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SPC Áø·áÀÇ·Ú¼¾ÅÍ¿Í ÇÔ²² Web-seminar¸¦ ÁøÇàÇÏ°í ÀÖ½À´Ï´Ù (¹®ÀÇ: 02-3410-0506). 2015³â 11¿ù 3ÀÏ (È­) Àú³á 7½Ã '½Äµµ¾Ï ¹× ´Ù¾çÇÑ ½ÄµµÁúȯÀÇ ³»½Ã°æ Áø´Ü' ½Ã°£¿¡ ³ª¿Â Áú¹® ÀϺο¡ ´ëÇÑ ´äº¯À» µå¸³´Ï´Ù. WebÀ¸·Î Âü¿©ÇØ ÁֽŠ¸ðµç ºÐµé²² ´Ù½Ã Çѹø °¨»çµå¸³´Ï´Ù. (»çÀüµî·Ï 133¸í Áß 83¸íÀÌ Âü¼®Çϼ̽À´Ï´Ù. »çÀüµî·Ï ´ëºñ Âü¼®À² 62.4%) ±× Áß 9¸íÀÇ ¼±»ý´ÔÀÇ Áú¹®¸ðÀ½ÀÔ´Ï´Ù.)

´ÙÀ½ Web-seminar´Â 12¿ù 8ÀÏ (È­) Àú³á 7½ÃÀ̸ç Á¦¸ñÀº '¿ì¸®³ª¶ó Á¶±âÀ§¾Ï ³»½Ã°æ Ä¡·áÀÇ ÇöȲ'ÀÔ´Ï´Ù (¸µÅ©).


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

Esophageal melanosisÀÇ °æÇèÀÌ ¾ø¾î¼­ ±×·±µ¥, Esophageal phlebectasia¿Í ±¸º°ÀÌ ¿ëÀÌÇÑÁö¿ä? ±¸ºÐÀÌ Àß ¾È°¡¸é Cushion signÀ» È®ÀÎÇÏ´Â °ÍÀÌ µµ¿òÀÌ µÇ°Ú´ÂÁö¿ä?

[ÀÌÁØÇà ´äº¯]

Phlebectasia´Â Ç÷°üÀÌ ´Ã¾î³­ °ÍÀ¸·Î ½±°Ô ±¸ºÐµÉ °Í °°½À´Ï´Ù. Cushion signÀ» º¼ Á¤µµ·Î Å©°Ô Ç÷°üÀÌ ´Ã¾î³­ °æ¿ìº¸´Ù´Â ¾à°£ °¡º±°Ô È®ÀåµÈ °æ¿ì°¡ ¸¹´Ù°í »ý°¢ÇÕ´Ï´Ù.

@ Âü°íÀÚ·á: EndoTODAY melanocytosis


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

½ÄµµÀÇ nevus¿Í ±¸º°Àº ¾î¶»°Ô Çϳª¿ä?

[ÀÌÁØÇà ´äº¯]

Àúµµ ½Äµµ nevus´Â º» ÀûÀÌ ¾ø¾î¼­ Á¤È®È÷ ´äº¯Çϱâ´Â ¾î·ÆÁö¸¸ ¹®Çå¿¡´Â ¾Æ·¡¿Í °°ÀÌ ³ª¿Í ÀÖ¾ú½À´Ï´Ù. Á¶Á÷°Ë»ç¿¡¼­ heavily pigmented dendritic melanocytes°¡ Ư¡ÀÎ °Í °°½À´Ï´Ù.

Melanocytic nevi are uncommonly seen in the esophageal mucosa. To our knowledge, only a single case of blue nevus is found in the literature, and this was reported by Lam et al from a 52-year-old Chinese woman who presented with linear patches of bluish pigmentation in her lower esophagus. Like its cutaneous and mucosal counterparts, this is characterized by the presence of dendritic melanocytes in the subepithelial connective tissue without junctional melanocytic activity. The absence of cytologic atypia and the presence of heavily pigmented dendritic melanocytes in stromal tissue differentiate the lesion from melanoma and melanocytosis. (Chang. Arch Pathol Lab Med 2006)

@ Âü°íÀÚ·á: EndoTODAY melanocytosis


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

½ÄµµÁ¢Çպγª À§¹®ºÎ¿¡¼­ µî¿¡¼­ Á¶Á÷°Ë»ç½Ã Á¢±Ù¹æ¹ýÀÌ Á» ¾î·Á¿ï ¶§°¡ ¸¹°í ÃâÇ÷ÀÌ Ç×»ó °ÆÁ¤µË´Ï´Ù. ¾ÈÀüÇÏ°Ô Á¶Á÷°Ë»ç¸¦ À§ÇÑ ÆÁÀÌ ÀÖ³ª¿ä?

[ÀÌÁØÇà ´äº¯]

½Äµµ À§ Á¢ÇÕºÎ, ƯÈ÷ ÇϺνĵµºÎÀ§´Â palisading vesselÀ̶ó°í ÇÏ¿© Ç÷°üÀÌ Á¡¸·Ãþ¿¡ Á¸ÀçÇÕ´Ï´Ù. Á¶Á÷°Ë»ç¸¦ Çϸé ÇÇ°¡ ¸¹ÀÌ ³ª¿À´Â ÀÌÀ¯ÀÔ´Ï´Ù. ±×·¯³ª ÀÛÀº Ç÷°üÀ̹ǷΠÀ̳» ¸Ü½À´Ï´Ù.


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

GE junction »ó¹æ¿¡¼­ Á¶Á÷°Ë»ç»ó papilloma·Î È®ÀεÆÁö¸¸ »çÀÌÁî°¡ 2cm ÀÌ»óÀ̾ follow up¸¸ Çصµ µÇ´Â °ÇÁö¿ä?

[ÀÌÁØÇà ´äº¯]

Papilloma´Â benignÀÔ´Ï´Ù. Á¶±Ý Å©´õ¶óµµ Ä¡·á´ë»óÀº ¾Æ´Ñ °Í °°½À´Ï´Ù. ¾Æ·¡ »çÁøÀº Á¶±Ý ºñÀüÇüÀûÀÌÁö¸¸ Å©°í °æ°ú°üÂû Çß´ø papillomaÀÔ´Ï´Ù.

Papilloma ¸î Áõ·Ê¸¦ ¼Ò°³ÇÕ´Ï´Ù.


½Äµµ À¯µÎÁ¾Àº ¸Å¿ì ÈçÇÕ´Ï´Ù. À¯µÎÁ¾Àº premalignant lesionÀÌ ¾Æ´Ï¹Ç·Î ±¸Å¿© ¹«¸®Çؼ­ Á¦°ÅÇÒ ÇÊ¿ä´Â ¾ø´Ù°í »ý°¢µË´Ï´Ù. ±×·¯³ª ½Äµµ¿¡ ȤÀÌ ÀÖ´Ù´Â »ý°¢¿¡ ¸Å¿ì ºÒ¾ÈÇØ ÇϽô ºÐµµ ÀÖ½À´Ï´Ù. ±×·¯ÇÑ °æ¿ì¿¡´Â ³»½Ã°æ Á¶Á÷°Ë»ç¸¦ ÅëÇÏ¿© ÀÛÀº À¯µÎÁ¾À» Á¦°ÅÇعö¸®¸é ÁÁ½À´Ï´Ù. ¿À´ÃÀÇ Áõ·Ê¿¡¼­´Â Á¶Á÷°Ë»ç forcepÀ¸·Î º´¼ÒÀÇ ¾Æ·¡ÂÊÀ» Àâ¾Æ ÇÑ ¹ø¿¡ Á¦°ÅÇÒ ¼ö ÀÖ¾ú½À´Ï´Ù. ȯÀÚ°¡ ¹«Ã´ ÁÁ¾ÆÇß´ø °ÍÀº ´ç¿¬ÇÑ ÀÏÀÔ´Ï´Ù. (EndoTODAY 2009. 2. 27.)


Esophageal papillomatosis


Hiatal hernia, reflux esophagitis°¡ ÀÖ´ø ȯÀÚÀÇ ÇϺνĵµ À¯µÎÁ¾À» ÀýÁ¦ÇÔ


Sentinel polypÀ¸·Î »ý°¢ÇÏ°í ÀýÁ¦ÇÏ¿´´Âµ¥ Á¶Á÷°Ë»ç´Â À¯µÎÁ¾À¸·Î ³ª¿È.


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

½Äµµ°üÂû¿¡ NBI°¡ µµ¿òÀÌ µÇ³ª¿ä? ƯÈ÷ ½Äµµ¾Ï¿¡ ´ëÇؼ­?

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½Äµµ¾Ï °íÀ§Çè ȯÀÚ(µÎ°æºÎ¾Ï, ½Äµµ¾Ï ³»½Ã°æÄ¡·á °ú°Å·Â)¿¡¼­ ºñÈ®´ë NBI ¼Ò°ß¿¡ ´ëÇÑ ÃÖ±Ù ³í¹®(Nagami. Am J Gastroenterol 2014)À» ¼Ò°³ÇÏ´Â °ÍÀ¸·Î ´äº¯À» ´ë½ÅÇÕ´Ï´Ù. ½Äµµ¾Ï¿¡¼­ NBIÀÇ À¯¿ë¼ºÀº È®´ë³»½Ã°æÀ» ÀÌ¿ëÇÒ ¶§ ¶Ñ·ÇÇÕ´Ï´Ù. ÀϹÝÀûÀÎ »óȲ¿¡¼­´Â È®´ë³»½Ã°æÀ» ÀÌ¿ëÇϱ⠾î·Á¿ì¹Ç·Î Åë»óÀÇ ºñÈ®´ë ³»½Ã°æ¿¡ NBI¸¦ Àû¿ëÇÕ´Ï´Ù. ÀÌ ¹æ¹ý(ºñÈ®´ë NBI)ÀÇ À¯¿ë¼º¿¡ ´ëÇÑ ÀÚ·á°¡ ºÎÁ·ÇÑ »óȲÀÔ´Ï´Ù.

°á·ÐÀº °íÀ§ÇèȯÀÚÀÇ screening endoscopy¿¡¼­ NBI´Â Lugol chromoendoscopy¸¦ ´ëüÇÒ ¼ö ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù. ¾Æ·¡ Ç¥¿¡¼­µµ ½Ç¼± ¹Ú½º 3¸íÀ» Á¦¿ÜÇÑ 29°³ÀÇ °íµµÀÌÇü¼º/½Äµµ¾Ï º´¼Ò°¡ ºñÈ®´ë NBI¿¡¼­ ¹ß°ßÀÌ µÇ¾ú±â ¶§¹®ÀÔ´Ï´Ù. ÀÌ Á¤µµÀÇ sensitivity¸é screening endoscopy ¿ëµµ·Î´Â ÃæºÐÇÏ´Ù°í »ý°¢µË´Ï´Ù. ±¦È÷ LugolÀ» »Ñ¸®´À¶ó °í»ýÇÒ ÇÊ¿äµµ ¾ø°í ³Ê¹« ¸¹Àº Lugol void area ¶§¹®¿¡ È¥¶õÀ» °ÞÀ» ÀÌÀ¯µµ ¾ø½À´Ï´Ù.

µÎ°æºÎ¾ÏÀ̳ª ½Äµµ¾Ï ³»½Ã°æÄ¡·á °ú°Å·Â°ú °°Àº °íÀ§Çè ÀÎÀÚ°¡ ¾ø´Â º¸ÅëÀÇ ³»½Ã°æ¿¡¼­ NBI¸¦ »ç¿ëÇØ¾ß ÇÏ´ÂÁö´Â ¹ÌÁö¼öÀÔ´Ï´Ù. ¿©·¯ ÀÇ°ßÀÌ °¡´ÉÇÏ°ÚÁö¸¸ Àú´Â ½ÄµµÀÇ °üÂûÀº Åë»óÀÇ ³»½Ã°æ(white light endoscopy)À̸é ÃæºÐÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù. NBI¸¦ ¹«ºÐº°ÇÏ°Ô »ç¿ëÇÏ¿© °Ë»çÀÇ sensitivity¸¦ ¹«ÇÑÈ÷ ³ôÀÏ ÀÌÀ¯´Â ¾øÀ» °Í °°½À´Ï´Ù. Screening¿¡¼­´Â È¿°ú¿Í À§ÇèÀÇ ±ÕÇüÀÌ Áß¿äÇϱ⠶§¹®ÀÔ´Ï´Ù.


Á¶±â½Äµµ¾Ï ºñÈ®´ë NBI ¼Ò°ßÀ» ¸î °³ ¼Ò°³ÇÕ´Ï´Ù.


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

½ÊÀÌÁöÀå bulb¿¡ diverticulum¿¡ À½½Ä °É·Á¼­ obstruction µÇ¾î forcepÀ¸·Î À½½ÄÀ» ¶â¾î³½ÀûÀÌ Àִµ¥ ÀÌ°Í¿¡ ´ëÇؼ­µµ ³»½Ã°æ¼ö¼úÀÌ ÀÖ³ª¿ä?

[ÀÌÁØÇà ´äº¯]

Zenker diverticulum ¹× ±âŸ ½Äµµ °Ô½ÇÀÇ »ó´ç¼ö´Â endoscopic septal incisionÀ¸·Î Ä¡·áÇÒ ¼ö ÀÖ½À´Ï´Ù (Zenker °Ô½ÇÀÇ ³»½Ã°æ Ä¡·á). ±×·¯³ª ½ÊÀÌÁöÀå °Ô½ÇÀº ½ÄµµÂÊ°ú ¹ß»ý ±âÀüµµ ´Ù¸£°í º®µµ ¾ã°í õ°ø ½Ã À§Ç輺µµ ³ô¾Æ¼­ ³»½Ã°æÄ¡·á´Â Àß ÇÏÁö ¾Ê´Â °ÍÀ¸·Î ¾Ë°í ÀÖ½À´Ï´Ù.

@ Âü°í: EndoTODAY ½ÊÀÌÁöÀå °Ô½Ç


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

À§¾ÏÀ¸·Î STG billoth II ¼ö¼ú ÇÑ ºÐµéÀº distal ¾î´À ºÎÀ§±îÁö °Ë»çÇØ¾ß Çϳª¿ä? (°¡´ÉÇÑ µ¥±îÁö?)

[ÀÌÁØÇà ´äº¯]

°¡´ÉÇÑ µ¥±îÁö µé¾î°¡ º¼ ÇÊ¿ä´Â ¾ø½À´Ï´Ù. ±×³É ½Äµµ, ÀÜÀ§, ±×¸®°í ¼ÒÀåÀÇ ¸Ç óÀ½ 5 cm Á¤µµ¸¸ º¸½Ã¸é ÃæºÐÇÕ´Ï´Ù. ÀÜÀ§¾Ï°ú ¹®ÇÕºÎÀÇ Àç¹ßÀ» º¸´Â °ÍÀÌ Áß¿äÇÑ ¸ñÇ¥ÀÔ´Ï´Ù.

@ Âü°í: EndoTODAY ¼ö¼ú ÈÄ ³»½Ã°æ ¼Ò°ß


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

(1) ¿¬°£350 ¿©°³ Âë ³»½Ã°æ ÇÏ´Â º´¿øÀε¥ ·ç°ñÀ» ²À ÁغñÇÏ´Â°Ô ÁÁÀ»±î¿ä? ¸ÞÆ¿·»ºí·ç¹Û¿¡ ¾ø¾î¼­¿ä.(2) Lugol's solution ÀÌ ½ÇÇè½Ç¿ë°ú ³»½Ã°æ¿ë(ÀÎü¿ë)ÀÌ µû·Î ÀÖ´ÂÁö¿ä? (3) ³»½Ã°æ½Ã Lugol ¿ø¾×À» Èñ¼®ÇؾßÇÏ´ÂÁö¿ä?

[ÀÌÁØÇà ´äº¯]

¼ÒÈ­°ü Á¡¸·Ç¥¸é¿¡ °¢Á¾ »ö¼Ò¸¦ »ìÆ÷ ¶Ç´Â ºÐ¹«ÇÏ¿©, Á¡¸·ÀÇ ¹Ì¼¼ÇÑ ¿äöÀ̳ª »öÁ¶ÀÇ º¯È­¸¦ ¾Ë±â ½±°Ô Çϰųª, Á¡¸·°ú »ö¼Ò°£ÀÇ Æ¯¼öÇÑ ±â´ÉÀ» ÀÌ¿ëÇÏ¿©, º¸Åë ³»½Ã°æ °üÂû¿¡¼­´Â Àß º¸ÀÌÁö ¾Ê´Â ¼Ò°ßÀ» ½±°Ô °üÂûÇÒ ¼ö ÀÖµµ·Ï ÇÏ´Â °ÍÀÌ »ö¼Ò³»½Ã°æ(chromoscopy)ÀÔ´Ï´Ù. ¸ÞÆ¿·» ºí·ç, Àεð°íÄ«¸£¹Î µî ¿©·¯ Á¾·ùÀÇ »ö¼Ò°¡ ¾²ÀÔ´Ï´Ù. ÀÌ Áß ½ÄµµÁúȯÀÇ Áø´Ü¿¡´Â ¿ä¿Àµå¹ý(Lugol¹ý)ÀÌ À¯¿ëÇÕ´Ï´Ù. º¸Åë 2 - 3 % ¿ë¾×À» 5 - 10 mL Á¤µµ »ç¿ëÇÕ´Ï´Ù.

·ç°ñ¿ë¾×ÀÌ ÆíÆò»óÇÇ ³»ÀÇ ±Û¸®ÄÚ°Õ°ú ¹ÝÀÀÇÏ¿© º¯»öµÇ´Â °ÍÀ» ÀÌ¿ëÇÑ ¹ÝÀÀ¹ýÀ¸·Î, Á¤»ó ±¸°­ ³», ÀÎÈĵÎ, ½ÄµµÁ¡¸· µîµîÀÌ ÆíÆò»óÇÇ·Î µ¤¿© ÀÖÀ¸¹Ç·Î ¿ä¿Àµå¿¡ ÀÇÇØ ¼öºÐ ³»¿¡ °¥»öÀ¸·Î º¯»öµË´Ï´Ù. ¿°Áõ¿¡ ÀÇÇÑ ÆíÆò»óÇÇÀÇ °á¼Õ, Àç»ý»óÇÇ, ÀÌÇü»óÇÇ, ¾Ï¿¡¼­´Â ±Û¸®ÄÚ°ÕÀÇ ³óµµ°¡ ¶³¾îÁ® Ȳ¹é»öÀÇ ¿°»öÀÌ µÇÁö ¾Ê´Â ºÎÀ§(Lugol void area)°¡ Çü¼ºµË´Ï´Ù.

¹±°Ô ¿°»öµÈ ¿µ¿ªÀº °æµµ~ÁߵÀÇ ÀÌÇü»óÇÇÀÎ °æ¿ì°¡ ¸¹½À´Ï´Ù. ¾ç¼ºÀÇ °æ¿ì Å©±â°¡ ÀÛ°í ¿øÇüÀÇ ¸ð½ÀÀ̸ç, ¾Ç¼ºÀÇ °æ¿ì ÁÖÀ§°¡ ºÒ±ÔÄ¢ÇÏ°í Å©±â°¡ 10mm ÀÌ»óÀÎ °æ¿ì°¡ ¸¹½À´Ï´Ù.

ÀÏ¹Ý ³»½Ã°æ¿¡¼­ Á¡¸·ÀýÁ¦¼ú¿¡ ÀûÇÕÇÑ ½ÄµµÀÇ Ç¥Ãþ¼º ¾ÏÀ» ã¾Æ³»±â´Â ¸Å¿ì ¾î·Æ´Ù°í ¾Ë·ÁÁ® ÀÖÀ¸¸ç, Lugol ¹ýÀ» ÀÌ¿ëÇÏ¿© ¿°»öÀÌ µÇÁö ¾Ê´Â ºÎÀ§¿¡¼­ »ý°ËÀ» ÇÔÀ¸·Î½á ¹ß°ßÀ²À» ³ôÀÏ ¼ö ÀÖ´Ù°í ÇÕ´Ï´Ù. ±×·¯³ª ÀÌ·¯ÇÑ Á¢±Ù¹ýÀÌ ½ÇÁ¦·Î ȯÀÚÀÇ »ýÁ¸±â°£À» ´Ã¸®´Âµ¥ ¾ó¸¶³ª µµ¿òÀÌ µÇ´ÂÁö´Â ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù.

°³¾÷°¡¿¡¼­ ·ç°ñÀ» ÁغñÇÒ ÇÊ¿ä´Â ¾øÀ» °Í °°½À´Ï´Ù. ÀϹÝÀûÀÎ °Ë»ç¿¡¼­´Â white light endoscopy·Î Àß °üÂûÇϸé ÃæºÐÇÕ´Ï´Ù.

ÃÖ±Ù LugolÀÌ ÀÇÇпëÀ¸·Î Çã°¡¹ÞÁö ¸øÇÏ¿´´Ù°í »ç¿ëÀÌ ÁßÁöµÇ¾ú½À´Ï´Ù. ÀÇÇпëÀ¸·Î Çã°¡¹ÞÀº LugolÀÌ °ð µµÀ﵃ °ÍÀ̶ó´Â ¼Ò¹®Àº µé¾ú´Âµ¥ Á¤È®È÷´Â Àß ¸ð¸£°Ú½À´Ï´Ù.

@ Âü°í: EndoTODAY »ö¼Ò³»½Ã°æ


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

BÇü °£¿° ¹ÙÀÌ·¯½º º¸±ÕÀÚµéÀº ÀÏȸ¿ë forcepÀ» ½á¾ß µÇ´ÂÁö¿ä? (¿ØÁö ¸ðµç »ç¶÷À» ´Ù ¾²¸é Áö±¸¸¦ Ȥ»ç½Ãų °Å °°¾Æ¼­¿ä. )

[ÀÌÁØÇà ´äº¯]

Reusable forcepµµ ±ÔÁ¤´ë·Î Àß ¼Òµ¶ÇÏ¸é ¹®Á¦°¡ ¾ø½À´Ï´Ù. EO °¡½º ¼Òµ¶ÀÌ Ç¥ÁØÀÔ´Ï´Ù. Á¤È®ÇÏÁö´Â ¾ÊÁö¸¸ autoclavµµ ¹®Á¦°¡ ¾ø´Ù´Â À̾߱⸦ µéÀº ÀûÀÌ ÀÖ½À´Ï´Ù. ±×·¯³ª Æ÷¸£¸»¸°¿¡ ´ã±Ù °ÍÀ¸·Î´Â ºÎÁ·ÇÏ´Ù°í ¾Ë°í ÀÖ½À´Ï´Ù.

Reusable forcepÀ» ±ÔÁ¤´ë·Î ¼Òµ¶Çϱ⠾î·Á¿î °³¾÷°¡¿¡¼­´Â 1ȸ¿ë Æ÷¼ÁÀ» ¾²´Â °ÍÀÌ ÁÁ½À´Ï´Ù.

°¨¿° °íÀ§Çè ȯÀÚ¸¦ screening ÇÑ ÈÄ ³»½Ã°æ °Ë»ç¸¦ ÇÏ´Â °ÍÀº ¾Æ´Õ´Ï´Ù. µû¶ó¼­ ¸ðµç ȯÀÚ¸¦ °¨¿° °íÀ§Ç豺À¸·Î °¡Á¤ÇÏ°í °Ë»çÇÏ´Â °ÍÀÌ ¿øÄ¢ÀÔ´Ï´Ù. Áï universal precautionÀÌ ÇÊ¿äÇÕ´Ï´Ù. ±×·¯³ª ÀÌ¹Ì °¨¿° °íÀ§Ç豺À¸·Î ¾Ë°í ÀÖ´Ù¸é 1ȸ¿ë forcepÀ» ¿ì¼±ÀûÀ¸·Î »ç¿ëÇÏ´Â °ÍÀº Ÿ´çÇÑ Àü·«À̶ó°í »ý°¢ÇÕ´Ï´Ù.


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

¿¹Àü¿¡ ÇÐȸ¿¡¼­ NSAIDs¿Í gastric ulcer¿¡ ´ëÇÑ °­ÀǸ¦ µé¾ú´Âµ¥, ¼ÒÈ­±â³»°ú ±³¼ö´ÔÀÌ H2 blocker´Â 2ÁÖ Áö³ª¸é ³»¼º(?)ÀÌ »ý±ä´Ù°í Çϼ̴µ¥ Ȥ½Ã ÀÚ¼¼È÷ ¼³¸íÇØ ÁÖ½Ç ¼ö ÀÖ´ÂÁö¿ä?

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H2RA´Â ÈǸ¢ÇÑ À§±Ë¾ç Ä¡·áÁ¦ÀÔ´Ï´Ù.

H2RA´Â À§½Äµµ¿ª·ùÁúȯÀÇ Ä¡·á¿¡µµ »ç¿ëµÉ ¼ö ÀÖ½À´Ï´Ù. ±×·¯³ª È¿°ú°¡ º°·ÎÀÔ´Ï´Ù. ºñ´Ü tolerance ¹®Á¦°¡ ¾Æ´Ï´õ¶óµµ ¾àÈ¿°¡ ºÒÃæºÐÇÕ´Ï´Ù. H2RA¸¦ ¾²´ø À§½Äµµ¿ª·ùÁúȯ ȯÀÚ¿¡°Ô PPI¸¦ ±ÇÇÏ¿© ÇöÀúÇÏ°Ô ÁÁ¾ÆÁø °æ¿ì¸¦ ¸¹ÀÌ º¸¾Ò½À´Ï´Ù. PPI´Â H2RAº¸´Ù Åõ¾à Ƚ¼ö°¡ Àû°í, ºÎÀÛ¿ë profileµµ ¸øÇÏÁö ¾Ê°í, °¡°Ý¸é¿¡¼­µµ Å©°Ô ºÒ¸®ÇÏÁö ¾Ê±â ¶§¹®¿¡ Çö ½ÃÁ¡¿¡¼­ À§½Äµµ¿ª·ùÁúȯÀÇ ÀϹÝÀûÀÎ Ä¡·á¿¡ H2RA¸¦ ¾´´Ù´Â °ÍÀº nonsenseÀÔ´Ï´Ù. ´ÜÁö Á¤Ã¥´ç±¹¿¡¼­ PPI¿¡ ´ëÇÑ »è°¨À» ³Ê¹« ¸¹ÀÌ ÇÏ°í À־, ÀÇ·á±â°üÀÌ ÀÌ¿¡ ÀûÀÀÇÑ °á°úÀÏ »ÓÀÔ´Ï´Ù.

AspirinÀ» Æ÷ÇÔÇÑ NSAID¸¦ »ç¿ëÇϴ ȯÀÚ Áß »óºÎÀ§Àå°ü ÇÕº´ÁõÀÇ °íÀ§Ç豺¿¡¼­´Â ¿¹¹æÁ¶Ä¡°¡ ÇÊ¿äÇÕ´Ï´Ù. ÀÌ·¯ÇÑ °ßÇØ´Â 2009³â °¡À̵å¶óÀο¡ »ó¼¼È÷ ±â¼úÇÏ¿´½À´Ï´Ù. ¼¼ °¡Áö Àü·«À» Á¦½ÃÇÏ¿´´Âµ¥¿ä, »ç½ÇÀº ÇÑ °¡ÁöÀÔ´Ï´Ù. MisoprostolÀº ºÎÀÛ¿ëÀÌ ¸¹¾Æ ½ÇÁ¦·Î Àû¿ëÇϱâ´Â ¾î·Æ½À´Ï´Ù. Cox-2 selective agent·Î ¹Ù²Ü ¼ö ÀÖ´Â °æ¿ì´Â ¸¹Áö ¾Ê½À´Ï´Ù. ÁøÅëÈ¿°ú°¡ ¾àÇϱ⠶§¹®ÀÔ´Ï´Ù. ±×·¡¼­ °á±¹ PPI¸¦ Ãß°¡ÇÏ´Â °Í ÀÌ¿Ü¿¡ ¸¶¶¥ÇÑ ¹æ¹ýÀÌ ¾ø½À´Ï´Ù. ´Ù¸¸ PPI ¿ë·®¿¡ ´ëÇÑ ³í¶õÀº ³²¾ÆÀÖ½À´Ï´Ù. ¿©ÇÏÆ° NSAID³ª aspirin °ü·Ã À§Àå°ü ºÎÀÛ¿ëÀ» ¿¹¹æÇϴµ¥´Â H2RA´Â È¿°ú°¡ ¾ø°í PPI°¡ È¿°úÀûÀ̶ó´Â °ÍÀº consensusÀÔ´Ï´Ù. ÇöÀç NSAID °ü·Ã ÇÕº´ÁõÀ» ¸·±â À§ÇÏ¿© H2RA¸¦ ¾²´Â °ÍÀº (1) °¡À̵å¶óÀο¡ ¾ø°í, (2) PPIº¸´Ù ÈξÀ ¸øÇÏ´Ù°í ¹àÇôÁ³°í, (3) H2RA¸¦ ¾²¸é masking È¿°ú¶§¹®¿¡ ¿ÀÈ÷·Á ÇÕº´ÁõÀÌ ¸¹¾ÆÁú ¿ì·Á±îÁö Á¦±âµÈ »óÅÂÀÔ´Ï´Ù.

H2 blocker°¡ Àå±â Ä¡·á·Î È¿°ú°¡ ¶³¾îÁö´Â ÀÌÀ¯´Â (1) À§»êºÐºñ´É·ÂÀÌ ¾àÇÏ´Ù´Â Á¡°ú (2) óÀ½¿¡´Â ±×³ª¸¶ À§»êÀ» »ó´çÈ÷ ¾ïÁ¦ÇÏÁö¸¸ ¸îÀÏÀÌ Áö³ª¸é À§»êºÐºñ¾ïÁ¦ È¿°ú°¡ ÇöÀúÈ÷ ¶³¾îÁø´Ù´Â Á¡ (tolerance) ¶§¹®ÀÔ´Ï´Ù.


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

Sliding hiatal hernia ÀÇ ³»½Ã°æ Áø´Ü¿¡¼­ Schazki's ring ÀÌ ÇʼöÀûÀΰÍÀÎÁö¿ä?

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Schatzki ringÀº B-ring (= mucosal ring)ÀÌ ÇöÀúÇϸ鼭 fixµÈ °æ¿ì¸¦ ¸»ÇÕ´Ï´Ù. Sliding hiatal hernia°¡ ½ÉÇϸ鼭 ÇùÂøÀ» µ¿¹ÝÇÑ °æ¿ì¶ó°í »ý°¢ÇÏ¸é µË´Ï´Ù. ¸ðµç sliding hiatal hernia¿¡¼­ Schatzki ringÀÌ º¸ÀÌ´Â °ÍÀº ¾Æ´Õ´Ï´Ù.

@ Âü°í: EndoTODAY hiatal hernia


[2015-11-4. À¥¼¼¹Ì³ª Áú¹®]

Á¶±â½Äµµ¾ÏÀÇ Depth of invasion ÀÌ M2 ÀÎ °æ¿ì, ÀϺ» ¿¬±¸ °á°ú¸¦ ±Ù°ÅÇÑ´Ù¸é, Ãß°¡·Î ¼ö¼úÇؾßÇÑ´Ù´Â Consensus ´Â ¾ø´ÂÁö¿ä?

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ÁÁÀº Áú¹®ÀÔ´Ï´Ù. ½Äµµ¾ÏÀº M2ºÎÅÍ ¸²ÇÁÀý ÀüÀÌ°¡ Àֱ⵵ ÇÏ°í M3ºÎÅÍ´Â Á¦¹ý ¸¹½À´Ï´Ù. ÀÏÀü¿¡ Á¦°¡ T1 ½Äµµ¾ÏÀÇ ¸²ÇÁÀý ÀüÀÌ À§Ç輺À» ºÐ¼®ÇÑ ¹Ù ÀÖ½À´Ï´Ù (J Gastroenterol Hepatol 2008). °á°ú ºÎºÐÀ» ¿Å±â¸é ¾Æ·¡¿Í °°½À´Ï´Ù.

"The frequency of lymph node involvement was 6.25% (4/64) in mucosal cancers and 29.3% (39/133) in submucosal cancers (P < 0.001). In patients with M1 (n = 32) and M2 (n = 14) cancers, no lymph node metastasis was found. In multivariate analysis, size larger than 20 mm, endoscopically non-flat type, and endo-lymphatic invasion were significant independent risk factors for lymph node metastasis. "

M3 ¾Ï¿¡¼­ ¸²ÇÁÀý ÀüÀÌ°¡ °©Àڱ⠸¹¾ÆÁö°í, SM¿¡¼­´Â ´õ¿í ¸¹´Ù´Â Á¡ÀÌ Áß¿äÇÕ´Ï´Ù. À§¾Ï¿¡¼­µµ depth of invasion¿¡ µû¶ó ¸²ÇÁÀý ÀüÀÌ°¡ ¸¹¾ÆÁöÁö¸¸ ½Äµµ¾Ï¿¡¼­´Â ±× Â÷ÀÌ°¡ ´õ¿í ÇöÀúÇÕ´Ï´Ù.

M3 ½Äµµ¾Ï Áß ¸²ÇÁÀý ÀüÀ̸¦ º¸ÀÎ °ÍÀº ´ëºÎºÐ Àå°æ 20mm ÀÌ»óÀ̾ú½À´Ï´Ù. ±×·¯³ª Àå°æ 10 mm ºÐÈ­Çü M3 ½Äµµ¾Ï¿¡¼­ ¸²ÇÁÀý ÀüÀ̸¦ º¸ÀÎ Áõ·Êµµ ÀÖ¾ú½À´Ï´Ù.

ÀϺ»¿¡¼­ÀÇ º¸°í¿¡ ÀÇÇϸé M2 ½Äµµ¾Ï¿¡¼­µµ °£È¤ ¸²ÇÁÀý ÀüÀÌ°¡ ÀÖ´Ù°í ÇÕ´Ï´Ù (Kodama. Surgery 1998).

¿äÄÁµ¥ depth of invasionÀÌ ºñ½ÁÇÏ´Ù¸é À§¾Ïº¸´Ù ½Äµµ¾Ï¿¡¼­ ¸²ÇÁÀý ÀüÀÌ°¡ ¸¹½À´Ï´Ù.

½Äµµ¾Ï ³»½Ã°æ Ä¡·á ÈÄ º´¸®°á°ú¿¡ µû¸¥ Ãß°¡Ä¡·áÀÇ ¿øÄ¢Àº ¾ÆÁ÷ È®¸³µÇ¾î ÀÖÁö ¾Ê½À´Ï´Ù. À§¾Ï ³»½Ã°æ Ä¡·á ÈÄ º´¸®ÇÐÀûÀ¸·Î ºÒ¿ÏÀü ÀýÁ¦³ª Àç¹ßÀ§ÇèÀÌ ³ôÀº °ÍÀ¸·Î ³ª¿À¸é ¹Ù·Î ¼ö¼úÀ» ÇÏ¸é ±×¸¸ÀÔ´Ï´Ù. ±×·¯³ª ½Äµµ¿¡¼­´Â ¼ö¼úÀÇ morbidity¿Í mortality°¡ ³ô±â ¶§¹®¿¡ À§ ESD ÈÄó·³ ½±°Ô ¼ö¼úÀ» °áÁ¤ÇÒ ¼ö ¾ø½À´Ï´Ù.

½Äµµ¾ÏÀº M3 º´¼Ò¿¡¼­ºÎÅÍ ¸²ÇÁÀý ÀüÀÌÀÇ À§ÇèÀÌ ³ôÀ¸¹Ç·Î M2·Î ÃßÁ¤µÇ´Â º´¼Ò°¡ Ä¡·áÀÇ ÀûÀÀÁõÀÔ´Ï´Ù. ±×·¯³ª ½ÇÁ¦ ³»½Ã°æ Ä¡·á¸¦ Çغ¸¸é M3³ª minute SM invasionÀÌ ÀÖ´Â °ÍÀ¸·Î ³ª¿À´Â ¼ö°¡ ¸¹½À´Ï´Ù. À̸¦ ¸ðµÎ ¼ö¼úÇÒ ¼öµµ ¾ø´Â ÀÏÀÌ°í ¾È ÇÒ ¼öµµ ¾ø´Â ÀÏÀÔ´Ï´Ù. ÇöÀçÀÇ °ü·Ê´Â M3´Â °æ°ú°üÂûÀ» ÇÏ°í SM invasionÀÌ ÀÖÀ¸¸é ¼ö¼úÀ̳ª chemoRT¸¦ Ãß°¡ÇÏ´Â °ÍÀÔ´Ï´Ù.


ÀϺ»¿¡¼­´Â minute SM invasionÀÌ ÀÖ´Â °æ¿ì ȤÀº M3ÀÇ °æ¿ì¿¡¼­ chemoRT¸¦ ±ÇÇÏ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ÃÖ±Ù º¸°íµÈ ÀϺ» ¿¬±¸¸¦ ¼Ò°³ÇÕ´Ï´Ù.

- From November 2004 to June 2010, 120 patients with superficial ESCC were treated by ESD at the Shiga University.

- Among the 120 patients, invasion to the muscularis mucosa or to the submucosal layer was pathologically observed in 18 patients and 14 of these received additional CRT instead of surgery.

- Radiation therapy was delivered 5 days per week at 2 Gy per fraction. The total dose was 40 Gy in 20 fractions over 4 weeks. The chemotherapy regimens consisted of 5-fluorouracil and cisplatin.

- No recurrence for 45 months.


¼ö³âÀü ±³ÈÆÀûÀÎ Áõ·Ê¸¦ °æÇèÇÑ ¹Ù ÀÖ½À´Ï´Ù. Á¶±â½Äµµ¾Ï¿¡ ´ëÇÑ ³»½Ã°æ Ä¡·á¸¦ ÇÏ¿´°í depth of invasionÀº M3°¡ ³ª¿ÔÀ¸³ª endolymphatic tumor emboli°¡ ¾ç¼ºÀ̾ú½À´Ï´Ù. À̸¦ È®ÀÎÇϱâ À§ÇÏ¿© immunohistochemistry (D2-40)¸¦ ½ÃÇàÇÏ¿´À» ¶§ positive in endolymphatic tumor emboli¿´½À´Ï´Ù. ¿©·¯ºÐÀº ¾î¶»°Ô ÇϽðڽÀ´Ï±î?

¼ö¼úÀ» ±ÇÇÏ¿´°í ¼ö¼ú ÈÄ º´¸®°á°ú¿¡¼­ 39°³ÀÇ ¸²ÇÁÀý Áß 1°³¿¡¼­ ÀüÀÌ°¡ ÀÖ¾ú½À´Ï´Ù. ½Äµµ¾Ï ³»½Ã°æ ¼ö¼ú ÈÄ Ãß°¡Ä¡·á ¿©ºÎ¸¦ °áÁ¤ÇÏ´Â °ÍÀº ¾î·Æ°íµµ Áß¿äÇÑ ÀÏÀÔ´Ï´Ù. ÁÁÀº º´¸®°ú ÀÇ»ç ¾øÀÌ ½Äµµ¾Ï ³»½Ã°æ Ä¡·á¸¦ ÇÑ´Ù´Â °ÍÀº ¸»ÀÌ µÇÁö ¾Ê½À´Ï´Ù.


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