총담관결석의 치료를 위해 안전하고 효과적인 ERCP를 시행하려면 적절한 예방적 항생제의 사용은 필수이며, 출혈 관련 합병증 감소를 위해 항응고제의 중단과 출혈 위험성이 높은 환자들에게 EST 대신 EPBD를 시행하는 것이 필요하다. 뿐만 아니라 PEP 감소를 위한 적절한 췌관 스텐트의 삽입을 고려해야 하며, 담낭 담석이 동반되었을 경우 총담관결석의 치료가 끝났다면, 환자 상태를 고려하여 선택적으로 담낭절제술을 시행해야 한다.

For the optimal treatment of common bile duct (CBD) stones, several facts should be considered before or during endoscopic retrograde cholangiopancreatography (ERCP). Prophylactic antibiotics is necessary for the patients with high risk of post ERCP cholangitis and cessation of anticoagulant should be considered for prevention of complications associated with post ERCP bleeding. Furthermore, endoscopic papillary balloon dilatation can be replaced with endoscopic sphincterotomy in patients with bleeding tendency such as chronic kidney disease, liver cirrhosis, thrombocytopenia etc. Prophylactic pancreatic duct stent can be helpful in reducing post ERCP pancreatitis (PEP) but caution is required as excessive attempts for selective cannulation into pancreatic duct for stent insertion can cause PEP. If gallbladder stone is present and treatment for CBD stones has been completed, prophylactic cholecystectomy should be performed selectively after consideration of patient’s condition.

서 론
본 론
    1. 예방적 항생제의 사용
    2. 항응고제의 중단
    3. 내시경 유두부 풍선확장술
    4. 예방적 췌관 스텐트 삽입
    5. 예방적 담낭절제술
결 론
ORCID
REFERENCES

• 이희승(연세대학교 의과대학 세브란스병원 내과학교실) | Hee Seung Lee (Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul)
• 이동욱(경북대학교 의과대학 칠곡경북대학교병원 내과학교실) | Dong Wook Lee (Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu)
• 박준성(연세대학교 의과대학 강남세브란스병원 외과학교실) | Joon Seong Park (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul)
• 김성훈(전북대학교 의과대학 내과학교실 및 전북대학교 임상의학연구소, 전북대학교병원 의생명연구원) | Seong-Hun Kim (Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea) Corresponding author