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[SMC Monday GI conference 2017-8-7. Tips from an expert in colonic polypectomy - À嵿°æ ±³¼ö´Ô Ư°­]

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[2018³â±îÁö Á¤¸®ÇÑ ³»¿ë]

[ÀÌÁØÇà ñÉ] 2017³â À嵿°æ ±³¼ö´Ô °­ÀÇ¿¡ 2018³â À嵿°æ ±³¼ö´Ô °­ÀÇ ³»¿ëÀ» º¸ÃæÇÏ¿´½À´Ï´Ù.

2018³â À嵿°æ ±³¼ö´Ô comment: (1) 2018³âµµ AJCC °¡À̵å¶óÀο¡¼­ in situ cancerÀÇ °³³ä»ó º¯È­°¡ ÀÖ¾ú½À´Ï´Ù. Lamina propria invasionÀÌ ÀÖ´Â °æ¿ì¸¸ in situ cancer¶ó°í ºÎ¸£´Â °ÍÀ¸·Î ¾ÆÀ̵ð¾î°¡ ¸ðÀÌ°í ÀÖ´Â °Í °°½À´Ï´Ù. (2) Submucosal injection fluidÀÇ sterility¿¡µµ ½Å°æÀ» ½á¾ß ÇÕ´Ï´Ù. ½Ã¼úÀÚ °³ÀÎ º¸´Ù´Â ³»½Ã°æ½Ç ÀÚüÀÇ quality control À̽´ÀÔ´Ï´Ù.

2017³â À嵿°æ ±³¼ö´Ô comment: "¼ú±â¿¡ ÇØ´çÇÏ´Â ºÎºÐÀº °¡À̵å¶óÀο¡¼­ ¸íÈ®È÷ ´äÀ» ãÁö ¸øÇÏ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ±â¼úÀÌ ÁÁÀ¸¸é ¸¹Àº ¹®Á¦¸¦ ½º½º·Î ÇØ°áÇÒ ¼ö ÀÖ½À´Ï´Ù. ±â¼úÀÌ ¿©·¯ºÐÀ» ÀÚÀ¯·Ó°Ô ÇÒ ¼ö ÀÖ´Ù°í³ª ÇÒ±î¿ä... ºÎ´ÜÈ÷ ³ë·ÂÇÏ¿© ¼ú±â¸¦ Çâ»ó½ÃÅ°½Ê½Ã¿ä."¶ó´Â ¸»·Î °­ÀǸ¦ ¸ÅµìÁöÀ¸¼Ì½À´Ï´Ù.

2016³â À嵿°æ ±³¼ö´Ô comment: LST°¡ ¹ß°ßµÇ°í one stage·Î Á¦°ÅÇϱ⠾î·Á¿î »óȲÀ̸é Á¶Á÷°Ë»ç¸¦ 1Á¡¸¸ ÇÏ°í submucosal injectionÀ» ÇÏÁö ¸»¾Æ¾ß ÇÕ´Ï´Ù. Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾Ê°í »çÁø¸¸ Àß Âï¾îµÎ°í ±³¼ö´Ô²² ÀÇ·ÚÇصµ µË´Ï´Ù. (À嵿°æ ±³¼ö´Ô²²¼­´Â "LST¿¡¼­ Á¶Á÷°Ë»ç ÇÏÁö ¾Ê¾Æµµ È¥³»Áö ¾Ê½À´Ï´Ù. ±×·¯³ª Á¶Á÷°Ë»ç¸¦ ¿©·¯°³ Çϸé È¥³¾ °ÍÀÔ´Ï´Ù"¶ó°í ¸»¾¸Çϼ̽À´Ï´Ù.)


1. ¿ëÁ¾ÀýÁ¦¼úÀÇ ¿øÄ¢

¿ëÁ¾ÀýÁ¦¼úÀÇ ´ë¿øÄ¢Àº ÀÌ°ÍÀÔ´Ï´Ù. ¾ÈÀüÇÏ°í ¿Ïº®ÇÏ°Ô Ä¡·áÇÏ°í Á¶Á÷À» Àß ¼ö°ÅÇÏ¿© º´¸®°Ë»ç¸¦ ÇØ¾ß ÇÕ´Ï´Ù.

¾ÏÀÌ ÀÇ½ÉµÉ ¶§¿¡´Â polyp trapÀ» »ç¿ëÇÏÁö ¾Ê´Â °ÍÀÌ ÁÁ½À´Ï´Ù. ³ª¿À´Â °úÁ¤¿¡¼­ ¿©·¯ Á¶°¢À¸·Î ³ª´©¾îÁú ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù.


2. ¿ëÁ¾ÀýÁ¦¼úÀÇ ´Ù¾çÇÑ ¹æ¹ý

´ë°­ º´¼ÒÀÇ Å©±â¿¡ µû¶ó Ä¡·á¹æ¹ýÀ» °áÁ¤ÇÕ´Ï´Ù.

´ë°­ º´¼ÒÀÇ Å©±â¿¡ µû¶ó Ä¡·á¹æ¹ýÀ» °áÁ¤ÇÕ´Ï´Ù.
1) Çѹø¿¡ Àâ¾Æ¼­ Á¦°ÅÇÒ ¼ö ÀÖ´Â Á¤µµ¿¡¼­¸¸ cold biopsy¸¦ Çϱ⠹ٶø´Ï´Ù. ´ë·« 3 mm Á¤µµ·Î »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù. µÎ¼¼¹ø cold biopsy¸¦ ÇØ¾ß ÇÏ´Â º´¼Ò´Â Â÷¶ó¸® cold snaringÀ» ÇϽñ⠹ٶø´Ï´Ù.
2) Cold snaringÀº 7mm±îÁö´Â ¾ÈÀüÇÏ°Ô ½ÃÇàÇÒ ¼ö ÀÖ½À´Ï´Ù. 10mm±îÁö´Â ÇÒ ¼ö ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù.
3) Hot biopsy polypectomy´Â ÅðÃâµÇ´Â ºÐÀ§±âÀÔ´Ï´Ù (À§(êÖ)¿Í´Â ¾à°£ ºÐÀ§±â°¡ ´Ù¸¨´Ï´Ù). »ý°¢º¸´Ù residual tumor°¡ ¸¹ÀÌ ³²°í, delayed perforationÀÇ À§ÇèÀÌ Àֱ⠶§¹®ÀÔ´Ï´Ù. ²À hot biopsy¸¦ ÇØ¾ß ÇÏ´Â °æ¿ì´Â ²À submucosal injection ÈÄ ½ÃÇàÇϽñ⠹ٶø´Ï´Ù.
4) Sessile serrated lesion¿¡¼­´Â margin¿¡ ´õ¿í ½Å°æÀ» ½á¾ß ÇÕ´Ï´Ù. MarginÀÌ ¾Ö¸ÅÇϱ⠶§¹®ÀÔ´Ï´Ù. InjectionÀ» ÇÑ ÈÄ¿¡¾ß marginÀÌ ´õ ¸í·áÇÏ°Ô º¸ÀÌ´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. ¿µ ¾Ö¸ÅÇϸé circumferential precuttingÀ» ÇÑ ÈÄ EMRÀ» ÇÏ¸é µË´Ï´Ù ('snare tip precutting and EMR').
5) ´ëÀå¿¡¼­´Â ESDÀÇ indicationÀ» Á¶±Ý strictÇÏ°Ô Àû¿ëÇÏ´Â °æÇâÀÔ´Ï´Ù. Piecemeal EMRÀÌ ³ª¸§´ë·ÎÀÇ ¿ªÇÒ°ú ÀåÁ¡ÀÌ Àֱ⠶§¹®ÀÔ´Ï´Ù. PiecemealÀ» ÇÏ´õ¶óµµ cancer°¡ ÀǽɵǴ ºÎÀ§´Â Å©°Ô ÇÑ µ¢¾î¸®·Î ¶³¾îÁöµµ·Ï ³ë·ÂÇϽñ⠹ٶø´Ï´Ù. Piecemeal resection ÈÄ ±ºµ¥±ºµ¥ ÀÜ·ùº´¼Ò°¡ º¸À̸é hot biopsy avulsionÀ» ÇϽñ⠹ٶø´Ï´Ù. APC´Â º°·Î ÁÁÁö ¾Ê½À´Ï´Ù.


3. Tips

Colonoscopy´Â ¹Ì´Â ±â¼úÀÌ ¾Æ´Õ´Ï´Ù. ¹Ð¸é cecum±îÁö µµ´ÞÇÒ ¼ö ¾ø½À´Ï´Ù. °è¼Ó '¹Ð´ç'À» ÇØ¾ß ÇÕ´Ï´Ù.

±âº»ÀûÀ¸·Î´Â cecum±îÁö µé¾î°£ ´ÙÀ½ ³ª¿À¸é¼­ ¿ëÁ¾À» Á¦°ÅÇÏ´Â °ÍÀÌ ±âº»ÀûÀÎ ¿øÄ¢ÀÔ´Ï´Ù. µé¾î°¡¸é¼­ ¹Ù·Î¹Ù·Î ¶¼´Â °Íº¸´Ù ÀüüÀûÀÎ »óȲÀ» ÆľÇÇÏ´Â °ÍÀÌ Áß¿äÇÕ´Ï´Ù. »©´Â »óȲ¿¡¼­ ³»½Ã°æÀÌ Á÷¼±È­µÇ¾î ÀýÁ¦¼úÀÌ ½¬¿öÁý´Ï´Ù.

¾Æ·¡ÂÊ stalkÀÌ ³²¾ÆÀÖ¾î¾ß ÃâÇ÷ÀÇ °æ¿ì ´ëóÇϱⰡ ½±½À´Ï´Ù. ¸Ç ¿À¸¥ÂÊÀÇ °æ¿ì cold snaringÀ¸·Î Á¦°ÅÇصµ ¹«³­ÇÕ´Ï´Ù. Mechanical cuttingÀ» °ÆÁ¤ÇÒ ÇÊ¿ä°¡ ¾ø½À´Ï´Ù. ÀϹÝÀûÀÎ EMR¿¡¼­´Â tenting ÈÄ ÅëÀüÇÏ´Â °ÍÀÌ Ç¥ÁØÀûÀÎ ¼ú±âÀÔ´Ï´Ù¸¸, cold snaring¿¡¼­´Â ´ç±âÁö ¾Ê°í ±× ÀÚ¸®¿¡¼­ snaring ÇÏ¿© Á¦°ÅÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. TentingÀ» ½ÃµµÇϸé ƨ°Ü³ª¿À´Â °æ¿ì°¡ ¸¹½À´Ï´Ù.

À嵿°æ ±³¼ö´Ô²²¼­´Â Winter school 2017¿¡¼­ ´Ù·ç¾ú´ø ºÎºÐµµ Âü°íÇ϶ó°í Á¶¾ðÇϼ̽À´Ï´Ù. ¾Æ·¡ ±×¸²À» Ŭ¸¯ÇØ Áֽñ⠹ٶø´Ï´Ù.

2017³â 2¿ù SMC Winter School °­ÀDZ³Àç 3 - ÇϺΠÀ§Àå°ü


[FAQ]

[2017-8-7. Áú¹®]

Àü ³»½Ã°æ¿¡¼­ ¿ëÁ¾ÀÌ 3°³ ÀÖ´Ù°í ÀǷڵǾú´Âµ¥, Á¶Á÷°Ë»çµµ ÇÏÁö ¾Ê¾Ò´Ù´Âµ¥ 2°³ ¹Û¿¡ º¸ÀÌÁö ¾Ê½À´Ï´Ù. ¾î¶»°Ô ±â·ÏÀ» ³²±â°í ¾î¶»°Ô ¼³¸íÀ» ÇØ¾ß ÇÒ±î¿ä?

[2017-8-7. À嵿°æ ±³¼ö´Ô ´äº¯]

±â¼úÀ» Á¤È®ÇÏ°Ô ÇÏ°í ÃßÀû°üÂûÀ» Á¶±Ý ª°Ô ÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù.


[2017-8-7. Áú¹®]

¾Æ½ºÇǸ°À̳ª ´Ù¸¥ Ç×Ç÷¼ÒÆÇÁ¦ ȤÀº Ç×ÀÀ°íÁ¦¿¡ ´ëÇÑ ¼±»ý´ÔÀÇ ´ë·«ÀûÀÎ »ý°¢Àº ¾î¶°ÇϽʴϱî?

[2017-8-7. À嵿°æ ±³¼ö´Ô ´äº¯]

¿ø·¡´Â ¾Æ½ºÇǸ° ¸Ô°í À־ ¿ëÁ¾ÀýÁ¦¼úÀ» ÇÒ ¼ö ÀÖ½À´Ï´Ù. Cardiology ÀûÀÎ °íÀ§Çè ȯÀÚ¿¡¼­´Â ½Ã¼úÀ» ÇÒ ¼ö ÀÖ½À´Ï´Ù.


[2018-7-2. Áú¹®]

´ëÀå³»½Ã°æ 200¿¹ºÎÅÍ ¿ëÁ¾ÀýÁ¦¼ú·Î ³Ñ¾î°¡´Â °ÍÀ» ±âº» Áøµµ·Î ÇÏ°í ÀÖ½À´Ï´Ù. Cold snaringµµ ÀÌ¿¡ ÇØ´çÇÏ´Â °ÍÀ¸·Î »ý°¢ÇϽʴϱî?

[2018-7-2. À嵿°æ ±³¼ö´Ô ´äº¯]

Cold snaringÀº ±âÁ¸ÀÇ scheduleº¸´Ù ÀÏÂï ½ÃÀÛÇصµ ÁÁÀ» °ÍÀ̶ó°í »ý°¢ÇÕ´Ï´Ù.


[2018-7-2. Áú¹®]

¿ëÁ¾ÀÌ ¸¹À» ¶§¿¡´Â Çѹø¿¡ ¸î °³±îÁö Ä¡·á¸¦ ÇØ¾ß Çմϱî?

[2018-7-2. À嵿°æ ±³¼ö´Ô ´äº¯]

6°³±îÁö º¸ÇèÀÌ µÇ´Â °ÍÀÌ ¹®Á¦ÀÌÁö¸¸, º¸Çè ±ÔÁ¤¿¡ µû¸£±âº¸´Ù´Â ȯÀÚ¸¦ À§ÇÏ¿© °¡±ÞÀû Ãæ½ÇÈ÷ Ä¡·áÇØ µå¸®´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù.


[2018-7-2. Áú¹®]

Ÿ º´¿ø¿¡¼­ õ°øÀ¸·Î ÀÇ·ÚµÈ È¯ÀÚ¿¡¼­ clippingÀ» ½ÃµµÇصµ ÁÁÀ»±î¿ä?

[2018-7-2. À嵿°æ ±³¼ö´Ô ´äº¯]

(1) ¸î ½Ã°£ À̳»¿¡ ¿Ô°í, (2) ȯÀÚÀÇ vitalÀÌ stableÇÏ°í, (3) bowel prepÀÌ Àß µÇ¾î ÀÖÀ¸¸é ³»½Ã°æ Ä¡·á¸¦ ½ÃµµÇÒ ¼ö ÀÖ½À´Ï´Ù. ±×·¯³ª, ´ÙÀ½ ³¯ ¿À¼Ì°Å³ª ȤÀº ´çÀÏÀÌ¶óµµ ½Ã°£ÀÌ Áö¿¬µÈ °æ¿ì¶ó¸é ¹Ù·Î ¼ö¼úÀ» ÇÏ´Â °ÍÀÌ ¾ÈÀüÇØ¾ß ÇÕ´Ï´Ù. ¾à°£ÀÇ ÅëÁõ ÀÌ¿Ü¿¡ vitalµµ stable ÇØ¾ß ÇÕ´Ï´Ù.




[References]

1) SMC Endoscopy Unit »ï¼º¼­¿ïº´¿ø ³»½Ã°æ½Ç

2) SMC Monday GI conference »ï¼º¼­¿ïº´¿ø ÀÏ¿ø³»½Ã°æ±³½Ç ¿ù¿äÁ¡½É¼ÒÈ­±âÁý´ãȸ

3) SMC Thursday endoscopy conference »ï¼º¼­¿ïº´¿ø ÀÏ¿ø³»½Ã°æ±³½Ç ¸ñ¿äÁ¡½É³»½Ã°æÁý´ãȸ

4) À嵿°æ ±³¼ö´Ô Winter School ¿ëÁ¾ÀýÁ¦¼ú °­ÀÇ PDF 13M

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