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EndoTODAY ³»½Ã°æ ±³½Ç


[Pentax ³»½Ã°æ] - ðû

1. Brief history

2. Pentax imageÀÇ Æ¯¼º

3. LED at the insertion tube tip of the Pentax IMAGINA system

4. Image enhancement of Pentax endoscope

5. A powerful educational platform

6. Other characteristics of IMAGINA system

7. Pentax users' feedback

8. ESD and Splash M-knife

9. Cases - FujifilmÀ¸·Î ¹ß°ß - Olympus·Î °Ë»ç - Pentax·Î Ä¡·áÇÑ Áõ·Ê µî

10. EndoGEL ESD hands-on training using Pentax endoscope, needle, and ESD knife

11. FAQ

12. References

2020³â ³»½Ã°æÇÐȸ ¼¼¹Ì³ª ÀÌÁØÇà °­ÀÇ (subnote)


1. Brief history

1998³â ±º´ë¿¡¼­ Pentax ³»½Ã°æÀ» óÀ½ ¸¸³µ½À´Ï´Ù. ¾Æ·¡´Â ´ç½Ã ÂïÀº »çÁøÀÔ´Ï´Ù. Situs inversus¿´½À´Ï´Ù.

01 ½Ã¸®Áî ½ºÄß. (EPM-3000 ÇÁ·Î¼¼¼­¿Í EG-2901 ½ºÄß. Pentax¿¡¼­ ¸¸µç ù¹ø° ³»½Ã°æ ÇÁ·Î¼¼¼­(monochrome)¸¦ ÀÌ¿ëÇÑ ³»½Ã°æÀÓ).


ÆæŹ½º ³»½Ã°æ ½ºÄß Àд ¹ýÀº »óºÎ½ºÄßÀº EG, ÇϺδ EC, ½ÊÀÌÁöÀå°æÀº ED¸¦ ¸ÕÀú ¾²°í, ÇØ´ç ½ºÄßÀÇ Á÷°æÀ» ÇÁ·£Ä¡·Î ¾´ ´ÙÀ½, Á¦Ç° ¸ðµ¨ ½Ã¸®Á ¾²´Â Çü½ÄÀÔ´Ï´Ù. ¾Æ·¡¿Í °°Àº ¼ø¼­·Î °³¹ßµÇ¾ú´Ù°í ÇÕ´Ï´Ù. ÃÖ±Ù¿¡´Â ENT/EUS Àü¿ë J10 Seriesµµ ÀÖ´Ù°í ÇÕ´Ï´Ù (ÇÁ·Î¼¼¼­´Â Ãâ½ÃµÇ¾î »ç¿ë ÁßÀÎ °Í¿¡ ȣȯ).

SeriesÈ­¸é³»½Ã°æÇÁ·Î¼¼¼­
01EG-2901 / EC-3801EPM-300
30KEG-2930K / EG-2731K / EC-3830KEPK-P
70KEG-2970K / EC-3870KEPK-1000
90KEG-2990K / EC-3890KEPK-3000
90iEG-2990i / EC-3890iEPK-i, EPK-i5000
i10EG29-i10 / EC34-i10 / EC38-i10EPK-i7010 (Optivista, Optivista Plus)
i10cEG29-i10c / EC34-i10c / EC38-i10cEPK-i5500c (Imagina)

* EPM: Endoscopy monochrome, EPK: Endoscopy color-chrome, i: digital, c: ³»½Ã°æ ¸»´Ü LED ±¤¿ø

* IMAGINA i10c ³»½Ã°æÀÌ Ãâ½ÃµÇ±â ÀÌÀü¿¡´Â »óºÎ ³»½Ã°æÀº ¸ðµÎ 27, 29 French »çÀÌÁîÀÇ Á¦Ç°ÀÌ °¢°¢ Ãâ½Ã, ¿î¿ëµÇ°í ÀÖ½À´Ï´Ù.


¾Æ·¡´Â 2019³â ÇöÀç ½ÃÆǵǰíÀÖ´Â Optivista plus (EPK-i7010) ½Ã½ºÅÛ°ú Imagina (EPK-i5500c)½Ã½ºÅÛÀÔ´Ï´Ù.

Pentax Optivista plus system. Image enhancement¸¦ °³¼±ÇÑ Á¦Ç°À¸·Î ±¤¿øÀº ³»½Ã°æ ½Ã½ºÅÛ¿¡ ÀÖ½À´Ï´Ù. IMAGINA ÀÌÀüÀÇ ÃÖ°í »ç¾ç ¸ðµ¨ÀÔ´Ï´Ù.

Pentax Imagina system (Spec/ȸ»ç ȨÆäÀÌÁö). »ðÀԺΠ¸»´Ü¿¡ LED ±¤¿øÀ» ¼³Ä¡ÇÑ Çõ½ÅÀûÀÎ Á¦Ç°À¸·Î PentaxÀÇ ÃֽŠ¸ðµ¨ÀÔ´Ï´Ù. (Imagina ¸Å´º¾ó)


2. PENTAX imageÀÇ Æ¯¼º

1) Color sensor

Olympus»ç´Â monochrome sensor (260, 290°è¿­)¿Í color sensor (160, 190 °è¿­)À» »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. Çѱ¹°ú ÀϺ»¿¡¼­´Â monochrome sensor ³»½Ã°æÀÌ ½ÃÆǵǰí ÀÖ°í ¼­±¸¿¡¼­´Â ÁÖ·Î color sensor°¡ »ç¿ëµË´Ï´Ù. Pentax¿¡¼­´Â °ú°ÅºÎÅÍ color sensor°¡ »ç¿ëµÇ°í ÀÖ½À´Ï´Ù.

Monochrome sensorÀÇ pixel¿¡ Bayer patternÀ¸·Î RBC filter¸¦ ÀÔÈù °ÍÀÌ color sensorÀÔ´Ï´Ù.

°³º° pixel À§¿¡ color filter¸¦ ÀÔÈù ¸ð½À

Monochrome sensor¿¡ color¸¦ Bayer patternÀ¸·Î ¹è¿­ÇÑ ¸ð½À

Color image´Â sensor¿¡¼­ ¸¸µé¾îÁø ½ÅÈ£¸¦ ±×´ë·Î »ç¿ëÇÏÁö ¾Ê°í software algorithmÀ» ÀÌ¿ëÇÏ¿© º¯ÇüÀ» °¡ÇÑ ÈÄ image file·Î ¸¸µé¾îÁý´Ï´Ù. µû¶ó¼­ °°Àº sensor¸¦ »ç¿ëÇÏ´õ¶óµµ ¾î¶² engineÀ» »ç¿ëÇÏ¿´´Â°¡¿¡ µû¶ó »ó´çÈ÷ ´Ù¸¥ °á°ú¹°ÀÌ ³ª¿É´Ï´Ù.

Monochrome sensor´Â Çػ󵵴 ¿ì¼öÇÏÁö¸¸ ¿òÁ÷ÀÌ´Â ¹°Ã¼¿¡¼­´Â color breakup Çö»óÀÌ ³ªÅ¸³³´Ï´Ù (Âü°í: Color breakup »ó¼¼ ¼³¸í). Color sensor´Â ¹Ý´ëÀÔ´Ï´Ù.

¿ìÃø»çÁø 12-1½Ã ¹æÇâ color break up

Color CCD¶ó´Â Ư¼º¶§¹®¿¡ ³»½Ã°æ °Ë»ç µµÁß freeze ¾øÀÌ ÃÔ¿µÇصµ È­Áú¿¡ º° ¹®Á¦°¡ ¾ø½À´Ï´Ù.

Pentax ³»½Ã°æ¿¡¼­´Â color sensor¸¦ »ç¿ëÇÏ°í ÀÖÀ¸¹Ç·Î Olympus 260, 290°ú´Â »ó´çÈ÷ ´Ù¸¥ ´À³¦ÀÇ image¸¦ º¸¿©ÁÝ´Ï´Ù. ÀüüÀûÀ¸·Î ÈξÀ ÀÚ¿¬½º·¯¿î ¿µ»óÀ» º¸¿©Áִµ¥ color breakupÀÌ ¾ø´Ù´Â °Íµµ ÇϳªÀÇ ÀÌÀ¯ÀÏ °ÍÀÔ´Ï´Ù. ResolutionÀº ´Ù¼Ò ³·´Ù´Â ´À³¦Àε¥ Áø´Ü¿¡ ÁöÀåÀÌ ÀÖ´Â Á¤µµ´Â ¾Æ´Ï¾ú½À´Ï´Ù.


2) ±ÙÁ¢ÃÔ¿µ¿¡ À¯¸®ÇÑ lens Ư¼º

Pentax Imagina´Â ±ÙÁ¢ÃÔ¿µÀÌ ¾ÆÁÖ ¿ì¼öÇÕ´Ï´Ù. ¾à°£ È®´ë ³»½Ã°æÀ» »ç¿ëÇÑ µíÇÑ ´À³¦À» ÁÝ´Ï´Ù.

Pentax Imagina·Î ±ÙÁ¢ ÃÔ¿µ

·»Áî¶ó´Â °ÍÀº focus°¡ ¸Â´Â ¿µ¿ªÀÌ ÀÖ°í À̸¦ depth of field¶ó°í ÇÕ´Ï´Ù. ¸Á¿ø·»Áî´Â depth of field°¡ Á¼¾Æ¼­ Àι°¸¸ ¼±¸íÇÏ°í ¹è°æÀº Èå·ÁÁý´Ï´Ù. ±¤°¢·»Áî´Â °¡±î¿î °÷ºÎÅÍ ¸Ö¸®±îÁö ¼±¸íÇÏ°Ô º¸ÀÔ´Ï´Ù. ³»½Ã°æ ·»Áî´Â ¾à°£ ±¤°¢À̶ó depth of field°¡ ³ÐÀº ÆíÀÌÁö¸¸ ±×·¡µµ ³Ê¹« ±ÙÁ¢Çϰųª ¸Ö¾îÁö¸é ¼±¸íµµ°¡ ¶³¾îÁý´Ï´Ù.

ß¾: ¸Á¿ø·»Áî, ù»: ±¤°¢·»Áî

Pentax Imagina°¡ ±ÙÁ¢ÃÔ¿µ¿¡ À¯¸®ÇÑ ÀÌÀ¯´Â ImaginaÀÇ ·»Áî°¡ Olympus 260, 290¿¡ ºñÇÏ¿© ±ÙÁ¢ÃÔ¿µ¿¡ À¯¸®Çϵµ·Ï ¼³°èµÇ¾î Àֱ⠶§¹®ÀÔ´Ï´Ù. Áï focus°¡ ¾à°£ ´õ °¡±õ½À´Ï´Ù. Olympus 260, 290¿¡ ºñÇÏ¿© ±Ù°Å¸®°¡ ´õ ¼±¸íÇÑ ´ë½Å ¿ø°Å¸®´Â ¾à°£ È帮°Ô º¸ÀÔ´Ï´Ù. Olympus´Â Ç¥¸é¿¡ Á¢±ÙÇϸé focus°¡ ¸ÂÁö ¾Ê¾Æ Èå·ÁÁö´Âµ¥ ´ë½Å ¿ø°Å¸®±îÁö ¼±¸íÇØ º¸ÀÔ´Ï´Ù. Á¢±ÙÇϸé È帮°Ô º¸Àδٴ ¾àÁ¡À» º¸¿ÏÇϱâ À§ÇÏ¿© Olympus¿¡¼­´Â dual focus¶ó´Â zoom lens ºñ½ÁÇÑ ±â´ÉÀ» Àû¿ëÇÏ¿´´Âµ¥ À̸¦ dual focus¶ó°í ÇÕ´Ï´Ù.

Olympus dual focusÀÇ ÀÛµ¿ ¿ø¸® (https://medical.olympusamerica.com/technology/dual-focus)

±Ù°Å¸®¸¦ Àß º¸ÀÌ°Ô ÇÒ °ÍÀÎÁö, ¿ø°Å¸®¸¦ Àß º¸ÀÌ°Ô ÇÒ °ÍÀÎÁö´Â ÀÏÁ¾ÀÇ trade-offÀÔ´Ï´Ù. ȸ»çÀÇ Ã¶ÇÐÀÌ ´ã°ÜÀÖ´Â °ÍÀÌÁö¿ä. ÃÖ±ÙÀÇ Áø´Ü³»½Ã°æ¿¡¼­´Â ºñ·Ï zoom ³»½Ã°æÀº ¾Æ´Ï´õ¶óµµ Ç¥¸é patternÀ» Áß½ÃÇϴ°æÇâÀ̹ǷΠPentax»ç¿¡¼­´Â ·»Áî Ư¼º »ó depth of field¸¦ ¾à°£ ±Ù°Å¸®·Î ¿Å±ä °Í °°½À´Ï´Ù. Á¤È®ÇÑ °ÍÀº ¾Æ´ÏÁö¸¸ Á¦°¡ ´ë°­ ±×¸²À¸·Î Ç¥ÇöÇØ º¸¾Ò½À´Ï´Ù.

¼±Á¾ ³»½Ã°æ Ä¡·á Á÷Àü¿¡ ¹ß°ßÇÑ À¶±âÇü xanthoma. Pentax ImaginaÀÇ lens Ư¼ºÀ» Àß º¸¿©ÁÖ´Â »çÁøÀ̶ó°í »ý°¢ÇÕ´Ï´Ù.

Á¶±âÀ§¾ÏÀÇ ³»½Ã°æ Áø´Ü°ú Ä¡·á¸¦ Àü°øÇÏ´Â Àú·Î¼­´Â magnifying endoscope³ª dual focus°¡ ÀåÂøµÈ Ưº°ÇÑ ³»½Ã°æÀ» ÀÌ¿ëÇÏÁö ¾Ê°íµµ ±ÙÁ¢ °üÂûÀÌ ¿ëÀÌÇÑ Imagina¿¡ ¸¶À½ÀÌ ²ø·È½À´Ï´Ù. ESD¿¡¼­ º´¼ÒÀÇ °æ°è ÆÇÁ¤¿¡ Å« µµ¿òÀ» ¹Þ°í ÀÖ½À´Ï´Ù.


3) Æí¾ÈÇÑ »ö¿Âµµ

Color image¿¡´Â »ö¿Âµµ¶ó´Â °ÍÀÌ ÀÖ½À´Ï´Ù. ¾ÆħÀ̳ª ¼®¾çÀº »ö¿Âµµ°¡ ³·¾Æ¼­ ºÓÀº »öÀ¸·Î º¸ÀÌ´Â °ÍÀÌ°í ¹Ù´å°¡¿¡¼­´Â »ö¿Âµµ°¡ ³ô¾Æ¼­ Ǫ¸£°Ô º¸ÀÌ´Â °ÍÀÔ´Ï´Ù.

Olympus »çÀÇ ¿µ»óÀº ¾à°£ ºÓ°Ô º¸ÀÌ°í (³·Àº »ö¿Âµµ), Pentax »çÀÇ ¿µ»óÀº À̺¸´Ù ¾à°£ Ǫ¸£°Ô º¸ÀÔ´Ï´Ù (³ôÀº »ö¿Âµµ). »ö¿Âµµ°¡ ³·À¸¸é °æ¹ÚÇغ¸À̱⠽±°í, »ö¿Âµµ°¡ ³ôÀ¸¸é Â÷°¡¿öº¸À̱⠽±½À´Ï´Ù. °³ÀÎ ÃëÇâÀ̶ó°í ÇÒ ¼ö ÀÖ½À´Ï´Ù. Àú´Â °æ¹ÚÇÑ ÂÊÀ» ÁÁ¾ÆÇÏ´Â ÆíÀº ¾Æ´Õ´Ï´Ù.


3. LED at the insertion tube tip of the Pentax endoscope (EG29-i10c / EC34-i10c / EC38-i10c endoscopes + EPK-i5500c Imagina processor)

³»½Ã°æÀÇ ±¤¿øÀº system¿¡ Àֱ⠸¶·ÃÀÔ´Ï´Ù. ¾Æ´Ï Àֱ⠸¶·ÃÀ̾ú½À´Ï´Ù. ³»½Ã°æ »ðÀԺο¡ ±¤ fiber°¡ ÀÖ¾î »ðÀԺΠ¸»´Ü±îÁö ºûÀÌ Àü´ÞµÇ´Â ¿ø¸®¿´½À´Ï´Ù. Á¦³í ·¥ÇÁÀÇ ¼ö¸í (´ë·« 500½Ã°£) ¶§¹®¿¡ °¡²û ·¥ÇÁ¸¦ ¹Ù²ã¾ß Çß½À´Ï´Ù. ³»½Ã°æÀ» ¿À·¡ »ç¿ëÇÏ¸é ±¤ fiber°¡ ²÷¾îÁ® È­¸éÀÌ Á¡Â÷ ¾îµÎ¿öÁö´Â ´ÜÁ¡µµ ÀÖ¾ú½À´Ï´Ù.

ÃÖ±Ù Pentax »ç¿¡¼­´Â ³»½Ã°æÀÇ ±¤¿øÀ» »ðÀԺΠ¸»´ÜÀÇ LED·Î ¹Ù²Û Á¦Ç°À» ¼Ò°³ÇÏ¿´½À´Ï´Ù. °ú°Å ´Ù¸¥ ȸ»ç¿¡¼­µµ ½ÃµµÇß´ø ¹æ½ÄÀÌÁö¸¸ ¾Æ¸¶µµ ¹ß¿­ ¹®Á¦¶§¹®¿¡ ³Î¸® »ç¿ëµÇÁö ¸øÇÏ°í withdraw µÈ °Í °°Àºµ¥, ¼¼¿ùÀÌ Èê·¯ ¹ß¿­ ¹®Á¦¸¦ ÇØ°áÇÑ Çõ½ÅÀûÀÎ Á¦Ç°ÀÌ ½ÃÀå¿¡ ³ª¿Â °ÍÀÔ´Ï´Ù (½Ã½ºÅÛ factsheet, ³»½Ã°æ factsheet). īŸ·Î±×¿¡´Â "temperature controlled LED illumination"À̶ó´Â ±â¼ú ¿ë¾î°¡ ¾º¿©ÀÖ°í, LED¿¡ heat sensor°¡ ÀÖ¾î ¿Âµµ¿¡ µû¶ó Á¶ÀýÀ» ÇÑ´Ù´Â ¼³¸íÀ» µé¾úÁö¸¸ Á¤È®ÇÑ ÀÛµ¿ ¿ø¸®´Â ÀÌÇØÇÒ ¼ö ¾ø¾ú½À´Ï´Ù.

³»½Ã°æ »ðÀԺο¡ ±¤ fiber°¡ ¾øÀ¸¹Ç·Î »ðÀԺθ¦ °¡´Ã°Ô ¸¸µé°Å³ª, working channelÀ» Å©°Ô ¸¸µé ¼ö ÀÖ´Â ¿©Áö°¡ »ý°å´Ù°í ÇÕ´Ï´Ù. 2019³â 4¿ùºÎÅÍ ´ëºÎºÐÀÇ ³»½Ã°æ °Ë»ç¸¦ Pentax Imagina·Î ÇÏ°í Àִµ¥ ¾ÆÁ÷±îÁö ¹ß¿­ ¹®Á¦´Â ¾ø¾ú½À´Ï´Ù.


4. Image enhancement of Pentax endoscope

Pentax´Â ºñ·Ï ±¤ÇÐÀû È®´ë³»½Ã°æÀ» Á¦°øÇÏÁö ¾Ê°í ÀÖÀ¸³ª, ¿À·¡ ÀüºÎÅÍ i-ScanÀ̶ó´Â image enhancement technology¸¦ Á¦°øÇÏ´ø ȸ»çÀÔ´Ï´Ù (World J Gastroenterol. 2010 - full text free).

OPTIVISTA system¿¡¼­´Â i-ScanÀÇ mode¸¦ ¹Ù²ã¼­ surface enhancement (SE)¿Í tone enhancement (TE) ±â´ÉÀ¸·Î ÀÌÇØÇϱ⠽±°Ô ¸¸µé¾ú´Ù°í ÇÕ´Ï´Ù. ¿©±â¿¡ optic filter¸¦ Àû¿ëÇÏ¿© Á¼Àº band¸¦ ÀÌ¿ëÇÑ optical enhancement (OE)¸¦ ´õÇÏ¿© ¼¼ °¡Áö mode°¡ °¡´ÉÇÏ°Ô µÇ¾ú½À´Ï´Ù.

i-Scan modes of OPTIVISTA system
Mode¿ëµµComments
i-Scan 1 = SE (surface enhancement)DetectionWith SE, the difference in luminance intensity between the pixels concerned and the surrounding pixels is analyzed and the edge components are enhanced.
i-Scan 2 = TE (tone enhancement)Pattern characterization
i-Scan 3 = OE (optical enhancement)Vessel characterizatonAn optical filter that produces bandwidth-limiting light. The main wavelenths of spectral transmission correspond to the peaks of the hemoglobin absoprtion spectrum and the light between these peaks is continously slightly emitted by raising baseline transmittance.

- SE, TE¸¦ ºñ±³ÇÒ ¼ö ÀÖ´Â mini atalas. PDF 4.7M

- OEÀÇ ±â¼úÀû Ư¡À» ¼³¸íÇÑ white paper. PDF 0.6M

IMAGINA system¿¡¼­´Â ±â°èÀûÀÎ optical filter¸¦ »ç¿ëÇÑ OE (optical enhancement)¸¦ ¾ø¾Ö°í, ´ë½Å contrast enhancement (CE)¶ó´Â softwareÀûÀÎ ¹æ¹ýÀ» Àû¿ëÇÏ¿´½À´Ï´Ù (Âü°í: i-scan technology).

CEÀÇ ±â¼úÀû Ư¡

i-Scan modes of IMAGINA system
Mode¿ëµµComments
SE (surface enhancement)Detection
CE (contrast enhancement)CE provides a sharper distinction between edges and contasting color by increasing the appearance of light-dark transition
TE (tone enhancement)Pattern characterization

IMAGINA ³»½Ã°æ scope´Â instrument channelÀÌ Å©´Ù´Â ÀåÁ¡À» ³»¼¼¿ì°í ÀÖ½À´Ï´Ù. IMAGINA ´ëÀå³»½Ã°æ¿¡´Â variable stiffness ±â´ÉÀÌ ¾ø´Â ´ë½Å TrueTorque (1 to 1 transfer torque from proximal to distal portion)¿Í i-FLEX (graduated flexibility of the insertion tube, Á¶ÀۺΠ°¡±î¿î °÷Àº ´Ù¼Ò stiffÇÏ°Ô, distal end¿¡ °¡±î¿î ºÎÀ§´Â ´Ù¼Ò flexibleÇÏ°Ô)¶ó´Â ±â¼úÀ» Àû¿ëÇÏ¿´´Ù°í ÇÕ´Ï´Ù. Zoom endoscopy°¡ ¾ø´Â ´ë½Å 2¹è±îÁö digital È®´ë ±â´ÉÀÌ ÀÖ½À´Ï´Ù. ³»½Ã°æ ÀÚü°¡ ¹æ¼öÀ̹ǷΠwater-proof capÀÌ ÇÊ¿äÇÏÁö ¾Ê°í, system°ú scope ¿¬°áÀÌ ½±´Ù°í ÇÕ´Ï´Ù.

ȸ»ç ȨÆäÀÌÁö ÀÚ·á

Telangiectasia in HHT (i-scan by EG29-i10c endoscope and Imagina processor)

[2019-7-18] Pentax ÁÖ°ü ¼¼¹Ì³ª¿¡¼­ ÇÑ ¿¬ÀÚÀÇ ÀÇ°ßÀÔ´Ï´Ù. ¼±ÅÃÀÌ ³Ê¹« ¸¹¾Æµµ Èûµç ¸ð¾çÀÔ´Ï´Ù.


5. A powerful educational platform

The video recording function enables capture of HD+ video fileds through a USB storage device.

Pentax Imagina systemÀº µ¿¿µ»ó ÃÔ¿µÀÌ ¸Å¿ì ½±½À´Ï´Ù. ³»½Ã°æ ½Ã½ºÅÛ¿¡ USB port°¡ ÀÖ¾î ³»½Ã°æ »çÁøÀ̳ª µ¿¿µ»óÀÌ ¹Ù·Î USB·Î ÀúÀåµË´Ï´Ù. ƯÈ÷ ȯÀÚ ID¸¦ ¸ðµÎ Áö¿ï ¼ö ÀÖ´Â Æí¸®ÇÑ ±â´ÉÀÌ À־ °³ÀÎÁ¤º¸ º¸È£¿¡ °­Á¡ÀÌ ÀÖ½À´Ï´Ù.

½Ã½ºÅÛ ÇÏ´Ü¿¡ µÎ °³ÀÇ USB port°¡ ÀÖ½À´Ï´Ù.

½Äµµ-À§ Á¢ÇպΠÅë°ú µ¿¿µ»óÀ» Âï¾î º¸¾Ò½À´Ï´Ù.

ÁÂȸÀü ÇÏ¿´´Ù°¡ ¿ìȸÀü ÇÏ´Â ±âºÐÀ» ´À²¸º¸½Ã±â ¹Ù¶ø´Ï´Ù.

ESD Àå¸éÀ» Âï´Â °Íµµ ¾î·Á¿î ÀÏÀÌ ¾Æ´Ï¾ú½À´Ï´Ù.

ESD using Dual knife with Pentax Imagina endoscope (50 years old female)


6. Other characteristics of IMAGINA (EPK-i5500c) system

1) EG29-i10c »ðÀԺΠ¸»´Ü¿¡ µÎ °³ÀÇ LED ±¤¿øÀÌ ÀÖ½À´Ï´Ù.

2) ±ÙÁ¢ °üÂûÀÌ ¿ëÀÌÇϵµ·Ï setting µÇ¾î ÀÖ½À´Ï´Ù.

3) Patient Identification Tab - ¹öÆ° Çϳª·Î ȯÀÚÀÇ ¸ðµç Á¤º¸¸¦ Áö¿ï ¼ö ÀÖ½À´Ï´Ù.

Patient ID TabÀ» ´­·¯ ¸ðµç Á¤º¸¸¦ Á¦°ÅÇÑ ±ú²ýÇÑ È­¸é

4) Main screeningÀÇ Çػ󵵰¡ 4 Á¾·ùÀÔ´Ï´Ù. °¢ º´¿øÀÇ È¯°æ¿¡ ¸Â´Â ÃÖ¼±ÀÇ Çػ󵵸¦ ¼±ÅÃÇÒ ¼ö ÀÖ½À´Ï´Ù. º´¿øÀÇ PACS°¡ super HD¸¦ Áö¿øÇÏÁö ¾Ê´Â °æ¿ì´Â HD±ÞÀ¸·Î °Ë»çÇÏ°í À̹ÌÁö¸¦ ÀúÀåÇϽʽÿä.

5) »çÁø Âï´Â buttonÀÌ °¡±õ°Ô À§Ä¡ÇÏ°í À־ ¼ÕÀÌ ÀÛÀº Àǻ翡°Ô À¯¸®ÇÕ´Ï´Ù.

6) ¸ðµç Imagina ³»½Ã°æ¿¡ water jet nozzleÀÌ ÀÖ¾î Ç¥¸é¿¡ ºÎÂøµÈ Á¡¾×À» Á¦°ÅÇϴµ¥ À¯¿ëÇÕ´Ï´Ù. °£È£»ç¿¡°Ô ¹° ³ÖÀº ÁÖ»ç±â ´Þ¶ó°í ¿äûÇÒ ÀÌÀ¯°¡ ¾ø½À´Ï´Ù. ESD¿¡¼­ bleeding control¿¡ ÃæºÐÇÑ ¾Ð·ÂÀ¸·Î ¹°ÀÌ ³ª¿É´Ï´Ù. ´Ù¸¸ working channel°ú water jet nozzleÀÌ °°Àº ¹æÇâÀ¸·Î µÇ¾î À־ Olympus¿Í´Â ¹°³ª¿À´Â °¢µµ°¡ ´Þ¶ó¼­ ´Ù¼Ò ¾î»öÇÕ´Ï´Ù. ±Ý¹æ ÀûÀÀÇÒ ¼ö ÀÖ½À´Ï´Ù.


7. Pentax users' feedback

[User feedback 1]

Pentax ³»½Ã°æ »ç¿ë °æÇèÀÌ ÀÖÀ¸½Å ¼±»ý´Ôµé²² ÀÇ°ßÀ» ´Þ¶ó´Â postingÀ» ÇÏ¿´´Âµ¥ ÇÑ Àü¹®°¡²²¼­ »ó¼¼ÇÑ ´äº¯À» Áּ̽À´Ï´Ù. ³»¿ëÀ» Àо½Ã¸é Á¦°¡ ¿Ö Àü¹®°¡¶ó°í ºÒ·¶´ÂÁö ¾Ë ¼ö ÀÖÀ¸½Ç °ÍÀÔ´Ï´Ù. ÀÚ½ÅÀÌ »ç¿ëÇÏ´Â µµ±¸¿¡ ´ëÇÏ¿© ÀÌ Á¤µµÀÇ °ßÇظ¦ °¡Áö´Â °ÍÀº ½¬¿î ÀÏÀÌ ¾Æ´Õ´Ï´Ù. ÁÁÀº ÀÇ°ß Áּż­ °¨»çÇÕ´Ï´Ù.

[2019-1-11. ¾Öµ¶ÀÚ ÆíÁö]

IMAGINA tester feebackÀÔ´Ï´Ù.

1. ³»½Ã°æÀÌ ÀüüÀûÀ¸·Î ÀÌÀü Á¦Ç°º¸´Ù °¡º­¿öÁ³½À´Ï´Ù.

2. Handle°ú knobÀÇ À¯°ÝÀÌ À־ ¾öÁö¼Õ°¡¶ô ÀÌ¿ëÀÌ Olympus º¸´Ù ºÒÆíÇÑ ´À³¦ÀÌ µé ¼ö ÀÖ½À´Ï´Ù. IMAGINA ÀÚü Ư¼ºº¸´Ù´Â PENTAX scopeÀÌ ÀüºÎ À¯°ÝÀÌ ÀÖ½À´Ï´Ù.

3. ±¤¿øÀÌ ³»½Ã°æ ¼±´Ü¿¡ Àֱ⶧¹®¿¡ ¸¸Áö¸é ¿­°¨ÀÌ ÀÖÁö¸¸ ½ÉÇÏÁö ¾Ê½À´Ï´Ù. cooling±â´ÉÀÌ ÀÖ´Ù°í ÇÕ´Ï´Ù.

4. º»Ã¼¿¡ fanÀÌ ¾ø¾î¼­ Á¶¿ëÇÕ´Ï´Ù.

5. ³»½Ã°æ°ú º»Ã¼ ¿¬°áºÎ¿¡ °íÁ¤ÇÉÀÌ ¾ø¾îÁ®¼­ ¿¬°áºÎ¿¡ Ãæ°ÝÀ» ÁÖ¸é(¿¹¸¦ µé¸é trapÀ» ¿¬°áÇϰųª »¬¶§) È­¸éÀÌ Èçµé¸± ¼ö ÀÖ½À´Ï´Ù.

6. ±¤¿øÀÇ Æ¯¼ºÀÎÁö ¸ð¸£°ÚÁö¸¸ white balance ¿¡ ¿¹¹ÎÇÕ´Ï´Ù. ´ëÃæ ¸ÂÃ߸é red color°¡ ³·°Ô ³ª¿É´Ï´Ù.

7. »ö°¨Àº 290°ú »ó´çÈ÷ À¯»çÇÕ´Ï´Ù. Á¢±Ù»çÁøÀ¸·Î¸¸ ºñ±³Çϸé ȸ»ç±¸ºÐÇϱ⠾î·Æ½À´Ï´Ù. °¡±îÀ̼­ °üÂûÇÒ ¶© ¶Ç·ÇÇÏ°Ô Àß º¸ÀÔ´Ï´Ù.

8. º»Ã¼°¡ µðÁöÅÐ ÅÍÄ¡Æе忡 ½ºÀ¬µµ µÇ°í À¯Àú¼¼Æõµ µÇ¼­ ÆíÇÑ Á¡µµ ÀÖÁö¸¸ ³»½Ã°æ ±³Ã¼ÇÒ¶§ ÅÍÄ¡µÇ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ±×·¯³ª °ú°Å i-scanÀ̳ª Optivistaº¸´Ù´Â °³¼±ÀÌ µÇ¾ú½À´Ï´Ù.

9. Àú´Â SE4, CE2, Light 0, R 0 B 0 À¸·Î »ç¿ëÇß½À´Ï´Ù. ȸ»ç ±ÇÀå»çÇ×µµ ÀÖÀ¸´Ï »öÁ¶Á¤¿¡ Âü°íÇϽʽÿÀ.

10. ´ëÀå³»½Ã°æ ¼±´ÜºÎ´Â trimmingÀÌ µÇ¾î ¿¹Àü¿¡ ºñÇØ edge°¡ °¢Á®ÀÖÁö ¾Ê½À´Ï´Ù. À§³»½Ã°æÀº ¾ÆÁ÷ °¢Á®ÀÖ½À´Ï´Ù. ¼öÁ¤¿äûÀº Çß½À´Ï´Ù.

[2019-1-11. ÀÌÁØÇà ´äº¯]

Á÷Á¢ÀûÀÎ ºñ±³´Â ¾î·ÆÁö¸¸ ¸¶Ä§ Pentax ³»½Ã°æÀ¸·Î °Ë»çÇÏ¿© ¹ß°ßµÈ À§¾ÏÀ» º» º´¿ø¿¡¼­ Olympus ³»½Ã°æÀ¸·Î Àç°ËÇÑ ÈÄ ¼ö¼úÇÑ È¯ÀÚ°¡ °è¼Å¼­ ³»½Ã°æ »çÁøÀ» »ìÆ캼 ±âȸ°¡ ÀÖ¾ú½À´Ï´Ù.

ß¾: ÀÇ·Ú îñ (Pentax, CE +2 mode), ù»: Olympus ÀÇ·Ú ý­ (Olympus)
Stomach, subtotal gastrectomy: Early gastric carcinoma
1. Location : [1] lower third, Center at antrum and anterior wall
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 2.5x2.3 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 3.5 cm, distal 4.5 cm
8. Lymph node metastasis : no metastasis in 22 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1a N0


[User feedback 2]

±³¼ö´Ô ¾È³çÇϼ¼¿ä. 1ÀÎ ³»°ú¸¦ ÇÏ´Ùº¸´Ï Àåºñµµ À§³»½Ã°æscope 1°³, ´ëÀåscope 1°³¸¦ ¿î¿ë ÁßÀÔ´Ï´Ù. ¸ÅÀÏ À§ 3~6°³, ´ëÀå 1~4°³ Á¤µµ¸¦ ²ÙÁØÈ÷ ÇÏ°í ÀÖ½À´Ï´Ù. 2015³â 1¿ù¿¡ °³¿øÇÏ¿© ¿ÃÇØ·Î ¸¸4³âÀÌ ³Ñ¾ú½À´Ï´Ù. Á¦°¡ Àåºñ¿¡ ±×¸® ¿¹¹ÎÇÑ ÆíÀº ¾Æ´Ï¶ó´Â Á¡À» ¹Ì¸® ¸»¾¸µå¸³´Ï´Ù. Áö±ØÈ÷ ÁÖ°üÀûÀÎ °üÁ¡¿¡¼­ ¸»¾¸µå¸®°Ú½À´Ï´Ù.

³»½Ã°æ È­Áú¸é

1. ¿Ã¸²Çª½º´Â ÄÜÆ®¶ó½ºÆ®°¡ °­ÇÏ¿© È­¸éÀÌ Â¸ÇÑ ´À³¦ÀÌ°í, ÈÄÁö³íÀº È­ÁúÀÌ ±²ÀåÈ÷ ºÎµå·¯¿ö ¹¶°ÔÁö´Â ´À³¦ÀÔ´Ï´Ù. ÆæŹ½º´Â ±× Áß°£¿¡ ÀÖ´Â ´À³¦ÀÔ´Ï´Ù.

2. EPK-i5000 Àº 2014³â ´ç½Ã HD±ÞÀ¸·Î ¼Ò°³°¡ µÇ¾ú´Âµ¥ Á¦ ´À³¦¿¡´Â ¿Ã¸²Çª½º 260Á¤µµÀÇ Çػ󵵶ó°í »ý°¢ÇÕ´Ï´Ù.(¿Ã¸²Çª½º¸¦ ¸¶Áö¸·À¸·Î Àâ¾Æº» ½ÃÀýÀÌ 5³â ÀüÀÔ´Ï´Ù.)

3. Á¦ °³ÀÎÀûÀÎ »ý°¢Àº º´º¯À» ã°í, º´º¯ÀÇ °æ°è¸¦ È®ÀÎÇÏ´Â µ¥¿¡´Â scopeÀÇ ¿µÇâÀº º°·Î ¾ø´Ù°í »ý°¢ÇÕ´Ï´Ù. ³»½Ã°æ °Ë»ç´Â videoÁö¸¸ ³²±â°í ´Ù¸¥ »ç¶÷µé¿¡°Ô º¸¿©ÁÖ´Â °Ç ½ºÆ¿ÄÆÀ̱⠶§¹®¿¡ contrast°¡ ÁÁÀº ¿Ã¸²Çª½º »çÁøÀÌ ¿¹»µº¸ÀÌÁö ¾Ê³ª ÇÏ´Â »ý°¢ÀÔ´Ï´Ù. ÇöÀç±îÁö´Â ÆæŹ½ºÀÇ È­Áú¿¡ ´ëÇؼ­´Â Àú´Â Å« ºÒ¸¸¾øÀÌ ¸¸Á·Çϸ鼭 »ç¿ëÁßÀÔ´Ï´Ù. ¹°·Ð ¿Ã¸²Çª½º ÃֽűâÁ¾ÀÇ »çÁøÀ» º¸¸é °®°í ½Í´Ù´Â »ý°¢À» Ç×»ó ÇÕ´Ï´Ù.

³»½Ã°æ Á¶ÀÛ¼º

1. ¿Ã¸²Çª½º ³»½Ã°æÀ» ¸¸Á³´ø ±â¾ïÀ¸·Î´Â ¿Ã¸²Çª½º´Â scopeÀÌ ±²ÀåÈ÷ ºÎµå·¯¿ü½À´Ï´Ù. ÆæŹ½º´Â ºÎµå·´±â º¸´Ù´Â Àû´çÈ÷ stiffÇÑ ´À³¦ÀÔ´Ï´Ù. scope ¼ö¸®Áß¿¡ ´ëüǰÀ» »ç¿ëÇØ º¸´Ï scopeÀÇ Ç¥¸é rubber°¡ ±²ÀåÈ÷ Áß¿äÇÏ´Ù´Â »ý°¢ÀÌ µé´õ±º¿ä. ³»½Ã°æ¼Òµ¶Á¦ ¿µÇâÀ¸·Î rubber Ç¥¸é ±¤ÅÃÀÌ ¾ø¾îÁ®¼­ grip °¨ÀÌ ÀÌ»óÇß´ø ´À³¦µµ ÀÖ½À´Ï´Ù.

2. ´ëÀå³»½Ã°æÂÊÀº Á¦°¡ °ø±Þ¹ÞÀº ¸ðµ¨Àº ±æÀÌ°¡ 1°¡Áö ÀÔ´Ï´Ù. ¿Ã¸²Çª½º´Â long scopeÀÌ ÀÖ¾ú°í stiffness¸¦ Á¶ÀýÇÏ´Â ÀåÄ¡°¡ ÀÖ¾ú´Âµ¥.. ´ëÀå³»½Ã°æÀ» ¿À·¡ÇÏ´Ùº¸´Ï ÇÊ¿äÇÑ °æ¿ì°¡ ¾ø¾ú½À´Ï´Ù.

³»½Ã°æ ¼¼Ã´ ¹× °ü¸®¸é

1. ÆæŹ½º ³»½Ã°æ scope°í º»Ã¼¿¬°áºÎÀ§´Â Çϳª·Î µÇ¾î ÀÖ°í ±â´Ù¶õ ¼è¸øÀ» ³Ö´Â °Íó·³ ÀåÂøÇÕ´Ï´Ù. ¿Ã¸²Çª½º ³»½Ã°æÀÇ ±â¾ïÀº ÇÉÀÌ ¿©·¯°³ À־ ¹«¸®ÇÏ°Ô ²È´Ùº¸¸é ÇÉÀÌ ¼Õ»óµÈ´Ù´Â ¸»À» µéÀº ÀûÀÌ ÀÖ½À´Ï´Ù(¹°·Ð ±â¾ï ¿À·ùÀÏ ¼ö ÀÖ½À´Ï´Ù). ÆæŹ½º´Â ±×·±¸é¿¡¼­ ´Ü¼øÇÏ°Ô ¸¸µé¾î¼­ °íÀåÀÌ Á» ´õ ÀûÁö ¾Ê³ª ÇÏ´Â »ý°¢ÀÌ µì´Ï´Ù.

2. ÇöÀç±îÁö 4³â°£ »ç¿ëÇß°í, À§³»½Ã°æÀº 1³â¿¡ ¾à 1000-1300°³, ´ëÀå³»½Ã°æÀº 500-700°³¾¿ Çß½À´Ï´Ù. ¾ÆÁ÷±îÁö Å« °íÀå¾øÀÌ À§scope 1°³, ´ëÀå scope 1°³·Î Àß ¿î¿ëÁßÀÔ´Ï´Ù.

ÃÑÆòÀ¸·Î´Â ÆæŹ½º EPK-i5000Àº º¸±ÞÇü ³»½Ã°æÀ¸·Î °¡¼ººñ°¡ ÁÁÀº ³»½Ã°æÀ̶ó°í »ý°¢ÇÕ´Ï´Ù.


[User feedback 3 (2019-6-2. GI fellow 3°³¿ùÂ÷)]

±³¼ö´Ô ¾È³çÇϽʴϱî? ÀÓ»ó°­»ç XXX ÀÔ´Ï´Ù.

Àú´Â ƯÈ÷³ª Pentax¿¡ ÀûÀÀÀ» ¸øÇÏ¿© À§³»½Ã°æ insertionµµ ¸øÇÏ°í ´ëÀå³»½Ã°æµµ ÇÑ »ç¶÷´ç cecal intubationÇϴµ¥ 30ºÐÀÌ»ó °É¸®°í, ¾ÈµÇ¼­ µµ¿òÀ» ¿äûÇÏ´Â °æ¿ìµµ ¸¹¾Ò´Âµ¥ ³ªÁß¿¡´Â ÈξÀ ³ª¾ÆÁö±ä ÇÏ¿´½À´Ï´Ù!!

¹°ÀÌ ³ª¿Í¼­ irrigationÀÌ Æí¸®ÇÏ°í È­ÁúÀÌ ÈξÀ ÁÁ¾Æ¼­ ƯÈ÷ À§³»½Ã°æ¿¡´Â ÁÁÀº °Í °°½À´Ï´Ù. ±×·¯³ª, ¾ÆÁ÷±îÁöµµ ´ëÀå³»½Ã°æÀÇ °æ¿ì¿¡´Â Àå°ü Àüü¸¦ ÂïÀ» ¶§ ¾Æ¿ôÆ÷Ä¿½º°¡ ³Ê¹« ¸¹ÀÌ µÇ°í, ¿À¸¥ÂÊÀ¸·Î ÅäÅ©°¡ Àß ¾È °É¸®°í °æµµ°¡ ´õ µüµüÇØÁö´Â ´À³¦°ú suction ¹öÆ°ÀÌ ¾ÈÂÊÀ¸·Î Àß ¸ÔÇô¼­ ¼Õ¸ñ¿¡ ÈûÀÌ ¸¹ÀÌ µé¾î°¡¼­ ¾î·Á¿òÀÌ ÀÖ´Â °Í °°½À´Ï´Ù!

[User feedback 4 (2019-6-3. GI fellow 3°³¿ùÂ÷)]

±³¼ö´Ô. ÀÓ»ó°­»ç XXX ÀÔ´Ï´Ù.

ÆæŹ½º ³»½Ã°æÀº óÀ½¿¡ Å©°Ô ºÒÆíÇÏ´Ù°¡ 3ÁÖ°¿¡´Â ´ë°­ ÀûÀÀÀÌ µÇ±ä Çß½À´Ï´Ù

ÀåÁ¡: (1) water jetÀÌ¿©¼­ Æí¸®ÇÑ Á¡. (2) ³»½Ã°æ ÀÛµ¿½Ã ¼ÒÀ½ÀÌ Àû´Ù. (3) °¡º±´Ù. (4) ´ëÀå³»½Ã°æ scopeÀÌ ±æ´Ù.

´ÜÁ¡: (1) EGD´Â H scope°ú Á÷°æÀÌ ºñ½ÁÇÏ¿© ½Äµµ ÇùÂø Àִ ȯÀÚ¿¡¼­´Â °Ë»ç°¡ ¾î·Á¿ü´Ù. (2) out-focusing µÇ¾î¼­ ¸Ö¸®¼­ ÂïÀ» ¶§ È­ÁúÀÌ ¸¹ÀÌ ¶³¾îÁø´Ù. (3) suction ÀÌ Àß ¾ÈµÈ´Ù. (4) colonoscopy °æµµ Á¶ÀýÀÌ ¾ÈµÈ´Ù.

¸¶Áö¸· ³¯±îÁö ÀûÀÀÀÌ ¾ÈµÈ °ÍÀº È­¸éÀÇ ÀÌÁú°¨ (?) °íÇØ»óµµÀ̱ä Çѵ¥, ¹º°¡ ¾î»öÇÑ ´À³¦°ú out-focusing µÇ´Â Á¡À̾ú´ø °Í °°½À´Ï´Ù.

[2019-6-3. ÀÌÁØÇà comment]

´Ã ºñ½ÁÇÑ À̾߱⸦ µè½À´Ï´Ù. óÀ½¿¡´Â ¾î»öÇߴµ¥ ½Ã°£ÀÌ Áö³ª¸é ÈξÀ ³ª¾ÆÁø´Ù´Â °ÍÀÌÁö¿ä. Marketshare 2, 3À§ ȸ»ç Á¦Ç°¿¡ ´ëÇÑ ºÒ¸¸Àº ´ëÇüº´¿ø¿¡¼­¸¸ ³ª¿É´Ï´Ù. ´Ã ¾²´ø ³»½Ã°æÀÌ ¾Æ´Ï¹Ç·Î ºÒÆíÇÏ´Ù´Â °ÍÀÔ´Ï´Ù. 1-2Â÷ ÀÇ·á±â°ü¿¡¼­´Â Pentax¸é Pentax, FujifilmÀ̸é Fujifilm°ú °°ÀÌ ÇÑ È¸»ç Á¦Ç°¸¸ »ç¿ëÇϹǷΠÀüÇô ¹®Á¦µÇÁö ¾Ê½À´Ï´Ù. ±×³É Àͼ÷ÇØÁö¸é ´Ù ¶È°°½À´Ï´Ù. Çö´ë ÀÚµ¿Â÷¸¦ ¸ô´Ù°¡ ¸£³ë ÀÚµ¿Â÷¸¦ ¿îÀüÇÏ´Â Á¤µµÀÇ Â÷ÀÌÀÏ °ÍÀÔ´Ï´Ù. ÀûÀÀ ½Ã°£ 5ºÐÀ̸é ÃæºÐÇÕ´Ï´Ù.

³»½Ã°æ Àü¹®°¡´Â ¾î´À ȸ»ç ³»½Ã°æµµ ÀüÇô ¹®Á¦°¡ ¾ø½À´Ï´Ù. Àú´Â Olympusµµ ¾²°í, Pentaxµµ ¾²°í, Fujifilmµµ ¾²´Âµ¥ ¾î´À Á¦Ç°¿¡¼­µµ ¾Æ¹«·± ¹®Á¦¸¦ ´À³¥ ¼ö ¾ø¾ú½À´Ï´Ù. ±×³É ´Ù ÁÁÀº ³»½Ã°æÀÔ´Ï´Ù. ±×·¯³ª, ¾ÆÁ÷ ³»½Ã°æ °æÇèÀÌ ¸¹Áö ¾Ê¾Ò°í ÇÑ È¸»ç ³»½Ã°æ¿¡¸¸ Àͼ÷ÇØÁø ÃʽÉÀÚ°¡ »õ·Î¿î ȸ»çÀÇ ³»½Ã°æÀ» ÀâÀ¸¸é óÀ½¿¡´Â ¾î»öÇÒ ¼ö ÀÖ½À´Ï´Ù. À§³»½Ã°æÀº »ó´ëÀûÀ¸·Î mechanics°¡ ´Ü¼øÇϹǷΠº° Â÷ÀÌ°¡ ¾øÁö¸¸ ´ëÀå³»½Ã°æÀº stiffnessµµ ´Ù¸£°í torque Ư¼ºµµ ´Ù¸£±â ¶§¹®¿¡ ÀûÀÀ½Ã°£ÀÌ Á» ´õ ÇÊ¿äÇÒ ¼ö ÀÖ½À´Ï´Ù. ÀûÀÀÇÏ¸é ¶È°°¾ÆÁý´Ï´Ù.

Àü°øÀÇ, ÀÓ»ó°­»ç training °úÁ¤¿¡¼­ ¿©·¯ ȸ»ç ³»½Ã°æÀ» Á¢ÇÏ°Ô ÇØ ÁÖ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. ȸ»ç¸¶´Ù Á¦Ç°¸¶´Ù Ư¼º°ú °¡¼ººñ°¡ ´Ù¸£¹Ç·Î Æø³Ð°Ô °æÇèÇغ¸´Â °ÍÀÌ ¾î¶³±î¿ä? ÇÑ È¸»ç ³»½Ã°æÀ¸·Î¸¸ trainingÀ» ¹Þ´Ù°¡ ´Ù¸¥ ³»½Ã°æÀ» »ç¿ëÇÏ´Â ÀÇ·á±â°ü¿¡ ÃëÁ÷ÇÏ´Â °æ¿ìµµ ¸¹½À´Ï´Ù. µÎ·ç ½á º¸´Â °ÍÀÌ ÁÁ½À´Ï´Ù.

Àú´Â Çѽĵµ ÁÁ¾ÆÇÏ°í Áß±¹½Äµµ ÁÁ¾ÆÇÏ°í ÀϽĵµ ÁÁ¾ÆÇÕ´Ï´Ù (¾ç½ÄÀº º°·Î^^). Olympusµµ ÁÁ¾ÆÇÏ°í, Pentaxµµ ÁÁ¾ÆÇÏ°í, Fujifilmµµ ÁÁ¾ÆÇÕ´Ï´Ù. °ñ°í·ç ¸Àº¸°í ½Í½À´Ï´Ù. °ñ°í·ç ½áº¸°í ½Í½À´Ï´Ù.


[User feedback 5 (2019-6-17. °£È£ÆÄÆ®)]


8. ESD and Splash-M knife

YouTube video clip in a new tap (minimal editing)

Splash M-knife is a new multi-functional ESD knife from Pentax company. It has a needle-type tip with hooking mechanism. At the distal end of the knife, there is a metal plate which is useful for bleeding control even in retracted position.

The length of the ESD needle is 2mm in extended position and 0.5mm in retracted position.

In a recent study from Japan, ESD using Splash-M knife appeared to reduce the usage of hemostatic forceps during the gastric ESD without increasing the adverse effects. It can reduce the total cost of the treatment.


2020-8-16 ³»½Ã°æÇÐȸ ¼¼¹Ì³ª¿¡¼­ Imagina i10c¿Í Splash M knife¸¦ ÀÌ¿ëÇÑ ESD Áõ·Ê¸¦ º¸¿©µå·È´õ´Ï ÇÑ ±³¼ö´Ô²²¼­ ¾Æ·¡¿Í °°Àº Ä«ÅåÀ» Áּ̽À´Ï´Ù.

Á¦°¡ Pentax Á¦Ç°ÀÌ Olympus Á¦Ç°º¸´Ù ESD¿¡ ´õ ÁÁ´Ù°í ÁÖÀåÇÏ´Â °ÍÀº ¾Æ´Õ´Ï´Ù. ±×³É Imagina i10cµµ À¯¿ëÇÏ°Ô ¾²°í ÀÖ´Ù´Â °Í »ÓÀÔ´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼­ ´ëºÎºÐÀÇ ESD´Â Olympus ³»½Ã°æÀ¸·Î ½ÃÇàµÇ°í ÀÖ½À´Ï´Ù. Àú´Â Olympus 290 ³»½Ã°æÀ¸·Î ESD¸¦ ÇÏÁö ¾Ê°í ÀÖÁö¸¸, ¸¹Àº ´ëÇÐÀÇ ¸¹Àº ±³¼ö´ÔµéÀº Olympus 290 ³»½Ã°æÀ¸·Î ¸ÚÁø ESD¸¦ ½Ã¼úÇÏ°í °è½Ê´Ï´Ù. ½Ã¼úÀÚÀÇ ÃëÇâÀÌ Áß¿äÇÑ °Í °°½À´Ï´Ù. Àú´Â ³ÐÀº channelÀÌ ÁÁ½À´Ï´Ù.

Á¦°¡ Pentax i10c¸¦ ESD¿¡ »ç¿ëÇÏ°í ÀÖ´Â ÀÌÀ¯´Â (1) angulationÀÌ ÁÁ´Ù´Â Á¡, (2) close-up view°¡ ¼±¸íÇÏ´Ù´Â Á¡, (3) working channelÀÇ ³»½Ã°æÀÌ 3.2mm¶ó´Â Á¡ ¶§¹®ÀÔ´Ï´Ù. ƯÈ÷ ³»°æ 3.2mm°¡ Áß¿äÇÕ´Ï´Ù. ESD ½Ã¼úÀÚ¸¶´Ù »ç¿ëÇÏ´Â techniqueÀÌ ´Ù¸¥µ¥, Àú´Â ½Ã¼ú µµÁß °ø±â¸¦ Á¶±Ý ³Ö°Å³ª Á¶±Ý »©´Â °ÍÀ» °Å¸® Á¶ÀýÀ» ÇÏ°í ÀÖ½À´Ï´Ù. Needle type knife¸¦ ÁÖ ¹«±â·Î »ç¿ëÇϱ⠶§¹®ÀÔ´Ï´Ù. µû¶ó¼­ knife¸¦ ³ÖÀº »óÅ¿¡¼­ suctionÀÌ °¡´ÉÇØ¾ß Çϴµ¥ À̸¦ À§Çؼ­´Â 0.1mmµµ Áß¿äÇÕ´Ï´Ù. ³»°æ 2.8mmÀÎ °æ¿ì IT-2 knife¸¦ ³ÖÀ¸¸é °ÅÀÇ suctionÀÌ µÇÁö ¾Ê½À´Ï´Ù. Dual knife¸¦ ³ÖÀ¸¸é suctionÀÌ ¾ÆÁÖ Àß µË´Ï´Ù. ³»°æÀÌ 3.2mmÀÎ °æ¿ì´Â knifeÀÇ Á¾·ù¿Í ¹«°üÇÏ°Ô suctionÀÌ Àß µË´Ï´Ù. Ä¡½ÇÀ» ÀÌ¿ëÇÑ traction method¸¦ »ç¿ëÇϱ⿡µµ 3.2mm°¡ ÁÁ½À´Ï´Ù. ±×·¡¼­ ¿À·¡µÈ ¸ðµ¨ÀÌÁö¸¸ Àú´Â ¿©ÀüÈ÷ Olympus 260J scope¸¦ »ç¶ûÇÕ´Ï´Ù. ³»°æÀÌ 3.2mmÀÔ´Ï´Ù. 290 ½Ã¸®Áî¿¡¼­´Â 2.8mm ¹Û¿¡ ¾ø´Â °Í °°½À´Ï´Ù. ¸î ´ë °¡Áö°í ÀÖ´Â Olympus 260J¸¦ ¾Æ³¢°í ¾Æ²¸ »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. ´ë¾ÈÀ¸·Î Pentax i10c¸¦ °í·ÁÇÏ°í ÀÖ½À´Ï´Ù. ÀúÀÇ °æ¿ì´Â ´çºÐ°£ Olympus 260J¿Í Pentax Imagina i10c µÎ °¡Áö¸¦ ESD¿¡ »ç¿ëÇÒ °Í °°½À´Ï´Ù.


PIVA project case 10 ESD for EGC using Pentax M knife only

Sex/age: M/62

Symptoms and signs: A 62 years old male patient visited my clinic due to a small gastric lesion found in the screening endoscopy. Outside pathology report was 'tubular adenoma with high grade dysplasia, suspicious od adenocarcinoma'. Outside pathology slide was reviewed by in-house pathologist of my hospital and the final pathology was 'adenocarcinoma, moderatly differentiated'. The CT scan was negative for metastasis. ESD was done with Pentax Splash M knife.

Endoscopic images:

Video clips:

4:04

Diagnosis and treatment: Final ESD pathology was as followings;

Stomach, GC of proximal antrum, ESD: Early gastric carcinoma
1. Location : antrum, greater curvature
2. Gross type : EGC type IIc+IIa
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 11 mm (2) vertical diameter, 10 mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N); safety margin : distal 14 mm, proximal 10 mm, anterior 10 mm, posterior 10 mm, deep 200 §­
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent


[Cases]

Unedited upper endoscopy video 1. Hematins in the gastric antrum of an aspirin user

ESD with Splash M knife


À§ÀüÁ¤ºÎ ¼Ò¸¸¿¡¼­ ±¹¼Ò º´¼Ò°¡ ¹ß°ßµÇ¾î Á¶Á÷°Ë»ç¿¡¼­ atypical glands·Î ³ª¿Í ÀǷڵǾú½À´Ï´Ù. ¿ÜºÎ½½¶óÀ̵å ÀçÆǵ¶°ú ³»½Ã°æ Àç°ËÀ» ÇÏ¿´°í °á°ú´Â ¾Æ·¡¿Í °°½À´Ï´Ù.

¿ÜºÎ½½¶óÀ̵å ÀçÆǵ¶: atypical glands, suspected tubular adenocarcinoma, moderately differentiated

º» º´¿ø Àç°Ë: tubular adenocarcinoma, moderately differentiated

¿ÜºÎ ù ³»½Ã°æ: Fujifilm ³»½Ã°æ, º» º´¿ø Àç°Ë: Olympus GIF-Q260

±×·±µ¥ Àç°ËÀ» ´ã´çÇϽŠfellow ¼±»ý´Ô²²¼­ depressed lesion µÎ°³°¡ ºÙ¾îÀÖ´Â ¾ç»óÀ̶ó¸é¼­ "¿·À¸·Î ´©¿öÀÖ´Â ´«»ç¶÷ ¸ð¾ç"À̶ó´Â ¿¹»Û Ç¥ÇöÀ» ½á Áּ̽À´Ï´Ù. ESD¸¦ ÇÏ¿´°í µÎ°³ÀÇ ÀÛÀº À§¾ÏÀÌ ³ª¶õÈ÷ À§Ä¡ÇÑ °ÍÀ¸·Î ³ª¿Ô½À´Ï´Ù. ´«»ç¶÷ÀÌ ¸Â¾Ò½À´Ï´Ù.

ESD: Pentax Imagina EG29-i10c

ESD: Early gastric carcinoma (x2)
1. Location : antrum, lesser curvature
2. Gross type : ¨ç EGC type IIb+IIa ¨è EGC type IIc+IIb
3. Histologic type : ¨ç. tubular adenocarcinoma, well differentiated, ¨è. tubular adenocarcinoma, moderately differentiated (WHYZ lesion)
4. Histologic type by Lauren : ¨ç,¨è intestinal
5. Size of carcinoma : ¨ç (1) longest diameter, 16 mm (2) vertical diameter, 10 mm; ¨è (1) longest diameter, 8 mm (2) vertical diameter, 8 mm
6. Depth of invasion : ¨ç,¨è invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 8 mm, proximal 13 mm, anterior 14 mm, posterior 10 mm, deep ¨ç:400 §­, deep ¨è: 350 §­
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Pre-existing adenoma : none
12. Microscopic ulcer : absent
13. Histologic heterogeneity: absent

FujifilmÀ¸·Î ¹ß°ßµÇ¾î ÀǷڵǾú°í Olympus·Î °Ë»çÇÏ¿´°í Pentax·Î Ä¡·áÇÏ¿´½À´Ï´Ù.


10³â Àü ½Äµµ¾Ï ³»½Ã°æ Ä¡·á¸¦ Çß´ø ȯÀÚÀÇ ÃßÀû³»½Ã°æÀ» ½ÃÇàÇÏ¿´½À´Ï´Ù. 10³â °£ Àç¹ß¾øÀÌ Àß Áö³»½Ã´Â ºÐÀ» º¸¸é °í»ý½º·´°Ô ESD Çß´ø º¸¶÷À» ´À³¦´Ï´Ù.


Esophagus, 30 cm from incisor, endoscopic sinus dissection: Squamous cell carcinoma, well differentiated:
1) size: 0.8x0.6 cm
2) invasion to lamina propria (M2)
3) no lymphovascular invasion
4) negative resection margins

°ú°Å¿¡´Â ÇÑ È¸»çÀÇ ³»½Ã°æ¸¸ »ç¿ëÇߴµ¥ ÃÖ±Ù¿¡´Â ¿©·¯ ȸ»çÀÇ ³»½Ã°æÀ» »ç¿ëÇϸ鼭 ±× Â÷À̸¦ ´À²¸º¸°í ÀÖ½À´Ï´Ù. Pentax ³»½Ã°æ EG29-i10cÀÇ È­¸éÀº ¹«Ã´ Â÷ºÐÇÏ´Ù´Â °ÍÀÌ ÀåÁ¡ÀÔ´Ï´Ù. ³»½Ã°æ °Ë»ç¸¦ Çϸ鼭 ¸¶À½ÀÌ Æí¾ÈÇØÁüÀ» ´À³§´Ï´Ù.


ÀÌ·¸°Ô ¹Ì¹¦ÇÑ º¯È­¸¦ ¾î¶»°Ô ãÀ¸¼Ì´ÂÁö ±Ã±ÝÇÏ°í Á¸°æ½º·¯¿ï »ÓÀÔ´Ï´Ù. Àú´Â white light·Î´Â ã±â ¾î·Á¿ö NBI¿Í indigocarmine chromoendoscopy¸¦ ÅëÇÏ¿© °¡±î½º·Î ã¾Æ¼­ ¾î·Æ°Ô Ä¡·á¸¦ ÇÏ¿´½À´Ï´Ù. ÈÞ~~


ESD: Early gastric carcinoma
1. Location : mid body, lesser curvature
2. Gross type : EGC type IIb
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 16 mm (2) vertical diameter, 14 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 3 mm, proximal 6 mm, anterior 10 mm, posterior 8 mm, deep 300 §­
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Pre-existing adenoma : none
12. Microscopic ulcer : absent
13. Histologic heterogeneity: absent


Initial outside biopsy was "atypical glands with high grade dysplasia". ESD (Pentax Imagina EG29-i10c endoscope, Finemedix transparent hood and Olympus Dual knife) was done and the final pathology was EGC, which was limited in the mucosal layer.


ESD: Early gastric carcinoma
1. Location : angle, lesser curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 32 mm (2) vertical diameter, 9 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 10 mm, proximal 9 mm, anterior 2 mm, posterior 4 mm, deep 250 §­
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Pre-existing adenoma : none
12. Microscopic ulcer : absent
13. Histologic heterogeneity: absent


MALToma. °³¾÷°¡¿¡¼­ Pentax EPKi-5000 ½Ã½ºÅÛ°ú EG-2990i scope·Î ¹ß°ßÇÑ MALToma
MALTomaÀÇ·Ú ÈÄ Olympus GIF-Q260 scope·Î Àç°Ë


°³¾÷°¡¿¡¼­ Pentax EPKi-5000 ½Ã½ºÅÛ°ú EG-2990i scope·Î ÃÔ¿µÇÑ À§½ÄµµÁ¢ÇպΠ»çÁøÀÔ´Ï´Ù. Contrast°¡ ´Ù¼Ò °­ÇÏ°Ô settingµÇ¾î ÀÖ±â´Â Çѵ¥¿ä... ÀÌ ¼Ò°ßÀ» ¾î¶»°Ô Çؼ®ÇÏ´ÂÁö ´ñ±ÛÀ» ºÙ¿©Áֽñ⠹ٶø´Ï´Ù. ÃÖ´ëÇÑ ÀÚ¼¼È÷...


ESD (unedited) using Pentax Imagina and Olympus Dual Knife

ß¾: ±Ë¾ç¼º ´ëÀå¿° Áø´Ü ½Ã ³»½Ã°æ. Olympus ³»½Ã°æ »çÁøÀε¥ contrast settingÀÌ ºÎÀûÀýÇÏ¿© ¸Å¿ì °­ÇÑ ´ëÁ¶¸¦ º¸ÀÌ°í ÀÖ¾î ¸Å¿ì »ý°æÇÏ°í subtleÇÑ º¯È­¸¦ º¼ ¼ö ¾ø´Â »óÅÂÀÔ´Ï´Ù. ¾Æ¹«¸® constast¸¦ °­ÇÏ°Ô ÇÏ´Â °ÍÀÌ À¯ÇàÀ̶óÁö¸¸ ³Ê¹« ½ÉÇÕ´Ï´Ù. Contrast¸¦ ³·Ãß°í white balance¸¦ ¸ÂÃß´Â ¹æÇâÀ¸·Î Á¶Á¤ÀÌ ÇÊ¿äÇÕ´Ï´Ù. ù»: ÃßÀû ³»½Ã°æ. Pentax ´ëÀå³»½Ã°æ (Imagina EC38-i10c) »çÁøÀ¸·Î º´¼ÒÀÇ subtleÇÑ º¯È­¸¦ Àß º¼ ¼ö ÀÖ´Â Á¤µµÀÇ contrastÀÔ´Ï´Ù.

¿©ÀÚ 80¼¼ Àúµµ¼±Á¾ÀÔ´Ï´Ù. ¾î¶»°Ô Ä¡·áÇϽðڽÀ´Ï±î? Àú´Â ¼ÒÀÛ¼úÀ» ÃßõÇÏ¿´½À´Ï´Ù.

Duodenal ulcer was found with Pentax Imagina endoscope (left picture). After Helicobacter eradication and 4 weeks of pantprazole, follow-up was done with Olympus Q260 endoscope (right picture). The quality of both endoscopes are all good. The best focus of Pentax Imagina is closer than Olympus Q260. The close up view is better with Pentax Imagina, but the distant view is better with Olympus Q260. It depends on the endoscopist's personal preference.


1:37. Posterior wall of the lower body. EGC IIc. PIVA14


[À§¾Ï 864]

A small flat elevated lesion was found during the screening endoscopy with Fujifilm endoscope. The patient was referred without biopsy. Repeated endoscopy with Olympus endoscope done and the biopsy result was 'atypical gland with high grade dysplasia and focal carcinomatous transformation.

ESD was done with Pentax Imagina endoscope, Olympus Dual knife, IT-2 knife, and Finemedix injector needle.


ESD. Early gastric carcinoma
1. Location : antrum, greater curvature
2. Gross type : EGC type IIa
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 20 mm (2) vertical diameter, 15 mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 9 mm, proximal 7 mm, anterior 8 mm, posterior 12 mm, deep 150 §­
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent

Endoscopies from different vendors have their own characteristics. I enjoy using all the different endoscopies in my daily practice and teaching.


[¿ì¸®¸» ñÉ]

Á¦ ¼Ò¼Ó ±â°ü¿¡¼­´Â ¿Ã¸²Çª½º, ÈÄÁöÇʸ§, Pentax¸¦ ¸ðµÎ »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù.

¿Ã¸²Çª½º´Â ¿¹³ª Áö±ÝÀ̳ª ñ«³»½Ã°æÀ¸·Î »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. È­ÁúÀÌ ÁÁ°í ³»±¸¼ºÀÌ ´ë´ÜÇÕ´Ï´Ù. ³»½Ã°æ°èÀÇ ¿ÕÁß¿ÕÀ̶ó°í ÇÒ¸¸ÇÕ´Ï´Ù.

ÈÄÁöÇʸ§Àº 15³â Àü Âë Dr. Yamamoto²²¼­ small balloon enteroscopy¸¦ °³¹ßÇÏ¿´À» ¶§ µµÀÔÇÏ¿´°í, ÀÌÈÄ ¿Ã¸²Çª½º single balloon enteroscopy·Î ¹Ù²Ù¾ú½À´Ï´Ù. ÇöÀç´Â ³»½Ã°æ½ÇÀÇ hands-on ±³À°¿¡ ÈÄÁöÇʸ§À» ÀÌ¿ëÇÏ°í ÀÖ½À´Ï´Ù.

Pentax´Â 2020³â¿¡ 4 system (³»½Ã°æ 28´ë)À» µµÀÔÇÏ¿´½À´Ï´Ù.

´ëÇк´¿øÀº ±³À°º´¿øÀ̹ǷΠ³»½Ã°æÀ» ¹è¿ì´Â fellow ¼±»ý´ÔµéÀÌ ¿©·¯ ȸ»çÀÇ ¸¹Àº ³»½Ã°æÀ» µÎ·ç °æÇèÇÒ ¼ö ÀÖ´Â ±âȸ¸¦ ¸¶·ÃÇÏ´Â °ÍÀº µµ¿òµÉ °Í °°½À´Ï´Ù. Àú´Â ÀÏÁÖÀÏ¿¡ ESD¸¦ 2 ¼¼¼Ç (ÇÑ ¼¼¼Ç¿¡ ESD ½Ã¼ú 2-3°³) ½ÃÇàÇÏ°í Àִµ¥ ÇÏ·ç´Â Olympus, ÇÏ·ç´Â Pentax¸¦ »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. Ç°Áú°ú °¡°Ý °æÀï·ÂÀ» °í·ÁÇÒ ¶§ ¼¼ ȸ»ç Á¦Ç° ¸ðµÎ ³ª¸§ÀÇ ÀåÁ¡ÀÌ ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù.


9. EndoGEL ESD hands-on training using Pentax endoscope, needle, and ESD knife

Artificial stomach mucosa (EndoGEL)¸¦ ÀÌ¿ëÇÑ hands-on trainingÀ» ½ÃÀÛÇÏ¿´½À´Ï´Ù (2019-6-26). ESD ¹è¿ì±â °úÁ¤ÀÇ Çʼö°¡ µÇ°í ÀÖ´Â simulation training¿¡ °¡Àå ÁÁÀº ¹æ¹ýÀÌ ¾Æ´Ñ°¡ »ý°¢µÇ¾ú½À´Ï´Ù.

Pig stomach modelÀ» ÀÌ¿ëÇÑ ESD ÈƷÿ¡ ºñÇÏ¿© Æí¸®ÇÑ Á¡ÀÌ ¸¹¾Ò½À´Ï´Ù. µÎ °¡Áö¸¸ ¸»¾¸µå¸®¸é ¾Æ·¡¿Í °°½À´Ï´Ù (1) ÈƷÿë pig stomachÀ» ±¸ÇÏ´Â °ÍÀº (¾ÆÁ÷±îÁö´Â ¹ýÀû ±Ù°Å°¡ ¾ø¾î¼­) ¹Ýµå½Ã ´©±º°¡ÀÇ µµ¿òÀÌ ÇÊ¿äÇÕ´Ï´Ù. EndoGELÀº ÆÄ´Â ¹°°ÇÀÔ´Ï´Ù. (2) Pig stomachÀ̳ª live pig¸¦ ÀÌ¿ëÇÑ ESD ÈÆ·ÃÀº µ¿¹° ¼ö¼ú½Ç¿¡¼­¸¸ °¡´ÉÇÕ´Ï´Ù. ³»½Ã°æ½ÇÀ̳ª ȸÀǽÇ, È£ÅÚ µî¿¡¼­´Â ½ÃÇàÇϱ⠾î·Æ½À´Ï´Ù. ¹Ý¸é EndoGEL ESD´Â Àå¼Ò¿¡ Á¦ÇÑÀÌ ¾ø½À´Ï´Ù.

EndoGELÀ» ÀÌ¿ëÇÑ ESD hands-on trainingÀ» ½ÃÇàÇÏ¿´½À´Ï´Ù. Á¢»ç ¼º´ÉÀÌ ÁÁ°í retrflectionÀÌ ¶Ù¾î³ª gastric ESD¿¡ ¸¹ÀÌ »ç¿ëÇÏ°í ÀÖ´Â Pentax IMAGINA EG29-i10c ³»½Ã°æÀ» ÀÌ¿ëÇÏ¿´½À´Ï´Ù.

EndoGEL training kit¸¦ ȸ»ç Ãßõ´ë·Î Á¶¸³ÇÑ ¸ð½ÀÀÔ´Ï´Ù.

Pentax»çÀÇ ESD knife (DN-D2718B)´Â ½Ã¼ú µµÁß Á¡¸·ÇÏÃþ¿¡ ÁÖ»çÇÒ ¼ö À־ catheter ±³Ã¼ ¾ø´Â ºü¸¥ ½Ã¼úÀÌ °¡´ÉÇÕ´Ï´Ù. ¾öû ÆíÇÕ´Ï´Ù.

Áغñ ¿Ï·á.

Sunarrow»ç ȨÆäÀÌÁö »çÁø

±×¸²À» clickÇϸé ȸ»ç¿¡¼­ Á¦°øÇÏ´Â µ¿¿µ»óÀ» º¸½Ç ¼ö ÀÖ½À´Ï´Ù.

EndoGEL »ç¿¡ Á¦°øÇÏ´Â Á¾ÀÌ box ¸ðµ¨º¸´Ù Kogen »çÀÇ EGD simulator¿¡ EndoGELÀ» ¼³Ä¡ÇÏ¿© ½Ã¼úÇÏ´Â °ÍÀÌ º¸´Ù realÇÏ°í ¾ÈÁ¤°¨ÀÌ ÀÖ¾î ´õ ÁÁ¾Ò½À´Ï´Ù.

Ç¥ÁØÀûÀÎ ESD ¹æ¹ýÀ» Àû¿ëÇÏ¿´½À´Ï´Ù. Marking »©°í.

À¯¼ºÆæÀ¸·Î º´¼Ò Ç¥½Ã¸¦ ÇÑ ÈÄ marking ¾øÀÌ °ð¹Ù·Î circumferential cuttingÀ» ÇÏ¿´½À´Ï´Ù. Needle type knife·Î Á¡¸·¿¡ Ç¥½ÃÇϸé ÀÛÀº ±¸¸ÛÀÌ ¸¸µé¾îÁö±â ¶§¹®ÀÔ´Ï´Ù.

EndoGELÀÇ Á¡¸·ÃþÀº ´Ù¼Ò ź·ÂÀÌ ÀÖ¾î Áß·Â ¹æÇâÀ¸·Î µ¹·Áµµ flapÀÌ ¸¸µé¾îÁöÁö ¾Ê¾Ò½À´Ï´Ù. Circumferential cutting ÈÄ ÇÑÂÊ¿¡ clippingÀ» ÇÏ¿© traction method¸¦ Àû¿ëÇÏ´Ï Á¡¸·ÇÏÃþÀÌ ³ëÃâµÇ¾î ½Ã¼úÇϱâ ÆíÇß½À´Ï´Ù.

Traction method¸¦ ÀÌ¿ëÇÏ¿© artificial mucosa¿¡ Ç¥½ÃÇÑ °¡»ó À§¾ÏÀ» ÃæºÐÇÑ resection marginÀ» È®º¸ÇÑ »óÅ·ΠÁ¦°ÅÇÏ¿´½À´Ï´Ù.

±â³äÀ¸·Î Á¦ ¹æ Ä¥ÆÇ¿¡ ºÙ¿©µÎ¾ú½À´Ï´Ù. World first clip-assisted EndoGEL ESD¿´½À´Ï´Ù. Àú´Â ¼¼°è ÃÖÃʸ¦ ÁÁ¾ÆÇÕ´Ï´Ù.

°í°¡ÀÇ ÀÇ·á¿ë clip ´ë½Å »ç¹«¿ë clipÀ¸·Îµµ traction ESD¸¦ ÇÒ ¼ö ÀÖ¾ú½À´Ï´Ù. ÀÛÀº Ã߸¦ ´Þ¾Ò½À´Ï´Ù.

EndoGEL Çϳª·Î ¿©·¯ °³ÀÇ ESD ¿¬½ÀÀ» ÇÒ ¼ö ÀÖ½À´Ï´Ù.

¿À´ÃÀÇ trainingÀ» µµ¿ÍÁֽŠ¿©·¯ºÐ²² °¨»çÀÇ ¸»¾¸À» ÀüÇÕ´Ï´Ù.


[FAQ]

[2019-7-25] Pentax Imagina ³»½Ã°æÀ» ÀÌ¿ëÇÑ ±³À° µ¿¿µ»óÀ» ÃÔ¿µÇÏ¿´½À´Ï´Ù.

  1. ³»½Ã°æ Á¦Ç° ¹× simulator ¼Ò°³ - Pentax Imagina ¹× Koken simulator (±¸Çü ¹× ½ÅÇü)
  2. ³»½Ã°æÀÇ ±¸Á¶ ¹× Àâ´Â ¹ý
  3. Torque rotation
  4. ±¸Çü simulator¸¦ ÀÌ¿ëÇÑ À§ÀÇ °üÂû
  5. ¸ñ³Ñ±è
  6. ½ÅÇü simulator¸¦ ÀÌ¿ëÇÑ À§ÀÇ °üÂû
  7. Á¶Á÷°Ë»ç

ÇöÀå¿ë µ¿¿µ»ó 3 - ³»½Ã°æ »ðÀÔ¹ý (Koken ±¸Çü simulator + Pentax Imagina)

[2020-8-16. ³»½Ã°æÇÐȸ ¼¼¹Ì³ª]

2020³â 8¿ù 16ÀÏ ³»½Ã°æÇÐȸ¼¼¹Ì³ª°¡ hybrid ¹æ½ÄÀ¸·Î ÁøÇàµÇ¾ú½À´Ï´Ù. Àú´Â ¹Ì¸® ³ìÈ­ÇÑ VOD·Î Pentax»ç IMAGINA ³»½Ã°æÀ» ¼Ò°³Çß½À´Ï´Ù (YouTube °­ÀÇ µ¿¿µ»ó).

2020-8-16. ÀÏ»êŲÅýº Off-line ¼¼¹Ì³ª ÇöÀå »çÁø

2020-8-16. ³»½Ã°æ¼¼¹Ì³ª. On-lineÀ¸·Î Á¢¼ÓÇÑ È­¸é

Q and A´Â ZoomÀ» ÀÌ¿ëÇÑ È­»óȸÀÇ Çü½ÄÀ̾ú½À´Ï´Ù. Çà»ç´Â ÀÏ»ê ŲÅýº¿¡¼­ ÁøÇàµÇ¾ú°í Àú´Â ÀÏ¿øµ¿ ±³¼ö¿¬±¸½Ç¿¡¼­ ´äÇߴµ¥¿ä... Image-enhanced endoscopy (IEE)°¡ ¾ÏÁø´ÜÀ² Çâ»ó¿¡ µµ¿òÀÌ µÇ´ÂÁö Áú¹®ÀÌ À־ ´ÙÀ½°ú °°ÀÌ ´äÇÏ¿´½À´Ï´Ù.

"IEE´Â white light endoscopy·Î ¹ß°ßµÈ º´¼ÒÀÇ ÀÚ¼¼ÇÑ Æò°¡¸¦ ¸ñÀûÀ¸·Î °³¹ßµÇ¾ú½À´Ï´Ù. ÀÏ´Ü ¾Ï Àǽɺ´¼Ò°¡ ¹ß°ßµÇ¸é IEE·Î º¸´Ù ÀÚ¼¼È÷ characterizationÀ» ÇÒ ¼ö ÀÖ½À´Ï´Ù. ±×·¯³ª white light endoscopy ´ë½Å IEE¸¦ ½á¼­ ¾Ï¹ß°ßÀ²ÀÌ ³ô¾ÆÁö´ÂÁö´Â ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù. NBI³ª i-scanÀÌ ½Äµµ¿¡¼­ squamous cancer/dysplasia ¹ß°ß¿¡ µµ¿òÀÌ µÈ´Ù´Â ±Ù°Å´Â ÀÖÀ¸³ª, À§¿¡¼­ ¾ÏÁø´ÜÀ² Áõ°¡¸¦ °¡Á®¿Â´Ù°í À̾߱âÇϱâ´Â ¾î·Æ½À´Ï´Ù. ³»½Ã°æÀ» ÇϽô ¿©·¯ ¼±»ý´Ôµé²²¼­´Â white light endoscopy¿¡ ÁýÁßÇÏ´Â °ÍÀÌ ÁÁÀ» °Í °°½À´Ï´Ù."

IEE´Â »ö¼Ò³»½Ã°æÀ» ´ëüÇÏ´Â ¸ñÀûÀ¸·Î °³¹ßµÈ °ÍÀÔ´Ï´Ù. White light endoscopy¿¡¼­ ¾ÏÀ̳ª ¼±Á¾ÀÌ ¹ß°ßµÇ¸é indigo carmineÀ» ºÐ¹«ÇÏ°í °üÂûÇÕ´Ï´Ù. ¹°·Ð »ó´çÈ÷ µµ¿òÀÌ µË´Ï´Ù. ±×·¸´Ù¸é white light endoscopy¿¡¼­ Ưº°ÇÑ ÀÌ»óÀÌ ¾ø¾ú´ø °æ¿ì indigo carmineÀ» ºÐ¹«ÇÏ¸é ¾î¶³±î¿ä? Indigo carmineÀÌ ¾Ï Áø´ÜÀ² Çâ»ó¿¡ µµ¿òÀÌ µÈ´Ù¸é IEEµµ ±×·² °¡´É¼ºÀÌ ³ôÀ» °ÍÀÔ´Ï´Ù. Indigo carmineÀÌ ¾Ï Áø´ÜÀ² Çâ»ó¿¡ µµ¿òµÇÁö ¾Ê´Â´Ù¸é IEEµµ ±×·¸Áö ¾ÊÀ» °¡´É¼ºÀÌ ³ôÀ» °ÍÀÔ´Ï´Ù.

ÀϺ»ÀÇ ¸î¸î ³»½Ã°æ½Ç¿¡¼­´Â »óºÎÀ§Àå°ü ³»½Ã°æ µµÁß routineÀ¸·Î indigo carmineÀ» »Ñ¸°´Ù°í ÇÕ´Ï´Ù. ±×·¯³ª routine chromoendoscopy°¡ µµ¿òÀÌ µÈ´Ù´Â Áõ°Å´Â °ÅÀÇ ¾ø½À´Ï´Ù. ¿À·¡ Àü Á¦°¡ ÇϺÎÀ§Àå°ü°ú »óºÎÀ§Àå°ü¿¡ ´ëÇÏ¿© °¢°¢ ¿¬±¸ÇÑ ¹Ù ÀÖ½À´Ï´Ù. ÇϺΠÀ§Àå°ü¿¡¼­´Â ±×³ª¸¶ tiny adenoma°¡ ¸î °³ ¹ß°ßµÇ¾ú½À´Ï´Ù. ±×·¯³ª »óºÎÀ§Àå°ü¿¡¼­´Â ÀüÇô µµ¿òµÇÁö ¾Ê´Â´Ù´Â °á°ú¸¦ ¾ò¾ú½À´Ï´Ù.

¾ÆÁ÷±îÁö´Â white light endoscopy·Î ÀÚ¼¼È÷ º¸´Â °ÍÀÌ ÃÖ¼±À̶ó°í »ý°¢ÇÕ´Ï´Ù. ³ª¹«º¸´Ù ½£À» º¸´Â °ÍÀÌ Áß¿äÇϱ⠶§¹®ÀÏ °ÍÀÔ´Ï´Ù.

Am J Gastroenterol 2003

´ëÇѼÒÈ­±â³»½Ã°æÇÐȸÁö 2005

±×·¸½À´Ï´Ù. ½Å±â¼úÀº ²À ÇÊ¿äÇÑ °æ¿ì°¡ ÀÖ´Â °ÍÀÔ´Ï´Ù. Æò¼Ò¿¡´Â º¸Åë ±â¼ú·Î Á·ÇÕ´Ï´Ù. White light endoscopy·Î õõÈ÷ ¿À·¡ º¸¸é ¾Ï ¹ß°ß¿¡ ¹®Á¦°¡ ¾ø½À´Ï´Ù. »¡¸® ´ëÃ溸´Â °ÍÀÌ ¹®Á¦ÀÌÁö white light endoscopy°¡ ¹®Á¦´Â ¾Æ´Õ´Ï´Ù. ¿À·¡ ÀÚ¼¼È÷ º¸¸é Áø´ÜÀ²ÀÌ ¿Ã¶ó°¡´Â °ÍÀÌÁö ½Å±â¼úÀ» ½è´Ù°í Áø´ÜÀ²ÀÌ ¿Ã¶ó°¡´Â °ÍÀº ¾Æ´Õ´Ï´Ù. Àû¾îµµ 2020³â ÇöÀç±îÁö´Â ±×·¸½À´Ï´Ù.

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´äº¯ 2. ¹Ì¶õÀº Á¡¸·Ãþ¿¡ ±¹ÇÑµÈ ¾èÀº ÇÔ¸ôÇü º´¼ÒÀÌ°í ±Ë¾çÀº Á¡¸·ÇÏÃþ ȤÀº ±× ÀÌ»ó±îÁö ¼Õ»óµÇ ±íÀº ÇÔ¸ôÇü º´¼ÒÀÔ´Ï´Ù. ³»½Ã°æ¿¡¼­ ¹Ì¶õ°ú ±Ë¾çÀÌ ¾Ö¸ÅÇÏ¸é ´ëºÎºÐ ¹Ì¶õÀÔ´Ï´Ù. ÇÑ ´«¿¡ µü ºÁµµ ¶Ñ·ÇÇÏ°Ô ±í°Ô ÆÄÀÎ °ÍÀÌ ±Ë¾çÀÔ´Ï´Ù. ÃÖ±Ù ½ÉÆò¿ø ±âÁØÀ» °í·ÁÇÏ¿© ¹Ì¶õÀ» ±Ë¾çÀ¸·Î °úÀ×Áø´ÜÇÏ´Â °æ¿ì°¡ Àִµ¥ ¹Ù¶÷Á÷ÇÏÁö ¾Ê½À´Ï´Ù. O»ç P»ç F»çÀÇ image enhancement endoscopy´Â Àå´ÜÁ¡ÀÌ À־ ¹¹°¡ ´õ ÁÁ´Ù°í ¸»Çϱ⠾î·Æ´Ù°í »ý°¢ÇÕ´Ï´Ù. O»ç´Â NBI¶ó´Â filter¸¦ ÀÌ¿ëÇÑ ¹æ¹ýÀε¥ ÇÑ °¡Áö Ç¥ÁØÀûÀÎ ¹æ¹ýÀ» Àû¿ëÇÏ°í È®´ë³»½Ã°æÀ̳ª Near focus¸¦ »ç¿ëÇÒ ¼ö À־ °Ë»çÀÚ¿¡ µû¸¥ °Ë»ç¹ý Â÷ÀÌ°¡ ¾øÀÌ ÀÏ°üµÈ ¿µ»óÀ» ¾òÀ» ¼ö À־ Àü¹®°¡ Áý´Ü¿¡¼­ NBI¸¦ ÀÌ¿ëÇÑ ºÐ·ù¹ýÀÌ ¸¸µé¾îÁ³½À´Ï´Ù. P»ç´Â ¸Å¿ì ´Ù¾çÇÑ settingÀ» Á¶ÀýÇÒ ¼ö À־ ÀÏ»ó Áø·á¿¡µµ Àû¿ëÇÒ ¼ö ÀÖ°í (Á¸Àç Áø´Ü) Ưº°ÇÑ º´¼Ò°¡ ¹ß°ßµÇ¾úÀ» ¶§ »ç¿ëÇÒ ¼ö ÀÖ½À´Ï´Ù (¼º°Ý Áø´Ü). ¼±ÅÃÀÇ ÆøÀÌ ³Ê¹« ³Ð¾î¼­ ´Ù¼Ò Çò°¥¸®±âµµ ÇÕ´Ï´Ù. Àú´Â ¸Þ´º°¡ ¸î °³ ¾ø´Â ½Ä´çÀÌ ÆíÇÏ´Ù°í ´À³¥ ¶§µµ ÀÖ½À´Ï´Ù. F»ç´Â ÃÖ±Ù »õ ¸ðµ¨ÀÌ ³ª¿Ô½À´Ï´Ù. Ultraviolet °è¿­ÀÇ ´ÜÆĸ¦ Ãß°¡ÇÑ ¹æ½Ä(BLI)°ú Red, Blue, Green »öÁ¶°£ÀÇ °Å¸®¸¦ ´Ã¸®´Â ¹æ½Ä(LCI)°¡ Àִµ¥ ÀúÈñ º´¿ø¿¡ ¾ÆÁ÷ µµÀÔµÇÁö ¾Ê¾Æ¼­ °æÇèÀÌ ¾ø½À´Ï´Ù.

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2020-9-9. ¼­¿ï´ë Pentax Imagina µ¥¸ð¿¡ ¾Õ¼­ Imagina »ç¿ë °æÇè¿¡ ´ëÇÏ¿© ZoomÀ¸·Î °­ÀÇ


[References]

1) EndoTODAY image enhanced endoscopy IEE

2) ¿µ»óÁõ°­³»½Ã°æ PDF. ÀåÀ翵 (³»½Ã°æÇÐȸ ¼¼¹Ì³ª)

3) Pentax ȸ»ç ¼Ò°³ (2019-7. ȸ»ç¿¡¼­ ¹ÞÀº ÀÚ·á)

4) i-Scan ¼Ò°³ (2019-7. ȸ»ç¿¡¼­ ¹ÞÀº ÀÚ·á)

5) EndoTODAY È®´ë³»½Ã°æ

6) Splash M knife case study - lower GI

7) ÀÌÁØÇ൵ Âü¿©ÇÏ¿´´ø clinical atlas

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