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[È®´ë³»½Ã°æ. Magnifying endoscopy] - ðû

[Position statement, 2021-7-4] ³»½Ã°æ 3»çÀÇ ÃÖ±Ù ³»½Ã°æÀº È®´ë³»½Ã°æÀÌ ¾Æ´Ï´õ¶óµµ ±ÙÁ¢ °üÂû¿¡ À¯¸®ÇÏ°Ô ·»ÁîÀÇ ÃÊÁ¡°Å¸®°¡ ¼³Á¤µÇ¾î ÀÖ½À´Ï´Ù. ÀÏ¹Ý ³»½Ã°æ¸¸À¸·Î Åë»óÀûÀÎ Áø´Ü°ú Ä¡·á¸¦ ½ÃÇàÇϴµ¥ °ÅÀÇ ¾Æ¹«·± ¹®Á¦°¡ ¾ø½À´Ï´Ù. Zoom ³»½Ã°æÀ» ÀÌ¿ëÇÑ NBI magnificationÀ¸·Î ÀÏ¹Ý ³»½Ã°æ¿¡¼­´Â º¼ ¼ö ¾ø´Â Èï¹Ì·Î¿î ¼Ò°ßÀ» °üÂûÇÒ ¼ö ÀÖÁö¸¸ ¾ÆÁ÷ ÀÓ»óÀû À¯¿ë¼ºÀº ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù. À§¾Ï ³»½Ã°æ Àü¹®°¡ ÀÔÀå¿¡¼­ È®´ë³»½Ã°æÀº Àü¹®°¡µéÀÇ °í±Þ½º·± Àå³­°¨ÀÔ´Ï´Ù. ½Äµµ¿¡¼­µµ ºñ½ÁÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù. ´ëÀå¿¡¼­´Â ´Ù¼ÒÀÇ À¯¿ë¼ºÀÌ ÀÖ½À´Ï´Ù.

1. Á¤»ó À§ÀÇ È®´ë³»½Ã°æ ¼Ò°ß

2. Intestinal metaplasiaÀÇ È®´ë³»½Ã°æ ¼Ò°ß

3. À§¾ÏÀÇ È®´ë³»½Ã°æ °üÂû - 3´Ü°è Á¢±Ù¹ý (MESDA-G, magnifying endoscopy simple diagnostic algorithm for EGC)

4. Á¶±âÀ§¾Ï ESD Àü lateral marginÀÇ È®ÀÎ

5. Undifferentiated-type Á¶±âÀ§¾Ï ESD Àü NBI È®´ë³»½Ã°æÀÇ À¯¿ë¼º

6. Near Focus

7. ½Äµµ esophagus

8. ´ëÀå image-enhanced endoscopy - PENTAX

9. References

PPT PDF 1.2M (GIE review, À̼ÒÁ¤)

YouTube


1. Á¤»ó À§ÀÇ È®´ë³»½Ã°æ ¼Ò°ß

À§ÀÇ Á¤»ó ¹× ºñÁ¤»ó È®´ë³»½Ã°æ ¼Ò°ßÀº Fukuoka ´ëÇÐÀÇ Yao ±³¼ö°¡ 2013³â Ann Gastroenterol¿Í 2015³â Clin Endosc¿¡ Àß Á¤¸®ÇÑ °ÍÀ» Âü°íÇϽʽÿÀ. VS (vessel plus surface) classification systemÀ̶ó°í ºÎ¸£´Â °ÍÀε¥ microvascular pattern°ú microsurface patternÀ» ÇѲ¨¹ø¿¡ ±â¼úÇÏ°í ÀÖÀ¸¹Ç·Î ´Ù¼Ò È¥¶õ½º·´½À´Ï´Ù. ÀÌ µÑÀ» µû·Î ¶Ç °°ÀÌ »ý°¢Çϸé ÀÌÇØ°¡ ½±½À´Ï´Ù.

(1) microvascular pattern (V) : subepitherial capillary network (SECN), CV (collecting venule), MV (The microvessel is a term used for vessels that appear in pathological mucosa.)
(2) microsurface pattern (S): marginal crypt epithelium (MCE), crypt opening (CO)


1) Á¤»ó fundic gland: microvascular patternÀº SECN (subepitheliral capillary network)°¡ ¹úÁý¸ð¾çÀ» ÀÌ·ç¸ç, microsurface patternÀº marginal crypt epithelium (MCE)¿¡ µÑ·¯½×ÀÎ crypt opening (CO)ÀÌ SECN Áß¾Ó¿¡ À§Ä¡ÇÕ´Ï´Ù. Helicobacter °¨¿°ÀÌ Àְųª À§Ã༺ º¯È­°¡ ÇöÀúÇÒ ¶§´Â ÀÌ·± Á¤»ó ¼Ò°ßÀÌ º¸ÀÌÁö ¾Ê°Ô µË´Ï´Ù.

(a) Schematic diagram of the microvascular architecture and the microsurface structure of the normal gastric fundic gland mucosa corresponding to the surface morphology as visualized by magnifying endoscopy (ME) with narrow-band imaging (NBI). The microvascular architecture is formed by the capillaries and collecting venules. The morphology of each capillary is that of a polygonal closed loop. These loops anastomose repeatedly with each other, forming a regular honeycomb-like subepithelial capillary network pattern. The microsurface structure is made up of the marginal crypt epithelium/white zone (MCE/WZ), and the intervening part in between. The epithelial morphology is visualized as a semitransparent white belt-like structure (the MCE/WZ), showing a circular or oval shape at the center of which lies the crypt opening. (b) ME with NBI of normal fundic gland mucosa. (Muto M. Digest Endosc 2016)

2) Á¤»ó pyloric gland: microvascular patternÀº dark brown colored coil-shaped open loop¸¦ ÀÌ·ç¸ç, microsurface patternÀº regular polygonal ¶Ç´Â curved marginal crypt epithelium patternÀ» ÀÌ·é´Ù.

Dark brown coil-shaped open loop capillary & polygonal or curved MCE (a) Schematic diagram of the microvascular architecture and the microsurface structure of the normal gastric pyloric gland mucosa corresponding to the surface morphology as visualized by magnifying endoscopy (ME) with narrow-band imaging (NBI). The microvascular architecture is formed by capillaries and collecting venules, but the latter are rarely observed from the mucosal surface. The morphology of each capillary is that of coil-shaped open loops. The mucosal surface structure is made up of the marginal crypt epithelium/white zone (MCE/WZ) and the intervening parts surrounded by MCE/WZ. The MCE/WZ morphology usually shows polygonal structures but may be curved or linear. (b) ME with NBI of normal pyloric gland mucosa. (Muto M. Digest Endosc 2016) Some arteroles penetrate the mucularis mucosa and branch the capillary within the lamina propria. (Fundic gland mucosa¿¡¼­´Â arterioleÀÌ Á¡¸·ÇÏÃþ¿¡ ±¹ÇÑµÈ ¹Ý¸é pyloric gland mucosa¿¡¼­´Â arterioleÀÌ lamina propria¿¡¼­µµ °üÂûµÈ´Ù´Â ÀǹÌÀÔ´Ï´Ù.)


2. Intestinal metaplasiaÀÇ È®´ë³»½Ã°æ ¼Ò°ß

(A) Magnifying endoscopy with narrow-band imaging (M-NBI) findings of light blue crest (LBC) in gastric mucosa with intestinal metaplasia. Fine light blue (light cyan colored) linear reflections are located on the epithelial margins, visualized using M-NBI. LBC is a marker of brush border on the epithelial surface of intestinal metaplasia. (B) M-NBI findings of white opaque substance (WOS) in gastric mucosa with intestinal metaplasia. WOS visualized by reflections/strong scattering of whole projected lights located in the surface epithelium of the intervening part. WOS is lipid micro-droplet that is densely accumulated within the epitheliuam or beneath the mucosal epithelium.


3. À§¾ÏÀÇ È®´ë³»½Ã°æ °üÂû - 3´Ü°è Á¢±Ù¹ý MESDA-G, magnifying endoscopy simple diagnostic algorithm for EGC)

1 ´Ü°è. Á¤»ó ¼Ò°ß ÀÍÈ÷±â - À§¾Ï ³»½Ã°æ Áø´ÜÀ» À§Çؼ­´Â fundic mucosa¿Í pyloric mucosaÀÇ Á¤»ó NBI È®´ë³»½Ã°æ ¼Ò°ßÀ» Àß ¾Ë¾Æ¾ß ÇÕ´Ï´Ù. Microvascular structure¿Í microsurface structure°¡ À§Ä¡¿¡ µû¶ó ´Ù¸£±â ¶§¹®ÀÔ´Ï´Ù.

  1. Microvascular architecture (V) : subepitherial capillary network (SECN), CV (collecting venule)
  2. Microsurface structure (S): marginal crypt epithelium (MCE), crypt opening (CO)

2 ´Ü°è. demarcation line ã±â - ¹é»ö±¤ ³»½Ã°æÀ¸·Î °üÂûÇÏ´Ù°¡ Àǽɽº·¯¿î ÇÔ¸ôºÎÀ§°¡ ÀÖÀ¸¸é NBI È®´ë³»½Ã°æÀ» Àû¿ëÇÕ´Ï´Ù. Á¤»ó°ú ºñÁ¤»óÀÇ °æ°è°¡ º¸À̸é À̸¦ demarcation lineÀ̶ó°í ºÎ¸¨´Ï´Ù (Gut Liver 2021). ÇÑ Àӻ󿬱¸¿¡ ÀÇÇÏ¸é °ËÁø ȯÀÚÀÇ 20% Á¤µµ¿¡¼­ suspicious lesionÀÌ º¸¿© NBI È®´ë³»½Ã°æÀ» Çß´Ù°í ÇÕ´Ï´Ù.

Digest Endosc 2015³â 7¿ùÈ£ WEO Upper GI Cancer Committe

ÁÂÃø »çÁøÀº demarcation lineÀÌ ¸íÈ®ÇÑ ¹Ý¸é ¿ìÃø »çÁø¿¡¼­´Â demarcation lineÀ» ãÀ» ¼ö ¾ø½À´Ï´Ù.

3 ´Ü°è. IMVP¿Í IMSP È®ÀÎ - ÀÏ´Ü demarcation lineÀÌ ÀÖÀ¸¸é microvascular pattern°ú microsurface patternÀ» °üÂûÇÕ´Ï´Ù (VS classification). Irregular microvascular pattern (IMVP)À̳ª irregular microsurface pattern (IMSP)ÀÌ ÀÖÀ¸¸é À§¾ÏÀ¸·Î Áø´ÜÇÒ ¼ö ÀÖ½À´Ï´Ù.

4 ´Ü°è (optional). Other M-NBI findings useful for diagnosis of EGC

1) VEC (vessels within an epithelial circle) - papillary structure or coexisting undifferentiated-type carcinoma and submucosal invasion

2) WGA (white globe appearance) - intraglandular necrotic debris

3) MCDL (multiple convex demarcation line) - non-cancerous depressed lesion

4) Dense-type crypt openings - low grade adenoma

5) Diagnosis of histological differentiation of EGC by M-NBI


[Cases and articles]

¼øõÇâ´ëÇб³ÀÇ ÃÖ±Ù ³í¹®ÀÇ Áõ·ÊÀÔ´Ï´Ù.

Korean J Helicobacter Up Gastrointest Res. 2015 Mar;15(1):39-43


Takashi Kanesaka. Endosc Int Open 2015

Takashi Kanesaka. Endosc Int Open 2015

Takashi Kanesaka. Endosc Int Open 2015

°¢ ¼Ò°ßÀÇ Áø´Ü Á¤È®µµ (Takashi Kanesaka. Endosc Int Open 2015)

Representative cases for each endoscopic microvascular finding. Target lesions indicated with white arrows. a Case 1: dilation and tortuosity were present, but difference in caliber and variation in shape were absent. This lesion was histologically diagnosed as noncancerous. b Case 2: tortuosity was present but dilation, difference in caliber, and variation in shape were absent. This lesion was histologically diagnosed as noncancerous. c Case 3: dilation, difference in caliber and variation in shape were present, but tortuosity was absent. This lesion was histologically diagnosed as cancerous. d Case 4: tortuosity and variation in shape were present but dilation and difference in caliber were absent. This lesion was histologically diagnosed as cancerous. (Takashi Kanesaka. Endosc Int Open 2015)


2016³â 1¿ùÈ£ Endoscopy Áö¿¡ ÀϺ» ¿¬±¸ÀÚµéÀÌ À§¾Ï È®´ë³»½Ã°æ¿¡ ´ëÇÑ »ó¼¼ÇÑ ³í¹®À» ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Shibagaki K. Endoscopy 2016). WLE (white light endoscopy), NBIME (magnification endoscopy with narrow-band imaging), A-NMIME (NBIME with acetic acid enhancement)¸¦ ÀÌ¿ëÇÏ¿© macroscopic pattern¿¡ µû¶ó M1/M2/M3, capillary pattern¿¡ µû¶ó C1/C2/C3/C4, surface pattern¿¡ µû¶ó S1/S2/S3À¸·Î ³ª´©¾ú°í °¢°¢ adenoma/differentiated type EGC/undifferentiated type EGC·Î °£ÁÖÇÏ¿´½À´Ï´Ù.

White-light endoscopy (WLE) images illustrating the macroscopic pattern classification of gastric mucosal neoplasms. Type M1, suggestive of adenoma, is a protruding or flat elevated whitish lesion with a roundish edge and a smooth or often nodular surface. Type M2, suggestive of differentiated adenocarcinoma, is an irregularly shaped and depressed, flat, or elevated lesion either with a red color or without discoloration. Type M3, suggestive of undifferentiated adenocarcinoma, is a depressed whitish lesion with or without variously sized reddish nodules.

Magnification endoscopy with narrow-band imaging (NBIME) images illustrating the capillary pattern classification of gastric mucosal neoplasms. Type C1, suggestive of adenoma, has capillaries with a homogenous diameter and distribution, which form round or oval networks (C1-a, network form) or grow within regular mucosal microstructures (C1-b, intra-microstructure form). Type C2, suggestive of differentiated adenocarcinoma, has capillaries with a heterogeneous diameter and distribution, which form a polygonal or incomplete network (C2-a, network form) or grow within irregular mucosal microstructures (C2-b, intra-microstructure form). Type C3, suggestive of undifferentiated adenocarcinoma, has capillaries with a heterogeneous diameter and distribution, which grow in a disordered fashion with an unclear mucosal microstructure. Type C4, which is not related to a specific histologic type, has capillaries that are invisible or obviously decreased in number.

Magnification endoscopy with narrow-band imaging and acetic acid enhancement (A-NBIME) images illustrating the microstructure pattern classification of gastric mucosal neoplasms. Type S1, suggestive of adenoma, has glandular crypts present, with homogeneously sized, shaped and arranged foveolae (S1-a, foveola form) or grooves (S1-b, groove form). Type S2, suggestive of differentiated adenocarcinoma, has glandular crypts present, with heterogeneous foveolae or grooves (S2-a, foveola form; S2-b, groove form). Type S3, suggestive of undifferentiated adenocarcinoma, has absent or severely decreased numbers of glandular crypts.

ÀúÀÚµéÀº ¾Æ·¡ Table 5 °á°ú¸¦ ¹ÙÅÁÀ¸·Î "A-NBIME showed statistically significantly higher diagnostic accuracy for gastric mucosal neoplasms, with good reproducibility, compared with WLE and NBIME, which provided similar lower accuracy."¶ó°í °á·ÐÁþ°í ÀÖ½À´Ï´Ù. ¾î¶»°Ô Çؼ®µÇ¾î¾ß ÇÒÁö °í¹ÎÀÔ´Ï´Ù. Acetic acid¸¦ »ç¿ëÇÑ È®´ë³»½Ã°æÀÌ µµ¿òÀÌ µÈ´Ù´Â °ÍÀº ÀÎÁ¤ÇÒ ¼ö ¹Û¿¡ ¾øÀ» °Í °°½À´Ï´Ù. ÇÏÁö¸¸ white light endoscopy¿Í NBI È®´ë³»½Ã°æÀÇ Â÷ÀÌ°¡ ¾ø´Ù´Â À̹ø °á°ú´Â ±âÁ¸¿¡ ¸¹Àº ÀϺ» ¿¬±¸ÀÚµéÀÌ NBI È®´ë³»½Ã°æÀÌ Áø´Ü¿¡ À¯¿ëÇÏ´Ù°í ÁÖÀåÇß´ø °Í°ú´Â »ó¹ÝµÇ´Â °ÍÀÔ´Ï´Ù. Àú´Â À̹ø ¿¬±¸ °á°ú¸¦ 'white light endoscopyµµ Àß º¸¸é »ó´çÈ÷ ÁÁ´Ù'´Â ¹æÇâÀ¸·Î Çؼ®ÇÏ°í ½Í½À´Ï´Ù. ÇâÈÄ ¾î¶² ¹æÇâÀ¸·Î °á·ÐÀÌ ¸ðÀÏÁö ÁöÄѺ¼ ÀÏÀÔ´Ï´Ù.


4. Á¶±âÀ§¾Ï ESD Àü lateral marginÀÇ È®ÀÎ

Differentiated-type¿¡¼­´Â white light endoscopy, chromoendoscopy, magnifying NBI ¼Ò°ßÀ¸·Î ¹üÀ§¸¦ Á¤ÇÒ ¼ö ÀÖ½À´Ï´Ù. ±×·¯³ª undifferentiated-type¿¡¼­´Â ÀÌ ¸ðµç °ÍÀÌ Å©°Ô µµ¿òµÇÁö ¾Ê¾Æ¼­ º´¼Ò ÁÖº¯ Á¶Á÷°Ë»ç¿¡ ÀÇÁ¸ÇÒ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. 2016³â ÀϺ» ¾Ï¿¬±¸È¸º´¿ø ¿¬±¸ÀÚµéÀÌ undifferentiated-type¿¡¼­µµ ¾î´À Á¤µµ µµ¿òÀÌ µÈ´Ù´Â ¹ßÇ¥¸¦ ÇÏ°í ÀÖÁö¸¸... (Horiuchi Y. Gastric Cancer 2016).


5. Undifferentiated-type Á¶±âÀ§¾Ï ESD Àü NBI È®´ë³»½Ã°æÀÇ À¯¿ë¼º

ÀüÅëÀûÀ¸·Î NBI È®´ë³»½Ã°æÀº differentiated-type EGC¿¡¼­ µµ¿òÀÌ µÇ°í undifferentiated-type EGC¿¡¼­´Â º°·Î µµ¿òµÇÁö ¾Ê´Â °ÍÀ¸·Î ¾Ë·ÁÁ³½À´Ï´Ù. 2016³â ÀϺ» ¾Ï¿¬±¸È¸º´¿ø ¿¬±¸ÀÚµéÀÌ undifferentiated-type EGC¿¡¼­µµ ¾î´À Á¤µµ µµ¿òÀÌ µÈ´Ù°í º¸°íÇÏ¿´½À´Ï´Ù (Horiuchi Y. Gastric Cancer 2016).


6. Near focus

È®´ë ³»½Ã°æÀ» ÅëÇÏ¿© microvascular pattern°ú microsurface patternÀ» °üÂûÇÏ´Â °ÍÀÌ À¯ÇàÀÔ´Ï´Ù. Zoom lensÀÇ À̵¿À» ÀÌ¿ëÇÑ Á¤½Ä È®´ë ³»½Ã°æÀÌ ¾Æ´Ñ ¸ðµ¨ Áß Near Focus¶ó´Â ±â´ÉÀ» °¡Áø ³»½Ã°æÀÌ ÀÖ½À´Ï´Ù (ÃÊÀå±â¿¡´Â dual focus¶ó°í ºÒ·¶½À´Ï´Ù). Near Focus´Â ¾à°£ digital ÀûÀ¸·Î buttonÀ» ´©¸£¸é ·»Áî Çϳª°¡ À§Ä¡¸¦ ¹Ù²ã focus°¡ °¡±õ°Ô ¹Ù²î´Â ±â´ÉÀÔ´Ï´Ù. Á» ´õ Á¢±ÙÇÏ·Á fine surface patternÀ» º¼ ¼ö ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù.

Olympus Near FocusÀÇ ÀÛµ¿ ¿ø¸® (https://medical.olympusamerica.com/technology/dual-focus)

¾Æ·¡ »çÁøÀº Á¤»ó À§Á¡¸·ÀÔ´Ï´Ù. ¿ìÃø Near Focus ¿µ»ó¿¡¼­ RACÀÌ ´õ Àß º¸´Ï´Ù. ¾à°£ÀÇ surface pattern°ú ÇÔ²².

Near Focus¸¦ ÄѸé zoom Á¤µµ´Â ¾Æ´ÏÁö¸¸ º¸Åë ³»½Ã°æº¸´Ù´Â ÈξÀ È®´ëµÈ ¿µ»óÀ» º¸°Ô µË´Ï´Ù. Áø´ÜÀû À¯¿ë¼ºÀº ¾ÆÁ÷ Àß ¸ð¸£°ÚÁö¸¸, Èï¹Ì·Î¿î Àå³­°¨ÀÎ °ÍÀº Ʋ¸² ¾ø½À´Ï´Ù. ¾Æ·¡ Áõ·ÊÀÇ ¿ìÃø ¾Æ·¡ »çÁøÀÌ Near focusÀÔ´Ï´Ù. Solid ºÎºÐÀÌ 30% Á¤µµ ÀÖ´Â Lauren diffuse type À§¾ÏÀ̾ú½À´Ï´Ù.


Stomach, subtotal gastrectomy: Early gastric carcinoma
1. Location : lower third, Center at antrum and postero-greater curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, poorly (solid) differentiated with signet ring cell component (20%)
4. Histologic type by Lauren : diffuse
5. Size : 2x1.5 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 4.1 cm, distal 6.6 cm
8. Lymph node metastasis : no metastasis in 37 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1b N0


7. ½Äµµ esophagus

½Äµµ È®´ë³»½Ã°æ¿¡¼­´Â IPCLÀ» °üÂûÇØ¾ß ÇÕ´Ï´Ù.

IPCL (ÀÚ·á Á¦°ø: À̼±¿µ ±³¼ö´Ô)

¸î °³ÀÇ ºÐ·ù¹ýÀÌ ÀÖ¾ú´Âµ¥ À̸¦ ÅëÇÕÇÏ¿©

ANBIIG Tailand 2020¿¡¼­ ÀϺ» Toranomon HospitalÀÇ Daisuke Kikuchi ¼±»ýÀÇ °­ÀǸ¦ ²À µé¾îº¸½Ã±â ¹Ù¶ø´Ï´Ù.


8. ´ëÀå image-enhanced endoscopy (IEE)

Image-enhanced endoscopy (IEE)
Conventional chromoendoscopyVirtual chromoendoscopy
Dye-basedEquipment-based
Contrast: indigocarmine
Absorptive: crystal violet
Optical: NBI (Olympus), OE (Pentax)
Electronic: FICE, i-scan SE & TE (Pentax)
Others: BLI, LCI (Fujifilm)
Pit patternCapillary pattern

»ö¼Ò³»½Ã°æÀ» ÀÌ¿ëÇÑ Kudo ºÐ·ù´Â pit patternÀ» º¸´Â °ÍÀÌ°í, NBI µîÀ» ÀÌ¿ëÇÑ Sano ºÐ·ù´Â capillary patternÀ» º¸´Â °ÍÀÔ´Ï´Ù. Hiroshima, NICE, JNETÀº capillary patternÀ» ÁÖ·Î º¸¸é¼­ surface patternÀ» Á¶±Ý ÂüÁ¶ÇÏ´Â ¹æ¹ýÀÔ´Ï´Ù.

Pit´Â intestinal glandÀÇ openingÀÔ´Ï´Ù. IndigocarmineÀ» ºÐ¹«Çϸé dye°¡ pit¿¡ °íÀ̹ǷΠpit°¡ °Ë°Ô º¸ÀÔ´Ï´Ù. Crystal violet ¿°»öÀ» Çϸé pit ÁÖº¯ »óÇǼ¼Æ÷ÀÇ ÇÙÀÌ ¿°»öµÇ¹Ç·Î pit ÀÚü´Â ÇϾé°Ô º¸ÀÔ´Ï´Ù.


[Conventional IEE (pit pattern)]

Kudo ºÐ·ù.

Hyperplastic polypÀ̳ª serrated polyp¿¡¼­´Â crypt »óºÎ Àý¹ÝÀÌ serration µÇ¸é¼­ ÇϺΰ¡ È®´ëµÇ±â ¶§¹®¿¡ pitÀÇ º¯È­°¡ ¿É´Ï´Ù.


[Equipment-base IEE]

»ö¼Ò ºÐ¹« ÈÄ È®´ë³»½Ã°æ ¼Ò°ßÀÎ pit patternÀº ÀÏÂïºÎÅÍ Kudo ºÐ·ù·Î ÅëÀϵǾú½À´Ï´Ù. ¹Ý¸é, NBI¸¦ ÀÌ¿ëÇÑ ´ëÀå³»½Ã°æ È®´ë³»½Ã°æ ¼Ò°ß¿¡ ´ëÇؼ­´Â ¸Å¿ì ¸¹Àº ºÐ·ù¹ýÀÌ ³­¸³ÇÏ¿´½À´Ï´Ù (Utsumi T. Clin Endosc 2015). ¸¶Ä§³» 2016³â ¿©¸§ JNET ºÐ·ù°¡ ³ª¿À¸é¼­ ÃÑÁ¤¸®µÇ´Â ºÐÀ§±âÀÔ´Ï´Ù (Sano Y. Digest Endosc 2016).

Sano ºÐ·ù. Capillary pattern¸¸ °üÂûÇϹǷΠºñ±³Àû °£´ÜÇÑ ºÐ·ùÀÔ´Ï´Ù. ±×·¯³ª Sano ºÐ·ù´Â È®´ë³»½Ã°æ °üÂûÀ» ÀüÁ¦·Î Àû¿ëÇÏ´Â ¹æ¹ýÀÔ´Ï´Ù.

NICE ºÐ·ù. Capillary patternÀ» ÁÖ·Î º¸¸é¼­ »öÁ¶³ª surface patternÀ» °üÂûÇÏ´Â ¹æ¹ýÀÔ´Ï´Ù. NICE II´Â Sano II-IIIA¿Í ºñ½ÁÇÏ°í NICE III´Â Sano IIIB¿Í ºñ½ÁÇÕ´Ï´Ù. Sano capillary pattern classificationÀº È®´ë³»½Ã°æÀ» ÀüÁ¦·Î Àû¿ëÇÑ °ÍÀÎ ¹Ý¸é, NICE ºÐ·ù´Â È®´ë³»½Ã°æÀÌ ¾Æ´Ñ ÀÏ¹Ý ³»½Ã°æÀ» ÀüÁ¦·Î ¸¸µé¾îÁø ¹æ¹ýÀÔ´Ï´Ù.

JNET ºÐ·ù. NICE II¸¦ JNET 2A, 2B·Î ³ª´« °ÍÀ¸·Î ÀÌÇØÇÏ¸é µÇ°Ú½À´Ï´Ù. NICE ºÐ·ùÀÇ ÇѰ踦 ±Øº¹Çϱâ À§ÇÑ JNET ºÐ·ù´Â È®´ë³»½Ã°æÀ» ÀüÁ¦·Î ¸¸µé¾îÁø ¹æ¹ýÀÔ´Ï´Ù.

JNET ºÐ·ù reference panel

Depth of invasion °üÂû¿¡´Â equipment-base IEE (Sano, NICE, JNET ºÐ·ù)º¸´Ù »ö¼Ò³»½Ã°æ ÈÄ È®´ë³»½Ã°æÀ¸·Î °üÂûÇÑ pit pattern ºÐ·ù°¡ ¿ì¿ùÇÑ °ÍÀ¸·Î ÀÎÁ¤µÇ°í ÀÖ½À´Ï´Ù. µû¶ó¼­ strategy¶ó´Â °ÍÀÌ Á¦¾ÈµÇ¾ú½À´Ï´Ù. °£´ÜÈ÷ ¸»ÇÏÀÚ¸é ÀÏ¹Ý ³»½Ã°æ(white light endoscopy)¿¡¼­ ÀÌ»ó ¼Ò°ßÀÌ º¸À̸é equipment-based IEE¸¦ Àû¿ë(°¡Àå °£´ÜÇÑ °ÍÀºNBI¸¦ ÄÑ´Â °ÍÀÔ´Ï´Ù)ÇÏ°í ¾È ÁÁÀº ¼Ò°ßÀÌ º¸À̸é pit patternÀ» º¸±â À§ÇÏ¿© crystal violet ¿°»ö ¹× È®´ë³»½Ã°æÀ» ÇÏ´Â °ÍÀÔ´Ï´Ù.

Three step strategy.

½ÇÁ¦ ȯÀÚ¿¡¼­´Â ¾Ö¸ÅÇÑ °æ¿ì°¡ ¾ÆÁÖ ¸¹½À´Ï´Ù. 2023³â 8¿ù 20ÀÏ KSGE seminarÀÇ Åä·ÐÀ» »ìÆ캸½Ã±â ¹Ù¶ø´Ï´Ù.

KSGE seminar. Log-in é©


[i-scan°ú optical enhancement (Pentax)]

Pentax´Â ºñ·Ï ±¤ÇÐÀû È®´ë³»½Ã°æÀ» Á¦°øÇÏÁö ¾Ê°í ÀÖÀ¸³ª i-ScanÀ̶ó´Â image enhancement technology¸¦ Á¦°øÇÏ´ø ȸ»çÀÔ´Ï´Ù (World J Gastroenterol. 2010 - full text free). ÃÖ±Ù¿¡´Â i-ScanÀÇ mode¸¦ ¹Ù²ã¼­ surface enhancement (SE)¿Í tone enhancement (TE) ±â´ÉÀ¸·Î ÀÌÇØÇϱ⠽±°Ô ¸¸µé¾ú´Ù°í ÇÕ´Ï´Ù. ¿©±â¿¡ optic filter¸¦ Àû¿ëÇÏ¿© Á¼Àº band¸¦ ÀÌ¿ëÇÑ optical enhancement (OE)¸¦ ´õÇÏ¿© ¼¼ °¡Áö mode°¡ °¡´ÉÇÏ°Ô µÇ¾ú½À´Ï´Ù. SE, TE¸¦ ºñ±³ÇÒ ¼ö ÀÖ´Â mini atlas¿Í OEÀÇ ±â¼úÀû Ư¡À» ¼³¸íÇÑ white paper¸¦ ¼Ò°³ÇÕ´Ï´Ù.

- SE, TE¸¦ ºñ±³ÇÒ ¼ö ÀÖ´Â mini atlas. PDF 4.7M

- OEÀÇ ±â¼úÀû Ư¡À» ¼³¸íÇÑ white paper. PDF 0.6M

º¸´Ù ÀÚ¼¼ÇÑ Á¤º¸´Â ¾Æ·¡ ¸µÅ©¿¡ ÀÖ½À´Ï´Ù.

* Âü°í: i-scan technology


[References]

1) EndoTODAY image enhanced endoscopy IEE

2) Magnifying endoscopy in upper GI tract ±è±¤ÇÏ (IDEN 2019)

3) NBI magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team Sano Y. Digest Endosc 2016 (PDF)

4) Image-enhanced endoscopy and its corresponding histopathology in the stomach Doyama H. Gut Liver 2021

5) 2017³â 5¿ù 20ÀÏ ³»½Ã°æ±â±â/½ºÅÙÆ®¿¬±¸È¸ ½ÉÆ÷Áö¾ö (±×·£µå¾Ú¹è¼­´õÈ£ÅÚ)

6) Olympus ȍ˂ magnifying endoscopy training phantom

2019-11-16 KSGE °æÁÖ

2019-11-16 KSGE °æÁÖ

7) íþå¯È®´ë³»½Ã°æ¿¬±¸È¸

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