양성 간외 담관 협착에서 완전 피막형 자가팽창성 금속 스텐트의 유용성과 안전성
The Efficacy and Safety of Fully Covered Self-expandable Metal Stents in Benign Extrahepatic Biliary Strictures
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 플라스틱 스텐트는 내경이 제한되어 있어 양성 담관 협착의 치료로 널리 이용하기에는 어려운 점이 있다. 저자들은 양성 담관 협착에서 완전 피막형 자가팽창성 금속 스텐트(fully covered self-expandable metal stent, FCSEMS)의 유용성과 안전성을 알아보고자 하였다. 대상 및 방법: 양성 담관 협착으로 FCSEMS를 삽입한 후 6개월 이상 추적한 12예(남:여=4:8, 평균나이 67세)를 대상으로 하였다. 담관 협착 12예(재발성 담관염 9예, 담낭절제술 후 손상 2예, 만성 췌장염 1예)에서 내시경 역행성 담췌관조영술로 각각 1개의 FCSEMS를 유두부를 관통하여 삽입하였다. 스텐트 유치와 관련된 합병증을 조사하여 안정성을 평가하였고, 협착 해소 여부와 스텐트 제거 후 재협착으로 스텐트의 효능을 평가하였으며, 스텐트의 제거 용이성을 조사하였다. 결과: 담관 협착이 있었던 12예는 모두 시술 당일부터 증상이 완화되었다. FCSEMS는 6.0개월(중앙값)간 유치하였으며, 스텐트 제거 후 8.5개월(중앙값)에 8명은 지속적으로 협착 증상이 해소되었고 4명은 스텐트 제거 후 재협착이 발생하였다. 스텐트 유치와 관련한 합병증은 심한 복통 2예, 췌장농양 1예, 스텐트 이탈 6예(십이지장 이탈 5예, 근위부 담관 이탈 1예)였다. 스텐트를 제거를 시도한 7예 모두 겸자로 쉽게 제거하였다. 결론: 양성 담관 협착에서 FCSEMS는 치료 효과가 신속하고 안전하며 쉽게 제거할 수 있는 장점이 있다. 그러나, 스텐트 제거 후 재협착의 빈도가 높고 이탈율이 높은 점은 향후 해결해야 할 과제로 생각한다.
Abstract
Background/Aims: For the endoscopic treatment of benign biliary strictures (BBS), it has been a drawback to use plastic stents or uncovered self-expandable metal stents. We investigated the efficacy and safety of temporary placing fully covered self-expandable metal stents (FCSEMS) in BBS. Methods: We enrolled 12 cases that followed up more than 6 months after insertion of a FCSEMS in BBS via ERCP. The cohort consisted of 9 patients with recurrent cholangitis, 2 patients with postcholecystectomy and 1 patient with chronic pancreatitis. The efficacy was assessed according to the resolution of strictures and also the restricture after stent removal, and the safety was evaluated according to the complications associated with stent placement. Finally, the removability of FCSEMSs was assessed. Results: The median time of FCSEMS placement was 6.0 months. Resolution of the BBS was confirmed in 8 cases (67%) after a median post-removal follow-up of 8.5 months. Restricture after stent removal happened in 4 cases (33%). The complications were severe abdominal pain (n=2), pancreatic abscess (n=1) and stent migration (n=6). In 7 cases, all the FCSEMSs were successfully removed by grasping them with forceps. Conclusions: Temporary placement of a FCSEMS in BBS showed good therapeutic effects, relative safety and easy removability. Further evaluation is needed for determining the causes of restricture and for developing a new stent with antimigration features.
참고문헌 (32)
- Costamagna G, "Current management of postoperative complications and benign biliary strictures", Gastrointest Endosc Clin N Am, 13, pp.635~648 (2003)
- Judah JR, "Endoscopic therapy of benign biliary strictures", World J Gastroenterol, 13, pp.3531~3539 (2007)
- Gibbons JC, "Progress in the endoscopic management of benign biliary strictures", J Gastroenterol Hepatol, 13, pp.116~124 (1998)
- Bourke MJ, "Sphincterotomy-associated biliary strictures: features and endoscopic management", Gastrointest Endosc, 52, pp.494~499 (2000)
- Costamagna G, "Covered self-expanding metal stents in benign biliary strictures: not yet a "new paradigm" but a promising alternative", Gastrointest Endosc, 67, pp.455~457 (2008)
- van Boeckel PG, "Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review", BMC Gastroenterol, 9, pp.96~ (2009)
- Libby ED, "Prevention of biliary stent clogging: a clinical review", Am J Gastroenterol, 91, pp.1301~1308 (1996)
- Catalano MF, "Treatment of symptomatic distal common bile duct stenosis secondary to chronic pancreatitis: comparison of single vs. multiple simultaneous stents", Gastrointest Endosc, 60, pp.945~952 (2004)
- Costamagna G, "Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents", Gastrointest Endosc, 54, pp.162~168 (2001)
- Pozsár J, "Endoscopic treatment of sphincterotomy-associated distal common bile duct strictures by using sequential insertion of multiple plastic stents", Gastrointest Endosc, 62, pp.85~91 (2005)
- Deviere J, "Management of common bile duct stricture caused by chronic pancreatitis with metal mesh self expandable stents", Gut, 35, pp.122~126 (1994)
- van Berkel AM, "Self-expanding metal stents in benign biliary strictures due to chronic pancreatitis", Endoscopy, 36, pp.381~384 (2004)
- Familiari P, "Endoscopic removal of malfunctioning biliary self-expandable metallic stents", Gastrointest Endosc, 62, pp.903~910 (2005)
- Shin HP, "Endoscopic removal of biliary self-expandable metallic stents: a prospective study", ENDOSCOPY, 38(12), pp.1250~1255 (2006), GEORG THIEME VERLAG KG
- Cantù P, "The treatment of patients with symptomatic common bile duct stenosis secondary to chronic pancreatitis using partially covered metal stents: a pilot study", Endoscopy, 37, pp.735~739 (2005)
- Kahaleh M, "Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm", Gastrointest Endosc, 67, pp.446~454 (2008)
- Behm B, "Partially covered self-expandable metallic stents for benign biliary strictures due to chronic pancreatitis", Endoscopy, 41, pp.547~551 (2009)
- Cahen DL, "Removable fully covered self-expandable metal stents in the treatment of common bile duct strictures due to chronic pancreatitis: a case series", Endoscopy, 40, pp.697~700 (2008)
- Mahajan A, "Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation", Gastrointest Endosc, 70, pp.303~309 (2009)
- Davids PH, "Benign biliary strictures. Surgery or endoscopy?", Ann Surg, 217, pp.237~243 (1993)
- Dumonceau JM, "Plastic and metal stents for postoperative benign bile duct strictures: the best and the worst", Gastrointest Endosc, 47, pp.8~17 (1998)
- Bergman JJ, "Long-term follow-up after biliary stent placement for postoperative bile duct stenosis", Gastrointest Endosc, 54, pp.154~161 (2001)
- Draganov P, "Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents", Gastrointest Endosc, 55, pp.680~686 (2002)
- Kassab C, "Endoscopic management of post-laparoscopic cholecystectomy biliary strictures. Long-term outcome in a multicenter study", Gastroenterol Clin Biol, 30, pp.124~129 (2006)
- Vitale GC, "Endoscopic management of postcholecystectomy bile duct strictures", J Am Coll Surg, 206, pp.918~923 (2008)
- Sakai Y, "Long-term prognosis of patients with endoscopically treated postoperative bile duct stricture and bile duct stricture due to chronic pancreatitis", J Gastroenterol Hepatol, 24, pp.1191~1197 (2009)
- Silvis SE, "Comparison of covered versus uncovered wire mesh stents in the canine biliary tract", Gastrointest Endosc, 40, pp.17~21 (1994)
- Kahaleh M, "Removal of self-expandable metallic Wallstents", Gastrointest Endosc, 60, pp.640~644 (2004)
- 이석영, "양성 담관 협착에서 스텐트 삽관의 장기적 효과에 영향을 미치는 요인 분석", Clinical Endoscopy, 32(1), pp.21~26 (2006), 대한소화기내시경학회
- Ho H, "Management of complications associated with partially covered biliary metal stents", Dig Dis Sci, 55, pp.516~522 (2010)
- Moon SH, "Modified fully covered self-expandable metal stents with antimigration features for benign pancreatic-duct strictures in advanced chronic pancreatitis, with a focus on the safety profile and reducing migration", Gastrointest Endosc, 72, pp.86~91 (2010)
- Leung JW, "The role of bacteria in the blockage of biliary stents", Gastrointest Endosc, 34, pp.19~22 (1988)