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EndoTODAY ³»½Ã°æ ±³½Ç


[»ö¼Ò³»½Ã°æ. Chromoendoscopy] - ðû

1. Introduction

2. How to apply the dye onto the lesion

3. Premedication with pronase in EGD

4. Lugol solution - Esophageal mucosal cancer, Esophageal submucosal cancer, Advanced esophageal cancer, Pink color sign, Barrett's esophagus, Side effects

5. Indigo carmine - Gastric adenoma and cancer, Bleeding by spraying, Is rountine spraying of indigo carmine helpful?

6. Acetic acid for GI chromoendoscopy

7. Methylene blue

8. FAQ

9. References


1. Introduction

»ö¼Ò³»½Ã°æÀº ÀÛ¿ë±âÀü¿¡ µû¶ó ¾Æ·¡¿Í °°ÀÌ 3 °¡Áö·Î ³ª´©¾îÁý´Ï´Ù. Tattooing agents¸¦ Æ÷ÇÔÇÏ¿© 4 °¡Áö·Î ³ª´©±âµµ ÇÕ´Ï´Ù.

  1. Absorptive (or vital) stain : taken up by epithelial cells either by diffusion or absorption
  2. Reactive stain : react with a specific constituent of the mucosal epithelial cell or with acid secretion at a specific pH level
  3. Topical contrast stain : do not enter cells but percolate into mucosal depressions


»ö¼Ò³»½Ã°æÀº ¾Æ´ÏÁö¸¸ melanosis coli ȯÀÚ¿¡¼­ ÀÛÀº ¼±Á¾ÀÌ ½±°Ô ¹ß°ßµÇ±âµµ ÇÕ´Ï´Ù. õ¿¬»ö¼Ò¶ó°í ÇÒ ¼ö ÀÖ°ÚÁö¿ä.


2. How to apply the dye onto the lesion

1) Biopsy channel·Î ÁÖÀÔ

»ö¼Ò¸¦ »Ñ¸®´Â °¡Àå ½¬¿î ¹æ¹ýÀº syringe¿¡ »ö¼Ò¸¦ ³ÖÀº ÈÄ biopsy channel·Î ÁÖÀÔÇÏ´Â °ÍÀÔ´Ï´Ù. Biopsy channelÀ» volume ¶§¹®¿¡ 10ml¸¦ ³ÖÀ¸¸é Á¶±Ý¹Û¿¡ »Ñ·ÁÁöÁö ¾Ê½À´Ï´Ù. ÀÌ ¶§ °ø±â¸¦ 10ml ½÷ÁÖ¸é lumen ³»ÀÇ dye°¡ »Ñ·ÁÁý´Ï´Ù. Àú´Â gastric ESDÇÒ ¶§ ´Ã ÀÌ ¹æ¹ýÀ» »ç¿ëÇÕ´Ï´Ù.

2) Spayer

»ö¼Ò´Â º¸Åë sprayer¸¦ ½á¼­ »Ñ¸³´Ï´Ù. °£È¤ ³Ê¹« °­ÇÏ°Ô »Ñ¸®¸é ÃâÇ÷ÀÌ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. ½Ã°£ÀÌ ¸¹ÀÌ °É¸®°í sprayer »ç¿ë¿¡ µû¸¥ Ãß°¡ ºñ¿ëµµ ÀÖ½À´Ï´Ù.

Gastrointest Endosc 2007;66:639-649

3) Injector needle

Àú´Â Á¾Á¾ injector needleÀ» »ç¿ëÇÕ´Ï´Ù. ¹°ÀÌ È帣´Â ¹æÇâÀ» Àß °í·ÁÇÏ¿© needleÀ» º´¼Ò ¿·¿¡ °¡Á®´í ÈÄ ÃµÃµÈ÷ dye¸¦ È긮´Â °ÍÀÔ´Ï´Ù. ¿©·¯ºÐµµ ½ÃµµÇØ º¸½Ê½Ã¿À.


3. Premedication with pronase in EGD

À§¿¡ Á¡¾×ÀÌ ºÙ¾îÀÖÀ¸¸é »ó¼¼ÇÑ °üÂû°ú Á¤È®ÇÑ Á¶Á÷°Ë»ç°¡ ¾î·Æ½À´Ï´Ù. ÁÖ»ç±â·Î ¹°À» »Ñ·Áº¸Áö¸¸ ¸¸Á·½º·´Áö ¸øÇÑ °æ¿ì°¡ ¸¹½À´Ï´Ù. ³»½Ã°æ °Ë»ç Àü proteinase°¡ Æ÷ÇÔµÈ ¾×ü¸¦ ¸¶½Ã¸é À§ÀÇ Á¡¾×ÀÌ °¨¼ÒµÇ¾î À§º®À» ±ú²ýÇÏ°Ô °üÂûÇÒ ¼ö ÀÖ½À´Ï´Ù.

ÀϺ»¿¡¼­´Â °ÅÀÇ Ç×»ó ÀÌ¿ëµÇ°í ÀÖ´Â ¸ð¾çÀε¥ ±¹³»¿¡¼­´Â »ç¿ë ºóµµ°¡ ³·½À´Ï´Ù. ÀÌÀ¯´Â ¸¹°ÚÁö¸¸, ¿ì¸®³ª¶óÀÇ À¯ÀÏÇÑ ³»½Ã°æ ¿ë pronase (»óÇ°¸í Endonase F)°¡ ¾ÆÁ÷ º¸Çè ±Þ¿©°¡ ¾Æ´Ñ °ÍÀÌ Áß¿äÇÑ ¹®Á¦ÀÏ °Í °°½À´Ï´Ù.


°Ç±¹´ëÇб³ À̼±¿µ ±³¼ö´Ô°ú ¼øõÇâ´ëÇб³ Á¤À챂 ¼±»ý´Ô²²¼­ EndoscopyÁöÀÇ Èï¹Ì·Î¿î ³í¹®À» ¼Ò°³ÇÕ´Ï´Ù. Á¦¸ñÀº Endoscopic flushing with pronase improves the quantity and quality of gastric biopsy: a prospective studyÀÔ´Ï´Ù. Á¶Á÷°Ë»ç Àü pronase·Î flushingÇϸé Á¶Á÷°Ë»çÀÇ ÁúÀÌ ÁÁ¾ÆÁø´Ù´Â ³»¿ëÀ̾ú½À´Ï´Ù. ¿ä¾àÀ» ¿Å±é´Ï´Ù.

Background and study aims: Pronase, a proteolytic enzyme, is known to improve mucosal visibility during esophagogastroduodenoscopy (EGD), but little is known about its effects on gastric biopsy. This study assessed whether endoscopic flushing with pronase improves the quality of gastric biopsy. Patients and methods: Consecutive patients who underwent EGD were randomly assigned to either the control group or the pronase group in a prospective setting. The first biopsy of the identified lesion was performed during endoscopy. Endoscopic flushing with either 50mL of water and dimethylpolysiloxane (DMPS; control group) or 50 mL of water, pronase, sodium bicarbonate, and DMPS (pronase group) was then applied to the lesion. After 5 minutes, the second biopsy was performed 2-3 mm away from the first biopsy site. The thickness of mucus, depth of the specimen, overall diagnostic adequacy, anatomical orientation, and crush artifact were measured to assess the quality of the biopsy. Results: Of the 208 patients, 10 were not analyzed due to the absence of an identifiable lesion. Compared with the control group, the pronase group showed significantly decreased thickness of mucus (P<0.001), increased depth of biopsy (P<0.001), improved anatomical orientation (P=0.010), and improved overall diagnostic assessment (P=0.011) in the second biopsied specimen following endoscopic flushing. The crush artifact and hemorrhage did not differ between the groups. Conclusions: Endoscopic flushing with pronase not only improved the depth of biopsy but also the anatomical orientation and overall diagnostic adequacy. Pronase can be recommended for flushing during EGD to improve the quantity and quality of biopsy.

Pronase´Â Æʺñ¿ÀÀÇ Endonase°¡ »ç¿ëµÇ¾ú½À´Ï´Ù.

¿ì¸®³ª¶ó¿¡¼­´Â ¾ÆÁ÷µµ (2019³â 8¿ù ÇöÀç) pronase (Endonase F)°¡ ºñº¸Çè(ÀÎÁ¤ ºñ±Þ¿© - 2,300¿ø Á¤µµ)ÀÎ °ÍÀÌ ¹®Á¦ÀÔ´Ï´Ù. °í°¡ÀÎ Endonase F°¡ ¾Æ´Ñ ÀÏ¹Ý °Å´ãÁ¦¶óµµ »ç¿ëÇϸé ÁÁ°ÚÁö¸¸ ±ÔÁ¤ »ó À̸¶Àú ½±Áö ¾Ê½À´Ï´Ù. ÀûÀÀÁõ¿¡ Æ÷ÇԵǾî ÀÖÁö ¾ÊÀ¸¹Ç·Î....... °á±¹ Endonase FÀÇ °¡°ÝÀ» ³·Ãß°í º¸Çè±Þ¿©·Î ÀüȯÇÏ¿© ¸ðµç ³»½Ã°æ °Ë»ç¿¡¼­ ±âº»ÀûÀ¸·Î »ç¿ëÇÏ´Â ¹æ½ÄÀÌ ÁÁÁö ¾ÊÀ»±î¿ä?

¾î¼¸é ¾Ë±â·ÐÀ̳ª °¡¼ÒÄݺ¸´Ù ¿£µµ³ªÁ¦°¡ ´õ Áß¿äÇÒÁö ¸ð¸¥´Ù´Â »ý°¢ÀÌ µì´Ï´Ù. (2019-8-19. ÀÌÁØÇà)


[2022-8-10] »ï¼º¼­¿ïº´¿ø¿¡ Endonase°¡ µµÀԵǾú½À´Ï´Ù. ¾ÆÁ÷Àº ºñ±Þ¿©À̹ǷΠ²À ÇÊ¿äÇÑ È¯ÀÚ¿¡¼­ ¼±ÅÃÀûÀ¸·Î »ç¿ëÇغ¼ »ý°¢ÀÔ´Ï´Ù. ÀÌ·¸°Ô³ª ÇʼöÀûÀÎ ¾àÁ¦°¡ ¾ÆÁ÷µµ ºñ±Þ¿©¶ó´Â »ç½Ç¿¡ ÁÂÀý°¨À» ´À³¦ÀÔ´Ï´Ù.


4-1. How to use Lugol chromoendoscopy

»ö¼Ò³»½Ã°æ Áß¿¡¼­ °¡Àå À¯¿ëÇÑ °ÍÀÌ ·ç°ñ¾×°ú Àεð°íÄ«¹ÎÀÔ´Ï´Ù. ·ç°ñ¾×ºÎÅÍ ½ÃÀÛÇÏ°Ú½À´Ï´Ù.

·ç°ñ¾×Àº Jean Guillaume Auguste LugolÀÇ À̸§¿¡¼­ ±â¿øµÇ¾ú½À´Ï´Ù. ·ç°ñ¾×ÀÇ iodineÀÌ nonkeratinized squamous epitheliumÀÇ ±Û¸®ÄÚ°Õ¿¡ affinity¸¦ °¡Áö°í Àֱ⠶§¹®¿¡ ½Äµµ³»½Ã°æ¿¡¼­ »ç¿ëµÇ´Â °ÍÀÔ´Ï´Ù. Á¤»ó ½Äµµ»óÇÇ´Â °¥»öÀ¸·Î ¿°»öµÇÁö¸¸ ÀÌÇü¼ºÀ̳ª ¾ÏÀÌ µÇ¸é ·ç°ñ¾×ÀÌ ÈíÂøµÇÁö ¾Ê½À´Ï´Ù (Lugol void area). ¾àÇÑ ÀÌÇü¼º¿¡¼­´Â Áß°£Á¤µµÀÇ »ö±òÀ» º¸ÀÏ ¼ö ÀÖ½À´Ï´Ù. º¸Åë 2 - 3 % ¿ë¾×À» 5 - 10 mL Á¤µµ »ç¿ëÇÕ´Ï´Ù.

·ç°ñ »ö¼Ò³»½Ã°æÀÇ tipÀº »ö¼ÒºÐ¹« ÈÄ °ø±â¸¦ ÈíÀÎÇÏ¿© ³»°­À» collapse½ÃÅ°°í 30ÃÊ Á¤µµ ±â´Ù¸®´Â °ÍÀÔ´Ï´Ù. ·ç°ñ¾×À» ½ÄµµÁ¡¸·¿¡ °ñ°í·ç Á¢Ã˽ÃÅ°±â À§ÇÔÀÔ´Ï´Ù.

»ý¸®½Ä¿°¼ö·Î ÈíÂøµÇÁö ¾ÊÀº ·ç°ñ¾×À» ¾Ä¾î³»¶ó´Â Ã¥µµ ÀÖ½À´Ï´Ù. ±×·¯³ª »ý¸®½Ä¿°¼ö·Î ¾ÄÁö ¾Ê¾Æµµ ÃæºÐÇÑ contrast°¡ ³ª¿À´Â °Í °°½À´Ï´Ù. »ý¸®½Ä¿°¼ö¸¦ ¾²¸é ¿ÀÈ÷·Á contrast°¡ ³·¾ÆÁú ¼ö ÀÖÀ¸¹Ç·Î Àú´Â °ÅÀÇ »ç¿ëÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù.

½Äµµ¾Ï ³»½Ã°æÄ¡·á Àü °æ°èÆÇÁ¤¿¡ ·ç°ñ¾×Àº ÇʼöÀÔ´Ï´Ù.

Á¶°Ç¿¡ µû¶ó ¾à°£ ´Ù¸¥ ´À³¦ÀÇ °¥»öÀ¸·Î º¸ÀÔ´Ï´Ù.

2.5 cm ½Äµµ¾ÏÀ¸·Î SM invasionÀÌ ÀÖ¾ú½À´Ï´Ù.


[2017-4-12. ·ç°ñ »ç¿ë protocol ´Ù½Ã È®ÀÎ ÇÔ]


4-2. Esophageal mucosal cancer cases of Lugol chromoendoscopy


4-3. Submucosal cancer cases of Lugol chromoendoscopy


4-4. Advanced esophageal cancer cases of Lugol chromoendoscopy

ÁøÇ༺ ½Äµµ¾Ï¿¡¼­´Â Á¶±â½Äµµ¾ÏÀÇ °æ¿ìº¸´Ù ·ç°ñ¾×ÀÇ À¯¿ë¼ºÀÌ ³·Áö¸¸ °£È¤ white light endoscopy¿¡¼­ º¸ÀÌ´Â °Íº¸´Ù ÈξÀ ³ÐÀº º´¼Ò°¡ È®ÀεǴ °æ¿ì´Â ÀÖ½À´Ï´Ù.

Proper muscle invasion (+)

Proper muscle invasion (+)

½Äµµ¿¡ °í·ç LugolÀ» ºÐ¹«ÇÏ¸é °£È¤ white light endoscopy¿¡¼­ ±×´ÙÁö ÀǽÉÇÏÁö ¸øÇß´ø Ç¥À缺 ½Äµµ¾ÏÀ» ¹ß°ßÇϱ⵵ ÇÕ´Ï´Ù.

»óÀýÄ¡ 33-36cm¿¡ ÁøÇ༺ ½Äµµ¾ÏÀÌ ÀÖ¾î ÀÇ·ÚµÈ È¯ÀÚÀÔ´Ï´Ù. Lugol spray ÈÄ 28-30cm¿¡¼­ Ç¥À缺 ½Äµµ¾ÏÀ» Ãß°¡·Î ¹ß°ßÇÏ¿´½À´Ï´Ù. Á¶Á÷°Ë»ç´Â ¸ðµÎ M/D squamous cell carcinoma¿´½À´Ï´Ù.


4-5. Pink color sign in Lugol chromoendoscopy?

·ç°ñ¾×¿¡ ¿°»öµÇÁö ¾ÊÀº ºÎÀ§¸¦ ¼ö ºÐ°£ °üÂûÇÏ¸é »öÁ¶°¡ ¿¬ÇØÁý´Ï´Ù. Pink ºûÀ¸·Î ¿¬ÇØÁö¸é ½Äµµ¾ÏÀ̶ó´Â ¼³ÀÌ ÀÖ½À´Ï´Ù. Pink color signÀ̶ó°í ÇÕ´Ï´Ù.

ÀϺ»ÀεéÀº °£È¤ ³Ê¹« ÁÖ°üÀûÀÎ ÁÖÀåÀ» Çϱ⵵ Çϴµ¥ pink color signµµ ±×·¯ÇÑ °æ¿ì °°½À´Ï´Ù. Àú´Â Å« Àǹ̸¦ ÁÖÁö ¾Ê°í ÀÖ½À´Ï´Ù. ¹«½ÃÇϱ⸦ ±ÇÇÕ´Ï´Ù.


4-6. Lugol chromoendoscopy for Barrett's esophagus

·ç°ñ¾×Àº squamocolumnar junctionÀÇ contrast¸¦ °­Á¶½Ãŵ´Ï´Ù. °ú°Å¿¡´Â °¡²û ¹Ù·¿½Äµµ¸¦ °üÂûÇϴµ¥ ÀÌ¿ëÇÏ¿´½À´Ï´Ù.

·ç°ñ¾×À» ÀÌ¿ëÇÑ ¹Ù·¿½Äµµ °üÂû

ÃÖ±Ù¿¡´Â ¹Ù·¿½ÄµµÀÇ Áø´ÜÀ» À§ÇÏ¿© ·ç°ñ¾×À» »ç¿ëÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù. ÀÌÀ¯´Â µÎ °¡ÁöÀÔ´Ï´Ù. (1) ÀÏ¹Ý white light endoscopyµµ ¹Ù·¿½Äµµ¸¦ °üÂûÇϴµ¥ ÃæºÐÇÕ´Ï´Ù. (2) °­Á¶¿µ»óÀ» ¾ò°í ½Í´Ù¸é NBI¸¦ ÀÌ¿ëÇÒ ¼ö ÀÖ½À´Ï´Ù. ÈξÀ °£´ÜÇѵ¥ ·ç°ñ¾× ¸øÁö ¾Ê°Ô ÁÁÀº ¿µ»óÀ» ¾òÀ» ¼ö ÀÖ½À´Ï´Ù.

NBI¸¦ ÀÌ¿ëÇÑ ¹Ù·¿½Äµµ °üÂû

¹Ù·¿½Äµµ¿¡¼­ ·ç°ñ¾×À» ¾²Áö ¸¶½Ê½Ã¿ä. ºñ¿ë-È¿°ú¸¦ °í·ÁÇϽʽÿä. °°Àº ÀÌÀ¯·Î ¿ª·ù¼º ½Äµµ¿°À̳ª sentinel polypÀ» Àß º¸±â À§ÇÏ¿© ·ç°ñ¾×À» ¾µ ÇÊ¿ä´Â ¾ø´Ù°í »ý°¢ÇÕ´Ï´Ù.

[Âü°í] NBI¿¡ ´ëÇÑ YouTube ÀÚ·á

YouTube


4-7. Side effects of Lugol chromoendoscopy

»ö¼Ò³»½Ã°æ¿¡ ºÎÀÛ¿ëÀº ¾ø´ÂÁö ¹®ÀÇÇϽŠºÐÀÌ °è½Ê´Ï´Ù. ¼¼»óÀÏ¿¡ 100% ¾ÈÀüÀ̶õ ¾ø´Â ¹ýÀÌ´Ï »ö¼Ò³»½Ã°æµµ ºÐ¸í ºÎÀÛ¿ëÀÌ ÀÖÀ» °ÍÀÔ´Ï´Ù. 2010³â ¾Æ»êº´¿ø Áõ·Ê¸¦ ¼Ò°³ÇÕ´Ï´Ù (´ëÇѼÒÈ­±â³»½Ã°æÇÐȸÁö 2010;41:224).

"·ç°ñ ¿ë¾×ÀÇ °¡´ÉÇÑ ºÎÀÛ¿ëÀ¸·Î´Â ¿À½É, ±¸Åä, ½É¿ÍºÎ ¹× »óº¹ºÎ ÅëÁõ µîÀÌ ÀÖ°í µå¹°°Ô È­Çмº ½Äµµ¿°À̳ª À§¿°ÀÌ ¹ß»ýÇÒ ¼ö ÀÖ´Ù. ÀϹÝÀûÀ¸·Î »ö¼Ò³»½Ã°æ½Ã 0.5¡­5%ÀÇ ¿ä¿Àµå°¡ Æ÷ÇÔµÈ ·ç°ñ ¿ë¾× 10¡­30 mL¸¦ ½Äµµ¿¡ »êÆ÷ÇÑ´Ù. Sreedharan µîÀº 3¡­5%ÀÇ ³ôÀº ¿ä¿Àµå ³óµµÀÇ ¿ë¾×¿¡¼­ Á¡¸· ¼Õ»óÀÌ Àß ¹ß»ýÇϹǷÎ, 1.5% Á¤µµ·Î ¿ä¿Àµå°¡ ³·Àº ³óµµÀÇ ¿ë¾×À» 10¡­20 mL »ç¿ëÇÔÀ¸·Î Á¡¸· ¼Õ»óÀ» ÁÙÀÏ ¼ö ÀÖ´Ù°í Á¦¾ÈÇÏ¿´´Ù. ±×·¯³ª ±Þ¼º ½Äµµ ¶Ç´Â À§ Á¡¸· ¼Õ»óÀÌ 1.0¡­1.5%ÀÇ ³·Àº ³óµµÀÇ ·ç°ñ ¿ë¾×À» »ç¿ëÇÑ Áõ·Ê¿¡¼­µµ º¸°íµÇ¾ú´Ù. Á¡¸· ¼Õ»óÀº 1.0¡­1.5%ÀÇ ³·Àº ³óµµÀÇ ·ç°ñ ¿ë¾×À» »ç¿ëÇÑ °æ¿ì¿¡´Â 1¡­2ÀÏ ÈÄ ¹ß°ßµÇ¾úÁö¸¸ 5.0%ÀÇ ³ôÀº ³óµµÀÇ ·ç°ñ ¿ë¾×À» »ç¿ëÇÑ Áõ·Ê¿¡¼­´Â °Ë»ç µµÁß ·ç°ñ ¿ë¾×ÀÇ ÈíÀÎÀ» À§ÇØ À§ ³»·Î ÀçÁøÀÔ ÇÏ¿´À» ¶§ Á¡¸·ÀÇ ¼Õ»óÀÌ È®ÀεǾú´Ù. ·ç°ñ ¿ë¾×À¸·Î ÀÎÇÑ Á¡¸· ¼Õ»óÀº ·ç°ñ ¿ë¾× »êÆ÷ ½ÃÁ¡°ú À§ Àç°Ë ½ÃÁ¡ »çÀÌÀÇ ½Ã°£ °£°ÝÀÌ ±æ¾îÁüÀ¸·Î½á ·ç°ñ ¿ë¾×ÀÇ À§ ÀÜ·ù½Ã°£ÀÌ ±æ¾îÁø °æ¿ì ½±°Ô ¹ß»ýÇÒ ¼ö ÀÖÁö¸¸, º» Áõ·Ê¿Í Sreedharan µîÀÇ º¸°í¿Í °°ÀÌ °í³óµµÀÇ ¿ë¾×À» »ç¿ëÇÑ °æ¿ì¿¡´Â À§ Àç°Ë±îÁöÀÇ ½Ã°£ °£°ÝÀÌ Âª´õ¶óµµ Á¡¸· ¼Õ»óÀÌ »ý±æ ¼ö ÀÖÀ½À» ¾Ë ¼ö ÀÖ´Ù."

´ëÇѼÒÈ­±â³»½Ã°æÇÐȸÁö 2010;41:224

»ö¼Ò³»½Ã°æ ÈÄ ºÎÀÛ¿ëÀÌ ¹ß»ýÇÒ ¼ö ÀÖÁö¸¸ ±× ºóµµ´Â ³·½À´Ï´Ù. ºÎÀÛ¿ë ¿ì·Á ¶§¹®¿¡ °Ë»ç¸¦ ÇÇÇÒ Á¤µµ´Â ¾Æ´Ï°í ´Ù¸¸ ³Ê¹« ³ôÁö ¾ÊÀº ³óµµ¸¦ »ç¿ëÇÏ°í ³²Àº ¿ë¾×Àº ÈíÀÎÇϸé ÁÁÀ» °ÍÀ̶ó »ý°¢ÇÕ´Ï´Ù.


4-8. Lugol solution °ø±Þ¿¡ ´ëÇÏ¿© (2016-4-14)

°ú°Å¿¡´Â ·ç°ñ ¿ë¾×À» °¢ º´¿ø¿¡¼­ Á¶Á¦ÇÏ¿© »ç¿ëÇÏ¿´½À´Ï´Ù. ±×·¯³ª ±× Àç·á°¡ ÀÇ·á¿ëÀ¸·Î Çã°¡¹ÞÀº °ÍÀÌ ¾Æ´Ï¶ó´Â ÁöÀûÀÌ À־ »ó´ç±â°£ »ç¿ëÇÏÁö ¸øÇÏ°í ÀÖ½À´Ï´Ù. ±× ´ë¾ÈÀ¸·Î 5% ·ç°ñ¾×ÀÎ Áª½ºÅ×ÀÎ ¿ë¾×(1º´´ç 10ml, 2¸¸ 7õ¿ø)À» °í·ÁÇÒ ¼ö ÀÖ½À´Ï´Ù. ÀûÀÀÁõÀÌ '°©»ó¼± ±â´É Ç×ÁøÁõ¿¡ ´ëÇÑ ¼ö¼ú Àüóġ'·Î Çã°¡ ¹ÞÀº Á¦Ç°ÀÎÁö¶ó »ö¼Ò³»½Ã°æ Áø´Ü¿ëÀ¸·Î »ç¿ëÇصµ ÀûÀýÇÑÁö´Â Àß ¸ð¸£°Ú½À´Ï´Ù. ¾Æ¸¶ ºñ±Þ¿©·Î ½á¾ß ÇÒÁöµµ ¸ð¸¨´Ï´Ù. Á¶¼ÓÈ÷ ÀûÀÀÁõÀÌ È®´ëµÇ¾î¾ß ÇÒ °Í °°½À´Ï´Ù.


[·ç°ñ ¿ë¾× ½ÃÆǾàÀ¸·Î »ç¿ëÇϱâ·Î ÇÔ (2016-7-11)]

¾ÈÀü¼º ¹®Á¦·Î ·ç°ñ ¿ë¾×À» Á¶Á¦ÇÏ¿© »ç¿ëÇÏ´Â °ÍÀÌ ±ÝÁöµÇ¾ú½À´Ï´Ù. ´ë¾ÈÀ¸·Î ½ÃÆǾàÀ» ½á¾ß Çϴµ¥ ±Þ¿© ó¹æÀÌ µÇÁö ¾Ê¾Æ¼­ ȯÀÚ ºÎ´ãÀº Áõ°¡µÇ¾ú½À´Ï´Ù. »ý»öÀº Á¤ºÎ¿¡¼­ ³»°í ¹Ù»Û ¸»Àº º´¿ø¿¡¼­ µè°í ºñ¿ëÀº ȯÀÚ°¡ ³»´Â ¾îó±¸´Ï ¾ø´Â Á¤Ã¥À̶ó°í »ý°¢µË´Ï´Ù.

¼ÒÈ­±â³»°ú ¼±»ý´Ôµé²² (ÂüÁ¶, ÈäºÎ¿Ü°ú ±³¼ö´Ôµé²²),

³»½Ã°æ °Ë»ç Áß ½Äµµ¾Ï ¶Ç´Â ½Äµµ¾Ï Àǽɺ´¼Ò°¡ ÀÖÀ» ¶§ ÀÌÁ¦±îÁö ¿ø³» Á¦Á¶ 1% Lugol solutionÀ» ¹«¼ö°¡·Î »ç¿ëÇØ ¿Ô¾úÀ¸³ª ±ÝÀÏ ºÎÅÍ´Â ¾ÈÀü¼ºÀÇ ¹®Á¦·Î ÇÊ¿ä½Ã ½ÃÆǾàÀ»(Çѱ¹Äݸ¶ Áª½ºÅ×ÀÎ ¿ë¾×) ºñ±Þ¿©(24200¿ø) ó¹æÇÏ¿© »ç¿ëÇØ¾ß ÇÕ´Ï´Ù.

³»½Ã°æ½Ç¿¡ ºñÇ°À» µÎ±â ¶§¹®¿¡ »ç¿ë¿¡´Â ¹®Á¦°¡ ¾ø°ÚÀ¸³ª ó¹æ½Ã ȯÀÚ ¶Ç´Â º¸È£ÀÚ¿¡°Ô Àǻ簡 Á÷Á¢ ¼³¸íÀ» Çصå·Á¾ß ÇÕ´Ï´Ù. µû¶ó¼­ ½Äµµ¾ÏÀ¸·Î ³»½Ã°æÀ» ½ÃÇàÇÏ´Â °æ¿ì °Ë»ç ½ÃÀÛÀü¿¡ ¹Ì¸® ºñ±Þ¿© ó¹æ¿¡ ´ëÇØ ¾Ë·Áµå¸®´Â °ÍÀÌ ÁÁ°Ú°í °Ë»ç Áß ¿¹±âÄ¡ ¾Ê°Ô »ç¿ëÇÏ°Ô µÉ °æ¿ì º¸È£ÀÚ(¾ø´Ù¸é ȯÀÚ)¿¡°Ô µû·Î ºñ±Þ¿© ó¹æÀ¸·Î ¿°»ö¾à »ç¿ëÀÌ ÇÊ¿äÇÔÀ» ¼³¸íµå·ÁÁֽʽÿÀ.

Áª½ºÅ×ÀÎ ¿ë¾×(ÄÚµå:LUGO5-S)Àº º´¿¡ 5% iodine 10ml°¡ µé¾î ÀÖ½À´Ï´Ù. Áö±Ý±îÁö IodineÀ» 1%·Î Èñ¼®ÇÏ¿© Àß »ç¿ëÇØ¿Ô¾úÀ¸¹Ç·Î ¾ÕÀ¸·Îµµ 5% iodineÀ» 1:4·Î Èñ¼®(5¹è ¹±°Ô)Çؼ­ »ç¿ëÇÏ¸é µÇ°Ú½À´Ï´Ù.


5-1. Indigo carmine

Indigo carmineÀº Á¦°¡ °¡Àå »ç¶ûÇÏ´Â »ö¼ÒÀÔ´Ï´Ù. °ÅÀÇ ¸ÅÀÏ »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. ´ÙÀ½Àº ·ç°ñ¾×ÀÔ´Ï´Ù. ±×·¯³ª »ç¿ë ºóµµ°¡ ´Ù¸¨´Ï´Ù. Indigo carmineÀÌ ¾ø´Â ESD´Â »ý°¢¸¸ Çصµ ²ûÁ÷ÇÕ´Ï´Ù. ±×·±µ¥ Àú´Â ¾ÆÁ÷ indigo carmineÀÇ Á¤È®ÇÑ ±â¿øÁ¶Â÷ ¸ð¸¨´Ï´Ù. Ȥ½Ã Á¤È®ÇÑ Á¤º¸¸¦ °¡Áö½Å ºÐÀº Á¦°Ô ¿¬¶ôÁֽñ⠹ٶø´Ï´Ù.

Á¦°¡ ¹è¿ì±â·Î´Â indigo´Â Ǫ¸¥ ½Ä¹°¼º »ö¼ÒÀÌ°í carmineÀº ºÓÀº µ¿¹°¼º »ö¼Ò(red coloring agent from eggs of female cochinea, a tropical insect from Mexico)ÀÔ´Ï´Ù. À̸¦ ¼¯Àº °ÍÀÌ indigo carmineÀ̶ó°í ¹è¿ü½À´Ï´Ù. ±×·±µ¥ ÃÖ±Ù WikipediaµîÀ» ã¾Æº¸´Ï indigo dyeÀÇ sulfonated formÀ» indigo carmineÀ̶ó°í ºÎ¸£¸ç Saxon blue¿Í °°Àº ¸»À̾ú½À´Ï´Ù. Á¤½Ä ¸íĪÀº 5,5'-indigotindisulfonate sodiumÀÌ¸ç ±¸Á¶½ÄÀº C16H8N2Na2O8S2ÀÔ´Ï´Ù (ÂüÁ¶: NCBI PubChem). pH 11.4¿¡¼­ Ǫ¸¥»öÀ¸·Î pH 13¿¡¼­ ³ë¶õ»öÀ¸·Î º¯Çϴ Ư¡ÀÌ À־ pH indicator·Î »ç¿ëµÈ´Ù°í ÇÏ¿´½À´Ï´Ù.

À̸§µµ ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù. Ingido carmine, indigocarmine (¶ç¾î ¾²±â ¾øÀ½), indigo-carmine (hyphen ÀÖÀ½), Indigo Carmine (¶ç¾î ¾²±â ÀÖ°í ´ë¹®ÀÚ) Áß ¾î¶² °ÍÀÌ ¿ÇÀºÁö ¸ð¸£°Ú½À´Ï´Ù. º¸Åë indigo carmine (¶ç¾î ¾²±â ÀÖ°í ¼Ò¹®ÀÚÀÌ°í hyphen ¾øÀ½)À̶ó°í ¾¹´Ï´Ù. ¾Æ¸¶ ÀÌ°Ô ¸ÂÀ» °ÍÀÔ´Ï´Ù.

ÀÇÇп¡¼­ indigo carmineÀÇ ¿ëµµ´Â ´Ù¾çÇÕ´Ï´Ù. °ú°Å¿¡´Â renal function test ¿ëÀ¸·Î Á¾Á¾ »ç¿ëµÇ¾ú½À´Ï´Ù. ºÎÀÛ¿ëÀ¸·Î´Â bradycardia, hypertension, bronchospasm, urticaria µîÀÌ °¡´ÉÇѵ¥ ÁÖ·Î Á¤¸ÆÁֻ翡¼­ ³ªÅ¸³³´Ï´Ù. À§³»½Ã°æ½Ã ºÐ¹«ÇÏ¿© ³ªÅ¸³ª´Â °Í °°Áö´Â ¾Ê½À´Ï´Ù. ±×·¯³ª ÁÖÀÇÇؼ­ ³ª»Ü °ÍÀº ¾ø½À´Ï´Ù. »ý°¢ÄÁµ¥ ESD¸¦ Çϸ鼭 ´Ù·® »ç¿ëÇÏ¸é ºÎÀÛ¿ëÀÌ ³ªÅ¸³¯Áö ¸ð¸¨´Ï´Ù. ±×·¯³ª ½ÇÁ¦ º¸°íµÈ °ÍÀ» º¸Áö´Â ¸øÇß½À´Ï´Ù.

°ú°Å (2010³â ÀüÈÄ) indigo carmineÀº °ø±ÞÀÌ ºÒ¾ÈÁ¤ÇÏ¿© °£È¤ Àç°í°¡ ¹Ù´Ú³ª´Â °æ¿ì°¡ ÀÖ¾ú½À´Ï´Ù. ±×·² ¶§¸¶´Ù methylene blue¸¦ ´ë½Å »ç¿ëÇß½À´Ï´Ù. ÀÌ°¡ ¾øÀ¸¸é ÀÕ¸öÀÔ´Ï´Ù. ÃÖ±Ù¿¡´Â ºñ±³Àû ¾ÈÁ¤ÀûÀ¸·Î °ø±ÞµÇ´Â °Í °°½À´Ï´Ù.


[Granules of indigo carmine]

Indigo carmineÀ» Èñ¼®ÇÏ¿© »ç¿ëÇÒ ¶§ Àß ¼¯Áö ¾ÊÀ¸¸é granuleÀÌ ¹¶Ä£ »óÅ·Π»Ñ·ÁÁý´Ï´Ù. ±×·°Àú·° º´¼Ò¸¦ »ìÇÊ ¼ö ÀÖÁö¸¸ ±ú²ýÇÑ »çÁøÀ» ¾òÀ» ¼ö ¾ø½À´Ï´Ù. ÁÖ»ç±â¸¦ ´Ù½Ã Èçµé¾îµµ ¹¶Ä£ granuleÀÌ Àß Ç®¸®Áö ¾Ê½À´Ï´Ù. ¾Æ±õÁö¸¸ ¹ö¸± ¼ö ¹Û¿¡ ¾ø´Â ÀÏÀÔ´Ï´Ù.


5-2. Indigo carmine for gastric adenoma and cancer

Indigo carmineÀº Á¡¸·Ç¥¸éÀÇ ¿äöÀ» °­Á¶ÇÏ´Â »ö¼ÒÀÔ´Ï´Ù. ±×·¡¼­ ¾Æ·¡ »çÁø°ú °°ÀÌ À§¾ÏÀÇ Áø´Ü°ú »ó¼¼ÇÑ Æò°¡¿¡ À¯¿ëÇÕ´Ï´Ù.

¼±Á¾À̳ª À§¾ÏÀÇ ³»½Ã°æ Ä¡·á Àü indigo carmineÀº ²À »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. »ö¼Ò »ìÆ÷ ÈÄ »ý°¢º¸´Ù º´¼Ò°¡ Ä¿¼­ ±ô¦ ³î¶ó±âµµ ÇÕ´Ï´Ù.


°¡¿îµ¥ »çÁøÀ» º¸½Ê½Ã¿À. ¶Ñ·ÇÇÏ°Ô À¶±âµÈ °÷º¸´Ù ¿øÀ§ºÎÂÊÀ¸·Î ³ÐÀº º´¼Ò°¡ º¸¿´½À´Ù.
Stomach, ESD: Tubular adenoma with low grade dysplasia
1. Location : antrum, lesser curvature
2. Gross type : elevated
3. Size of adenoma : (1) longest diameter, 36 mm (2) vertical diameter, 31 mm
4. Resection margin : negative resection margins(N)

°æ°è°¡ ºÒºÐ¸íÇÑ À§¾ÏÀÇ ³»½Ã°æ Ä¡·á¿´½À´Ï´Ù. Indigo carmineÀÌ ¸Å¿ì À¯¿ëÇÏ¿´½À´Ï´Ù.
Stomach, ESD: Early gastric carcinoma
1. Location : antrum, lesser curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 30 mm (2) vertical diameter, 7 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 15 mm, proximal 8 mm, anterior 6 mm, posterior 6 mm, deep 350 §­
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Pre-existing adenoma : none
12. Microscopic ulcer : absent
13. Histologic heterogeneity: absent
14. Associated finding: Gastritis cystica superficialis

Indigo carmineÀº ¿äöÀÌ ¾ø´Â º´¼Ò¿¡¼­´Â ¿ÀÈ÷·Á ³ª»Ü ¼ö ÀÖ½À´Ï´Ù. ¾Æ·¡ »çÁøÀº EGC IIbÀε¥ indigo carmineÀ» »Ñ¸° ÈÄ ¿ÀÈ÷·Á Àß º¸ÀÌÁö ¾Ê¾Ò½À´Ï´Ù. ÀÌ·² ¶§´Â irrigationÀ» Çؾ߸¸ ´Ù½Ã »ó¼¼ÇÑ °üÂûÀ» ÇÒ ¼ö ÀÖ½À´Ï´Ù.


5-3. Bleeding by spraying indigo carmine solution

Indigo carmine ¿ë¾×Àº sprayer¸¦ ÀÌ¿ëÇÏ¿© »Ñ¸®´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. °£È¤ ³Ê¹« °­ÇÏ°Ô ºÐ¹«µÇ¾î º´¼Ò¿¡¼­ ÃâÇ÷ÀÌ ¹ß»ýÇÕ´Ï´Ù. Àß º¸±â À§ÇÏ¿© »ö¼Ò¸¦ »Ñ·È´Âµ¥ ¿ÀÈ÷·Á Àß º¸ÀÌÁö ¾Ê°Ô µÇ¾úÀ¸´Ï ³¶Æа¡ ¾Æ´Ò ¼ö ¾ø½À´Ï´Ù. Àû´çÈ÷ õõÈ÷ ºÐ¹«ÇÏ´Â ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù.

Àú´Â ÀÌ·± °æ¿ì¸¦ ¸·±â À§ÇÏ¿© sprayer¸¦ ¾²Áö ¾Ê°í ÁÖ»ç±â¸¦ ÀÌ¿ëÇÏ¿© ³»½Ã°æ working channel·Î Á÷Á¢ indigo carmine ¾×À» ÁÖÀÔÇÕ´Ï´Ù. ³»½Ã°æ working channelÀÌ °¡µæÂù ÈÄ¿¡¾ß indigo carmine ¾×ÀÌ ºÐ¹«µË´Ï´Ù. µû¶ó¼­ 10 ml ÁÖ»ç±â¸¦ ¾²¸é óÀ½¿¡´Â °ÅÀÇ ³ª¿À´Â °ÍÀÌ ¾ø½À´Ï´Ù. ´Ù½Ã °°Àº ÁÖ»ç±â·Î °ø±â¸¦ ÁÖÀÔÇÏ¸é ±×¶§¼­¾ß indigo carmine ¾×ÀÌ ÂÓ~~~ »Ñ·ÁÁý´Ï´Ù. Sprayer º¸´Ù ¾Ð·ÂÀÌ ³·À¸¹Ç·Î ÃâÇ÷ÀÌ ¹ß»ýÇÏÁö ¾Ê½À´Ï´Ù.

Àú¿Í °°ÀÌ ¾à°£ ¹«½ÄÇÑ ¹æ¹ý(¹«½ÄÇØ º¸ÀÌÁö¸¸ ¸Å¿ì ÁÁÀº ¹æ¹ýÀÔ´Ï´Ù)À» ¾µ ¶§¿¡´Â ÇÑ °¡Áö ÁÖÀÇÁ¡ÀÌ ÀÖ½À´Ï´Ù. Dye¸¦ ´Ù »Ñ¸° ÈÄ Áï½Ã salineÀ» 10 ml Á¤µµ ³Ö¾îÁֽʽÿÀ. ±×·¸Áö ¾ÊÀ¸¸é forcepÀ̳ª knife¸¦ ³Ö°í »¬ ¶§ dye°¡ »ç¹æÀ¸·Î Æ¢°Ô µË´Ï´Ù.


5-4. Is rountine spraying of indigo carmine helpful?

White light endoscopy¿¡¼­ ¾ÏÀ̳ª ¼±Á¾ÀÌ ¹ß°ßµÇ¸é indigo carmineÀ» ºÐ¹«ÇÏ°í °üÂûÇÕ´Ï´Ù. ¹°·Ð »ó´çÈ÷ µµ¿òÀÌ µË´Ï´Ù. ±×·¸´Ù¸é white light endoscopy¿¡¼­ Ưº°ÇÑ ÀÌ»óÀÌ ¾ø¾ú´ø °æ¿ì indigo carmineÀ» ºÐ¹«ÇÏ¸é ¾î¶³±î¿ä?

ÀϺ»ÀÇ ¸î¸î ³»½Ã°æ½Ç¿¡¼­´Â »óºÎÀ§Àå°ü ³»½Ã°æ µµÁß routineÀ¸·Î indigo carmineÀ» »Ñ¸°´Ù°í ÇÕ´Ï´Ù. ±×·¯³ª routine chromoendoscopy°¡ µµ¿òÀÌ µÈ´Ù´Â Áõ°Å´Â °ÅÀÇ ¾ø½À´Ï´Ù. Á¦°¡ ÇϺÎÀ§Àå°ü°ú »óºÎÀ§Àå°ü¿¡ ´ëÇÏ¿© °¢°¢ ¿¬±¸ÇÑ ¹Ù ÀÖ½À´Ï´Ù. ÇϺΠÀ§Àå°ü¿¡¼­´Â ±×³ª¸¶ tiny adenoma°¡ ¸î °³ ¹ß°ßµÇ¾ú½À´Ï´Ù. ±×·¯³ª »óºÎÀ§Àå°ü¿¡¼­´Â ÀüÇô µµ¿òµÇÁö ¾Ê´Â´Ù´Â °á°ú¸¦ ¾ò¾ú½À´Ï´Ù.

¾ÆÁ÷±îÁö´Â white light endoscopy·Î ÀÚ¼¼È÷ º¸´Â °ÍÀÌ ÃÖ¼±À̶ó°í »ý°¢ÇÕ´Ï´Ù. ³ª¹«º¸´Ù ½£À» º¸´Â °ÍÀÌ Áß¿äÇϱ⠶§¹®ÀÏ °ÍÀÔ´Ï´Ù.


6. Acetic acid for GI chromoendoscopy

Acetic acid´Â pKa 4.8ÀÇ ¾à»ê¼ºÀ¸·Î °¡Àå ÀÛÀº Áö¹æ»ê(smallest of the fatty acids)ÀÔ´Ï´Ù. ¾×ü»óÅÂÀÇ glacial acetic acid¸¦ Èñ¼®ÇÏ¿© »ç¿ëÇÕ´Ï´Ù.

Acetic acid´Â ¼ö½Ê³â ÀüºÎÅÍ uterine cervixÀÇ squamous columnar junctionÀ» °üÂûÇϱâ À§ÇÏ¿© colposcopy¿¡¼­ »ç¿ëµÇ¾î ¿Ô½À´Ï´Ù. ÃÖ±Ù¿¡´Â À§Àå°ü³»½Ã°æ¿¡¼­µµ °£È¤ »ç¿ëµË´Ï´Ù. »êºÎÀΰú ¿µ¿ª¿¡¼­´Â 3-5% ¿ë¾×À», À§Àå°ü³»½Ã°æ¿¡¼­´Â 1-3% ¿ë¾×À» »ç¿ëÇÕ´Ï´Ù.

Unbuffered acetic acid°¡ »óÇǼ¼Æ÷¸¦ ¸¸³ª¸é ÀϽÃÀûÀ¸·Î »óÇǼ¼Æ÷ ´Ü¹é±¸Á¶¸¦ º¯È­½Ãŵ´Ï´Ù. Squamous epitheliumÀº ÇϾé°Ô º¯ÇÏ°í columnar epitheliumÀº ºÓ°Ô ºÎ¾î¿À¸£¸é¼­ Ç¥¸é±¸Á¶°¡ °­Á¶µË´Ï´Ù. ¹Ù·¿½Äµµ, Àå»óÇÇÈ­»ý ¹× ÀÌÇü¼ºÀÇ °üÂû¿¡ µµ¿òÀÌ µÈ´Ù°í ¾Ë·ÁÁ®ÀÖÁö¸¸ (Rey. Endoscopy 2005) ½ÇÁ¦ ÀÓ»ó¿¡¼­ »ç¿ëµÇ´Â °æ¿ì´Â °ÅÀÇ ¾ø½À´Ï´Ù. Àúµµ ¿¹¸¦ º¸¿©µå¸®Áö ¸øÇÕ´Ï´Ù. »ç¿ë °æÇèÀÌ ¾ø±â ¶§¹®ÀÔ´Ï´Ù. ´ëÀå ÂÊ¿¡¼­´Â Á¾Á¾ »ç¿ëµÈ´Ù°í ÇÕ´Ï´Ù.

@ EndoTODAY°¡ ³ª°£ ÈÄ ¿©·¯ ¼±»ý´ÔÀ¸·ÎºÎÅÍ ¿¬¶ôÀÌ ¿Ô½À´Ï´Ù. Acetic acid¸¦ »óºÎÀ§Àå°ü¿¡¼­ »ç¿ëÇÏ´Â º´¿øÀÌ ¸¹Àºµ¥ ³Ê¹« ¼ÒȦÀÌ ´Ù·ç¾îÁ³´Ù´Â ÁöÀûÀ̾ú½À´Ï´Ù. °¨»çÇÕ´Ï´Ù.


7. Methylene blue

Methylene blue´Â methylthionine chloride ¿ë¾×À» ÁöĪÇÏ´Â ¿ë¾îÀÔ´Ï´Ù. º¸Åë 0.5-1 % ¿ë¾×À» ºÐ¹«ÇÏ°í 1-2ºÐ ±â´Ù¸° ÈÄ ¹°·Î ¾Ä°í °üÂûÇÕ´Ï´Ù. ±×·¯¸é intestinal metaplasia ºÎÀ§°¡ Ǫ¸¥»öÀ¸·Î ¿°»öµË´Ï´Ù. ƯÀÌÇÏ°Ôµµ gastric metaplasia´Â ¿°»öµÇÁö ¾Ê½À´Ï´Ù.

Methylene blue¸¦ ´Ù·® »ç¿ëÇÏ¸é ¼Òº¯À̳ª ´ëº¯ÀÌ Çª¸¥ »öÀ¸·Î º¯ÇÒ ¼ö ÀÖÀ¸¹Ç·Î ³î¶óÁö ¸¶½Ê½Ã¿À.

¾Æ·¡ »çÁøÀº intestinal metaplasia¿¡ methylene blue¸¦ »Ñ¸° ÈÄ º¯È­¸¦ º¸¿©ÁÖ°í ÀÖ½À´Ï´Ù (¹°·Ð Àá½Ã ±â´Ù¸° ÈÄ ¹°·Î ¾Ä¾ú½À´Ï´Ù). ±×·¯³ª ½ÇÁ¦ ÀÓ»ó¿¡¼­ intestinal metaplasia¸¦ È®ÀÎÇϱâ À§ÇÏ¿© methylene blue¸¦ »ç¿ëÇÒ ÇÊ¿ä´Â ¾ø´Ù°í º¾´Ï´Ù. (1) White light endoscopy¸¦ ÀÌ¿ëÇصµ ÃæºÐÈ÷ °üÂûÇÒ ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù. (2) Metaplastic gastritis·Î Áø´ÜÇѵé (°£È¤ °ËÁø °£°ÝÀ» Á¶ÀýÇÏ´Â °Í ÀÌ¿Ü¿¡) Ưº°È÷ ´Þ¶óÁö´Â °Íµµ ¾ø±â ¶§¹®ÀÔ´Ï´Ù.

ÃÖ±Ù Àú´Â methylene blue¸¦ °ÅÀÇ »ç¿ëÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù. ¹°·Ð ±³°ú¼­¿¡¼­´Â ¹Ù·¿½Äµµ¿¡¼­ methylene blue°¡ À¯¿ëÇÏ´Ù°í µÇ¾î ÀÖ½À´Ï´Ù. ±×·¯³ª Á¦°¡ °æÇèÇÑ ¹Ù·¿½ÄµµµéÀº white light endoscopy·Î ÃæºÐÈ÷ Àß º¸¿´À¸¸ç, NBI¸¦ ¾²¸é ´õÇÒ ³ªÀ§ ¾øÀÌ ¸íÈ®ÇØÁ³½À´Ï´Ù. µµ¹«Áö »ö¼Ò°¡ ÇÊ¿äÇÏ´Ù´Â »ý°¢ÀÌ µéÁö ¾Ê¾Ò½À´Ï´Ù.

´ÙÀ½¿¡ ¸»¾¸µå¸± indigo carmineÀº °ø±ÞÀÌ ºÒ¾ÈÁ¤ÇÑ »ö¼ÒÀÔ´Ï´Ù. °£È¤ indigo carmineÀÌ ¶³¾îÁú ¶§°¡ ÀÖ´Ù´Â ¸»¾¸ÀÔ´Ï´Ù. ÀÌ·² ¶§ ´ë¿ëÀ¸·Î methylene blue¸¦ ¾µ ¼ö ÀÖ½À´Ï´Ù. ÀÌ°ÍÀÌ ÇöÀç Àú¿¡°Ô´Â methylene blueÀÇ À¯ÀÏÇÑ ¿ëµµÀÔ´Ï´Ù. Áï indigo carmine ´ë¿ë Á¤µµÀÇ °¡Ä¡°¡ ÀüºÎÀÎ ¼ÀÀÔ´Ï´Ù.


[FAQ]

[2018-9-19. ¾Öµ¶ÀÚ Áú¹®]

Àú´Â ·ÎÄÿ¡¼­ ±Ù¹«ÇÏ´Â ¼ÒÈ­±âÀÇ»çÀε¥ ÃÖ±Ù Àεð°íÄ«¹Î °ø±Þ¿¡ Â÷ÁúÀÌ »ý°å´ÂÁö °ø±ÞÀÌ ¾ÈµÈ´Ù°í ÇÏ´õ¶ó±¸¿ä. °ú°Å¿¡ Æ÷½ºÆÃÇϽŠ±Û Áß¿¡ Àεð°íÄ«¹Î ´ë½Å ¸ÞÆ¿·»ºí·ç¸¦ ´ëüÀç·Î »ç¿ëÇϽŴٰí Çϼ̴µ¥ ±× »ç¿ë¸ñÀûÀÌ Á¡¸·»óŸ¦ Æò°¡ÇϱâÀ§ÇÑ µµÆ÷¿ëÀÎÁö ¾Æ´Ï¸é ±× ¿Ü¿¡ ´ëÀå¿ëÁ¾ Á¦°Å¸¦ À§ÇØ injectionµµ °¡´ÉÇÑ °ÇÁö¿¡ ´ëÇØ ±Ã±ÝÇؼ­ ¸ÞÀϵ帳´Ï´Ù. ±×¸®°í ¶Ç ´Ù¸¥ ´ëüÀç ¾à¹°ÀÌ ÀÖ´ÂÁö ¾Ë·ÁÁÖ½Ã¸é °¨»çÇÏ°Ú½À´Ï´Ù.

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Àεð°íÄ«¹Î ´ë½Å ¸ÞÆ¿·»ºí·ç¸¦ »ç¿ëÇϱ⵵ ÇÑ ÀûÀÌ ÀÖ½À´Ï´Ù. ¿äöÀ» º¸±â À§ÇÑ ¿ëµµ¿´½À´Ï´Ù. ±×·¯³ª ¾Æ½Ã´Ù½ÃÇÇ Àεð°íÄ«¹ÎÀº Èí¼öµÇÁö ¾Ê´Â ¾àÀÌ°í ¸ÞÆ¿·»ºí·ç´Â Èí¼öµÇ´Â °ÍÀ̹ǷΠ´ëüÇÏ´Â ¾àÀº ¾Æ´Ï°í ±×³É ÀӽùæÆíÀ̾úµé »ÓÀÔ´Ï´Ù. Àεð°íÄ«¹ÎÀ» ´ë½ÅÇÒ ¼ö ÀÖ´Â ÁÁÀº alternative´Â ¾ÆÁ÷ ¾ø´Â °Í °°½À´Ï´Ù.


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[References]

1) EndoTODAY »ö¼Ò³»½Ã°æ

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