Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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A Case of Argon Plasma Trimming of a Biliary Metallic Stent Causing a Duodenal Obstruction

십이지장 폐쇄를 유발한 총담관 금속 스텐트의 아르곤 플라즈마 절단술 1예

  • Cho, Jun-Hyung (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Dong, Seok-Ho (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Cho, Chang-Hyun (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Jang, Jae-Young (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Kim, Hyo-Jong (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Kim, Byung-Ho (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Chang, Young-Woon (Department of Internal Medicine, Kyunghee University College of Medicine) ;
  • Chang, Rin (Department of Internal Medicine, Kyunghee University College of Medicine)
  • 조준형 (경희대학교 의과대학 내과학교실) ;
  • 동석호 (경희대학교 의과대학 내과학교실) ;
  • 조창현 (경희대학교 의과대학 내과학교실) ;
  • 장재영 (경희대학교 의과대학 내과학교실) ;
  • 김효종 (경희대학교 의과대학 내과학교실) ;
  • 김병호 (경희대학교 의과대학 내과학교실) ;
  • 장영운 (경희대학교 의과대학 내과학교실) ;
  • 장린 (경희대학교 의과대학 내과학교실)
  • Published : 2011.03.30
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Abstract

Metallic stents are being widely used in patients with a malignant obstruction of the biliary tract. The advent of metallic stents was heralded as a solution to the problem of plastic stent occlusion. Metallic stents prolong stent patency by lowering occlusion rates, but they may malfunction for several reasons, including occlusion from tumor ingrowth or migration after the procedure. Distal migration or impaction of metallic stents against the duodenal wall may cause severe complications, including duodenal obstruction, perforation and acute upper gastrointestinal bleeding. Several techniques have been developed to manage distal migration of a biliary metallic stent and remove the malfunctioning stent endoscopically. We report on a 43-year-old male who underwent endoscopic palliative biliary drainage because of obstructive pancreatic head cancer. We transected the distal end of the metallic stent using an argon plasma coagulator, treating the duodenal obstruction without any complications.

악성 종양에 의한 담관 폐쇄 환자에서 담즙 배출을 위한 금속 스텐트 삽입술은 플라스틱 스텐트에 비해 시술 후 스텐트의 폐쇄 빈도가 적고, 우수한 스텐트 개방성과 낮은 재시술 빈도의 장점이 있어 현재 널리 쓰이고 있다. 그러나 시술 후 스텐트 위치 이동의 가능성도 여전히 있어 총담관에 삽입된 금속 스텐트가 십이지장 관내강으로 이동한 경우, 스텐트 원위부의 금속 와이어에 의해 십이지장 점막이 손상을 받게 되면 십이지장 출혈, 천공 또는 심한 점막 부종을 동반한 관내강 폐쇄가 발생할 수 있다. 이러한 금속 스텐트와 관련된 합병증이 발생한 경우 스텐트를 완전히 제거 또는 일부를 절단하는 치료가 필요한데, 현재까지 이와 관련된 내시경적 시술들이 고안되어 왔다. 저자들은 총담관 폐쇄를 동반한 췌장암 환자에서 총담관 금속 스텐트 삽입 후 금속 스텐트에 의해 발생한 십이지장 폐쇄를 아르곤 플라즈마(argon plasma)를 이용한 스텐트 절단술로 치료한 1예를 경험하여 문헌고찰과 함께 보고한다.

Keywords

References

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