[Description exercise 3 Çؼ³]

[ÀܼҸ® ÇѸ¶µð]

³»½Ã°æÀ» óÀ½ ½ÃÀÛÇÏ¸é ¾Ö¸ÅÇÑ ºÎºÐÀÌ ¸¹ÀÌ º¸ÀÔ´Ï´Ù. ¸ðµÎ ±â¼úÇÏ°í Á¶Á÷°Ë»ç¸¦ ÇÏ°í ½ÍÀº À¯È¤¿¡ ºüÁý´Ï´Ù. ±×·¯³ª Áö³ªÄ¡°Ô ¸¹Àº Á¶Á÷°Ë»ç´Â ȯÀÚ¿¡°Ô µµ¿òµÇ´Â °æ¿ì°¡ °ÅÀÇ ¾ø½À´Ï´Ù. Àӻ󰡷μ­ÀÇ Åµµ¸¦ À¯ÁöÇÏ°í ²À ÇÊ¿äÇÑ °æ¿ì¸¸ Á¶Á÷°Ë»ç¸¦ ÇÏ´Â °ÍÀÌ ÁÁÀ» ¶§°¡ ¸¹½À´Ï´Ù. ¾Æ¿¹ ½½Â½ ¸ø º» ù ÇÏ´Â °ÍÀÌ È¯ÀÚ¿¡°Ô µµ¿òµÇ´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. ¿¹¹ÎÇÑ È¯ÀÚ´Â ¾ÆÁÖ ÀÛÀº ¼Ò°ß¿¡ ÁýÂøÇÏ¿© °úÀ× °Ë»ç¸¦ ¹Þ´Â °æ¿ìµµ ¸¹±â ¶§¹®ÀÔ´Ï´Ù.

50´ë ÈÄ¹Ý ³²¼º¿¡¼­ ¹ß°ßµÈ fundusÀÇ tiny SMT. 2mm Á¤µµ¶ó°í »ý°¢µË´Ï´Ù. ½½Â½ ¹«½ÃÇصµ ÁÁÀ» Å©±â ¾Æ´Ñ°¡ ÆǴܵǴµ¥ °Ë»çÀÚ´Â À̸¦ »çÁøÂï°í Á¶Á÷°Ë»ç¸¦ ÇÏ¿´°í °á°úÁö¿¡ ±â·ÏÀ» ³²°ÜµÎ¾ú½À´Ï´Ù.

¿¹»óÇÏ¿´´ø ¹Ù¿Í °°ÀÌ Á¶Á÷°Ë»ç¿¡¼­´Â ¾Æ¹«·± ÀÌ»ó ¼Ò°ßÀÌ ¾ø¾ú½À´Ï´Ù. »ç½Ç ÀÌ¿Í °°Àº tiny SMT¿¡¼­ Á¶Á÷°Ë»ç´Â °ÅÀÇ ¾Æ¹«·± Àǹ̰¡ ¾ø½À´Ï´Ù.


Case 15. Near GE junction

¼Ò°ß: Squamocolumnar junctionÀÌ hiatal openingº¸´Ù upward elevationµÇ¾î ÀÖ¾î hiatal hernia°¡ ÀÖÀ½. SC junction¿¡ 1½Ã ¹æÇâ¿¡ 5mm ÀÌÇÏÀÇ star-shapeÀÇ mucosal break°¡ 2°³ Á¤µµ °üÂûµÇ¸ç, mucosal break Á÷ÇϹ濡 ¾à 6-7mm Å©±âÀÇ sessile hyperemic poylpÀÌ ÀÖÀ½. Mucosal breaks¿Í sessile hyperemic polyp »çÀÌ¿¡´Â 5mm Á¤µµÀÇ ¾èÀº ±Ë¾çµµ º¸ÀÌ°í ÀÖÀ½.

Áø´Ü: (1) Reflux esophagitis, LA-A, (2) Sentinal polyp, (3) Sliding hiatal hernia


[ÀÌÁØÇà comment]

Ãʺ¸Àڵ鿡°Ô´Â ´Ù¼Ò ¾î·Á¿î ¹®Á¦ÀÔ´Ï´Ù. ´Ùµé Èûµé¾î ÇÕ´Ï´Ù.

(1) Sentinel polypÀº mucosal break¿ÍÀÇ À§Ä¡°ü°è¸¦ ¾ð±ÞÇÏ¸é ´õ ÁÁ°Ú½À´Ï´Ù. Áï sentinel polyp Á÷»ó¹æÀÇ short mucosal break¿Í ÁÖº¯ Á¡¸·ÀÇ ¹é»ö ȥŹÀÌ º¸ÀÔ´Ï´Ù. Sentinel polypÀÇ Å©±â¸¦ ¸ðµÎµé Á¶±Ý Å©°Ô º» °Í °°½À´Ï´Ù. Àú´Â 6-7mm Á¤µµ·Î º¸¾Ò´Âµ¥¿ä... »ç½Ç ³»½Ã°æÀ» Çغ¸Áö ¾ÊÀº ºÐµéÀÌ º´¼ÒÀÇ Å©±â¸¦ Á¤È®È÷ ÃøÁ¤Çϱâ´Â ¾î·Á¿ï °Í °°³×¿ä. Polyp¿¡ ´ëÇÏ¿© edge´Â clearÇÏ°í marginÀ» erythematousÇϸç fold´Â ¾î¶°ÇÏ°í ±â¼úÇÑ ºÐÀÌ °è½Ê´Ï´Ù. ±×·¯³ª ÀÌ·¯ÇÑ ±â¼úÀº ÇÔ¸ôÇü º´¼Ò¿¡ ÀûÇÕÇÑ ³»¿ëÀÔ´Ï´Ù. ´ë°­ ¿ë¾î´Â ÀÍÇûÀ¸´Ï ¾ÕÀ¸·Î´Â À¶±âÇü º´¼Ò¿Í ÇÔ¸ôÇü º´¼Ò °¢°¢¿¡ Àû´çÇÑ ±â¼ú¹ýÀ» °í¹ÎÇغ¸¼¼¿ä.

(2) Sentinel polyp°ú ÇÔ²² reflux esophagitis°¡ °üÂûµÇ´Âµ¥¿ä, LA-C·Î ÁֽŠºÐÀÌ °è¼Ì½À´Ï´Ù. ÇϺνĵµ¿¡´Â 4-6°³ Á¤µµÀÇ longitudinal fold°¡ ÀÖÀ¸¸ç ÀÌ foldµéÀÇ top¿¡ mucosal break°¡ »ý±â´Â °ÍÀÔ´Ï´Ù. Confluent ÇÏ´Ù°í ºÎ¸£·Á¸é ÀÌ foldÀÇ mucosal break¿Í Àú foldÀÇ mucosal fold°¡ À¶ÇյǴ °ÍÀÔ´Ï´Ù. Sentinel polyp »ó¹æ¿¡´Â star shapeÀÇ fold°¡ º¸À̱⠸¶·ÃÀε¥ À̸¦ confluent mucosal break·Î º¸´Â °ÍÀº °úÀ×ÀÔ´Ï´Ù. ÀÌ È¯ÀÚ´Â sentinel polyp with reflux esophagitis LA-A, mild hiatal hernia·Î ÁÖ¸é °¡Àå ÁÁ°Ú½À´Ï´Ù.

(3) Short segment Barrett esophagus¸¦ ¾ð±ÞÇϽŠºÐµµ °è½Ã´Âµ¥¿ä, ¿©·¯ ÀÌÀ¯·Î 1cm ÀÌÇÏÀÇ Barrett esophagus ÀÇ½É ºÎÀ§´Â ¹«½ÃÇÒ °ÍÀ» ±ÇÇÏ°í ÀÖ½À´Ï´Ù.

(4) º¸ÃÊ¿ëÁ¾ÀÌ µü ÁÁÀº ¸»Àä... ½Äµµ ¿ëÁ¾ÀÎÁö À§ ¿ëÁ¾ÀÎÁö Çϳª¸¦ °í¸£¶ó¸é À§ ¿ëÁ¾¿¡ °¡±õ½À´Ï´Ù.

(5) º¸ÀÌ´Â °Í¸¸ ¾¹½Ã´Ù. »ó»ó ±ÝÁö!

ÇÑ Àü°øÀÇ ¼±»ý´Ô²²¼­ ulcer¶ó´Â Ç¥ÇöÀ» ¾²¼Å¼­ mucosal breakÀÇ °³³ä¿¡ ´ëÇÏ¿© ¾Æ·¡¿Í °°ÀÌ ¼³¸íÇÏ¿´½À´Ï´Ù (Âü°í: EndoTODAY mucosal breakÀÇ Á¤ÀÇ).

* Âü°í: EndoTODAY ¹Ù·¿ ½Äµµ, EndoTODAY º¸ÃÊ ¿ëÁ¾


Case 16. Mid to lower esophagus

¼Ò°ß: ÁßÇϺνĵµ¿¡ circumferenceÀÇ 75%¸¦ ħ¹üÇÑ mass lesionÀÌ °üÂûµÊ. Å©±â ÃøÁ¤Àº ¾î·Á¿ì³ª 5 cm ÀÌ»óÀ¸·Î ÃßÁ¤µÊ. MassÀÇ Ç¥¸éÀº uneven, focal hyperemicÇÏ°í whitish discolorationÀÌ µ¿¹ÝµÇ°í ÀÖÀ½. Mass·Î ÀÎÇØ °ü°­ÀÌ Á¼¾ÆÁ® ÀÖ°í ³»½Ã°æÀ» Åë°ú½Ãų ¼ö ¾ø¾úÀ½.

Áø´Ü: Advanced esophageal cancer, type I


[ÀÌÁØÇà comment]

¸Ö¸®¼­ º» ù ÀλóÀÌ ¹«¾ùÀ̾ú½À´Ï±î? "¾Æ... Á¼¾ÆÁ³±¸³ª!" ±×·¸½À´Ï´Ù. Á¼¾ÆÁ³´Ù°í »ý°¢ÇÏ¸é °¨º°Áø´ÜÀÌ ½¬¿öÁý´Ï´Ù. °£È¤ esophageal varix³ª telangiectasia¶ó°í ´äÇÑ ºÐÀÌ °è½Ê´Ï´Ù. ½Äµµ¾Ï Ä¡°í´Â Ç¥¸éÀÌ ¸Å²öÇÑ ÆíÀÌ°í, ¶Ç Ç÷°üµµ ´Ã¾î³ª À־ ±×·¸°Ô ´äÇÑ °ÍÀÌ°ÚÁö¿ä. ½£À» º¸Áö ¸øÇÏ°í ³ª¹«¸¸ º» °ÍÀÔ´Ï´Ù. ¸Ö¸®¼­ º» ùÀλó. ¹¹ ±×·± °ÍÀÌ Áß¿äÇÕ´Ï´Ù.

½Äµµ¾ÏÀº »ó´çÈ÷ ´Ù¾çÇÑ ¸ð¾çÀ» º¸ÀÏ ¼ö ÀÖÀ½À» ÀØÁö ¸¶¼¼¿ä.

ÀÌ·± °æ¿ì¿¡µµ Å©±â¸¦ ¾ð±ÞÇØ¾ß ÇÏ´ÂÁö Àß ¸ð¸£°Ú½À´Ï´Ù. ½áµµ ÁÁ°í ¾²Áö ¾Ê¾Æµµ ÁÁ½À´Ï´Ù. ObstructionÀ¸·Î ÀÎÇÏ¿© ±íÀº °üÂûÀÌ ¾î·Æ½À´Ï´Ù. óÀ½ºÎÅÍ °£ÀüÀÌ°¡ À־ ¼ö¼úÇÒ ¼ö ¾ø¾ú½À´Ï´Ù.

EndoTODAY ºÐ·ù¹ý - ½Äµµ¾ÏÀ» º¸¼¼¿ä.

* Âü°í: EndoTODAY ½Äµµ¾Ï


Case 17

¼Ò°ß: ÀüÁ¤ºÎ Èĺ®¿¡ 1cm Å©±âÀÇ yellow flat lesionÀÌ º¸ÀÌ¸ç ±× Ç¥¸éÀº ¾à°£ granularÇÔ.

Áø´Ü: Xanthoma


[ÀÌÁØÇà comment]

ÃʽÉÀÚµéÀº ÀÌ·± ½¬¿î ¹®Á¦¸¦ Ʋ¸®´Â ¼ö°¡ ÀÖ½À´Ï´Ù. XanthomaÀÔ´Ï´Ù.

* Âü°í: EndoTODAY Ȳ»öÁ¾


Case 18 (melena)

¼Ò°ß: À§°¢¿¡ 3x2cm Å©±âÀÇ ±Ë¾çÀÌ ÀÖÀ½. Edge´Â sharpÇÏ°í marginÀº edematousÇϸç, fold º¯È­´Â ¾øÀ½. UlcerÀÇ ¹Ù´ÚÀº dirty white exudate·Î µ¤ÇôÀÖ°í ÇÑ °³ÀÇ exposed vesselÀÌ ÀÖÀ½.

Áø´Ü: Benign gastric ulcer, active 2 stage, Forrest classification IIa


[ÀÌÁØÇà comment]

Melena·Î ³»¿øÇÑ ±Ë¾çÀÌ´Ï AHS (active-healing-scar) ºÐ·ù´Â Ç×»ó activeÀÔ´Ï´Ù. ´ç¿¬ÇÏÁö ¾Ê½À´Ï±î? ActiveÇϴϱî ÃâÇ÷ÀÌ ¹ß»ýÇÑ °ÍÀÔ´Ï´Ù. ±×·¡¼­ Áß¿äÇÑ °ÍÀº Forrest ºÐ·ùÀÔ´Ï´Ù. (1) ³»½Ã°æ Ä¡·á¸¦ ÇØ¾ß ÇÒ±î? (2) ÀçÃâÇ÷·üÀÌ ¾î´À Á¤µµÀϱî? ÀÌ·± Áú¹®¿¡ ´äÇÏ·Á¸é Forrest ºÐ·ù¸¦ ¾Ë¾Æ¾ß ÇÕ´Ï´Ù.

º´¼ÒÀÇ ¹æÇâÀº 2 dimensionÀ» ¸ðµÎ Á¦½ÃÇϼ¼¿ä. ¿¹¸¦ µé¸é, À§ ÀüÁ¤ºÎ ¼Ò¸¸. AngleÀº ´Ù¼Ò ¾Ö¸ÅÇѵ¥¿ä... º¸Åë angleÀÇ Áß¾Ó, angleÀÇ Àüº®ÂÊ, angleÀÇ Èĺ®ÂÊ°ú °°ÀÌ Ç¥½ÃÇϸé ÁÁ½À´Ï´Ù.

º´±â´Â A2 stage·Î º¸¼¼¿ä. A1´Â ±Ë¾çÀº ÀÛ°í edema°¡ ½ÉÇÑ °Í, A2´Â ±Ë¾çÀº Å©°í edema°¡ ¾à°£ ºüÁø °Í. A1º¸´Ù A2°¡ ±íÀ» ¼ö ÀÖ½À´Ï´Ù.

* Âü°í: EndoTODAY ¼ÒÈ­¼º ±Ë¾ç ÃâÇ÷


Case 19

¼Ò°ß: ÀüÁ¤ºÎ ¼Ò¸¸ Èĺ®Ãø¿¡ ¾à 2.5cm Å©±âÀÇ nodular elevated lesionÀÌ ÀÖÀ½. º´º¯ÀÇ Á߽ɺδ ¾à°£ ÇÔ¸ôµÇ¾î ÀÖÀ¸¸ç °æ°è´Â ºñ±³Àû ¸íÈ®ÇÔ. Ç¥¸éÀÌ unevenÇϸç 6½Ã¹æÇâÀ¸·Î focal hyperemia¸¦ º¸ÀÌ°í ÀÖÀ½.

Áø´Ü: EGC IIa+IIc


[ÀÌÁØÇà comment]

EGCÀÇ ºÐ·ùµµ ¾Ö¸ÅÇÑ °æ¿ì°¡ ÀÖ½À´Ï´Ù. 2013³â 5¿ù 23ÀϺÎÅÍ 2013³â 6¿ù 9ÀϱîÁö EndoTODAY¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù. EndoTODAY 20130427µµ Âü°íÇϼ¼¿ä. EGC ´Â 2c¿Í °°ÀÌ ¾²Áö ¾Ê°í IIc¿Í °°ÀÌ ¾²´Â °ÍÀÌ °ü·ÊÀÔ´Ï´Ù. ÀÌÀ¯´Â ¸ð¸¨´Ï´Ù. AGC´Â type II¿Í °°ÀÌ ¾²±âµµ ÇÏ°í type 2·Î ¾²±âµµ ÇÕ´Ï´Ù. ÀÌ ¶ÇÇÑ ÀÌÀ¯´Â ¸ð¸¨´Ï´Ù.

Stomach, endoscopic submucosal dissection:
Early gastric carcinoma:
1. Location : antrum, posterior wall
2. Gross type : EGC type IIa+IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 3.3x2.5 cm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin: free from carcinoma, safety margin: distal 1 cm, proximal 1 cm, anterior 1 cm, posterior 2 cm
8. Lymphatic invasion : not identified
9. Venous invasion : not identified
10. Perineural invasion : not identified
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent


Case 20

¼Ò°ß: ÁßüºÎ ´ë¸¸ ±×¸®°í Èĺ®Ãø±îÁö ulcerative lesionÀÌ °üÂûµÇ¸ç ÁÖº¯À¸·Î ħÀ±µÈ ¼Ò°ßÀÓ. Àå°æ 7-8 cm Á¤µµÀÓ. ÇÔ¹°ºÎ Ç¥¸éÀº ¸Å¿ì unevenÇϸç dirty exudates¿Í hematinµéÀÌ º¸ÀÌ°í ÀÖÀ½.

Áø´Ü: AGC, Borrmann type III


[ÀÌÁØÇà comment]

AGCÀÇ ±â¼ú°ú ºÐ·ù°¡ EGCº¸´Ù ¾î·Á¿ï ¶§°¡ ÀÖ½À´Ï´Ù. ±Ë¾çÀº ¸ÂÁö¸¸ ÁÖº¯À¸·Î ħÀ±µÈ °æ¿ìÀÔ´Ï´Ù. º¸¸¸ 3ÇüÀÌ ¸Â½À´Ï´Ù. º¸¸¸ 2ÇüÀ̶ó°í ÇÏ·Á¸é À¶±âµÈ ºÎÀ§ÀÇ Áß¾Ó¿¡ ±íÀº ÇÔ¸ôÀÌ À־ ¸¶Ä¡ ±Ë¾çÀÌ ÀÖ°í ÁÖº¯¿¡ 1-2cm Á¤µµÀÇ margin elevationÀÌ ÀÖ¾î¾ß ÇÕ´Ï´Ù. ´Ù¼Ò ¾Ö¸ÅÇÏ¸é ±×³É Borrmann type III·Î ºÎ¸¨½Ã´Ù. º¸¸¸ 3ÇüÀ̳ª 4ÇüÀº Å©±â ÁüÀÛÀÌ ¾î·Æ±â ¶§¹®¿¡ ³»½Ã°æ °á°úÁö¿¡ Å©±â¸¦ ¾²Áö ¾Ê´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ¾Æ¹«¸® ±×·¸´õ¶óµµ ÁüÀÛÀÌ¶óµµ Çؼ­ ½á ÁÖ¼¼¿ä. ¸ð¸£°ÚÀ¸¸é... º¸¸¸ 3ÇüÀº 7 cm, º¸¸¸ 4ÇüÀº 10cm¶ó°í ¾²¸é µË´Ï´Ù.^^

¼ö¼úÀ» ÇÏ¿´°í ¾Æ·¡ÀÇ °á°ú¿´½À´Ï´Ù.

Stomach, total gastrectomy:
Advanced gastric carcinoma, Borrmann type III, mid body to high body of posterior wall and greater curvature,
Adenocarcinoma, poorly differentiated, diffuse type;
1) tumor size: 7x7 cm
2) extension to proper muscle layer
3) endolymphatic tumor emboli: present
4) peritumoral lymphoid follicles
5) negative resection margins (proximal: 5.5 cm; distal: 7.5 cm)
6) metastasis to 16 out of 48 regional lymph nodes (16/48: lesser curvature, 8/26; greater curvature, 3/10; "7", 5/6; "8", 0/6)
AJCC Stage IV (T2a, N3, MX)

¾Æ·¡ µ¿¿µ»óÀ» °øºÎÇϽñ⠹ٶø´Ï´Ù.

Endoscopic findings of gastric cancers (KINGCA2023)


Case 21. Duodenal bulb

¼Ò°ß: ½ÊÀÌÁöÀå ±¸ºÎ¿¡ ¿©·¯°³ÀÇ ¾à°£ paleÇÑ granular lesionµéÀÌ scattered µÇ¾î ÀÖÀ½.

Áø´Ü: Gastric heterotopia (= heterotopic gastric mucosa in the duodenum)


[ÀÌÁØÇà comment]

°£È¤ duodenal lymphoid hyperplasia¿Í ±¸ºÐÀÌ ¾î·Æ±âµµ ÇÕ´Ï´Ù. Heterotopic gastric mucosaº¸´Ù lymphoid hyperplasia°¡ º¸´Ù ±ÕÀÏÇÏ°Ô small nodularÇÑ ¾ç»óÀÔ´Ï´Ù.

* Âü°í: EndoTODAY ½ÊÀÌÁöÀåÀÇ À̼Ҽº À§Á¡¸·


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ÇÑ ¿Ü±¹ÀÎ ¼±»ý´Ô ´äº¯Àε¥, ¿µ¾î Ç¥ÇöÀ» ¹è¿ï ¼ö ÀÖ½À´Ï´Ù.

2016-11.

2023-7-8. º»°ú 4Çг⠽ǽÀÇлýµéÀÇ ´äº¯¿¡ comment¸¦ ºÙ¿´½À´Ï´Ù. Çлý°ú Áöµµ±³¼ö(¹Î¾ç¿ø ±³¼ö´Ô)¿¡°Ô ¸ÞÀÏ·Î º¸³Â½À´Ï´Ù.

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