원인 불명의 위장관 출혈에서 64채널 다중검출 컴퓨터단층촬영, 캡슐내시경, 이중풍선소장내시경의 임상적 유용성

Abstract

Objective: Obscure gastrointestinal bleeding primarily originates from small-bowel lesions. It is difficult to detect the lesions by using classical diagnostic modalities, and thus, new methods have been developed. The aim of study was to evaluate the clinical usefulness of 64-channel multidetector computed tomography, capsule endoscopy, and double-balloon enteroscopy for detection of obscure gastrointestinal bleeding. Methods: This retrospective study analyzed the findings of 64-channel multidetector computed tomography, capsule endoscopy,and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding treated at Soonchunhyang University Seoul Hospital between January 1, 2008 and September 30, 2010. Results: Five of 22 positive findings (22.7%) were obtained using 64-channel multidetector computed tomography. The computed tomography could not detect active bleeding lesions but it played an important role on the evaluation of extraluminal lesions. The diagnostic yield of capsule endoscopy was 82.4%. No cases of capsule retention were detected in this study. Bleeding lesions were identified in all cases through the use of double-balloon enteroscopy. One hemoclipping and 2 biopsies were performed. Conclusion: Sixty-four-channel multidetector computed tomography can be used to evaluate extraluminal lesions. Capsule endoscopy is the most convenient endoscopy method. Invasive procedures can be performed using double-balloon enteroscopy. These methods can be used complementarily to diagnose and treat occult gastrointestinal bleeding. Use of capsule endoscopy after screening with 64-channel multidetector computed tomography in the case of patients with occult gastrointestinal bleeding is suggested. In case of lesions wherein invasive procedures are required, use of double-balloon is preferred.