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[Gastric cancer 559 - Multiple ESD 후 협착]

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여러번의 ESD 후 distal antrum이 제법 좁아진 환자입니다. 그러나 증상도 없고 내시경도 잘 통과되었습니다. 첫번째 ESD는 proximal antrum이므로 별 상관은 없는데, 두번째와 세번째 ESD가 가까운 곳에 circular 한 방향에 위치하고 있어서 협착이 발생한 것 같습니다. 국소 재발을 막기 위하여 늘 lateral margin을 충분히 확보하기 위하여 노력하고 있지만, 협착 측면을 고려하면 lateral margin은 넓을수록 좋은 것은 아닌 것 같습니다. 늘 갈등합니다.

9년 전 첫번째 ESD

Stomach, endoscopic submucosal dissection:
. Early gastric carcinoma ;
1. Location : proximal antrum, posterior wall
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 1.2x1x0.1 cm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin: free from carcinoma, safety margin: distal 0.9 cm, proximal 0.5 cm, anterior 1.2 cm, posterior 1.2 cm
8. Lymphatic invasion : not identified
9. Venous invasion : not identified
10. Perineural invasion : not identified
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent

3년 전 2번째 ESD

Stomach, endoscopic submucosal dissection:
. Early gastric carcinoma
1. Location : antrum, posterior wall
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, 10mm (2) vertical diameter, 5mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 11 mm, proximal 6 mm, anterior 12 mm, posterior 14 mm
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

2달 전 3번째 ESD

Stomach, endoscopic submucosal dissection:
. Early gastric carcinoma
1. Location : antrum, greater 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, 16 mm (2) vertical diameter, 8 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 8 mm, proximal 12 mm, anterior 16 mm, posterior 10 mm, deep 80 ㎛
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



© 일원내시경교실 바른내시경연구소 이준행. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.