내시경 유두괄약근절개술에서 자동조절절개장치(Endocut)와 기존 혼합 절개파의 합병증 비교
Comparison of Complication between Automatically Controlled Cut System (Endocut) and Conventional Blended Cut Current over Endoscopic Sphincterotomy
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목적: 내시경 유두괄약근절개술(endoscopic sphincterotomy, EST)은 췌장과 담도 질환에서 흔히 사용하는 내시경적 치료 방법이나 출혈, 췌장염, 천공 등의 합병증이 발생할 수 있다. 최근에 괄약근절개술을 위한 전류에 자동조절절개장치(automatically controlled cut system, Endocut)가 출혈을 감소시키는 것으로 보고되고 있다. 이에 저자들은 EST 시 Endocut과 기존 혼합 절개파(conventional blended cut current)를 사용하였을 때 발생한 합병증을 비교하고자 하였다. 대상 및 방법: 2005년 9월부터 2006년 7월까지 EST를 받은 519명의 환자들을 대상으로 하였고 144명이 Endocut (ERBE VIO 300D)으로, 375명이 기존 혼합 절개파(Olympus UES-30)로 EST를 각각 받았다. 각 그룹 간 발생한 EST의 합병증을 후향적으로 비교하였다. 결과: Endocut군과 기존 혼합 절개파군 간에 나이, 성별, EST 적응증에 통계학적 차이가 없었다. 내시경적 출혈은 Endocut군에서 6.9% (10예/144예), 혼합 절개파군에서 8.5% (31예/375예)가 관찰되었다(p=0.62). 임상적 출혈은 Endocut군에서 1.4% (2예/144예)였고 혼합 절개파군에서는 2.2% (8예/375예)였다(p=0.58). Endocut군은 모두 경도의 출혈이었고 혼합 절개파군에서는 경도의 출혈이 3예, 중등도 출혈이 4예, 중증 출혈이 1예 발생하였다. 췌장염은 Endocut군에서 6.0% (8예/134예), 혼합 절개파군에서 5.7% (21예/352예) 발생하였다(p=0.83). 천공은 혼합 절개파군에서만 2예 발생하였다. 결론: EST 시 Endocut과 기존 혼합 절개파 간에 출혈, 췌장염, 천공 등의 합병증에 있어 두 군 간에 통계적으로 차이가 없었다.
Abstract
Background/Aims: Endoscopic sphincterotomy (EST) is a common therapeutic technique for biliary and pancreatic diseases. However, it is associated with complications such as bleeding, pancreatitis, and perforation. Automatically controlled cut system (Endocut) is known to reduce the level of hemorrhage but lead to pancreatitis. This study examined whether or not the Endocut can reduce the rate of complications of EST compared with that of the conventional blended cut current. Methods: From September 2005 to July 2006, 519 patients were treated with EST using either Endocut (ERBE VIO 300D, 144 patients) or the conventional blended cut current (Olympus UES-30, 375 patients). Two groups were compared retrospectively for the complications of EST. Results: There were no significant differences in age, gender, and the indications for EST between the two groups. Endoscopically observed bleeding and clinically evident bleeding occurred in 6.9% (10/144), 1.4% (2/144) in the Endocut group and 8.5% (31/375), 2.2% (8/375) in the conventional blended cut current group, respectively (p=0.62 and 0.58, respectively). Clinical bleeding occurred in 2 patients in the Endocut group but it was mild and easily controlled by endoscopic treatment. Mild, moderate, and severe clinical bleeding occurred in 3, 4, and 1 patient in the blended group, respectively. Pancreatitis was encountered in 6.0% (8/134) of the Endocut group and in 5.7% (21/352) of the blended group (p=0.83). Perforation only occurred in 2 patients in the blended group. Conclusions: There were a similar number of complications from EST in the Endocut and conventional blended cut current groups. (Korean J Gastrointest Endosc 2007;34:256-262)
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