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[Soonchunhyang International Conference of Interventional Endoscopy and Laparoscopy (¼øõÇâ ½ÉÆ÷Áö¾ö)]

¼øõÇâ´ëÇп¡¼­ ÁغñÇÑ ESD ½ÉÆ÷Áö¾ö¿¡ ´Ù³à¿Ô½À´Ï´Ù.


1. How I do it - Esophagus (µ¿¾Æ´ëÇб³ ÀåÁø¼®)

Who are expert endoscopist? (Japanese Society of Esophageal Diseases Guideline)
1) Experienced more than 5,000 EGDs, and all of them had specialist qualifications from the Japan Gastroenterological Endoscopy Society.
2) Each endoscopist had more than 1year of experience with NBI, and had performed NBI in more than 150 cases.

Á¶ÁÖ¿µ ¼±»ý´Ô²²¼­´Â ESD candidateÀÎ Á¶±â½Äµµ¾Ï¿¡¼­ Á¶Á÷°Ë»ç ¾øÀÌ NBI Áø´Ü ÈÄ ¹Ù·Î Ä¡·áÇÒ °ÍÀ» Á¦¾ÈÇϼ̽À´Ï´Ù. ÀåÁø¼® ¼±»ý´ÔÀº minimal biopsy´Â ÇÊ¿äÇÏ´Ù´Â ÀÇ°ßÀ» Áּ̽À´Ï´Ù. Satoshi Tanabe ¼±»ý´ÔÀº ÀϺ»¿¡¼­µµ ESD Àü¹®°¡´Â no biopsy¸¦ ÃßõÇÏÁö¸¸ º»ÀÎÀº minimal biopsy (1°³?)¸¦ ÃßõÇϼ̽À´Ï´Ù.

ÀÌÁØÇà ÀÇ°ß: ¿ì¸®³ª¶ó ÀÇ·áÇö½Ç¿¡¼­ Á¶Á÷°Ë»ç ¾øÀÌ Ä¡·áÇÏ´Â °ÍÀº »çȸÀû, ¹ýÀû ¹®Á¦¸¦ ÀÏÀ¸Å³ À§ÇèÀÌ Å®´Ï´Ù. ¿¹¸¦ µé¾î Á¶Á÷°Ë»ç ¾øÀÌ ESD¸¦ ÇÑ ÈÄ ÃÖÁ¾ °á°ú°¡ nonspecificÀ¸·Î ³ª¿À¸é ºñ¿ë¹®Á¦, °úÀ×Ä¡·á À̽´ µîÀÌ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. Ưº°ÇÑ °æ¿ì°¡ ¾Æ´Ï¶ó¸é 2°³ Á¤µµÀÇ Á¶Á÷°Ë»ç´Â ÇÊ¿äÇÏ´Ù°í º¾´Ï´Ù.


2. How I do it - Stomach (°æÈñ´ëÇб³ ÀåÀ翵)


ÀåÀ翵 ±³¼ö´Ô²²¼­ EndoTODAY¸¦ À§ÇÏ¿© Á¦°øÇØ ÁֽŠ»çÁøÀÔ´Ï´Ù. À§½Äµµ Á¢ÇպΠ¾Ï (SM cancer).


À§ ȯÀÚÀÇ 1³â Àü ³»½Ã°æ »çÁø. 1³â Àü¿¡´Â º´¼Ò°¡ ¾ø¾úÀ»±î? ÀÖ±â´Â Çѵ¥ ³Ê¹« ¹Ì¼¼Çß´ø °ÍÀϱî?

ÀåÀ翵 ±³¼ö´Ô²²¼­´Â LASEREO system (Fujifilm)µµ ¼Ò°³ÇØ Áּ̽À´Ï´Ù.
1) Normal: white light observation
2) FICE: color enhancement
3) BLI: Observation of vessel and mucosal structure. peak wavelength 410 nm
4) BLI-bright: Observatin of vessel and mucosal structure


Literature PDF 3.5 M

Á¶Á÷°Ë»ç¿¡ ´ëÇؼ­´Â 1985³â Gut¿¡ ½Ç¸° Daesh µîÀÇ ³í¹®À» ¼Ò°³ÇØ Áּ̽À´Ï´Ù (Comparison of weight, depth, and diagnostic accuracy of specimens obtained with 16 different biopsy forceps designed for gastrointestinal endoscopy). °á·ÐÀº ´ÙÀ½°ú °°¾Ò½À´Ï´Ù.

In vitro and in vivo in the dog, the standard sized forceps also produced specimens of greater diagnostic adequacy than the paediatric forceps. At endoscopy in patients, however, we could not detect any influence of the size, shape, and presence of forceps spike or fenestration on the diagnostic adequacy of the specimens.

ÀÌÁØÇà ÀÇ°ß: Å« °âÀÚ·Î °­ÇÏ°Ô ´­·¯ Á¶Á÷°Ë»ç¸¦ Çϸé Á¶±Ý ´õ Å« Á¶Á÷À» ¾òÀ» ¼ö ÀÖÀ» °ÍÀÔ´Ï´Ù. ±×·¯³ª ÃÖ±Ù ³»½Ã°æÀº 30³â Àü ³»½Ã°æ¿¡ ºñÇÏ¿© ÈξÀ ¼±¸íÇϱ⠶§¹®¿¡ ÀÚ¼¼È÷ °üÂûÇÏ°í ¼¶¼¼ÇÏ°Ô target biopsy¸¦ ÇÑ´Ù¸é ÀÛÀº °âÀÚ·Î »ì¦ Á¶Á÷°Ë»ç¸¦ Çصµ Áø´ÜÀ²À» À¯ÁöÇÒ ¼ö ÀÖ´Ù°í º¾´Ï´Ù.


4. How I do it - Colon (¼øõÇâ´ëÇб³ °íºÀ¹Î)

Advanced adenoma ȤÀº colon cancer miss rate: 2-6%


5. Confocal laser endomicroscopy (CLE) - Tao Yu, Shangdong University Qilu Hospital

Confocal microscopy´Â 1955³â¿¡ Marvin Minsky ¹Ú»ç°¡ °³¹ßÇÏ¿´½À´Ï´Ù. 4³â Àü probe-based CLE°¡ °³¹ßµÇ¾ú½À´Ï´Ù.

Diagnosis systems for CLE
1) Mainz's criteria for colorectal pathology
2) Quli classification for gastric disease
3) Miami classification for pCLE


6. ESD for EGC - strategy after noncurative resection (¼øõÇâ´ëÇб³ È«¼öÁø)

È«±³¼ö´Ô²²¼­´Â differentiated typeÀÌ°í only lateral margin positiveÀÎ °æ¿ì 6mm ÀÌÇϸé closed observation ȤÀº endoscopic surgery¸¦ ±ÇÇÏ´Â algorithmÀ» ¼Ò°³ÇØ Áּ̽À´Ï´Ù. ±×¸®°í undifferentiated EGCÀÇ incomplete resection¿¡¼­´Â ¹Ýµå½Ã ¼ö¼úÀÌ ÇÊ¿äÇÏ´Ù´Â Á¡À» °­Á¶Çϼ̽À´Ï´Ù. ±×·±µ¥ ESD ÈÄ Àǻ簡 ¼ö¼úÀ» ±ÇÇÑ È¯ÀÚ Áß ÀϺδ ¼ö¼úÀ» ¹ÞÁö ¾Ê½À´Ï´Ù (10~40%). ÀÌ ºÎºÐ¿¡ ´ëÇÑ ÁúÀÇ ÀÀ´äÀÌ ÀÖ¾ú½À´Ï´Ù.

¾Æ·¡´Â È«¼öÁø ±³¼ö´Ô ÆÀ¿¡¼­ 2013³â Gastrointestinal Endoscopy¿¡ ¹ßÇ¥ÇÑ lateral margin positivity °ü·Ã ³í¹®ÀÇ ÀϺÎÀÔ´Ï´Ù (Han & Hong GIE 2013:78:956-961).

Âü°í: EndoTODAY on multiple lateral margin positive cases


7. ESD for SET - clinical outcomes in Korea (°¡Ãµ´ëÇб³ ±è°æ¿À)

endoscopic submucosal tunnel resection

endoscopic submucosal & muscular resection

R1 resectionÀÇ ÃßÀû°üÂû¿¡ ´ëÇÑ Áú¹®ÀÌ ÀÖ¾ú°í ¾ÆÁ÷ R1ÀÇ Àǹ̰¡ ºÒºÐ¸íÇÏ´Ù´Â ¿¬ÀÚÀÇ ´äº¯ÀÌ ÀÖ¾ú½À´Ï´Ù. ÁÂÀåÀ̽ŠÀüÈÆÀç ±³¼ö´Ô²²¼­µµ demarcationÀÌ ÁÁÀº °æ¿ì Àç¹ßÇÏÁö ¾Ê´Â´Ù´Â °æÇèÀ» ¼Ò°³Çϼ̽À´Ï´Ù. ¶Ç ´Ù¸¥ ÁÂÀåÀ̽ŠTanabe ¼±»ý´ÔÀº ÀϺ»¿¡¼­´Â LECS (laparoscopy endoscopy collaboration surgery)°¡ ¸¹ÀÌ ¾²ÀÎ´Ù°í ¼Ò°³ÇØ Áּ̽À´Ï´Ù.


8. Pathologic consultation for endoscopists (ÀÎÇÏ´ëÇб³ º´¸®°ú ±èÁعÌ)

Àú´Â ¾Æ·¡¿Í °°Àº Áú¹®À» Çß½À´Ï´Ù.

We endoscopists see the pathology report only. We don't know whether the case was difficult by the pathologists' point of view. Sometimes I make a call to a pathologist to discuss some pathology report. Quite often, I am surprised to find that my interpretation of the pathology report is a little bit different from the pathologist's interpretation. Communication is an issue here. So my question is ... How do you communicate with your endoscopists other than pathology report and how often?

±èÁØ¹Ì ¼±»ý´Ô²²¼­´Â ³»½Ã°æ Àǻ簡 º´¸®°ú¸¦ ¹æ¹®ÇÏ¿© ½½¶óÀ̵带 º¸¿©´Þ¶ó°í ¿äûÇÏ´Â °æ¿ì°¡ Àִµ¥ ¸Å¿ì µµ¿òÀÌ µÈ´Ù°í Çϼ̽À´Ï´Ù. º´¸®°ú¿¡¼­µµ ³»½Ã°æ Àǻ翡°Ô °¡²û ÀüÈ­¸¦ °É°Å³ª text message¸¦ º¸³»±âµµ ÇÑ´Ù°í ÇÕ´Ï´Ù. °í¸¶¿î ÀÏÀÌ ¾Æ´Ò ¼ö ¾ø½À´Ï´Ù. ±×·¸½À´Ï´Ù. ¿ì¸® ³»½Ã°æÀǻ簡 º´¸®°ú¸¦ Á» ´õ ÀÚÁÖ Ã£¾Æ°¡¾ß°Ú´Ù´Â »ý°¢ÀÌ µé¾ú½À´Ï´Ù. º´¸®°ú ¼±»ý´ÔÀÌ ¿ì¸®¿¡°Ô ÀüÈ­¸¦ ÇØ Áֽô °Íµµ ¾ðÁ¦³ª ȯ¿µÀÌÁö¸¸.


9. Difficult cases of ESD (Satoshi Tanabe, Kitasato University Hospital)


Tanabe ¼±»ý´ÔÀÌ ESD ÇϽô settingÀ» º¸¿©ÁÖ´Â ½½¶óÀ̵åÀÔ´Ï´Ù. Âü°í°¡ µÉ °Í °°³×¿ä.


2014³â 8¿ù±îÁöÀÇ ÀڷḦ º¸¿©ÁÖ¾ú´Ù´Â Á¡¿¡ ³î¶ú½À´Ï´Ù. ÀϺ»ÀÇ major endoscopy center¿¡¼­´Â ¸ðµÎ realtimeÀ¸·Î µ¥ÀÌŸ¸¦ ³Ö°í ºÐ¼®ÀڷḦ »ÌÀ» ¼ö ÀÖ´Â ½Ã½ºÅÛÀ» °®Ãß°í ÀÖ½À´Ï´Ù. À̸¦ À§Çؼ­ ½Ã¼úÀÌ ³¡³ª¸é Áï½Ã »ó¼¼ÇÑ ÀڷḦ ³Ö¾î¾ß ÇÕ´Ï´Ù. Á¦°¡ °ú°Å¿¡ ½ºÁî¿ÀÄ« ¾Ï¼¾Å͸¦ ¹æ¹®ÇÏ¿´À» ¶§ ´ÚÅÍ ¿À³ë´Â ÇÑ Áõ·Ê ´ç 10-15ºÐ Á¤µµ ÀڷḦ ÀÔ·ÂÇÏ°í ÀÖ¾ú½À´Ï´Ù. °£È¤ ½Ã¼ú½Ã°£º¸´Ù ÀÚ·áÀԷ½ð£ÀÌ ´õ ±ä °æ¿ìµµ ÀÖ´Ù°í µé¾ú½À´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼­ ÀÌ·¸°Ô ½Ã¼úÀÚ°¡ »ó¼¼È÷ ÀڷḦ ÀÔ·ÂÇÏ´Â ¿¹´Â °ÅÀÇ ¾ø´Â °Í °°½À´Ï´Ù. ¿ì¸®´Â ÀÚ¸£±âµµ ¹Ùºü ±â·Ï¿¡´Â ½Ã°£À» ³»Áö ¸øÇÏ´Â »óȲÀÔ´Ï´Ù. Á» ¿©À¯¸¦ °¡Á®¾ß ÇÒ °Í °°½À´Ï´Ù.


Á¢±ÙÀÌ ±î´Ù·Î¿î °æ¿ì »ç¿ëÇÒ ¼ö ÀÖ´Â ¹æ¹ýµéÀÔ´Ï´Ù. ÀÌ Áß Tanabe ±³¼ö´ÔÀº double scope method¸¦ »ç¿ëÇÑ´Ù°í ÇÕ´Ï´Ù. À۳⿡ ³ª¿Â ³í¹®À» ¼Ò°³ÇØ Áּ̽À´Ï´Ù. Double-endoscope endoscopic submucosal dissection for the treatment of early gastric cancer accompanied by an ulcer scar (with video) Gastrointest Endosc 2013;78:266-73