내시경초음파의 시대에 역행성췌담도내시경이 실패했을때 경피적 내시경적 랑데뷰 시술의 유용성에 대한 연구
Usefulness of combined percutaneous-endoscopic rendezvous techniques after failed therapeutic endoscopic retrograde cholangiography in the era of endoscopic ultrasound guided rendezvous
- 주제(키워드) Endoscopic retrograde cholangiopancreatography , percutaneous endoscopic rendezvous , endoscopic ultrasound guided rendezvous
- 발행기관 아주대학교
- 지도교수 김진홍
- 발행년도 2018
- 학위수여년월 2018. 2
- 학위명 박사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000027613
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
The rendezvous approach is a salvage technique after failure of endoscopic retrograde cholangiography (ERC). In certain circumstances, percutaneous-endoscopic rendezvous (PE-RV) is preferred, and endoscopic ultrasound-guided rendezvous (EUS-RV) is difficult to perform. We aimed to evaluate PE-RV outcomes, describe the PE-RV techniques, and identify potential indications for PE-RV over EUS-RV. Retrospective analysis was conducted of a prospectively designed ERC database between January 2005 and December 2016 at a tertiary referral center including cases where PE-RV was used as a salvage procedure after ERC failure. During the study period, PE-RV was performed in 42 cases after failed therapeutic ERC; 15 had a surgically altered enteric anatomy. The technical success rate of PE-RV was 92.9% (39/42), with a therapeutic success rate of 88.1% (37/42). Potential indications for PE-RV over EUS-RV were identified in 23 cases, and either PE-RV or EUS-RV could have effectively been used in 19 cases. Endoscopic bile duct access was successfully achieved with PE-RV in 39 cases with accessible biliary orifice using one of PE-RV cannulation techniques (classic, n=11; parallel, n=19; and adjunctive maneuvers, n=9). PE-RV uses a unique technology and has clinical indications that distinguish it from EUS-RV. Therefore, PE-RV can still be considered a useful salvage technique for the treatment of biliary obstruction after ERC failure.
more목차
Ⅰ. INTRODUCTION 1
Ⅱ. METHODS 1
A. Patients 1
B. Percutaneous-endoscopic rendezvous procedure 2
C. Measurements 3
D. Statistical analyses 4
Ⅲ. RESULTS 4
Ⅳ. DISCUSSION 6
Ⅴ. CONCLUSIONS 10
VI. REFERENCES 23
국문요약 27
