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침형절개도 누공형성술의 유용성 및 합병증

Usefulness and Complications of Needle Knife Fistulotomy as a Rescue Procedure in Patients with Pancreaticobiliary Disease

대한소화기학회지 2020년 75권 6호 p.341 ~ 346
이용재 ( Lee Yong-Jae ) - Pusan National University School of Medicine Department of Internal Medicine

강대환 ( Kang Dae-Hwan ) - Pusan National University School of Medicine Department of Internal Medicine
김형욱 ( Kim Hyung-Wook ) - Pusan National University School of Medicine Department of Internal Medicine
박수범 ( Park Su-Bum ) - Pusan National University School of Medicine Department of Internal Medicine
김수진 ( Kim Su-Jin ) - Pusan National University School of Medicine Department of Internal Medicine
남형석 ( Nam Hyeong-Seok ) - Pusan National University School of Medicine Department of Internal Medicine
류대곤 ( Ryu Dae-Gon ) - Pusan National University School of Medicine Department of Internal Medicine

Abstract


Background/Aims: Needle knife fistulotomy (NKF) is a technique to facilitate pancreatic and biliary duct access during ERCP. The double-guidewire technique (DGT) is also used in cases of difficult cannulation, but it can increase the incidence of post-ERCP-pancreatitis (PEP). This study examined the success and complication rates of NKF after unsuccessful standard cannulation or DGT in patients with pancreaticobiliary disease.

Methods: The data of 209 patients who received NKF as a rescue procedure between January 2009 and December 2016 were reviewed retrospectively. The cannulation success and complication rates were assessed.

Results: The overall cannulation success rate was 90.4%. The success rates of patients who received NKF after standard cannulation or DGT were similar (82.6% [142/172] and 73.0% [27/37], respectively, p=0.179). Furthermore, there was no significant difference in the incidence of procedure-related adverse events between the two groups (10.5% [18/172] and 16.2% [6/37], respectively, p=0.391). Endoscopic retrograde pancreatic drainage (ERPD) insertion decreased the incidence of PEP (0% [0/16] in ERPD and 14.6% [19/130] in non-ERPD, p=0.132) among patients who received PD cannulation.

Conclusions: NKF is an effective and safe method that can be considered for rescue management after the initial failure of standard cannulation or DGT. NKF following standard cannulation can be preferred over NKF following DGT because of the higher success rate and the lower rate of pancreatitis, but the difference was not significant. PD stenting in patients at high risk of PEP can be considered to decrease pancreatitis.

키워드

Pancreatitis; Complication; Cholangiopancreatography, endoscopic retrograde
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