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[Sentinel polyp. º¸ÃÊ ¿ëÁ¾] - ðû

[Position statement, version 2018-3-26]

Sentinel polypÀÌ Ã³À½ ¹ß°ßµÇ¾úÀ» ¶§¿¡´Â Á¶Á÷°Ë»ç¸¦ ÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. °æ°ú°üÂû Áß ¸ð¾çÀÌ º¯ÇÏ¿´À» ¶§¿¡µµ Á¶Á÷°Ë»ç°¡ ÇÊ¿äÇÕ´Ï´Ù. ´Ù¸¸ º´¸®°á°ú Çؼ®¿¡ ¾à°£ÀÇ ÁÖÀÇ°¡ ÇÊ¿äÇÕ´Ï´Ù.


1. Sentinel polyp Á¤ÀÇ

º¸ÃÊ¿ëÁ¾(sentinel polyp)Àº À§½Äµµ¿ª·ùÁúȯÀÇ ÀÌÂ÷ÀûÀÎ ³»½Ã°æ ¼Ò°ßÀÇ ÇϳªÀÔ´Ï´Ù. »ê¿ª·ù³ª °¡½¿¾²¸²°ú °°Àº ÀüÇüÀûÀÎ À§½Äµµ¿ª·ùÁúȯÀÇ Áõ»óÀ» °¡Áø ȯÀÚ¿¡¼­µµ ¹ß°ßµÇÁö¸¸, Á¾Á¾ ¹«Áõ»ó ¼ºÀÎÀÇ °Ç°­°ËÁø¿¡¼­ ¹ß°ßµÇ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ƯÈ÷ ¿ì¸®³ª¶ó¿¡¼­´Â 40¼¼ ÀÌ»óÀÇ ¼ºÀο¡¼­ À§¾Ï Á¶±âÁø´ÜÀ» À§ÇÑ °Ç°­°ËÁø ³»½Ã°æÀÌ È°¹ßÈ÷ ½ÃÇàµÇ°í ÀÖÀ¸¹Ç·Î ¹«Áõ»ó º¸ÃÊ¿ëÁ¾À» µå¹°Áö ¾Ê°Ô ¸¸³ª°Ô µË´Ï´Ù.

À§ »çÁøÀº À§½Äµµ ¿ª·ùÁúȯÀÇ ÀÓ»ó»óÀÌ ¶Ñ·ÇÇÏÁö ¾ÊÀº ȯÀÚÀÇ ³»½Ã°æ¿¡¼­ ¿ì¿¬È÷ ¹ß°ßµÈ À§½Äµµ Á¢ÇÕºÎÀÇ ÀÌ»ó¼Ò°ßÀÔ´Ï´Ù. À§¿¡ ȤÀÌ »ý°å´Ù°í ÇÏ¿© Àü°¡Á·ÀÌ ±ô¦ ³î¶ó¼­ 3Â÷ ÀÇ·á±â°üÀ» ãÀº °æ¿ìÀÔ´Ï´Ù¸¸ ³»½Ã°æ ¼Ò°ßÀº ÀüÇüÀûÀÎ Sentinel polyp¿´½À´Ï´Ù. ÀÓ»óÀûÀ¸·Î º°´Ù¸¥ ÀÇÀÇ°¡ ¾ø´Â ¼Ò°ßÀÔ´Ï´Ù.


2. Sentinel polyp ³»½Ã°æ ¼Ò°ß

º¸ÃÊ¿ëÁ¾Àº ½Äµµ¿­°øÅ»Àå(hiatal hernia)°¡ ¾ø´Â ȯÀÚ¿¡¼­ ¹ß°ßµÉ ¼öµµ ÀÖÀ¸³ª ´ëºÎºÐ ¾à°£ÀÇ ½Äµµ¿­°øÅ»ÀåÀ» °¡Áø ȯÀÚ¿¡¼­ °üÂûµË´Ï´Ù. ¾Ç¼ºÁúȯ°ú °¨º°Çϱâ À§ÇÏ¿© óÀ½ ¹ß°ßµÇ¾úÀ» ¶§¿¡´Â 2°³ Á¤µµÀÇ Á¶Á÷°Ë»ç¸¦ ÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù.

½Äµµ¿­°øÅ»ÀåÀÇ Á¤µµ´Â 2-3 cm ¹Ì¸¸ÀÌ ´ëºÎºÐÀÔ´Ï´Ù. º¸ÃÊ¿ëÁ¾ÀÇ À§Ä¡´Â ½ÄµµÀ§ Á¢ÇպΠÁ÷ÇϹæÀÇ Å»À島 ¾ÈÀ̸ç À§ÀÇ Àüº®À̳ª ´ë¸¸ ¹æÇâ¿¡¼­ È£¹ßÇÕ´Ï´Ù. ÀÌ °æ¿ì º¸ÃÊ¿ëÁ¾Àº Å»À島±îÁö ¿¬°áµÈ À§Á¡¸·ÁÖ¸§ÀÇ ¸»´ÜÀÌ ºÎÇ®¾î¿À¸¥ ¾ç»óÀ» º¸ÀÔ´Ï´Ù. ¸ð¾çÀº ´ëºÎºÐ µÕ±ÛÁö¸¸ °£È¤ ±æÂßÇÑ °æ¿ìµµ ÀÖ½À´Ï´Ù.

º¸ÃÊ¿ëÁ¾ÀÇ Á÷»ó¹æ¿¡¼­ ¼±Çü, »ï°¢Çü, ȤÀº º° ¸ð¾çÀÇ ¹Ì¶õ ¶Ç´Â ±Ë¾çÀÌ µ¿¹ÝµÇ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù.


3. Sentinel polyp Àå±â ÃßÀû°üÂû

2³â¿¡ Çѹø Á¤±âÀûÀ¸·Î screening endoscopy¸¦ ¹Þ´Â ºÐÀÇ »çÁøÀÔ´Ï´Ù. ¾ðÁ¨°¡ °ÇÁø ÈÄ Åõ¾àÀ» ¹ÞÀº ÀûÀÌ ÀÖ´Ù°í ÇÏ¿´½À´Ï´Ù¸¸.... Àú´Â Áõ»óÀÌ ¾ø´Ù°í ÇÏ¿© Åõ¾àÀ» ±ÇÇÏÁö ¾Ê¾Ò½À´Ï´Ù.


¾Æ·¡ ȯÀÚµµ °ÅÀÇ 2³â¿¡ Çѹø Á¤±âÀûÀ¸·Î screening endoscopy¸¦ ¹Þ´Â ºÐÀÇ »çÁøÀÔ´Ï´Ù. Áõ»óµµ ¾ø¾î¼­ Åõ¾àÀº ±ÇÇÏÁö ¾Ê¾Ò½À´Ï´Ù. °ÅÀÇ 10³â°¡ º¯È­°¡ ¾ø½À´Ï´Ù.


4. Sentinel polyps in young patient

°£È¤ ¼Ò¾Æû¼Ò³â°ú¿¡¼­µµ sentinel polypÀÌ Áø´ÜµÇ°ï ÇÕ´Ï´Ù. Screening endoscopy ´ë»óÀÌ ¾Æ´Ï¹Ç·Î ´ëºÎºÐ Áõ»ó ¶§¹®¿¡ °Ë»ç¸¦ ¹ÞÀº °æ¿ìÀÔ´Ï´Ù.

14¼¼

18¼¼

18¼¼

24¼¼


5. Sentinel polyp Ä¡·á

°ú°Å º¸ÃÊ¿ëÁ¾Àº À§Á¾¾ç(pseudotumor) ȤÀº ¿°Áõ¼º ¿ëÁ¾ (inflammatory polyp)À¸·Î ºÒ¸®¸é¼­ ºÒÇÊ¿äÇÏ°Ô ¿Ã°¡¹Ì¸¦ ÀÌ¿ëÇÏ¿© ³»½Ã°æ ¿ëÁ¾ÀýÁ¦¼ú·Î Ä¡·áÇϱ⵵ ÇÏ¿´½À´Ï´Ù. ±×·¯³ª º¸ÃÊ¿ëÁ¾ ÀÚü´Â ÁøÇ༺ÀÌ ¾Æ´Ï°í ¾Ç¼ºÁúȯÀÌ ¾Æ´Ï¹Ç·Î Ưº°ÇÑ Ä¡·á°¡ ÇÊ¿ä¾ø½À´Ï´Ù. À§½Äµµ¿ª·ùÁúȯ¿¡ ´ëÇÑ ºñ¾à¹°Ä¡·á¿Í ÇÔ²² ¼ö °³¿ùÀÇ ¾ç¼ºÀÚÆßÇÁ¾ïÁ¦Á¦¸¦ Åõ¿©ÇÏ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. °£È¤ ¾à¹°Åõ¿©·Î ÀÎÇÏ¿© º¸ÃÊ¿ëÁ¾ÀÌ Á¦°ÅµÇ±âµµ ÇÏÁö¸¸ Àå±â°£ º¯È­¾øÀÌ Áö¼ÓµÇ´Â ¿¹µµ ÀÖ½À´Ï´Ù.


6. Sentinel polyp°ú À¯»çÇÑ µé¹®¾Ï (Cardia cancer, mimicking sentinel polyp)

º¸ÃÊ¿ëÁ¾ÀÇ ³»½Ã°æ Áø´Ü¿¡¼­ °¡Àå Áß¿äÇÑ Á¡Àº ¾Ç¼ºÁúȯ°úÀÇ °¨º°Áø´ÜÀÌ´Ù. °£È¤ µé¹®¾Ï(cardia cancer)ÀÌ º¸ÃÊ¿ëÁ¾°ú ºñ½ÁÇÑ ¸ð½ÀÀ» º¸ÀÌ´Â °æ¿ì°¡ ÀÖÀ¸¹Ç·Î ¸Å¿ì ÁÖÀÇÇØ¾ß ÇÑ´Ù.

µé¹®¾Ï. Proper muscle invasion (+), LN (-)


Early gastric carcinoma
1. Location : upper third, center at cardia (Siewert II)
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma (P/D)
4. Histologic type by Lauren : mixed
5. Size : 2.2x1.5 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 2.3 cm, distal 16 cm
8. Lymph node metastasis : no metastasis in 21
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified

50´ë ¿©¼ºÀÇ cardia cancer¿´½À´Ï´Ù. ESD°¡ ¸Å¿ì ¾î·Á¿ü´Âµ¥ ´ÙÇེ·´°Ô °á°ú´Â ÁÁ¾Ò½À´Ï´Ù.
Stomach, endoscopic submucosal dissection:
Early gastric carcinoma
1. Location : cardia
2. Gross type : EGC type IIa
3. Histologic type : tubular adenocarcinoma, moderately differentiated >> papillary adenocarcinoma, moderately differentiated (about 20%)
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 12mm (2) vertical diameter, 7mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 8 mm, proximal 5 mm, anterior 4 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


EG junction, ESD : Adenocarcinoma, well differentiated
1. Location : esophagogastric junction
2. Size of invasive carcinoma : (1) longest diameter, 10 mm (2) vertical diameter, 9 mm
3. Tumor multicentricity : single
4. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
5. Resection margin : free from carcinoma(N), safety margin : distal 13 mm, proximal 7 mm, anterior 12 mm, posterior 24 mm, deep 100 §­
6. Lymphatic invasion : not identified(N)
7. Venous invasion : not identified(N)
8. Perineural invasion : not identified(N)
9. Peritumoral lymphoid follicle: not identified(N)

º¸ÃÊ¿ëÁ¾ÀÌ Ã³À½ ¹ß°ßµÇ¸é Á¶Á÷°Ë»ç¸¦ ÅëÇÏ¿© ¾ÏÀÌ ¾Æ´Ï¶ó´Â Á¡À» È®ÀÎÇØ¾ß Çϸç, PPI Åõ¿© ÈÄ ÃßÀû°üÂûÀ» ÇØ º¸´Â °ÍÀÌ ÁÁ½À´Ï´Ù.


7. Sentinel polyp °ú À¯»çÇÑ ¹Ù·¿ ½Äµµ¾Ï (Barrett adenocarcinoma, mimicking sentinel polyp)

°ËÁø ³»½Ã°æ¿¡¼­ sentinel polyp ÀǽÉÀ¸·Î Á¶Á÷°Ë»ç¸¦ ÇÏ¿´´Âµ¥ atypical gland·Î ³ª¿Í ÃßÀû°Ë»ç¸¦ ÅëÇÏ¿© adenocarcinoma·Î Áø´ÜµÇ¾ú½À´Ï´Ù. Barrett adenocarcinoma·Î ÆǴܵǾî ESD¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù (¹Îº´ÈÆ ±³¼ö´Ô).


Esophagus, #1x1 : GE junction, biopsy(ESD) :
Early gastric carcinoma arising from Barrett's esophagus
1. Location : GE junction
2. Gross type : EGC type IIb
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 9 mm (2) vertical diameter, 4.5 mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 8 mm, proximal 9 mm, anterior 12 mm, posterior 14 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

¾Æ¹«¸® sentinel polyp °°¾Æµµ óÀ½ ¹ß°ßµÇ¾ú°Å³ª °ú°Å¿Í ¸ð¾çÀÌ ´Ù¸£´Ù¸é Á¶Á÷°Ë»ç¸¦ ÇØ¾ß ÇÕ´Ï´Ù.

* Âü°í: EndoTODAY ¹Ù·¿½Äµµ¼±¾Ï


8. ¾Ç¼ºÁúȯ°ú °¨º°ÀÌ ¾î·Á¿ü´ø º¸ÃÊ¿ëÁ¾ (Sentinel polyp, mimicking malignancy)

60´ë ³²ÀÚȯÀÚ°¡ ¿ì¿¬È÷ °Ç°­°ËÁø¿¡¼­ ¹ß°ßµÈ ½Äµµ¾Ï ÀǽɼҰßÀ¸·Î ÀǷڵǾú´Ù. ¿ÜºÎ º´¿ø¿¡¼­ ½ÃÇàÇÑ À§³»½Ã°æ °Ë»ç»ó À§½ÄµµÁ¢Çպο¡¼­ ¾à 6-7 mmÀÇ ¹ßÀû¼º ¿ëÁ¾ÀÌ ¹ß°ßµÇ¾ú´Ù. ±× Ç¥¸éÀº ¸Å²öÇÏ¿´À¸³ª ȸ¹é»ö »ïÃâ¹°·Î µ¤¿© ÀÖ¾ú´Ù. ¿ëÁ¾ ±ÙÀ§ºÎÀÇ À§Ä¡´Â ÆíÆò»óÇÇ-¿øÁÖ»óÇÇÁ¢ÇÕºÎ¿Í ºñ½ÁÇÑ ÁöÁ¡À̾úÀ¸¸ç, ¿ëÁ¾ÀÇ ±ÙÀ§ºÎ¿¡´Â º°¸ð¾çÀÇ Á¡¸·»óÇØ(mucosal break)°¡ ÀÖ¾ú°í ȸ¹é»öÀÇ »ïÃâ¹°·Î µ¤¿© ÀÖ¾ú´Ù. ÀÏ»ó»ýÈ°¿¡ ºÒÆíÀ» Áִ Ưº°ÇÑ Áõ¼¼´Â ¾ø¾úÀ¸¸ç »ê¿ª·ù, °¡½¿¾²¸², ÈäÅë, ¿¬ÇÏÀå¾Ö µî ÀüÇüÀûÀÎ À§½Äµµ¿ª·ùÁúȯÀÇ Áõ¼¼µµ °¡Áö°í ÀÖÁö ¾Ê¾Ò´Ù. °¡Á··ÂÀ̳ª °ú°Å·Â¿¡¼­ ƯÀ̼ҰßÀÌ ¾ø¾ú´Ù.

Á¶Á÷°Ë»ç¿¡¼­ ½Äµµ»óÇÇÀÇ ½ÉÇÑ ÀÌÇü¼º°ú ¸¸¼º È°µ¿¼º ¿°Áõ°ú ¹Ì¶õ(severe dysplasia of squamous epithelium and chronic active inflammation and erosion)ÀÇ ¼Ò°ßÀ¸·Î ÆíÆò»óÇǼ¼Æ÷¾ÏÀ» ¹èÁ¦ÇÒ ¼ö ¾ø´Ù(squamous cell carcinoma cannot be excluded)°í Æǵ¶µÇ¾ú´Ù. °°Àº ½½¶óÀ̵带 ÀçÆǵ¶ÇÑ ¼Ò°ßµµ ºÐÈ­°¡ ÁÁÀº ÆíÆò»óÇǾϿ¡ ÇÕ´çÇÏ´Ù(consistent with squamous cell carcinoma, well differentiated)·Î º¸°í µÇ¾ú´Ù.

Á¶Á÷°Ë»ç¿¡¼­ ¾Ç¼ºÁúȯÀÇ °¡´É¼ºÀÌ ½Ã»çµÇ¾úÁö¸¸ ÀüÇüÀûÀÎ º¸ÃÊ¿ëÁ¾ (sentinel polyp)ÀÇ ³»½Ã°æ ¼Ò°ßÀ̾ú°í Áõ»óÀº ¾ø¾ú±â ¶§¹®¿¡ ´Ü±â°£ÀÇ ¾à¹°Ä¡·á ÈÄ ÃßÀû³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇϱâ·Î ÇÏ¿´´Ù. ¾ç¼ºÀÚÆßÇÁ¾ïÁ¦Á¦(proton pump inhibitor, PPI)¸¦ 2°³¿ù Åõ¾àÇÑ ÈÄ ½ÃÇàÇÑ À§³»½Ã°æ¿¡¼­ ¿ëÁ¾Àº ÇöÀúÈ÷ ÀÛ¾ÆÁ³À¸¸ç ¿ëÁ¾ÀÇ ±ÙÀ§ºÎ¿¡¼­ °üÂûµÇ´ø º°¸ð¾çÀÇ Á¡¸·»óÇØ´Â ¿ÏÀüÈ÷ ¾ø¾îÁ³´Ù.

ÃßÀû³»½Ã°æÀÇ Á¶Á÷°Ë»ç¿¡¼­ Á¤»ó½Äµµ¿Í À§¿° ¼Ò°ß(acanthotic squamous epithelium and gastric mucosa showing chronic inactive gastritis)À» º¸¿´´Ù. Àý¹Ý ¿ë·®À» ¾ç¼ºÀÚÆßÇÁ¾ïÁ¦Á¦¸¦ 2ÀÏ¿¡ Çѹø 1³â°£ º¹¿ëÇÑ ÈÄ ½ÃÇàÇÑ ÃßÀû³»½Ã°æ¿¡¼­ ¿ëÁ¾À̳ª Á¡¸·»óÇØ´Â ´õ ÀÌ»ó °üÂûµÇÁö ¾Ê¾Ò´Ù. ÀÌÈÄ ¾à¹° Åõ¾àÀ» Áß´ÜÇÏ°í °æ°ú°üÂû ÁßÀÌ´Ù.

Sentinel polypÀÌ ÀÖÀ¸³ª acid regurgitationÀ̳ª heartburnÀÌ ¾ø´Â ȯÀÚ¿¡¼­ Ä¡·á°¡ ÇÊ¿äÇÑ°¡¿¡ ´ëÇؼ­´Â ³í¶õÀÌ °¡´ÉÇÏ°Ú½À´Ï´Ù. Àú´Â À§½Äµµ¿ª·ù¿¡ ÀÇÇÑ ¶Ñ·ÇÇÑ Áõ¼¼°¡ ¾ø´Â ÇÑ ¾à¹°Ä¡·á¸¦ ±ÇÇÏÁö´Â ¾Ê°í À§½Äµµ¿ª·ùÁúȯ¿¡ ´ëÇÑ ºñ¾à¹°Àû Ä¡·á(½Ä½À°ü ±³Á¤ µî)¸¦ ÇϽõµ·Ï ±ÇÇÏ°í ÀÖ½À´Ï´Ù. ¿©·¯ºÐµéÀº ¾î¶»°Ô ÇÏ°í °è½Ã´ÂÁö¿ä?


Benign polyp °°Àºµ¥ ¿ÜºÎ¿¡¼­ ½ÃÇàÇÑ Á¶Á÷°Ë»ç °á°ú°¡ "suspicious for malignancy"¶ó°í µÇ¾î À־ È®ÀÎÀ» À§ÇÏ¿© EMR polypectomy¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù. ÃÖÁ¾ º´¸® °á°úÀÀ ¿¹»óÇÑ ¹Ù´ë·Î "acanthotic squamous epithelium with focal inflamed granulation tissue"·Î ³ª¿Ô½À´Ï´Ù. Àüü¸¦ ÀýÁ¦ÇÏ¿© ¾È½ÉÀ» ÇÏ°Ô µÇ¾ú´Ù Á¤µµÀÇ Àǹ̰¡ ÀÖÀ» °Í °°½À´Ï´Ù.


[FAQ]

[¾Öµ¶ÀÚ ÀÇ°ß 1]

Ç×»ó±³¼ö´ÔÀÇ ÁÁÀº °­ÀÇ ¿­½ÉÈ÷ µè°í ÀÖ´Â ±¤ÁÖÀÇ ¼ÒÈ­±â³»°ú ÀÇ»çÀÔ´Ï´Ù. À̹ø ³»¿ëÁß¿¡ sentinal polyp¿¡ ´ëÇؼ­ ±Ã±ÝÇؼ­ ¸ÞÀÏ ¿Ã¸³´Ï´Ù. Àú ¿ª½Ã sentinal polypÀº ȯÀںе鲲 ¿ëÁ¾À̶ó°í ¸»¾¸µå¸®Áö ¾Ê°í ¿ª·ù¼º ½Äµµ¿°¿¡ ÀÇÇÑ ÈäÅͶó°í ¸»¾¸µå¸®´Âµ¥¿ä, °£È¤ Å©±â°¡ Áõ°¡ÇÏ´Â ¿ëÁ¾ÀÌ ÀÖ¾î ¿ëÁ¾ÀýÁ¦¼úÀ» ½ÃÇàÇØ¾ß Çϳª ¹«Ã´À̳ª °í¹ÎµÇ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ¹°·Ð Áõ»óÀÌ ¾ø¾î Áö¼ÓÀûÀ¸·Î ¾à¹°À» º¹¿ë½ÃÅ°Áö´Â ¾Ê´Â ȯÀںеéÀÔ´Ï´Ù. Ȥ½Ã ½Ã¼ú ÈÄ GERD°¡ ¿ÀÈ÷·Á ½ÉÇØÁöÁö ¾ÊÀ»±î °ÆÁ¤µµ µË´Ï´Ù. ±³¼ö´Ô²²¼­´Â Å©±â º¯È­°¡ ÀÖ´Â sentinal polypÀ» ¾î¶»°Ô ÇϽôÂÁö ±Ã±ÝÇÕ´Ï´Ù.

[ÁÖÀÎÀå ´äº¯]

ÁÁÀº ¸»¾¸ °¨»çÇÕ´Ï´Ù. »ç½Ç sentinel polypÀÌ °è¼Ó Ä¿Áö´Â °æ¿ì´Â °ÅÀÇ ¾ø´Ù°í »ý°¢ÇÕ´Ï´Ù. óÀ½ºÎÅÍ ¾î´À Å©±â¿´´Ù°¡ wax and waneÀ» ÇÏ´Â °æ¿ì°¡ ¸¹¾Æ º¸ÀÔ´Ï´Ù. Áö¼ÓÀûÀ¸·Î linearÇÏ°Ô Ä¿Áö´Â °æ¿ì´Â ¸Å¿ì Àû½À´Ï´Ù. ¿ì¿¬È÷ ¾ÆÁÖ Ã³À½¿¡ ¹ß°ßµÇ¸é ´ÙÀ½ ³»½Ã°æ¿¡¼­ Á¶±Ý ´õ Ä¿Áö°ÚÁö¸¸, º¸Åë Á¦Ç®¿¡ ÁöÃļ­ ¾î´À Å©±â¿¡ µµ´ÞÇÑ ÈÄ ¸ØÃß´Â °Í °°½À´Ï´Ù. ÇöÀúÈ÷ Ä¿Áö¸é ¿ëÁ¾ÀýÁ¦¼úÀ» ÇÒ ¼öµµ ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù¸¸ Àú´Â °æÇèÀÌ ¾ø½À´Ï´Ù.


[¾Öµ¶ÀÚ ÀÇ°ß 2]

º¸ÃÊ ¿ëÁ¾ÀÌ Àǽɵɶ§´Â Á¶Á÷ °Ë»ç¸¦ Ç×»ó ÇØ¾ß Çϳª¿ä? Á¦°¡ À۳⿡ º¸ÃÊ ¿ëÁ¾ÀÎ ÁÙ ¾Ë¾ÒÁö¸¸ ¿ì¿¬È÷ Á¶Á÷°Ë»ç¸¦ Çß´õ´Ï Á¶±â ½Äµµ¾ÏÀÌ Áø´ÜµÇ¾î ³»½Ã°æ ÀýÁ¦¸¦ ½ÃÇàÇÏ¿´´ø ȯÀÚ°¡ ÀÖ¾ú½À´Ï´Ù. ¸¸¾à, Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾Ê¾Ò´Ù¸é °£°úµÇ¾úÀ» °Í °°Àºµ¥, À°¾È ¼Ò°ßÀ¸·Î´Â Á¶±â ½Äµµ¾Ïº¸´Ù´Â º¸ÃÊ ¿ëÁ¾ÀÎ ÁÙ ¾Ë¾Ò¾ú½À´Ï´Ù.

[ÁÖÀÎÀå ´äº¯]

ÁÁÀº Áú¹® °¨»çÇÕ´Ï´Ù. ¹°·Ð º¸ÃÊ ¿ëÁ¾À¸·Î »ý°¢ÇÏ¿´´Âµ¥ ¿ì¿¬ÇÑ Á¶Á÷°Ë»ç·Î ½Äµµ¾ÏÀÌ Áø´ÜµÈ ¿¹°¡ ÀÖ½À´Ï´Ù. ±×·¯³ª ´ëºÎºÐ ³»½Ã°æ À°¾È¼Ò°ß¸¸À¸·Îµµ º¸ÃÊ ¿ëÁ¾Àº º¸ÃÊ ¿ëÁ¾À¸·Î, ½Äµµ¾ÏÀº ½Äµµ¾ÏÀ¸·Î Áø´ÜÇÒ ¼ö ÀÖ½À´Ï´Ù. ´Ù¸¸ È®ÀÎÀ» À§ÇÏ¿© óÀ½ ¹ß°ßµÇ¾úÀ» ¶§¿¡´Â Á¶Á÷°Ë»ç¸¦ ÇÒ °ÍÀ» ÃßõÇÕ´Ï´Ù. 1³â ÈÄ ÃßÀû °Ë»ç¿¡¼­ Å« º¯È­°¡ ¾ø´Ù¸é °è¼ÓµÈ Á¶Á÷°Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê´Ù°í »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù.


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¹«Áõ»ó ERD¸¦ ¾î¶»°Ô ÇÒ °ÍÀΰ¡¿¡ ´ëÇÑ °Í°ú ºñ½ÁÇÑ ¾ê±â¶ó°í »ý°¢ÇÕ´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼­ ERD°¡ ÀÖ´Â °æ¿ì ƯÈ÷ ³²ÀÚ¶ó¸é ´ëºÎºÐ ¿ì¸®°¡ ¾Ë°íÀÖ´Â ÀüÇüÀûÀÎ Áõ»óÀ» Ưº°È÷ È£¼ÒÇÏÁö´Â ¾Ê´õ¶ó±¸¿ä. ±×·¡µµ ȯÀÚ¿¡°Ô ´ç½ÅÀÌ Á¤»óÀÌ ¾Æ´Ï´Ù, »ýÈ°½À°ü ±³Á¤À» ÇؾßÇÑ´Ù´Â Ãø¸é¿¡¼­ 1-2´Þ Á¤µµÀÇ PPI¸¦ ±ÇÀ¯ÇÏ°í ÀÖ½À´Ï´Ù. ¿ÀÈ÷·Á Áõ»óÀÌ ¾ø´Â °Ô ´õ ¹«¼­¿ï ¼ö°¡ ÀÖ´Ù°í ¾ê±âÇÕ´Ï´Ù. (³ªÁß¿¡ hiatal hernia°¡ µÉ ¼ö ÀÖÀ» °¡´É¼º..)

Sentinel polyp¿¡ ´ëÇؼ­µµ ´ëºÎºÐ erosionÀ» µ¿¹ÝÇϱ⠶§¹®¿¡ 1-2´ÞÀÇ ¾à¹°Ä¡·á¸¦ ±ÇÇÏ°í ÃßÀû°üÂûÀ» ÇÕ´Ï´Ù. 10³âµ¿¾È º¯È­°¡ ¾ø´Â ȯÀÚÀÇ °æ¿ì ù 2´ÞÀÇ PPI°¡ Àǹ̰¡ ¾ø°ÚÁö¸¸¿ä... ÀûÀýÇÑ ¾à¹°Ä¡·á¿Í »ýÈ°½À°ü ±³Á¤À¸·Î Ä¡·áÇÒ ¼ö ÀÖ´Ù´Â °ÍÀ» °­Á¶Çϱâ À§ÇØ ¾àÀ» ÁÝ´Ï´Ù. ¿ì¸®³ª¶ó ¹®È­´Â ¾àÀ» ¾È ¸ÔÀ¸¸é ´ëºÎºÐ ±¦Âú´Ù°í »ý°¢ÇÕ´Ï´Ù. ÀúÈñ°¡ ¿­½ÉÈ÷ ¼³¸íÇÑ´Ù°í ÇÏ´õ¶óµµ ¾àÀ» ÁÖÁö ¾ÊÀ¸¸é ±¦Âú´Ù°í »ý°¢ÇÒ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. °á·ÐÀûÀ¸·Î sentinel polyp¿¡ ´ëÇؼ­ PPI 1-2´Þ Ä¡·á ÈÄ Ã³À½ Áø´ÜµÈ °æ¿ì 6°³¿ù ³»Áö 1³â ÈÄ follow-up ³»½Ã°æÀÌ ÇÊ¿äÇÏ´Ù°í ¼³¸íÇÏ°í ÀÖ½À´Ï´Ù.

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¹«Áõ»ó erosive esophagitisÀÇ Ä¡·á¿¡ ´ëÇÑ °ßÇØ´Â ´Ù¾çÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù. Àú´Â ¾à¹°Ä¡·á¸¦ ±ÇÇÏÁö ¾Ê°í ÀÖÁö¸¸, ¾à¹°Ä¡·á¸¦ ±ÇÇÏ´Â ¼±»ý´ÔµéÀÇ °ßÇصµ Àǹ̰¡ ÀÖ´Ù°í »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù. ÇÑ ¸¶µð·Î ´äÀÌ ¾ø´Â °ÍÀÌÁö¿ä. ´Ù¸¸ ȯÀÚ¿¡ µû¶ó ´Þ¶óÁú ¼ö ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù. 1Â÷ º´¿øÀÌ ´Ù¸£°í 2Â÷ º´¿ø, 3Â÷ º´¿øÀÌ ´Ù¸£´Ù°í »ý°¢ÇÕ´Ï´Ù. ¼­¿ïÀÇ º´¿øÀÌ ´Ù¸£°í ±¤¿ª½ÃÀÇ º´¿øÀÌ ´Ù¸£°í À¾¸éÀÇ º´¿øÀÌ ´Ù¸¦ °Í °°½À´Ï´Ù. ÀÚ½ÅÀÇ °ßÇØ¿Í È¯ÀÚÀÇ Æ¯¼ºÀ» Àß °í·ÁÇÏ¿© »óȲº°·Î ÃÖ¼±ÀÇ ´äÀ» ãÀ¸¸é µÇÁö ¾ÊÀ»±î¿ä? ¾îÂ¥ÇÇ Á¤´äÀÌ ¾ø´Â ¹®Á¦À̴ϱî...


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EndoTODAYÀÇ ¿­·ÄÇÑ ±¸µ¶ÀÚ ÀÔ´Ï´Ù. Sentinel polyp part¸¦ ÃÖ±Ù Àоú½À´Ï´Ù. ÃÖ±Ù ³»½Ã°æ case¿¡¼­ sentinel polyp¼Ò°ßÀÌ ÀÖ¾î ÷ºÎÇÕ´Ï´Ù. 1³âÀü »çÁøµµ ÀÖ½À´Ï´Ù. À°¾ÈÀûÀ¸·Î´Â sentinel polypÀ̶ó°í »ý°¢µÇ¸ç 1³âÀÌ Áö³ª Å©±â³ª ¹ßÀûÀÇ Á¤µµ´Â ÁÙ¾îµéÀº °ÍÀ¸·Î »ý°¢µË´Ï´Ù. ±×·¯³ª, Á¶Á÷°Ë»ç´Â µÎ¹ø ¸ðµÎ squamous papilloma¶ó°í ³ª¿Ô½À´Ï´Ù. ÷ºÎÇÑ PDF ÆÄÀÏÀ» º¸¸é inflammatory polyp ºÎºÐ¿¡¼­ "The typical features area mixture of granulation tissue and in?ammation of the lamina propria covered by squamous epithelium showing features of basal hyperplasia... In the past, several of these have been erroneously reported as squamous cell papilloma."¶ó´Â ¼³¸íÀÌ Àִµ¥ ÀÌ caseÀÇ Á¶Á÷ ¼Ò°ßÀº À§ÀÇ ¼³¸í°ú °°Àº °ÍÀÌ ¾Æ´Ñ°¡ »ý°¢µË´Ï´Ù. Sentinel polypÀ¸·Î »ý°¢ÇÏ¿© 1-2³â µÚ f/uÇϱâ·Î ÇÏ¿´½À´Ï´Ù. ±³¼ö´ÔÀÇ ÀÇ°ßÀ» ¾î¶°ÇϽÅÁö¿ä.

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ÁÁÀº Áõ·Ê °¨»çÇÕ´Ï´Ù. ³»½Ã°æ À°¾È¼Ò°ßÀº ÀüÇüÀûÀÎ sentinel polypÀÔ´Ï´Ù. Squamocolumnar junction Á÷»ó¹æÀÇ µÕ±Ù sessile polypÀε¥, Ç¥¸éÀº ¹ßÀûµÇ¾î ÀÖ°í ¾à°£ Èò»öÀÇ ±×¹°¸ð¾çÀÇ ÁÙÀÌ ÀÖ½À´Ï´Ù. PolypÀÇ ¾Æ·¡·Î´Â stomach high body·ÎºÎÅÍ ²ø·Á¿À´Â µíÇÑ ¸ð¾çÀÇ fold°¡ ÀÖÀ¸¸ç polypÀÇ À§ÂÊÀ¸·Î´Â »ï°¢Çü ȤÀº ¸¶¸§¸ð²Ã ¸ð¾çÀÇ ³ÐÁö¸¸ ªÀº mucosal break°¡ ÀÖ½À´Ï´Ù. ÀüÇüÀûÀÎ hiatal hernia´Â ¾øÁö¸¸ 2013³â ³»½Ã°æ ¿ø°æ »çÁøÀ» º¸¸é ¼ÒÀ§ short segment hiatal hernia°¡ ÀÖÀ¸¸é¼­ ÇϺΠ½ÄµµÀÇ Á¡¸·Àº ¾à°£ µÎ²¨¿öÁ® dirty white discolorationÀ» º¸ÀÌ°í ÀÖÀ¸¸ç ÀÌ·Î ÀÎÇÏ¿© pallisading vesselÀÌ Àß º¸ÀÌÁö ¾Ê°í ÀÖ½À´Ï´Ù. ÀÌ·¯ÇÑ ¼Ò°ßµéÀº ÀüºÎ ÀüÇüÀûÀÎ sentinel polyp (= inflammatory polyp)ÀÇ ¼Ò°ßÀÔ´Ï´Ù. Á¶Á÷°Ë»ç¿¡¼­ papilloma·Î ¿ÀÀ뵃 ¼ö ÀÖ´Ù´Â ¼±»ý´ÔÀÇ ¾ð±Þ¿¡ 100% °°Àº ÀÇ°ßÀÔ´Ï´Ù. Àú´Â ȯÀÚ°¡ À§½Äµµ¿ª·ùÀÇ Áõ»óÀÌ ÀÖÀ¸¸é PPI¸¦ µå¸®°í ±×·¸Áö ¾ÊÀ¸¸é PPI¸¦ µå¸®Áö ¾Ê°í ÀÖ½À´Ï´Ù. üÁß°ü¸®, ÀûÀýÇÑ ¿îµ¿, ¾ß½Ä, °ú½Ä, Áö¹æ½Ä ÇÇÇÏ±â µî »ýÈ°½À°ü °³¼±¸¸ ±ÇÇÏ°í ÀÖ½À´Ï´Ù.

¼±»ý´Ô²²¼­ ¾Ë·ÁÁֽŠÀÚ·á Gastrointestinal Polyps (Edited by Najib Y. Haboubi, Karel Geobes, Neil A. Shepherd and Ian C. Talbot)ÀÇ inflammatory polypÀ̶ó´Â Á¦¸ñ ¾Æ·¡¿¡ ¼³¸íµÈ ºÎºÐÀ» ¿©·¯ ¾Öµ¶ÀÚ¸¦ À§ÇÏ¿© ÀÌ°÷¿¡ ¿Å°Üº¸°Ú½À´Ï´Ù.

1) Synonym: oesophagogastric polyp, inflammatory reflux polyp, oesophagogastric polyp-fold complex

2) Endoscopic appearance:
- Characteristically these appear as a solitary small sessile polypoid lesion occurring at or near the gastro-oesophageal junction. Less commonly they can appear as multiple small sessile polypoid lesions.
- Endoscopically the lesions are round.
- They vary from 5-20 mm in diameter, with a smooth and erythematous surface, often with a small superficial erosion on the top.
- Endoscopic features of oesophagitis are often found.
- There may be a prominent fold of mucosa (a sentinel fold) leading up to the polyp from the gastro-oesophageal junction.

3) Microscopic features: The typical features are a mixture of granulation tissue and inflammation of the lamina propria covered by squamous epithelium showing features of basal hyperplasia, with varying erosion of the epithelium and often marked active inflammatory cell infiltrate. Sometimes the polyp is partially covered by junctional columnar epithelium. The adjacent oesophageal mucosa is usually inflamed.

4) Biological behaviour and associated conditions: Inflammatory polyps develop mostly in patients with a hiatus hernia and/or with reflux oesophagitis. They can also occur in patients without such a history and in patients with other less common causes of oesophagitis. They are entirely benign. In the past, several of these have been erroneously reported as squamous cell papilloma.

5) Management: No treatment is needed, except for the associated oesophagitis.


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Áö³­ 3¿ù¿¡ À§Àå³»½Ã°æÇÐȸ¿Í ¼ÒÈ­±â³»½Ã°æÇÐȸ¿¡¼­ ¼±»ý´ÔÀÇ °­ÀǸ¦ µé¾ú½À´Ï´Ù. ±³¼ö´Ô²²¼­ °­ÀÇ¿¡¼­ ¾ð±ÞÇϽŠ¸Å¿ì µå¹® ÄÉÀ̽º °°¾Æ ¹®Àǵ帳´Ï´Ù. ´ÜºÐÀý ¹Ù·¿½Äµµ ºÎÀ§ EGJ¿¡¼­ sentinel polypÀ¸·Î »ý°¢µÇ´Â exudate·Î µ¤ÀÎ polyp(¾à 0.7cm)ÀÌ ÀÖ¾î Á¶Á÷°Ë»ç¸¦ ÇÏ¿´´Âµ¥ ´ÙÀ½°ú °°Àº °á°ú°¡ ³ª¿Ô½À´Ï´Ù.

Dx: Tissue from gastro-esophageal junction, endoscopic biopsy ;
Suggestive of malignancy.
Suggestive of adenocarcinoma, well differentiated of gastro-esophageal junction.
Note) In gastro-esophageal junction (B), atypical metaplastic glands with pleomorphic nuclei and irregular pattern are present, with overlying squamous epithelium. So, the possibility of adenocarcinoma arising from Barrett's esophagus is suggested.

Barrett's esophagus¿¡¼­ ±âÀÎÇÑ adenocarcinoma °°´Ù´Â Á¶Á÷°á°úÀε¥ ±³¼ö´Ô °­ÀÇ¿¡¼­ long segment Barrett's esophagusµµ ¾Æ´Ï°í SSBE¿¡¼­´Â ¸Å¿ì µå¹°°í ¿ì¸®³ª¶ó¿¡¼­´Â ¸î ÄÉÀ̽º ¾ø´Ù°í µé¾ú´ø ±â¾ïÀÌ ³³´Ï´Ù. »ç½Ç sentinel polypÀ» Á¶Á÷°Ë»ç Çغ¸¸é °ÅÀÇ ´ëºÎºÐ hyperplastic polypÀ¸·Î ³ª¿Í¼­ ¹Ù»Ü ¶§´Â Å©Áö ¾ÊÀ¸¸é ±×³É ³Ñ¾î°¡°íÇ À¯È¤À» ¹Þ½À´Ï´Ù¸¸... óÀ½ ¹ß°ßµÈ sentinel polypÀº ÇѹøÂë Á¶Á÷°Ë»ç·Î È®ÀÎÇØ º¸ÀÚ´Â ±³¼ö´Ô ¸»¾¸ÀÌ »ý°¢³ª°í, ¿ØÁö Á» ÁöÀúºÐÇغ¸¿©¼­ Á¶Á÷°Ë»ç¸¦ Çߴµ¥ ¶æ¹ÛÀÇ °á°ú°¡ ³ª¿Ô½À´Ï´Ù. ´öºÐ¿¡ Çϸ¶ÅÍ¸é µå¹°´Ù´Â ÀÌÀ¯·Î ³Ñ¾î°¥»·ÇÑ ÄÉÀ̽º¸¦ Àâ¾Æ³½°Í °°¾Æ °¡½¿À» ¾µ¾î³»·È½À´Ï´Ù. ÀÌ Á¤µµ¸é ESD·Î Ä¡·áÇÒ ¼ö ÀÖÀ»±î¿ä? ¿ì¹®ÀÔ´Ï´Ù¸¸, Barrett's esophagus¿¡¼­ ±âÀÎÇÑ adenocarcinoma¸é ½Äµµ¾ÏÀ¸·Î º¸¾Æ¾ß µÉ±î¿ä?

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¾È³çÇϽʴϱî. ÆùÄ«·Î ÂïÀº Èñ¹ÌÇÑ »çÁø ÇÑ Àå ¹Û¿¡ ¾ø±â ¶§¹®¿¡ Á¤È®ÇÑ ÆÇ´ÜÀº ¾î·Á¿î °Í °°½À´Ï´Ù. ¼¼ °¡Áö ÀÇ°ß µå¸³´Ï´Ù.

1) ¾ÆÁ÷ ¾ÏÀ̶ó°í ´ÜÁ¤Çϱâ´Â ¾î·Á¿ï °Í °°½À´Ï´Ù. À§½ÄµµÁ¢Çպδ ¿°ÁõÀÌ ¸¹À¸¹Ç·Î ÀÌ·Î ÀÎÇÑ regenerative atypia¿Í neoplasia¿¡ ÀÇÇÑ dysplasia¸¦ º´¸®ÇÐÀûÀ¸·Î ±¸ºÐÇϱ⠾î·Æ½À´Ï´Ù. µû¶ó¼­ ÀÏ´Ü º´¸® Æǵ¶¿¡ ´ëÇÑ 2Â÷ ÀÇ°ßÀ» ±¸ÇØ¾ß ÇÏ°í, PPI¸¦ Àá½Ã Åõ¾àÇÏ°í Á¶Á÷°Ë»ç Àç°ËÀ¸·Î ¾Ï ¿©ºÎ¸¦ È®ÀÎÇÏ´Â °ÍÀÌ ÇÊ¿äÇÕ´Ï´Ù. ¾ÏÀ¸·Î È®ÀÎµÇ¸é ³»½Ã°æÄ¡·á´Â °¡´ÉÇÕ´Ï´Ù. ¿©±â¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù. ¾Ï ÀǽÉÀ¸·Î ¿À¼Ì´Âµ¥ ¾ÏÀÌ ¾Æ´Ñ °ÍÀ¸·Î È®ÀεǾú´ø ÇູÇÑ Áõ·ÊÀÔ´Ï´Ù.

2) Barrett's esophagus¿¡¼­ ±âÀÎÇÑ adenocarcinoma´Â ½Äµµ¾ÏÀ¸·Î ºÐ·ùÇÏ°í ÀÖ½À´Ï´Ù.

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Sentinel polypÀ¸·Î ÀÇ·ÚµÈ ºÐÀÔ´Ï´Ù.

±×·±µ¥ »çÁøÀ» ÀÚ¼¼È÷ º¸´Ï sentinel polyp¿¡ ¿¬ÇÏ¿© ÀÛÀº »ï°¢Çü ¸ð¾çÀÇ mucosal break°¡ ÀÖ½À´Ï´Ù. ¸»ÇÏÀÚ¸é reflux esophagitis LA-A¶ó°í ÇÒ ¼ö ÀÖ½À´Ï´Ù. üÁß°ü¸®, ¾ß½Ä, °ú½Ä, Áö¹æ½ÄÀ» ÇÇÇÏ´Â Á¤µµÀÇ ºñ¾à¹°¿ä¹ýÀ» ±ÇÇÏ´Â »óȲÀÔ´Ï´Ù. ¸¸¾à »ê¿ª·ù Áõ»óÀÌ ÀÖÀ¸¸é PPI³ª P-CABÀ» threshold therapy·Î ÃßõÇϸé ÁÁ°Ú½À´Ï´Ù. 1-2ÁÖ ¸ÅÀÏ µå¼Å¼­ Áõ»óÀÇ º¯È­¸¦ º¸°í, ¸¸¾à µµ¿òµÇ¸é Åõ¾à°£°ÝÀ» ´Ã¸®°Å³ª (threshold therapy) ȤÀº ÇÊ¿ä ½Ã µå½Ã´Â °Í (on demand)À» ½ÃµµÇÕ´Ï´Ù.



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