The Efficacy and Safety of Needle-Knife Papillotomy for Endoscopic Sphincterotomy and Cholangiography / 대한소화기내시경학회지

BACKGROUND: Conventional endoscopic sphincterotomy with papillotome(CES) is an established method of management for patients with biliary obstruction from various causes. However, an alternative treatment to CES must be considered when antecedent cholangiagraphy is unsuccessful or when cannulatian with the conventional papillotome fails. The needle-knife papillotomy(NKP) is one of the alternative methods to CES. Recently, it has been suggested that NKP can be used to achieve diagnostic cholangiography. But NKP is controversial because results from studies assessing its efficacy and safety are conflicting. The current study was undertaken to assess retrospectively the efficacy and safety of NKP and CES. METHODS: All enrolled patients(CES group 113, NKP group 105) underwent ERCP between September 1993 and August 1996 at Korea Univeisity Guro Hospital. NKP for cannulation was used only when biliary tract disease was suspected but deep canulation failed inspite of several attempts. The efficacy and safety of NKP and CES were evaluated according to the rate of success of performing purposes(removal of common bile duct stones, inser tion of endoscopic nasobiliary drainage or endoprosthesis, treatment of sphincter of Oddi dysfunction, and cannulation) and complications(bleeding, perforation, pancreatitis). RESULTS: 1. Overall success rates of performing purposes were 92.9% in CES group(removal of common bile duct stones 95.2%, insertion of endoscopic nasobiliary drainage or endoprosthesis 84.6%, treatment of sphincter of Oddi dysfunction 100%) and 80.0% in NKP group(removal of common bile duct stone 86.7%, insertion of endoscopic nasobiliary drainage or endoprosthesis 80.6%, treatment of SO dysfunction 100%, cannulation 70.6%). The success rate of CES was significantly higher than that of NKP(p=0.04). 2. The morbidity rate of NKP was 10.5%(8 bleeding cases, 1 perforation case, 2 pancreatitis cases) but was not significantly different from that of rate for CES 8.0%(9 bleeding dases). 19 patients with complications recovered uneventfully with conservative treatment. Only 1 patient(ampullary carcinoma) undertwent operation due to severe bleeding after NKP. There was no procedure-related mortality in both groups. CONCLUSION: NKP is an effective endoscopic tool allowing successful endoscopic sphincterotomy when conventional technique fails. And, in carefully selelected cases, NKP is a useful aid for a successful diagnostic cholangiograph.

A Case of Rubella Complicated with Hemolytic Anemia / 감염

Rubella is a viral disease usually characterized by a benign febrile exanthem, manifested with fever, posterior occipital lymphadenopathy and pinkish rash in children. Most cases are recovered without any sequelae. However, it may lead to serious cardiac and ocular congenital malformation and fetal death in pregnant woman. Additionally postnatal rubella can be unusually complicated by encephalitis, meningitis, thrombocytopenic purpura, pneumonia and multiple organ disorder. Especially, hemolytic anemia following postnatally acquired rubella is very rare. Of the world, only twenty cases were reported in Japan during rubella outbreak from 1975 to 1977, and majority were Coombs' positive cases. But no case was reported until now in Korea. Resurgence of rubella has been recognized among adolescents in Korea since 1995. We experienced an adolescent patient with Coombs'-negative hemolytic anemia following rubella infection who has recovered by conservative management. We report the case with a review of literatures.