내시경적 역행성 담췌관조영술 중 선택적 삽관은 유두가 보이지 않는 경우, 특히 게실 내 유두(intradiverticular papilla, IDP) 또는 점막 주름에 의해 유두가 덮여 있을 때 어려울 수 있다. Endoclip을 이용한 삽관술은 유두를 외번시키고 고정하는 데 효과적이며, 단독으로 또는 다른 기구와 함께 사용할 수 있는 안전한 기술이다. 본 증례에서는 endoclip을 사용하여 IDP 2예와 점막 주름에 의해 유두가 덮인 1예에서 성공적으로 유두 삽관을 수행한 경험을 보고한다. 두 증례에서는 endoclip만을 사용하여 보이지 않는 유두를 재위치시켜 삽관에 성공하였고, 한 증례에서는 endoclip을 이용해 여분의 주름을 카테터로 밀어 내어 삽관에 성공하였다. Endoclip을 이용한 유두 삽관술은 다양한 상황에서 단독으로 또는 다른 기구와 함께 적용할 수 있는 유용한 방법으로 평가된다.

유두주위게실은 담석의 발생 및 재발에 영향을 주는 위험인자로 보고된 바 있다. 하지만 유두주위게실이 내 시 경 역 행 담 췌 관 조 영 술 ( e n d o s c o p i c r e t r o g r a d e cholangiopancreatography) 시행 중 선택적 담관 삽관의 성공률에 영향을 주는지에 대해서는 논란의 여지가 있다. 다만, 실제 임상에서는 유두주위게실로 인해 선택적 담관 삽관이 어려운 경우가 분명히 존재하며, 이를 해결하기 위한 다양한 방법이 보고되었다. 본고에서는 생검겸자를 이용해 선택적 담관 삽관에 성공한 증례를 보고하고자 한다.

Background/Aim: Endoscopic retrograde cholangiopancreatography (ERCP) training requires varying degrees of staff assistance regarding operation of the fluoroscopy machine via a foot pedal. Efficiency is important to acquire during this training due to radiation risks. In this study, we evaluate the effect of controlling endoscopy and fluoroscopy unit on duct cannulation rates (CRs) and total fluoroscopy time (FT) for fellows in training. Methods: 204 patients undergoing ERCP were randomized to one of two groups: 1) “Endoscopist Driven” group in which the endoscopist controlled the foot pedal for fluoroscopy, and 2) “Assistant Driven” group in which attending or fellow controlled the foot pedal while the other team member controlled the endoscope. Various measures including selective duct CR and total FT were recorded. Results: There was no significant difference in mean procedure duration between the two groups (32 minutes vs. 33 minutes, p=0.70). There was also no statistically significant difference in CR (83.7% vs. 77.4%, p=0.25) or FT (3.27 minutes vs. 3.54 minutes, p=0.48). Conclusions: ERCP is a technically challenging procedure which requires extensive supervision. This study demonstrates that CR and FT are not affected by who controls the fluoroscopy.

Extravasation is the accidental injection or leakage of fluid into the subcutaneous or perivascular tissues. Some drugs can cause serious injury such as severe tissue injury, necrosis, and etc. Here we report a case of chemical burn by sodium bicarbonate extravasation due to accidental venous puncture during arterial cannulation. A 42-years-old woman has taken emergency laparotomy surgery due to a stab wound to the abdomen. Massive blood loss has developed, and consequently vital signs were unstable and metabolic acidosis has developed. Sodium bicarbonate has administered via a peripheral intravenous line on the dorsal vein of a right hand that runs to the cephalic vein. However, the cephalic vein that runs by the side of the radial artery has punctured accidentally during the attempt of right radial artery cannulation. Second degree superficial and deep chemical burn by sodium bicarbonate extravasation has developed. Skin lesion about 3 × 4 cm2 with erythema and bullae formation has developed. There were no necrotic changes and the digital sensation was intact. Wet dressing and silicon foam dressing were prescribed. After two weeks, she was discharged. Until then, dermis exposure about 1 × 1 cm2 remained although the skin lesions became getting well.