Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

Characteristics of Lesions Misdiagnosed as Obscure Gastrointestinal Bleeding

원인불명 위장관 출혈로 오인된 상하부위장관 출혈의 빈도와 특성

  • Choi, Hyun-Sook (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Jin-Oh (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Dong-Kyun (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Jeon, Sung-Ran (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Jung, Yoon-Ho (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Hyun-Gun (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Lee, Tae-Hee (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Cho, Won-Young (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Wan-Jung (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Ko, Bong-Min (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Lee, Moon-Sung (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Cho, Joo-Young (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Lee, Joon-Sung (Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine)
  • 최현숙 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 김진오 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 김동균 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 전성란 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 정윤호 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 김현건 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 이태희 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 조원영 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 김완중 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 고봉민 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 이문성 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 조주영 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 이준성 (순천향대학교 의과대학 내과학교실, 소화기연구소)
  • Received : 2009.12.28
  • Accepted : 2010.07.27
  • Published : 2010.08.30
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Abstract

Background/Aims: Double balloon enteroscopy (DBE) and capsule endoscopy (CE) are useful for evaluation of obscure gastrointestinal bleeding (OGIB). However, many bleeding sources within reach of conventional upper and lower endoscopes can be missed in patients who have undergone DBE and CE for OGIB. The aim of this study was to determine the incidence and characteristics of OGIB lesions within reach of a conventional endoscope in patients undergoing DBE and CE for the indication of OGIB. Methods: This retrospective study included 134 patients who were evaluated for OGIB between March 2003 and May 2009 at Soonchunhyang University Hospital. Results: Of the 134 patients, 76 underwent CE, 28 patients underwent DBE, and 30 underwent both CE and DBE. The incidence of OGIB lesions within reach of a conventional upper and lower endoscopy was 9.7% (n=13) and the mean age of patients was 51 years (range: 20 to 69 years). The most commonly missed lesion was duodenal ulcer (n=8). The other missed lesions were gastric ulcer (n=2), terminal ileal ulcer (n=2) and ileocecal valve ulcer (n=1). Conclusions: The duodenum should be observed closely in initial upper and lower endoscopy by experienced endoscopists. Performing a second EGD and ileocolonoscopy before DBE and CE may increase the diagnostic yield and improve cost-effectiveness in patients with OGIB.

목적: 캡슐내시경과 이중풍선소장내시경은 원인불명의 위장관 출혈을 찾기 위한 유용한 검사이나 많은 예의 경우 상하부 위장관내시경으로 관찰할 수 있는 부위에서 병변이 관찰되기도 한다. 이번 연구에서는 원인불명의 위장관 출혈로 캡슐내시경 또는 이중풍선소장내시경을 시행한 환자들 중에서 상하부위장관내시경으로 관찰할 수 있는 위치에 병변이 있었던 환자들의 빈도를 파악하고 임상적인 특징을 분석하였다. 대상 및 방법: 2003년 3월부터 2009년 5월까지 원인불명의 위장관 출혈로 캡슐내시경 또는 이중풍선소장내시경을 시행했던 134명의 환자들을 대상으로 병변이 상하부위장관내시경으로 확인할 수 있는 위치에 있었던 환자들의 빈도와 임상적인 특징, 병변의 위치를 분석하였다. 결과: 대상환자 134명 중 캡슐내시경만 시행한 경우는 76명, 이중풍선소장내시경만 시행한 경우는 28명, 캡슐내시경과 이중 풍선소장내시경을 모두 시행한 경우는 30명이었다. 상하부위장관내시경으로 관찰할 수 있는 곳에 병변이 있었던 환자는 총 13명(9.7%)으로 십이지장궤양이 8명으로 가장 많았고, 위궤양 2명, 말단회장궤양 2명, 회맹판궤양 1명이었다. 13명 중 6명은 재시행한 내시경검사에서 병변이 발견되었으며 7명은 처음 시행한 내시경에서 출혈이 의심스러운 병변이 관찰되었으나 소장 출혈의 원인을 배제하기 위해 소장검사를 시행하였다. 결론: 원인불명의 위장관 출혈로 내원한 환자들 중 상하부내시경으로 관찰할 수 있는 곳에 병변이 있었던 경우는 9.7%였으며, 주 병변은 십이지장 구부였다. 따라서 초기 상하부내시경 검사에서 십이지장 병변 등에 대한 보다 세심한 관찰이 필요하며, 초기 내시경시 혈액 응괴 및 환자의 불안정한 상태 등으로 면밀한 관찰이 이루어지지 못한 경우 소장검사를 시행하기 전에 상하부위장관 검사를 재시행하는 것이 불필요한 이중풍선소장내시경과 캡슐내시경을 줄일 수 있을 것으로 생각한다.

Keywords

References

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