Parasite | Eso | Sto | Cancer | ESD
★ EndoGEL ESD hands-on training
[Learning ESD. ESD ¹è¿ì±â. ESD ±³À°] - End of document
1) One week ESD training course at SMC
2) ESD ¹è¿ì±âÀÇ ÇÙ½É : hands-on training
4) Ãßõ ±³Àç
5) ESD hands-on training - EndoGEL ESD, Ex vivo pig stomach ESD, Live pig ESD
6) ÃʽÉÀÚ¸¦ À§ÇÑ technical tips
7) ÀÌÁØÇàÀÇ 2004³â ÀϺ» ESD ÇöÀå Ž¹æ±â
8) Feedback - CEE (continous ESD education)
10) º´µ¿¿¡¼ÀÇ È¯ÀÚ °ü¸® - CP (clinical pathway)
11) FAQ - ESD¸¦ Ã¥º¸°í ¹è¿ì¸é ¾ÈµÈ´Ù°í »ý°¢ÇÕ´Ï´Ù.
12) References
ESD (endoscopic submucosal dissection) training at Samsung Medical Center consists of (1) introductory lectures, (2) ESD observation, (3) ESD conference and ESD planning session, (4) Hands-on training using EndoGEL ESD (artificial layer) or live pig ESD
Time | Schedule | Tutor | Location |
Monday AM | Orientation and introductory lectures | LJH | Conference room |
Monday PM | BOXIM & EndoGEL ESD hands-on training | LJH | Simulator room |
Tuesday AM | Observation: stomach ESD | MBH, LH | Cancer center endoscopy room |
Tuesday PM | Observation: stomach ESD | LJH | Cancer center endoscopy room |
Wednesday AM | Observation: stomach ESD | LJH | Main building endoscopy room |
Wednesday PM | Observation: colon ESD | KER | Main building endoscopy room |
Thursday AM | EndoGEL ESD/POEM hands-on training | LJH | Simulation room |
Thursday PM | ESD planning session - next week case | LJH | Professor Lee's office |
Friday AM | Observation: EGD and ablation treatment | LJH | Main building endoscopy room |
Friday PM | Observation: colon ESD | HSN | Main building endoscopy room |
* Live pig ESD hands-on session can be oraganized if the number of trainee is 5 or more.
* One day live pig hands-on session is open to everyone, if available.
* More information about observership program at SMC: https://www.samsunghospital.com/gb/language/english/education/observerShip.do
* Contact point: International Training Office (e-mail: dominique.cho@samsung.com)
2. ESD ¹è¿ì±âÀÇ ÇÙ½É : hands-on training
ESD´Â ¼ú±âÀÔ´Ï´Ù. ¼ú±â´Â hands-onÀ¸·Î ¹è¿ö¾ß ÇÕ´Ï´Ù. ESD¸¦ ¹è¿ì´Â ºÐµéÀº ¿ì¼± ÀúÀÇ assistantºÎÅÍ ÇÏ°Ô µË´Ï´Ù. Àú¿Í ÇÔ²² ÀúÀÇ ½Ã¼ú°úÁ¤¿¡ Âü¿©ÇÏ¸é¼ ESDÀÇ °úÁ¤À» ¹è¿ì°í ¾Æ¿ï·¯ Á¶Á÷°âÀÚ, knife, Coagrasper µîÀ» ÀÚÀ¯ÀÚÀç·Î ´Ù·ê ¼ö ÀÖ°Ô µË´Ï´Ù. ±× ÀÌÈÄ ESD °úÁ¤ Áß ½¬¿î ºÎºÐºÎÅÍ Á¶±Ý¾¿ Á¶±Ý¾¿ Àú¿Í ¼ÕÀ» ¹Ù²ã°¡¸ç ½Ã¼ú¿¡ Âü¿©ÇÏ´Â °ÍÀÌÁö¿ä. °¡Àå ÇÙ½ÉÀûÀÎ ºÎºÐÀº Ç×»ó Á¦°¡ Çϰí, ´Ù¼Ò ºÎ¼öÀûÀÎ ºÎºÐÀº fellowµéÀÌ µµ¿ÍÁÖ´Â ¹æ½ÄÀÔ´Ï´Ù.
ÀÌÁØÇà °ÀÇ (2017). Àý°³µµÀÇ ¼±Åðú °íÁÖÆÄ ¹ß»ýÀåÄ¡ - ÃʽÉÀÚÀÇ °æ¿ì Dual knife + IT-2 knife ¹ýÀÌ °¡Àå ¹«³ÇÕ´Ï´Ù. Dual knife¸¦ ÀÌ¿ëÇÏ¿© initial cuttingÀ» ³ÖÀº ÈÄ IT-2 knife¸¦ ÀÌ¿ëÇÏ¿© circumferential cutting°ú submucosal dissectionÀ» ÇÏ´Â ¹æ¹ýÀÔ´Ï´Ù. ȤÀº Dual knife¸¦ ÀÌ¿ëÇÏ¿© initial cutting°ú circumferential cutting±îÁö ¸¶Ä¡°í submucosal dissectionÀº IT-2 knife·Î ÇÏ´Â °Íµµ ³ª»ÚÁö ¾Ê½À´Ï´Ù. ±âŸ ¾Æ·¡¿Í °°Àº ¸¹Àº Á¾·ù°¡ Àִµ¥ ´Ù ºñ½Áºñ½Á ÇÕ´Ï´Ù. Àڱ⿡°Ô Àͼ÷ÇÑ °ÍÀÌ °¡Àå ÁÁ´Ù°í º¸¸é µË´Ï´Ù. Àú´Â °ÅÀÇ ´ëºÎºÐ Dual knife aloneÀ¸·Î ½Ã¼úÇϰí ÀÖ°í °£È¤ Dual knife + IT-2 knife¸¦ ¾²±âµµ ÇÕ´Ï´Ù. ÇâÈÄ ±¹»êÀ» ½á º¸·Á°í ÇÕ´Ï´Ù. ǰÁúÀÌ °¥¼ö·Ï ÁÁ¾ÆÁö°í ÀÖ´Â ÆòÀ̴ϱî¿ä.
¿ì¸®¸» ESD ±³Àçµµ ÁÁ½À´Ï´Ù. Àú´Â ÀϺ» Ã¥ÀÌ ¿ì¸®¸»·Î ¹ø¿ªµÈ °ÍÀº ²À ã¾Æ¼ º¸°í ÀÖ½À´Ï´Ù. ÀϺ» Ã¥ Áß Á¦ÀÏ ÁÁÀº °Íµé¸¸ ¹ø¿ªµÉ °ÍÀ̶ó°í »ý°¢Çϱ⠶§¹®ÀÔ´Ï´Ù. ƯÈ÷ ¾Æ·¡ Ã¥À» ÃßõÇÕ´Ï´Ù.
µ¿°æ´ë Fujishiro ¼±»ý´Ô ÆÀ¿¡¼ ³ª¿Â Ã¥À¸·Î º´¼ÒÀÇ À§Ä¡º°·Î IT knife¿Í Dual knife¸¦ ÀÌ¿ëÇÑ ESD ¼ú±â°¡ Àß ¼³¸íµÇ¾î ÀÖ½À´Ï´Ù.
µÅÁö stomachÀ» ÀÌ¿ëÇÑ ESD hands-on trainingµµ µµ¿òÀÌ µË´Ï´Ù (EndoTODAY ESD animal model training).
2008-7-31. »ï¼º¼¿ïº´¿ø ³»½Ã°æ½Ç¿¡¼ ¿ª»ç»ó óÀ½ ¿¸° pig stomachÀ» ÀÌ¿ëÇÑ hands-on training ¼¼¼Ç.
2016³â. »ï¼º¼¿ïº´¿ø ³»½Ã°æ½Ç.
Artificial stomach mucosa (EndoGEL)¸¦ ÀÌ¿ëÇÑ hands-on trainingÀ» ½ÃÀÛÇÏ¿´½À´Ï´Ù (2019-6-26). ESD ¹è¿ì±â °úÁ¤ÀÇ Çʼö°¡ µÇ°í ÀÖ´Â simulation training¿¡ °¡Àå ÁÁÀº ¹æ¹ýÀÌ ¾Æ´Ñ°¡ »ý°¢µÇ¾ú½À´Ï´Ù. (±¸ÀÔó: SUNARROW LIMITED, ´ã´çÀÚ: Yoshitomi Takahashi (ÍÔÎéýìÜØ), yoshitomi.takahashi@sunarrow.co.jp, 1°³ ´ç 409.10´Þ·¯, 2019³â 9¿ù ±¸ÀÔÀ» ÁøÇàÇÏ¿´°í Åë°ü ºñ¿ë°ú ±âŸ ºñ¿ëÀ» ¸ðµÎ ±¸ÀÔÇÏ¿© 2°³¿¡ 1,175,000¿øÀ̾ú½À´Ï´Ù. Çϳª¿¡ 60¸¸¿ø ²ÃÀÔ´Ï´Ù.)
Pig stomach modelÀ» ÀÌ¿ëÇÑ ESD ÈÆ·Ã¿¡ ºñÇÏ¿© Æí¸®ÇÑ Á¡ÀÌ ¸¹¾Ò½À´Ï´Ù. µÎ °¡Áö¸¸ ¸»¾¸µå¸®¸é ¾Æ·¡¿Í °°½À´Ï´Ù (1) ÈÆ·Ã¿ë pig stomachÀ» ±¸ÇÏ´Â °ÍÀº (¾ÆÁ÷±îÁö´Â ¹ýÀû ±Ù°Å°¡ ¾ø¾î¼) ¹Ýµå½Ã ´©±º°¡ÀÇ µµ¿òÀÌ ÇÊ¿äÇÕ´Ï´Ù. EndoGELÀº ÆÄ´Â ¹°°ÇÀÔ´Ï´Ù. (2) Pig stomachÀ̳ª live pig¸¦ ÀÌ¿ëÇÑ ESD ÈÆ·ÃÀº µ¿¹° ¼ö¼ú½Ç¿¡¼¸¸ °¡´ÉÇÕ´Ï´Ù. ³»½Ã°æ½ÇÀ̳ª ȸÀǽÇ, È£ÅÚ µî¿¡¼´Â ½ÃÇàÇÏ±â ¾î·Æ½À´Ï´Ù. ¹Ý¸é EndoGEL ESD´Â Àå¼Ò¿¡ Á¦ÇÑÀÌ ¾ø½À´Ï´Ù.
EndoGEL ESD hands-on trainingÀÇ °¡Àå ÁÁÀº ¹æ¹ýÀº °³ÀÎ ±³½À´Ï´Ù. IntroductionÀ» Æ÷ÇÔÇÏ¿© 4½Ã°£ µ¿¾È ±âÃÊÈÆ·Ã°ú 6°³ÀÇ EndoGEL ESD¸¦ ÇÏ´Â °ÍÀÔ´Ï´Ù. 2020³â 6¿ù 17ÀÏ Ã¹ °³Àα³½ÀÀ» ½ÃÇàÇÏ¿´½À´Ï´Ù.
º¸´Ù ÀÚ¼¼ÇÑ ³»¿ëÀº EndoTODAY EndoGEL ESD trainingÀ» Âü°íÇϽñ⠹ٶø´Ï´Ù.
[Ex vivo pig stomach ESD hands-on]
Live pig ESD´Â Ư¼öÇÑ ½Ã¼³°ú Àåºñ, ±×¸®°í ¸¹Àº ºñ¿ëÀÌ ÇÊ¿äÇϹǷΠÀÚÁÖ Çϱâ´Â ¾î·Æ½À´Ï´Ù. ±× ´ë½Å ÀýÁ¦ÇÑ À§¸¦ »ç¿ëÇÒ ¼ö ÀÖ½À´Ï´Ù. Ex vivo pig stomach ESD¶ó°í ºÎ¸¨´Ï´Ù.
º¸´Ù ÀÚ¼¼ÇÑ ³»¿ëÀº EndoTODAY Ex vivo pig stomach ESD trainingÀ» Âü°íÇϽñ⠹ٶø´Ï´Ù.
Live pig ESD´Â Ư¼öÇÑ ½Ã¼³°ú Àåºñ, ±×¸®°í ¸¹Àº ºñ¿ëÀÌ ÇÊ¿äÇϹǷΠÀÚÁÖ Çϱâ´Â ¾î·Æ½À´Ï´Ù. µå¹® ±âȸ¸¦ ÃÖ´ëÇÑ È°¿ëÇÒ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù.
Live pig ESD¸¦ ÇÏ¸é¼ Ãµ°øÀÌ ¹ß»ýÇϸé clip closure¸¦ ½ÃÇàÇÕ´Ï´Ù. º¹°³» °ø±â°¡ ³Ê¹« ¸¹À¸¸é ÁÖ»ç±â·Î °ø±â¸¦ Á¦°ÅÇÏ¸é µµ¿òÀÌ µË´Ï´Ù. ±×·¯³ª live pig POEM µµÁß Ãµ°øÀÌ ¹ß»ýÇÏ¸é ¾Æ¹«¸® ÁÖÀÇÇØµµ pig°¡ Áï½Ã ȤÀº ¼ö½ÊºÐ À̳»¿¡ »ç¸ÁÇÑ´Ù´Â °ÍÀÌ ¹®Á¦ÀÔ´Ï´Ù. ¾î¸° µÅÁöÀ̰í Èä°ÀÌ À۱⠶§¹®ÀÌ ¾Æ´Ñ°¡ ½Í½À´Ï´Ù. Live pig POEM¿¡ ¾Õ¼ EndoGELÀ» ÀÌ¿ëÇÑ POEMÀ» ¿¬½ÀÇÏ¸é µ¿¹°½Ç½ÀÀÌ ´õ Àß µÇÁö ¾ÊÀ»±î »ý°¢µË´Ï´Ù.
º¸´Ù ÀÚ¼¼ÇÑ ³»¿ëÀº EndoTODAY Live pig ESD trainingÀ» Âü°íÇϽñ⠹ٶø´Ï´Ù.
6. ÃʽÉÀÚ¸¦ À§ÇÑ technical tips
°¡Àå ¸¹ÀÌ »ç¿ëÇÏ´Â knife´Â IT-2 knife¿Í Dual knifeÀÔ´Ï´Ù. IT-2 knife´Â ´ç±âµíÀÌ, Dual knife´Â ¹ÐµíÀÌ ÀÚ¸£´Â µµ±¸ÀÔ´Ï´Ù. Àú´Â Dual knife¸¦ IT-2 knifeó·³ »ç¿ëÇϰí ÀÖ½À´Ï´Ù. 10³â Á¤µµ IT-2 knife¸¦ »ç¿ëÇÏ´Ù°¡, Á¤ºÎ¿¡¼ ESD¿¡¼ ÇϳªÀÇ knife¸¸ ¾²µµ·Ï ±ÇÇÏ´Â Á¤Ã¥À» ¹ßÇ¥ÇÑ ÈÄ·Î Dual knife·Î ¹Ù²å½À´Ï´Ù. ÀÏÁ¾ÀÇ º¯ÀýÀä.... ±×·¡¼ classicÇÑ ¹æ¹ýÀÌ ¾Æ´Ï¶ó ÀâÁ¾°°Àº ¹æ¹ýÀÌ µÇ¾ú½À´Ï´Ù. Dual knife¸¦ IT-2 knife ó·³ ¾²´Â °ÍÀÌ ÀÌÁØÇà styleÀÔ´Ï´Ù.
5mm ¹Û¿¡ Á¡À» Âï°í 5mm ¹ÛÀ» ÀÚ¸¥´Ù´Â »ý°¢À¸·Î ½Ã¼úÇϽʽÿä. 10mm ¹Û¿¡ Á¡À» Âï°í Á¡À» ¿¬°áÇÏ¿© ÀÚ¸£´Â ºÐµµ °è½Ê´Ï´Ù. Ãʺ¸ÀÚÀÇ °æ¿ì´Â Á¶±Ý ÃÎÃÎÈ÷ Á¡À» Âï¾îµÎ¸é ÆíÇÕ´Ï´Ù. Difficult location¿¡¼µµ ´Ù¼Ò ¸¹Àº Á¡ÀÌ µµ¿òÀÌ µË´Ï´Ù.
Initial circumferential cutting¿¡¼ Á¡¸·ÃþÀÌ ¿ÏÀüÈ÷ cutting µÇÁö ¾ÊÀ¸¸é (= muscularis mucosa ÃþÀÌ ³²À¸¸é) ½Ã¼ú ÈĹݺο¡ ¾î·Á¿òÀÌ ¹ß»ýÇÕ´Ï´Ù. ¾îµð±îÁö ÀýÁ¦ÇØ¾ß ÇÒÁö Á¤Çϱ⠾î·Á¿öÁö±â ¶§¹®ÀÔ´Ï´Ù. EndoCut ¸ðµå·Î partial circumferential cuttingÀ» ÇÏ°í ¿¬À̾î Swift coagualtion ¸ðµå·Î partial submucosal dissectionÀ» ´õÇϸé muscularis mucosa ÃþÀÌ È®½ÇÈ÷ ²÷¾îÁö°í ´ÙÀ½ ´Ü°è¿¡¼ submucosal dissectionÀÌ ½¬¿öÁý´Ï´Ù.
Á¡¸·ÇÏÃþ fiber¸¦ º¸¸é¼ Çϳª¾¿ Çϳª¾¿ ÀÚ¸¥´Ù´Â ´À³¦À¸·Î ÁøÇàÇÏ¿© Áֽʽÿä. »ý°¢º¸´Ù ¹Ù¦ Á¢±ÙÇÏ¿© ½Ã¼úÇϽʽÿÀ. ¾î·Á¿ì¸é Á¢±ÙÇÑ´Ù!
Submucosal dissection targetnÀº Á¡¸·ÇÏÃþ ÇÏ´Ü 1/3ÀÔ´Ï´Ù. ±×·¯³ª º´¼ÒÀÇ periphery¿¡¼´Â ±×·¸°Ô ±í°Ô ÀÚ¸¦ Çʿ䰡 ¾ø½À´Ï´Ù.
Transparent hood¸¦ ÀÌ¿ëÇÏ¿© Á¡¸·ÇÏÃþÀ» ³ëÃâ½Ã۸é ÀýÁ¦ÇÒ ºÎÀ§¿¡ Á¢±ÙÇϱ⠽¬¿î °æ¿ì°¡ ÀÖ½À´Ï´Ù.
´Ã Áß·ÂÀÇ ¹æÇâÀ» »ý°¢ÇÏ¸ç ½Ã¼úÇϽʽÿÀ. ÀýÁ¦µÈ ºÎºÐÀÌ ¹ú¾îÁ®¼ ±× ´ÙÀ½ Á¡¸·ÇÏ ÀýÁ¦°¡ ½±°Ô µÇµµ·Ï ¸¸µå¼¼¿ä. À§¿¡¼´Â ´Ã fundusÂÊÀÌ Á߷¹æÇâÀÔ´Ï´Ù. ȯÀÚ°¡ left decubitus·Î ´©¿öÀÖÀ¸´Ï±î... Áß·ÂÀÇ ÀÌ¿ëÀÌ ¾î·Á¿ì¸é capÀÇ µµ¿òÀ» ¹Þ¾Æ flapÀ» ¹ú·Á¾ß Çϰí, ÀÌ°Ô ¾î·Á¿ì¸é Traction method for ESD
¸¦ Àû¿ëÇØ¾ß ÇÕ´Ï´Ù.
7. ÀÌÁØÇàÀÇ 2004³â ÀϺ» ESD ÇöÀå Ž¹æ±â
Á¦°¡ ESD¸¦ ¹è¿ï ¹«·Æ(2004³â)Àº ¿ö³« ÃʱâÀÎÁö¶ó ÀϺ»ÀÇ ¿©·¯ º´¿øÀ» ã¾Æ´Ù´Ï¸ç ESD¸¦ ¾î±ú³Ê¸Ó·Î ¹è¿ü½À´Ï´Ù. ´ç½ÃÀÇ ¸Þ¸ðÀÔ´Ï´Ù. ³«¼ ¼öÁØÀÌÁö¸¸ Á¦ ½º½º·Î ESD¸¦ ÀÍÈ÷´Âµ¥ Å©°Ô µµ¿òÀÌ µÇ¾ú½À´Ï´Ù. ´Ù½Ã Àо´Ï âÇÇÇÑ À̾߱â, ³²µé¿¡°Ô Á¶±Ý ¹Ì¾ÈÇÑ commentµµ µé¾îÀÖ½À´Ï´Ù. ±×·¯³ª ¹ú½á 10³â ÀÌ»ó Áö³ ¿¾ ÀÚ·áÀÔ´Ï´Ù. ¼öÁ¤¾øÀÌ ±×´ë·Î °ø°³ÇÕ´Ï´Ù. ESD ÃÊâ±â ¿ª»çÀÇ ÇÑ Àå¸éÀ̶ó »ý°¢ÇÏ°í ³Ê±×·¯ÀÌ ÀÌÇØÇÏ¿© Áֽñ⠹ٶø´Ï´Ù.
1) µ¿°æ¾Ï¼¾ÅÍ - ESDÀÇ superstar Dr. Gotoda¿Í ±×ÀÇ ÀþÀº Á¦ÀÚ Dr. Oda
2) È÷·Î½Ã¸¶´ëÇÐ - ´ëÀå ESD ´ë°¡ Dr. Danaka¿Í ±×ÀÇ ÀþÀº Á¦ÀÚ Dr. Oka
3) µ¿°æ´ëÇб³ - Flex knife, Dual knife¸¦ °³¹ßÇÑ Dr. Yahagi¿Í ±×ÀÇ ÀþÀº Á¦ÀÚ Dr. Fujishiro
4) ½ÃÁî¿ÀÄ« ¾Ï¼¾ÅÍ - µ¿°æ¾Ï¼¾ÅÍ¿¡¼ ESD¸¦ °³¹ßÇÏ°í ½ÃÁî¿ÀÄ« ¾Ï¼¾ÅÍ·Î ¿Å±ä Dr. Ono
5) ÁöÄ¡´ëÇб³ - Double balloon enteroscopy¸¦ °³¹ßÇÑ Dr. Yamamoto
8. Feedback°ú CEE (continous ESD education)
1) óÀ½ ESD¸¦ ÇÒ ¶§¿¡´Â Àý´ë·Î È¥ÀÚ ½Ã¼úÇÏÁö ¸¶½Ã°í °æÇè ¸¹Àº ¼±»ý´ÔÀ» ¸ð¼Å¼ ÇÔ²² ½Ã¼úÇϱ⠹ٶø´Ï´Ù. Á÷Á¢ ÇöÀåÀ¸·Î ¿À½Ã°Ô Çϱ⠾î·Á¿î °æ¿ì´Â FaceTime µîÀ» ÀÌ¿ëÇÏ¿© µ¿¿µ»ó ½Ç½Ã°£ ÄÚÄ¡¸¦ ¹ÞÀ¸½Ã¸é ÁÁ½À´Ï´Ù.
2) ³»½Ã°æ »çÁøÀ̳ª µ¿¿µ»óÀ» °æÇè ¸¹Àº ¼±»ý´Ô²² º¸³»¼ comment¸¦ ¹ÞÀ¸¸é Å©°Ô µµ¿òÀÌ µË´Ï´Ù.
¾î¶² ¼±»ý´Ô²²¼ óÀ½À¸·Î È¥ÀÚ partial ESD + snare cuttingÀ» ½ÃÇàÇÑ ÈÄ »çÁøÀ» º¸³»Áּ̽À´Ï´Ù. (2005)
¾î¶² ¼±»ý´Ô²²¼ óÀ½À¸·Î È¥ÀÚ esophageal ESD¸¦ ½ÃÇàÇÑ ÈÄ »çÁøÀ» º¸³»Áּ̽À´Ï´Ù. (2007)
3) ÇÚµåÆù adaptor (ÁöÇÏö ³ëÁ¡ °°Àº °÷¿¡¼ 3000¿ø¿¡ ±¸ÀÔÇÒ ¼ö ÀÖÀ½)¸¦ ÀÌ¿ëÇÏ¿© ÀÏ¹Ý Ä«¸Þ¶ó¿ë »ï¹ßÀÌ¿¡ ÇÚµåÆùÀ» ÀåÂøÇÏ¸é ½±°Ô µ¿¿µ»ó ÃÔ¿µÀ» ÇÒ ¼ö ÀÖ½À´Ï´Ù.
Ç¥ÁØÀûÀÎ ¼³¸í¼¸¦ ÀÌ¿ëÇϰí ÀÖ½À´Ï´Ù. ÇÊ¿äÇÑ °æ¿ì ȯÀÚº°·Î Á¶±Ý º¯°æÇϱ⵵ ÇÕ´Ï´Ù. 2017³â 4¿ù ÇöÀç »ç¿ëÇϰí ÀÖ´Â ¼³¸í¼´Â ¾Æ·¡¿Í °°½À´Ï´Ù (ÃֽйöÀü)
85% Á¤µµ´Â ³»½Ã°æÀ¸·Î ÇØ°áÇÒ ¼ö ÀÖ´Ù°í »ý°¢µË´Ï´Ù. 15% Á¤µµ´Â ³»½Ã°æ Ä¡·á ÈÄ ´Ù½Ã Çѹø ¼ö¼úÀ» ¹Þ¾Æ¾ß ÇÕ´Ï´Ù.
°ú°Å¿¡´Â À§¾ÏȯÀÚ ¸ðµÎ°¡ ¼ö¼úÀ» ¹Þ¾Ò½À´Ï´Ù. ÃÖ±Ù¿¡´Â ÀϺΠÀÛÀº Á¶±âÀ§¾ÏÀº ³»½Ã°æÀ¸·Î Ä¡·áÇϰí ÀÖ½À´Ï´Ù. ¾Õ¼ 85% Á¤µµ¶ó°í ¸»¾¸µå¸° ÀÌÀ¯´Â Á¶°Ç¿¡ ¸Â¾Æ¾ß Çϱ⠶§¹®ÀÔ´Ï´Ù. ³»½Ã°æ Ä¡·á ÈÄ º´¸®°á°úÀÇ Á¶°ÇÀÌ ¸ÂÀ¸¸é ¼ö¼ú°ú ºñ½ÁÇÏ°Ô 95% Á¤µµÀÇ ¿ÏÄ¡À²(=Àç¹ß·ü 5%)¿¡ µµ´ÞÇÒ ¼ö ÀÖ½À´Ï´Ù. ÀÌ °æ¿ì Àç¹ßÀº µÎ °¡Áö°¡ ÀÖ½À´Ï´Ù. ÀÏÀü¿¡ Ä¡·áÇÑ À§¾ÏÀÌ Àç¹ßÇÏ´Â °æ¿ì¿Í »õ·Î¿î À§¾ÏÀÌ ´Ù¸¥ ÀÚ¸®¿¡ Çϳª ´õ »ý±â´Â °æ¿ìÀÔ´Ï´Ù. ¹°·Ð ´Ù¸¥ ÀÚ¸®ÀÇ »õ·Î¿î ¾Ï("À̼Ҽº Àç¹ß")ÀÌ ´õ ¸¹½À´Ï´Ù. Àç¹ßÀº ±× Á¾·ù¿Í ¾ç»ó¿¡ µû¶ó ÀýÁ¦¼ú·Î Ä¡·áÇÒ ¼ö ÀÖ´Â °æ¿ì°¡ ¸¹Áö¸¸, °£È¤ ¼ö¼úÀ̳ª ³»½Ã°æÀýÁ¦¼ú µî ±ÙÄ¡Àû Ä¡·á°¡ ¾î·Á¿ö Ç×¾ÏÄ¡·á¸¦ ÇÒ ¼ö ¹Û¿¡ ¾ø±âµµ ÇÕ´Ï´Ù.
½Ã¼ú¹æ¹ýÀº ³»½Ã°æÁ¡¸·ÇÏÀýÁ¦¼ú(ESD)ÀÔ´Ï´Ù. À̸¦ À§ÇÏ¿© 3¹Ú 4ÀÏÀÇ ÀÔ¿øÀÌ ÇÊ¿äÇÕ´Ï´Ù. Áغñ½Ã°£À» Á¦¿ÜÇÏ°í ½Ã¼ú ÀÚü¿¡ ¼Ò¿äµÇ´Â ½Ã°£Àº Æò±Õ 45ºÐÀÔ´Ï´Ù. °£È¤ º´º¯ÀÌ À§º®°ú ¶³¾îÁöÁö ¾Ê¾Æ ÀýÁ¦°¡ ºÒ°¡´ÉÇÑ °æ¿ì°¡ Àִµ¥ ("non-lifting") ±× ºóµµ´Â 1% Á¤µµÀÔ´Ï´Ù.
½Ã¼ú ÈÄ ¾à°£ÀÇ º¹ÅëÀÌ °¡´ÉÇϸç ÃâÇ÷°ú õ°ø (=À§º®¿¡ ÀÛÀº ±¸¸ÛÀÌ ³²)ÀÌ 5-6% Á¤µµ ¹ß»ýÇÕ´Ï´Ù. Ȥ½Ã ÇÕº´ÁõÀÌ ÀÖ´õ¶óµµ ´ëºÎºÐ ÀÔ¿ø±â°£¿¡ ¹ß»ýÇÕ´Ï´Ù. Åð¿ø ÈÄ ÃâÇ÷ÇÏ´Â °æ¿ì´Â 1%ÀÔ´Ï´Ù.
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Ä¡·á °èȹ: ESD
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10. º´µ¿¿¡¼ÀÇ È¯ÀÚ °ü¸® - CP (clinical pathway)
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3¹Ú 4ÀÏ CP¿¡ µû¸¥ ó¹æ ȸéÀº ¾Æ·¡¿Í °°½À´Ï´Ù.
½Ã¼ú ÈÄ H2RA¸¦ »ç¿ëÇϰí ÀÖ´Â Á¡ÀÌ Æ¯Â¡ÀÔ´Ï´Ù. PPI·Î º¯°æÀ» °í¹Î ÁßÀÔ´Ï´Ù.
½Ã¼ú ´ÙÀ½ ³¯ ¾ÆÄ§ ±Ý½Ä, Á¡½É ¹°, Àú³á Á×À» µå¸®°í ÀÖ½À´Ï´Ù. ¾ÆÄ§ CBC¸¦ »¬±î °í¹Î ÁßÀÔ´Ï´Ù.
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[2013-8-27. ¾Öµ¶ÀÚ Áú¹®]
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ÇÐȸ³ª Áý´ãȸ¸¦ ¿½ÉÈ÷ ã¾Æ´Ù´Ï´Â °Íµµ µµ¿òÀÌ µË´Ï´Ù. Á¤ÈÆ¿ë ±³¼ö´Ô²²¼ À§¿øÀåÀ¸·Î °è½Ã´Â ESD ¿¬±¸È¸ Áý´ãȸ¿¡ Âü¼®ÇÏ½Ç °ÍÀ» °·ÂÈ÷ ÃßõÇÕ´Ï´Ù. Àü±¹ °¢Áö¿¡¼ µ¹¾Æ°¡¸é¼ °³ÃֵǴ Çà»çÀÔ´Ï´Ù. ¾Æ¹«¸® ¸Ö´õ¶ó°í ²À Âü¼®Çϱ⠹ٶø´Ï´Ù. Best Quality ConferenceÀÔ´Ï´Ù.
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"ESD´Â ±â±¸µµ ¹ßÀüÇÏ¿´°í, Ã¥ÀÚµµ ¸¹°í, seminar³ª live demonstration Âü¼®±âȸµµ ¿·ÁÀÖÀ¸¹Ç·Î ´©±¸³ª ÇÒ ¼ö ÀÖ´Â ½¬¿î ½Ã¼úÀÌ µÇ¾ú½À´Ï´Ù. ±×·¯³ª 100¹øÀº ÇØ¾ß ½¬¿öÁý´Ï´Ù. ±×º¸´Ù Àü(îñ)ÀÌ ¹®Á¦ÀÔ´Ï´Ù. ¼¿ïÀÇ 3Â÷ ÀÇ·á±â°ü¿¡¼ ÀÏÇÏ´Â Àú·Î¼´Â ESD°¡ °¥¼ö·Ï Èûµé¾îÁüÀ» ´À³§´Ï´Ù. ½±°í ÀÛÀº º´¼Ò´Â Áö¹æÀ̳ª 2Â÷º´¿ø¿¡¼ ´Ù Ä¡·áÇϰí ÀÖÀ¸¹Ç·Î ¾î·Á¿î º´¼Ò¸¸ selectionµÇ¾î ÀǷڵǴ °Í ¾Æ´Ñ°¡ ½Í½À´Ï´Ù. ¿ì¸®³ª¶óÀÇ ESD ¼öÁØÀÌ ¸¹ÀÌ ³ô¾ÆÁ³±â ¶§¹®¿¡ ´Ùµé Àß ÇÏ°í °è½Ã¸®¶ó°í ¹Ï½À´Ï´Ù. ±×·¯³ª °£È¤ À§Ä¡°¡ ÆòÀÌÇÏ°í ±î´Ù·Î¿î ¸ð¾çÀÌ ¾Æ´Ñµ¥µµ ¾îó±¸´Ï ¾ø´Â ÇüÆí¾ø´Â ½Ã¼ú ÈÄ lateral margin involvement ȤÀº local recurrence·Î ÀǷڵǴ ȯÀÚµµ ÀÖ½À´Ï´Ù. ÂüÀ¸·Î ¾ÈŸ±î¿î ÀÏÀÔ´Ï´Ù.
Àú´Â ¿©·¯ºÐ¿¡°Ô ù ¸î ¹øÀÇ ½Ã¼ú¿¡ ÁÖÀÇÇ϶ó°í ¸»¾¸µå¸®°í ½Í½À´Ï´Ù. Àû¾îµµ 10-20¹ø Á¤µµ´Â °æÇ踹Àº ±³¼ö(ȤÀº °í¼ö)µéÀÇ ½Ã¼úÀ» completeÇÏ°Ô observation ÇϽñ⠹ٶø´Ï´Ù. ±Ùó ´ëÇк´¿øÀ» ¹æ¹®ÇÏ½Ã¸é µË´Ï´Ù. Àü°øÀÇ ½ÃÀý¿¡ º» °ÍÀº ¼Ò¿ëÀÌ ¾ø½À´Ï´Ù. ±¸°æ²ÛÀÌ ¾Æ´Ï¶ó °ß½À»ýÀÇ Åµµ·Î, ³»°¡ Á÷Á¢ ½ÃµµÇغ¸°Ú´Ù´Â ¸¶À½À¸·Î observationÀ» Çϸé Àü°øÀÇ ¶§¿¡´Â º¼ ¼ö ¾ø¾ú´ø ¸¹Àº °ÍÀÌ º¸ÀÏ °ÍÀÔ´Ï´Ù.
¸¶Áö¸· ºÎŹÀÔ´Ï´Ù. Á¦¹ß ÄÚÄ¡¸¦ ¹Þ¾Æ°¡¸é¼ ¹è¿ì½Ã±â ¹Ù¶ø´Ï´Ù. ÀÚ½ÅÀÇ Ã¹ ESD ½Ã¼ú ¶§ °æÇ踹Àº ¼±¹è¸¦ ³»½Ã°æ½Ç·Î ¸ð¼Å¼ µÚ¿¡¼ ºÁ ´Þ¶ó°í ºÎʵ叮½Ê½Ã¿ä. ±×³¯ Àú³á ¸ÚÁø ½Ä»ç(ȤÀº ¼ú)¸¦ ´ëÁ¢ÇÏ½Ã¸é µË´Ï´Ù. Àý´ë È¥ÀÚ ½ÃÀÛÇÏÁö ¸¶½Ê½Ã¿ä. ±×¸®°í ÀÚ½ÅÀÌ Çß´ø ½Ã¼ú Àå¸é »çÁøÀ» e-mail·Î º¸³»¼ comment¸¦ ¹ÞÀ¸½Ê½Ã¿ä. ±Ý¹æ ½Ç·ÂÀÌ ´Ã °ÍÀÔ´Ï´Ù."
±³¼ö´ÔÀÇ °¡¸£Ä§ ´öºÐ¿¡ ESD¸¦ ¿½ÉÈ÷ Çϰí ÀÖ½À´Ï´Ù. Àú¹ø ´Þ¿¡ 5°³¸¦ Çߴµ¥ antrumÀº ¾È ¿À°í body¶û angle¸¸ ¿Í¼ óÀ½¿¡´Â ¸¹ÀÌ Èûµé¾ú´Âµ¥, ±×·¡µµ Á¶±Ý¾¿ ³ª¾ÆÁö´Â °Í °°¾Æ ´ÙÇàÀÔ´Ï´Ù. 1³â µ¿¾È ±³¼ö´Ô ¿·¿¡¼ º» ´öºÐ¿¡ ESD ÇÏ¸é¼ ¸Ó¸®°¡ ¾Æ´Ñ ¸öÀÌ ¸ÕÀú ¿òÁ÷À̰í ÀÖ´õ¶ó°í¿ä..¤¾¤¾
ÃÖ±Ù EndoTODAY¿¡ mixed adenocarcinoma¿¡ ´ëÇÑ Æ÷½ºÆÃÀ» ºÃ´Âµ¥, Àúµµ ¾î¶»°Ô ÇØ¾ßÇÒ Áö °í¹ÎÀ̶ó Á¶¾ðÀ» ±¸ÇϰíÀÚ ÇÕ´Ï´Ù. 70¼¼ ¿©ÀÚ·Î Á÷Àå¾Ï°ú ³úÃâÇ÷ÀÇ º´·ÂÀÌ ÀÖ´Â ºÐÀ¸·Î LC of LB¿¡ 1.5cm Á¤µµµÇ´Â IIa+IIc º´º¯ÀÌ ÀÖ¾î ESD ½ÃÇàÇÏ¿´½À´Ï´Ù.
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Stomach, angle, endoscopic submucosal dissection: MIXED ADENOCARCINOMA (Tubular adenocarcinoma, moderately differentiated, 60%, Poorly cohesive carcinoma, 20%, and Mucinous adenocarcinoma, 20%)
1) Size: about 1.59 x 0.83 cm
2) Invades into the mucosa and muscularis mucosa
3) Depth: Total tumor depth: 0.07 cm, No submucosal invasion
4) Lymphovascular invasion: not present
5) Resection margin: free from the tumor
- Distance from the closest lateral margin: 1.31 cm
- Distance from the closest deep margin: 0.03 cm
Immnohistochemical stain: p53: (-), Aberrant expression, HER2 (c-erbB2): (Negative, -), MLH-1 (+)MM±îÁö¸¸ ħ¹üÇß°í, ¼ö¼úÀ» Çϱ⿡´Â °í·É ¹× underlying diseases°¡ ÀÖ¾î close observationÀ» ÇÏ·Á°í Çϴµ¥, ±¦ÂúÀ»±î¿ä?
[2019-5-13. ÀÌÁØÇà ´äº¯]
¾È³çÇϽʴϱî.
ESD ÈÄ ÃÖÁ¾ º´¸®°á°ú ¹ÌºÐÈ È¥Àç¾Ï(mixed, histological heterogeneity)À¸·Î ³ª¿À¸é ´Ã °í¹ÎÀÔ´Ï´Ù. ¼ø¼öÇÏ°Ô ¹ÌºÐÈ Á¶Á÷Çü À§¾ÏÀ̰í 2cm ÀÌÇÏÀ̰í Á¡¸·¾ÏÀ̸é Ãß°¡ Ä¡·á ¾øÀÌ °æ°ú°üÂûÀ» Çϴµ¥, ¹ÌºÐÈ È¥Àç¾ÏÀÇ °æ¿ì´Â ¼ø¼øÇÑ ¹ÌºÐÈ Á¶Á÷Çü¾Ï À§¾Ï¿¡ ºñÇÏ¿© Á» ´õ aggressiveÇÏ´Ù´Â ¿¬±¸ °á°ú(Shim CN. Surg Endosc 2015)µµ ÀÖ¾î¼ °í¹ÎÇÏÁö ¾ÊÀ» ¼ö ¾ø½À´Ï´Ù. 2018³â ÇÑ ¾Öµ¶ÀÚ Áú¹®°ú ´äº¯À» º¸½Ã¸é ÀúÀÇ Á¢±Ù¹ýÀ» º¸½Ç ¼ö ÀÖÀ» °ÍÀÔ´Ï´Ù. ´Ù½Ã ¸»¾²µå¸®¸é...
(1) ¹ÌºÐÈ È¥Àç¾Ï, Àå°æ 2cm ÀÌÇÏ, Á¡¸·¾Ï, ÀýÁ¦ º¯¿¬ À½¼º, L/V (-/-)ÀÌ¸é ¿ÏÀüÀýÁ¦·Î º¸°í °æ°ú°üÂûÀ» ÇÕ´Ï´Ù.
(2) ¹ÌºÐÈ È¥Àç¾ÏÀ̰í Á¡¸·ÇϾÏÀÌ¸é ¼ö¼úÀ» ±ÇÇÕ´Ï´Ù. È¥Àç¾ÏÀÌ ¾Æ´Ñ pureÇÑ ¹ÌºÐÈ Á¶Á÷Çü À§¾Ï¿¡¼µµ Á¡¸·ÇϾÏÀÌ¸é ¼ö¼úÀ» ±ÇÇÕ´Ï´Ù. SM 500um¶ó´Â ±âºÐÀº ºÐÈÇü À§¾Ï¿¡¼¸¸ Àû¿ëÇϰí ÀÖ½À´Ï´Ù.
(3) ¹ÌºÐÈ È¥Àç¾Ï Áß (1) Á¡¸·¾Ï 2cm Ãʰú, (2) Á¡¸·¾Ï lateral margin positive´Â ¾Ö¸ÅÇÕ´Ï´Ù. Case-by-case·Î Á¢±ÙÇϰí ÀÖ½À´Ï´Ù.
ÀÌ·¯ÇÑ ±âÁØ¿¡ µû¸£¸é ºñ·Ï ¹ÌºÐÈ È¥Àç¾ÏÀÌÁö¸¸ ±ò²ûÇÑ ³»½Ã°æ ½Ã¼úÀÌ µÇ¾ú°í, Á¡¸·¾ÏÀ̰í, 2cm ÀÌÇÏÀ̰í, ´Ù¸¥ Àç¹ß À§ÇèÀÌ ¾øÀ¸¹Ç·Î ȯÀÚÀÇ °Ç°»óÅÂ¿Í ¹«°üÇÏ°Ô ¼ö¼úÀ̳ª Ç×¾ÏÄ¡·á µî Ãß°¡Ä¡·á°¡ ÇÊ¿äÇÏÁö ¾Ê´Ù°í »ý°¢ÇÕ´Ï´Ù. ƯÈ÷ ¹®ÀÇÇϽŠȯÀÚ´Â °í·ÉÀ̰í ŸÀå±â Áúȯµµ ÀÖÀ¸¹Ç·Î ´õ¿í ±×·¯ÇÕ´Ï´Ù. Primary cancer Àç¹ß°ú metachronous cancer¸¦ Æ÷ÇÔÇÏ¿© ´ë° 5³â 5% Àç¹ß·üÀ» ¿¹»óÇÏ´Â »óÅ¿¡¼ °æ°ú°üÂû ÇÒ ¼ö ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù.
[2020-4-1. ÀÌÁØÇà]
2020³â 4¿ù ´ëÇѼÒȱ⳻½Ã°æÇÐȸ¿¡¼´Â À§Àå°üÁ¾¾ç ³»½Ã°æÄ¡·á Clinical practice guidelineÀ» ¹ßÇ¥ÇÏ¿´½À´Ï´Ù. ºñ±³Àû reasonable ÇÏ´Ù°í »ý°¢µÇ¾ú½À´Ï´Ù. ÇÙ½É tableÀÔ´Ï´Ù.
[2020-4-1. ÀÌÁØÇà]
ÇÑ È¸»ç(Koken)¿¡¼ ESD training modelÀ» ¸¸µé¾ú´Ù±â¿¡ »ìÆìº¸¾Ò½À´Ï´Ù. À§¸ðÇüÀÌ°í ¿©·¯ ±¸¸ÛÀÌ ÀÖ°í ±× °÷¿¡ ex vivo pig stomachÀ» Àû´çÈ÷ Àß¶ó ³ÖÀ¸¸é ½ÇÁ¦ À§¿Í ºñ½ÁÇÏ°Ô ESD¸¦ ÇÒ ¼ö ÀÖ´Ù°í ÇÕ´Ï´Ù.
Ex vivo pig stomachÀº µ¿¹° ½ÇÇè½Ç¿¡¼ ½á¾ß ÇϹǷΠ¹«Ã´ ¹ø°Å·Î¿ï °Í °°½À´Ï´Ù. Ex vivo pig stomachÀ» Á» ´õ ÀÚÀ¯·Ó°Ô »ç¿ëÇÒ ¼ö Àִ ȯ°æ¿¡¼´Â ½ÃµµÇÒ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù.
[2020-8-24. ¾Öµ¶ÀÚ ÆíÁö]
Ex vivo pig stomach ESD training ¿¡ ÃÊ´ëÇØÁּż Á¤¸» °¨»çÇß½À´Ï´Ù. Endogel ESD, ex vivo pig stomach ESD, live pig ESD ¸ðµÎ ±³¼ö´ÔÀÌ ±âȸÁֽðí, °¡¸£ÃÄ °ÌÀ» ¸Ô°í ȯÀÚ¸¦ ½ÃÀÛµµ ¸øÇß´ø Á¦°¡ ÀÌÁ¦´Â Çѹø ÇØº¼ ¼ö ÀÖ°Ú´Ù¶ó´Â ¸¶À½ÀÌ µé¾ú½À´Ï´Ù.
Ex vivo pig stomachÀº real ÇÒ °Å¶ó°í »ý°¢À» ¾ÈÇÏ°í °¬´Âµ¥ simulator¿¡ ¿¬°áÀ» ÇÏ´Ï Àú´Â »ç½Ç live pig ÇÒ ¶§ÀÇ ´À³¦°ú Å©°Ô ´Ù¸£Áö ¾Ê¾Ò½À´Ï´Ù. ÃÖ±Ù¿¡ ESD case°¡ ¾ø¾ú´Âµ¥ ¸¶Áö¸·¿¡ ±³¼ö´Ô°ú ÇÔ²² ÇÑ ¸¶Áö¸· ESD 1°³°¡ ÀúÇÑÅ× Å« µµ¿òÀÌ µÇ¾ú½À´Ï´Ù. ±×¸®°í, ERBE setting°ú accessary¸¦ Àß ¾Ë¸é ESD Çϴµ¥ Å« µµ¿òÀÌ µÇ°Ú´Ù¶ó´Â »ý°¢µµ ¸¹ÀÌ µé¾ú½À´Ï´Ù.
Ç×»ó ³»½Ã°æ ±³À°¿¡ Èû½áÁּż ³Ê¹« °¨»çÇÕ´Ï´Ù.
Ÿº´¿ø¿¡ ÀÖÁö¸¸ ±³¼ö´Ô ºí·Î±×, °ÀǸ¦ µè°í ¹è¿ì´Â ÀúÈñµéÀÌ ÀÖ´Ù´Â °ÍÀ» ±â¾ïÇØÁÖ¼¼¿ä.
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[2020-10-24. ÀÌÁØÇà comment]
Ä¡·á³»½Ã°æ ¹è¿ì´Âµ¥ FacebookÀÌ µµ¿òµË´Ï´Ù. ¿ì¸®³ª¶óó·³ Ä¡·á³»½Ã°æ Àü¹®°¡°¡ ¸¹Àº ³ª¶ó¿¡¼´Â ¼±ÈĹ質 Àα٠º´¿ø¿¡¼ ¹è¿ì¸é µÇÁö¸¸, Ä¡·á³»½Ã°æÀÌ ³«ÈÄµÈ ³ª¶ó¿¡¼´Â FacebookÀÌ ¸Å¿ì Áß¿äÇÑ information source¶ó°í ÇÕ´Ï´Ù. GINTE (Group of International Therapeutic Endoscopy) ¶ó´Â Facebook groupÀÌ °¡Àå À¯¸íÇÑ °Í °°½À´Ï´Ù. À۳⿡ È«Äá¿¡ °¬À» ¶§ ±×°÷ ÀþÀº Àǻ簡 ³Ê¹« ÁÁ´Ù¸é¼ ¾Ë·ÁÁÖ¾î Àúµµ °¡ÀÔÇÏ¿´½À´Ï´Ù. ±×·¯³ª ÁÖÀÇÇØ¾ß ÇÒ °Í °°½À´Ï´Ù. ÀûÀÀÁõÀÌ°í ¹¹°í ´Ù ¹«½ÃÇϰí Àڱ⠽ǷÂÀ» °ú½ÃÇÏ´Â Àå¼Ò·Î ¾²À̰í Àֱ⠶§¹®ÀÔ´Ï´Ù.
Greece Àǻ簡 3½Ã°£ °É·Á Å« ESD¸¦ Çß´Ù°í ¿Ã¸° postingÀÔ´Ï´Ù.
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±×·³¿¡µµ ºÒ±¸ÇÏ°í ¾öû Å« ESD°¡ ½ÃÇàµÇ¾ú½À´Ï´Ù. 3½Ã°£ °É·È´Ù°í ÀÚ¶ûó·³ ¾º¿©Àִµ¥¿ä... Á¦°¡ º¸±â¿¡´Â ºÒÇÊ¿äÇÑ ESDÀÔ´Ï´Ù.
YouTube³ª FacebookÀ» º¸°í ¹è¿ì´Â °Íº¸´Ù´Â ¼±¹è³ª ±³¼ö´ÔÀ» ã¾Æ°¡ face to face, man to manÀ¸·Î µµÁ¦±³À°½ÄÀ¸·Î Àü¼ö¹ÞÀ¸½Ã±â ¹Ù¶ø´Ï´Ù. ¼¾ç ÀÇ»çµéÀÇ Çê¼Ò¸®¿¡ Ȧ¸®Áö ¸¶½Ã°í...
2017-3-28. One point lesson - ESD (1). Animal simulation Çϱâ Àü ÇÔ²² ¸ð¿©¼ °øºÎ¸¦ Çß½À´Ï´Ù. Áø´Ü ³»½Ã°æ¿¡¼ EMR ½Ã´ë¸¦ °ÅÃÄ ESD ½Ã´ë·Î ³Ñ¾î¿À´Â ¿ª»çºÎÅÍ ¹è¿ì´Â °ÍÀÌ ¼ø¼¶ó°í »ý°¢ÇÕ´Ï´Ù. °¡²û ¿¾³¯ ±³°ú¼¸¦ µÚôÀÏ Çʿ䰡 ÀÖ½À´Ï´Ù.
2017-4-25. °æÁÖ µ¿±¹´ë ¾çÀç³² ¼±»ý´Ô
2018-5-29. ESD workshop. ÀÌÁØÇà ±³¼ö °ÀÇ µ¿¿µ»ó ½Ãû
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Stomach, endoscopic submucosal dissection:
Early gastric carcinoma
1. Location : mid 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, 6 mm (2) vertical diameter, 6 mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 8 mm, proximal 8 mm, anterior 12 mm, posterior 10 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
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Stomach, endoscopic submucosal dissection:
Early gastric carcinoma
1. Location : mid antrum, postero-lesser curvature
2. Gross type : EGC type IIa+IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 16mm (2) vertical diameter, 14mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 9 mm, proximal 13 mm, anterior 18 mm, posterior 10 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
EndoGEL ESD hands-on training °³Àα³½À°ú live pig ESD hands-on trainingÀ» ¹ÞÀ¸¼Ì´ø ¼±»ý´ÔÀÇ ¸ÚÁø ESD
ESD; EARLY GASTRIC CARCINOMA
1) tumor size: 1 x 0.7cm
2) Gross type: EGC type IIc
3) histologic classification: tubular adenocarcinoma, moderate differentiated
4) invasion depth: lamia propria (pT1a)
5) lymphatic invasion: not identified
6) venous invasion: not identified
7) resection margin, lateral: free of tumor (safety distance: 6mm)
8) resection margin, base: free of tumor (safety distance: 400§)
2) õ±â´©¼³ - Tips for ESD
4) EndoTODAY EngoGEL ESD hands-on training
6) Electrosurgical unit setting (ESU) - ¿ø¸®ºÎÅÍ ERBE VIO 300D±îÁö
7) µ¿°æ NTT º´¿ø ESD training for foreigners
8) 2 x 2 VIP ESD training in London and Mainz
9) Facebook resource
10) EndoTODAY SMC ³»½Ã°æ simulator ±³À° ½Ã½ºÅÛ °³¹ß - °æÇè°ú ¿ª»ç
11) EndoTODAY ESD animal model training - °æÇè°ú ¿ª»ç
13) ´ëÀå ESD µ¿¿µ»ó (Facebook)
© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.