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EndoTODAY ³»½Ã°æ ±³½Ç


[Classifications. ºÐ·ù¹ý] - ðû

1. Esophagus

2. Stomach

3. Gastric cancer

4. Colon


[Esophagus]

1. ½Äµµ Ä­µð´ÙÁõ. Esophageal candidiasis (Kodsi classification)

* Âü°í: EndoTODAY ½Äµµ Ä­µð´ÙÁõ


2. ºÎ½Ä¼º ½Äµµ¿°. Corrosive esophagitis

0: normal

1: edema and hyperemia of mucosa

2a: friability, hemorrhage, erosions, blisters, whitish membranes, exudates, and superficial ulcerations

2b: grade 2a plus deep discrete or circumferential ulcerations

3a: small scattered necrosis

3b: extensive necrosis

* Âü°í: EndoTODAY ºÎ½Ä¼º ½Äµµ¿°


3. ¿ª·ù¼º ½Äµµ¿°. Reflux esophagitis

* Âü°í: EndoTODAY ¿ª·ù¼º ½Äµµ¿°


4. ¹Ù·¿½Äµµ. Barrett esophagus

* Âü°í: EndoTODAY ¹Ù·¿ ½Äµµ


5. ½Äµµ¾Ï. Esophageal cancer

¿¹: Advanced esophageal cancer, type 3 (¶Ç´Â Advanced esophageal cancer, ulceroinfiltrative type)
    Superficial esophageal cancer, IIb

½Äµµ¾ÏÀº À§¾Ï¸¸Å­ ³»½Ã°æ ºÐ·ù°¡ À¯¿ëÇÏÁö ¾Ê½À´Ï´Ù. ³»½Ã°æ °á°úÁö¿¡´Â superficial esophageal cancer ȤÀº advanced esophageal cancer¶ó°í °£´ÜÈ÷ ¾²´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ±×·¯³ª ½Äµµ¾Ï¿¡¼­µµ À§¾Ïó·³ ³»½Ã°æ ºÐ·ù¸¦ Àû¿ëÇÏ¸é ¿©·¯ Ãø¸é¿¡¼­ À¯¿ëÇÒ °Í °°½À´Ï´Ù. 2009³â ¹ßÇ¥µÈ Japanese classification of esophageal cancer (10th ed)¿¡¼­ Á¦½ÃµÈ ¹æ¹ýÀ» µû¸¨½Ã´Ù (Esophagus 2009:6:1-25). À§¾ÏÀÇ ºÐ·ù¿Í ¸Å¿ì À¯»çÇϱ⠶§¹®¿¡ ¿Ü¿ì±â´Â ½±½À´Ï´Ù.

* Âü°í: EndoTODAY ½Äµµ¾Ï


6. Hiatal hernia - Hill grade

* Âü°í: EndoTODAY ½Äµµ¿­°øÅ»Àå Hiatal hernia


7. ½ÄµµÁ¤¸Æ·ù. Esophageal varix

Digest Endosc 2010

LocationÀº Ls, Lm, Li·Î, formÀº F1, F2, F3À¸·Î, red color signÀº RC0, RC1, RC2, RC3À¸·Î ÅëÀÏÇÏ¿© »ç¿ëÇսôÙ.

2022-4-14. Single topic symposium on esophageal varix grading

F1 (linear, < 5mm)°ú F2 (beaded or tortuous, >5mm)ÀÇ ±¸ºÐÀÌ ¾Ö¸ÅÇϸé F1À¸·Î ÁØ´Ù. ¾à°£ beaded ÇÑ ¸ð¾çÀÌ´õ¶óµµ 5mm ¹Ì¸¸À̸é F1À¸·Î ÁØ´Ù.

F2¿Í F3ÀÇ ±¸ºÐÀº ÀÓ»óÀûÀ¸·Î º° Â÷ÀÌ°¡ ¾ø´Ù.

¾Ö¸ÅÇÏ¸é ¼¼°Ô Áֱ⺸´Ù´Â ¾àÇÏ°Ô ÁØ´Ù.

EVLÀ» ¿©·¯¹ø ½ÃÇà¹ÞÀº ȯÀÚ¿¡¼­´Â F1,2,3 ±¸ºÐÀÌ ¾î·Æ´Ù. Ä¡·á°¡ ÇÊ¿äÇÏ´Ù°í ÆǴܵǸé F2, Ä¡·á°¡ ÇÊ¿äÇÏÁö ¾Ê´Ù°í ÆǴܵǸé F1À» Áֱ⵵ ÇÑ´Ù. »çÁøÀ» Àß Âï¾îµÎ´Â °ÍÀÌ Áß¿äÇÏ´Ù.

* Âü°í: EndoTODAY ½ÄµµÁ¤¸Æ·ù


[Stomach]

1. Gastric varix and portal hypertensive gastropathy

Baveno classification

* Âü°í: EndoTODAY ¹®¸Æ¾ÐÇ×Áø À§º´Áõ


2. À§Ã༺ À§¿°. Atrophic gastritis

* Âü°í: EndoTODAY À§Ã༺ À§¿°


3. ¼ÒÈ­¼º ±Ë¾ç. Benign peptic ulcer (AHS system = Sakita-Miwa ºÐ·ù)

- Active stage 1 (A1): Active and blurred edge. ¹æ±Ý ±Ë¾çÀÌ ¸¸µé¾îÁø °æ¿ì·Î ºñ±³Àû ÀÛ°í ±íÀº ulcer crater°¡ ÀÖ°í ÁÖº¯ Á¡¸·ÀÌ ½ÉÇÏ°Ô ºÎ¾î ÀÖ½À´Ï´Ù. ¾ÆÁ÷ Àç»ý»óÇdzª fold º¯È­´Â ¾ø½À´Ï´Ù.
- Active stage 2 (A2): Active and sharp edge. ¸çÄ¥ Á¤µµ Áö³­ ±Ë¾çÀÔ´Ï´Ù. Ulcer crater´Â A1 stageº¸´Ù ³Ð¾îÁöÁö¸¸ ÁÖº¯ Á¡¸· ºÎÁ¾ÀÌ ´Ù¼Ò ¿ÏÈ­µÇ¾î º¸ÀÔ´Ï´Ù. Àç»ý»óÇdzª fold º¯È­°¡ ¾ÆÁÖ »ì¦ º¸ÀÏ ¼ö ÀÖ½À´Ï´Ù.
- Healing stage 1 (H1): Healing with regenerating epithelium. ÁÖº¯ Á¡¸· ºÎÁ¾Àº °ÅÀÇ °¡¶ó¾ÉÀº »óÅÂÀ̸ç regenerating epitheliumÀÌ ÇöÀúÈ÷ º¸ÀÔ´Ï´Ù. ±×·¯³ª ¾ÆÁ÷ ulcer crater°¡ Á¦¹ý ¸¹ÀÌ ³²¾ÆÀÖ½À´Ï´Ù. Fold º¯È­µµ µ¿¹ÝµË´Ï´Ù.
- Healing stage 2 (H2): Almost healed by regeneration. ÁÖº¯ Á¡¸· ºÎÁ¾Àº ¸ðµÎ °¡¶ó¾É¾Ò°í, Àç»ý»óÇÇ°¡ ´ëºÎºÐÀ» ÀÚÄ¡ÇÏ°í ulcer crater´Â ¾ÆÁÖ Á¶±Ý ³²¾ÆÀÖ½À´Ï´Ù. Fold º¯È­°¡ ÇöÀúÇÕ´Ï´Ù.
- Scar stage 1 (S1): Red scar. Ulcer crater´Â ¾ø°í Àç»ý»óÇÇ°¡ ¾à°£ ºÓÀº »öÁ¶·Î º¸ÀÌ°í fold¸¸ ³²¾ÆÀÖ½À´Ï´Ù.
- Scar stage 2 (S2): White scar. Fold¸¸ ³²¾ÆÀÖ°í ulcer crater³ª Àç»ý»óÇÇ°¡ º¸ÀÌÁö ¾Ê½À´Ï´Ù. Àç»ý»óÇÇ°¡ ¿À·¡µÇ¾î Á¤»ó Á¡¸·°ú ±¸ºÐÀÌ ¾î·Á¿î °æ¿ìÀÔ´Ï´Ù.

2015³â ½ÄÇ°ÀǾàÇ°¾ÈÀüÆò°¡¿ø¿¡¼­ ¹ß°£ÇÑ ¼ÒÈ­¼º±Ë¾ç Ä¡·áÁ¦ ÀÓ»ó½ÃÇè °¡À̵å¶óÀÎ ¹Î¿øÀÎ ¾È³»¼­¿¡ ¼Ò°³µÈ Sakita-Miwa ºÐ·ù

ÀϺ»¿¡¼­´Â ±Ë¾ç º´±â¿¡ µû¶ó Àç»ý»óÇÇ°¡ º¯È­µÇ´Â ¸ð½ÀÀ» »ó¼¼È÷ ºÐ·ùÇϱ⵵ ÇÕ´Ï´Ù. ³»½Ã°æÇÐȸ ¼¼¹Ì³ª ·ùÁ¾¼± ±³¼ö´Ô °­ÀÇ·Ï°ú ±è¿µ´ë ±³¼ö´Ô °­ÀÇ·Ï¿¡ ¼Ò°³µÈ ¹Ù ÀÖ¾î ±× ³»¿ëÀ» ¿Å±é´Ï´Ù. ±×·¯³ª ¿ë¾î°¡ ³Ê¹« ¾î·Á¿ö¼­ Àú´Â »ç¿ëÀ» ±ÇÇÏÁö ¾Ê½À´Ï´Ù. ±×³É Âü°í¸¸ Çϼ¼¿ä.

A1À» Á¦¿ÜÇÑ ¸ðµç ¼ÒÈ­¼º±Ë¾çÀÇ º´±â¿¡¼­ Àç»ý »óÇÇ°¡ °üÂûµÇ´Âµ¥ Ä¡À¯°úÁ¤¿¡ µû¶ó ´Ù¾çÇÑ ÇüÅ·Π³ªÅ¸³ª°Ô µÈ´Ù. ±Ë¾çº¯¿¬¿¡ ¸·°ú °°Àº ÇüÅÂÀÇ ¸·¾ç Àç»ý »óÇÇ°¡ A2 ½Ã±â¿¡ ³ªÅ¸³­´Ù. H1~H2ÀÇ Ä¡À¯°úÁ¤±â¿¡´Â ¿ïŸ¸®³ª ¼ºÃ¤¿Í °°Àº ÇüÅÂÀÇ Ã¥»ó ȤÀº ¹æÃßÇü Àç»ý»óÇÇ°¡ °üÂûµÇ°Å³ª Á¶°¢µ¹À» ±ò¾Æ³õÀº µíÇÑ ºÎ¼®»ó Àç»ý»óÇÇ°¡ º¸À̱⵵ ÇÑ´Ù. Ä¡À¯°úÁ¤±â¿¡ ³ªÅ¸³­ Àç»ý »óÇÇÀÇ ¿©·¯ ÇüŵéÀÌ S1 ½Ã±â¿¡´Â ´Ù¾çÇÏ°Ô °üÂûµÈ´Ù.

* Âü°í: EndoTODAY ¼ÒÈ­¼º ±Ë¾ç


4. ÃâÇ÷¼º ±Ë¾ç. Ulcer with GI bleeding

Adherent clotÀÌ Ä¿¼­ irrigationµîÀ¸·Î Á¦°ÅÇÏ´Ï ±× ¾Æ·¡¿¡ exposed vesselÀÌ ÀÖ¾ú½À´Ï´Ù. Electrocauterization ½ÃÇàÇÏ¿´½À´Ï´Ù.

ÀÌ Á¤µµ·Î ½ÉÇÑ exposed vesselÀº angiography·Î ÇØ°áÇϱ⠾î·Æ½À´Ï´Ù. Coagrasper¸¦ ÀÌ¿ëÇÑ electrocauterizationÀ̳ª clippingÀÌ ÇÊ¿äÇÕ´Ï´Ù.

* Âü°í: EndoTODAY ÃâÇ÷¼º ±Ë¾ç


5. À§¿ëÁ¾. Gastric polyp (Yamada classification - old style)

* Âü°í: EndoTODAY À§¿ëÁ¾


[Stomach cancer]

1. Á¶±âÀ§¾Ï. Early gastric cancer

¿¹: EGC, IIc

PPT PDF 0.4 M

* Âü°í: EndoTODAY Á¶±âÀ§¾Ï ºÐ·ù


2. ÁøÇ༺ À§¾Ï. Advanced gastric cancer

¿¹: AGC, Borrmann type 3


[Colon]

1. Bowel preparation

ÀåÁ¤°áµµ¸¦ ÆÇÁ¤ÇÏ´Â ¹æ¹ýÀº ´Ù¾çÇÕ´Ï´Ù. ÀúÈñ ±â°ü¿¡¼­´Â °ú°Å Aronchick ¹æ¹ýÀ» »ç¿ëÇÏ¿´À¸³ª ¸î ³â ÀüºÎÅÍ segmentº°·Î ÀåÁ¤°áµµ¸¦ Æò°¡ÇÏ¿© ÇÕ»êÇÏ´Â Boston ¹æ¹ýÀ¸·Î º¯°æÇÏ¿´½À´Ï´Ù. Right colon, T colon, Left colon¿¡ °¢°¢ 0-3Á¡À» ºÎ¿©ÇÏ¿© µµÇÕ 0-9Á¡±îÁö Æò°¡ÇÏ´Â ¹æ¹ýÀÔ´Ï´Ù. °¡Àå ³ª»Û °ÍÀÌ 0Á¡, °¡Àå ÁÁÀº °ÍÀÌ 9Á¡ÀÔ´Ï´Ù.

º¸½ºÅæ ½ºÄÉÀÏÀ» Á¤È®È÷ Àû¿ëÇÏ·Á¸é »ç¿ëÀÚ°£ ´«³ôÀ̸¦ ¸ÂÃç¾ß ÇÕ´Ï´Ù. CORI¿¡¼­ Á¦°øÇÏ´Â º¸½ºÅæ ½ºÄÉÀÏ ¿¬½À µ¿¿µ»óÀ¸·Î ÈÆ·ÃÇÒ °ÍÀ» ±ÇÇÕ´Ï´Ù.

µ¿¿µ»ó 8ºÐ

¼­¾ç »ç¶÷¿¡ ºñÇÏ¿© ¿ì¸®³ª¶ó »ç¶÷µéÀÌ °°Àº ÀåÁ¤°á¹ýÀ» »ç¿ëÇصµ Á» ´õ ÀåÀÌ ±ú²ýÇØÁø´Ù°í ÇÕ´Ï´Ù. ±× ÀÌÀ¯´Â ¸ð¸£°Ú½À´Ï´Ù.

* Âü°í: Bowel preparation before colonoscopy (ASGE guideline 2015)

* Âü°í : EndoTODAY ÀåÁ¤°á


2. ´ëÀå ¿ëÁ¾, LST, Á¶±â ´ëÀå¾Ï. Colon polyp, LST (laterally spreading tumor) and early colon cancer

¿¹: Rectal polyp, Is

* Âü°í : ´ëÀå¿ëÁ¾ÀÇ Áø´Ü°ú Ä¡·á (´ëÇÑÀÇ»çÇùȸÁö)


3. ÁøÇ༺ ´ëÀå¾Ï. Advanced colon cancer

¿¹: Advanced colon cancer, type 3 (¶Ç´Â Advanced colon cancer, ulceroinfiltrative type)

Æĸ® ºÐ·ù

Advanced colon cancer, type 1 / 2 / 3 / 4 (¶Ç´Â polypoid type / ulcerative type / ulceroinfiltrative type / diffuse infiltrative type)

* Âü°í: ÁøÇ༺ À§¾Ï ȤÀº ÁøÇ༺ ´ëÀå¾Ï¿¡ ´ëÇÑ º¸¸¸ ºÐ·ù¿Í Æĸ® ºÐ·ù´Â °ÅÀÇ µ¿ÀÏÇÕ´Ï´Ù. ´ëÀå¾Ï¿¡ ´ëÇÏ¿© º¸¸¸ ºÐ·ù¸¦ ºÙÀ̸é 'Advanced colon cancer, Borrmann type 3'¿Í °°ÀÌ ´Ù¼Ò ¾î»öÇÕ´Ï´Ù. ±×·¯¹Ç·Î Àú´Â 'Advanced colon cancer, type 3'¿Í °°Àº ¹æ½ÄÀ» ÃßõÇÕ´Ï´Ù.


4. ±Ë¾ç¼º ´ëÀå¿°. Ulcerative colitis

±Ë¾ç¼º ´ëÀå¿°ÀÇ ÁßÁõµµ´Â Ulcertive colitis disease activity index (Mayo score, range: 0-12)¸¦ »ç¿ëÇÕ´Ï´Ù. Stool frequency, rectal bleeding, endoscopy findings, physician's global assessment Ç׸ñÀÌ ÀÖ½À´Ï´Ù.

ÀÌ Áß ³»½Ã°æ ¼Ò°ß¸¸ Mayo endoscopy scoringÀ¸·Î ÀÌ¿ëÇÕ´Ï´Ù.

»ï¼º¼­¿ïº´¿ø Ç¥ÁØ reference (ÀÛ¼º: ¹é³²¿µ). Áõ·Êº° scoring ¿¹´Â ¿©±â¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù.

Nature Reviews Gastroenterology & Hepatology 7, 15-29 (January 2010)

ÀÎÅͳݿ¡¼­ °¡Á®¿Â Ãâó ¹Ì»ó ÀÚ·á

±Ë¾ç¼º ´ëÀå¿°ÀÇ ¶Ç ´Ù¸¥ ³»½Ã°æ scoringÀ¸·Î UCEIS°¡ ÀÖ½À´Ï´Ù.

¹Ì¶õ°ú ±Ë¾çÀÇ ±¸ºÐÀÌ ¾î·Á¿ì¹Ç·Î 5mm ÀÌÇÏ´Â ¹Ì¶õÀ¸·Î 5mm ÃÊ°ú´Â ulcer·Î ºÐ·ùÇÏ°í ÀÖ½À´Ï´Ù.

* Âü°í: ±Ë¾ç¼º ´ëÀå¿° Áø´Ü °¡À̵å¶óÀÎ (2009)


5. Å©·Ðº´. Crohn's disease


6. Radiation proctitis

* Âü°í: EndoTODAY ¹æ»ç¼± °ü·Ã À§Àå°ü ¼Õ»ó

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