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ÀϽà : 2016³â 10¿ù 1ÀÏ 14:30~20:30

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1. Ç︮ÄÚ¹ÚÅÍ Ä¡·á Á¦´ë·Î Çϱâ (Á¦ÁÖ´ëÇб³ ³ª¼ö¿µ)

Á¦±ÕÄ¡·á¿¡¼­ À§»ê ºÐºñ ¾ïÁ¦´Â ¸Å¿ì Áß¿äÇÕ´Ï´Ù.

Clarithromycin ³»¼º±ÕÁÖ¿¡¼­ p-CABÀÌ À¯¸ÁÇÒ °Í °°½À´Ï´Ù.

AmoxicillinÀ» ÇÏ·ç 4¹øÀ¸·Î ³ª´² ÁÖ¸é Á¦±ÕÀ²ÀÌ ³ô¾ÆÁý´Ï´Ù.

Èí¿¬Àº Á¦±ÕÀ²À» ³·Ãä´Ï´Ù.

* ÁÂÀå (Á¤ÈÆ¿ë ¼±»ý´Ô) comment: PPI-based triple therapyÀÇ È¿°ú°¡ ³·¾ÆÁö°í À־ Á¶¸¸°£ ÀÏÂ÷¿ä¹ý¿¡¼­ Á¦¿ÜµÉ °¡´É¼ºÀÌ ÀÖ½À´Ï´Ù. °ü·Ã ±¹Ã¥¿¬±¸°¡ ÁøÇà ÁßÀÔ´Ï´Ù.


2. ³»½Ã°æ ±¸Á¶¿Í ¿ø¸®. Á¦´ë·Î ¾Ë°í »ç¿ëÇϱâ (ÀÎÁ¦´ëº´¿ø ¹®Á¤¼·)

1997³â 3¿ù 13ÀÏ Áß¾ÓÀϺ¸¿¡ ½Ç¸° Ȳ¼¼Èñ ±âÀÚÀÇ ±â»çÀÔ´Ï´Ù. ¾Æ·¡ Àü¹®À» ¿Å±é´Ï´Ù.

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ÇöÀç À§.½ÊÀÌÁöÀå ±Ë¾çÀ» ÀÏÀ¸Å°´Â Ç︮ÄÚ¹ÚÅÍÀÇ °æ¿ì ³»½Ã°æÀ» ÅëÇÑ °¨¿°·üÀÌ 50% ÀÌ»óÀ¸·Î ÃßÁ¤µÈ´Ù. ¿ì¸®³ª¶ó ¼ºÀÎÀÇ Ç︮ÄÚ¹ÚÅÍ °¨¿°·üÀº 60~80%.¿©±â¿¡ ÃÖ±Ùµé¾î ÀÌÀÇ °¨¿°¿©ºÎ¸¦ ¾Ë±â À§ÇØ À§³»½Ã°æ °Ë»ç¸¦ ¹Þ´Â À̵éÀÌ ´Ã°í ÀÖ¾î ¹®Á¦ÀÇ ½É°¢¼ºÀ» ´õÇØÁÖ°í ÀÖ´Ù.Áï À§³»½Ã°æÀ¸·Î °üÂûÇßÀ» ¶§ ±Ë¾ç.¾ÏµîÀ» ÀǽÉÇÒ ¸¸ÇÑ ¾Æ¹«·± ¼Ò°ßÀÌ ¾ø´Âµ¥µµ À§ Á¶Á÷°Ë»ç¸¦ ÇÏ´Â °æÇâÀÌ ÀÖ´Ù´Â °Í.¼­¿ï´ëº´¿ø ³»°ú ¼ÛÀμº(áäìÒá¤)±³¼ö´Â¡°Ç︮ÄÚ¹ÚÅÍ´Â ±Ë¾çȯÀÚ ¿Ü¿¡´Â Ưº°ÇÑ °æ¿ì¸¦ Á¦¿ÜÇÏ°ï Ä¡·áÇÒ ÇÊ¿ä°¡ ¾øÀ» »Ó¸¸ ¾Æ´Ï¶ó ÀÌ ±ÕÀº Ç÷û¹× È£Èí±â °Ë»ç¸¦ ÅëÇؼ­µµ È®ÀÎÇÒ ¼ö ÀÖÀ¸¹Ç·Î ±»ÀÌ ³»½Ã°æÀ¸·Î Á¶Á÷°Ë»çÇÒ ÇÊ¿ä´Â ¾ø´Ù¡±°í °­Á¶Çß´Ù.

ÀÌ°°Àº °¨¿°ÀÇ À§Ç輺¿¡ ´ëÇØ ÀÇÇаèÀÇ ½ÇÅÂÁ¶»ç³ª º´¿øÃøÀÇ ´ëÃ¥Àº ÇöÀç Àü¹«ÇÑ ½ÇÁ¤.º´¿ø °ü°èÀÚµéÀº¡°°Ë»çÇÑ ³»½Ã°æ.Á¶Á÷°Ë»ç ±â±¸.¹°º´µîÀ» 2% ±Û·çŸ¸£¾Ëµ¥ÇÏÀ̵å¶õ ¼Òµ¶¾àÀ¸·Î 30ºÐÁ¤µµ öÀúÈ÷ ¼Òµ¶ÇÏ¸é ¿¹¹æÀÌ °¡´ÉÇÏ´Ù¡±°í ÇÏÁö¸¸ ÁÖ¿ä ³»½Ã°æ¼¾ÅÍÀÇ ÇÏ·ç °Ë»çÀοøÀÌ ¼ö½Ê¸í¿¡¼­ ¸¹°Ô´Â 1¹é¸í ÀÌ»ó µÇ±â ¶§¹®¿¡ °ú¿¬ öÀúÇÑ ¼Òµ¶ÀÌ ÀÌ·ç¾îÁö°í ÀÖ´ÂÁö¿¡ ´ëÇؼ­´Â Àü¹®°¡µéµµ ȸÀÇÀûÀÌ´Ù. Sº´¿ø °¨¿°°ü¸®À§¿øÀåÀ» ¸Ã°í ÀÖ´Â P±³¼ö´Â¡°ÇÐȸÀÇ ¼Òµ¶±ÔÁ¤À» Áöų °æ¿ì ³»½Ã°æ ÇÑ´ë·Î ÇÏ·ç °Ë»çÇÒ ¼ö ÀÖ´Â ÀοøÀÌ 5~6¸í¿¡ ºÒ°úÇÏ´Ù¡±¸ç¡°±×·¯³ª º´¿ø °æ¿µ»ó °í°¡ÀÇ ³»½Ã°æ°ú ¼¼Ã´±â¸¦ ´Ã¸± ¼ö ¾ø´Â °ÍÀÌ Çö½Ç¡±À̶ó°í ½ÇÅäÇÑ´Ù.

»ï¼º¼­¿ïº´¿ø ¼ÒÈ­±â³»°ú ÀÌÁ¾Ã¶(×Ýñ£ôË)±³¼ö´Â¡°°¨¿° °¡´É¼ºÀ» ¹Ì¸® ¸·±â À§ÇØ °¡Àå Áß¿äÇÑ °ÍÀº ÀÇ·áÀΰú º´¿ø °æ¿µÀÚ°¡ ÀÇ·áÀÇ ÁúÀ» ³ôÀÌ·Á´Â Àνġ±À̶ó¸ç¡°º´¿ø¿¡¼­´Â ½Ã¼³°³¼±À» À§ÇÑ ÅõÀÚ¸¦ ¾Æ³¢Áö ¸»¾Æ¾ß ÇÏ°í Á¤ºÎÂ÷¿ø¿¡¼­´Â ³»½Ã°æ ¼ö°¡ÀÇ Àλó°ú ¼Òµ¶ºÎºÐÀÇ ÀǷẸÇè¼ö°¡¸¦ ÀÎÁ¤ÇØ¾ß ÇÒ °Í¡±À̶ó°í °­Á¶Çß´Ù. ¹°·Ð ÀÌ°°Àº °¨¿° °¡´É¼ºÀ» °¨¾ÈÇÏ´õ¶óµµ ³»½Ã°æ °Ë»çÀÇ À¯¿ë¼º°ú Çʿ伺Àº µÎ¸»ÇÒ ÇÊ¿äµµ ¾ø´Ù.

áä±³¼ö´Â¡°À§³»½Ã°æ °Ë»ç´Â (1) ¼ÒÈ­ºÒ·®.¼Ó¾²¸².üÁß°¨¼ÒµîÀÇ À§ÀåÁúȯ Áõ»óÀÌ 1°³¿ù ÀÌ»ó Áö¼ÓµÇ´Â »ç¶÷ (2)¾Æ¹«·± Áõ»óÀÌ ¾ø´õ¶óµµ 40¼¼ ÀÌÈÄ¿£ Á¶±âÀ§¾Ï Áø´ÜÀ» À§ÇØ 3³â¿¡ Çѹø¾¿Àº ¹Þ¾Æ¾ß ÇÑ´Ù¡±°í ±ÇÀåÇÑ´Ù.Áï 1°³ÀÇ ¾Ï¼¼Æ÷°¡ ³»½Ã°æ °Ë»ç·Î °üÂûµÉ ¸¸ÇÑ Å©±â·Î ÁøÇàµÉ ¶§±îÁöÀÇ ±â°£Àº 2³â¹Ý Á¤µµÀ̹ǷΠ3³âÁ¤µµ¿¡ Çѹø¾¿¸¸ ³»½Ã°æ °Ë»ç¸¦ ÇÏ¸é ´ëºÎºÐÀº Á¶±âÀ§¾Ï ¹ß°ßÀÌ °¡´ÉÇÏ´Ù´Â °ÍÀÌ´Ù. ¡´È²¼¼Èñ Àü¹®±âÀÚ.Àǻ硵

¹®Á¤¼· ±³¼ö´ÔÀÇ °­ÀǸ¦ µè°í PD ¼öøÀ» °Ë»öÇØ º¸¾Ò½À´Ï´Ù. µ¿¿µ»óÀ» º¸±â´Â ¾î·Á¿ü´Âµ¥, PD ¼öøÀ» ¿ä¾àÇÑ blog¸¦ ãÀ» ¼ö ÀÖ¾ú½À´Ï´Ù. ¾Æ·¡´Â PD ¼öø ´Ù½Ã º¸±â ½ºÅ©¸° ¼¦ÀÔ´Ï´Ù.


3. À§½ÄµµÁ¢Çպκ´º¯ (¼º±Õ°ü´ëÇб³ »ï¼º¼­¿ïº´¿ø ÀÌÁØÇà)

Àú´Â ȯÀÚÀÇ Áõ»óÀ» Àß ¹°¾îº» ÈÄ ³»½Ã°æ °Ë»ç¸¦ ½ÃÀÛÇØ¾ß ÇÑ´Ù´Â Á¡À» °­Á¶ÇÏ¿´½À´Ï´Ù. GE junction cancer ȯÀÚ Áß ¸î ´Þ Àü ³»½Ã°æ °Ë»ç¸¦ ¹Þ¾Ò´ø °ú°Å·ÂÀ» °¡Áø °æ¿ì°¡ ÀÖ½À´Ï´Ù. Ȥ½Ã Àǻ簡 ȯÀÚÀÇ Áõ»óÀ» Àß ¾Ë°í ÀÖ¾ú´Ù¸é missÇÒ È®·üÀÌ Á¶±ÝÀÌ¶óµµ ³·¾ÒÀ» °ÍÀÔ´Ï´Ù. Dysphagia Áõ»óÀÌ ÀÖ´Ù¸é GE junctionÀ» ´õ ÀÚ¼¼È÷ °üÂûÇÒ °ÍÀ̱⠶§¹®ÀÔ´Ï´Ù.

°£È¤ Àǻ簡 ȯÀÚ¸¦ ¸¸³ª±â Àü¿¡ sedation ¾àÁ¦¸¦ Åõ¿©ÇÏ´Â ³»½Ã°æ½ÇÀÌ Àִµ¥ ÀÌ´Â ¸Å¿ì ÁÁÁö ¾Ê´Ù°í »ý°¢ÇÕ´Ï´Ù. ȯÀÚ¿Í Àǻ簡 ¸î ¸¶µð¶óµµ ³ª´« ÈÄ sedation ¾àÁ¦¸¦ Åõ¿©ÇØ¾ß ÇÕ´Ï´Ù. ȯÀÚ°¡ ¾î¶² Áõ»óÀ» °¡Áö°í ÀÖ´ÂÁö ³»½Ã°æ °Ë»ç Á÷Àü ²À ´Ù½Ã Çѹø ¹°¾îº¸½Ã±â ¹Ù¶ø´Ï´Ù. ÀÌ·± °üÁ¡¿¡¼­ Àú´Â Áø´Ü ³»½Ã°æÀ» ¾ç¹æ¿¡¼­ ÇÏ´Â °ÍÀº ÁÁÁö ¾Ê´Ù°í »ý°¢ÇÕ´Ï´Ù.

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4. ³»½Ã°æÀ» Àß ÇÏ´Â ÆÁ (¼­¿ï¾Æ»êº´¿ø Á¤ÈÆ¿ë)

Á¤ÈÆ¿ë ±³¼ö´ÔÀº µÎ °¡Áö¸¦ °­Á¶Çϼ̽À´Ï´Ù. (1) Àß ¹Þ´Â ¹ýÀ» ¾Ë¾Æ¾ß Àß ÇÒ ¼ö ÀÖ½À´Ï´Ù. (2) FeedbackÀÌ Áß¿äÇÕ´Ï´Ù.


5. ´ëÀå Æú¸³ ÀýÁ¦¼ú (¼øõÇâ´ëÇб³ °íºÀ¹Î)

Bowel preparationÀÌ Áß¿äÇÕ´Ï´Ù. °£È£»ç³ª Á÷¿øÀÌ À弼ô¾× º¹¿ë¹ýÀ» ¼³¸íÇÏ°ÚÁö¸¸, Àǻ簡 ¹Ì¸® Á÷Á¢ bowel preparation¿¡ ´ëÇÏ¿© ¼³¸íÇØ ÁÖ¸é Å©°Ô µµ¿òÀÌ µË´Ï´Ù.

°íºÀ¹Î ±³¼ö²²¼­ ¼Ò°³ÇϽŠESU settingÀÔ´Ï´Ù. Effect´Â °­ÇÏ°Ô Watt´Â ¾àÇÏ°Ô »ç¿ëÇÏ´Â °æÇâÀ̾ú½À´Ï´Ù. Dry CutÀ̶ó´Â ¸Å¿ì °­ÇÑ ¸ðµå·Î initial mucosal incisionÀ» ÇÑ´Ù´Â Á¡µµ ³î¶ø½À´Ï´Ù.

Mucosal incision (Dual knife)Dry Cut E2 30W
Mucosal incision (Hook knife)Endo Cut E2 D2 I2
Submucosal dissection (Dual knife)Swift Coag E4 30W
Submucosal dissection (Hook knife)Swift Coag E4 40W
Coagulation (Coagrasper)Soft Coag E5 50W


6. ´ã³¶ º´º¯ (¼­¿ï´ëÇб³ ±è¿ëÅÂ)

±è¿ëÅ ±³¼ö´Ô²²¼­´Â ´ã³¶ ¿ëÁ¾ÀÌ 1 cm ÀÌ»óÀÌ¶óµµ ½ÇÁ¦·Î ¾ÏÀÇ ºñÀ²Àº ³·´Ù°í ¸»¾¸Çϼ̽À´Ï´Ù. StoneÀÌ ÇÔ²² ÀÖ´Â ´ã³¶¿ëÁ¾À̶ó°í ´õ À§ÇèÇÑ °ÍÀº ¾Æ´Ï¶ó°í ÇÕ´Ï´Ù.


7. Èï¹Ì·Î¿î Áõ·Ê - ´Ù¹ß¼º ´ëÀå ¿ëÁ¾À¸·Î ¿ÀÀÎµÈ inverted colonic diverticulum (ÇѶ󺴿ø À¯±â´ö)

Èï¹Ì·Î¿î Áõ·Ê¿´½À´Ï´Ù. Polypó·³ º¸ÀÌ´Â ºÎÀ§ ÁÖº¯ÀÇ ¹°°á¸ð¾ç ÁÖ¸§ÀÌ Æ¯Â¡Àû ¼Ò°ßÀÔ´Ï´Ù.

¹®Çå¿¡ ½Ç¸° À¯»ç Áõ·Ê¸¦ ¼Ò°³ÇÕ´Ï´Ù.

A 42-year-old man with a history of mild, intermittent pain on the lower left side of the abdomen presented with an episode of painless hematochezia. The physical examination was normal, and his hematocrit was 44 percent. Diverticulosis of the sigmoid colon (Panel A) was revealed during flexible sigmoidoscopy for evaluation of the bleeding. There were multiple diverticula and a 1-cm sessile polypoid lesion (Panel B) that was the same color as the surrounding mucosa. The polyp vanished with the application of gentle pressure from the tip of a closed pair of biopsy forceps, confirming that the lesion was merely an inverted colonic diverticulum (Panel C). These pseudopolyps are typically surrounded by diverticula. The diagnosis can usually be confirmed by paying close attention to the color of the lesion and determining whether the lesion disappears with the application of gentle pressure. The patient's gastrointestinal bleeding was attributed to diverticulosis of the sigmoid colon. He has since remained asymptomatic with the use of a high-fiber diet and antispasmodic agents. (NEJM 1999)

Can J Gastroenterol 2010

Ann Gastroenterol 2014


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[References]

1) ³»½Ã°æÇÐȸ ÇмúÇà»ç on-line Áß°è

2) [2016-9-24. ¿¬ÇÕ ´º½º] '¹°¹æ¿ï È­°¡' ±èâ¿­ ¹Ì¼ú°ü Á¦ÁÖµµ¿¡ ¹® ¿­¾î

3) Á¦ÁÖÀÇ ÇÑ °íµîÇб³



© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.