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5,236예의 내시경적 용종절제술 후의 지연출혈에 대한 경험

Delayed Bleeding in a Colonoscopic Polypectomy

대한대장항문학회지 2000년 16권 6호 p.462 ~ 468
김현식 ( Kim Hyun-Sik ) - 송도병원 외과

김건욱 ( Kim Khun-Uk ) - 송도병원 외과
박원갑 ( Park Won-Kap ) - 송도병원 외과
조경아 ( Jo Kyung-Ah ) - 송도병원 외과
황도연 ( Hwang Do-Yeon ) - 송도병원 외과
강용원 ( Kang Yong-Won ) - 송도병원 외과
윤서구 ( Yoon Seo-Gu ) - 송도병원 외과
이광렬 ( Lee Kwang-Ryul ) - 송도병원 외과
이종균 ( Lee Jong-Kyun ) - 송도병원 외과
김광연 ( Kim Kwang-Yeon ) - 송도병원 외과

Abstract


Purpose: Delayed hemorrhage rarely happens after a colonoscopic polypectomy, ranging from 0.2 to 1.8% in frequency. Although its occurrence is unpredictable and it may be serious in some cases, scanty data on its causes, characteristics, and effective management exist in Korea. This study was conducted to provide such data, especially data on the characteristics of delayed hemorrhage and its effective management.

Methods: From 1997 to 1999, one endoscopist at Song-Do Colorectal Hospital performed 5236 polypectomies on 2511 patients. Delayed hemorrhage occurred after 9 of those polypectomies, for a bleeding incidence rate of 0.17% (9/5236). The authors reviewed those 9 incidence of delayed hemorrhage, which involved 9 patients and 9 lesions, with emphasis on the characteristics of the bleeding and the treatment.

Results: The mean age of the 9 patients was 50 years, and the male-to-female ratio was 8:1. The sigmoid colon was involved in 4 of those patients (44.4%), and the right-sided colon was involved in another 4 of those patients. Lesions smaller than 11 mm were either sessile or flat-elevated and accounted for 6 of the 9 lesions (66.7%). The remaning lesions, which were larger than 10 mm, were either pedunculated or semipedunculated. Three (3) of the 9 patients (33.3%) experienced bleeding on day 1, the most common bleeding day. Another 5 patients (55.6%) experienced bleeding during the next 4 days (days 2 to 5). The last patient experienced bleeding on day 9, the latest bleeding day. A snare polypectomy had been performed on 7 of the 9 patients (77.8%), and a hot biopsy had been performed on the other 2 (22.2%). All delayed bleeding was treated by using hemoclips; additional epinephrine injection was used in 55.6% of the cases and an additional detachable snare in 22.2%. Rebleeding was noticed the day following the initial treatment of bleeding in one case and was managed by using hemoclips.

Conclusion: The first 5 days after a colonoscopic polypectomy are crucial, and caution is required during the next 5 days. Thorough knowledge about preventing and managing bleeding is essential.

키워드

지연 출혈;용종절제술;지혈클립;분리형 올가미
Delayed hemorrhage;Polypectomy;Hemoclip;Detachable snare
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KCI
KoreaMed
KAMS