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EndoTODAY ³»½Ã°æ ±³½Ç


[½Äµµ¾Ï ³»½Ã°æÄ¡·á ÈÄ ÇùÂø. Stricture after ESD for esophageal cancer]

1. ÇùÂø ÇÕº´ÁõÀÇ ºóµµ

Á¶±â½Äµµ¾Ï ³»½Ã°æÄ¡·á ÈÄ ÇùÂøÀÇ ºóµµ´Â 3% ºÎÅÍ 30% Á¤µµÀÔ´Ï´Ù.


2. °¡º­¿î ½Äµµ ÇùÂøÀÇ Áõ»ó

¾ÆÁÖ °æÇÑ ÇùÂøÀº Áõ»óÀÌ ¾ø½À´Ï´Ù. Áß°£ Á¤µµÀÇ ÇùÂø¿¡¼­´Â °£È¤ Áõ»óÀÌ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. ½Ä»ýÈ°À» Á¶½ÉÇϸé Áõ»óÀ» ÇÇÇÒ ¼ö ÀÖ½À´Ï´Ù.


3. Ä¡·á (1) - dz¼±È®Àå¼ú

½ÄµµÇùÂøÀÇ Ç¥ÁØÄ¡·á´Â dz¼±È®Àå¼úÀÔ´Ï´Ù. ±×·¯³ª ÇÑ ¹øÀ¸·Î ³¡³ª´Â °æ¿ì´Â º°·Î ¾ø½À´Ï´Ù. ´ëºÎºÐ ¸î ÁÖ °£°ÝÀ¸·Î ¿©·¯¹ø ¹Ýº¹ÇØ¾ß ÇÕ´Ï´Ù. ¸¶Áö¸· Ä¡·á ÈÄ¿¡µµ ¾à°£ÀÇ ÇùÂøÁõ¼¼°¡ ³²±âµµ ÇÕ´Ï´Ù.


4. Ä¡·á (2) - Mercedes Benz cutting

CircumferenceÀÇ 75% Á¤µµ ESD¸¦ ½ÃÇàÇÑ È¯ÀÚ¿¡¼­ ÇùÂøÀ¸·Î È®Àå¼úÀ» ÇÏ¿´½À´Ï´Ù. Áõ»ó Àç¹ß·Î ¸î Â÷·Ê ¹Ýº¹Çß½À´Ï´Ù. ±×·¯³ª Áõ»óÀÌ Áö¼ÓµÇ¾ú½À´Ï´Ù.

dz¼±È®Àå¼úÀÇ ´ÜÁ¡Àº blindÇÑ Ä¡·á¶ó´Â °ÍÀÔ´Ï´Ù. dz¼±À» È®ÀåÇϸé ÇùÂøºÎÀ§ Áß °¡Àå ¾àÇÑ ¹æÇâÀ¸·Î 1-2°÷ÀÌ ¹ú¾îÁý´Ï´Ù. ¹Ý¸é IT-knife¸¦ ÀÌ¿ëÇÑ Mercedes Benz cutting¿¡¼­´Â Á÷Á¢ º¸¸é¼­ ¿©·¯ ¹æÇâÀ» ÀÚ¸¦ ¼ö ÀÖ½À´Ï´Ù. ÀÌ È¯ÀÚ¿¡¼­´Â Mercedes Benz cuttingÀ» ½ÃÇàÇÑ ÈÄ 18 mm TTS balloon dilatationÀ¸·Î ¸¶¹«¸®ÇÏ¿´½À´Ï´Ù (²À ÇÊ¿äÇÑ ÀýÂ÷´Â ¾Æ´Õ´Ï´Ù). Áõ»óÀº ¸Å¿ì ÁÁ¾ÆÁ³½À´Ï´Ù. ´õ ÀÌ»óÀÇ È®Àå¼úÀº ÇÊ¿ä¾ø¾ú½À´Ï´Ù.

Mercedes Benz cuttingÀ¸·Î ºÒ¸®´Â ÀÌÀ¯´Â knife¸¦ ÀÌ¿ëÇÏ¿© Àû¾îµµ ¼¼ ¹æÇâ ÀÌ»óÀ» ÀÚ¸£±â ¶§¹®ÀÔ´Ï´Ù. Mercedes Benz ȸ»çÀÇ logo¸¦ º¸¸é ±Ý¹æ ÀÌÇØ°¡ µË´Ï´Ù.

ÀÌ È¯ÀÚ¿¡¼­´Â Mercedes Benz cuttingÀ» ¿©·¯ ¹æÇâÀ¸·Î ½ÃÇàÇÏ¿´½À´Ï´Ù. Áõ»óÀÌ ÁÁ¾ÆÁú ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù.


5. Ä¡·á (3) - »õ·Î¿î Ä¡·á¹æ¹ý¹ýÀº ¾ø½À´Ï±î?

¸¹Àº ´Ù¾çÇÑ ¹æ¹ýÀ» ¼Ò°³ÇÑ review¿¡¼­ ¿Å±é´Ï´Ù (Isomoto. Dig Endosc 2013).


6. ¿¹¹æ (1) - °æ±¸ steroid

ESD ÈÄ ÇùÂø ¿¹¹æ °æ±¸ steroid 8ÁÖ ÄÚ½º (ÀϺ»ÀÇ ÀüÅëÀûÀÎ dosing)
ESD 2ÀÏ° Pd Åõ¾à ½ÃÀÛ
1ÁÖ: ¸ÅÀÏ 30mg (5mg 6¾Ë)
2ÁÖ: ¸ÅÀÏ 30mg (5mg 6¾Ë)
3ÁÖ: ¸ÅÀÏ 25mg (5mg 5¾Ë)
4ÁÖ: ¸ÅÀÏ 25mg (5mg 5¾Ë)
5ÁÖ: ¸ÅÀÏ 20mg (5mg 4¾Ë)
6ÁÖ: ¸ÅÀÏ 15mg (5mg 3¾Ë)
7ÁÖ: ¸ÅÀÏ 10mg (5mg 2¾Ë)
8ÁÖ: ¸ÅÀÏ 5mg (5mg 1¾Ë)
9ÁÖ: Áß´Ü

ESD ÈÄ ÇùÂø ¿¹¹æ °æ±¸ steroid 4ÁÖ ÄÚ½º (¹Î¾ç¿ø ±³¼ö´Ô, 2021³â±îÁö)
ESD 2ÀÏ° Pd Åõ¾à ½ÃÀÛ
1ÁÖ: ¸ÅÀÏ 30mg (5mg 6¾Ë)
2ÁÖ: ¸ÅÀÏ 30mg (5mg 6¾Ë)
3ÁÖ: ¸ÅÀÏ 20mg (5mg 4¾Ë)
4ÁÖ: ¸ÅÀÏ 10mg (5mg 2¾Ë)
5ÁÖ: Áß´Ü

ÀüÅëÀûÀ¸·Î ÀϺ»¿¡¼­ »ç¿ëÇÏ´ø 8ÁÖ ÄÚ½º°¡ ¸¹ÀÌ »ç¿ëµÇ¾ú´Âµ¥ »ï¼º¼­¿ïº´¿ø ¹Î¾ç¿ø ±³¼ö´Ô ÆÀ¿¡¼­´Â Ãʱ⠿뷮Àº µ¿ÀÏÇÏ°Ô »ç¿ëÇ쵂 ºü¸£°Ô ÁÙÀÌ´Â 4ÁÖ ÄÚ½º¸¦ »ç¿ëÇÏ¿´½À´Ï´Ù. ºÐ¼® °á°ú 4Áַεµ È¿°ú´Â ºñ½ÁÇÏ¿´½À´Ï´Ù.

2022-11-22 SMC ³»½Ã°æ ¼¼¹Ì³ª¿¡¼­ ¹Î¾ç¿ø ±³¼ö´Ô²²¼­´Â ÇâÈÄ Ãʱ⠿뷮À» Á» ´õ ³ôÀÌ°í ±â°£Àº À¯ÁöÇϰųª ´ÜÃà½ÃÅ°´Â ¹æÇâÀ¸·Î º¯°æÇÒ °ÍÀ» °í·ÁÇÏ°í ÀÖ´Ù°í ¸»¾¸Çϼ̽À´Ï´Ù.


[Áõ·Ê]

Large esophageal ESD ÈÄ 8ÁÖ oral steroid »ç¿ëÇÏ¿´°í °ÅÀÇ ÇùÂøÀÌ ¹ß»ýÇÏÁö ¾Ê¾Ò´ø Áõ·Ê

Oral steroid°¡ È¿°úÀûÀ̾ú´ø °æ¿ì
Squamous cell carcinoma, moderately differentiated
1. Location : 35-38cm from incisor
2. Size of carcinoma : (1) longest diameter, 24mm (2) vertical diameter, 22mm
3. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
4. Resection margin : free from carcinoma(N), safety margin : distal 6 mm, proximal 2 mm, anterior 12 mm, posterior 4 mm
5. Lymphatic invasion : not identified(N)
6. Venous invasion : not identified(N)
7. Perineural invasion : not identified(N)
8. Peritumoral lymphoid follicle: present


7. ¿¹¹æ (2) - ±¹¼Ò triamcinolone injection

Intralesional triamcinolone ¹æ¹ýÀº µÎ °¡Áö°¡ ÀÖ½À´Ï´Ù. ESD ¸çÄ¥ ÈÄ ¿°Áõ¹ÝÀÀÀÌ ½ÃÀÛµÉ ¶§ ÁÖ»çÇÏ´Â ¹æ¹ý°ú ESD°¡ ¸· ³¡³­ ½ÃÁ¡¿¡¼­ ÁÖ»çÇÏ´Â ¹æ¹ýÀÔ´Ï´Ù.

1) Multiple session injection: 3, 7, 10 days after ESD

ÀϺ» ´Ï°¡Å¸ ´ëÇп¡¼­ ½Äµµ¾Ï ESD ÈÄ triamcinolone injectionÀ¸·Î ÇùÂø ¹ß»ýÀ» ¿¹¹æÇÒ ¼ö ÀÖ´Ù´Â non-randomized study °á°ú¸¦ ¹ßÇ¥ÇÑ ¹Ù ÀÖ½À´Ï´Ù (PubMed link). ETI (endoscopic triamcinolone injection)Àº semi-circumferential ÀÌ»óÀÇ Á¡¸·ÀÌ Á¦°ÅµÈ ȯÀÚ¸¦ ´ë»óÀ¸·Î ½ÃÇàµÇ¾ú½À´Ï´Ù. ETI¸¦ ½ÃÇàÇÏÁö ¾ÊÀº ȯÀÚ¿¡ ´ëÇÏ¿© ÇùÂø ¹ß»ýµµ Àû¾ú°í È®Àå¼ú Ƚ¼öµµ Àû¾ú´Ù°í ÇÕ´Ï´Ù. ETI ¹æ¹ýÀº ¾Æ·¡¿Í °°ÀÌ ¼Ò°³µÇ¾î ÀÖ¾ú½À´Ï´Ù.

ETI (endoscopic triamcinolone injection) was performed by using triamcinolone acetonide (10 mg/mL) without further dilution beginning at 3 days after ESD. Premedication for sedation and pain relief was not performed. A 25-gauge, 4-mm needle (TOP Corporation, Tokyo, Japan) was used for injections. A 1-mL syringe was used to inject triamcinolone manually, which facilitated secure injection with consistent pressure. After the needle was inserted shallowly (so as to avoid injuring the muscularis propria), triamcinolone was injected in aliquots of 0.2 mL (2 mg) into the cautery ulcer base (Fig. 1). Injections were performed equally (1 cm apart) in a semicircumferential fashion (Fig. 2). The number of injections per session was dependent on the size of resection and ranged from 9 to 31. The total dose of triamcinolone per session ranged from 18 to 62 mg. Sessions were performed at 3, 7, and 10 days after ESD (total of 3 sessions).


2) Single session injection immediately after ESD

'Single session injection immediately after ESD'¿¡ ´ëÇؼ­´Â ¾Æ»êº´¿ø Á¤ÈÆ¿ë ±³¼ö´ÔÀÇ Áõ·Êº¸°í°¡ ÀÖ½À´Ï´Ù (Clin Endosc 2013;46:643-646). ESD·Î Á¡¸·ÇÏÃþÀÌ °ÅÀÇ ¾ø¾îÁø »óȲ¿¡¼­ Á¡¸·ÇÏÃþ¿¡ triamcinoloneÀ» ÁÖ»çÇØ¾ß ÇϹǷΠ±â¼úÀûÀ¸·Î ½±Áö ¾Ê´Ù°í ÇÕ´Ï´Ù.


8. ¿¹¹æ (3) - Balloon dilation (2014-10-11. °­³²¼¼ºê¶õ½º½ÉÆ÷Áö¾ö ¿¬¼¼´ëÇб³ Á¤Çö¼ö)

1) TTS balloon dilatationÀϹݷÐ

- no more than 3 incremental inflations

- maximal balloon diameter in the previous session = first balloon in the next sessions

- 15mm : tolerable to modified regular diet

2) ESD ÈÄ stricture¿¡ ´ëÇÏ¿©

Preemptive balloon dilatation (2/week for 8 weeks, Á¡¸·ÀÌ ¿ÏÀüÈ÷ healing µÉ ¶§±îÁö) ÀϺΠȿ°ú°¡ ÀÖ´Â µí ÇÏÁö¸¸ oral steroid º¸´Ù´Â ¸øÇÔ.

Preemtive ballon dilatation°ú ÇÔ²² tranilast (PO 8 weeks) »ç¿ëÇÏ¸é µµ¿òÀÌ µÈ´Ù. 33% (with tranilast) vs 67% (without tranilast)

3) ¿¬ÀÚÀÇ °á·Ð: Oral prednisolone, often combined with early balloon dilation, offers the sole validated and affordable treatment option.


9. ¿¹¹æ (4) - Stent and others (2014-10-11. °­³²¼¼ºê¶õ½º½ÉÆ÷Áö¾ö ¿¬¼¼´ëÇб³ À±¿µÈÆ)

- Benign stenosis¿¡¼­ ½ºÅÄÆ®¸¦ Àß »ç¿ëÇÏÁö ¾Ê´Â °ÍÀ½ migration, hyperplatic tissue reaction, embedding into esophageal wall, new stricture formation, perforation, fistula formation µîÀÇ ¿ì·Á°¡ Àֱ⠶§¹®ÀÓ.

- Metal stent, plastic stent, biodegradable stentÀÇ ºñ±³

- 35¹ø dz¼±È®Àå¼ú·Îµµ È£ÀüµÇÁö ¾Ê¾Ò´Âµ¥ stent¸¦ ÇÑ ÈÄ ÁÁ¾ÆÁ³´Ù´Â ÀϺ» Áõ·Ê°¡ ÀÖÀ½.

- Áß±¹¿¡¼­ ½ºÅÄÆ®¸¦ ¿¹¹æÀûÀ¸·Î »ç¿ëÇÏ¿´´Ù´Â ¿¬±¸°¡ ¹ßÇ¥µÈ ¹Ù ÀÖÀ½. (Wen. DDS 2014:59;658)

- Mytomycin C local injection or local application (MMC¸¦ Àû½Å cotton pledgetÀ» 3-5ºÐ Á¤µµ Á¢Ã˽ÃÅ°´Â ¹æ¹ý)µµ promising ÇØ º¸ÀÓ.

- 5-FU, N-acetylcysteine, amniotic membrane graft, gastroesoohageal endoscopic mucosal transplant, µîÀ» ½ÃµµÇÑ ¿¬±¸°¡ ÀÖÀ½.


10. ¿¹¹æ (5) - Polyglicolic acid sheet / tissue-engineering cell sheet (2014-10-11. °­³²¼¼ºê¶õ½º½ÉÆ÷Áö¾ö Yamaguchi Naoyuki, Nagasaki University, Japan)

Esophageal ESD ÈÄ ÇùÂøÀÇ À§ÇèÀÎÀÚ: more than 3/4 circumference, 4cm, cervical area

Triamcinolone injection immediately after ESD: À̸¦ À§ÇÏ¿© ¸Å¿ì ªÀº ³»½Ã°æ ÁÖ»çħÀ» °³¹ßÇÏ¿´À½.

Semicircular case¿¡¼­´Â triamcinolone injection immediately after ESD¿Í oral steroidÀÇ È¿°ú°¡ ºñ½ÁÇÏÁö¸¸ complete circular case¿¡¼­´Â oral steroid treatment°¡ ´õ È¿°úÀûÀÓ. ÀÌ·¯ÇÑ °á°ú¸¦ ¹ÙÅÁÀ¸·Î Yamaguchi ±³¼ö´ÔÀº ¾Æ·¡¿Í °°Àº ¾Ë°í¸®ÁòÀ» º¸¿©ÁÖ¾úÀ½.

Yamaguchi ±³¼ö´ÔÀÇ »õ·Î¿î ¹æ¹ýÀ» µÎ °¡Áö ¼Ò°³Çϼ̽À´Ï´Ù. À̹ø ½ÉÆ÷Áö¾ö Âü¼®ÀÚµéÀÌ °¡Àå Èï¹Ì·Ó°Ô »ý°¢ÇÑ ÁÖÁ¦¿´½À´Ï´Ù. EndoTODAY¿¡¼­´Â Á¦¸ñ¸¸ ¼Ò°³ÇÕ´Ï´Ù.

1) Cell sheet transplantation with a transfer is the world's first attempt in the digestive area.

2) PGA felt + fibrin glue sealing method


11. ¿¹¹æ (6) - Botox injection

½Äµµ ESD ÈÄ stricture¸¦ ÁÙÀ̱â À§ÇÏ¿© Botox Áֻ縦 ½ÃµµÇÑ Áß±¹ ³í¹®ÀÔ´Ï´Ù (Wen J. Gastrointest Endosc 2016). Botox´Â TGF-beta1À» ÁÙ¿© collagen ħÂøÀ» °æ°¨½ÃÅ°´Â ±âÀüÀ» °¡Áö°í Àִµ¥, surgical would fibrosis¸¦ ÁÙÀÌ´Â °ÍÀ¸·Î ¾Ë·ÁÁ® ÀÖ½À´Ï´Ù. À̸¦ ½Äµµ ESD ÈÄ ÇùÂø ¹æÁö¿¡ Àû¿ëÇÑ ¿¬±¸ÀÔ´Ï´Ù.

¾î´À ºÎÀ§¿¡ ¾ó¸¶³ª ÁÖ»çÇß´ÂÁö ±Ã±ÝÇÏ½Ã¸é ¾Æ·¡¸¦ º¸½Ê½Ã¿À.

A single session of BTX-A (Lanzhou Institute of Biological Products, Lanzhou, China) injections was undertaken immediately after ESD. A total of 100 units of BTX-A was diluted with 5 mL of saline solution (20 units/mL). The BTX-A solution was injected in 0.5 mL increments into 10 separate points equally spaced along the circumference of the defect with a 25-gauge, 4-mm needle (TOP Corporation, Tokyo, Japan). The injections were placed deeply at the level of the muscularis propria along the junction of the defect and the normal tissue. However, in patients with full circumference mucosal defect, BTX-A was injected superficially into the base of the cautery ulcer. All patients with group were injected with 100 units of BTX-A, regardless of the size.


12. 2016³â 10¿ù 8ÀÏ SGI meeting Mitsuhiro Fujishiro ±³¼ö °­ÀÇ

Splash M-knife: Submucosal injectionÀÌ °¡´ÉÇÏ°í hemostatic power°¡ ÁÁÀ½.

Circumferential ESD ÈÄ ¸Å¿ì ¸¹Àº dz¼± È®Àå¼ú(preventive balloon dilatation)À» ÇÏ¿´´ø ¿À·¡µÈ ȯÀÚ¸¦ º¸¿©ÁÖ¾ú½À´Ï´Ù. ÃÖ±Ù¿¡´Â ¸î °¡Áö ¿¹¹æ Àü·«À» »ç¿ëÇϱ⠶§¹®¿¡ ½ÉÇÑ stricture¸¦ º¸À̴ ȯÀÚ´Â °ÅÀÇ ¾ø½À´Ï´Ù.

±âÁ¸ÀÇ steroid injection ÀÌ¿ÜÀÇ ¸î °¡Áö ¹æ¹ýÀÌ ¼Ò°³µÇ¾ú½À´Ï´Ù. Fujishiro ¹Ú»çÀÇ °á·ÐÀº steroid¿Í shieldingÀ» ÇÔ²² »ç¿ëÇÏ´Â °ÍÀÌ °¡Àå ÁÁÀ» °Í °°´Ù´Â °ÍÀ̾ú½À´Ï´Ù. Triamcinolon injection°ú PGA shieldingÀ» ÇÔ²² »ç¿ëÇÏ´Â °æ¿ì oral steroid´Â ó¹æÇÏÁö ¾Ê´Â´Ù°í ÇÕ´Ï´Ù.

(1) Biodegradable stent (Saito Y. Dig Dis Sci 2008) - commercially availableÇÏÁö ¾Ê½À´Ï´Ù.

(2) Cell sheet technology (Ohki. Gastroenterology 2012)

(3) Polyglycolic acid sheets and fibrin glue (Tokyo University)

Sakaguchi Y. Endoscopy 2015

(4) Triamcinolone injection and shielding with PGA and fibrin glue (Tokyo University)

A representative case where postoperative stricture was prevented after wide-spreading ESD. Chromoendoscopy showed a semi-circumferential lesion in the esophagus (a), and the lesion was resected en bloc with endoscopic submucosal dissection (b). This resulted in endoscopic resection of over 3/4 the circumference of the esophagus (c). Triamcinolone was injected into the perimeter of the ESD defect (d), followed by shielding with PGA sheets and fibrin glue (e). Endoscopic follow-up 12 weeks later revealed no stricture (f). (Sakaguchi Y. Am J Gastroenterol 2016 )


13. Recent review - Approaches for stricture prevention after esophageal endoscopic resection

Abe. GIE 2017

Abe. GIE 2017


14. °³ÀÎÀû °á·Ð: ÇùÂø ¿¹¹æÀ» À§ÇÑ Ä¡·á(pre-emptive treatment)°¡ ÇÊ¿äÇÑ°¡?

Clin Endosc 2014;47:124-126¿¡ ±èÇü±æ ¼±»ý´Ô²²¼­ ¾Æ·¡¿Í °°Àº ¹®ÀåÀ¸·Î ³¡³ª´Â "When Is Pre-Emptive Treatment Necessary after Endoscopic Mucosal Resection of Early Esophageal Neoplasm?"À̶ó´Â Á¦¸ñÀÇ ±ÛÀ» ±â°íÇϼ̽À´Ï´Ù.

Àú´Â °ú°Å¿¡´Â ¿¹¹æº¸´Ù´Â ÀÏ´Ü ÇÕº´ÁõÀÌ ¹ß»ýÇÑ È¯ÀÚ¿¡ ´ëÇÑ Àû±ØÀû Ä¡·á¸¦ ¼±È£ÇÏ¿´½À´Ï´Ù. ÇÕº´Áõ ¹ß»ý·Ê°¡ ¸Å¿ì Àû¾ú±â ¶§¹®ÀÔ´Ï´Ù. ±×·±µ¥ ÃÖ±Ù¿¡´Â single session triamcinolone injection immediate after ESD ȤÀº oral steroid therapy¸¦ »ç¿ëÇÏ·Á°í ÇÕ´Ï´Ù. °ú°Åº¸´Ù ³ÐÀº º´¼Ò¿¡ ´ëÇÑ ³»½Ã°æ Ä¡·á¸¦ ½ÃµµÇÏ°í Àֱ⠶§¹®ÀÔ´Ï´Ù. º¸´Ù ÀÚ¼¼ÇÑ ³»¿ëÀº Gangnam Severance Single Topic Endoscopic Conference (GSTEC)'¸¦ Âü°íÇϱ⠹ٶø´Ï´Ù. ÀúÀÇ °á·ÐÀº ¾Æ·¡¿Í °°½À´Ï´Ù.

Large esophageal ESD ÈÄ 8ÁÖ oral steroid »ç¿ëÇÏ¿´°í °ÅÀÇ ÇùÂøÀÌ ¹ß»ýÇÏÁö ¾Ê¾Ò´ø Áõ·Ê

1) ½Äµµ ESD ÈÄ ÇùÂø¿ì·Á°¡ ÀÖÀ¸¸é ESD Á÷ÈÄ intralesional triamcinolone injectionÀ̳ª 8-12ÁÖ oral steroid therapy¸¦ ½ÃÇàÇÏ´Â °ÍÀÌ ÁÁ°ÚÀ½. SemicircularÀÎ °æ¿ì´Â µÑ Áß Çϳª¸¦ ¼±ÅÃÇÒ ¼ö ÀÖÁö¸¸ circumferentialÇÑ °æ¿ì¿¡´Â oral steroid therapy¸¦ ¼±ÅÃÇÏ´Â °ÍÀÌ ÇÕ¸®ÀûÀ¸·Î »ý°¢µÊ.

2) 'ESD 3ÀÏ ÈĺÎÅÍ ¹Ýº¹Çؼ­ intralesional triamcinolon injectionÀ» ÇÏ´Â ¹æ¹ý'À̳ª 'preemptive balloon dilatation ¹æ¹ý'Àº ¿ì¸®³ª¶ó Çö½Ç¿¡ ³Ê¹« ¹ø°Å·Î¿ï °ÍÀ¸·Î »ý°¢µÊ.

3) Cell sheet³ª PGA shieldingÀº ¿ì¸®³ª¶ó¿¡¼­ ÀûÀýÇÑ °¡°Ý¿¡ available ÇÏÁö ¾ÊÀ½

4) ½Äµµ¾Ï ESD ÈÄ °æ±¸ steroid 8ÁÖ Ä¡·á Ç¥ÁØ protocol: ESD 2ÀÏ° 30mgÀ¸·Î ½ÃÀÛÇÑ ÈÄ ¸ÅÁÖ 30, 30, 25, 25, 20, 15, 10, 5·Î õõÈ÷ ÁÙ¿© ³ª°¨. ½Äµµ¾Ï¿¡¼­´Â º¸Åë 8ÁÖ ÄÚ½º¸¦ »ç¿ëÇÏ°í À§¿¡¼­´Â °£È¤ 4ÁÖ ÄÚ½º¸¦ »ç¿ë.

ESD ÈÄ ÇùÂø ¿¹¹æ °æ±¸ steroid 8ÁÖ ÄÚ½º
ESD 2ÀÏ° Pd Åõ¾à ½ÃÀÛ
1ÁÖ: ¸ÅÀÏ 30mg (5mg 6¾Ë)
2ÁÖ: ¸ÅÀÏ 30mg (5mg 6¾Ë)
3ÁÖ: ¸ÅÀÏ 25mg (5mg 5¾Ë)
4ÁÖ: ¸ÅÀÏ 25mg (5mg 5¾Ë)
5ÁÖ: ¸ÅÀÏ 20mg (5mg 4¾Ë)
6ÁÖ: ¸ÅÀÏ 15mg (5mg 3¾Ë)
7ÁÖ: ¸ÅÀÏ 10mg (5mg 2¾Ë)
8ÁÖ: ¸ÅÀÏ 5mg (5mg 1¾Ë)
9ÁÖ: Áß´Ü

ESD ÈÄ ÇùÂø ¿¹¹æ °æ±¸ steroid 4ÁÖ ÄÚ½º
ESD 2ÀÏ° Pd Åõ¾à ½ÃÀÛ
1ÁÖ: ¸ÅÀÏ 30mg (5mg 6¾Ë)
2ÁÖ: ¸ÅÀÏ 20mg (5mg 4¾Ë)
3ÁÖ: ¸ÅÀÏ 10mg (5mg 2¾Ë)
4ÁÖ: ¸ÅÀÏ 5mg (5mg 1¾Ë)
5ÁÖ: Áß´Ü


[FAQ]

[2014-10-6. ¾Öµ¶ÀÚ Áú¹®]

Mercedes Benz technique À̸§ÀÌ Âü ÁÁ½À´Ï´Ù. Àúµµ °ü½ÉÀÌ ÀÖ¾ú´Âµ¥ electrical current´Â ÀϹÝÀûÀÎ mucosal cutting current¸¦ ¾²½Ã°ÚÁö¿ä?

[2014-10-6. ÀÌÁØÇà ´äº¯]

Áß¿äÇÑ point¸¦ Áú¹®Çϼ̽À´Ï´Ù. »ç½Ç ESU (electrosurgical unit) settingÀº Âü°íÇÒ »ÓÀÌÁö ±×´ë·Î µû¶óÇÏ¸é °ï¶õÇÕ´Ï´Ù. ¾î¶² knifeÀΰ¡¿¡ µû¶ó ´Ù¸£°í, ESU°¡ »õ°ÍÀÎÁö ³°Àº °ÍÀÎÁö¿¡ µû¶ó ´Ù¸£°í, ½Ã¼úÀÚÀÇ ½À°ü(knife¸¦ ´Ù·ç´Â ¾Ð·ÂÀ̳ª ¼Óµµ)¿¡ µû¶ó ´Þ¶óÁý´Ï´Ù.

´ë ¿øÄ¢Àº ÀÌ·¸½À´Ï´Ù. Cutting current¸¦ ¸¹ÀÌ »ç¿ëÇϸé sharpÇÏ°Ô À߸®±â´Â Çϴµ¥ immediate bleedingÀÌ ¸¹½À´Ï´Ù. õ°ø ¿ì·Áµµ ³ô½À´Ï´Ù. Coagulation current¸¦ ¸¹ÀÌ »ç¿ëÇÏ¸é µÐŹÇÏ°Ô À߸®Áö¸¸ immediate bleedingÀº Àû½À´Ï´Ù. ´Ù¸¸ delayed bleedingÀº Á¶±Ý ¸¹À» ¼ö ÀÖ½À´Ï´Ù. Àú´Â ºñ·Ï ÃâÇ÷ÀÌ ¸¹´õ¶óµµ sharpÇÏ°Ô À߸®´Â °ÍÀ» ¼±È£ÇÏ´Â ÆíÀÔ´Ï´Ù. ±×·¡¼­ ESD¸¦ ÇÒ ¶§¿¡µµ °ÅÀÇ Endocutting¸¸ »ç¿ëÇÕ´Ï´Ù (Endocut I. effect 3, cutting duration 3, cutting interval 3). Endocut Q, Auto cut, Dry cut, High cut, Swift coagulation, Forced coagulationµî ´Ù¾çÇÑ mode¸¦ »ç¿ëÇÒ ¼ö ÀÖÁö¸¸ Àú´Â °ÅÀÇ ½áº» °æÇèÀÌ ¾ø½À´Ï´Ù. Endocut I¿¡ ¸¸Á·ÇÏ°í ÀÖ½À´Ï´Ù.

ºñ½ÁÇÑ Áõ·Ê Çϳª ¼Ò°³ÇÏ°Ú½À´Ï´Ù. GERD Áõ»óÀÌ ÇöÀúÇÑ È¯ÀÚ·Î hiatal hernia°¡ ÀÖ°í mucosal ring stricture(Schatzki ring)À¸·Î ¿¬ÇÏ°ï¶õÀÌ ÀÖ´ø ºÐÀÔ´Ï´Ù. TTS balloon dilatationÀ» ÇÏ¿´´Âµ¥ ÇÑ ¹æÇâÀ¸·Î¸¸ ÀýÁ¦°¡ µÇ¾ú½À´Ï´Ù. ÈçÈ÷ ÀÖ´Â ÀÏÀÔ´Ï´Ù. Áõ»óÀº °ð Àç¹ßÇÏ¿´°í À̹ø¿¡´Â Mercedes Benz cuttingÀ» ½ÃÇàÇÏ¿´½À´Ï´Ù. ¿©·¯ ¹æÇâÀ¸·Î ÀýÁ¦ÇÑ ÈÄ IT-2 knife¸¦ circumferentialÇÏ°Ô µ¹·Á¼­ Á¡¸·°ú Á¼¾ÆÁø fibrosis ºÎºÐÀ» ¸ðµÎ Á¦°ÅÇÏ¿´½À´Ï´Ù. Áõ»óÀº Áï½Ã È£ÀüµÇ¾ú°í ȯÀÚ´Â ´ë¸¸Á·À̾ú½À´Ï´Ù.

ÀÌ ½Ã¼ú°ú °ü·ÃµÈ º¸´Ù ÀÚ¼¼ÇÑ »çÇ×Àº Traversing Difficult Esophageal Strictures from the Retrograde Approach¸¦ º¸½Ã±â ¹Ù¶ø´Ï´Ù.


[2014-10-6. ¾Öµ¶ÀÚ Áú¹®]

Á¶±âÀ§¾ÏÀÇ ³»½Ã°æ Ä¡·áÈÄ ¹ß»ýÇÑ ÇùÂø¿¡µµ ÀÌ¿ë °¡´ÉÇÒ±î¿ä? Distal antrumºÎÀ§ÀÇ ESD ½ÃÇàÈÄ ÇùÂøÀ¸·Î ½ÄÀÌÁøÇà¿¡ ¾î·Á¿òÀ» °Þ°í Àִ ȯÀÚµéÀÌ ÀÖ½À´Ï´Ù. ³»½Ã°æ Åë°ú´Â °¡´ÉÇϳª, deformity°¡ ¹®Á¦°¡ ¾Æ´Ò±î »ý°¢µÇ´Âµ¥ balloon dilatationÀÌ Å« Àǹ̴ ¾ø¾î º¸¿´½À´Ï´Ù. ÁÁÀº ¹æ¹ýÀÌ ¾øÀ»·±Áö¿ä? ¤Ð¤Ð

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½Äµµ ÇùÂøÀº ºñ±³Àû Á¼Àº segment¿¡ °ÉÃļ­ webó·³ ¹ß»ýÇÏ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. µû¶ó¼­ TTS balloon dilatationÀ̳ª Mercedes Benz cutting µîÀÌ À¯¿ëÇÕ´Ï´Ù. ±×·¯³ª À§ÀÇ ÇùÂøÀº Á» ´õ ³ÐÀº segment¿¡ °É·Á¼­ ¹¶ÅüÇÏ°Ô ¹ß»ýÇÏ´Â °æÇâÀÔ´Ï´Ù. µû¶ó¼­ balloon dilatationÀº ½ÃµµÇغ¼ ¼ö ÀÖÁö¸¸ Mercedes Benz cutting ¹ýÀº À¯¿ëÇÏÁö ¾ÊÀ» °Í °°½À´Ï´Ù.


[References]

1) EndoTODAY À§(êÖ) ESD ÈÄ ÇùÂø

2) EndoTODAY ½Äµµ(ãÝÔ³) ESD ÈÄ ÇùÂø

3) 2014 Gangnam Severance Single Topic Endoscopic Conference (GSTEC) - Stricture after esophageal ESD

4) EndoTODAY Á¶±â½Äµµ¾Ï ³»½Ã°æÄ¡·á (2012-12¿ù-22 ºÎÅÍ 2012-12-31)

5) Jain D, Singhal S. Esophageal stricture prevention after ESD Clin Endosc 2016 (review)

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