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EndoTODAY ³»½Ã°æ ±³½Ç


[Obscure GI bleeding]

1. Position statement (2013-4-10. ÀÌÁØÇà)

Obscure GI bleeding ȯÀÚÀÇ »óºÎ ³»½Ã°æ°ú ÇϺΠ³»½Ã°æÀÌ À½¼ºÀÏ ¶§ CT¸¦ ¸ÕÀú ÇÏ°í ÀÌ»óÀÌ ¾øÀ» ¶§ capsule endoscopy¸¦ ±ÇÇÏ°í ÀÖ½À´Ï´Ù. ÀÏ°ß capsule endoscopy¸¦ ¸ÕÀú ÇÏ°í CT¸¦ °í·ÁÇÏ´Â ¹æ¹ýÀÌ ³í¸®ÀûÀ¸·Î º¸ÀÔ´Ï´Ù¸¸, ÀúÀÇ Á÷°ü°ú °æÇèÀ¸·Î´Â CT°¡ ÈξÀ ºü¸£°í °´°üÀûÀ̶ó°í »ý°¢µË´Ï´Ù. Capsule endoscopy¸¦ ±ÇÇÏÁö ¾Ê´Â´Ù´Â À̾߱â´Â ¾Æ´Õ´Ï´Ù. ´Ù¸¸ Á¦ ȯÀÚ¿¡¼­´Â CT¸¦ ¸ÕÀú ÇÏ°í À־ capsule endoscopy°¡ ÇÊ¿äÇÑ °æ¿ì°¡ ÈξÀ ÀûÀ» »ÓÀÔ´Ï´Ù.


2. ºÐ·ù ¹× ¿øÀÎ

Ohmiya N. Dig Endoscopy 2015

Á¦°¡ °¡Àå °­Á¶ÇÏ°í ½ÍÀº ³»¿ëÀÔ´Ï´Ù. À§³»½Ã°æ°ú ´ëÀå³»½Ã°æÀ» ¹Ýº¹ÇÏ´Â °ÍÀÌ µµ¿òµÉ ¶§°¡ ¸¹½À´Ï´Ù. À§³»½Ã°æÀ̳ª ´ëÀå³»½Ã°æ¿¡¼­ ÃâÇ÷º´¼Ò¸¦ ³õÄ¡°í ¾û¶×ÇÏ°Ô ¼ÒÀåÃâÇ÷ ȯÀÚ·Î Áø´ÜÀ» ºÙÀÌ´Â °æ¿ì°¡ Àֱ⠶§¹®ÀÔ´Ï´Ù.


3. Capsule endoscopy·Î ¿øÀÎÀ» ¹àÈ÷Áö ¸øÇÏ¿´´ø obscure GI bleeding¿¡¼­ CT°¡ µµ¿òÀÌ µÇ¾ú´ø ÀλóÀûÀÎ Áõ·Ê

Capsule endoscopy°¡ ±¹³»¿¡ óÀ½ µµÀԵǴø ½ÃÀý(2009³â ?)ÀÇ È¯ÀÚÀÔ´Ï´Ù. Recurrent melena·Î capsule endoscopy, angiography, RBC scanµîÀ» ½ÃÇàÇÏ¿´À¸³ª Áø´ÜµÇÁö ¾Ê¾Æ ÀÀ±Þ½Ç·Î ¿À¼Ì½À´Ï´Ù. ´ç½Ã ÀÀ±Þ½Ç protocolÀº À§Àå°ü ÃâÇ÷¿¡¼­ »óÇϺΠ³»½Ã°æ¿¡ ÀÌ»óÀÌ ¾øÀ¸¸é CT¸¦ Âï´Â °ÍÀ̾ú½À´Ï´Ù. ¾ÆÁÖ ´Ü¼øÇÑ protocolÀÔ´Ï´Ù. Á¦°¡ »ç¶ûÇÏ´Â ¹æ½ÄÀÔ´Ï´Ù. Simplicity. KISS (keep it simple and smart).

CT¿¡¼­ Áï½Ã mass°¡ ¹ß°ßµÇ¾ú°í ¼ö¼úÇÏ¿© GIST°¡ ³ª¿Ô½À´Ï´Ù.

ȯÀÚ°¡ ¹°¾ú½À´Ï´Ù. "ÁøÀÛ CT¸¦ ÂïÁö ¾Ê¾Ò´ø ÀÌÀ¯°¡ ¹«¾ùÀϱî¿ä?" Àú´Â ±Ã»öÇÑ ´äº¯À» ÇÒ ¼ö ¹Û¿¡ ¾ø¾ú½À´Ï´Ù. "±Û½ê¿ä..... ±Û½ê¿ä..... ¹¹¶ö±î..... Àú¾ß ¿À´Ã óÀ½ ȯÀÚºÐÀ» ÁøÂûÇÑ °ÍÀ̹ǷΠ°ú°Å »óȲÀ» Á¤È®È÷ ¾Ë ¼ö´Â ¾øÁö¸¸..... ÀúÈñ°¡ CT¸¦ Âï¾î Áø´ÜÇÏ¿´´ø °ÍÀº °ÅÀÇ ¿ì¿¬¿¡ °¡±õ´Ù°í º¸½Ã¸é µÇ´Âµ¥¿ä.... Ã¥¿¡ ³ª¿ÍÀÖ´Â ¿øÄ¢Àº ±×ÂÊ º´¿ø¿¡¼­ ÇÏ¿´´ø °Í´ë·Î ÇÏ´Â °ÍÀÌ ¸Â½À´Ï´Ù..... ±³°ú¼­ ¾îµð¿¡µµ ÀÌ·± °æ¿ì CT¸¦ ÂïÀ¸¶ó´Â ¸»ÀÌ ¾ø½À´Ï´Ù.....ÀúÈñ¾ß ¿©·¯ °Ë»ç¿¡¼­ Áø´ÜÀÌ ³ª¿ÀÁö ¾Ê¾Ò´Ù´Ï ±Ã¿©ÁöÃ¥À¸·Î CT¸¦ ÇÒ ¼ö ¹Û¿¡ ¾ø¾ú´ø °ÍÀÌÁö¿ä..... ¾î¿ ¼ö ¾ø¾î ±×·¸°Ô µÇ¾ú´Ù°í º¸½Ã¸é µË´Ï´Ù..... Àú¾ß ´ÜÁö ¿îÀÌ ÁÁ¾Ò´ø °ÍÀ̶ó°í..... ..... ..... ¾î¤jµç ´ÙÇàÀÔ´Ï´Ù... Áö±ÝÀÌ¶óµµ Áø´ÜÇؼ­....."

¿Ö CT¶ó´Â ½¬¿î ±æÀ» ³öµÎ°í º¹ÀâÇÑ °Ë»ç¸¦ ¿Õâ ½ÃÇàÇÏ°Ô µÇ¾ú´ø °ÍÀϱî¿ä? ´ç½Ã obscure GI bleedingÀ» ¼³¸íÇÑ ±³°ú¼­¸¦ º¸¸é ¾îµð¿¡µµ CT¸¦ ÂïÀ¸¶ó´Â ¸»ÀÌ ¾ø¾ú½À´Ï´Ù. Angiography, RBC scan, Capsule endoscopy, enteroscopyµî ¾î·Æ°í º¹ÀâÇÑ °Ë»ç¸¸ ÀÜ¶à ¼³¸íµÇ¾î ÀÖ¾ú½À´Ï´Ù. ±³°ú¼­ÀÇ ÀúÀڵ鵵 fancyÇÑ °Ë»ç¿¡ ²ø¸®´Â ¸ð¾çÀÔ´Ï´Ù. À¯ÇàÀ̶ö±î... trend¶ö±î... ¹¹ ±×·± °ÍÀÌ ÀÖ½À´Ï´Ù. CT¾ß ³Ê¹« Æò¹üÇÑ °Ë»çÀ̹ǷΠÁø´Ü algorithm¿¡ ³Ö´Â °ÍÀº Ã̽º·´´Ù°í »ý°¢ÇÏ´Â ¸ð¾çÀÔ´Ï´Ù. ±³°ú¼­ ÀúÀÚµéÀÌ ±×·± »óȲÀÌ´Ï ¿ì¸®°°Àº Æò¹üÇÑ ÀÇ»çµéÀº Ã¥À» º¸°í ±×´ë·Î ÇÒ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. ÇлýÀÌ¾ß ¼±»ý´Ô ¸»¾¸´ë·Î ÇÏ´Â °ÍÀÌÁö¿ä. ±×·±µ¥ ¼±»ý´Ôµµ Àΰ£ÀÎÁö¶ó À¯Çà¿¡ ²ø¸®´Â ¸ð¾çÀÔ´Ï´Ù. ¹¹ »çÁ¤Àº ±×·¸°Ô µÇ¾ú´ø °ÍÀÔ´Ï´Ù. ȯÀÚ°¡ ÀÌÇØÇÒ ¼ö ÀÖÀ»±î¿ä? ±³°ú¼­¸¦ µû¶ó Çϸé Áø´ÜµÇÁö ¾ÊÀ» ¼ö ÀÖ´Ù´Â »çÁ¤À» ÀÌÇØÇÒ ¼ö ÀÖÀ»±î¿ä? ±³°ú¼­°¡ ¸ðµç °æ¿ì¸¦ cover ÇÒ ¼ö ¾ø´Ù´Â °ÍÀ» ÀÌÇØÇÒ ¼ö ÀÖÀ»±î¿ä? Àΰ£ÀÇ ¸öÀº ÀÇÇÐ ±³°ú¼­°¡ coverÇϱ⿡´Â ³Ê¹« º¹ÀâÇÏ´Ù´Â °ÍÀ» ÀÌÇØÇÒ ¼ö ÀÖÀ»±î¿ä? ±³°ú¼­º¸´Ù Æò¹üÇÑ ÀÇ»çÀÇ °æÇèÀÌ ´õ Áß¿äÇÒ ¼ö ÀÖ´Ù´Â °ÍÀ» ÀÌÇØÇÒ ¼ö ÀÖÀ»±î¿ä?

FancyÇÑ °Ë»çº¸´Ù ¿À·¡µÇ°í ÈçÇÑ Æò¹üÇÑ º¸Åë °Ë»ç, Ã̽º·´´Ù°í ´À²¸Áö´Â ½Î°í Àͼ÷ÇÑ °Ë»ç°¡ ´õ ÁÁÀ» ¼ö ÀÖ½À´Ï´Ù. »õ ½Å¹ßº¸´Ù Çå ½Å¹ßÀÌ ÆíÇÑ ¿ø¸®¿Í ºñ½ÁÇÕ´Ï´Ù. CT´Â °¡°Ý´ëºñ ¼º´ÉÀÌ ¸Å¿ì ÁÁÀº °Ë»çÀÔ´Ï´Ù. ¾à°£ÀÇ radiation hazard°¡ ´ÜÁ¡ÀÌÁö¸¸ ÀÓ»óÀû À¯¿ë¼ºÀ» °í·ÁÇϸé Å©°Ô ¹®Á¦µÇÁö ¾Ê½À´Ï´Ù. Àú´Â ±×·¸°Ô ¹Ï½À´Ï´Ù.

Obscure GI bleeding¿¡ ´ëÇÑ ÃÖ±Ù review¿¡¼­ CT°¡ ºÎÈ°ÇÑ °ÍÀ» º¸¾Ò½À´Ï´Ù. ¾ó¸¶³ª ¹Ý°©´øÁö..... ¾Ë°íº¸´Ï ¿¹Àü ¹æ½ÄÀÌ ÁÁ¾Ò´ø °ÍÀÌÁö¿ä. ±¸°üÀÌ ¸í°üÀÎ °æ¿ìÀÔ´Ï´Ù.

FancyÇÑ °Í ³Ê¹« ÁÁ¾ÆÇÏÁö ¸¿½Ã´Ù. º¸±â ÁÁÀº ¶±ÀÌ ¸Ô±â¿¡´Â ÁÁÁö ¾ÊÀ» ¼ö ÀÖ½À´Ï´Ù.


[2018-3-8. ¸ñ¿äÁý´ãȸ Áõ·Ê]

Melena·Î À§´ëÀå³»½Ã°æ °Ë»ç¸¦ ¹Þ¾ÒÀ¸³ª Ưº°ÇÑ ÀÌ»óÀÌ ¾ø¾ú½À´Ï´Ù. CT¿¡¼­ ¼ÒÀå º´¼Ò°¡ ¹ß°ßµÇ¾ú½À´Ï´Ù.


Small intestine, segmental resection: Mucinous adenocarcinoma
1. Location: terminal ileum
2. Gross type: ulcerofungating
3. Size: 11x9 cm
4. Depth of invasion: penetrates visceral peritoneum(pT4a)
5. Resection margin: free from carcinoma
6. Lymphatic invasion: present
7. Venous invasion: not identified
8. Perineural invasion: present(extramural)

ÀÌ È¯ÀÚ¿¡¼­ Ư±âÇÒ Á¡Àº CT Àü capsule ³»½Ã°æÀ» ¹Þ¾Ò´Âµ¥ º´¼Ò°¡ ¹ß°ßµÇÁö ¾Ê¾Ò´Ù´Â °ÍÀÔ´Ï´Ù. Àú´Â capsule Àü CT °Ë»ç°¡ ²À ÇÊ¿äÇÏ´Ù°í »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù. Practiceµµ ±×·¸°Ô ÇÏ°í ÀÖ½À´Ï´Ù.


4. 'Capsule endoscopy·Î ¿øÀÎÀ» ¹àÈ÷Áö ¸øÇÏ¿´´ø obscure GI bleeding¿¡¼­ CT°¡ µµ¿òÀÌ µÇ¾ú´ø ÀλóÀûÀÎ Áõ·Ê'¿¡ ´ëÇÑ ¿©·¯ºÐÀÇ ÀÇ°ß°ú ÀÌÁØÇàÀÇ ´äº¯

[2013-4-9 ¾Öµ¶ÀÚ ÀÇ°ß. S´ë ±³¼ö]

¼±»ý´ÔÀÇ ÀÇ°ß¿¡ °ÅÀÇ ´ëºÎºÐ µ¿ÀÇÇϳª ÇÑ°¡Áö ´Ù¸¥ Á¡ÀÌ ÀÖ¾î ÀÇ°ß µå¸³´Ï´Ù. Obscure bleedingÀÌ small bowel bleedingÀÌ ´ëºÎºÐÀÎ Á¡, small bowel bleedingÀÇ ¿øÀÎ Áß CT¿¡¼­ ¹ß°ßÀÌ µÉ ¸¸ÇÑ mass·Î presentationÇÏ´Â °æ¿ì (cancer, GIST, lymphoma µî)°¡ »ó´ëÀûÀ¸·Î ÈçÇÏÁö ¾Ê´Ù´Â Á¡¿¡¼­ EGD, colon¿¡¼­ ÀÌ»ó¼Ò°ß ¾øÀ» ¶§ ´ÙÀ½ approach·Î CT¸¦ ±ÇÇÏ´Â °ÍÀº ÀûÀýÇÏ´Ù°í º¸±â ¾î·Æ´Ù°í »ý°¢ÇÕ´Ï´Ù. Lumen³»·Î BleedingÀ» µ¿¹ÝÇÑ´Ù¸é ´ç¿¬È÷ mucosal abnormality°¡ ÀÖÀ» °ÍÀÌ°í, CT¿¡¼­ º¸Àϸ¸ÇÑ mass¶ó¸é capsule¿¡¼­ º¸ÀÌÁö ¾Ê¾Ò´Ù´Â °ÍÀÌ ¿ÀÈ÷·Á ÀÌ»óÇÑ Á¡ÀÔ´Ï´Ù. À§ÀÇ case¿Í °°ÀÌ Å©±â°¡ Å« º´º¯ÀÌ ¾Èº¸¿´´Ù´Â °ÍÀº Á» ÀÌÇØÇϱ⠾î·Æ½À´Ï´Ù (bleedingÀÌ ÀÖ¾ú´Ù¸é extrlaluminal lesionÀÌ ¾Æ´Ï¾úÀ»ÅÙµ¥¿ä...) Capsule¿¡¼­µµ ¼Ò°ßÀÌ º¸ÀÌÁö ¾ÊÀ» °æ¿ì CT¸¦ º¸Á¶ÀûÀ¸·Î ½ÃÇàÇغ¼ ¼ö ÀÖÁö¸¸ CT¸¦ ¸ÕÀú ½ÃÇàÇÏ´Â °ÍÀº ÀÌ·ÐÀûÀ¸·Î ÀûÀýÄ¡ ¾Ê´Ù°í »ý°¢ÇÕ´Ï´Ù.

[2013-4-10. ÀÌÁØÇà ´äº¯]

ÁÁÀº ÀÇ°ßÀÔ´Ï´Ù. »ç½Ç ¾ðÁ¨°¡ obscure GI bleedingÀÇ Áø´Ü algorithm¿¡ CT°¡ µé¾î°¡ ÀÖ´Â °ÍÀ» ¹ß°ßÇÏ°í ¹«Ã´ Áñ°Å¿ö ÇÑ °æÇèÀÌ ÀÖ½À´Ï´Ù. ±×·±µ¥ ¸·»ó ¿À´Ã ãÀ¸·Á°í Çߴµ¥ ¹ß°ßÇÒ ¼ö ¾ø¾ú½À´Ï´Ù. ¿©ÇÏÆ° ¾ÆÁ÷±îÁö ÁÁÀº ¿¬±¸¸¦ ÅëÇÏ¿© CT°¡ obscure GI bleeding¿¡¼­ Áß¿äÇÑ ¿ªÇÒÀÌ ÀÖ´Ù°í ÀÔÁõµÈ °æ¿ì´Â °ÅÀÇ ¾ø´Â °Í °°½À´Ï´Ù. ±×·¯³ª Àú´Â °æÇè»ó µµ¿òÀÌ µÈ´Ù°í »ý°¢ÇÕ´Ï´Ù. ±×¸®°í ¿µ»óÀÇÇаúÂÊÀÇ Àú³Î¿¡¼­´Â °¡²û °£Á¢ÀûÀÎ ¾ð±ÞÀÌ ÀÖ½À´Ï´Ù. µÎ ºÐ ¼±»ý´ÔÀÇ ÀÇ°ß¿¡ ¹Ý´ëÇÏ´Â °ÍÀº ¾Æ´Õ´Ï´Ù¸¸... Àú´Â ¾ÆÁ÷µµ capsule endoscopy¸¦ Çϱâ Àü¿¡ CT¸¦ ±ÇÇÏ°í ÀÖ½À´Ï´Ù. Àç¹Ì¸¦ ¸¹ÀÌ º¸¾Ò½À´Ï´Ù. Á» ´õ °æÇèÀÌ ½×ÀÌ¸é ´Ù½Ã ³íÀÇÇØ º¸´Â ¼ö ¹Û¿¡ ¾ø´Ù°í º¾´Ï´Ù. ¾Æ·¡¸¦ ÂüÁ¶ÇϽñ⠹ٶø´Ï´Ù.

1. 2005³â EndoscopyÁö¿¡ ½Ç¸° ICCE consensus for obscure gastrointestinal bleedingÀÇ ±×¸²¿¡¼­µµ CT´Â ã¾Æº¼ ¼ö ¾ø½À´Ï´Ù.

2. ÃÖ±Ù Sleisenger ±³°ú¼­¿¡µµ ¾ÆÁ÷ obscure GI bleeding Áø´Ü ¾Ë°í¸®Áò¿¡ CT´Â ¾ø´Â °ÍÀÌ ¸Â½À´Ï´Ù.

3. ±×·¯³ª 2008³â ItalyÀÇ ¿µ»óÀÇÇаú ÀÇ»çµéÀÌ ¹ßÇ¥ÇÑ ¸®ºä(Filippone. 2009)¿¡¼­ multidetector CT°¡ obscure GI bleeding¿¡¼­ mural ¹× extra-mural lesionÀ» º¸´Âµ¥ À¯¸®ÇÏ´Ù°í ¾ð±ÞÇÏ°í ÀÖ½À´Ï´Ù. °°Àº ÀúÀÚµéÀÇ ÃÖ±Ù ¸®ºä(Filippone. 2012)¿¡´Â ÀÌ·± ¹®Àåµµ ³ª¿É´Ï´Ù.

"When CE results to be negative or inconclusive, we include MDCT in the our diagnostic work-up. In our experience, CE performance may somtimes be inferior to MDCT in the detection of SB neoplasms since they may be hidden by blood clost in case of active bleeding."

[2014-4-10 ¾Öµ¶ÀÚ ÀÇ°ß. Y´ë ±³¼ö]

CT À½¼ºÀε¥ CE¿¡¼­ ã¾Ò´Ù°í ÇÏ¿© CT¸¦ ´Ù½Ã º¸¸é ³õÃÆ´ø °ÍµéÀÌ È®ÀεǴ °æ¿ìµµ ÀÖ¾î Æǵ¶ÀÇ ¹®Á¦ÀÌÁö ½ÇÁ¦ CT¿¡¼­ º¸ÀÌÁö ¾Ê´Â °æ¿ì´Â Á» ´õ ÀûÀ» °ÍÀ¸·Î »ý°¢µË´Ï´Ù. CT°¡ ¿ì¼±ÀÌ°í CE´Â ±× ÈÄÀÇ ¹®Á¦¶ó°í »ý°¢µË´Ï´Ù. »ý°¢¸¸Å­ CE À¯¿ëÇÔÀ» ¸¹ÀÌ ´À³¢Áø ¸øÇÕ´Ï´Ù. ±×¸®°í ÀÌ¹Ì Å¸°Ë»ç¿¡¼­ È®ÀÎµÈ º´º¯À» ĸ½¶³»½Ã°æÀ¸·Î ´Ù½Ã È®ÀÎÇÏ·Á´Â ³ë·ÂÀº ¹«ÀǹÌÇѵ¥ ½ÇÁ¦ Áý´ãȸµéÀ» °¡ º¸¸é ³Ê¹« ¸¹½À´Ï´Ù. °³ÀÎÀûÀ¸·Î CE ó¹æÀº 1³â¿¡ 2-3°³ Á¤µµ ³»°Ô µË´Ï´Ù.

[2014-4-10 ¾Öµ¶ÀÚ ÀÇ°ß. K º´¿ø Àü¹®ÀÇ]

Áø´Ü ¾Ë°í¸®Áò¿¡ CT°¡ µé¾î°£ 2°³ÀÇ ³í¹®À» ¼ÛºÎµå¸³´Ï´Ù. ÀÎÀûÀ¸·Î Àúµµ ¼±»ý´Ô ÀÇ°ß¿¡ µ¿ÀÇÇÕ´Ï´Ù. CapsuleÀº ÀÏ´Ü °í°¡ÀÌ°í preparationÀÌ ÇÊ¿äÇؼ­ Áï½Ã °Ë»ç¸¦ ½ÃÇàÇÏ°í °á°ú¸¦ »¡¸® ¾Ë ¼öµµ ¾ø½À´Ï´Ù. ¿ì¸®³ª¶ó ó·³ CTÀÇ Á¢±Ùµµ°¡ ¿ì¼öÇÑ ³ª¶ó´Â CT¸¦ ¸ÕÀúÇÏ´Â °ÍÀÌ ºñ¿ëÈ¿°úÀûÀÎ ¸é¿¡¼­ ¿ì¼öÇÏ´Ù°í ÆǴܵ˴ϴÙ. ƯÈ÷ ¾ÏȯÀÚ°¡ ¸¹Àº ÀúÈñº´¿øÀº Obscure GI bleeding½Ã small bowel·Î metastasis°¡ ¸¹½À´Ï´Ù. CT angiography¸¦ ÀÌ¿ëÇÏ¿© ÃâÇ÷À§Ä¡¸¦ ¹Ì¸® ¾Ë°í angioembolizationÀ̳ª ¼ö¼úÀ» µé¾î°¡¸é Ä¡·á ¼º°ø·üµµ ³ôÈú ¼ö ÀÖÀ» °Í °°½À´Ï´Ù.

[2014-4-10. ¾Öµ¶ÀÚ ÀÇ°ß. U´ë ±³¼ö]

Àúµµ ´ëü·Î ¼ÒÀå ÇÁ·ÎÅäÄÝÀÇ CT¸¦ ¸ÕÀú Âï°í ÀÖ´Ù´Â Á¡À» ¸»¾¸ µå¸®°í ½Í½À´Ï´Ù. ĸ½¶Àº ÇãȲÇÏ°Ô ³õÄ¡´Â Å« Á¾¾çµéÀÌ °£È¤ ÀÖ´Ù´Â Á¡ÀÌ ÀÏ´Ü °¡Àå Å« ÀÌÀ¯ÀÔ´Ï´Ù. ¼ÒÀå³»½Ã°æ¿¡ ºñÇØ Ä¸½¶ÀÌ Á¾¾ç º´º¯À» Àß ³õÄ£´Ù´Â °ÍÀº ºñ±³Àû Àß ¾Ë·ÁÁø »ç½ÇÀÔ´Ï´Ù. ±×·¸´Ù°í óÀ½ºÎÅÍ ¼ÒÀå³»½Ã°æÀ» Çϱ⿡´Â Á» ºÎ´ã½º·´ÁÒ. ĸ½¶ÀÌ Å« Á¾¾çÀ» °£È¤ ³õÄ¡´Â ÀÌÀ¯´Â ¾Æ¸¶µµ ĸ½¶ÀÇ Å»ýÀûÀÎ ÇÑ°è ¶§¹®ÀÌ ÇÑ ¿øÀÎÀÏ °Í °°°í, µ¿½Ã¿¡ ´©°¡ Æǵ¶ ÇÏ´À³Äµµ Áß¿äÇÑ ¿øÀÎÀÎÀÚ Áß Çϳª¶ó°í º¾´Ï´Ù. ÀÌ Á¡Àº CTµµ ¸¶Âù°¡ÁöÀÔ´Ï´Ù.

°á±¹ º´¿øµéÀÌ °¢ÀÚ Àڱ⠺´¿øµé¿¡¼­ ¾î¶² °Ë»ç¹ýÀÌ ¾î´À Á¤µµ Á¤È®µµ¸¦ °¡Áö´À³Ä¸¦ ¾î´À Á¤µµ ÆľÇÇÏ°í ÀÖ¾î¾ß ÇÒ °Å¶ó°í º¾´Ï´Ù. ĸ½¶ Æǵ¶ÀÇ °í¼ö°¡ ÃæºÐÇÑ ½Ã°£À» µé¿© Á¤¼º²¯ Æǵ¶ÇÏ´Â º´¿ø°ú °æÇèÀÌ ¸¹Áö ¾ÊÀº Æç·Î¿ì ¼±»ý´ÔÀÌ ´ëÃæ º¸°í °£Ãß·Á³õÀº ºÎºÐ¸¸À» ½ºÅÂÇÁ°¡ È®ÀÎÇÏ´Â º´¿øÀÇ Á¢±Ù¹ýÀÌ °°À» ¼ö ¾øÀ» °ÍÀÔ´Ï´Ù. CT ÇÁ·ÎÅäÄÝÀ» Àß °³¹ßÇÏ¿© ÀûÀýÇÑ ¼ÒÀå È®ÀåÀ» ½ÃÅ°°í Á¤¼º²¯ Âï¾î¼­ Æǵ¶ °í¼ö°¡ ¿­½ÉÈ÷ Æǵ¶ÇÏ´Â º´¿ø°ú ´ëÃæ(?, ±×·± °÷Àº ¾ø°Ú½À´Ï´Ù¸¸...) Âï¾î¼­ ´ëÃæ Æǵ¶ÇÏ´Â °÷ÀÇ Á¢±Ù¹ýÀÌ °°À» ¼ö ¾øÀ» °ÍÀ̱⠶§¹®ÀÔ´Ï´Ù.

Àú´Â °³ÀÎÀûÀ¸·Î ĸ½¶ ³»½Ã°æÀÇ yield°¡ »ý°¢º¸´Ù ³ôÁö ¸øÇÏ°í, ĸ½¶ °á°ú¿¡ µû¶ó ½ÇÁ¦ planÀ» È®½ÇÈ÷ ¹Ù²ãÁÖ´Â yield´Â ´õ¿í ³·´Ù´Â Á¡, °£È¤ Á¾¾çÀ» ³õÄ¡´Â Å»ýÀûÀΠĸ½¶ÀÇ ÇÑ°èµµ ´Ù¼Ò °ÆÁ¤µÇ°í, È®½ÇÇÏ°Ô Ç÷£ÀÌ °áÁ¤µÇ´Â ¸î ¿¹¸¦ Á¦¿ÜÇÏ¸é °á±¹ ĸ½¶ ÈÄ¿¡ ´Ù½Ã CT Âï°Ô µÇ´Â °æ¿ì°¡ ¸¹´Ù´Â Á¡À» °í·ÁÇÏ°í ÀÖ½À´Ï´Ù. ±×·² ¹Ù¿¡´Â ¸ÕÀú CT¸¦ Âï¾î ÈçÄ¡ ¾ÊÁö¸¸ Å« º´º¯ ³ª¿À¸é ´õ work-up ¾øÀÌ Ä¡·á°èȹÀ» Á¤ÇÏ°í, Ưº°ÇÑ °ÍÀÌ ¾øÀ¸¸é ±× ´ÙÀ½¿¡ ĸ½¶ µî ´Ù¸¥ °Ë»ç¸¦ °í·ÁÇÕ´Ï´Ù.

÷ºÎÇÏ´Â GI Endosc 2010 ÁöħÀ» º¸¸é, ºñ·Ï Á¡¼±À¸·Î µÇ¾î ÀÖ±ä ÇÏÁö¸¸ ĸ½¶À̳ª ¼ÒÀå³»½Ã°æ°ú °°Àº ·¹º§¿¡ CT¸¦ ¿Ã·Á³õ°í ÀÖ±ä ÇÕ´Ï´Ù (¹°·Ð ÀÌ ¾Ë°í¸®µë¿¡µµ CT¸¦ ¸ÕÀú Ç϶ó´Â °ÍÀº ¾Æ´Õ´Ï´Ù). ÇÑÆí, Nature Review Gastro 2010¿¡¼­´Â CT°¡ ¾Ë°í¸®µë¿¡ ³ª¿À±ä ÇÏÁö¸¸ ĸ½¶À̳ª ¼ÒÀå°æº¸´Ù´Â µÚ·Î ¹Ð·Á ÀÖ½À´Ï´Ù. ¾î·µç, ÀÌ·± ¾Ë°í¸®µëÀÌ ½Ã»çÇÏ´Â ¹Ù´Â CT°¡ ¿Ãµå ÆмÇÀ̱ä ÇÏÁö¸¸ ÃÖ±Ù multi-detector CTÀÇ °æ¿ì ¿¹Àü CT¿¡ ºñÇØ ¿ÏÀüÈ÷ ¹«½ÃÇÒ Á¤µµ´Â ¾Æ´Ï¶ó´Â, OGIB¿¡¼­ ¾î´À Á¤µµ ¿ªÇÒÀÌ ÀÖÀ» ¼ö ÀÖ´Ù´Â °ÍÀ» ÀǹÌÇÑ´Ù´Â Á¡À̶ó°í º¾´Ï´Ù. ¿©±â¿¡, ¾Õ¼­ À̾߱âµå¸° °Íó·³, °¢ º´¿øÀÇ »çÁ¤ÀÌ ¹Ýµå½Ã ÇÔ²² °í·ÁµÇ¾î¼­ °Ë»ç ¼ø¼­°¡ Á¤ÇØÁ®¾ßÇÒ °ÍÀ̶ó°í »ý°¢ÇÕ´Ï´Ù.

[2013-4-11. ¾Öµ¶ÀÚ ÀÇ°ß. J´ë ±³¼ö]

ĸ½¶³»½Ã°æ Àü¿¡ CT angiography¸¦ ¸ÕÀúÇÑ´Ù´Â ÀÇ°ß¿¡ Àúµµ µ¿ÀÇÇÕ´Ï´Ù. º»¿ø¿¡¼­µµ obscure GI bleeding¿¡¼­ À§, ´ëÀå³»½Ã°æ ´ÙÀ½¿¡ CT angiography -> capsule endoscopy ¼øÀ¸·Î ÇÏ°í ÀÖ½À´Ï´Ù. ĸ½¶³»½Ã°æ °Ë»ç°¡ °í°¡ °Ë»çÀÎ °Íµµ ÀÌ·¯ÇÑ protocolÀ» µû¸£´Â ÀÌÀ¯ Áß¿¡ Çϳª¶ó°í »ý°¢ÇÕ´Ï´Ù. Âü°í·Î Clinical Endoscopy 2013³âµµ¿¡ ½É±â³² ±³¼ö´Ô µî¿¡ ÀÇÇÑ ¼ÒÈ­°ü ¿µ»ó¿¬±¸È¸¿¡¼­ ¹ßÇ¥ÇÑ obscure GI bleeding guidelineÀ» ÷ºÎÇÕ´Ï´Ù. ¸¶Áö¸· page appendix¿¡¼­ ĸ½¶³»½Ã°æ°ú CT enterography¸¦ °°Àº ¼öÁØÀ¸·Î °Ë»çÇÒ °ÍÀ» Á¦¾ÈÇÏ°í ÀÖ½À´Ï´Ù.

[2013-4-15. ÀÌÁØÇà ´äº¯]

Obscure GI bleeding¿¡¼­ capsule endoscopyÀÇ ¿ªÇÒÀº °ú´ëÆò°¡µÇ°í ÀÖ°í, Conventional CT ¹× CT angiographyÀÇ ¿ªÇÒÀº °ú¼ÒÆò°¡µÇ°í ÀÖ´Ù°í »ý°¢µË´Ï´Ù. À§³»½Ã°æ°ú ´ëÀå³»½Ã°æ¿¡ ¹®Á¦°¡ ¾ø´Â ȯÀÚ¿¡¼­ capsule endoscopy¸¦ ¸ÕÀú ÇÒ °ÍÀÎÁö CT (ȤÀº CT angiography)¸¦ ¸ÕÀú ÇÒ °ÍÀÎÁöÀÇ ³í¶õÀº °è¼ÓµÉ °Í °°½À´Ï´Ù. Àå´ÜÁ¡ÀÌ ¼­·Î ´Ù¸£±â ¶§¹®ÀÔ´Ï´Ù. °¢ º´¿øÀÇ »çÁ¤À̳ª ÀÇ·áÁøÀÇ °æÇè¿¡ ÀÇÇØ ´Þ¶óÁú ¼ö ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù. ±×·¯³ª Àú´Â obscure GI bleeding ȯÀÚ¿¡¼­ À§³»½Ã°æ, ´ëÀå³»½Ã°æ, capsule endoscopy, small bowel enteroscopyµî °ú°Å algorithm¿¡ µé¾îÀÖ´Â °Ë»ç¿¡¼­ ¿øÀÎÀÌ ¹àÇôÁöÁö ¾ÊÀº °æ¿ì ¹Ýµå½Ã CT (ȤÀº CT angiography)´Â ½ÃÇàµÇ¾î¾ß ÇÑ´Ù°í »ý°¢ÇÕ´Ï´Ù. CT°¡ ºüÁ®¼­ Áø´ÜÀÌ µÇÁö ¸øÇϴ ȯÀÚ´Â ¾ø¾î¾ß Çϱ⠶§¹®ÀÔ´Ï´Ù. ÀÀ±Þ½Ç µîÀÇ active bleeding »óȲ¿¡¼­´Â CT angiography¸¦ °­·ÂÈ÷ ÃßõÇÕ´Ï´Ù. CT angiographyÀÇ ÇØ»ó·ÂÀ̳ª Áø´Ü power´Â °ú°Å¿¡ ºñÇÏ¿© ¾öû ¹ßÀüÇÏ°í ÀÖ½À´Ï´Ù. ³î¶ó¿ï Á¤µµÀÔ´Ï´Ù. Çѹø ÀÌ¿ëÇØ º¸½Ã±â ¹Ù¶ø´Ï´Ù.

[2014-8-21. ¾Öµ¶ÀÚ ÀÇ°ß]

¼±»ý´Ô ÀÇ°ß¿¡ ÀüÀûÀ¸·Î µ¿ÀÇÇÕ´Ï´Ù. °á±¹ bleedingÀ» ¾î¶»°Ô Áø´ÜÇÏ´À³ÄÀÇ ¹®Á¦ÀÎ°Í °°½À´Ï´Ù. °ú°Å¿¡µµ GI bleedingÀÇ focus¸¦ ã´Â ¹æ¹ýÀÌ 2°¡Áö ÀÖ¾ú´Âµ¥ Çϳª°¡ endoscopy¶ó¸é ³ª¸ÓÁö´Â angio¿´½À´Ï´Ù. ÃÖ±Ù ³ª¿Â CT angio´Â arterial phase¸¦ Ãß°¡ÇÏ¿© angioÀÇ ¿ªÇÒÀ» ´ë½ÅÇÏ°Ô µÇ¾ú´Ù°í º¸¸é µÉ °Í °°½À´Ï´Ù. 10³âÀü ³»½Ã°æÀ¸·Î ÇØ°áÇÏÁö ¸øÇÑ GI bleedingȯÀÚ¿¡ ´ëÇØ CT (´ç½Ã´Â liver dynamic CT¸¦ Âï¾ú¾ú½À´Ï´Ù)·Î ÃßÁ¤ Áø´ÜÀ» ÇÏ°í MRÀ» Âï¾î¼­ small bowel GIST bleedingÀ» Áø´ÜÇÏ¿´°í massÀÇ Å©±â°¡ 3-4 cm¿¡ ´ÞÇÏ¿´Áö¸¸ 2-3 cm Á¤µµµÇ´Â °ÅÀÇ appendectomy incisionÁ¤µµÀÇ Å©±â·Î ¿­°í ¼ö¼úÇؼ­ Ä¡·á¸¦ÇÑ °æÇèÀÌ ÀÖ½À´Ï´Ù. ÀÌÈķεµ Àú´Â diagnostic angio¸¦ ´ë½ÅÇؼ­ CT angio¸¦ Âï°íÀִµ¥, CT°¡ ÀÌ¹Ì Ç¥ÁØÈ­µÇ¾îÀÖ´Â °Ë»ç¶ó¼­ ½Ã¼úÀÚÀÇ ¼÷·Ãµµ¿Í °ü°è¾øÀÌ ÀÏÁ¤ÇÑ Á¤µµÀÇ Áø´ÜÀ» ÇØÁֹǷΠÇöÀç ¿ì¸®³ª¶óÀÇ »óȲ¿¡¼­´Â obscure GI bleeding¿¡¼­ »©³õÀ» ¼ö ¾ø´Â °Ë»ç¶ó°í »ý°¢ÇÕ´Ï´Ù.

[2014-8-22. ¾Öµ¶ÀÚ ÀÇ°ß]

Àü¿¡ textbook¿¡ OGIB¿¡¼­ CTÀÇ ¿ªÇÒ¿¡ ´ëÇÑ ³»¿ëÀ» º»ÀûÀÌ À־ ¿À´Ã ´Ù½Ã ã¾Æº¸¾Ò°í Âü°í ¹®Çå(Delvaux 2005)À» º¸³»µå¸®°íÀÚ ÇÕ´Ï´Ù.

Âü°í·Î ³»½Ã°æÇÐȸ ĸ½¶³»½Ã°æ ±³°ú¼­¿¡¼­´Â ´ÙÀ½°ú °°ÀÌ ¼Ò°³ÇÏ°í ÀÖ½À´Ï´Ù.

"ICCE 2005¿¡¼­ Á¦¾ÈµÈ ¾Ë°í¸®Áò¿¡¼­ °£°úµÈ °Í Çϳª´Â ĸ½¶³»½Ã°æ Àú·ù¿Í Á¾¾ç¿¡ ´ëÇÑ °í·ÁÀÌ´Ù. Delvaux µîÀº ÀÌ ¹®Á¦ÀÇ ÇØ°áÀ» À§ÇØ Ä¸½¶³»½Ã°æ Àü CT¸¦ ½ÃÇàÇÒ °ÍÀ» Á¦¾ÈÇÏ°í ÀÖ´Ù. ¼ÒÀå¿¡¼­ 2cm ÀÌ»óÀÇ Á¾¾çÀÌ ¹ß°ßµÇ°Å³ª ½ÉÇÑ ÇùÂøÀÌ ÀǽɵǾî ĸ½¶³»½Ã°æ Àú·ùµÉ À§Ç輺ÀÌ ³ô¾Æ º¸ÀÌ´Â °æ¿ì¿¡´Â ¹Ù·Î ¼ö¼úÀ» °í·ÁÇϰųª, ÀÌÁßdz¼±¼ÒÀå³»½Ã°æÀ¸·Î Á¶Á÷ °Ë»ç¸¦ ½ÃÇàÇÑ ÈÄ Ä¡·á ¹æħÀ» °áÁ¤ÇÏ´Â °ÍÀÌ ÀûÀýÇÒ °ÍÀÌ´Ù."

[2014-8-22. ¾Öµ¶ÀÚ ÀÇ°ß]

±³¼ö´Ô²²¼­ ¸»¾¸ÇϽŠObscure GI bleeding ¿¡¼­ CT¸¦ Âï´Â °Í¿¡ ´ëÇÏ¿© Àú´Â °æÇè»ó 100% µ¿ÀÇÇÕ´Ï´Ù. Á¦°¡ ER ´ã´ç fellow ¿´À»¶§, GI bleeding À» ÁÖ¼Ò·Î ³»¿øÇÑ È¯ÀÚµé Áß Á¤¸» ¸¹Àº ¼ö¿¡¼­ EGD/colonoscopy °¡ negative ·Î ³ª¿É´Ï´Ù. ÀÌ·± °æ¿ì fellow ´Â »ó´çÈ÷ °í¹Î½º·¯¿î °ÍÀÌ, HbÀº ¶³¾îÁ® Àִµ¥ (8-10 »çÀÌ) Áö±Ý ¸· active bleeding Àº ¾Æ´Ñ.. ±×·± ȯÀÚ°¡ ´ëºÎºÐÀ̱⠶§¹®ÀÔ´Ï´Ù. "ȯÀÚÀÇ ¸»À» ¹ÏÀ» ¼ö ÀÖÀ»±î?"¶ó´Â »ý°¢±îÁö ÇÏ°Ô µÇ¸é¼­ °á·Ð ¾øÀÌ Áý¿¡ º¸³»±âµµ ¹¹ÇÑ ±×·± »óȲÀÌ µÇ°ï ÇÕ´Ï´Ù. ±×·±µ¥ Á¦°¡ ´ã´çÇÑ ÇÑ ´Þ µ¿¾È 2°Ç À̻󿡼­ small bowel tumor°¡ CT ¿¡¼­ ¹ß°ßµÇ¾ú´ø °ÍÀ¸·Î ±â¾ïÇÕ´Ï´Ù. Àú´Â routine ÇÏ°Ô Âï¾ú½À´Ï´Ù. ȯÀÚµéÀÌ CT ÃÔ¿µ¿¡ °ÅºÎ°¨À» ÀüÇô º¸ÀÌÁö ¾Ê½À´Ï´Ù. ³»½Ã°æº¸´Ù´Â ÈξÀ ÈûÀÌ ´ú µé±â ¶§¹®ÀÔ´Ï´Ù. ÂïÁö ¾Ê¾Æ ³õÄ¡´Â °Í º¸´Ù´Â, routine ÇÏ°Ô Âï´Â °ÍÀÌ ³´´Ù°í »ý°¢ÇÕ´Ï´Ù.

[2015-3-5. ¾Öµ¶ÀÚ ÆíÁö]

Y´ë LÀÔ´Ï´Ù. ÀÌÀü¿¡ obscure GI bleeding¿¡ ´ëÇÑ ³»¿ë¿¡¼­ ±³¼ö´ÔÀº »ó ÇϺΠ³»½Ã°æÈÄ¿¡ CT¸¦ ¸¹ÀÌ Âï°í ÀÖ´Ù°í Çϼ̽À´Ï´Ù. Àúµµ ÀüÀûÀ¸·Î µ¿ÀÇÇÕ´Ï´Ù. ÃÖ±Ù Á¦°¡ º» ³í¹®¿¡¼­ CT¿¡ ´ëÇÑ ÁÁÀº ±×¸²ÀÌ ÀÖ¾î º¸³»µå¸³´Ï´Ù (Digest Endosc 2015).


[2016-2-13. ¼ÒÀ忬±¸È¸ ¿öÅ©¼¥]

'Áõ·Ê·Î Ç®¾îº¸´Â ¼ÒÀå Á¾¾ç Áø´Ü Àü·«' °­ÀǸ¦ µé¾ú½À´Ï´Ù. ´Ù¾çÇÑ Áõ·Ê¸¦ º¼ ¼ö ÀÖ´Â ÁÁÀº ½Ã°£À̾ú½À´Ï´Ù. ´Ù¸¸ obscure GI bleedingÀÇ diagnostic algorithm¿¡¼­ 'capsule endoscopy¸¦ ½ÃÇàÇÏ°í ÀÌ»ó ¼Ò°ßÀÌ ÀÖÀ¸¸é enteroscopy ÈÄ ¼ö¼úÀ» ÇÑ´Ù' ºÎºÐ¿¡ µ¿ÀÇÇÒ ¼ö ¾ø¾î¼­ ±×¿¡ ´ëÇÑ comment¸¦ ÇÏ¿´½À´Ï´Ù.

¾Æ¸¶µµ 2015³â 9¿ù ¹ßÇ¥µÈ ACG guidelineÀ» ¹ÙÅÁÀ¸·Î ÇÑ algorithmÀ̾ú´ø °Í °°½À´Ï´Ù. 2015³â °¡À̵å¶óÀο¡´Â "Video capsule endoscopy (VCE) should be considered as a first-line procedure for SB evaluation after upper and lower GI sources have been excluded, including second-look endoscopy when indicated (strong recommendation, moderate level of evidence)."¶ó°í ¾ð±ÞµÈ ¹Ùµµ ÀÖÀ¸´Ï ¹«¸®´Â ¾Æ´Õ´Ï´Ù. ±×·¯³ª Àú´Â CTµµ ÇÏÁö ¾Ê°í ȯÀÚ¸¦ ¼ö¼úÀå¿¡ º¸³½´Ù´Â °Í¿¡ µ¿ÀÇÇϱ⠾î·Á¿ü½À´Ï´Ù. Àú´Â ¿ÀÈ÷·Á obscure GI bleedingÀÇ Ã¹ °Ë»ç°¡ CT ȤÀº CT enteroscopy°¡ µÇ¾î¾ß ÇÑ´Ù°í »ý°¢ÇÏ´Â ÂÊÀÔ´Ï´Ù.

¹Ì±¹ °¡À̵å¶óÀÎÀ» ±×³É ´ä½ÀÇÒ °ÍÀÌ ¾Æ´Ï¶ó ¿ì¸®³ª¶ó¿¡ ¾î¶»°Ô Àû¿ëÇÒÁö Àß »ý°¢ÇØ º¼ ÇÊ¿ä°¡ ÀÖÀ» °Í °°½À´Ï´Ù.


[2016-11-2. APDW2016 PG course. Naoki Ohmiya ¼±»ý´Ô °­ÀÇ]

Ohmiya N. Dig Endoscopy 2015

Occult¿Í overt GI bleedingÀÇ ¿øÀÎÀÌ Å©°Ô ´Ù¸£Áö ¾ÊÀ¸¹Ç·Î Ohmiya ¼±»ý´ÔÀº µÑÀ» ±¸ºÐÇÏÁö ¾Ê´Â algorithmÀ» Á¦¾ÈÇÏ¿´½À´Ï´Ù. Obscure GI bleeding (overt and occult)¿¡¼­ °¡Àå ¸ÕÀú chest-pelvic plain X-ray & contrast-enhanced CT¸¦ ù¹ø° °Ë»ç·Î Á¦¾ÈÇÏ¿´½À´Ï´Ù.

Ohmiya N. Dig Endoscopy 2015

Àú´Â ´ÙÀ½°ú °°Àº Áú¹®À» Çß½À´Ï´Ù. "In my opinon, the role of abdominal CT has been underestimated in the evaluation of obscure GI bleeding. So, I am very happy to see your algorithm. My question is what kind of CT do you recommend; just routine contrast-enhanced CT or CT angiography." ¿¬ÀÚ´Â °°Àº »ý°¢À» °¡Áö°í ÀÖ´Ù°í ´äÇϸ鼭, Àڽŵµ capsule endoscopy³ª enteroscopy Àü¿¡ CT¸¦ ½ÃÇàÇÏ°í ÀÖ´Ù°í ´äÇÏ¿´½À´Ï´Ù.

Active bleedingÀÇ °æ¿ì¿¡´Â small bowel enteroscopy¸¦ ¹Ù·Î ½ÃÇàÇÏ´Â °ÍÀÌ ´õ ÁÁÁö ¾ÊÀºÁö floor¿¡¼­ Áú¹®ÀÌ ÀÖ¾ú½À´Ï´Ù. ¿¬ÀÚ´Â CT´Â ´Ù¼Ò °í°¡ÀÌÁö¸¸ ½±°Ô ½ÃÇàÇÒ ¼ö ÀÖ´Ù°í ´äÇϸ鼭 "CT is the first diagnostic tool in Japan." À̶ó°í ÁÖÀåÇß½À´Ï´Ù. »óºÎ ³»½Ã°æ°ú ÇϺΠ³»½Ã°æ¿¡ ÀÌ»óÀÌ ¾øÀ» ¶§ capsule endoscopy³ª small bowel enteroscopy·Î ³Ñ¾î°¡±â Àü CTºÎÅÍ ÂïÀÚ´Â ¿¬ÀÚÀÇ ÁÖÀå¿¡ ÀüÀûÀ¸·Î µ¿ÀÇÇÕ´Ï´Ù.

* Âü°í: EndoTODAY Obscure GI bleeding


[Algorithm review]

1) 2005³â EndoscopyÁö¿¡ ½Ç¸° ICCE consensus for obscure gastrointestinal bleedingÀÇ ±×¸²¿¡¼­µµ CT´Â ã¾Æº¼ ¼ö ¾ø½À´Ï´Ù.

2) Sleisenger ±³°ú¼­(9ÆÇ)¿¡µµ ¾ÆÁ÷ obscure GI bleeding Áø´Ü ¾Ë°í¸®Áò¿¡ CT´Â ¾ø´Â °ÍÀÌ ¸Â½À´Ï´Ù.

3) [2014-8-22. Ãß°¡] 2005³â ¹®Çå¿¡ capsule endoscopy Àü CT¸¦ Ç϶ó´Â °ÍÀ» ã¾Ò½À´Ï´Ù. ¾Ë·ÁÁֽŠ¾Öµ¶ÀÚ¿¡°Ô °¨»çµå¸³´Ï´Ù.

Delvaux 2005

4) Gastrointest Endosc¿¡ ½Ç¸° position statement (2010): Overt obscure GI bleeding algorithm¿¡ capsule endoscopy¿Í parellelÇÏ°Ô CT angiograpny°¡ ¾ð±ÞµÇ¾î ÀÖ½À´Ï´Ù. ´Ù¸¸ È­»ìÇ¥°¡ dashed lineÀ¸·Î µÇ¾î À־ less-preferred optionÀ¸·Î Á¦½ÃµÈ Á¡ÀÌ ´Ù¼Ò ¾Æ½±½À´Ï´Ù.

5) Gastrointest Endosc¿¡ ½Ç¸° position statement (2010): Occult obscure GI bleeding algorithm¿¡µµ capsule endoscopy¿Í parellelÇÏ°Ô CT angiograpny°¡ ¾ð±ÞµÇ¾î ÀÖ½À´Ï´Ù. ´Ù¸¸ È­»ìÇ¥°¡ dashed lineÀ¸·Î µÇ¾î À־ less-preferred optionÀ¸·Î Á¦½ÃµÈ Á¡ÀÌ ´Ù¼Ò ¾Æ½±½À´Ï´Ù.

6) 2010³â ÇÑ ¸®ºä(Occult and obscure gastrointestinal bleeding: causes and clinical management)¿¡¼­ obscure GI bleeding ȯÀÚ Áø´Ü algorithm¿¡ capsule endoscopy ´ÙÀ½À¸·Î CT°¡ µé¾î°¡ ÀÖ½À´Ï´Ù.

7) Clin Endosc 2013;46:45-53¿¡ ½Ç¸° ½É±â³² ±³¼ö´ÔÀÇ ¸®ºä¿¡ CT enterography°¡ capsule endoscopy¿Í ´ëµîÇÏ°Ô ¾ð±ÞµÇ¾î ÀÖ½À´Ï´Ù.

8) [2015-3-5] 2015³â Digest Endosc¿¡ ½Ç¸° ÀϺ»ÀÇ Á¢±Ù¹ý

Digest Endosc 2015



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