• Clinical Endoscopy
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• 제55권6호
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• pp.757-759
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• 2022

• 대한영상의학회지
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• 제84권6호
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• pp.1350-1360
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• 2023

목적 악성 담관 폐쇄 환자에서 경피경간 담도 배액술을 시행할 때 유증상 이탈을 유발하는 예측 인자에 대해 연구를 진행하고자 한다. 대상과 방법 2010년 1월부터 2015년 2월까지 572명의 악성 담관 폐쇄 환자에서 시행한 733건의 경피경간 담도 배액술을 대상으로 후향적 연구를 시행하였다. 카테터의 거치 기간, 접근 위치, 카테터 팁의 위치, 삽입 각도, 피그테일 루프의 유무, 도관 직경을 평가하였다. 결과 추적관찰 기간 동안 157명의 환자에서 224건(30.56%)의 도관 이탈이 발생하였다. 그중 146건(19.92%)가 유증상 도관 이탈이었다. 배액관 이탈 발생까지의 기간은 평균 30일(범위: 1-159일)이었다. 유증상 도관 이탈은 배액관의 교체(137명) 또는 담관 스텐트 삽입(9명)을 통해 치료하였다. 남성(교차비: 1.636, 95% 신뢰구간: 1.131-2.367, p = 0.009), 우측 접근(교차비: 1.567, 95% 신뢰구간: 1.080-2.274, p = 0.018), 도관 삽입 각도 증가(교차비: 1.015, 95% 신뢰구간: 1.005-1.026, p = 0.005), 불완전 피그테일 루프(교차비: 1.672, 95% 신뢰구간: 1.098-2.545, p = 0.016)가 독립적인 경피경간 담도 배액술 도관 유증상 이탈의 예측 인자였다. 결론 유증상 이탈을 유발하는 예측인자에는 남성, 우측 접근, 도관 삽입 각도 증가, 불완전 피그테일 루프가 있다.

• Clinical Endoscopy
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• 제55권6호
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• pp.784-792
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• 2022

Background/Aims: Patients with acute cholecystitis (AC) after metallic stent (MS) placement for malignant biliary obstruction (MBO) have a high surgical risk. We performed percutaneous transhepatic gallbladder aspiration (PTGBA) as the first treatment for AC. We aimed to identify the risk factors for AC after MS placement and the poor response factors of PTGBA. Methods: We enrolled 401 patients who underwent MS placement for MBO between April 2011 and March 2020. The incidence of AC was 10.7%. Of these 43 patients, 37 underwent PTGBA as the first treatment. The patients' responses to PTGBA were divided into good and poor response groups. Results: There were 20 patients in good response group and 17 patients in poor response group. Risk factors for cholecystitis after MS placement included cystic duct obstruction (p<0.001) and covered MS (p<0.001). Cystic duct obstruction (p=0.003) and uncovered MS (p=0.011) demonstrated significantly poor responses to PTGBA. Cystic duct obstruction is a risk factor for cholecystitis and poor response factor for PTGBA, whereas covered MS is a risk factor for cholecystitis and an uncovered MS is a poor response factor of PTGBA for cholecystitis. Conclusions: The onset and poor response factors of AC after MS placement were different between covered and uncovered MS. PTGBA can be a viable option for AC after MS placement, especially in patients with covered MS.

• Gut and Liver
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• 제12권6호
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• pp.722-727
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• 2018

Background/Aims: Although endoscopic bilateral stent-instent placement is challenging, many recent studies have reported promising outcomes regarding technical success and endoscopic re-intervention. This study aimed to evaluate the technical accessibility of stent-in-stent placement using large cell-type stents in patients with inoperable malignant hilar biliary obstruction. Methods: Forty-three patients with inoperable malignant hilar biliary obstruction from four academic centers were prospectively enrolled from March 2013 to June 2015. Results: Bilateral stent-in-stent placement using two large cell-type stents was successfully performed in 88.4% of the patients (38/43). In four of the five cases with technical failure, the delivery sheath of the second stent became caught in the hook-cross-type vertex of the large cell of the first stent, and subsequent attempts to pass a guidewire and stent assembly through the mesh failed. Functional success was achieved in all cases of technical success. Stent occlusion occurred in 63.2% of the patients (24/38), with a median patient survival of 300 days. The median stent patency was 198 days. The stent patency rate was 82.9%, 63.1%, and 32.1% at 3, 6, and 12 months postoperatively, respectively. Endoscopic re-intervention was performed in 14 patients, whereas 10 underwent percutaneous drainage. Conclusions: Large cell-type stents for endoscopic bilateral stent-in-stent placement had acceptable functional success and stent patency when technically successful. However, the technical difficulty associated with the entanglement of the second stent delivery sheath in the hook-cross-type vertex of the first stent may preclude large cell-type stents from being considered as a dedicated standard tool for stent-in-stent placement.

• 대한자기공명의과학회:학술대회논문집
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• 대한자기공명의과학회 2006년도 제11차 학술대회
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• pp.62-62
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• 2006

• Clinical Endoscopy
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• 제55권3호
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• pp.434-442
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• 2022

Background/Aims: Covered self-expandable metallic stents (CMSs) are widely used for malignant distal biliary obstructions (MDBOs) caused by pancreatic carcinoma. This study compared the efficacy and safety of the laser-cut-type and braided-type CMSs. Methods: To palliate MDBOs caused by pancreatic carcinoma, the laser-cut-type CMSs was used from April 2014 to March 2017, and the braided-type CMSs was used from April 2017 to March 2019. The tested self-expandable metallic stents were equipped with different anti-migration systems. Results: In total, 47 patients received CMSs for MDBOs (24 laser-cut type, 23 braided-type). The time to recurrent biliary obstruction (TRBO) was significantly longer in the braided-type CMSs (p=0.0008), and the median time to stent dysfunction or patient death was 141 and 265 days in the laser-cut-type CMSs and braided-type CMSs, respectively (p=0.0023). Stent migration was the major cause of stent dysfunction in both groups, which occurred in 37.5% of the laser-cut-type CMSs and 13.0% of the braided-type CMSs. There were no differences in the survival duration between the groups. Conclusions: The TRBO was significantly longer for the braided-type CMSs with an anti-migration system than for the laser-cut-type. Stent migration tended to be less frequent with the braided-type CMSs than with the laser-cut-type CMSs.

• Investigative Magnetic Resonance Imaging
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• 제1권1호
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• pp.148-153
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• 1997

목적: 다양한 간외담도질환에서 3차원적 자기공명췌담도조영술(MR cholangiopancreatography, MRCP)의 진단적 가치를 내시경적 역생성 췌담도조영술(ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY, ERCP)와 비교하여 알아보고자 하였다. 대상 및 방법: 간외담도질환이 의심되는 46명의 환자에 대하여 MRCP와 ERCP를 각각 시행하였다. MRCP는 reverse fast imaging with a steady-state free precession(reverse FISP:PSIF) 기법을 이용하여 얻어낸 후 MIP algorithm을 이용하여 재구성하였다. 담도확장여부와 폐쇄부위 진단에 대한 MRCP의 정확성을 ERCP를 최적기준으로 하여 평가하였다. 또한 악성 및 양성병변의 감별과 종합적인 진단정확도를 MRCP와 ERCP간에 비교하였다. 결과: MRCP의 담도확장여부 예측은 민감도 94.6%, 특이도 75.0%, 정확도 91.1%였다. 폐쇄부위 예측의 정확도는 87.0%였다. 악성과 양성병변의 감별에 있어 MRCP와 ERCP의 민감도, 특이도, 정확도는 각각 76.2%, 87.5%, 82.2%와 71.4%, 83.3%, 77.8%였다. 각각의 지롼에 대한 전체적 진단의 정확도는 MRCP가 60.0%, ERCP가 55.6%였다. 결론: 3D MRCP는 간외담도질환에 있어 ERCP와 비교하여 손색없는 진단적 가치를 가지며, 앞으로 ERCP를 대체할 수 있는 좋은 검사방법이라고 생각된다.

• Clinical Endoscopy
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• 제55권3호
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• pp.458-462
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• 2022

Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) is widely performed not only as an alternative to transpapillary biliary drainage, but also as primary drainage for malignant biliary obstruction. For anatomical reasons, this technique carries an unavoidable risk of mispuncturing intrahepatic vessels. We report a technique for troubleshooting EUS-guided portal vein coiling to prevent bleeding from the intrahepatic portal vein after mispuncture during interventional EUS. EUS-HGS was planned for a 59-year-old male patient with unresectable pancreatic cancer. The dilated bile duct (lumen diameter, 2.8 mm) was punctured with a 19-gauge needle, and a guidewire was inserted. After bougie dilation, the guidewire was found to be inside the intrahepatic portal vein. Embolizing coils were placed to prevent bleeding. Embolization coils were successfully inserted under stabilization of the catheter using a double-lumen cannula with a guidewire. Following these procedures, the patient was asymptomatic. Computed tomography performed the next day revealed no complications.

• Korean Journal of Radiology
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• 제1권2호
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• pp.65-72
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• 2000

Objective: To compare the efficacy of suprapapillary and transpapillary methods of transhepatic biliary metallic stent placement in malignant biliary strictures and to specify the indications of each method applied. Materials and Methods: Stents were placed in 59 patients. Strictures were categorized as type A (within 3 cm of the ampulla, n = 27), type B (over 3 cm from ampulla, n = 7), type C (within 3 cm of the bending portion, n = 9), or type D (over 3 cm above the bending portion, n=16). The stenting method was suprapapillary in 34 cases and transpapillary in 25. The rates of initial and long-term patency and of early recurrence were compared. Results: Initial patency rates for the suprapapillary and transpapillary methods were 1/7 (14.3%) and 20/20 (100%) respectively for type A (p < 0.0001), 4/5 (80.0%) and 2/2 for type B, 3/7 (42.9%) and 2/2 for type C, and 15/16 (93.8%) and 0/0 for type D. Early recurrence rates were 7/30 (23.3%) using the suprapapillary method and 4/29 (13.8%) using the transpapillary method (p = 0.51). The long-term patency rate did not differ significantly according to either type (p = 0.37) or method (p = 0.62). Conclusion: For good initial patency, the transpapillary method is recommended for strictures of the distal extrahepatic duct near the ampulla and just above the bending portion. Long-term patency is not influenced by the stenting method employed.

• Radiation Oncology Journal
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• 제21권1호
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• pp.35-43
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• 2003

목적 : 속발성 담도부 종양에 의한 담도 페쇄로 방사선치료를 시행한 환자 중 고선량률 관내 근접치료를 시행한 환자를 대상으로 생존기간, 고식적 치료 효과, 예후인자, 치료에 수반된 부작용을 조사하여 방사선치료의 유용성에 대해 분석하고자 하였다. 대상 및 방법 : 1992년 12월부터 20이년 8월까지 속발성 담도부 종양에 의한 담도 폐쇄가 발생한 24명의 환자를 대상으로 후향적인 연구를 하였다. 환자의 연령은 35세부터 82세(중앙 연령 58.5세)였다. 대상 환자를 원발 종양 부위에 따라 분류해 보면 위암이 12명, 담낭암이 6명, 간암이 3명, 췌장암이 2명, 대장암이 1명이었다. 환자의 중앙 추적조사기간은 7.2개월(3$\~$76개월)이었다. 외부방사선치료는 24명 중 18명에서 시행하였으며 매일 1.8$\~$2.5 Gy씩 주 5회 분할치료를 하였고 30$\~$61.2 Gy (중앙값 50 Gy)의 방사선량이 조사되었다. 고선량률 관내 근접치료는 주당 2회에서 3회를 치료하였고 16명의 환자는 일일분할선량을 3 Gy로, 8명의 환자에서는 분할선량을 2.5 Gy로 하루 2회 시행하는 방법으로 치료하였다. 고선량률 관내 근접치료의 총조사선량은 9$\~$30 Gy (중앙값 15 Gy)이었다. 결과 : 대상 환자 24명 중 22명은 추적기간 중 사망하였다. 환자의 중앙 생존 기간은 7.3개월이었고 6개월 이상 생존한 환자는 13명(54.2$\%$), 1년 이상 생존한 환자는 5명(20.8$\%$)이었다. 단일변량분석에서 1년 이상 생존에 영향을 준 유의한 인자는 총 방사선량50 Gy 이상)(p=0.0200)이었고 다변량분석에서도 총 방사선량(50 ey 이상)(p=0.0337)이 유의성을 보였다. 추적조사 기간 동안 5명의 환자에서 방사선치료로 인한 담도염이 의심되었다. 1명의 환자에서 치료후 7개월에 혈액담즙증(hemobllla)이 발생하였으나 이는 방사선치료에 의한 후기 합병증보다는 종양의 국소적인 진행에 의한 천공으로 생각되었다 결론 : 담도의 배액술을 시행한 후 고선량률 관내 근접치료를 시행할 경우 기존의 배액술만 시행한 환자에 비해생존기간의 연장이 기대되었고 고선량률 관내 근접치료를 외부방사선치료에 추가할 경우 추가 방사선량은 효과적으로 조사할 수 있었고 예후인자인 총 방사선량을 늘릴 수 있었다. 외부방사선치료 및 고선량률 관내 근접치료에 따른 부작용은 대증 요법에 의해 효과적으로 조절되어 안전한 치료였다