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[SMC basic endoscopy course (3 months)]

1. Timetable

SMC basic endoscopy training course (3 months)
Program1st month2nd month3rd month
On-line lecture


KSGE lectures 1-10 KSGE lectures 11-20
Staff lecture (1) Insertion
(2) Description
(3) Common GI disorders
One point lesson One point lesson
Book & Journal club Textbook reading with tutors Review the review Review the review
Description training 1, 2, 3, 4 5, 6, 7, 8 9, 10, 11, 12
Gastric cancers 1,000 Season 1 Season 2 Season 3
Weekly conference Endoscopy conference
GI conference
Endoscopy conference
GI conference
Endoscopy conference
GI conference
Observation and hands-on Weekly observation
Simulator training
Daily observation Hands-on
Others EndoTODAY
Topic presentation 1, 2, 3
EndoTODAY
Topic presentation 4, 5, 6
EndoTODAY
Topic presentation 7, 8, 9
Quiz 365


2. ³»½Ã°æ ÃʽÉÀڵ鲲 ºÎŹµå¸³´Ï´Ù (2017-3-18. ±èÅÂÁØ ±³¼ö´Ô)

±èÅÂÁØ ±³¼ö´Ô²²¼­ ¿©·¯ Àü°øÀÇ, Àӻ󰭻翡°Ô ´çºÎÀÇ ÆíÁö¸¦ º¸³Â½À´Ï´Ù. ÐÝΡè¬ðÉÀÔ´Ï´Ù. ¿Å±é´Ï´Ù.

¾È³çÇϽʴϱî. ¼±»ý´Ôµé²²¼­ º´µ¿°ú ³»½Ã°æ½Ç¿¡¼­ ¿­½ÉÈ÷ ÇØÁּż­ °¨»çµå¸³´Ï´Ù. ´Ù½Ã Çѹø ´çºÎµå¸®°í ½ÍÀº »çÇ×µéÀÌ ÀÖ½À´Ï´Ù.

1) ȯÀÚ ÆľÇÇϱâ - ³»½Ã°æ °Ë»ç Àü EMRÀ» ÅëÇÏ¿© ȯÀÚ¸¦ Àß ÆľÇÇØ¾ß ÇÕ´Ï´Ù. Áõ»ó¾øÀÌ °ËÁø ¸ñÀûÀÇ °Ë»çµµ ÀÖÀ¸³ª, ´ëºÎºÐ Áõ»óÀ» °¡Áö°í ¼ÒÈ­±â³»°ú ¿Ü·¡¸¦ ¹æ¹®ÇÏ¿© °Ë»çÇϴ ȯÀÚµéÀÌ ´õ ¸¹½À´Ï´Ù. °Ë»ç ÀÌÀ¯, Á¶Á÷ °Ë»ç°¡ ÇÊ¿äÇÑ ºÎºÐÀÌ ÀÖ´ÂÁö, Á» ´õ ÁÖÀDZí°Ô °üÂûÇØ¾ß ÇÏ´Â ºÎºÐÀº ¾ø´ÂÁö µîµîÀ» Àß ÆľÇÇÏ°í °Ë»ç¸¦ ½ÃÀÛÇϽʽÿÀ. °ú°Å ³»½Ã°æ °Ë»ç °á°ú¿Í »çÁøÀ» ¸®ºäÇÏ´Â °ÍÀº ¹°·Ð º¹ºÎ CT¿Í °°ÀÌ À§Àå°ü ÁúȯÀ» ¾Ë ¼ö ÀÖ´Â ´Ù¸¥ °Ë»çµµ È®ÀÎÇÏ¸é µµ¿òÀÌ µË´Ï´Ù. ¿¹¸¦ µé¾î º¹ºÎ CT¿¡¼­ prominent AoV - r/o AoV adenoma ¼Ò°ßÀÌ ÀÖÀ¸¸é AoV¸¦ ´õ¿í ÁÖÀDZí°Ô °üÂûÇϽñ⠹ٶø´Ï´Ù.

2) ¹Ù¸£°Ô °üÂûÇÏ°í »çÁø Âï±â - Blind area°¡ ¾øÀÌ °Ë»çÇϱâ À§ÇÏ¿© ÀÏÁ¤ÇÑ ÆÐÅÏÀ» °¡Áö°í ½Äµµ, À§, ½ÊÀÌÁöÀåÀ» °üÂûÇϽʽÿÀ. ³»½Ã°æ »çÁøÀº Ä¿¹Â´ÏÄÉÀ̼ÇÀÇ ¼ö´ÜÀ̱⠶§¹®¿¡ Àß ¼¼Ã´µÈ »óÅ¿¡¼­ Èçµé¸®Áö ¾Êµµ·Ï ÁÖÀÇÇϽʽÿÀ. ÃÖ±Ù ÀÌÁØÇà ±³¼ö´Ô²²¼­ Á¦¾ÈÇÑ ¹Ù¿Í °°ÀÌ ±âº» »çÁøÀº ²À ³²±â½Ã°í, ȯÀÚ¿¡ µû¶ó ÇÊ¿äÇÑ ºÎÀ§°¡ ÀÖÀ¸¸é Á» ´õ ÃÔ¿µÇÏ¸é µË´Ï´Ù. º´¼Ò°¡ ¹ß°ßµÇ¸é ¿ø°æ, Áß°£, ±Ù°æ, Á¶Á÷°Ë»ç ÈÄ ÀÌ·¸°Ô 4ÀåÀ» Âï´Â °ÍÀÌ ±âº»ÀÔ´Ï´Ù. (º´¼Ò¶ó ÇÔÀº À§Ä¡ÆľÇÀÌ ÇÊ¿äÇÑ ÀǹÌÀÖ´Â º´¼Ò¸¦ ¸»Çϴµ¥, Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇÑ ´Ü¼ø¹Ì¶õ¿¡ ´ëÇؼ­µµ ¸ðµÎ 4Àå±îÁö ÂïÀ» ÇÊ¿ä´Â ¾øÀ» °Í °°½À´Ï´Ù.)

3) °üÂûÇÏ´Â ¼ø¼­´Â ¾à°£¾¿ ´Ù¸¦ ¼ö ÀÖÀ¸³ª ´ë·« ´ÙÀ½°ú °°½À´Ï´Ù.

  1. ¸ñ³Ñ±â±â (»ðÀÔÀÌ Àͼ÷ÇÏÁö ¾ÊÀº ¼±»ý´ÔµéÀº ÈĵκÎÀ§¸¦ °üÂûÇÏ°í »çÁøÀº ¾È Âï¾îµµ ±¦Âú½À´Ï´Ù. ÈĵκÎÀ§¿¡¼­ ¿À·¡ ¸Ó¹°´Ù°¡ ȯÀÚ°¡ Èûµé¾î ÇÏ´Â °æ¿ì°¡ Á¾Á¾ Àֱ⠶§¹®ÀÔ´Ï´Ù.)
  2. ½Äµµ¸¦ °üÂûÇϸ鼭 »çÁøÂï±â
  3. GEJ¿¡¼­ Z-lineÀ» °üÂûÇÏ°í »çÁøÂï±â
  4. ½ÊÀÌÁöÀå ±¸ºÎ °üÂûÇÏ°í »çÁøÂï±â (SDA angle ÀÌ º¸ÀÌ°Ô²û »çÁøÀÌ ³ª¿Àµµ·Ï ³ë·ÂÇսôÙ. )
  5. ½ÊÀÌÁöÀå Á¦2ºÎ·Î ³Ñ¾î°¡ major papilla¿Í minor papilla¸¦ È®ÀÎÇÏ°í AoV¸¦ °üÂûÇÏ°í »çÁøÀ» Âï½À´Ï´Ù.
  6. ´Ù½Ã À§·Î ³ª¿Í antrumÀ» °üÂûÇÕ´Ï´Ù. AntrumÀº º´º¯ÀÌ Àß ¹ß»ýÇÏ´Â ºÎÀ§À̹ǷΠ°¡Àå ÁÖÀ§±í°Ô °üÂûÇØ¾ß ÇÕ´Ï´Ù. proximal antrum¿¡¼­ AW, GC, PW side¸¦ °üÂûÇÏ°í mid-antrum À§Ä¡¿¡¼­ ´Ù½Ã mid, distal antrumÀÇ GC, AW, PW side¸¦ °üÂûÇÏ°í ³­ ´ÙÀ½ antrum LC side¸¦ °üÂûÇÕ´Ï´Ù. ±×¸®°í angleÀ» °üÂûÇÏ°í angleÀÇ AW, PW sideµµ °üÂûÇÕ´Ï´Ù. ÀúÀÇ °æ¿ì¿¡ antrum »çÁøÀº pylorus°¡ °¡¿îµ¥¿¡ À§Ä¡Çϵµ·Ï Çؼ­ ÀüüÀûÀÎ antrum »çÁøÀ» ÇÑÀå Âï°í antrum LC side ¿Í angleÀ» Âï½À´Ï´Ù.
  7. AntrumÀ» ´Ù °üÂûÇÏ¿´À¸¸é bodyÀÇ GC side°¡ 6-7½Ã¿¡ À§Ä¡Çϵµ·Ï Çؼ­ fundusÂÊÀ¸·Î ¿Ã¶ó°©´Ï´Ù. ¿Ã¶ó°¡¸é¼­ °íÀÎ ¾×ü¸¦ ÈíÀÔÇÕ´Ï´Ù.
  8. Fundus Àüü°¡ °¡¿îµ¥ À§Ä¡Çϵµ·Ï ÇÏ¿© °üÂûÇÏ°í »çÁøÀ» Âï½À´Ï´Ù.
  9. Up angleÀ» ÃÖ´ëÇÑ ÇÏ¿© cardia ºÎºÐÀ» °üÂûÇÕ´Ï´Ù. À̶§ ³»½Ã°æ ¼±´ÜÀÌ ÃæºÐÈ÷ flexion µÇÁö ¾ÊÀ¸¸é Á¿ì³ëºêµµ ÇÔ²² »ç¿ëÇÏ¿© cardia°¡ È­¸é Áß¾Ó¿¡ Àߺ¸À̵µ·Ï ÇÏ¿© ³»½Ã°æÀ» 360µµ µ¹·Á°¡¸é¼­ °üÂûÇÏ¸ç »çÁøÀ» Âï½À´Ï´Ù.
  10. ´ÙÀ½À¸·Î body ÀÇ LC side¸¦ °üÂûÇÏ¸ç ³»½Ã°æÀ» ÀüÁø½Ãŵ´Ï´Ù. high body LC side → mid body LC side → low body LC side¸¦ °üÂûÇÏ°í ´Ù½Ã angleÀ» ¹Ù¶óº¸°Ô µË´Ï´Ù. °üÂûÇϸ鼭 LC side »çÁøÀ» 1-2Àå Âï½À´Ï´Ù.
  11. ³»½Ã°æÀ» ȸ¼öÇϸ鼭 bodyÀÇ GC side¸¦ °üÂûÇÕ´Ï´Ù. PW side°¡ blind portionÀÌ´Ï º´º¯À» ³õÄ¡Áö ¾Êµµ·Ï Àß °üÂûÇÕ´Ï´Ù. Low body → mid body → high body ¼ø¼­·Î °üÂûÇÏ°Ô µÇ¸ç °¢ ºÎÀ§¸¶´Ù AW/GC/PW side¸¦ ¸ðµÎ °üÂûÇÕ´Ï´Ù. °üÂû½Ã °ø±â¸¦ ÃæºÐÈ÷ ³Ö¾î ÁÖ¸§»çÀ̵µ ³õÄ¡Áö ¾Ê½À´Ï´Ù.
  12. ¸¶Áö¸·À¸·Î funusÀÇ GC side portionÀ» °üÂûÇϸ鼭 »çÁøÀ» ÃÔ¿µÇÕ´Ï´Ù. Àú°°Àº °æ¿ì´Â high body GC¸¦ ¹Ù¶óº¸´Ù°¡ ÁÖ¸§À» µû¶ó ½Ã°è¹Ý´ë¹æÇâÀ¸·Î ȸÀüÀ» Çϸ鼭 °üÂûÇÕ´Ï´Ù. ±×·¸°Ô °üÂûÇϸé fundus¸¦ ȸÀüÇÏ¸ç ´Ù º¸°í ¸¶Áö¸·À¸·Î ³»½Ã°æÀÌ high body posteroGC side ¸¦ ¹Ù¶óº¸°Ô µÇ¸ç GEJ, cardia ¹Ù·Î ¾Æ·¡ºÎºÐÀÔ´Ï´Ù. °üÂûÀ» ´ÙÇÏ¿´À¸¸é °ø±â¸¦ »©°í Z-lineÀ» ´Ù½Ã °üÂûÇÏ°í ½Äµµ¸¦ °üÂûÇϸ鼭 ³»½Ã°æÀ» ¸¶¹«¸®ÇÕ´Ï´Ù.

4) Target biopsy - TargetingÀ» ÀßÇØ¾ß ÇÕ´Ï´Ù. ¾û¶×ÇÑ °÷À» Çؼ­ Áø´ÜÀÌ ¾ÈµÇ´Â °æ¿ì°¡ ¾øµµ·Ï ÇսôÙ. Á¶Á÷°Ë»ç¸¦ ¹«Á¶°Ç ¸¹ÀÌ ÇÑ´Ù°í ÁÁÀº °ÍÀº ¾Æ´Õ´Ï´Ù. Á¤È®ÇÏ°Ô ¿øÇÏ´Â °÷¿¡¼­ target biopsy¸¦ ÇÏ¿©¾ß Áø´Ü yield¸¦ ³ôÀÏ ¼ö ÀÖ½À´Ï´Ù.

5) °Ë»ç ÈÄ »çÁø ¸®ºäÇϱâ - °Ë»ç ÈÄ Æǵ¶Çϱâ Àü¿¡ ½ÃÇàÇÑ »çÁøµéÀ» ¸®ºäÇϸ鼭 Ȥ½Ã ³õÄ£ º´º¯Àº ¾ø´ÂÁö Æǵ¶ÀÌ ¿Ã¹Ù¸¥Áö È®ÀÎÇØ¾ß ÇÕ´Ï´Ù.

6) Á¶Á÷°Ë»ç °á°ú ÇÐÀÎÇϱâ - ȯÀÚ ¼öøÀ» ¸¸µé¾î¼­ º»ÀÎÀÌ ½ÃÇàÇÑ Á¶Á÷°Ë»ç °á°ú¸¦ ²À È®ÀÎÇÕ´Ï´Ù.

±âº»ÀûÀÎ ³»¿ëÀ» ´Ù½Ã Çѹø ¸»¾¸µå¸®´Â ÀÌÀ¯´Â óÀ½ ½ÃÀÛÇÒ ¶§ ÁÁÀº ½À°üÀ» °®´Â °ÍÀÌ Áß¿äÇϱ⠶§¹®ÀÔ´Ï´Ù. °¨»çÇÕ´Ï´Ù.

[2017-3-28. ¾Öµ¶ÀÚ ÆíÁö]

º¸³»ÁֽŠ¸ÞÀÏÀÇ °üÂû ¼ø¼­¸¦ º¸¸é 'ÈĵΠ- ½Äµµ - ½ÊÀÌÁöÀå - À§' ¼ø¼­·Î º¸¶ó°í ¾Ë·Á Áּ̽À´Ï´Ù. Àú´Â ½Äµµ¸¦ ³ª¿Ã ¶§ Á¦ÀÏ ¸¶Áö¸·¿¡ ÂïÀ¸¶ó°í ¹è¿ü°í ±×·¸°Ô ÇÏ°í ÀÖ½À´Ï´Ù. ÀÌÀ¯´Â "¾Ð·ÂÀ̶ó ÇÔÀº ´ÜÀ§ ¸éÀû´ç °¡ÇØÁö´Â ÈûÀ¸·Î Á¤ÀÇÇÒ ¼ö Àִµ¥, À§³ª ½ÊÀÌÁöÀå°ú ºñ±³ÇÏ¸é ½Äµµ´Â ÆØâÀÌ ¾î·Á¿î ±â°ü(?)À¸·Î ¾Ð·ÂÀÌ ³ô¾ÆÁüÀ» ½±°Ô ´À³¥ ¼ö ÀÖ´Ù. ÀÏ¹Ý ³»½Ã°æ¿¡¼­ ¾î·Æ°Ô Èĵθ¦ ³Ñ°å´Âµ¥ ½Äµµ¿¡ °ø±â¸¦ ³Ö¾î°¡¸é¼­ À¯ÀDZí°Ô °üÂûÀ» ½ÃÀÛÇÑ´Ù¸é ȯÀÚ°¡ Èûµé¾î ÇÒ ¼ö ÀÖÀ¸¸ç, ÁøÁ¤ ³»½Ã°æ¿¡¼­µµ ÃæºÐÈ÷ ÁøÁ¤ÀÌ ¾È µÈ »óÅ¿¡¼­ ÀÚ±ØÀÌ °¡ÇØÁú ¼ö ÀÖ¾î´Ù. ¹Ý´ë·Î ÀÏ¹Ý ³»½Ã°æ¿¡¼­ ȯÀÚ°¡ ÀûÀÀÀ» ÇÏ°í ¾ÈÁ¤À» ÃëÇÑ »óÅÂÀÎ °Ë»ç ¸¶Áö¸·ÀÌ¸é ½Äµµ¸¦ ÃæºÐÈ÷ °üÂûÇÏ´õ¶óµµ ȯÀÚ°¡ ÈûµéÁö ¾ÊÀ» ¼ö ÀÖ´Ù."¶ó°í ¹è¿ü½À´Ï´Ù.

Ȥ½Ã ÀÌ ¼ø¼­¿¡ ´ëÇؼ­´Â ¾î¶»°Ô »ý°¢À» ÇϽôÂÁö¿ä? ȯÀÚ°¡ Æí¾ÈÇØ¾ß ¹Ù¸¥ ³»½Ã°æÀ» ÇÒ ¼ö ÀÖÀ» °Í °°¾Æ¼­¿ä.

[2017-4-1. ±èÅÂÁØ ±³¼ö´Ô ´äº¯]

Á¦°¡ ÆíÁö¿¡¼­ ÀǵµÇÑ Á¡Àº µé¾î°¥ ¶§µµ °üÂûÇÏ°í ³ª¿Ã ¶§µµ °üÂûÇÏÀÚ´Â ÃëÁö¿´½À´Ï´Ù. ¼±»ý´Ô ÀÇ°ßó·³ Àúµµ ´ë°³´Â µé¾î°¥ ¶§´Â Âß ÈȾ°í ³ª¿Ã ¶§ Á» ´õ ÀÚ¼¼È÷ °üÂûÇÏ´Â ÆíÀÔ´Ï´Ù. ³»½Ã°æÀ» °üÂûÇÏ´Â ¹æ¹ý “G ¼ø¼­´Â ´Ù¾çÇÒ ¼ö ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù. ÀÏ·Ê·Î ¸Å¿ì ²Ä²ÄÇÏ°Ô »çÁøÀ» Âï´Â °ÍÀ» ±ÇÀåÇÏ´Â °÷µµ ÀÖ½À´Ï´Ù. ¸ÞÀÌÁ®¸®±× ŸÀÚµéÀÌ Å¸±¸ÆûÀÌ Á¦°¢°¢ÀÌÁö¸¸ ±×µéµµ óÀ½¿¡ ¹è¿ï ¶§´Â °¡Àå ±âÃÊÀûÀΠŸ±¸ÆûºÎÅÍ ¿¬½ÀÇßÀ» °ÍÀÔ´Ï´Ù.. ¹è¿ö°¡¸é¼­ Àڽſ¡°Ô ¸Â´Â Ÿ±¸ ÆûÀ» °¡Áö°Ô µÈ °Íó·³...

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º¸´Ù Á¤È®È÷ ¸»Çϸé '(ÈĵÎ) - ½Äµµ - À§ ÀϺΠ- ½ÊÀÌÁöÀå - À§ ÀüºÎ - ½Äµµ - (ÈĵÎ)'ÀÏ °Í °°½À´Ï´Ù.

¸ÕÀú Èĵδ ³»½Ã°æ¿¡¼­ °üÂûÇϸé ÁÁÁö¸¸ °üÂûÇÏÁö ¸øÇصµ Å¿ÇÒ ÀÏÀº ¾Æ´Õ´Ï´Ù. º¼ ¼ö ÀÖÀ¸¸é º¸°í º¼ ¼ö ¾øÀ¸¸é ¾È ºÁµµ ¹«¹æÇÕ´Ï´Ù. ³»½Ã°æ Á¶ÀÛÀÌ Àͼ÷ÇÏÁö ¸øÇÑ »óÅ¿¡¼­ ¹«¸®Çؼ­ óÀ½ºÎÅÍ Èĵθ¦ º¸·Á ÇÏ¸é ¸ñ³Ñ±èÀÌ ¾î·Á¿öÁú ¼ö ÀÖ½À´Ï´Ù.

½Äµµ´Â ¼¼ °¡Áö Àü·«ÀÌ °¡´ÉÇÕ´Ï´Ù. (1) óÀ½¿¡´Â ±×³É Áö³ª°¡°í ³ª¿Ã ¶§ º»´Ù. (2) óÀ½¿¡ ÀÚ¼¼È÷ º¸°í ³ª¿Ã ¶§´Â °¡º±°Ô º»´Ù. (3) óÀ½¿¡ °¡º±°Ô º¸°í ³ª¿Ã ¶§ ÀÚ¼¼È÷ º»´Ù. Áú¹® ÁֽŠ¼±»ý´ÔÀº (1)¹øÀ», ±èÅÂÁØ ¼±»ý´ÔÀº (3)¹øÀÔ´Ï´Ù. Àú´Â (2)¿¡ °¡±õ½À´Ï´Ù. óÀ½¿¡ ½Äµµ¸¦ º¸Áö ¾Ê°í À§³ª ½ÊÀÌÁöÀåºÎÅÍ °üÂûÇÏ¸é ¸¶Áö¸·¿¡ ½Äµµ¸¦ °£°úÇÏ´Â °æ¿ì°¡ ÀûÁö ¾Ê½À´Ï´Ù. ƯÈ÷ À§¿¡¼­ Áß¿äÇÑ º´ÀÌ ¹ß°ßµÇ°í ƯÈ÷ Á¶Á÷°Ë»ç µîÀ» ÇÑ »óȲÀ̸é, ³»½Ã°æ ÀÇ»çÀÇ ±äÀåÀÌ ¶³¾îÁö¸é¼­ ½Äµµ¸¦ °£°úÇϱ⠽±½À´Ï´Ù. ±×·¡¼­ Àú´Â °¡±ÞÀû µé¾î°¥ ¶§ ½Äµµ¸¦ ÀÚ¼¼È÷ º¸°í ³ª¿Ã ¶§ ´Ù½Ã Çѹø È®ÀÎÇÏ´Â ½À°üÀ» °¡Áö°í ÀÖ½À´Ï´Ù. »çÁøÀº µé¾î°¥ ¶§ Âï¾îµµ ÁÁ°í ³ª¿Ã ¶§ Âï¾îµµ ÁÁÀ» °Í °°½À´Ï´Ù.



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