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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

3) ±âº» µ¿¿µ»ó °­ÀÇ

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)

9) ¿Ü·¡¿¡¼­ÀÇ È¯ÀÚ ¼³¸í

10) º´µ¿¿¡¼­ÀÇ È¯ÀÚ °ü¸® - CP (clinical pathway)

11) First ESD

12) FAQ - ESD¸¦ Ã¥º¸°í ¹è¿ì¸é ¾ÈµÈ´Ù°í »ý°¢ÇÕ´Ï´Ù.

13) References


1. ESD training at SMC

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

TimeScheduleTutorLocation
Monday AMOrientation and introductory lecturesLJHConference room
Monday PMBOXIM & EndoGEL ESD hands-on trainingLJHSimulator room
Tuesday AMObservation: stomach ESDMBH, LHCancer center endoscopy room
Tuesday PMObservation: stomach ESDLJHCancer center endoscopy room
Wednesday AMObservation: stomach ESDLJHMain building endoscopy room
Wednesday PMObservation: colon ESDKERMain building endoscopy room
Thursday AMEndoGEL ESD/POEM hands-on trainingLJHSimulation room
Thursday PMESD planning session - next week caseLJHProfessor Lee's office
Friday AMObservation: EGD and ablation treatmentLJHMain building endoscopy room
Friday PMObservation: colon ESDHSNMain 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¿©Çϸ鼭 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.

2017³â º½. Á¦°¡ assist¸¦ ÇÏ´Â ¸ð½À´Ï´Ù.


3. ±âº» µ¿¿µ»ó °­ÀÇ

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.


4. Ãßõ ±³Àç

¿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.


5. ESD animal model training

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.

2017³â. »ï¼º¼­¿ïº´¿ø µ¿¹°½ÇÇè½Ç.

2018³â. »ï¼º¼­¿ïº´¿ø µ¿¹°½ÇÇè½Ç.


[EndoGEL ESD hands-on]

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.)

2019-11-30. KDDW

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.

2020³â 8¿ù 15ÀÏ

º¸´Ù ÀÚ¼¼ÇÑ ³»¿ëÀº EndoTODAY Ex vivo pig stomach ESD trainingÀ» Âü°íÇϽñ⠹ٶø´Ï´Ù.


[Live pig ESD hands-on]

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.

2019-12-5. áæÓö training center

Live pig ESD¸¦ Çϸ鼭 õ°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.


9. ¿Ü·¡¿¡¼­ÀÇ È¯ÀÚ ¼³¸í

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.

³»½Ã°æ ½Ã¼ú ÈÄ ÃÖÁ¾ º´¸®°á°ú´Â 1ÁÖÀÏ ÈÄ ¿Ü·¡¿¡¼­ º¸½Ç ¼ö ÀÖ½À´Ï´Ù. ÀüüÀûÀ¸·Î 7¸í Áß 6¸í, Áï 85% Á¤µµ´Â Ãß°¡ Ä¡·á°¡ ÇÊ¿ä¾ø´Â °ÍÀ¸·Î ³ª¿É´Ï´Ù. ±×·±µ¥ 7¸í Áß 1¸í, Áï 15% Á¤µµ´Â º´¸®°á°ú¿¡¼­ ¼¼Æ÷Çü, ±íÀÌ, ¹üÀ§, ¸²ÇÁ°ü ħÀ± µî¿¡ ¹®Á¦°¡ ÀÖ´Ù°í ³ª¿É´Ï´Ù. ÀÌ °æ¿ì´Â Àç¹ß À§ÇèÀÌ ³ô¾Æ¼­ ¼ö¼ú(À§ÀýÁ¦¼ú)ÀÌ ÇÊ¿äÇÕ´Ï´Ù. º¸Åë ¿Ü°ú·Î ÀÔ¿øÇÏ¿© ¼ö¼úÀ» ¹Þ°Ô µË´Ï´Ù. °£È¤ ¾ÏÀ̶ó´Â Áø´ÜÀ¸·Î ³»½Ã°æÄ¡·á¸¦ ÇÏ¿´À¸³ª ´Ü¼ø ¿°ÁõÀ¸·Î¸¸ ³ª¿À´Â ºÐµµ ÀÖÀ¸³ª ±× ºóµµ´Â 3%ÀÔ´Ï´Ù.

½Ã¼ú 2°³¿ù ÈÄ ³»½Ã°æ °Ë»ç¸¦ ÅëÇÏ¿© Ä¡·áºÎÀ§´Â ´Ù ¾Æ¹°¾ú´ÂÁö, ÀÜ·ùº´¼Ò´Â ¾ø´ÂÁö È®ÀÎÇÏ¿© ¹®Á¦°¡ ¾øÀ¸¸é ´õ ÀÌ»ó Ä¡·á´Â ¾ø½À´Ï´Ù. ÀÌÈÄ´Â 6°³¿ù °£°ÝÀ¸·Î 3³â°£, ±× ÀÌÈķδ ¸Å³â Àç°ËÀ» ±ÇÇÕ´Ï´Ù. ¿ø·¡ º´¼Ò°¡ Àç¹ßÇÏ´Â °æ¿ìµµ ÀÖÁö¸¸, ù º´¼Ò¿Í ¹«°üÇÑ »õ·Î¿î º´¼Ò°¡ ¹ß°ßµÇ´Â °æ¿ìµµ ¸¹½À´Ï´Ù.

À§¾ÏÀ̳ª À§¼±Á¾ÀÌ ÀÖ´Â ºÐ¿¡¼­ ´ëÀå¾ÏÀ̳ª ´ëÀå ¼±Á¾µµ Àß »ý±ä´Ù°í ÇÕ´Ï´Ù. 2-3³â ³»¿¡ °Ë»ç¸¦ ¹ÞÁö ¾ÊÀ¸¼Ì´Ù¸é ´ëÀå³»½Ã°æ °Ë»ç¸¦ ¹Þ¾Æº¸½Ã±æ ±ÇÇÕ´Ï´Ù.

Ä¡·á °èȹ: ESD


Á¶±âÀ§¾Ï ³»½Ã°æÄ¡·á¸¦ °í·ÁÇϴ ȯÀÚ¿¡°Ô ¾î¶»°Ô ¼³¸íÇÏ´Â °ÍÀÌ ÁÁÀ»Áö ´Ã °í¹ÎÀÔ´Ï´Ù. ´Ù¼Ò Á¤¼­ÀûÀ¸·Î ¼³¸íÇÏ´Â ¹æ¹ý°ú ¾ÆÁÖ °úÇÐÀûÀ¸·Î ¼³¸íÇÏ´Â ¹æ¹ý µî ´Ù¾çÇÑ Á¢±Ù¹ýÀÌ °¡´ÉÇÒ °Í °°½À´Ï´Ù. ÇÑ ±³¼ö´ÔÀÇ ¼³¸í¼­¸¦ º¸¾Ò´Âµ¥, ¾ÆÁÖ Èï¹Ì·Î¿ü½À´Ï´Ù. Àúµµ °úÇÐÀûÀ¸·Î ¼³¸íÇÏ´Â ÆíÀε¥, Àúº¸´Ù ´õ data¸¦ ¸¹ÀÌ ÀοëÇÏ´Â °ÍÀ» º¸°í ±ô¦ ³î¶ú½À´Ï´Ù. Fact¿¡ ±Ù°ÅÇÑ ¼³¸í, ÀÚ½ÅÀÇ data¿¡ ±Ù°ÅÇÑ ¼³¸íÀÇ ¸ð¹ü ´ä¾ÈÀ̶ó°í »ý°¢ÇÕ´Ï´Ù. ¿Å±é´Ï´Ù.

"ÇöÀç±îÁöÀÇ Áø´ÜÀº À§¾ÏÀÌÁö¸¸ ´ÙÇàÈ÷ º´±â°¡ ³·¾Æ ¿¹Èİ¡ ÁÁÀ» °¡´É¼ºÀÌ ³ôÀº 'Á¶±âÀ§¾Ï'ÀÔ ´Ï´Ù.

Á¶±âÀ§¾ÏÀÇ Ä¡·á ¹æ¹ýÀº '¼ö¼ú'°ú '³»½Ã°æ Ä¡·á' µÎ °¡Áö°¡ ÀÖ½À´Ï´Ù. ÀüÅëÀûÀΠǥÁØ Ä¡·á ¹æ¹ýÀÎ '¼ö¼ú'Àº °³º¹À̳ª º¹°­°æÀ» ÅëÇØ À§ '¹Û'¿¡¼­ Á¢±ÙÇϱ⠶§¹®¿¡ À§³» À§¾Ï º´º¯Àº ¹°·ÐÀ̰í À§ '¹Û'ÀÇ ¸²ÇÁÀýµé±îÁö Á¦°Å°¡ °¡´ÉÇϹǷΠ°¡Àå È®½ÇÇÑ Ä¡·á¹æ¹ýÀÔ´Ï´Ù. ´Ü ¼ö¼ú ½Ã À§ÀÇ 2/3 ¶Ç´Â À§ Àüü¸¦ ÀýÁ¦ÇϹǷΠ¼ö¼ú ÈÄ 1³â°£Àº ÅëÁõ, üÁß °¨¼Ò µîÀ¸·Î »îÀÇ ÁúÀÌ ÀúÇϵǴ °æ¿ì°¡ ¸¹½À´Ï´Ù. ¶ÇÇÑ ¼ö¼ú ÀÚü¿Í ¿¬°üµÈ »ç¸Á·üÀÌ ¿ì¸®³ª¶ó Æò±ÕÀº 0.9%À̰í ÀúÈñ º´¿ø°ú °°Àº ´ëÇü º´¿øÀÇ °æ¿ì´Â À̺¸´Ù ³·À¸³ª 0.1-0.2% Á¤µµ´Â Á¸ÀçÇÕ´Ï´Ù.

³»½Ã°æ Ä¡·á´Â ¼ö¼ú°ú´Â ¹Ý´ë·Î À§ '¾È'¿¡¼­ º´¼Ò¿¡ Á¢±ÙÇØ Ä¡·áÇÏ´Â ¹æ¹ýÀÔ´Ï´Ù. À§ '¾È'¿¡¼­ Á¢±ÙÇØ ³»½Ã°æ°ú Àü±â Àý°³µµ¸¦ ÀÌ¿ëÇØ À§³» º´º¯¸¸ Á¦°ÅÇÏ°Ô µÇ¹Ç·Î ½Ã¼ú ÈÄ¿¡µµ À§´Â ±×´ë·Î ÀÖ¾î ¼ö¼ú°ú ´Þ¸® ½Ã¼ú ÈÄ »îÀÇ Áú ÀúÇÏ´Â °ÅÀÇ ¾ø½À´Ï´Ù. ´Ü, ³»½Ã°æ Ä¡·á´Â ¼ö¼ú°ú´Â ´Þ¸® À§ '¹Û'ÀÇ ¸²ÇÁÀýµéÀº Á¦°Å°¡ ºÒ°¡´ÉÇϹǷΠÀ§ '¹Û'À¸·ÎÀÇ ÀüÀÌ °¡´É¼ºÀÌ ÀÖ´Â º´º¯Àº ½Ã¼ú ´ë»óÀÌ ¾Æ´Õ´Ï´Ù. µû¶ó¼­ ³»½Ã°æÀû ÀýÁ¦ ÈÄ º´º¯À» Á¶Á÷ °Ë»çÇßÀ» ¶§ º´º¯ÀÌ ½Ã¼ú Àü Æò°¡º¸´Ù ±í°Å³ª ³Ð¾î¼­ ÃßÈÄ À§ '¹Û'À¸·ÎÀÇ ÀüÀÌ °¡´É¼ºÀ» ¹èÁ¦ÇÒ ¼ö ¾ø´Â °æ¿ì¿¡´Â Ãß°¡ÀûÀÎ ¼ö¼úÀû Ä¡·á°¡ ÇÊ¿äÇϸç ÀÌ·¯ÇÑ °æ¿ì´Â 15% Á¤µµÀÔ´Ï´Ù.

³»½Ã°æ ½Ã¼ú ÈÄ ´ÙÇàÈ÷ ±ÙÄ¡Àû ÀýÁ¦ (curative resection) ±âÁØÀ» ¸¸Á·½ÃŰ´Â 85%¿¡ ÇØ´çÇÏ°Ô µÇ´Â °æ¿ì´Â Ãß°¡ÀûÀÎ Ä¡·á ¾øÀÌ 5³â°£ 6°³¿ù¸¶´Ù ÃßÀû °üÂûÀ» ¹ÞÀ¸½Ã°Ô µË´Ï´Ù. ÀÌ °æ¿ì 5³â °£ ÃßÀû °üÂûÇßÀ» ¶§ À§³»ÀÇ ´Ù¸¥ °÷¿¡¼­ Ãß°¡·Î À§¾ÏÀÌ ¹ß»ýÇÒ È®·üÀº 3-5% Á¤µµÀ̰í À§ '¹Û'À¸·ÎÀÇ ÀüÀ̰¡ ¹ß°ßµÇ´Â °æ¿ì´Â 0.1-0.2% Á¤µµÀÔ´Ï´Ù. À§³» Àç¹ßÀÇ °æ¿ì´Â ´ëºÎºÐ Ãß°¡ÀûÀÎ '³»½Ã°æ' Ä¡·á·Î ±ÙÄ¡Àû ÀýÁ¦°¡ °¡´ÉÇϰí À§ '¹Û' Àç¹ßÀÇ °æ¿ìµµ Àý¹Ý Á¤µµÀÇ °æ¿ì´Â Ãß°¡ÀûÀÎ '¼ö¼úÀû' Ä¡·á·Î ¿ÏÄ¡°¡ °¡´ÉÇÕ´Ï´Ù. °á±¹ ¼ö¼úÀû Ä¡·á°¡ ºÒ°¡´ÉÇÑ À§ '¹Û' Àç¹ß ¹ß»ý È®·üÀº 0.05-0.1% Á¤µµÀÎ ¼ÀÀε¥, ÀÌ´Â ¼ö¼ú ÀÚü¿Í ¿¬°üµÈ »ç¸Á·ü°ú ´ëµîÇϰųª ³·Àº ¼öÁØÀÔ´Ï´Ù.

³»½Ã°æ Ä¡·á ½Ã ¹ß»ý °¡´ÉÇÑ ´ëÇ¥ÀûÀÎ ÇÕº´ÁõÀº ÃâÇ÷°ú õ°øÀε¥ ½Ã¼ú ÈÄ ÃâÇ÷ÀÇ ¹ß»ý·üÀº 4-5%, ½Ã¼ú Áß Ãµ°øÀÇ ¹ß»ýÀ²Àº 3-4% Á¤µµÀÔ´Ï´Ù. ÀÌ·¯ÇÑ ÇÕº´ÁõÀº ´ëºÎºÐ ³»½Ã°æÀ¸·Î Ä¡·á°¡ °¡´ÉÇϳª µå¹°°Ô ¼ö¼úÀû Ä¡·á±îÁö ÇÊ¿äÇÑ °æ¿ìµµ ÀÖ½À´Ï´Ù. ´ëºÎºÐÀÇ Ãµ°øÀº ½Ã¼ú Áß ¹ß»ýÇϳª ½Ã¼ú ÈÄ¿¡ ¹ß»ýÇÏ´Â 'Áö¿¬' õ°øµµ 0.2-0.5% Á¤µµ·Î µå¹°°Ô ¹ß»ýÇÒ ¼ö Àִµ¥ ÀÌ °æ¿ì´Â ´ëºÎºÐ ¼ö¼úÀû Ä¡·á°¡ ÇÊ¿äÇÕ´Ï´Ù.

À§ º®ÀÇ µÎ²²°¡ 5 mm Á¤µµ¿©¼­ ³»½Ã°æ ½Ã¼ú½Ã¿¡´Â º´º¯ Á¡¸·ÇÏ¿¡ »ý¸®½Ä¿°¼ö³ª ¾à¹°À» ÁÖÀÔÇØ º´º¯À» ±ÙÀ°Ãþ°ú ºÐ¸®½ÃŲ ÀÌÈÄ¿¡ ½Ã¼úÇÏ°Ô µÇ´Âµ¥ º´º¯¿¡ ¼¶À¯È­ (±»Àº »ì)°¡ ÀÖ´Â °æ¿ì¿¡´Â º´º¯ÀÌ ±ÙÀ°Ãþ°ú ºÐ¸®µÇÁö ¾ÊÀ» ¼ö ÀÖ°í ÀÌ·¯ÇÑ °æ¿ì´Â ³»½Ã°æ Ä¡·á°¡ ºÒ°¡´ÉÇÏ¸ç ¼ö¼úÀû Ä¡·á¸¦ ¹ÞÀ¸¼Å¾ß ÇÕ´Ï´Ù."


10. º´µ¿¿¡¼­ÀÇ È¯ÀÚ °ü¸® - CP (clinical pathway)

2016³â±îÁö 4¹Ú 5ÀÏ CP¸¦ »ç¿ëÇÏ¿´½À´Ï´Ù.

2016³â±îÁö »ç¿ëÇÑ 4¹Ú 5ÀÏ CP

2017³âºÎÅÍ 3¹Ú 4ÀÏ·Î º¯°æÇÏ¿´½À´Ï´Ù. Åð¿ø ½Ã ÃÖÁ¾ º´¸® °á°ú°¡ ³ª¿ÀÁö ¾Ê±â ¶§¹®¿¡ 1ÁÖÀÏ ÈÄ ¿Ü·¡¿¡¼­ °á°ú¸¦ È®ÀÎÇÏ´Â °ÍÀÌ ´Þ¶óÁø Á¡ÀÔ´Ï´Ù. ȯÀÚÀÇ ¿äûÀÌ À־ ÁÙÀÎ °ÍÀº ¾Æ´Õ´Ï´Ù. °¨µ¶ ±â°üÀ¸·ÎºÎÅÍ ÀÔ¿ø±â°£À» ÁÙÀ̶ó´Â ¾Ð·ÂÀÌ ÀÖ¾ú±â ¶§¹®¿¡ ¾î¿ ¼ö ¾øÀÌ º¯°æÇÑ Ãø¸éÀÌ °­ÇÕ´Ï´Ù. Áö¹æ ȯÀÚ°¡ ¸¹Àº º´¿ø Ư¼º »ó ȯÀÚµéÀº °á°ú±îÁö º¸°í Åð¿øÇÏ°í ½Í¾îÇÏ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù.

3¹Ú 4ÀÏ CP¿¡ µû¸¥ ó¹æ È­¸éÀº 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.

ù ÃßÀû³»½Ã°æÀº 8ÁÖ ÈÄ ½ÃÇàÇϰí ÀÖ½À´Ï´Ù. Åð¿ø ½Ã PPI¸¦ 8ÁÖ Ã³¹æÇϰí ÀÖ½À´Ï´Ù. 4ÁÖ·Î ÁÙÀÏ±î °í¹Î ÁßÀÔ´Ï´Ù.

½Ã¼ú Àü µ¿ÀǼ­ ȹµæÀº ÇʼöÀÔ´Ï´Ù.


[First ESD]

ESD´Â stepwiseÇÏ°Ô ¹è¿ö¾ß ÇÕ´Ï´Ù.

ÀúÈñ ±â°ü¿¡¼­´Â fellow 1³âÂ÷ ¶§ EndoGEL ESD hands-on trainingÀ» 1-2ȸ Âü¿©ÇÏ°Ô ÇÕ´Ï´Ù. Fellow 2³âÂ÷ ¶§¿¡´Â EndoGEL ESD hands-on training¸¦ ¿©·¯¹ø °æÇèÇÏ°Ô ÇÑ ÈÄ ex-vivo pig stomach ESD hands-on training¿Í live pig ESD training¸¦ ÁøÇàÇÕ´Ï´Ù. ¸¶Áö¸·À¸·Î tutor¿Í ÇÔ²² ESD¸¦ ½Ã¼úÇϸ鼭 ¼¼¼¼ÇÑ detailÀ» step-by-stepÀ¸·Î °¡¸£Ä¡°í ÀÖ½À´Ï´Ù.

Fellow trainingÀ» ¸¶Ä¡°í ù ESD¸¦ È¥ÀÚ ½ÃÇàÇÏ´Â °ÍÀº ½±Áö ¾ÊÀº ÀÏÀÔ´Ï´Ù. ±×·¯³ª fellow °úÁ¤¿¡ Ãæ½ÇÇÑ ÈÆ·ÃÀ» ¹Þ¾Ò´Ù¸é ÀǿܷΠ±Ý¹æ Àß ÇÒ ¼ö ÀÖ½À´Ï´Ù. 2019³â fellow 2³âÂ÷ °úÁ¤À» ¹â¾Ò´ø ÇÑ ¼±»ý´Ô²²¼­´Â Áö¿ª º´¿ø¿¡ ÃëÁ÷ÇÏ¿© 1³â¿¡ gastric ESD¸¦ 70¿©°³ ½Ã¼úÇÏ¿´´Ù´Â À̾߱⸦ µé¾ú½À´Ï´Ù. À§³»½Ã°æ°ú ´ëÀå³»½Ã°æÀ» ¸ðµÎ ½ÃÇàÇϸ鼭 gastric ESD¸¦ ù ÇØ¿¡ 70¿©°³¸¦ ½Ã¼úÇÏ¿´´Ù´Â °ÍÀº ´ë´ÜÇÑ ¼º°ú°¡ ¾Æ´Ò ¼ö ¾ø½À´Ï´Ù. Áö¿ª ȯÀڵ鿡°Ô Å« °øÇåÀ» ÇϽŠÁ¡À» Ä¡ÇÏÇÕ´Ï´Ù.

Fellow trainingÀ» ¸¶Ä¡°í ÃëÁ÷ÇÑ ÈÄ Ã¹ ESD¸¦ Çϸé ÀûÁö ¾ÊÀº °¨°ÝÀ» ´À³§´Ï´Ù. Á¾Á¾ Àú¿¡°Ô »çÁøÀ» º¸³»Áּż­ ½º½ÂÀ» °¨µ¿½ÃŰ´Â ºÐµéÀÌ ÀÖ½À´Ï´Ù. ´ë´ÜÈ÷ °¨»çÇÕ´Ï´Ù.

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§­)

Glandular intraepithelial neoplasia, high grade (high grade dysplasia), 18 x 15mm, resection margin : uninvolved (4, 7, 12, 10mm)

¿©·¯ºÐ. °í»ý ¸¹À¸¼Ì½À´Ï´Ù. ÈĹèµéµµ ´õ¿í ¿­½ÉÈ÷ °¡¸£Ä¡°Ú½À´Ï´Ù.


[FAQ]

[2013-8-27. ¾Öµ¶ÀÚ Áú¹®]

Àú´Â À۳⿡ Æç·Î¿ì ¸¶Ãưí ÇöÀç ½ºÅÜ 1³âÂ÷ ÀÔ´Ï´Ù. ÃÖ±Ù ESD¸¦ ¸î ÄÉÀ̽º ½ÃÀÛÇß½À´Ï´Ù. ESD °ü·ÃÇØ¼­ ÃßÃµÇØÁÖ½Ç ¸¸ÇÑ Ã¥ÀÌ Àִ°¡ ÇØ¼­ ¸ÞÀÏ µå¸³´Ï´Ù. ½ÃÁß¿¡ ³ª¿Í Àִ åÀÌ ÀÖ±â´Â Çѵ¥ ³»¿ëÀÌ ¾î¶²Áö Àß ¾Ë ¼ö ¾ø°í...

[2013-8-27. ÀÌÁØÇà ´äº¯]

Ã¥À» ÇѱǸ¸ ±ÇÇÑ´Ù¸é ¾Æ·¡ Ã¥ÀÔ´Ï´Ù. ESD ¿¬±¸È¸¿¡¼­ ³ª¿Â °ÍÀÔ´Ï´Ù. ¸î ±ÇÀ» ´õ º»´Ù¸é ÀϺ»Ã¥ ¹ø¿ªµÈ °ÍÀ» º¸½Ã¸é µË´Ï´Ù.

ESD¸¦ Ã¥º¸°í ¹è¿ì¸é ¾ÈµÈ´Ù°í »ý°¢ÇÕ´Ï´Ù. ¹Ýµå½Ã µµÁ¦±³À°À¸·Î ¹è¿ö¾ß ÇÕ´Ï´Ù. ±×·¡¾ß ºÒ½ÖÇÑ È¯ÀÚ°¡ ³ª¿ÀÁö ¾Ê½À´Ï´Ù. È¥ÀÚ ÀÍÇôµµ ¾ðÁ¨°¡´Â ÀßÇÏ°Ô µÈ´Ù´Â ÀϺΠÁÖÀå¿¡ µ¿ÀÇÇÕ´Ï´Ù. ±×·¯³ª È¥ÀÚ ÇÏ´Ùº¸¸é ÀßÇϱâ Àü±îÁö ȯÀÚ¿¡°Ô ¹Ì¾ÈÇÑ ÀÏÀÌ °è¼Ó ¹ß»ýÇÕ´Ï´Ù. ÂüÀ¸·Î ¾ÈŸ±õ½À´Ï´Ù. «À» ³»¼­ ±Ùó ´ëÇк´¿øÀ» ¹æ¹®ÇÏ¿© Á÷Á¢ º¸°í ¹è¿ì´Â °ÍÀÌ ÁÁ½À´Ï´Ù.

ESD ´ë°¡ Áß ÇѺÐÀÎ ±¹¸³¾Ï¼¾ÅÍ ÃÖÀÏÁÖ ±³¼ö´Ô²²¼­ ¼ö³â Àü EMR-P¿¡ ´ëÇÑ learning curve¸¦ ÁÖÁ¦·Î ³í¹®À» ¹ßÇ¥ÇϽŠ¹Ù ÀÖ½À´Ï´Ù. ù 40¿¹º¸´Ù µÎ¹øÂ° 40¿¹¿¡¼­ ÈξÀ ¾ÈÁ¤ÀûÀ̰í ÁÁÀº °á°ú¸¦ º¸¿´½À´Ï´Ù. ESD¿¡ ´ëÇØ¼­´Â learning curve°¡ ´õ °¡ÆÄ¸£´Ù´Â °ÍÀÌ Á¤¼³ÀÔ´Ï´Ù. Áï óÀ½ ¸î½Ê·ÊÀÇ ESD´Â ¹«Ã´ ¾î·Æ°í ¸¸Á·ÇÒ¸¸ÇÑ °á°ú°¡ ³ª¿ÀÁö ¾Ê´Â´Ù´Â °ÍÀÔ´Ï´Ù. È¥ÀÚ Ã¥º¸°í ¹è¿ì¸é ¾È µÇ°Ú½À´Ï´Ù. °³ÀÎ tutor¸¦ ã¾Æ¾ß ÇÕ´Ï´Ù.

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.

ÀϺ»¿¡¼­´Â ÁÖ¸»¿¡ µ¿°æ¿¡¼­ ÇÐȸ°¡ ¿­¸®¸é ¿ù¿äÀÏÀ̳ª È­¿äÀϱîÁö µ¿°æ¿¡ ¸Ó¹«¸£´Â ÀÇ»çµéÀÌ ¸¹´Ù°í ÇÕ´Ï´Ù. ¿ù¿äÀÏ, È­¿äÀÏ ¾ÆÄ§¿¡ ¿©·¯ º´¿øÀ» ¹æ¹®ÇÏ¿© ESD ½Ã¼úÀå¸éÀ» observationÇÒ ¸ñÀûÀÌÁö¿ä. ³ªÀÌ Áö±ßÇÑ ¼±»ý´ÔµéÀÌ ÀþÀº ÀÇ»çÀÇ ½Ã¼úÀå¸éÀ» º¸¸é¼­ °í°³¸¦ ²ô´öÀ̰í Áú¹®µµ ÇÏ´Â ¸ð½ÀÀÌ Âü ¾Æ¸§´ä½À´Ï´Ù. Âü°íÇÒ¸¸ÇÕ´Ï´Ù.


ÀÏÀü¿¡ ¼Ò°³ÇÑ ¹Ù ÀÖ½À´Ï´Ù¸¸......2013³â 7¿ù 7ÀÏ Á¦ 20ȸ ´ëÇѼÒÈ­±â³»½Ã°æÇÐȸ ºÎ¿ï°æÁöȸ ¼¼¹Ì³ª¿¡¼­ Á¦°¡ commentÇÑ ³»¿ëÀ» ¿Å±é´Ï´Ù.

ºÎ¿ï°æ ¼¼¹Ì³ª breakfast meeting Àå¸é

"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."


[2019-5-13. ¾Öµ¶ÀÚ ÆíÁö]

±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 Çϸ鼭 ¸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.


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 À־ °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 ´ëÇѼÒÈ­±â³»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.

11¿ù¿¡ ºË°Ú½À´Ï´Ù.


[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.

Ä¡·á Àü ³»½Ã°æ »çÁøÀÔ´Ï´Ù. Focal lesionÀ̶ó±âº¸´Ù´Â diffuseÇÑ metaplastic changeÀ̹ǷΠESDÀÇ ÀûÀÀÁõÀÌ ¾È µÇ´Â º´¼Ò·Î º¸ÀÔ´Ï´Ù.

±×·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...


[Archives]

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

½Ã¼ú½Ã°£: 31ºÐ
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


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


[References]

1) EndoATLAS ESD

2) õ±â´©¼³ - Tips for ESD

3) ÀÌÁØÇàÀÇ How I do it - ESD

4) EndoTODAY EngoGEL ESD hands-on training

5) EndoTODAY live pig ESD

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

12) EndoTODAY learning ESD

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.