Risk Factors for Recurrent Bile Duct Stones after Endoscopic Clearance of Common Bile Duct Stones / 대한소화기학회지

BACKGROUND/AIMS: We aimed to explore the risk factors contributing to the recurrence of common bile duct (CBD) stones after successful endoscopic stone clearance, focused on the anatomical factors of CBD and presence or absence of ursodeoxycholic acid (UDCA)/Rowachol(R) medication. METHODS: One hundred fourteen patients who underwent CBD stone(s) extraction by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy at our institution from August 2004 to January 2007 were included. Univariate and multivariate analyses for the risk factors including the distal CBD angle, length of the distal CBD arm and medication such as ursodeoxycholic acid (UDCA) and/or Rowachol(R) for recurrent CBD stone(s) were performed. RESULTS: The recurrence of CBD stone(s) was found in 22 (19.3%) patients. On univariate analysis, presence of pneumobilia, presence of type 1 or type 2 periampullary diverticulum, mechanical lithotripsy and multiple sessions of ERCP were significant contributors for the recurrence of CBD stone(s). On multivariate analysis, the presence of type 1 periampullary diverticulum (OR 7.90, 95% CI: 1.56-40.16) and multiple sessions of ERCP (OR 7.56, 95% CI: 2.21-25.87) were significant contributors. Acute distal CBD angulation (< or =135degrees), shorter distal CBD arm (< or =36 mm), technical difficulty of CBD stone(s) clearance, and the prescription of UDCA and/or Rowachol(R) were not significantly associated with the recurrence of CBD stone(s). CONCLUSIONS: The recurrence of CBD stone(s) was more commonly found in the patients group with type 1 periampullary diverticulum and multiple sessions of ERCP. Therefore, patients with these risk factors should be on regular follow up.

Clinical Application and Safety of Endoscopic Pancreatic Sphincterotomy in 339 Cases / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic pancreatic sphincterotomy (EPST) has been performed more frequently in recent years. However, it is less widely practiced than biliary sphincterotomy due to lack of firm scientific data regarding its indication and safety. The aims of this study are to evaluate EPST with regard to indications, complications, and safety. METHODS: We retrospectively reviewed and analyzed the results of EPST performed in three hundred thirty nine patients from January 2000 to April 2004.RESULTS: Complications occurred in 37 patients (10.7%) which included pancreatitis, hemorrhage, perforation, cholangitis, sepsis, and stenosis of sphincterotomy site. They were successfully managed by medical treatment. No mortalities were reported. CONCLUSIONS: EPST is a relatively safe procedure in various pancreatic diseases. Incidence of long-term complications awaits further investigations. EPST enlarges our endotherapeutic armamentarium and deserves additional evaluation.

Sphincterotomy - Induced Hemorrhage: Prevalence, Risk Factors and Endoscopic Hemostasis / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic biliary sphincterotomy (EST)-induced hemorrhage occurs in approximately 0.5-12% of procedures. We prospectively investigated the risk factors of EST-induced hemorrhage and evaluated its safety as well as the effectiveness of endoscopic hemostasis. METHODS: One thousand three hundred and four patients, who underwent EST between July 1996 and June 1998, were enrolled. As a hemostatic treatment, epinephrine spray was initially used. If bleeding persisted, epinephrine injection was performed consecutively. In patients with exposed vessels, epinephrine injection followed by alcohol injection was given. RESULTS: EST-induced hemorrhage occurred in 136 (10.4%) patients. Types of sphincterotome (needle-knife sphincterotome, p=0.0079) and cutting speed (so-called, zipper cut, p=0.03) were revealed as significant variables for the occurrence of bleeding. Once bleeding occurred, patients with an associated ampullary lesion (impacted stone or cancer) or with coagulopathy were more likely to bleed profusely. Initial hemostasis was achieved in all patients. However, rebleeding occurred in eight patients who were initially classified in the moderate or severe bleeding group. Finally, EST-induced hemorrhage was successfully controlled in all patients after 1-3 treatment sessions (mean: 1.1 sessions). The difference in the incidence of complications between the groups with and without endoscopic hemostasis was not statistically significant. CONCLUSIONS: The use of needle-knife sphincterotome and cutting speed were independent risk factors for bleeding occurrence. Once bleeding occurred, its severity was affected by the associated ampullary lesion (impacted stone or cancer) or coagulopathy. Endoscopic hemostasis with epinephrine and/or alcohol was effective and safe in EST-induced hemorrhage.