Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

Endoscopic Treatment with Band Ligation and Electrocoagulation forNon-Variceal, Non-Ulcer Upper Gastrointestinal Bleeding

비정맥류 비궤양성 상부위장관 출혈에서 내시경 밴드 결찰술과 전기 응고법의 치료효과

Kim, Hwa-Min;Ku, Yang-Suh;Chung, Moon-Gi;Kim, Young-Nam;Lim, Do-Yoon;Kwon, Kwang-An;Park, Dong-Kyun;Kim, Sun-Suk;Kim, Yeon-Suk;Kwon, So-Young;Kim, Yu-Kyung;Choi, Duck-Joo;Kim, Ju-Hyun
김화민;구양서;정문기;김영남;임도윤;권광안;박동균;김선숙;김연석;권소영;김유경;최덕주;김주현

  • Published : 20060000
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Abstract

Background/Aims: This study compared the therapeutic efficacy of endoscopic band ligation (EBL) with that of electrocoagulation for treating non-variceal, non-ulcer (NVNU) upper gastrointestinal (UGI) bleeding. Methods: This study included 89 patients who underwent EBL and 56 patients in whom monopolar electrocoagulation was performed for NVNU UGI bleeding. The lesions treated were Mallory-Weiss tear in 91 patients, Dieulafoy's lesion in 42 patients and angiodysplasia in 12 patients. Results: The initial hemostatic rate was 97% in the EBL group and 91% in the electrocoagulation group, but this was not statistically different. Rebleeding occurred in 5 of 89 patients (5.6%) in the EBL group and in 8 of 56 patients (14.3%) in the electrocoagulation group (p=0.07). Thrombocytopenia or prothrombin time prolongation was confirmed to be a significant risk factor for rebleeding. The rebleeding rate in the high risk group was significantly lower than in the EBL group (9% vs. 30%, respectively, p=0.03). The median procedure time was significantly shorter in the EBL group compared with that in the electrocoagulation group (median 5.6 minutes vs. 8.3 minutes, respectively, p=0.04). Conclusions: EBL and electrocoagulation are both effective for treating NVNU UGI bleeding, and EBL is especially safe and effective for the cases with a high risk for rebleeding.

목적: 비정맥류 비궤양성 상부위장관 출혈 환자에서 내시경 밴드 결찰술과 전기응고법의 치료 효과를 알아 보았다. 대상 및 방법: 1999년 7월부터 2004년 6월까지 비정맥류 비궤양성 상부위장관 출혈로 내시경 치료를 시행한 145명의 의무 기록을 후향적으로 조사하였다. 대상 환자의 평균 연령은 49.8±15.2세, 남자가 127명이 었다. 출혈 원인은 Mallory-Weiss 증후군 91명, Dieulafoy 병변 42명, 혈관이형성증 12명이었다. 치료 방법은 밴드 결찰군이 89명으로 평균 1.17 (1∼3)개의 밴드를 사용하였으며 단극 전기응고군은 56명이었다. 결과: 전체 환자의 1차 지혈 성공률은 94%이었으며 밴드 결찰술 97%, 전기응고법 91%로 통계학적 차이는 없었다. 모두 13예에서 재출혈이 발생하였고 밴드 결찰군 5명(6%), 전기응고군 8명(14%)이었다(p=0.07). 재출혈과 관련된 위험인자는 혈소판 감소와 프로트롬빈 시간의 연장이었다. 혈소판 감소나 프로트롬빈 시간의 연장이 있는 재출혈의 고위험군은 모두 58명이었으며 재출혈률은 17% (10/58)이었고 치료 방법에 따른 재출혈률은 밴드 결찰군이 9% (3/35), 전기 응고군은 30% (7/23)로 밴드 결찰군에서 의미있게 재출혈이 적었다(p=0.03). 두 치료군 간의 입원 기간은 차이가 없었으나 시술 시간은 밴드 결찰군이 짧았다. 두 치료군 모두 내시경 치료와 관련된 합병증은 없었다. 결론: 비정맥류 비궤양성 상부위장관 출혈에서 내시경 밴드 결찰술과 전기 응고법은 모두 효과적이며 특히 밴드 결찰술은 재출혈의 위험요인을 가진 경우 안전하고 효과적인 치료법으로 생각한다.

Keywords

References

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