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ÀÌ·¯ÇÑ ½Ã¼ú ÈÄ ÃßÀû ³»½Ã°æÀº ¾ðÁ¦ ÇØ¾ß µÉ±î¿ä?

2022³â ÇöÀç ±¹³» °¡À̵å¶óÀÎ ¿ä¾àÀÔ´Ï´Ù. 10°³ ÀÌ»óÀÇ adenoma°¡ ÀÖ¾ú´ø °æ¿ì¸¦ Á¦¿ÜÇÏ°í´Â ¸ù¶¥ 3³â ȤÀº ±× ÀÌÈÄÀÔ´Ï´Ù. ¸Å³â ´ëÀå³»½Ã°æ °Ë»ç¸¦ ¹Þ´Â ºÐµéÀÌ ¸¹´Ù´Â °ÍÀº ÀÇÇÐÀûÀÎ non-sense »óȲÀÔ´Ï´Ù.


1. Surveillance colonoscopy: moving toward "precision surveillance" (2019-3-22 Expert meeting ±èÅÂÁØ ±³¼ö´Ô °­ÀÇ)

Low risk adenoma¶õ 1 ¶Ç´Â 2°³ÀÇ ÀÛÀº ¼±Á¾À» ÀǹÌÇϴµ¥ ÀÌ·± °æ¿ì ¿ì¸®³ª¶ó °¡À̵å¶óÀο¡¼­´Â 5³â ÈÄ ¹Ì±¹ °¡À̵å¶óÀο¡¼­´Â 5³â¿¡¼­ 10³â ÈÄ f/u ÇÒ °ÍÀ» ±ÇÀ¯ÇÏ°í ÀÖ½À´Ï´Ù. Low risk adenoma ¿¡ ´ëÇÑ surveillance intervalÀº adenoma °¡ ¾ø´Â Á¤»ó ±×·ì°ú ºñ½ÁÇÏ°Ô Á¦½ÃµË´Ï´Ù. ±× ÀÌÀ¯´Â low risk adenoma ±ºÀÇ (1) metachronous advanced adenoma ¹ß»ý·ü, (2) ´ëÀå¾Ï ¹ß»ý·ü, (3) ´ëÀå¾Ï »ç¸Á·üÀÌ general populationÀ̳ª no adenoma ±º°ú ºñ½ÁÇϱ⠶§¹®ÀÔ´Ï´Ù.

¿ì¸®³ª¶ó ¿¬±¸ÀÔ´Ï´Ù. High risk groupÀº metachronous advanced adenoma ¹ß»ý·üÀÌ ³ô¾ÒÁö¸¸ low risk groupÀº Á¤»ó ±×·ì°ú Â÷ÀÌ°¡ ¾ø¾ú½À´Ï´Ù.

Low-risk adenoma ¿Í´Â ´Ù¸£°Ô high risk adenoma´Â ´ëÀå¾Ï »ç¸Á À§Çèµµ°¡ ´õ ³ô¾Ò½À´Ï´Ù.

Index colonoscopy ÈÄ ´ëÀå¾Ï ¹ß»ý·üÀÔ´Ï´Ù. Advanced adenoma°¡ ÀÖ¾ú´ø »ç¶÷ÀÌ ´ëÀå¾Ï¿¡ Àß °É¸³´Ï´Ù. ±×·¯³ª non-advanced adenoma¿´´ø »ç¶÷Àº ¼±Á¾ÀÌ ¾ø¾ú´ø »ç¶÷°ú Â÷ÀÌ°¡ ¾ø¾ú½À´Ï´Ù.

°°Àº ÀڷḦ ±×·¡ÇÁ·Î º¸¿©ÁÖ´Â °ÍÀÔ´Ï´Ù.

High risk groupÀÇ ´ëÇؼ­µµ ¸î °¡Áö Ç®¸®Áö ¾ÊÀº À̽´°¡ ÀÖ½À´Ï´Ù. ³»½Ã°æ È­ÁúÀÌ ÁÁ¾ÆÁö¸é¼­ 5mm ÀÌÇÏÀÇ ¸Å¿ì ÀÛÀº ¿ëÁ¾ ¹ß°ßÀ²ÀÌ Áõ°¡ÇÏ¿´°í ÀÌ·Î ÀÎÇØ ¼±Á¾¹ß°ßÀ²ÀÌ ³ô¾ÆÁ³½À´Ï´Ù. µû¶ó¼­ "´Ù¼öÀÇ 5mm ÀÌÇÏ ÀÛÀº ¼±Á¾µé"µµ Á¤¸» high risk¿¡ ÇØ´çÇÏ´ÂÁö Àǹ®ÀÌ Á¦±âµÇ°í ÀÖ½À´Ï´Ù.

Multiple diminutive adenoma¿¡ ´ëÇÑ ¿¬±¸¸¦ ½ÃÇàÇÏ¿´´Âµ¥ screening colonoscopy¿¡¼­ ÇÑ °³ ÀÌ»óÀÇ ¼±Á¾À» Á¦°ÅÇÑ »ç¶÷µéÀ» ´ë»óÀ¸·Î ºÐ¼®À» ÇÏ¿´½À´Ï´Ù. °¡À̵å¶óÀδë·Î 1-2 ÀÛÀº ¼±Á¾À» °¡Áø ȯÀÚµéÀ» low risk groupÀ¸·Î ±¸ºÐÇÏ°í high risk groupÀº ´ÙÀ½°ú °°ÀÌ 3°³ÀÇ ±×·ìÀ» ¼¼ºÐÈ­ ÇÏ¿´½À´Ï´Ù. Å©±â°¡ 3°³ ÀÌ»óÀÌÁö¸¸ diminutive non-advanced adenomaÀÎ °æ¿ì, Å©±â°¡ 6-9mmÀÇ small non-advanced adenoma°æ¿ì, advanced adenomaÀÎ °æ¿ì·Î ³ª´©¾î surveillance colonoscopy¿¡¼­ÀÇ advanced neoplasiaÀÇ ¹ß»ýÀ» ºñ±³ÇÏ¿´½À´Ï´Ù. ´ç¿¬È÷ 1-2°³ÀÇ ÀÛÀº ¼±Á¾À» °¡Áø low risk group¿¡¼­ ¹ß»ýÀÌ °¡Àå ÀÛ¾Ò°í diminutive, small, advanced adenoma¼øÀ¸·Î ¹ß»ýÀÌ Áõ°¡ÇÏ¿´½À´Ï´Ù. (ÀÌÁØÇà ñÉ: ±èÁ¤À±, ±èÅÂÁØ ¼±»ý´Ô. ¸ÚÁø ¿¬±¸ ÃàÇϵ帳´Ï´Ù.)

°í·ÉÀÌ À§ÇèÀÎÀÚÀÔ´Ï´Ù.

³²¼ºÀÌ À§ÇèÀÎÀÚÀÔ´Ï´Ù.

°Ë»ç¸¦ ½ÃÇàÇÑ ÀÇ»çÀÇ adenoma detection rateµµ Áß¿äÇÕ´Ï´Ù. ³·Àº ADRÀ» °¡Áø ³»½Ã°æÀǻ翡°Ô screeningÀ» ¹Þ°Ô µÇ¸é ³ôÀº ADRÀ» °¡Áø ³»½Ã°æ Àǻ翡°Ô ¹Þ´Â °Íº¸´Ù metachronous advanced neoplasiaÀÇ À§Çèµµ°¡ ³ô½À´Ï´Ù. µû¶ó¼­ low-risk adenoma¸¦ °¡Áø »ç¶÷ÀÌ ¾çÁúÀÇ ´ëÀå³»½Ã°æÀ» ½ÃÇà¹Þ¾Ò´Ù¸é interval cancerÀÇ À§ÇèÀº ³ôÁö ¾Ê½À´Ï´Ù.

ÇÑ °ËÁø¼¾ÅÍÀÇ adenoma detection rateÀÔ´Ï´Ù.

±èÅÂÁØ ±³¼ö´ÔÀÇ ¸ÚÁø °­ÀÇÀÇ ¸ÚÁø summaryÀÔ´Ï´Ù.


[FAQ]

[2015-10-3. ¾Öµ¶ÀÚ Áú¹®]

´ëÀå ³»½Ã°æ ÈÄ ÃßÀû°Ë»ç¿¡ °üÇÑ Áú¹®ÀÔ´Ï´Ù. Æò¼Ò °Ç°­ÇÏ´ø 70´ë Áß¹Ý ³²¼ºÀÇ Ã¹ ´ëÀå³»½Ã°æÀ̾ú½À´Ï´Ù. ±¸ºÒ°áÀå¿¡¼­ 0.7-0.8 cm ¿ëÁ¾ÀÌ °üÂûµÇ¾î EMR polypectomy¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù. Hyperplastic polypÀ¸·Î ÃßÁ¤µÇ´Â diminutive polpyÀÌ ±¸ºÒ°áÀå, Á÷Àå¿¡ °ÉÃÄ 10±ºµ¥ °¡±îÀÌ °üÂûµÇ¾úÀ¸³ª ´ëÇ¥ÀûÀÎ 2~3°÷¸¸ Æ÷¼ÁÀ¸·Î Á¦°ÅÈÄ °Ë»ç¸¦ ¸¶ÃƽÀ´Ï´Ù. Á¶Á÷°Ë»ç °á°ú´Â ¿¹»ó´ë·Î ÀÚÀßÇÑ ¿ëÁ¾µéÀº °úÇü¼º ¿ëÁ¾ÀÌ¿´À¸³ª Å« ¿ëÁ¾Àº 'adenomatous polyp - high grade dysplasia, margin is unclear'¿´½À´Ï´Ù. ȯÀÚ¿¡°Ô ¼³¸í ÈÄ ESD¸¦ À§ÇØ ´ëÇк´¿øÀ¸·Î Àü¿øÇØ¾ß ÇÒÁö... ¾Æ´Ï¸é 3°³¿ù µÚ Àç°ËÇÏ¿© ³²Àº ¿ëÁ¾ÀÌ ÀÖÀ¸¸é Ä¡·á¸¦ Á¦°¡ °è¼ÓÇÒÁö ÆÇ´ÜÀÌ ¼­Áö ¾Ê¾Æ °í¹ÎÇÏ°í ÀÖ½À´Ï´Ù. º¹ºÎ CT´Â Á¤»óÀ̾ú½À´Ï´Ù.


[2015-10-5. Àü¹®°¡ ´äº¯ (I º´¿ø K ±³¼ö)]

ÃÖ±Ù Clin Endosc¿¡ °ÔÀçµÈ Á¾¼³¿¡ ÀÇÇϸé high grade dysplasia´Â D01 ÄÚµå ºÎ¿©°¡ °¡´ÉÇÕ´Ï´Ù. ÇÏÁö¸¸ ±×·¸´Ù°í Çؼ­ ´õ °Ë»ç³ª Ä¡·á°¡ ÇÊ¿äÇÑ °ÍÀº ¾Æ´Ï¶ó°í ÆǴܵ˴ϴÙ.

°¡Àå ¸ÕÀú ½Ã¼úÀ» ½ÃÇàÇÑ Àǻ簡 ´Ù½Ã Çѹø »çÁøÀ» ¸®ºäÇϸ鼭, ¹®Á¦¾øÀÌ µÇ¾ú´ÂÁö È®ÀÎÇÒ ÇÊ¿ä°¡ ÀÖ½À´Ï´Ù. ¶ÇÇÑ margin evaluationÀÌ Á¦´ë·Î µÇÁö ¾ÊÀº °ÍÀº Á¦°Å½Ã coagulation effect ¶§¹®À̱⵵ ÇÕ´Ï´Ù. 1´Þ ÈÄ ÃßÀû ´ëÀå³»½Ã°æ°ú EMR site Á¶Á÷°Ë»ç¸¦ ±ÇÇÕ´Ï´Ù. 3°³¿ù ÈÄ¿¡´Â °¡²û EMR site¸¦ ãÁö ¸øÇϱ⠶§¹®ÀÔ´Ï´Ù. ¸¸¾à EMR site°¡ clearÇÏ°í Á¶Á÷°Ë»ç¿¡¼­µµ ÀÌ»ó ¼Ò°ßÀÌ ¾ø´Ù¸é ´õ ÀÌ»óÀÇ Ãß°¡ ½Ã¼úÀº ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù. ¿ëÁ¾ÀÌ ³²¾Æ ÀÖ´Ù¸é ´ç¿¬È÷ Ãß°¡ ½Ã¼úÀÌ ÇÊ¿äÇÕ´Ï´Ù.

ÃßÀû ³»½Ã°æ ½Ã±â¿¡ ´ëÇÑ Á¾¼³ (´ëÇѼÒÈ­±âÇÐȸÁö 2012, Intest Res 2012)À» ¼Ò°³ÇÕ´Ï´Ù. °íÀ§Ç豺¿¡¼­´Â 3³â ÈÄ¿¡ ÇÒ °ÍÀ» ±ÇÀ¯ÇÏ¿´³×¿ä. ¹°·Ð ¿ÏÀü ÀýÁ¦¸¦ ÀüÁ¦·Î...


[2015-10-6. ÀÌÁØÇà ÀÇ°ß]

À§ Àü¹®°¡ ´äº¯¿¡ µ¿ÀÇÇÕ´Ï´Ù. 3´Þ µÚ´Â ³Ê¹« ´Ê´Ù°í »ý°¢ÇÕ´Ï´Ù.

Áú¹®°ú Á¶±Ý ´Ù¸¥ À̾߱âÀÌÁö¸¸ ´ëÀå³»½Ã°æ °£°Ý¿¡ ´ëÇÑ Á¦ ÀÇ°ßÀ» ¸»¾¸µå¸³´Ï´Ù. ÀÏÀü¿¡ º» º´¿ø ÀÓ»ó°­»ç ±èÅÂÁØ ¼±»ý´Ô²²¼­ Á¤¸®ÇÑ ³»¿ëÀ» ¼Ò°³ÇÕ´Ï´Ù. ¼­¾ç°ú ¿ì¸®³ª¶óÀÇ °¡À̵å¶óÀÎÀÌ Á¶±Ý ´Ù¸¨´Ï´Ù. ¿ì¸®³ª¶ó´Â ¾Æ¹« °Íµµ ¾øÀ¸¸é 5³â, ¹º°¡ Á¶±Ý ÀÌ»óÇϸé 3³âÀÔ´Ï´Ù. ´ëÀå ¿ëÁ¾ÀÌ ¿ÏÀüÀýÁ¦°¡ µÇ¾ú´Ù¸é 1-2³â ÈÄ¿¡ Àç°ËÀ» ±ÇÇÒ ÀÌÀ¯°¡ ¾ø½À´Ï´Ù. 3³âÀ̸é ÃæºÐÇÕ´Ï´Ù.

±×·±µ¥ ½ÃÁß¿¡¼­´Â 6°³¿ùÀ̳ª 1³â ÈÄ Àç°ËÀÌ ³²¹ßµÇ°í ÀÖ´Â °Í °°½À´Ï´Ù. '1³â ÈÄ Àç°Ë'Àº ±Ç°í¾È ¾îµð¿¡µµ ¾ø´Â ÀÌ»óÇÑ ÃʽÄÀÔ´Ï´Ù. 1³â ÈÄ ´ëÀå³»½Ã°æÀ» ÀÚ²Ù ±ÇÇÏ´Â ºÐÀº ½º½º·Î "³ª´Â ´ëÀå³»½Ã°æ ½Ç·ÂÀÌ ºÎÁ·ÇÕ´Ï´Ù"¶ó°í È«º¸ÇÏ´Â °ÍÀ̳ª ¸¶Âù°¡ÁöÀÔ´Ï´Ù. âÇÇÇØ ÇÏ¼Å¾ß ÇÕ´Ï´Ù. ÀûÀýÇÑ °Ë»ç °£°ÝÀ» ±ÇÇÏ´Â °ÍÀº ¸Å¿ì Áß¿äÇÑ ´ëÀå³»½Ã°æ ÁúÁöÇ¥ÀÔ´Ï´Ù. 2014³â ¹Ì±¹ DDW¿¡¼­ Á¦¾ÈµÈ ´ëÀå³»½Ã°æ ÁúÁöÇ¥¸¦ º¸½Ã±â ¹Ù¶ø´Ï´Ù.

  1. Adenoma detection rate (ADR) >25% (³²ÀÚ¿¡¼­´Â 30%, ¿©ÀÚ´Â 20%). ADRÀ» ³ôÀ̱â À§Çؼ­ (1) withdrawal timeÀ» ´Ã¸®°í, (2) ÀåÁ¤°áÀ» Çâ»ó½ÃÅ°°í, (3) cecum¿¡¼­ retroflectionÀ» ÇÏ´Â °ÍÀÌ ÃßõµË´Ï´Ù.
  2. Documented appropriate indication for colonoscopy > 80%. There is no clear indication for the early repeated examination in 23.5%.
  3. Adequate bowel preparation in outpatient setting > 85%. SplittingÀÌ ÁÁ½À´Ï´Ù.
  4. Cecal intubation rate with photodocumentation > 95%
  5. Documented appropriate recommendation for next colonoscopy > 90%.
  6. Average withdrawal time > 6 minutes. Withdrawal time¿¡ ´ëÇؼ­´Â 6ºÐÀ̶ó´Â ¼ýÀÚ°¡ misquotedµÇ°í ÀÖ½À´Ï´Ù. Every single colonoscopy°¡ Ç×»ó 6ºÐ ÀÌ»óÀÌ µÇ¾î¾ß ÇÑ´Ù´Â ¶æÀº ¾Æ´Õ´Ï´Ù. ÀåÁ¤°áÀÌ ÁÁ°í °üÂûÀÌ ½¬¿î °Ë»ç´Â 6ºÐº¸´Ù ª°Ô ³¡³¯ ¼ö ÀÖ½À´Ï´Ù.
  7. Perforation < 1/1000
  8. Postpolypectomy bleeding < 1%

°Ë»ç¸¦ Àß ÇսôÙ. ±×·¡¼­ ³Ê¹« ÀÚÁÖ ÇÏÁö´Â ¸¿½Ã´Ù. °¡À̵å¶óÀÎÀ» Áöŵ½Ã´Ù.


[2016-6-19. Ãß°¡]

Digest Endosc 2016¿¡ ¹Ì±¹°ú À¯·´ÀÇ post-polypectomy surveillance recommendationÀÌ ¿ä¾à ¼Ò°³µÇ¾ú½À´Ï´Ù (Vleugels. Digest Endosc 2016). ¿ì¸®³ª¶óÀÇ °üÇຸ´Ù ÈξÀ °£°ÝÀÌ ³Ð´Ù´Â °ÍÀ» ¾Ë ¼ö ÀÖ½À´Ï´Ù.

°°Àº Digest Endosc 2016ÀÇ 3±Ç¿¡ ¿ì¸®³ª¶ó¿Í ÀϺ»ÀÇ post-polypectomy surveillance recommendationÀÌ ¿ä¾à ¼Ò°³µÇ¾ú½À´Ï´Ù (Matsuda T. Digest Endosc 2016).

¾î´À ³ª¶óÀÇ ¾î¶² °¡À̵å¶óÀο¡µµ '1³â ÈÄ ´ëÀå ³»½Ã°æ Àç°Ë'À̶ó´Â Ç׸ñÀº ¾ø½À´Ï´Ù. ¿©°£Çؼ­´Â 5³âÀÌ°í ½ÉÇÏ´Ù ½ÍÀ¸¸é 3³âÀÔ´Ï´Ù.


[References]

1) EndoTODAY interval cancer

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