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[ESD ÈÄ ÅëÁõ. Pain after ESD]


1. ESD ÈÄ ÅëÁõ

EMR/ESD ÈÄ ¸î ½Ã°£ µ¿¾È ÅëÁõÀ» È£¼ÒÇϴ ȯÀÚ°¡ ÀÖ½À´Ï´Ù. º¸Åë ¼Ò·®ÀÇ ÁøÅëÁ¦·Î Àß Á¶ÀýµÇ°í ±Ý¹æ È£ÀüµË´Ï´Ù. ½Ã¼ú ¸î ½Ã°£ ÈÄ Áö¼ÓÀûÀÎ ÅëÁõÀÌ °£ÇæÀû ÅëÁõÀ¸·Î ¹Ù²ò´Ï´Ù. ¸¸¾à ½ÉÇÑ ÅëÁõÀÌ Áö¼ÓÀûÀ¸·Î ³ªÅ¸³ª¸é õ°øÀ̳ª post-ESD coagulation syndromeÀ» ÀǽÉÇϽʽÿä.

¸ðµç ÅëÁõÀº ÀûÀýÈ÷ Æò°¡ÇÏ°í ±â·ÏÀ» ³²±â´Â °ÍÀÌ ÁÁ½À´Ï´Ù. Numeric rating scale (NRS)À̳ª faces pain rating scale (FPS)¸¦ ÀÌ¿ëÇϽñ⠹ٶø´Ï´Ù.


2. ESD Àü PPI¸¦ Åõ¿©Çϸé ÅëÁõÀ» ÁÙÀÏ ¼ö ÀÖ½À´Ï´Ù. (2015-7-26)

2015³â Endoscopy Áö¿¡ ¿¬¼¼´ëÇб³ °­³²¼¼ºê¶õ½º º´¿ø À±¿µÈÆ ±³¼ö´ÔÆÀ¿¡¼­ ¸ÚÁø Àӻ󿬱¸¸¦ ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Á¤´ÙÇö. Endoscopy 2015 Dec). ESD Àü PPI¸¦ Åõ¿©Çϸé ÅëÁõÀ» ÁÙÀÏ ¼ö ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù.

Results: The incidence of moderate-to-severe pain after ESD was significantly lower in the group that received preprocedure PPI (44.9%) compared to those who did not (62.8%). Female sex, tumors of the distal stomach (i.e. lower third), baseline dyspeptic symptoms, and positive acid infusion testing were variables that correlated significantly with the development of pain after ESD, although female sex was not significant in multivariate analysis.

À±¿µÈÆ ±³¼ö´ÔÀº 10cm visual analog scaleÀ» ÀÌ¿ëÇÏ¿© 3À» ÃÊ°úÇÏ´Â °æ¿ì ÅëÁõÀÌ ÀÖ´Ù°í Æò°¡ÇÏ¿´½À´Ï´Ù. 156¸í Áß 84¸í(53.8%)¿¡¼­ ÅëÁõÀÌ ÀÖ¾ú½À´Ï´Ù. Á¶±Ý ¸¹Àº µí ÇÕ´Ï´Ù. ±âÁØÀ» ¾î¶»°Ô Àâ´À³Ä¿¡ µû¶ó ´Þ¶óÁú °Í °°½À´Ï´Ù.

'À§ÀüÁ¤ºÎ º´¼Ò¿¡ ´ëÇÑ ESD ÈÄ'¿Í 'Æò¼Ò dyspeptic symptomÀÌ ÀÖ´ø ȯÀÚ'¿¡¼­ ÅëÁõÀÌ ¸¹´Ù´Â °Í - ÀúÀÚµéÀº ÀÌ·¸°Ô ¼³¸íÇÏ°í ÀÖ½À´Ï´Ù. "Peristaltic contractions of the edematous, inflamed antrum and pylorus may explain the greater frequency of antral pain after ESD." - Àº Æò¼ÒÀÇ ÀÓ»ó°æÇè°ú ÀÏÄ¡ÇÏ´Â ¼Ò°ßÀ¸·Î ¿¬±¸ °á°ú°¡ ¹ÏÀ»¸¸ÇÏ´Ù´Â °ÍÀ» ÀÔÁõÇÕ´Ï´Ù. ESD Àü PPI¸¦ Åõ¿©Çϸé ÅëÁõÀ» ÁÙÀÏ ¼ö ÀÖ´Ù´Â °á°ú´Â ´çÀå ¹Ý¿µÇØ¾ß ÇÒ °Í °°½À´Ï´Ù. À±±³¼ö´ÔÀº ESD ½Ã¼ú 2½Ã°£ Àü¿¡ IV·Î standard dose¸¦ Åõ¿©Çß´Ù°í ÇÕ´Ï´Ù. º¸Çè ±Þ¿© À̽´°¡ Á¦ÇÑÁ¡ÀÌÁö¸¸...

In the pre-ESD therapy group, a standard intravenous dose of PPI was given 2 hours before ESD. In both the pre- and post-ESD therapy groups, patients received intravenous PPI in standard doses, once in the evening after ESD and twice on Day 1 after ESD. Starting on Day 2 after ESD, standard once-daily doses of PPI were administered to patients orally in both groups for 4 weeks.

PIÀ̽ŠÀ±¿µÈÆ ±³¼ö´Ô²² ÀúÀڷμ­ÀÇ ÇѸ¶µð¸¦ ºÎŹÇÏ¿© ¹ÞÀº ´äº¯ÀÔ´Ï´Ù.


¼Ò°³ÀÇ ±ÛÀº ÀÌ¹Ì Àß Àû¾îÁּ̽À´Ï´Ù¸¸, Á¦ ÀÔÀå¿¡¼­ Á¶±Ý °­Á¶ÇÏ°í ½ÍÀº ºÎºÐÀº

1. ³í¹®ÀÇ ±âȹÀǵµ¿¡ ´ëÇÑ ºÎºÐÀÔ´Ï´Ù. ±âÁ¸ ESD ¿¡ ´ëÇÑ ¿¬±¸µé¿¡´Â õ°ø°ú ÃâÇ÷°ú °°Àº ÁÖ¿ä ÇÕº´Áõ¿¡ ´ëÇÑ ºÐ¼®Àº ³Ê¹«³ª ¸¹ÀÌ ÀÖ¾úÁö¸¸, ESD ÈÄ ÅëÁõÀ» ÁÖÁ¦·Î ÇÑ ¿¬±¸´Â º°·Î ¾ø¾ú´Ù´Â Á¡°ú

2. ºÐ¼®ÀÇ °á°ú Áß °­Á¶ÇÏ°í ½ÍÀº ¿ì¼± ¼øÀ§ÀÔ´Ï´Ù. ³í¹®ÀÇ abstract ¿¡´Â ½Ã¼úÀü PPI Åõ¿©, Æò»ó½ÃÀÇ dyspeptic symptom, antral location, positive acid infusion test ¼ø¼­·Î À¯ÀÇÇÑ ÀÎÀÚ¸¦ ¿­°ÅÇÏ¿´Áö¸¸ (ÀÌ´Â Editor ÀÇ ÀÇ°ßÀ̾ú½À´Ï´Ù), À̵é ÀÎÀÚµé Áß¿¡¼­ Á¦°Ô °¡Àå Èï¹Ì·Î¿ü°í ¶Ç °­Á¶ÇÏ°í ½ÍÀº ºÎºÐÀº ³í¹®¿¡ ±â¼úµÈ ¼ø¼­¿Í´Â ´Þ¸®, positive acid infusion test, Æò»ó½Ã dyspeptic symptom, antral location ÀÌ ¿ì¼±ÀÌ°í, ½Ã¼úÀü PPI Åõ¿©´Â ¸Ç ¸¶Áö¸· ¼øÀ§ÀÔ´Ï´Ù. Áï, ³»Àå °¨°¢ÀÇ pain thresould¿Í antral 3 CPM peristalsis °¡ ESD ÈÄ pain ¿¡ ¿µÇâÀ» ¹ÌÄ£´Ù´Â Á¡ÀÌ ºÐ¼®À» Çϸ鼭 °¡Àå Èï¹Ì·Î¿ü´ø Á¡ÀÔ´Ï´Ù.

¾Æ¹«Æ° °ü½É °¡Á®Áּż­ ´ë´ÜÈ÷ °¨»çµå¸³´Ï´Ù


3. ESD ÈÄ dexamethasoneÀ» ÁÖ»çÇϸé ÅëÁõÀ» ÁÙÀÏ ¼ö ÀÖ½À´Ï´Ù. (2015-7-26)

¿¬¼¼´ëÇб³ º´¿ø¿¡ °è½Ã´Ù »ï¼º¼­¿ïº´¿øÀ¸·Î ¿Å±â½Å ÀÌÇõ ±³¼ö´Ô²²¼­ ¿¬¼¼´ë °è½Ç ¶§ÀÇ ¿¬±¸ÀÔ´Ï´Ù (ÀÌÇý¿ø. Surg Endosc 2014). ESD ÈÄ dexamethasoneÀ» ÁÖ»çÇϸé ÅëÁõÀ» ÁÙÀÏ ¼ö ÀÖ´Ù°í ÇÕ´Ï´Ù. ¿Ü°ú ¿µ¿ª¿¡¼­´Â ºñ½ÁÇÑ ÀÚ·á°¡ ¸¹´Ù°í Çϴµ¥ gastric ESD ¿µ¿ª¿¡¼­´Â óÀ½ÀÎ °Í °°½À´Ï´Ù.

METHODS: The efficacy of intravenous dexamethasone 0.15 mg/kg (DEXA group) compared with saline-only placebo (placebo) for epigastric pain after ESD of early gastric neoplasms was assessed in a double-blinded, placebo-controlled trial.

RESULTS: A total of 36 patients participated in the study. The mean 6-h PPI value was lower (p < 0.001) in the DEXA group (1.61 ¡¾ 0.21) than in the placebo group (2.66 ¡¾ 0.19).


4. Proper muscle damage¿Í pain°ú´Â °ü·ÃÀÌ ¾øÀ»±î¿ä? (2015-7-26)

ESD ÈÄ delayed healingÀÇ ÀÎÀÚ¸¦ ¿¬±¸ÇÑ ÀϺ» ³í¹®ÀÔ´Ï´Ù (Horikawa. Digest Endosc 2015 - Epub). Submucosal fibrosis¿Í ½Ã¼ú µµÁß proper muscle damage°¡ delayed healing°ú °ü·ÃµÈ´Ù°í ÇÕ´Ï´Ù.

Àú´Â Ȥ½Ã ½Ã¼ú µµÁß proper muscle damage°¡ ½Ã¼ú ÈÄ pain°ú °ü·ÃµÇÁö ¾ÊÀ»±î ÀǽÉÇغ¾´Ï´Ù. ´©±º°¡ ü°èÀûÀ¸·Î ¿¬±¸Çغ¸¸é ÁÁÀ» °Í °°½À´Ï´Ù.

½Ã¼ú µµÁß proper muscle damage´Â submucosal fibrosis¿Í °°Àº º´¼ÒÀÇ Æ¯Â¡»Ó¸¸ ¾Æ´Ï¶ó electrosurgical unit ¼³Á¤°úµµ °ü·ÃÀÌ ÀÖÁö ¾ÊÀ»±î¿ä?


5. IV magnesium sulfate (50 mg/kg before sedation) (2015-10-4)

¿¬¼¼´ëÇб³ ¸¶Ãë°ú¿¡¼­ ESD ÀüÈÄÀÇ ÅëÁõ¿¡ ´ëÇÏ¿© Èï¹Ì·Î¿î °á°ú¸¦ ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Kim JE. Surg Endosc [Epub]). Magnesium sulfate´Â ÁøÅë, ÁøÁ¤ È¿°ú°¡ ÀÖ´Â ¾àÀÔ´Ï´Ù. ESD¸¦ À§ÇÑ ÁøÁ¤ Á÷Àü intravenous magnesium sulfate 50 mg/kg¸¦ Åõ¿©ÇÑ È¯ÀÚ±º¿¡¼­ ESD µµÁß°ú ÀÌÈÄÀÇ ÁøÅëÁ¦ ¿ë·®ÀÌ ÀÛ¾Ò´Ù°í ÇÕ´Ï´Ù.

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