소장질환이 의심되는 환자에서 이중풍선 소장내시경검사와 캡슐내시경검사의 비교
Comparison of Double Balloon Enteroscopy and Capsule Endoscopy for Patients with Suspected Small Bowel Diseases
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목적: 이중풍선 소장내시경과 캡슐내시경이 도입되면서 전체 소장을 관찰할 수 있게 되었다. 본 연구는 소장질환이 의심되는 환자를 대상으로 이중풍선 소장내시경검사와 캡슐내시경검사의 진단율 및 임상적 유용성에 대해 비교 연구하였다. 대상 및 방법: 2003년 5월부터 2005년 7월까지 원인 불명의 소화관 출혈, 만성 복통, 만성 설사, 염증성 소장 질환, 종양 등 여러 소장 질환이 의심되어 캡슐내시경검사를 시행한 35명과 이중풍선 소장내시경검사를 시행한 환자 25명을 대상으로 하였다. 양 군의 임상적 특성, 진단율, 치료에 미친 영향 등을 분석하였다. 결과: 이중풍선 소장내시경검사의 진단율은 80% (20/25), 캡슐내시경검사는 65.7% (23/35)로 유의한 차이가 없었으나(p=0.226), 이중풍선 소장내시경검사의 진단율이 다소 높은 경향이었다. 이중풍선 소장내시경 검사 환자군은 내시경 시술로 치료하였던 예가 4명(16%), 약물 치료 4명(16%), 수술 10명(40%), 단순 관찰 7명(28%)이었고, 캡슐내시경 검사 환자군은 수술 2명(6%), 약물 치료 5명(14%), 단순 관찰 28명(80%)으로서 이중풍선 소장내시경검사 군에서 발견한 병변에 대하여 수술이나 내시경 시술 등 적극적인 치료를 한 예가 더 많았다(Table 72% vs. 20%, p＜0.01). 결론: 소장질환이 의심되는 환자에서 이중풍선 소장내시경검사와 캡슐내시경검사의 전체 진단율은 비슷하였지만 치료 결정에 미치는 영향은 이중풍선 소장내시경검사가 더 큰 것으로 나타났다.
Abstract
Background/Aims: Double balloon enteroscopy (DBE) and capsule endoscopy (CE) are two new methods for evaluating small bowel diseases. However, the clinical relevance of these procedures remains to be uncovered. We investigated the diagnostic and therapeutic impact of DBE and CE for patients with suspected small bowel diseases. Methods: We retrospectively reviewed the medical records of 60 patients who were examined by DBE or CE for suspected small bowel diseases between May 2003 and September 2005. The diagnostic yield and therapeutic impact were compared between the two groups. Results: Thirty-five patients were examined by CE and 25 patients were examined by DBE. DBE showed abnormal findings in 20 patients (80%). CE detected abnormal findings in 23 patients (65.7%). The overall diagnostic yield was not different between the two groups (p=0.226). In the DBE group, therapeutic interventions were performed in 18 patients (72%). In the CE group, therapeutic interventions were performed in 7 patients (20%). The overall therapeutic impact showed a significant difference between the two procedures (p<0.001). Conclusions: Although there is no significant difference in the diagnostic yield between the two procedures, DBE appears to have a higher therapeutic yield than CE for patients with suspected small bowel diseases. (Korean J Gastrointest Endosc 2007;35:379-384)
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