의인성 Mallory-Weiss 증후군의 임상적 특징
Clinical Features of Iatrogenic Mallory-Weiss Syndrome
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목적: 상부위장관 내시경 시행 도중에 발생하는 의인성 Mallory-Weiss 증후군은 흔치 않으며 발병률은 0.07∼0.49%로 보고된다. 저자들은 의인성 Mallory-Weiss 증후군의 빈도와 임상적 특징에 대하여 알아보고자 하였다. 대상 및 방법: 건양대학교병원 소화기내과에서 54,188예의 상부위장관 내시경 검사 중 진단된 의인성 Mallory-Weiss 증후군 환자 46명(0.08%)을 대상으로 후향적으로 조사하였다. 결과: 대상 환자 46명의 평균나이는 52.5±19.6세이었고, 남자는 35명(76%), 여자는 11명(24%)이었다. 상부위장관 내시경 검사 도중 트림이나 구역 후에 발생한 경우는 36명(78.2%)이 있었고, 식도 열공 탈장(hiatal hernia)이 동반된 환자는 20명(43.5%)이었다. 대상 환자들을 분석한 결과 남자에서 우세하게 발병하였고 통계적으로 유의한 차이가 있었다. 연령대에 따른 발병률도 유의한 차이가 있었다. 모든 예에서 점막의 열상과 함께 삼출성 출혈을 보였으며 지혈술을 받은 환자는 16명(34.8%)이었다. 추적 상부위장관 내시경 검사를 받은 수는 17명(36.9%)이었고 경과는 모두 양호하였다. 심한 임상 경과를 보인 환자는 없었다. 결론: 의인성 Mallory-Weiss 증후군의 발병률은 0.08%로 드물게 발생하며 대부분 양호한 경과를 보였다. 상부위장관 내시경 검사 시에 예견 가능한 위험인자가 있는 경우나 호발하는 동반 질환이 있는 경우에 트림과 구역을 최소화할 수 있도록 주의를 요한다.
Abstract
Background/Aims: The detection of iatrogenic Mallory-Weiss syndrome during the course of upper GI endoscopy is apparently rare. The aim of this study was identify the clinical features of the disease and associated medical conditions. Methods: We retrospectively analyzed 46 cases (0.08%) of iatrogenic Mallory- Weiss syndrome identified from 54,188 consecutive upper GI endoscopies performed at our institution during a period of 85 months. Results: A total of 36 patients (78.2%) had retching or belching during the procedure. Hiatal hernias were noted in 20 patients (43.5%). We identified a difference of the attack rate by sex and age for iatrogenic Mallory-Weiss syndrome; the disorder developed predominantly in men. All of the patients had a mucosal tear and oozing and 16 patients underwent endoscopic hemostasis. After being diagnosed with iatrogenic Mallory-Weiss syndrome, 17 patients underwent follow- up endoscopy and all of the patients showed good results without rebleeding. No patient showed a complicated clinical course. Conclusions: A small number of patients had iatrogenic Mallory-Weiss syndrome and most of the patients showed a good prognosis. If there is a predictable risk factor identified during an upper GI endoscopy or an associated medical condition, special care needs to be taken to minimize belching or retching.
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