| 급성 담석성 췌장염에서 내시경 유두 괄약근절개술 및 담낭절제술의 역할 |
| 정지봉*·류지곤·박주경·윤원재·이상협·황진혁†·이준규‡·김용태·윤용범 |
| 서울대학교 의과대학 내과학교실, *보라매병원, 간연구소, †분당서울대학교병원, ‡동국대학교 의과대학 내과학교실 |
| The Roles of Endoscopic Sphincterotomy and Cholecystectomy in Acute Biliary Pancreatitis |
| Ji Bong Jeong, M.D.*, Ji Kon Ryu, M.D., Joo Kyung Park, M.D., Won Jae Yoon, M.D., Sang Hyub Lee, M.D., Jin-Hyeok Hwang, M.D.†, Jun Kyu Lee, M.D.‡, Yong-Tae Kim, M.D. and Yong Bum Yoon, M.D. |
| Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, *Seoul National University Boramae Hospital, Seoul, †Seoul National University Bundang Hospital, Bundang, ‡Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea |
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| Abstract |
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Background/Aims:
Stone removal can prevent recurrence of acute biliary pancreatitis. This study examined the natural course of acute biliary pancreatitis and compared the results obtained using endoscopic sphincterotomy (EST) and cholecystectomy. In addition, the incidence and risk factors associated with acute cholecystitis were estimated when a cholecystectomy had not been performed.
Methods:
The medical records of 113 patients diagnosed with acute biliary pancreatitis in Seoul National University Hospital from January 1990 to April 2005 were reviewed retrospectively.
Results:
Twenty-five patients received no specific treatment of which 15 (60.0%) experienced a recurrence during a mean follow-up period of 36.0 months. Fifty-two patients received EST only and did not experience a recurrence during a mean follow-up of 29.8 months. Thirty-six patients underwent a cholecystectomy, and 1 (2.8%) patient experienced a second attack during a follow-up of 35.2 months. The clinical factors predictive of pancreatitis recurrence in patients without treatment could not be identified. Acute cholecystitis developed in 7 out of 77 (9.1%) patients who did not receive a cholecystectomy during a mean follow-up period of 33.3 months, and patients with both gallbladdor and common bile duct stones were found to be more prone to a recurrence.
Conclusions:
Sixty percent of patients with acute biliary pancreatitis without treatment experienced a second attack, which could be prevented by EST. A cholecystectomy is not always necessary as a routine treatment after EST for preventing pancreatitis, and is recommended for patients with both visible gallbladdor and common bile duct stones at the time of the first attack. (Korean J Gastrointest Endosc 2006;33:152158) |
| Key Words:
Acute pancreatitis, Cholelithiasis, Choledocholithiasis, Acute cholecystitis, Cholecystectomy |
| 주요어:
급성 췌장염, 담석증, 총담관결석증, 급성 담낭염, 담낭절제술 |
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