傍乳頭総胆管十二指腸瘻に対する内視鏡的乳頭切開術の意義

概要

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Parapapillary choledochoduodenal fistula has been found more frequently than before since the introduction of duodenoscopy and ERCP. This paper presents the value and effect of endoscopic fistulotomy (EFT) in these cases.Parapapillary choleddochoduodenal fistula is usually observed on the longitudinal fold of the duodenal papilla or on its orla side. The papillotome is inserted into the common bile duct through the orifice of the duodenal papilla, then the wall between the orifice of the papilla and the fistula is cut to open the distal portion of the choledochus widely.Endoscopic fistulotomy was attempted on 7 cases and the procedure was successfully performed in all cases leading to wide open stoma of the distal common bile duct with unrestrained outflow of the bile.Residual stones, a common additional findings in cases with parapapillary choledochoduodenal fistula, may deliver spontaneously after endoscopic fistulotomy or can be removed by a basket catheter.Endoscopic fistulotomy in cases with parapapillary choledochoduodenal fistula is a reliable method especially in high risk patients and a real alternative to surgical treatment.
財団法人日本消化器病学会の論文