반복되는 담도성 산통을 호소하는 환자에서 담관 내압검사와 담낭스캔의 의의

초록

Background/Aims: This study was aimed to evaluate the clinical significance of the sphincter of Oddi manometry (SOM), cholescintigraphy, endoscopic sphincterotomy(EST), and cholecystectomy in patients complaining of recurrent biliary-type abdominal pain. Methods: 20 patients with recurrent biliary-type abdominal pain not explained by conventional diagnostic studies were sampled. All the patients with manometrically verified sphincter of Oddi dysfunction(SOD) and some patients with normal or failed manometry underwent EST. Among those with normal or failed manometry laparoscopic cholecystectomy was performed to patients with acalculous cholecystopathy(ACP) diagnosed by cholescintigraphy. Results: Of 26 sessions of SOM tried in all the 20 cases, 21 sessions in 17 cases were technically successful. Among those 17 patients, SOM was abnormal in 9 cases(6:sphincter of Oddi dyskinesia; 3:sphincter of Oddi stenosis). Four of five patients undergoing cholescintigraphy in patients with normal or failed manometry were verified as ACP. The procedure-related pancreatitis occurred in 7/26 sessions after SOM and in 3/12 sessions after EST. In 1 case, a micro-perforation followed EST. All these patients with complications recovered uneventfully. Mean duration of follow-up was 13.5(range 7-24) months. EST was of benefit to 7 of 9 patients with manometrically verified SOD and also to all 3 patients with normal or failed manometry undergoing EST. Laparoscopic cholecystectomy was of benefit to all 3 patients with ACP undergoing cholecystectomy. Conclusions: Extensive diagnostic procedures such as SOM and cholescintigraphy and proper therapy according to their results should be considered with patients complaining of recurrent biliary-type abdominal pain not explained by other conventional diagnostic studies.

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