췌석은 만성췌장염에서 흔히 동반되는 소견으로 반복되는 복통과 췌장염의 원인이 될 수 있다. 췌석은 췌관 협착과 자주 동반되고 췌관내 박혀 있는 경우가 많아 바스켓을 이용하여 제거하기 어렵다. 체외충격파쇄석술(ESWL)로 치료하기도 하나 반복 시술이 필요하고 성공률도 높지 않았다. 최근에 개발된 SpyGlass™ DS II (Boston Scientific, Marlborough, MA, USA)는 직경이 3.5 mm로 가늘어 췌관이 확장되어 있을 때 안으로 삽입이 가능하게 되었다. 그리고 직접 췌석을 보면서 전기수압쇄석술(EHL)이나 레이저 유도 쇄석술(laser lithotripsy)를 시행하며 췌석을 제거해 볼 수 있게 되었다. 본고에서는 SpyGlass™ DS II와 EHL을 이용하여 10 mm 이상의 다발성 췌석을 제거하는 방법을 소개하고자 한다.

Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It can be a life-threatening condition if it is not recognized early. Patients with severe cholangitis may present with hypotension, and mental status changes. The most frequent causes of acute cholangitis are biliary calculi, benign biliary stricture, and malignancy. The most common pathogens isolated are gram-negative bacteria (Escherichia coli , followed by Klebsiella species and Enterobacter species). A diagnosis of acute cholangitis requires evidence of systemic inflammation, cholestasis, and imaging with biliary obstruction. Imaging studies may consist of ultrasound, computed tomography, magnetic resonance cholangiopancreatography, and/or endoscopic ultrasound. The mainstay of treatment consists of fluid resuscitation, antibiotics, and biliary drainage. Penicillin/β-lactamase, third-generation cephalosporin, or carbapenem are all acceptable choices for first-line treatment. In patients with severe cholangitis, biliary drainage should be performed within 24 hours. Patients with severe acute cholangitis require urgent (within 24 hours) biliary decompression. Endoscopic retrograde cholangiopancreatography remains the preferred modality for biliary drainage. In conclusion, acute cholangitis is mostly treatable when recognized and treated early. Recognizing and initiating early treatment leads to markedly decreased patient morbidity and mortality.

내시경역행담췌관조영술(ERCP)은 다양한 췌장 담도 질환을 가진 환자의 진단 및 치료에 있어 표준이 되고 있다. 치료 ERCP 시술이 점차 복잡해짐에 따라 그 요구에 맞추어 ERCP 부속기구는 발전하고 있다. 선택 삽관부터 내시경 괄약근 절개술/풍선확장술, 풍선 혹은 바스켓을 이용한 담관담석 제거에 이르기까지 다양한 ERCP 부속기구가 필요하고 최적의 환자 치료와 안전을 위해서는 이에 대한 정확한 지식과 올바른 사용이 필수적이다. 본고에서는 진단과 치료 ERCP에 필요한 최신의 ERCP 부속기구에 대해 다루고자 한다.

기관지담관루는 간세포암 환자에서 여러 차례의 간동맥화학색전술 후 드물게 일어날 수 있는 합병증이다. 본 증례의 78세 남자 환자는 11차례의 간동맥화학색전술을 시행받고 5개월 후 발생한 기침과 담즙성 객담으로 내원하였다. MRCP상 기관지담관루는 오른쪽 간내담관(B7)과 기관지 사이에 위치하였다. ERCP를 시도하였으나 심한 간문부의 폐쇄로 기관지담관루가 위치한 우측 간내담관을 조영할 수 없었고, 이후 PTBD를 시행하여 매일 30-50 mL의 담즙이 배출되면서 객담 배출은 멈추었다. PTBD 배액관을 유지하고 2개월 동안 관찰하였으나 누공이 지속되어 두 번째 ERCP를 시행하여 기관지담관루 부위에 플라스틱 스텐트를 유치하였다. 1주 후 PTBD를 통하여 시행한 담도조영술에서 기관지담관루는 소실되었다. 환자는 스텐트 시술 이후에 더 이상 객담을 배출하지 않았고 2개월 이후에 시행한 ERCP에서도 기관지담관루가 관찰되지 않았다.

배경목적: 내시경 초음파 유도하 췌장 저류액 배액은 효과적인 시술이나 이 시술에 특화된 맞춤형 부속기구는 부족한 실정이다. 이 연구의 목적은 내시경 초음파 유도하 경위장관 배액술 전용으로 새로 고안된 양측 플랜지가 있는 완전피막형 금속 스텐트의 유용성을 평가하고자 하였다. 방법: 동물연구는 한 마리의 개를 대상으로 하였고 임상연는 췌장 저류액을 가진 5명의 환자 (5명은 췌장가성낭종, 1명은 벽 형성 췌장괴사)를 대상으로 하여 내시경 초음파 유도하 배액술을 시행하였다. 연구의 성과는 기술적, 임상적 성공여부, 합병증, 스텐트 제거 가능 여부로 판단하였다. 결과: 동물연구에서 스텐트는 내시경 초음파 유도하 경십이지장 접근으로 합병증 없이 성공적으로 유치되었다. 시술 직후 시행한 부검에서 담낭-십이지장 연결은 온전하였다. 6명의 환자에서 모두 스텐트는 성공적으로 유치되었다. 모든 환자에서 시술후 합병증과 스텐트 이탈은 없었다. 결론: 새로 고안된 양측 플랜지가 있는 완전피막형 금속스텐트를 사용한 췌장저류액의 내시경 초음파 유도하 경위장관 배액술은 기술적으로 가능하였고 심각한 합병증은 없었다. 스텐트 선단부의 맞춤형 플랜지 형상은 시술의 효과를 배가시켰다.

Firms acquire customers using myriad forms of marketing media (Neslin & Shankar 2009), and different media strategies yield different results to the firms. Therefore, allocating media strategy given a firm’s spending raises important questions for managers. This is especially the case since the media landscape has changed dramatically, with new media channels incorporating online, mobile, and social media now being considered the mainstream. It is crucial to understand how each form of media influences consumers and how it operates alongside traditional media. Based on Stephen and Galak (2012), marketers distinguish earned media from paid media. Earned media is defined as media activity that a company does not directly generate, such as press mentions on the internet and online community posts in consumer-generated social media. On the other hand, paid media refers to the media activity which a company generates (for example, television, radio, print, and direct mail). It is common for firms to consider using earned media and paid media at the same time when developing marketing communication strategies. Despite the coexistence of paid and earned media channels, previous empirical findings focus either on paid media or earned media and suggest that these individually will increase a firm’s marketing outcomes. However, there is a lack of research that examines the question of whether the use of paid media and earned media at the same time is synergistic. The effects of a cross media synergy only focuses on the resource allocation within paid media (for example, TV–Radio (Edell & Keller 1989), TV–Magazine (Confer & McGlathery 1991), TV–Print (Dijkstra, Buijtels, & Van Raaij 2005), and TV, Radio, Print and Outdoor (Briggs, Krishnan, & Sheeran 2003)). Thus, by considering paid media and earned media concurrently, this study investigates whether the synergies between paid and earned media have a stronger effect on a firm’s long term profitability than the isolated effects of TV or word of mouth (WOM) alone. In addition, the research on earned media has focused on short-term outcomes such as customer actions (for example, website sign-ups) and sales growth, sales rank, cross-product sales, and ratings (Trusov, Bucklin, & Pauwels 2009; Li & Hitt 2008; Moe & Trusov 2011). Moreover, in the limited research on the relationship between earned media and long-term outcomes, the outcomes are restricted to those related to soft metrics of communication effectiveness (for example, attitude and brand awareness). Therefore, we use customer equity, which is regarded as a forward looking firm outcome variable, thereby enabling marketers to monitor and measure the long-term financial impact of marketing spending (Kumar & Shah 2015). Moreover, cross-media synergy can be accurately measured by customer equity, which incorporates both customer acquisition and retention. Based on Villanueva, Yoo, and Hassens (2008), customers acquired through paid media focus more on trials, whereas customers acquired through earned media provide the firm with more repeats. In other words, paid media plays a key role in the acquisition of customers, while, on the other hand, earned media increase the retention of customers. Thus, it is appropriate to measure the cross-media synergy with the customer equity (long term profitability) that can capture the customer acquisition and retention simultaneously. Regarding the long term impact of the firm’s media strategy, previous research has used the economic impact of traditional marketing channel (for example, television, radio, magazine or newspaper, advertisement, e-mail links, and direct mail) versus that of WOM (for example, links from Web sites, magazine, or newspaper articles, referrals from friends or colleagues, referrals from professional organizations or associations, and referrals from search engines) on customer equity. Traditional marketing had a stronger effect than WOM in the short term, while WOM is a quiet, gradual-impact, long lasting driver (Villanueva, Yoo, & Hassens 2008). This result can be attributed to the different characteristics of each media channel. Although earned media, including WOM, is not entirely controlled by the firm, earned media may be more likely to last longer for various reasons. One of the reasons for this phenomenon is that earned media has greater credibility than conventional marketing activities that are implemented by the firms, and is therefore more persuasive than conventional advertising (Brown & Reingen 1987, Villanueva, Yoo, & Hassens 2008). In other words, considering the impact of each type of media in itself, earned media is more effective in increasing long-term profitability. However, the interaction effect of earned and paid media has not been empirically tested yet. Thus, it is conceivable that a cross-media synergy (incorporating the implementation of earned media and paid media at the same time) will last longer than the implementation of each isolated media. As Armelini and Villanueva (2010) pointed out, earned media and paid media have complementary effects. For example, offline advertising increases website visitation by influencing consumer awareness, while online advertising directly leads to website traffic (Ilfeld & Winer 2002). The consumer buying process involves distinct stages such as awareness, consideration, and purchase (Lavidge & Stener 2000) and each media influences customer buying behavior in a different way. Hence, it enhances the effectiveness in terms of long-term profitability to utilize the cross-media effect properly. For example, in the car industry, 64 % new car buyers become aware of the features and benefits of a car by obtaining information online, even though they purchase their cars from an offline dealership (J.D. Power and Associates 2004). This finding implies that a firm’s implementation of both paid and earned media properly will maximize the customers’ arousal of the target brands. Furthermore, converging paid media and earned media is expected to proliferate the growth of a firm’s profitability, such as sales, revenue, and customer’s equity, at an exponential rate. For example, the effects of TV advertising execution can be enhanced by press mentions that a company does not directly generate; this is because press mentions support the credence of TV advertising. Inversely, since paid media activities reach the audience relatively more than WOM (due to the high audience penetration share), the online share of press mention can proliferate rapidly with the execution of paid media activities. Therefore, the interaction between earned media and paid media has a greater effect on customer equity than isolated media implementation. The impact of a media synergy has more positive effect and last longer than isolated media implementation (and our model is displayed in Fig. 1). We collect data on marketing efforts, word-of-mouth circumstance, and performance of a telecommunication company. Based on customer equity models and quarterly marketing and performance data, we first estimate the lifetime value of the newly acquired and existing customers. Thereafter, we determine the customer equity of the company over each period. We develop and employ a time-series model for examining the relationship between cross media efforts (paid media vs. earned media) and the estimated firm’s customer equity. Finally, we examine the synergistic effect of cross media on the firm’s long-term profitability.