현성 소장 출혈 의심 환자에서 이중풍선 소장내시경 후 추적 관찰: 재출혈률을 중심으로
Follow-up after Double Balloon Enteroscopy in Patients with Suspected Small Bowel Bleeding: Focused on the Rebleeding Rate
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목적: 현성 소장 출혈 의심 환자에서 이중풍선 소장내시경(DBE)은 높은 병변 발견율을 보이지만, 추적 경과에 대한 연구는 부족하다. 저자들은 현성 소장 출혈이 의심되어 DBE를 시행한 환자들의 추적 경과를 분석하여 장기 유용성을 알아보고자 하였다. 대상 및 방법: 2005년 1월부터 2007년 12월까지 서울아산병원에서 현성 소장 출혈이 의심되어 DBE를 시행한 60명(13∼85세, 남：녀=39：21)을 후향적으로 분석하였다. 결과: DBE를 시행하기 전 중앙값 2회(1∼5회)의 출혈 병력이 있었고 입원 시 가장 낮았던 혈색소 수치는 7.9±2.1 g/dL였으며 수혈을 필요로 했던 경우는 49명(82%)이었다. 41명에서 출혈 의심 병변을 발견하여 68%의 병변 발견율을 보였는데 이 중 혈관병변이 12명, 표재성점막병변이 18명, GIST/림프종/폴립의 종양병변이 5명, 게실, 크론병 등의 기타병변이 6명이었다. 중앙값 552일의 추적 기간 동안 60명 중 17명(28%)에서 재출혈을 보였으며 6개월, 12개월, 24개월 누적 재출혈률은 각각 22%, 27%, 30%이었다. DBE로 출혈 의심 병변을 발견한 경우와 발견하지 못한 경우의 누적 재출혈률에서 유의한 차이는 없었다(p=0.295). 혈관병변 및 표재성점막병변의 경우 6개월, 12개월 누적 재출혈률은 각각 34%, 45%로 종양병변 및 기타병변의 0%, 0%에 비해 유의하게 높았다(p=0.013). 결론: 현성 소장 출혈에서 DBE 후 재출혈률은 병변 발견 여부에 관계없이 낮지 않으며, 혈관병변 및 표재성점막병변의 경우 내시경 지혈술 등 중재적 치료를 시행하더라도 높은 재출혈률을 보이므로 세심한 추적 관찰이 필요하다.
Abstract
Background/Aims: Double balloon enteroscopy (DBE) is an effective modality for making the diagnosis and managing suspected small bowel bleeding. However, there is limited data on the follow-up results after DBE. The aim of this study was to evaluate the long-term clinical outcome after DBE in patients with suspected small bowel bleeding. Methods: We retrospectively analyzed the rebleeding rate of 60 consecutive patients (M：F=39：21, age: 13∼85 years) who underwent DBE because of suspected small bowel bleeding at Asan Medical Center during a 3 year period. Results: The median follow-up period was 552 days. Bleeding sources were detected by DBE in 41 patients. The cumulative rebleeding rate at 6, 12 and 24 months was 22%, 27% and 30%, respectively. There was no significant difference in the cumulative rebleeding rate between the patients with bleeding sources detected by the initial DBE and those without bleeding sources detected by the initial DBE. The cumulative rebleeding rate at 6 and 12 months was significantly higher for the patients with vascular or superficial mucosal lesions than for the patients with tumors or other lesions (p=0.013). Conclusions: The rebleeding risk after DBE is not low for patients with suspected small bowel bleeding. The rebleeding risk is especially high for patients with vascular or superficial mucosal lesions, and this may necessitate careful follow-up.
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