. Pancreas 1989" 680-689,

2 "et al. Biliary stent blockage with bacterial biofilm" 546-553,

3 "Vandermeeren A. Stenting in severe chronic pancreatitis results of medium- term follow-up in seventy-six patients. Endoscopy 1991" 171-176,

4 "Transverso LW. Endoscopic placement of pancreatic stents and drains in the management of pancreatitis. Ann Surg 1989" 261-266,

5 "Thomas E. The bacteriology of pancreatic duct stents. Gastroenterology 1993"

6 "Soehendra N. New modalities for treating chronic pancreatitis. Endoscopy 1989" 70-74,

7 "Pancreatic and biliary drainage using endoscopy- endoscopic pancreatic drainage (mainly for pancreatic stent)" 16 : 277-285, 1997

8 "Mandel N. Analysis of occluded pancreas divisum stents" isduodenalrefluxthecause?gastrointestendosc1988

9 "Long-term results of endoscopic management of pancreas divisum with recurrent acute pancreatitis" 55 : 376-381, 2002

10 "Lehman GA. The occlusion rate of pancreatic stents. Gastrointest Endosc 1994" 611-613,

11 "Laemmli UK. Cleavage of structural proteins during the assembly of the head of bacteriophage T4. Nature 1970" 680-685,

12 "Hogan WJ. Preliminary experience with endoscopic stent placement in benign pancreatic diseases. Gastrointest Endosc 1988" 16-18,

13 "Endoscopic stent therapy in advanced chronic pancreatitis" 98 : 821-826, 2003

14 "Endoscopic pancreatic sphincterotomy" 47 : 240-249, 1998

15 "Analysis of occluded pancreatic stents and juices in patients with chronic pancreatitis" 45 : 52-58, 1997

16 "Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy" 44 : 268-275, 1997