Crohn病の小腸出血例の内視鏡診断―治療およびその臨床経過

Small Bowel Bleeding in Crohn's Disease

要旨　本検討は，Crohn病（CD）における小腸出血の頻度，内視鏡検査の有用性および治療経過を明らかにすることを目的とした．当科においてダブルバルーン小腸内視鏡検査（DBE）を施行した155例のCD患者を対象とした．上下部消化管内視鏡検査で出血源を指摘できない，（1）DBE施行前の顕出血例，（2）出血源検索目的のDBE施行例，（3）出血症状の有無にかかわらずDBEで出血源を指摘しえた症例，を小腸出血例と定義した．小腸出血例は15例（9.7％）であり，このうち10例（66.7％）は，DBEで出血源を同定しえた．内視鏡的止血術（6症例）を含む保存的治療によって，すべての症例で一時止血が得られた．再出血は，15例中5例（33％）に認められ，累積非再出血率は，12か月後で73％，36か月後で63％だった．出血が原因で外科手術に至った症例や死亡例はなかった．再出血例5例は，非再出血例10例と比較し，出血部位が吻合部である頻度が有意に高かった．病型，初回出血後の治療内容および内視鏡的止血術の有無別での比較では，再出血例と非再出血例に明らかな相違を指摘できなかった．

　The aim of this study is to clarify the incidence, usefulness of endoscopic diagnosis, endoscopic treatment and clinical course of small bowel bleeding in patients with CD（Crohn's disease）. One hundred and fifty-five patients with CD who underwent DBE at our department were the subjects in this study. We stated that small bowel bleeding cases were those（1）whose indications for DBE were obscure gastrointestinal bleeding,（2）in whom was observed severe bleeding during DBE,（3）whose bleeding focus in DBE was able to be identified. Patients with upper GI bleeding or colorectal bleeding were excluded. Fifteen（9.7％）of 155 subjects were small bowel bleeding cases. The bleeding focus of ten of these small-bowel bleeding cases was able to be identified endoscopically. Temporary hemostasis in all cases was accomplished using conservative therapy including endoscopic hemostasis. Re-bleeding was observed in 5（33％）of 15 cases. The cumulative non re-bleeding rates were 63 and 73％ at 12 and 36 months after initial DBE respectively. There were no cases that needed surgery due to small bowel bleeding. Re-bleeding cases frequently have significantly more anastomotic lesions as their bleeding focus in comparison with non re-bleeding cases. On the other hand, there were no significant differences between re-bleeding cases and non re-bleeding ones according to clinical features, therapies used and whether or not endoscopic hemostasis was carried out. In conclusion, this present study shows the incidence of small bowel bleeding in patients with CD and their clinical course. DBE is useful for diagnosis and treatment in such cases.