EndoTODAY | EndoATLAS | OPD

Parasite | Eso | Sto | Cancer | ESD

Boxim | DEX | Sono | Schedule

Home | Recent | Blog | Links


[³í¹® Àбâ 2016³â 4¿ù]

Previous | Next

¿¬¼¼´ëÇб³ ½ÅÃ̼¼ºê¶õ½º º´¿ø¿¡¼­ ESD indication criteria¿¡ µû¸¥ outcome¿¡ ´ëÇÑ ¸ÞŸºÐ¼®À» ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Park SW. Surg Endosc 2016). °á·ÐÀ» ¿Å±é´Ï´Ù. "This meta-analysis suggests that the EI group showed acceptable long-term outcomes with local recurrence rate that was not significantly inferior, although the metachronous recurrence rate was higher compared with that in the AI group." ±×·¯³ª ¾Æ·¡ ±×¸²°ú °°ÀÌ complete resection rate¿Í curative resection rate´Â È®½ÇÈ÷ Â÷ÀÌ°¡ ³³´Ï´Ù.

Áö±Ý±îÁöÀÇ ¿¬±¸´Â ¸ðµÎ ½Ã¼ú ÈÄ º´¸®°á°ú¿¡ µû¸¥ diagnostic groupÀ» ±âÃÊ·Î ºÐ¼®µÈ ¿¬±¸ÀÔ´Ï´Ù. ¸ÞŸºÐ¼®µµ ¸¶Âù°¡ÁöÀÏ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. ¿©ÇÏÆ° absolute indicationÀ¸·Î »ý°¢ÇÏ°í ½Ã¼úÇߴµ¥ expanded indicationÀ¸·Î ³ª¿Ô´ø ȯÀÚ°¡ ´ëºÎºÐÀÏ °Í °°½À´Ï´Ù. À̹ø ¸ÞŸºÐ¼®ÀÇ °á°ú°¡ pretreatment expanded indication ȯÀÚ¿¡ ´ëÇÑ ESD¸¦ Á¤´çÈ­ÇÏ´Â ÀÚ·á·Î ÀÐÈ÷Áö ¾Ê±â¸¦ ¹Ù¶ø´Ï´Ù.

* Âü°í: Diagnostic group classification¿¡ ´ëÇÑ ÀÌÁØÇàÀÇ ºÐ¼®


NTT Medical Center Tokyo¿¡¼­ 2¸íÀÇ gastric ESD °æÇèÀÌ ¾ø´Â Ãʺ¸ÀÚ¸¦ animal modelÀ» ÀÌ¿ëÇÏ¿© colon ESD¸¦ °¡¸£Ä×´ø °æÇèÀ» ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Ohata K. Endosc Int Open. 2016 Mar; 4(3): E333-E339).

Ex vivo porcine "proximal colon" model. The porcine colorectum was placed upside down and anchored inside a square box, so as to simulate the human colon.

"In conclusion, our trainees achieved relatively high self-completion and R0 resection rates without the occurrence of any severe complications, suggesting that our training programs are useful for trainees without experience performing gastric ESD. Ex vivo animal models, which were constructed to simulate the paradoxical endoscopic movements and a lumen with many folds and flexions, may be useful for the acquisition of colorectal ESD-specific techniques. The presence of fibrosis was identified as a significant independent predictor of a prolonged operation time; thus, cases with fibrosis should be avoided during the introductory stages of performing colorectal ESD. To achieve safe and proficient colorectal ESD, prior intensive learning and expert supervision are also necessary."

¿ÇÀº À̾߱âÀÔ´Ï´Ù. ÃʽÉÀÚ´Â ¿­½ÉÈ÷ learning ÇØ¾ß ÇÏ°í expert´Â ¿­½ÉÈ÷ supervision ÇØ¾ß ÇÕ´Ï´Ù.

* Âü°í: EndoTODAY simulator¸¦ ÀÌ¿ëÇÑ ³»½Ã°æ ±³À°


BSG/ESGE guidelin on antiplatelets and anticoagulants (2016)

Ç×Ç÷¼ÒÆÇÁ¦, Ç×ÀÀ°íÁ¦¿¡ ´ëÇÑ À¯·´ÂÊ °¡À̵å¶óÀÎÀÌ ¹ßÇ¥µÇ¾ú½À´Ï´Ù (Veitch AM. Endoscopy 2016). ¿ª½Ã ³»½Ã°æ Á¶Á÷°Ë»ç ÇÒ ¶§¿¡´Â ¾Æ½ºÇǸ°, Ŭ·ÎÇǵµ±×·¤, ¿ÍÆĸ°À» ²÷Áö ¸»µµ·Ï ±ÇÇÏ°í ÀÖ½À´Ï´Ù. '¾Æ½ºÇǸ° + Ŭ·ÎÇǵµ±×·¤' »ç¿ëȯÀÚ¿¡¼­´Â ºñ·Ï ½Ã¼úÀÌ °íÀ§ÇèÀÌ¶óµµ Àû¾îµµ ¾Æ½ºÇǸ°Àº °è¼Ó ¾²¶ó°í ÁÖÀåÇÏ°í ÀÖ½À´Ï´Ù. Ŭ·ÎÇǵµ±×·¤À» ²÷´õ¶óµµ ½Ã¼ú 5ÀÏ Àü¿¡ ²÷´Â °ÍÀÔ´Ï´Ù. 7ÀÏ ÀüÀÌ ¾Æ´Ï¶ó...

°³ÀÎÀûÀ¸·Î´Â ¿ÍÆĸ°¸¸ »©°í ¸ðµÎ µ¿ÀÇÇÕ´Ï´Ù.

1) P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor): For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation);

For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation).

For high-risk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation).

2) Warfarin: For low-risk endoscopic procedures we suggest that warfarin therapy should be continued (low quality evidence, moderate recommendation). It should be ensured that the INR does not exceed the therapeutic range in the week prior to the procedure

3) Direct Oral Anticoagulants (DOAC): For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation). For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ¡Ã 48 hours before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30-50 mL/min we recommend that the last dose of DOAC be taken 72 hours before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation).

4) Post endoscopic procedure: If antiplatelet or anticoagulant therapy is discontinued, then we recommend this should be resumed up to 48 hours after the procedure depending on the perceived bleeding and thrombotic risks (moderate quality evidence, strong recommendation).

ESD¿¡ ´ëÇÑ ÄÚ¸àÆ®µµ ÀÖ¾ú½À´Ï´Ù. À§ ESD·Î ÀÎÇÑ ÃâÇ÷·üÀº 5.8%¿´´Âµ¥ »ç¸Á·Êµµ ÀÖ¾ú½À´Ï´Ù.

Compared with EMR, ESD presents a higher procedure-related bleeding rates irrespective to the location of the lesion treated (Cao Y. Endoscopy 2009). This is mostly a problem in the stomach; the mean rate of post procedural bleeding across five recent large studies (>6,000 patients in total) of gastric ESD was 5.8%. Nevertheless, severe consequences were rare (1 death, 3 angiographic interventions, and no surgery). In the oesophagus, a recent meta-analysis of 15 studies provided a pooled estimate of post-ESD delayed bleeding of only 2.1 %. With respect to colonic ESD, a systematic review (total, 2,774 patients) found a bleeding rate of 2%. No bleeding-related mortality was noted in oesophageal or colonic studies. A large multicentre prospective Japanese register confirmed this low rate of post colorectal ESD bleeding with only 18/816 events (2.2%). A higher bleeding rate was reported by a small prospective European study, though this included only rectal lesions, which present a higher risk of delayed bleeding.


EB virus associated gastric cancer (¼º±Õ°üÀÇ´ë º´¸®°ú ±è°æ¹Ì) J Gastric Cancer 2016;16:1

Epstein-Barr virus-associated gastric carcinoma (EBVaGC) is one of the four subtypes of gastric carcinoma (GC), as defined by the novel classification recently proposed by The Cancer Genome Atlas. EBVaGC has several clinicopathological features such as longer survival and higher frequency of lymphoepithelioma-like carcinoma (LELC) and carcinoma with Crohn¡¯s disease-like lymphoid reaction that distinguish it from EBV-negative GC. The intensity and pattern of host cellular immune response in GC have been found to significantly correlate with the prognosis of patients with GC, suggesting that immune reaction and tumor microenvironment have critical roles in the progression of GC, and in particular, EBVaGC. Here, we reviewed the cellular and molecular mechanisms underlying prominent immune reactions in patients with EBVaGC. In EBVaGC, deregulation of the expression of immune response-related genes promotes marked intra- or peritumoral immune cell infiltration. The expression of programmed death receptor-ligand 1 is known to be increased in EBVaGC, and therefore, it has been proposed as a favorable prognostic factor for patients with EBVaGC, albeit some data supporting this claim are controversial. Overall, the underlying mechanisms and clinical significance of the host cellular immune response in patients with EBVaGC have not been thoroughly elucidated. Therefore, further research is necessary to better understand the role of tumor microenvironment in EBVaGC.


Korean gastric carcinoid multicenter study

2016³â ´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸÁö¿¡ Á¦1Çü À§À¯¾ÏÁ¾ Ä¡·á¼ºÀû¿¡ ´ëÇÑ ´Ù±â°ü °øµ¿¿¬±¸°¡ ¹ßÇ¥µÇ¾ú½À´Ï´Ù (Lee HS. KJHUGIR 2016).

À§ ½Å°æ³»ºÐºñÁ¾¾ç 223¿¹ Áß 104¿¹(46.6%)°¡ Á¦1ÇüÀ̾úÀ¸¸ç, 94¿¹ÀÇ ÃßÀû°üÂû °á°ú°¡ ºÐ¼®µÇ¾ú½À´Ï´Ù.67¿¹´Â ³»½Ã°æÄ¡·á, 27¿¹´Â °æ°ú°üÂûµÇ¾ú½À´Ï´Ù. ³»½Ã°æÄ¡·á±ºÀÇ 14¿¹(20.9%)´Â ±¹¼ÒÀç¹ßÇÏ¿© ³»½Ã°æ Ä¡·á°¡ Ãß°¡µÇ¾ú°í, °æ°ú°üÂû±ºÀÇ 8¿¹(29.6%)´Â Á¾¾çÀÌ Ä¿Á®¼­ ³»½Ã°æÄ¡·á°¡ ÇÊ¿äÇß½À´Ï´Ù. ¸ðµç ȯÀÚ¿¡¼­ ¿ø°Ý ÀüÀÌ´Â ¾ø¾ú½À´Ï´Ù.

* Âü°í: EndoTODAY À§ À¯¾ÏÁ¾


³»½Ã°æ Ŭ¸³ Á¦°ÅÇϱâ

2016³â ´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸÁö¿¡ ±èÈñ¸¸ ¼±»ý´Ô²²¼­ Èï¹Ì·Î¿î case series¸¦ ¹ßÇ¥Çϼ̽À´Ï´Ù (Jung HY. KJHUGR 2016). ³»½Ã°æ µµÁß ¹ß°ßµÈ Ŭ¸³ÀÇ »ó´ç ºÎºÐÀ» grasping forcepÀ¸·Î Àâ¾Æ´ç°Ü Á¦°ÅÇÒ ¼ö ÀÖ¾ú´Ù´Â °ÍÀÔ´Ï´Ù. ÀϺο¡¼­ ÃâÇ÷ÀÌ ÀÖ¾ú´Âµ¥ Áï½Ã Ŭ¸³À» ´Ù½Ã ÀåÂøÇÏ¿© ÁöÇ÷ÇÏ¿´´Ù°í µÇ¾î ÀÖ½À´Ï´Ù.

Ŭ¸³ °¡Áø ȯÀÚÀÇ MRI ¾ÈÀü¼º¿¡ ´ëÇÑ ³í¶õÀÌ ÀÖ´Â Çö ½ÃÁ¡¿¡¼­ »ó´çÈ÷ ÀǹÌÀÖ´Â ½Ãµµ¶ó°í »ý°¢ÇÕ´Ï´Ù. Àúµµ °í¹ÎÀÔ´Ï´Ù. º¸ÀÌ¸é ´Ù ¾ø¾Ö¹ö¸±±î?

* Âü°í: EndoTODAY Ŭ¸³


2016³â ´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸÁö¿¡ º¸°íµÈ Àü³²´ë Áõ·ÊÀÔ´Ï´Ù (Son DJ. KJHUGR 2016). Mixed type adenocarcinoma with poorly differentiated histology, 15 mm Å©±â, lamina propria±îÁö ħÀ±µÈ EGC IIb¿´°í ½Ã¼úµµ Àß µÇ¾ú´Âµ¥ 7³â ÈÄ ´Ù¹ß¼º Àç¹ßÀ» º¸¿´½À´Ï´Ù. Poorly´Â ³ª»Ú°í mixed´Â ´õ ³ª»Û °Í °°½À´Ï´Ù.

* Âü°í: EndoTODAY ¹®Çå¿¡ º¸°íµÈ ESD ÈÄ À§ ÀÌ¿ÜÀÇ Àç¹ß


ESD for superficial spreading EGC

¿¬¼¼´ëÇб³¿¡¼­ superficial spreading EGC¿¡ ´ëÇÑ ºÐ¼®À» ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Lee KJ. Medicine (Baltimore) 2016).


Botox for the prevention of ESD scar

½Äµµ ESD ÈÄ stricture¸¦ ÁÙÀ̱â À§ÇÏ¿© Botox Áֻ縦 ½ÃµµÇÑ Áß±¹ ³í¹®ÀÔ´Ï´Ù (Wen J. Gastrointest Endosc 2016). Botox´Â TGF-beta1À» ÁÙ¿© collagen ħÂøÀ» °æ°¨½ÃÅ°´Â ±âÀüÀ» °¡Áö°í Àִµ¥, surgical would fibrosis¸¦ ÁÙÀÌ´Â °ÍÀ¸·Î ¾Ë·ÁÁ® ÀÖ½À´Ï´Ù. À̸¦ ½Äµµ ESD ÈÄ ÇùÂø ¹æÁö¿¡ Àû¿ëÇÑ ¿¬±¸ÀÔ´Ï´Ù.

¾î´À ºÎÀ§¿¡ ¾ó¸¶³ª ÁÖ»çÇß´ÂÁö ±Ã±ÝÇÏ½Ã¸é ¾Æ·¡¸¦ º¸½Ê½Ã¿À.

A single session of BTX-A (Lanzhou Institute of Biological Products, Lanzhou, China) injections was undertaken immediately after ESD. A total of 100 units of BTX-A was diluted with 5 mL of saline solution (20 units/mL). The BTX-A solution was injected in 0.5 mL increments into 10 separate points equally spaced along the circumference of the defect with a 25-gauge, 4-mm needle (TOP Corporation, Tokyo, Japan). The injections were placed deeply at the level of the muscularis propria along the junction of the defect and the normal tissue. However, in patients with full circumference mucosal defect, BTX-A was injected superficially into the base of the cautery ulcer. All patients with group were injected with 100 units of BTX-A, regardless of the size.

* Âü°í: EndoTODAY ½Äµµ¾Ï ³»½Ã°æÄ¡·á ÈÄ ÇùÂø


[Áõ·Êº¸°í] Multidrug-Resistant Tuberculous Mediastinal Lymphadenitis, with an Esophagomediastinal Fistula, Mimicking an Esophageal Submucosal Tumor (Kim DW. Clin Endos 2016)¶ó´Â ±ä Á¦¸ñÀÇ Áõ·Êº¸°í¸¦ ÇÏ¿´½À´Ï´Ù.

Odynophagia¸¦ ÁÖ¼Ò·Î ³»¿øÇÑ È¯ÀÚÀε¥ óÀ½¿¡´Â ½Äµµ SMT·Î ÃßÁ¤µÇ¾úÀ¸³ª CT¿¡¼­ mediastinal lymph node°¡ Ä¿Á® ÀÖ¾î ÀÇ·ÚµÈ ºÐÀÔ´Ï´Ù. Àç°Ë¿¡¼­ ½Äµµ SMT-like lesionÀÇ Áß¾Ó¿¡¼­ ÇÔ¸ôºÎ(fistula ?)°¡ º¸¿´°í EBUS-TBNA¿¡¼­ AFB stainingÀº À½¼ºÀ̾úÀ¸³ª PCR ¾ç¼ºÀ̾ú°í ¹è¾ç¿¡¼­ ´ÙÁ¦³»¼º °áÇÙ(INH ³»¼º, RFP ³»¼º)ÀÌ È®ÀεǾú½À´Ï´Ù.



© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà