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[KINGCA 2019]

2³â °£ÀÇ Àӱ⸦ ¸¶Ä¡¸ç


1. Master class (Çмú´ëȸ Àü ±â°ü ¹æ¹® ÇÁ·Î±×·¥)

[KINGCA 2019 Master class] (Çмú´ëȸ Àü ±â°ü ¹æ¹® ÇÁ·Î±×·¥)

4/3 9:00-17:00. Clinical observation (operating room or endoscopy unit)

4/3 18:00. Welcome dinner

4/4 9:00-17:00. Clinical observation (operating room or endoscopy unit)

4/5 9:00-12:00. BOX simulation workshop for foreigners (simulation center)

4/5 13:00-15:00. Description exercise workshop (endoscopy unit conference room)

This is tricky. Because the center is depressed and margin is slightly elevated. We call it depressed lesion because marginal elevation is considered as secondary change. Actually, folds are formed only in the depressed lesions. So, the endoscopic diagnosis is EGC IIc (not IIa).

4/5 18:00. Dinner

4/8 9:00-12:00. BOX simulation workshop for foreigners (simulation center)

4/8 13:00-15:00. Special lecture - Gastric cancer screening in Korea by Lee Jun Haeng (endoscopy unit conference room)

PPT PDF 2.1M

4/8 18:00-21:00. ESD hands-on training with pig stomach model (SMC animal lab)

4/9 9:00-17:00. Clinical observation (operating room or endoscopy unit)


[April 11 10:50 D-room] Education session - ÀÌÁØÇà °­ÀÇ

PPT PDF 5.6M (subnote)

°­ÀÇ ÈÄ ÁÂÀå ¹× ¿¬ÀÚµé°ú ÇÔ²²


[April 12 8:30 B-room] ÃÖÀÏÁÖ ±³¼ö´Ô °­ÀÇ

Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á¿¡ ´ëÇÑ ¼¼°èÀûÀÎ ¿¬±¸(NEJM 2018)¸¦ ¹ßÇ¥ÇϽŠÃÖÀÏÁÖ ±³¼ö´ÔÀÇ °­ÀÇ°¡ ÀÖ¾ú½À´Ï´Ù. ÀÌ·± ³»¿ëÀº ÀúÀÚ Á÷°­ÀÌ µüÀÔ´Ï´Ù.

Correa °¡¼³

À§¾Ï ȯÀÚÀÇ Ç︮ÄÚ¹ÚÅÍ Ä¡·á¿¡ ´ëÇÑ °¢±¹ÀÇ °¡À̵å¶óÀÎÀÔ´Ï´Ù. ³»½Ã°æÄ¡·á ÈÄ¿¡´Â ´ëºÎºÐ Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á¸¦ ±ÇÇÏ°í ÀÖÀ¸³ª ¼ö¼ú ÈÄ Ä¡·á¸¦ ±ÇÇÏ°í ÀÖ´Â °÷Àº ¸¹Áö ¾Ê½À´Ï´Ù.

2018 NEJM ³í¹®ÀÇ study design

Á¦±ÕÄ¡·á´Â ¾Ï ¹ß»ý·üÀ» ÀǹÌÀÖ°Ô °¨¼Ò½ÃÄ×½À´Ï´Ù.

Hp Á¦±ÕÄ¡·á ÀÚü°¡ ¾Ï ¹ß»ýÀ» ÁÙ¿´´ÂÁö ȤÀº Ç×»ýÁ¦ »ç¿ëÀÌ ¾Ï ¹ß»ýÀ» ÁÙ¿´´ÂÁö¿¡ ´ëÇÑ ³íÀÇ°¡ ÀÖ½À´Ï´Ù. ÇöÀçÀÇ ÀÚ·á´Â Ç×»ýÁ¦ »ç¿ëÀÌ ¾Æ´Ï¶ó Hp Á¦±Õ ÀÚü°¡ ¾Ï¹ß»ýÀ» ÁÙÀÎ °ÍÀ» º¸¿©ÁÖ°í ÀÖ½À´Ï´Ù.

¶Ç ´Ù¸¥ primary outcomeÀÎ atrophy¿Í metaplasiaÀÇ º¯È­ÀÔ´Ï´Ù. Á¦±ÕÄ¡·á ÈÄ atrophy¿Í metaplasia°¡ ÀǹÌÀÖ°Ô È£ÀüµÇ¾ú½À´Ï´Ù.

ÇöÀçÀÇ °¡Àå Å« concernÀº Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á°¡ survivalÀ» Áõ°¡½ÃÅ°Áö´Â ¸øÇß´Ù´Â Á¡ÀÔ´Ï´Ù. ¿ÀÈ÷·Á...

Subtotal gastrectomy ÈÄ Á¦±ÕÄ¡·áÀÇ È¿°ú¸¦ ºÐ¼®ÇÑ ¿¬±¸ÀÔ´Ï´Ù. Cho SJ. APT 2013:38:477

ºñ·Ï Àç¹ß·üÀÇ Â÷ÀÌ´Â ¾ø¾úÀ¸³ª Hp Á¦±ÕÄ¡·á´Â surrogate markerÀÎ atrophy score¸¦ È£Àü½ÃÄ×½À´Ï´Ù.

ÃÖÀÏÁÖ ±³¼ö´ÔÀÇ ¸ÚÁø °á·ÐÀÔ´Ï´Ù. ÀÌ·± Å« ÁÖÁ¦¿¡ ´ëÇÑ °­ÀǸ¦ ¿À·ÎÁö º»ÀÎÀÇ ¿¬±¸ ÀڷḸÀ¸·Î °á·Ð±îÁö À̲ø ¼ö ÀÖ´Ù´Â °ÍÀº ³î¶ó¿î ÀÏÀÔ´Ï´Ù.

ÃÖÀÏÁÖ ±³¼ö´Ô²²¼­´Â 2019³â 1¿ù 26ÀÏ Ç︮ÄÚ¹ÚÅÍÇÐȸ ºÎ»ê°æ³²Áöȸ ½ÉÆ÷Áö¾ö¿¡¼­µµ ºñ½ÁÇÑ ½½¶óÀ̵带 º¸¿©ÁֽŠ¹Ù ÀÖ½À´Ï´Ù. ¸ÚÁø ¿ä¾àÀÔ´Ï´Ù.

ÃÖÀÏÁÖ ±³¼ö´ÔÀÇ ¶Ç ´Ù¸¥ ¸ÚÁø ¿¬±¸°¡ °ð ¹ßÇ¥µÉ °Í °°½À´Ï´Ù. ÀÌ¹Ì enrollment¿Í followupÀÌ ³¡³µ°í ºÐ¼® ÁßÀ̹ǷΠÁ¶¸¸°£ °á°ú¸¦ ¹ßÇ¥ÇÒ ¼ö ÀÖÀ» °Í °°´Ù°í ÇÕ´Ï´Ù. 15³â Àü¿¡ ½ÃÀÛÇÏ¿© Áö±Ý±îÁö °è¼ÓµÇ°í ÀÖ´Â ´ë´ÜÇÑ projectÀÔ´Ï´Ù.

ÃÖÀÏÁÖ ±³¼ö´ÔÀÇ ¶Ç ´Ù¸¥ ¿¬±¸µµ ±â´ëµË´Ï´Ù. General population¿¡¼­ Helicobacter Á¦±ÕÄ¡·áÀÇ È¿°ú¸¦ º¸±â À§ÇÑ ´Ù±â°£ RCT°¡ ÁøÇàµÇ°í ÀÖÀ¸¸ç ÇöÀç ȯÀÚ enrollment ÁßÀ̶ó°í ÇÕ´Ï´Ù. "´ë´ÜÇÕ´Ï´Ù"¸¦ ¹Ýº¹ÇÏ¿© ¿ÜÄ¥ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. Á¸°æÇÕ´Ï´Ù.


ESD curability

1) Additional gastrectomy after non-curative ESD (¾ö¹æ¿ï)

À§¾Ï ³»½Ã°æÄ¡·á ÈÄ º´¸®ÇÐÀû non-curative °á°ú´Â 15% Á¤µµ ³ª¿É´Ï´Ù. ¿øÄ¢Àº ¼ö¼úÀ» ±ÇÇÏ´Â °ÍÀε¥, ½ÇÁ¦·Î ¼ö¼úÀ» ¹Þ´Â ȯÀÚ´Â Àý¹Ý Á¤µµÀÔ´Ï´Ù.

½ÇÁ¦ ¼ö¼úÀ» ¹Þ´Â ȯÀÚÀÇ ºñÀ²Àº ±â°ü¸¶´Ù Å« Â÷À̸¦ º¸ÀÔ´Ï´Ù. ¾ö¹æ¿ï ±³¼ö´Ô²²¼­ Á¤¸®ÇÑ ÀÚ·á Áß »ï¼º¼­¿ïº´¿øÀÇ ¼ö¼ú·üÀÌ °¡Àå ³ô¾Ò½À´Ï´Ù (Çϴûö ¹ØÁÙ). ±èÀº¶õ ±³¼ö´Ô ³í¹®¿¡¼­ ¼ö¼ú·üÀº 70.8%¿´½À´Ï´Ù.

»ï¼º¼­¿ïº´¿ø ȯÀÚµéÀÌ ´Ù¸¥ º´¿ø ȯÀڵ鿡 ºñÇÏ¿© À¯³­È÷ ÀÇ»çÀÇ ¸»À» Àß µè´Â °ÍÀϱî¿ä? À¯³­È÷ °ÌÀÌ ¸¹Àº °ÍÀϱî¿ä? À¯³­È÷ ¿ë°¨ÇÑ °ÍÀϱî¿ä? Àú´Â ±×·¸°Ô »ý°¢ÇÏÁö ¾Ê½À´Ï´Ù. ¼³¸íÀÇ Â÷ÀÌÀÏ °ÍÀ¸·Î »ý°¢ÇÕ´Ï´Ù. ÀúÈñ ÆÀÀº ȯÀÚ¿¡°Ô ¸Å¿ì ÀÚ¼¼È÷ ¼³¸íÇÏ´Â °ÍÀ¸·Î À¯¸íÇÕ´Ï´Ù. »çÀü¿¡ ¼ö¼úÀÌ ÇÊ¿äÇÑ °á°ú°¡ ³ª¿Ã ¼ö ÀÖ´Ù´Â °ÍÀ» ¸Å¿ì ÀÚ¼¼È÷ ¼³¸íÇÏ°í ÀÖ½À´Ï´Ù. ¶Ç ÇÏ°í, ¶Ç ÇÏ°í, ¶Ç ÇÏ°í... ȯÀÚÀÇ ±Ã±ÝÁõÀÌ ÀüÇô ¾øÀ» ¶§±îÁö ¹Ýº¹ÇÏ°í ÀÖ½À´Ï´Ù. ±×·¡¼­ non-curative pathology °á°ú¸¦ ¸»¾¸µå¸®¸é ³Ê¹«³ª ÀÚ¿¬½º·´°Ô ¼ö¼úÀåÀ¸·Î ÇâÇÏ°Ô µÇ´Â °Í °°½À´Ï´Ù.

Æò±ÕÀÎ 50%°¡ ÁÁÀ»±î¿ä, ¾Æ´Ï¸é »ï¼º¼­¿ïº´¿øÀÇ 70%°¡ ÁÁÀ»±î¿ä? »ç½Ç ¾Æ¹«µµ ´äÀ» ¸ð¸£´Â ¹®Á¦ÀÔ´Ï´Ù. ³ªÁß¿¡ ³ªÁß¿¡ longterm outcomeÀ» ºñ±³ÇÏ¸é ´äÀ» ¾Ë ¼ö ÀÖÀ»Áö ¸ð¸£°Ú³×¿ä. ¿µ¿øÈ÷ ¸ð¸¦ ¼öµµ ÀÖ°í.


[References]

1) À§¾ÏÇÐȸ ÇмúÇà»ç on-line Áß°è

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