－S 579 －
― F-29 ―
경동맥 색전술로 치료한 십이지장게실 출혈 1예
충남대학교 의학전문대학원 내과학교실 박남환*, 남관우, 이희정, 홍순창, 문희석, 이엄석, 성재규, 정현용
십이지장게실을 가진 대부분의 환자들은 증상이 없지만 일부 환자에서 게실염, 출혈, 담관염, 누공 형성, 천공, 췌장염, 십이지장 폐쇄 등의 합병증이 발생할 수 있다. 특히 출혈을 동반한 십이지장게실은 드물고 일반적인 상부 위장관 출혈로 시행한 정규 검사로는 진단하기 어려워 측시경, 혈관 조영술 또는 수술로 확진한 경우가 대부분이다. 국내에서는 십이지장게실에서의 출혈을 수술 뿐만 아니라 내시경적 지혈술로 치료한 몇 개의 증례가 보고된 바 있지만, 경동맥 색전술로 치료한 예는 국내에서 아직까지 보고된 바 없다. 저자들은 대량 상부 위장관 출혈 및 혈액량감소로 인한 쇽으로 내원한 환자에서 내시경적 관찰의 실패로 복부 전산화 단층촬영을 시행하였고, 십이지장게실 출혈로 진 단하여 경동맥 색전술로 치료한 증례를 경험하였기에 이를 문헌고찰과 함께 보고하고자 한다.
― F-30 ―
Comparison of the effectiveness of lansoprazole and lansoprazole plus ecabet sodium in the treatment of iatrogenic gastric ulcer after EMR
Department of Internal Medicine, Chung-Ang University College of Medicine
*Eun Kyung Baek, Chang Hwan Choi, Ki-Seong Kim, Seung-Yong Lee, Bong Ki Cha, Hyun Woong Lee, Jae Hyuk Do, Sae Kyung Chang
Background and Aim: Endoscopic mucosal resection (EMR) is widely performed as a curative treatment modality for gastric neoplasm. EMR, however, inevitably Results in the formation of iatrogenic gastric ulcer at the resected area. This study was aimed to compare the efficacy of lansoprazole (LS) plus ecabet sodium (ES) compared with lansoprazole alone on the healing of gastric ulcer induced by EMR. Methods:
A total of 67 patients were enrolled. After EMR, patients were randomly assigned to either the LS group (lansoprazole 30 mg once a day for 28 days, n=34) or the LS+ES group (lansoprazole 30 mg once a day for 7 days and ecabet sodium 1.5g twice a day for 21 days, n=33).
Four weeks after EMR, the ulcer stage and size (maximal diameter × diameter perpendicular to the maximal diameter) were compared between the two groups. Ulcer reduction ratio was determined by dividing the ulcer size at 4 weeks after EMR by the initial ulcer size. Moreover, ulcer-related symptoms, bleeding rates, adverse effects, and drug compliance were compared. Results: The median age of the study groups was 63.6 (range:46-81years) and 35 (78.3%) patients were men. The two groups were comparable in terms of baseline clinicopathologic characteristics. Four weeks after EMR, the two groups did not differ with respect to the ulcer stages (p=0.569). The ulcer reduction ratios were not different significantly between the LS group and the LS+ES group, but the treatment efficacy was slightly better in the LS+ES group (0.09±0.123 vs. 0.05±0.055, p=0.092). No differences were observed between the two groups with regard to ulcer-related symptoms, drug compliance, adverse drug event, and bleeding rates. Conclusion: For EMR-induced ulcer, the treatment with LS for 1 week followed by ES for 3 weeks was effective as much as the treatment with LS for 4 weeks. The replacement of ES after 1 week LS therapy may improves the efficacy of iatrogenic ulcer treatment.
Key word: endoscopic mucosal resection, iatrogenic ulcer, lansoprazole, ecabet sodium
