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[Sentinel polyps in young patients]

°£È¤ ¼Ò¾Æû¼Ò³â°ú¿¡¼­µµ sentinel polypÀÌ Áø´ÜµÇ°ï ÇÕ´Ï´Ù. Screening endoscopy ´ë»óÀÌ ¾Æ´Ï¹Ç·Î ´ëºÎºÐ Áõ»ó ¶§¹®¿¡ °Ë»ç¸¦ ¹ÞÀº °æ¿ìÀÔ´Ï´Ù.

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[¾Öµ¶ÀÚ 1 ÀÇ°ß] Ç×»ó±³¼ö´ÔÀÇ ÁÁÀº °­ÀÇ ¿­½ÉÈ÷ µè°í ÀÖ´Â ±¤ÁÖÀÇ ¼ÒÈ­±â³»°ú ÀÇ»çÀÔ´Ï´Ù. À̹ø ³»¿ëÁß¿¡ sentinal polyp¿¡ ´ëÇؼ­ ±Ã±ÝÇؼ­ ¸ÞÀÏ ¿Ã¸³´Ï´Ù. Àú ¿ª½Ã sentinal polypÀº ȯÀںе鲲 ¿ëÁ¾À̶ó°í ¸»¾¸µå¸®Áö ¾Ê°í ¿ª·ù¼º ½Äµµ¿°¿¡ ÀÇÇÑ ÈäÅͶó°í ¸»¾¸µå¸®´Âµ¥¿ä, °£È¤ Å©±â°¡ Áõ°¡ÇÏ´Â ¿ëÁ¾ÀÌ ÀÖ¾î ¿ëÁ¾ÀýÁ¦¼úÀ» ½ÃÇàÇØ¾ß Çϳª ¹«Ã´À̳ª °í¹ÎµÇ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ¹°·Ð Áõ»óÀÌ ¾ø¾î Áö¼ÓÀûÀ¸·Î ¾à¹°À» º¹¿ë½ÃÅ°Áö´Â ¾Ê´Â ȯÀںеéÀÔ´Ï´Ù. Ȥ½Ã ½Ã¼ú ÈÄ GERD°¡ ¿ÀÈ÷·Á ½ÉÇØÁöÁö ¾ÊÀ»±î °ÆÁ¤µµ µË´Ï´Ù. ±³¼ö´Ô²²¼­´Â Å©±â º¯È­°¡ ÀÖ´Â sentinal polypÀ» ¾î¶»°Ô ÇϽôÂÁö ±Ã±ÝÇÕ´Ï´Ù.

[ÁÖÀÎÀå ´äº¯] ÁÁÀº ¸»¾¸ °¨»çÇÕ´Ï´Ù. »ç½Ç sentinel polypÀÌ °è¼Ó Ä¿Áö´Â °æ¿ì´Â °ÅÀÇ ¾ø´Ù°í »ý°¢ÇÕ´Ï´Ù. óÀ½ºÎÅÍ ¾î´À Å©±â¿´´Ù°¡ wax and waneÀ» ÇÏ´Â °æ¿ì°¡ ¸¹¾Æ º¸ÀÔ´Ï´Ù. Áö¼ÓÀûÀ¸·Î linearÇÏ°Ô Ä¿Áö´Â °æ¿ì´Â ¸Å¿ì Àû½À´Ï´Ù. ¿ì¿¬È÷ ¾ÆÁÖ Ã³À½¿¡ ¹ß°ßµÇ¸é ´ÙÀ½ ³»½Ã°æ¿¡¼­ Á¶±Ý ´õ Ä¿Áö°ÚÁö¸¸, º¸Åë Á¦Ç®¿¡ ÁöÃļ­ ¾î´À Å©±â¿¡ µµ´ÞÇÑ ÈÄ ¸ØÃß´Â °Í °°½À´Ï´Ù. ÇöÀúÈ÷ Ä¿Áö¸é ¿ëÁ¾ÀýÁ¦¼úÀ» ÇÒ ¼öµµ ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù¸¸ Àú´Â °æÇèÀÌ ¾ø½À´Ï´Ù.


[¾Öµ¶ÀÚ 2 ÀÇ°ß] º¸ÃÊ ¿ëÁ¾ÀÌ Àǽɵɶ§´Â Á¶Á÷ °Ë»ç¸¦ Ç×»ó ÇØ¾ß Çϳª¿ä? Á¦°¡ À۳⿡ º¸ÃÊ ¿ëÁ¾ÀÎ ÁÙ ¾Ë¾ÒÁö¸¸ ¿ì¿¬È÷ Á¶Á÷°Ë»ç¸¦ Çß´õ´Ï Á¶±â ½Äµµ¾ÏÀÌ Áø´ÜµÇ¾î ³»½Ã°æ ÀýÁ¦¸¦ ½ÃÇàÇÏ¿´´ø ȯÀÚ°¡ ÀÖ¾ú½À´Ï´Ù. ¸¸¾à, Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾Ê¾Ò´Ù¸é °£°úµÇ¾úÀ» °Í °°Àºµ¥, À°¾È ¼Ò°ßÀ¸·Î´Â Á¶±â ½Äµµ¾Ïº¸´Ù´Â º¸ÃÊ ¿ëÁ¾ÀÎ ÁÙ ¾Ë¾Ò¾ú½À´Ï´Ù.

[ÁÖÀÎÀå ´äº¯] ÁÁÀº Áú¹® °¨»çÇÕ´Ï´Ù. ¹°·Ð º¸ÃÊ ¿ëÁ¾À¸·Î »ý°¢ÇÏ¿´´Âµ¥ ¿ì¿¬ÇÑ Á¶Á÷°Ë»ç·Î ½Äµµ¾ÏÀÌ Áø´ÜµÈ ¿¹°¡ ÀÖ½À´Ï´Ù. ±×·¯³ª ´ëºÎºÐ ³»½Ã°æ À°¾È¼Ò°ß¸¸À¸·Îµµ º¸ÃÊ ¿ëÁ¾Àº º¸ÃÊ ¿ëÁ¾À¸·Î, ½Äµµ¾ÏÀº ½Äµµ¾ÏÀ¸·Î Áø´ÜÇÒ ¼ö ÀÖ½À´Ï´Ù. ´Ù¸¸ È®ÀÎÀ» À§ÇÏ¿© óÀ½ ¹ß°ßµÇ¾úÀ» ¶§¿¡´Â Á¶Á÷°Ë»ç¸¦ ÇÒ °ÍÀ» ÃßõÇÕ´Ï´Ù. 1³â ÈÄ ÃßÀû °Ë»ç¿¡¼­ Å« º¯È­°¡ ¾ø´Ù¸é °è¼ÓµÈ Á¶Á÷°Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê´Ù°í »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù.


[¾Öµ¶ÀÚ 3 ÀÇ°ß] ¹«Áõ»ó ERD¸¦ ¾î¶»°Ô ÇÒ °ÍÀΰ¡¿¡ ´ëÇÑ °Í°ú ºñ½ÁÇÑ ¾ê±â¶ó°í »ý°¢ÇÕ´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼­ ERD°¡ ÀÖ´Â °æ¿ì ƯÈ÷ ³²ÀÚ¶ó¸é ´ëºÎºÐ ¿ì¸®°¡ ¾Ë°íÀÖ´Â ÀüÇüÀûÀÎ Áõ»óÀ» Ưº°È÷ È£¼ÒÇÏÁö´Â ¾Ê´õ¶ó±¸¿ä. ±×·¡µµ ȯÀÚ¿¡°Ô ´ç½ÅÀÌ Á¤»óÀÌ ¾Æ´Ï´Ù, »ýÈ°½À°ü ±³Á¤À» ÇؾßÇÑ´Ù´Â Ãø¸é¿¡¼­ 1-2´Þ Á¤µµÀÇ PPI¸¦ ±ÇÀ¯ÇÏ°í ÀÖ½À´Ï´Ù. ¿ÀÈ÷·Á Áõ»óÀÌ ¾ø´Â °Ô ´õ ¹«¼­¿ï ¼ö°¡ ÀÖ´Ù°í ¾ê±âÇÕ´Ï´Ù. (³ªÁß¿¡ hiatal hernia°¡ µÉ ¼ö ÀÖÀ» °¡´É¼º..)

Sentinel polyp¿¡ ´ëÇؼ­µµ ´ëºÎºÐ erosionÀ» µ¿¹ÝÇϱ⠶§¹®¿¡ 1-2´ÞÀÇ ¾à¹°Ä¡·á¸¦ ±ÇÇÏ°í ÃßÀû°üÂûÀ» ÇÕ´Ï´Ù. 10³âµ¿¾È º¯È­°¡ ¾ø´Â ȯÀÚÀÇ °æ¿ì ù 2´ÞÀÇ PPI°¡ Àǹ̰¡ ¾ø°ÚÁö¸¸¿ä... ÀûÀýÇÑ ¾à¹°Ä¡·á¿Í »ýÈ°½À°ü ±³Á¤À¸·Î Ä¡·áÇÒ ¼ö ÀÖ´Ù´Â °ÍÀ» °­Á¶Çϱâ À§ÇØ ¾àÀ» ÁÝ´Ï´Ù. ¿ì¸®³ª¶ó ¹®È­´Â ¾àÀ» ¾È ¸ÔÀ¸¸é ´ëºÎºÐ ±¦Âú´Ù°í »ý°¢ÇÕ´Ï´Ù. ÀúÈñ°¡ ¿­½ÉÈ÷ ¼³¸íÇÑ´Ù°í ÇÏ´õ¶óµµ ¾àÀ» ÁÖÁö ¾ÊÀ¸¸é ±¦Âú´Ù°í »ý°¢ÇÒ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. °á·ÐÀûÀ¸·Î sentinel polyp¿¡ ´ëÇؼ­ PPI 1-2´Þ Ä¡·á ÈÄ Ã³À½ Áø´ÜµÈ °æ¿ì 6°³¿ù ³»Áö 1³â ÈÄ follow-up ³»½Ã°æÀÌ ÇÊ¿äÇÏ´Ù°í ¼³¸íÇÏ°í ÀÖ½À´Ï´Ù.

[ÁÖÀÎÀå ´äº¯] ¹«Áõ»ó erosive esophagitisÀÇ Ä¡·á¿¡ ´ëÇÑ °ßÇØ´Â ´Ù¾çÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù. Àú´Â ¾à¹°Ä¡·á¸¦ ±ÇÇÏÁö ¾Ê°í ÀÖÁö¸¸, ¾à¹°Ä¡·á¸¦ ±ÇÇÏ´Â ¼±»ý´ÔµéÀÇ °ßÇصµ Àǹ̰¡ ÀÖ´Ù°í »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù. ÇÑ ¸¶µð·Î ´äÀÌ ¾ø´Â °ÍÀÌÁö¿ä. ´Ù¸¸ ȯÀÚ¿¡ µû¶ó ´Þ¶óÁú ¼ö ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù. 1Â÷ º´¿øÀÌ ´Ù¸£°í 2Â÷ º´¿ø, 3Â÷ º´¿øÀÌ ´Ù¸£´Ù°í »ý°¢ÇÕ´Ï´Ù. ¼­¿ïÀÇ º´¿øÀÌ ´Ù¸£°í ±¤¿ª½ÃÀÇ º´¿øÀÌ ´Ù¸£°í À¾¸éÀÇ º´¿øÀÌ ´Ù¸¦ °Í °°½À´Ï´Ù. ÀÚ½ÅÀÇ °ßÇØ¿Í È¯ÀÚÀÇ Æ¯¼ºÀ» Àß °í·ÁÇÏ¿© »óȲº°·Î ÃÖ¼±ÀÇ ´äÀ» ãÀ¸¸é µÇÁö ¾ÊÀ»±î¿ä? ¾îÂ¥ÇÇ Á¤´äÀÌ ¾ø´Â ¹®Á¦À̴ϱî...


[¾Öµ¶ÀÚ 4 ÀÇ°ß] EndoTODAYÀÇ ¿­·ÄÇÑ ±¸µ¶ÀÚ ÀÔ´Ï´Ù. Sentinel polyp part¸¦ ÃÖ±Ù Àоú½À´Ï´Ù. ÃÖ±Ù ³»½Ã°æ case¿¡¼­ sentinel polyp¼Ò°ßÀÌ ÀÖ¾î ÷ºÎÇÕ´Ï´Ù. 1³âÀü »çÁøµµ ÀÖ½À´Ï´Ù. À°¾ÈÀûÀ¸·Î´Â sentinel polypÀ̶ó°í »ý°¢µÇ¸ç 1³âÀÌ Áö³ª Å©±â³ª ¹ßÀûÀÇ Á¤µµ´Â ÁÙ¾îµéÀº °ÍÀ¸·Î »ý°¢µË´Ï´Ù. ±×·¯³ª, Á¶Á÷°Ë»ç´Â µÎ¹ø ¸ðµÎ squamous papilloma¶ó°í ³ª¿Ô½À´Ï´Ù. ÷ºÎÇÑ PDF ÆÄÀÏÀ» º¸¸é inflammatory polyp ºÎºÐ¿¡¼­ "The typical features area mixture of granulation tissue and in?ammation of the lamina propria covered by squamous epithelium showing features of basal hyperplasia... In the past, several of these have been erroneously reported as squamous cell papilloma."¶ó´Â ¼³¸íÀÌ Àִµ¥ ÀÌ caseÀÇ Á¶Á÷ ¼Ò°ßÀº À§ÀÇ ¼³¸í°ú °°Àº °ÍÀÌ ¾Æ´Ñ°¡ »ý°¢µË´Ï´Ù. Sentinel polypÀ¸·Î »ý°¢ÇÏ¿© 1-2³â µÚ f/uÇϱâ·Î ÇÏ¿´½À´Ï´Ù. ±³¼ö´ÔÀÇ ÀÇ°ßÀ» ¾î¶°ÇϽÅÁö¿ä.


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[ÁÖÀÎÀå ´äº¯] ÁÁÀº Áõ·Ê °¨»çÇÕ´Ï´Ù. ³»½Ã°æ À°¾È¼Ò°ßÀº ÀüÇüÀûÀÎ sentinel polypÀÔ´Ï´Ù. Squamocolumnar junction Á÷»ó¹æÀÇ µÕ±Ù sessile polypÀε¥, Ç¥¸éÀº ¹ßÀûµÇ¾î ÀÖ°í ¾à°£ Èò»öÀÇ ±×¹°¸ð¾çÀÇ ÁÙÀÌ ÀÖ½À´Ï´Ù. PolypÀÇ ¾Æ·¡·Î´Â stomach high body·ÎºÎÅÍ ²ø·Á¿À´Â µíÇÑ ¸ð¾çÀÇ fold°¡ ÀÖÀ¸¸ç polypÀÇ À§ÂÊÀ¸·Î´Â »ï°¢Çü ȤÀº ¸¶¸§¸ð²Ã ¸ð¾çÀÇ ³ÐÁö¸¸ ªÀº mucosal break°¡ ÀÖ½À´Ï´Ù. ÀüÇüÀûÀÎ hiatal hernia´Â ¾øÁö¸¸ 2013³â ³»½Ã°æ ¿ø°æ »çÁøÀ» º¸¸é ¼ÒÀ§ short segment hiatal hernia°¡ ÀÖÀ¸¸é¼­ ÇϺΠ½ÄµµÀÇ Á¡¸·Àº ¾à°£ µÎ²¨¿öÁ® dirty white discolorationÀ» º¸ÀÌ°í ÀÖÀ¸¸ç ÀÌ·Î ÀÎÇÏ¿© pallisading vesselÀÌ Àß º¸ÀÌÁö ¾Ê°í ÀÖ½À´Ï´Ù. ÀÌ·¯ÇÑ ¼Ò°ßµéÀº ÀüºÎ ÀüÇüÀûÀÎ sentinel polyp (= inflammatory polyp)ÀÇ ¼Ò°ßÀÔ´Ï´Ù. Á¶Á÷°Ë»ç¿¡¼­ papilloma·Î ¿ÀÀ뵃 ¼ö ÀÖ´Ù´Â ¼±»ý´ÔÀÇ ¾ð±Þ¿¡ 100% °°Àº ÀÇ°ßÀÔ´Ï´Ù. Àú´Â ȯÀÚ°¡ À§½Äµµ¿ª·ùÀÇ Áõ»óÀÌ ÀÖÀ¸¸é PPI¸¦ µå¸®°í ±×·¸Áö ¾ÊÀ¸¸é PPI¸¦ µå¸®Áö ¾Ê°í ÀÖ½À´Ï´Ù. üÁß°ü¸®, ÀûÀýÇÑ ¿îµ¿, ¾ß½Ä, °ú½Ä, Áö¹æ½Ä ÇÇÇÏ±â µî »ýÈ°½À°ü °³¼±¸¸ ±ÇÇÏ°í ÀÖ½À´Ï´Ù.

¼±»ý´Ô²²¼­ º¸³»ÁֽŠÀÚ·á Gastrointestinal Polyps (Edited by Najib Y. Haboubi, Karel Geobes, Neil A. Shepherd and Ian C. Talbot)ÀÇ inflammatory polypÀ̶ó´Â Á¦¸ñ ¾Æ·¡¿¡ ¼³¸íµÈ ºÎºÐÀ» ¿©·¯ ¾Öµ¶ÀÚ¸¦ À§ÇÏ¿© ÀÌ°÷¿¡ ¿Å°Üº¸°Ú½À´Ï´Ù.

1) Synonym: oesophagogastric polyp, inflammatory reflux polyp, oesophagogastric polyp-fold complex

2) Endoscopic appearance:
- Characteristically these appear as a solitary small sessile polypoid lesion occurring at or near the gastro-oesophageal junction. Less commonly they can appear as multiple small sessile polypoid lesions.
- Endoscopically the lesions are round.
- They vary from 5-20 mm in diameter, with a smooth and erythematous surface, often with a small superficial erosion on the top.
- Endoscopic features of oesophagitis are often found.
- There may be a prominent fold of mucosa (a sentinel fold) leading up to the polyp from the gastro-oesophageal junction.

3) Microscopic features: The typical features are a mixture of granulation tissue and inflammation of the lamina propria covered by squamous epithelium showing features of basal hyperplasia, with varying erosion of the epithelium and often marked active inflammatory cell infiltrate. Sometimes the polyp is partially covered by junctional columnar epithelium. The adjacent oesophageal mucosa is usually inflamed.

4) Biological behaviour and associated conditions: Inflammatory polyps develop mostly in patients with a hiatus hernia and/or with reflux oesophagitis. They can also occur in patients without such a history and in patients with other less common causes of oesophagitis. They are entirely benign. In the past, several of these have been erroneously reported as squamous cell papilloma.

5) Management: No treatment is needed, except for the associated oesophagitis.

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