COMPLICATIONS OF ENDOSCOPIC SPHINCTEROTOMY
スポンサーリンク
概要
- 論文の詳細を見る
Thirty-two years have passed since endoscopic sphincterotomy (ES) was developed. Complications, such as pancreatitis, hemorrhage and perforation are still problems after the procedure is performed, and they were reviewed in this paper using PubMed research. Pancreatitis developed in the cases of hyperamylasemia at a rate five times the normal upper limit four hours after ES. The complication rate for pancreatitis was 0.7 to 5.4 percent. Multivariet analysis showed multiple cannulation into the pancreatic duct, difficult cannulation, low volume experience (less than 40 case per year), sphincter of Oddi dysfunction, small bile duct (<5mm), gender (female) and precutting as significant. Pancreatic stenting after the procedure is useful for preventing pancreatitis in difficult cases. The rate of hemorrhage was 0.45 to 2.5 percent and was mostly recognized 2 to 3 days following ES. Factors contributing to hemorrhage were prolonged prothrombin time, bleeding during the procedure, low volume (less than 200 cases a year) and precutting. Hypersaline-epinephrin was mostly applied for hemostasis. Whenever heat coagulation or hemoclip is used, the pancreatic orifice should be protected to ensure it remains open. The perforation rate was 0.3 to 1.2 percent. The factors associated with perforation were precutting and Billroth II. Pneumoretroperitoneum was recognized in 29 percent after ES. Treatment is not required when asymptomatic. It is possible to treat peripapillary microperforation coservatively using naso-biliary drainage. Surgery is required whenever the free duodenal wall is perforated.
- 社団法人 日本消化器内視鏡学会の論文
社団法人 日本消化器内視鏡学会 | 論文
- 経皮内視鏡的胃瘻造設術を受けた患者における生存期間と栄養評価の関係
- 内視鏡的バルーン拡張術にて治療しえたPlummer-Vinson症候群の2例
- 糖尿病に合併した急性壊死性食道炎の1例
- 内視鏡的経鼻膵管ドレナージとオクトレオチドが有効であった膵性胸水の1例
- 重症急性膵炎後膵膿瘍に対し超音波内視鏡ガイド下ドレナージ術が有効であった1例