Pub Date : 2023-01-31DOI: 10.15279/kpba.2023.28.1.1
Jonghyun Lee, S. Han
Since the development of endoscopic ultrasound (EUS), the importance in the using EUS in pancreas and biliary tree has gradually increased. In order to properly observe the pancreas and biliary tree in EUS, it is necessary to learn landmark structures at each location, such as the stomach and duodenum, and to learn the positional relationship between them and normal structures. In this article, we will deal with the examination method at each position of the linear and radial EUS and reveal the normal EUS image.
{"title":"Endoscopic Ultrasound Images of Normal Anatomy of the Pancreas and Biliary Tree","authors":"Jonghyun Lee, S. Han","doi":"10.15279/kpba.2023.28.1.1","DOIUrl":"https://doi.org/10.15279/kpba.2023.28.1.1","url":null,"abstract":"Since the development of endoscopic ultrasound (EUS), the importance in the using EUS in pancreas and biliary tree has gradually increased. In order to properly observe the pancreas and biliary tree in EUS, it is necessary to learn landmark structures at each location, such as the stomach and duodenum, and to learn the positional relationship between them and normal structures. In this article, we will deal with the examination method at each position of the linear and radial EUS and reveal the normal EUS image.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132937614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-31DOI: 10.15279/kpba.2023.28.1.19
Young Rong Kim, C. Oh, Min Yang
Gallbladder cancer is the most common cause of hilar biliary obstruction; however, it rarely causes combined biliary, duodenal, and colon triple obstruction. In this case, the quality of life for a patient with recurrent gallbladder cancer with combined duodenal, colonic, and biliary obstruction was improved by endoscopic and endosonographic palliation, despite its technical difficulty and complexity. Seven metal stents were implanted one by one using only endoscopic methods. Successful stent-in-stent placement and endoscopic ultrasound-guided stenting after failed ERCP improved the patient’s quality of life to the extent that there was no need for any external drainage.
{"title":"Endoscopic and Endosonographic Palliation for Triple Obstruction Caused by Recurrent Gallbladder Cancer: A Case Report","authors":"Young Rong Kim, C. Oh, Min Yang","doi":"10.15279/kpba.2023.28.1.19","DOIUrl":"https://doi.org/10.15279/kpba.2023.28.1.19","url":null,"abstract":"Gallbladder cancer is the most common cause of hilar biliary obstruction; however, it rarely causes combined biliary, duodenal, and colon triple obstruction. In this case, the quality of life for a patient with recurrent gallbladder cancer with combined duodenal, colonic, and biliary obstruction was improved by endoscopic and endosonographic palliation, despite its technical difficulty and complexity. Seven metal stents were implanted one by one using only endoscopic methods. Successful stent-in-stent placement and endoscopic ultrasound-guided stenting after failed ERCP improved the patient’s quality of life to the extent that there was no need for any external drainage.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126839218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-31DOI: 10.15279/kpba.2022.27.4.150
H. Lee, E. Lee
Subepithelial tumors (SETs) are often found accidentally during gastroscopy, most commonly in the stomach. If a raised lesion is observed around the major papilla, the relationship with the common bile duct or pancreas should be evaluated, and not only SET but also cancer or autoimmune disease should be considered in the differential diagnosis. Herein, we present a case of prominent major papilla mimicking a SET that was accidentally discovered during endoscopy. The patient was asymptomatic, and the physical and laboratory findings were normal. The biopsy findings were nonspecific and imaging findings suggested possible malignancy; thus, surgical ampullectomy was performed. The histopathological results confirmed IgG4-related ampullitis. This case suggests that immunoglobulin G4 (IgG4)-related disease may manifest with atypical findings, hindering its diagnosis and treatment.
{"title":"Mass-Forming Immunoglobulin G4-Related Ampullitis Mimicking a Duodenal Subepithelial Tumor: A Case Report","authors":"H. Lee, E. Lee","doi":"10.15279/kpba.2022.27.4.150","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.4.150","url":null,"abstract":"Subepithelial tumors (SETs) are often found accidentally during gastroscopy, most commonly in the stomach. If a raised lesion is observed around the major papilla, the relationship with the common bile duct or pancreas should be evaluated, and not only SET but also cancer or autoimmune disease should be considered in the differential diagnosis. Herein, we present a case of prominent major papilla mimicking a SET that was accidentally discovered during endoscopy. The patient was asymptomatic, and the physical and laboratory findings were normal. The biopsy findings were nonspecific and imaging findings suggested possible malignancy; thus, surgical ampullectomy was performed. The histopathological results confirmed IgG4-related ampullitis. This case suggests that immunoglobulin G4 (IgG4)-related disease may manifest with atypical findings, hindering its diagnosis and treatment.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134437016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-31DOI: 10.15279/kpba.2022.27.4.154
Jung Hun Kim, Y. Cheon, T. Lee, Sang Hoon Lee
Pancreatic stones are a common finding of chronic pancreatitis and may causerecurrent abdominal pain and pancreatitis. Pancreatic stones are often accompaniedby stenosis of the pancreatic duct and are often impacted within the pancreaticduct, so it is not easy to remove the pancreatic stones using a basket. Until now,extracorporeal shock wave lithotripsy has been used, but it requires repeatedprocedures and the success rate is not very high. The recently developed SpyGlass™DS II (Boston Scientific, Marlborough, MA, USA) has a 3.5 mm diameter that allowsinsertion into the dilated pancreatic duct, it is possible to remove the pancreaticstones using electrohydraulic lithotripsy (EHL) or laser lithotripsy while directlyviewing the pancreatic stones. In this paper, we would like to introduce a method toremove multiple pancreatic stones larger than 10 mm using SpyGlass™ DS II with EHL.
胰腺结石是慢性胰腺炎的常见发现，可引起经常性腹痛和胰腺炎。胰结石常伴有胰管狭窄，并常嵌塞于胰管内，因此用提篮取出胰结石并不容易。到目前为止，体外冲击波碎石术已经被使用，但它需要重复的过程，成功率不是很高。最近开发的SpyGlass™DS II (Boston Scientific, Marlborough, MA, USA)直径为3.5 mm，允许插入扩张的胰管，可以使用电液碎石术(EHL)或激光碎石术去除胰石，同时直接观察胰石。在本文中，我们想介绍一种使用SpyGlass™DS II与EHL去除大于10 mm的多发胰腺结石的方法。
{"title":"Intractable Pancreatic Stone Removal Using SpyGlass™ DS II with Electrohydraulic Lithotripsy: A Case Report and Literature Review","authors":"Jung Hun Kim, Y. Cheon, T. Lee, Sang Hoon Lee","doi":"10.15279/kpba.2022.27.4.154","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.4.154","url":null,"abstract":"Pancreatic stones are a common finding of chronic pancreatitis and may causerecurrent abdominal pain and pancreatitis. Pancreatic stones are often accompaniedby stenosis of the pancreatic duct and are often impacted within the pancreaticduct, so it is not easy to remove the pancreatic stones using a basket. Until now,extracorporeal shock wave lithotripsy has been used, but it requires repeatedprocedures and the success rate is not very high. The recently developed SpyGlass™DS II (Boston Scientific, Marlborough, MA, USA) has a 3.5 mm diameter that allowsinsertion into the dilated pancreatic duct, it is possible to remove the pancreaticstones using electrohydraulic lithotripsy (EHL) or laser lithotripsy while directlyviewing the pancreatic stones. In this paper, we would like to introduce a method toremove multiple pancreatic stones larger than 10 mm using SpyGlass™ DS II with EHL.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134266717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-31DOI: 10.15279/kpba.2022.27.4.164
A. Nugroho, A. Widodo, Indah Jamtani, A. Rachmawati
Chronic fibroinflammatory pancreatitis causes irreparable damage to the pancreatic parenchyma. This frequently results in food restrictions, painkiller addiction, and serious quality of life impairment in children. We observed a 13-year-old girl who had previously been hospitalized multiple times and had undergone acute pancreatitis arrived with excruciating abdominal pain and recurrent hematemesis. A chronic intra-pseudocyst bleed and an ampulla of Vater hemorrhage were discovered during an upper gastrointestinal endoscopy. A 3×2×1 cm pancreatic head pseudocyst was discovered on the magnetic resonance cholangiopancreatography, however the computed tomography scan revealed a pancreatic head pseudocyst, pancreatic duct stones, and substantial peripancreatic inflammation. The multidisciplinary team determined that Frey’s surgery was the most efficient method to minimize her suffering. No complications occurred during the healing phase following surgery, and two years later, neither recurrence bleeding nor abdominal pain appeared. In summary, Frey’s method is a secure and efficient intervention when applied by a multidisciplinary team.
{"title":"Frey’s Procedure for Chronic Pancreatitis in an Adolescent with Recurrent Upper Gastrointestinal Bleeding: A Case Report","authors":"A. Nugroho, A. Widodo, Indah Jamtani, A. Rachmawati","doi":"10.15279/kpba.2022.27.4.164","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.4.164","url":null,"abstract":"Chronic fibroinflammatory pancreatitis causes irreparable damage to the pancreatic parenchyma. This frequently results in food restrictions, painkiller addiction, and serious quality of life impairment in children. We observed a 13-year-old girl who had previously been hospitalized multiple times and had undergone acute pancreatitis arrived with excruciating abdominal pain and recurrent hematemesis. A chronic intra-pseudocyst bleed and an ampulla of Vater hemorrhage were discovered during an upper gastrointestinal endoscopy. A 3×2×1 cm pancreatic head pseudocyst was discovered on the magnetic resonance cholangiopancreatography, however the computed tomography scan revealed a pancreatic head pseudocyst, pancreatic duct stones, and substantial peripancreatic inflammation. The multidisciplinary team determined that Frey’s surgery was the most efficient method to minimize her suffering. No complications occurred during the healing phase following surgery, and two years later, neither recurrence bleeding nor abdominal pain appeared. In summary, Frey’s method is a secure and efficient intervention when applied by a multidisciplinary team.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"148 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133608031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-31DOI: 10.15279/kpba.2022.27.4.145
C. Koo, Khek Yu Ho
Pancreatic cysts are a heterogenous group of lesions that can be differentiated into mucinous and non-mucinous cysts based on their malignant potential. Crosssectional imaging alone is inadequate to reliably distinguish between the two groups. Endoscopic ultrasound (EUS) and fine needle aspiration has been used for analysis of the cyst morphology and cyst fluid. Traditional markers such as fluid carcinoembryonic antigen and cytology have been useful particularly for the assessment of indeterminate cysts or those with high-risk features, but the overall diagnostic accuracy is still sub-par. As a result, new techniques have been described to improve the ability of EUS to risk stratify a pancreatic cyst. In this review, we describe some of the novel EUS‑based techniques in the evaluation of pancreatic cysts, namely needle-based confocal laser endomicroscopy, through the needle cystoscopy, and through the needle biopsy techniques.
{"title":"Endoscopic Ultrasound-Based Evaluation of Pancreatic Cysts: New Invasive Modalities","authors":"C. Koo, Khek Yu Ho","doi":"10.15279/kpba.2022.27.4.145","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.4.145","url":null,"abstract":"Pancreatic cysts are a heterogenous group of lesions that can be differentiated into mucinous and non-mucinous cysts based on their malignant potential. Crosssectional imaging alone is inadequate to reliably distinguish between the two groups. Endoscopic ultrasound (EUS) and fine needle aspiration has been used for analysis of the cyst morphology and cyst fluid. Traditional markers such as fluid carcinoembryonic antigen and cytology have been useful particularly for the assessment of indeterminate cysts or those with high-risk features, but the overall diagnostic accuracy is still sub-par. As a result, new techniques have been described to improve the ability of EUS to risk stratify a pancreatic cyst. In this review, we describe some of the novel EUS‑based techniques in the evaluation of pancreatic cysts, namely needle-based confocal laser endomicroscopy, through the needle cystoscopy, and through the needle biopsy techniques.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123129525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-31DOI: 10.15279/kpba.2022.27.3.121
Yang Tae Park, J. Kang, Jae Seon Kim, M. Jung, S. Kim, Jaehee Cho, S. Woo, K. Lee, E. Kim, Hyo Jung Kim
Background/Aim: In gallbladder cancer (GBC), gender differences in incidence and mortality rates have been reported with geographic variation. However, there is little known about sex-related difference in GBC prognosis. This study compares prognostic factors according to gender for GBC.Methods: We searched clinicopathological factors in all stages of 952 GBC patients from seven medical centers in Korea. A total of 927 patients were enrolled and surgery with curative resection was performed in 499 patients.Results: Carbohydrate antigen (≥37 U/mL) was a significant prognostic factor in both females and males (odd ratio [OR], 4.30; 95% confidence interval [CI], 3.13-5.89; p<0.001). Age was a significant factor only in female patients, elderly patients were associated with low resectability and the likelihood of T-stage >2; an independent predictor of poor prognosis via multivariate analysis (OR, 1.03; 95% CI, 1.01-1.05; p=0.005, OR, 1.05; 95% CI, 1.02-1.08; p=0.002). Body mass index (BMI) also showed gender difference, and lower BMI (≤25 kg/m2) was the significant good indicator of multivariate analysis for lymph node metastasis in female patients (OR, 0.42; 95% CI, 0.23-0.77; p=0.005) but, the significant poor indicator of univariate analysis for advanced T-stage in male (OR, 2.79; 95% CI, 1.40-5.54; p=0.003).Conclusions: These results suggest that there is a possibility of gender difference in GBC prognosis. Age and high BMI were poor prognostic factors for curative resection for female GBC patients.
{"title":"Multi-Center Study on Gender Difference in Resectability and Pathologic Prognosis of Gallbladder Cancer","authors":"Yang Tae Park, J. Kang, Jae Seon Kim, M. Jung, S. Kim, Jaehee Cho, S. Woo, K. Lee, E. Kim, Hyo Jung Kim","doi":"10.15279/kpba.2022.27.3.121","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.3.121","url":null,"abstract":"Background/Aim: In gallbladder cancer (GBC), gender differences in incidence and mortality rates have been reported with geographic variation. However, there is little known about sex-related difference in GBC prognosis. This study compares prognostic factors according to gender for GBC.Methods: We searched clinicopathological factors in all stages of 952 GBC patients from seven medical centers in Korea. A total of 927 patients were enrolled and surgery with curative resection was performed in 499 patients.Results: Carbohydrate antigen (≥37 U/mL) was a significant prognostic factor in both females and males (odd ratio [OR], 4.30; 95% confidence interval [CI], 3.13-5.89; p<0.001). Age was a significant factor only in female patients, elderly patients were associated with low resectability and the likelihood of T-stage >2; an independent predictor of poor prognosis via multivariate analysis (OR, 1.03; 95% CI, 1.01-1.05; p=0.005, OR, 1.05; 95% CI, 1.02-1.08; p=0.002). Body mass index (BMI) also showed gender difference, and lower BMI (≤25 kg/m2) was the significant good indicator of multivariate analysis for lymph node metastasis in female patients (OR, 0.42; 95% CI, 0.23-0.77; p=0.005) but, the significant poor indicator of univariate analysis for advanced T-stage in male (OR, 2.79; 95% CI, 1.40-5.54; p=0.003).Conclusions: These results suggest that there is a possibility of gender difference in GBC prognosis. Age and high BMI were poor prognostic factors for curative resection for female GBC patients.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116017848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-31DOI: 10.15279/kpba.2022.27.3.111
H. Lee
Cholangiocarcinoma consists of a heterogeneous group of aggressive and rare malignancies that arise from the bile ducts outside or inside the liver. Although surgical resection remains the only potential curative treatment option for patients with cholangiocarcinoma, curative surgery is only possible in a small number of cases. Furthermore, recurrence rates are high even among patients who undergo surgical resection. Unfortunately, a significant proportion of patients present with locally advanced, unresectable disease. Recently, neoadjuvant chemotherapy has emerged as a promising method to identify patients with poor prognosis, avoiding pathological and non-therapeutic resection, as well as potentially downstaging tumors which cannot be resected initially. This therapeutic strategy has the potential to improve local and distant control, to achieve R0 resection and to prevent distant metastasis. However, few data are currently available supporting neoadjuvant chemotherapy in cholangiocarcinoma and several questions remains unanswered. Adjuvant chemotherapy is administered after surgery to eradicate any remaining cancer cells with the goal of reducing the chances of recurrence. And chemotherapy is also frequently used in cholangiocarcinoma as an adjunct to surgical resection, but the appropriate sequence of chemotherapy with surgery is unclear.
{"title":"Neoadjuvant and Adjuvant Chemotherapy for Cholangiocarcinoma","authors":"H. Lee","doi":"10.15279/kpba.2022.27.3.111","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.3.111","url":null,"abstract":"Cholangiocarcinoma consists of a heterogeneous group of aggressive and rare malignancies that arise from the bile ducts outside or inside the liver. Although surgical resection remains the only potential curative treatment option for patients with cholangiocarcinoma, curative surgery is only possible in a small number of cases. Furthermore, recurrence rates are high even among patients who undergo surgical resection. Unfortunately, a significant proportion of patients present with locally advanced, unresectable disease. Recently, neoadjuvant chemotherapy has emerged as a promising method to identify patients with poor prognosis, avoiding pathological and non-therapeutic resection, as well as potentially downstaging tumors which cannot be resected initially. This therapeutic strategy has the potential to improve local and distant control, to achieve R0 resection and to prevent distant metastasis. However, few data are currently available supporting neoadjuvant chemotherapy in cholangiocarcinoma and several questions remains unanswered. Adjuvant chemotherapy is administered after surgery to eradicate any remaining cancer cells with the goal of reducing the chances of recurrence. And chemotherapy is also frequently used in cholangiocarcinoma as an adjunct to surgical resection, but the appropriate sequence of chemotherapy with surgery is unclear.","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123609757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-31DOI: 10.15279/kpba.2022.27.3.140
S. Han
30여 년 전 선형초음파(linear echoendoscope)가 개발된 이후 현재까지 내시경 초음파(endoscopic ultrasound, EUS)를 통한 다양한 중재술이 시행되고 있다. 가장 많이 사용되는 EUS 유도하 세침흡인술(EUS-fine needle aspiration)부터 다양한 내시경 초음파 유도하 배액술(EUS-guided drainage)과 중재술들이 시행되고 있다. 본고에서는 최근 많은 연구들이 보고되고 있는 내시경 초음파 유도하 위장문합술(EUS-guided gastroenterostomy, EUS-GE)을 소개하고자 한다. Gastric outlet obstruction (GOO)은 췌장암 또는 원위부 위암 환자에서 발생하며 췌장암 환자의 15-20% 정도에서 발생하는 것으로 알려져 있다. GOO는 전통적으로 수술을 통해 위장문합술(gastroenterostomy, GE)을 시행하거나, 내시경을 통한 self-expandable metal stent (SEMS)를 삽입하는 방법으로 해결한다. 하지만 진행성 암을 가지고 있는 환자에서 수술을 하는 것이 침습적인 것으로 생각되어, 내시경을 통한 SEMS 삽입을 많이 시행하게 된다. 이러한 SEMS의 삽입은 덜 침습적이지만 6개월 이내에 최대 50%에서 다시 폐쇄가 발생하여 재시술이 필요한 경우가 많다. 최근 Lumen apposing metallic stent (LAMS)가 개발되면서 이를 이용한 시술들이 연구되고 있다. 이는 양쪽의 flap이 장을 잡아주는 역할을 하여 이탈을 방지해주고, 16-20 mm 정도의 큰 내경을 제공하고 있어, 이를 통해 EUS-GE를 GOO에서 시행하고 있다. 이러한 EUS를 통한 위장문합술의 경우 덜 침습적이면서 이론적으로는 암의 국소진행과는 관계없어 재시술이 필요하지 않아 유용할 수 있다. EUS-GE와 내시경을 통한 SEMS 삽입을 비교한 5개의 연구 659명의 환자를 대상으로 한 메타분석에 따르면, 기술적/임상적 성공률은 비슷하였다(technical success 95.2% vs. 96.9%, clinical success 93.3% vs. 85.6%). 시술 이후 합병증의 발생률 또한 비슷하였지만 재시술의 비율은 EUS-GE가 현저히 낮음을 보여주었다(4% vs. 23.6%, p=0.001). 하지만 최근 8개 기관 467명의 환자를 대상으로 EUS-GE를 시행한 대규모 연구에서는 stent misdeployment의 비율이 9.85% (46 cases)로 높게 나타났으며, 이 중 11%의 Received Feb. 19, 2022 Accepted Jul. 29, 2022
从30多年前开发出线性超音波(linear echoendoscope)以来，到目前为止，通过内窥镜超音波(endoscopic ultrasound, EUS)实施了多种仲裁手术。从最常用的EUS诱导下针吸引术(EUS-fine needle aspiration)到多种内视镜超音波诱导下引流术(EUS-guided drainage)和仲裁术。本文将介绍近年来有许多研究报告的内窥镜超音波诱导下胃肠门合术(EUS-guided gastroenterostomy, EUS-GE)。Gastric outlet obstruction (GOO)发生于胰腺癌或原胃胃癌患者，约15-20%的胰腺癌患者。GOO的传统方法是，通过手术进行胃肠门合术(gastroenterostomy, GE)，或通过内视镜插入self-expandable metal stent (SEMS)。但是在患有进行性癌症的患者身上进行手术被认为是侵袭性的，因此很多人都要通过内视镜进行SEMS插入。这些SEMS的插入没有太大的侵袭性，但在6个月内，最多有50%的人会再次关闭，因此需要重新启动。最近随着Lumen apposing metallic stent (LAMS)的开发，正在研究利用该技术的手术。两边的flap起到了控制肠道的作用，防止了脱离，并提供了16-20毫米左右的大内径，因此EUS-GE在GOO中执行。这种通过EUS的胃肠门合术的侵袭性较低，理论上与癌症的局部发展无关，不需要再手术，因此可能会很有用。根据对5个研究中659名患者进行EUS-GE和内窥镜插入的meta分析，技术/临床成功率相似(technical success 95.2% vs. 96.9%， clinical success 93.3% vs. 85.6%)。手术后并发症的发生率也相似，但复施术的比率显示EUS-GE明显较低(4% vs. 23.6%， p=0.001)。但是，在最近对8家机构的467名患者实施的大规模研究中，stent misdeployment的比例高达9.85% (46 cases)，其中11%的Received Feb. 19、2022 Accepted Jul. 29、2022
{"title":"Endoscopic Ultrasonography-Guided Gastroenterostomy","authors":"S. Han","doi":"10.15279/kpba.2022.27.3.140","DOIUrl":"https://doi.org/10.15279/kpba.2022.27.3.140","url":null,"abstract":"30여 년 전 선형초음파(linear echoendoscope)가 개발된 이후 현재까지 내시경 초음파(endoscopic ultrasound, EUS)를 통한 다양한 중재술이 시행되고 있다. 가장 많이 사용되는 EUS 유도하 세침흡인술(EUS-fine needle aspiration)부터 다양한 내시경 초음파 유도하 배액술(EUS-guided drainage)과 중재술들이 시행되고 있다. 본고에서는 최근 많은 연구들이 보고되고 있는 내시경 초음파 유도하 위장문합술(EUS-guided gastroenterostomy, EUS-GE)을 소개하고자 한다. Gastric outlet obstruction (GOO)은 췌장암 또는 원위부 위암 환자에서 발생하며 췌장암 환자의 15-20% 정도에서 발생하는 것으로 알려져 있다. GOO는 전통적으로 수술을 통해 위장문합술(gastroenterostomy, GE)을 시행하거나, 내시경을 통한 self-expandable metal stent (SEMS)를 삽입하는 방법으로 해결한다. 하지만 진행성 암을 가지고 있는 환자에서 수술을 하는 것이 침습적인 것으로 생각되어, 내시경을 통한 SEMS 삽입을 많이 시행하게 된다. 이러한 SEMS의 삽입은 덜 침습적이지만 6개월 이내에 최대 50%에서 다시 폐쇄가 발생하여 재시술이 필요한 경우가 많다. 최근 Lumen apposing metallic stent (LAMS)가 개발되면서 이를 이용한 시술들이 연구되고 있다. 이는 양쪽의 flap이 장을 잡아주는 역할을 하여 이탈을 방지해주고, 16-20 mm 정도의 큰 내경을 제공하고 있어, 이를 통해 EUS-GE를 GOO에서 시행하고 있다. 이러한 EUS를 통한 위장문합술의 경우 덜 침습적이면서 이론적으로는 암의 국소진행과는 관계없어 재시술이 필요하지 않아 유용할 수 있다. EUS-GE와 내시경을 통한 SEMS 삽입을 비교한 5개의 연구 659명의 환자를 대상으로 한 메타분석에 따르면, 기술적/임상적 성공률은 비슷하였다(technical success 95.2% vs. 96.9%, clinical success 93.3% vs. 85.6%). 시술 이후 합병증의 발생률 또한 비슷하였지만 재시술의 비율은 EUS-GE가 현저히 낮음을 보여주었다(4% vs. 23.6%, p=0.001). 하지만 최근 8개 기관 467명의 환자를 대상으로 EUS-GE를 시행한 대규모 연구에서는 stent misdeployment의 비율이 9.85% (46 cases)로 높게 나타났으며, 이 중 11%의 Received Feb. 19, 2022 Accepted Jul. 29, 2022","PeriodicalId":342618,"journal":{"name":"The Korean Journal of Pancreas and Biliary Tract","volume":"447 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133702820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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