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EndoTODAY ³»½Ã°æ ±³½Ç


[EndoManual. Quick reference - Endoscopy protocol at SMC] - ðû

1. Basic 񃧯

2. Esophagus ½Äµµ

3. Stomach À§ - Á¶Á÷°Ë»ç, ³»½Ã°æÄ¡·á ÈÄ ÃßÀû°Ë»ç, Helicobacter

4. Duodenum ½ÊÀÌÁöÀå

5. Colon ´ëÀå

6. Others ±âŸ

2022-2-19. Winter School


À§³»½Ã°æ °á°ú ±â¼ú¹ý

´ÙÀ½ÀÇ ¼ø¼­·Î ±â¼úÇϼ¼¿ä. Çѱ۰ú ¿µ¹®À» È¥¿ëÇصµ ÁÁ½À´Ï´Ù. Àڽſ¡¼­ ÆíÇÑ ¹æ¹ýÀ¸·Î ¾²±â ¹Ù¶ø´Ï´Ù.

(1) À§Ä¡
(2) Å©±â
(3) ÁÖ¼Ò°ß (massÀÎÁö, superficial lesionÀÎÁö, ulcerative lesionÀÎÁö µî)
(4) ºÎ¼Ò°ß - ÀûÀýÇÑ ¿ë¾î¸¦ »ç¿ëÇÏ¿© »ó¼¼È÷ ±â¼úÇØ ÁÖ¼¼¿ä.
(5) Áø´Ü (impression)
(6) ºÐ·ù

* SMC style·Î ³»½Ã°æ ¼Ò°ßÀ» ±â¼úÇÏ´Â ¹æ¹ýÀ» º¸´Ù ±í°Ô ¹è¿ì°í ½ÍÀ¸½Å ºÐ¿¡°Ô´Â description exercise workshop (DEX)À» ±ÇÇÕ´Ï´Ù.

* Âü°í: EndoTODAY ³»½Ã°æ ¹è¿ì±â ÃʽÉÀÚ ±³½Ç DEX


À§³»½Ã°æ »çÁø ÃÔ¿µ¹ý

* Âü°í: EndoTODAY ³»½Ã°æ »çÁø ÃÔ¿µ¹ý


½Äµµ¾Ï/½ÄµµÀÌÇü¼º ³»½Ã°æ Ä¡·á ÈÄ ÃßÀû Á¶Á÷°Ë»ç °¡À̵å

1) Ä¡·á ÈÄ Ã¹ ³»½Ã°æ½Ã Á¶Á÷°Ë»ç 2Á¡
2) ½Äµµ¾ÏÀÇ °æ¿ì 5³â±îÁö´Â ¸Å ÃßÀû ³»½Ã°æ¸¶´Ù Á¶Á÷°Ë»ç 1-2Á¡, ÀÌÈÄ´Â Àç¹ßÀÇ½É ¼Ò°ßÀÌ ÀÖÀ» ¶§ Á¶Á÷°Ë»ç
3) ½ÄµµÀÌÇü¼ºÀÇ °æ¿ì 1³â±îÁö¸¸ Á¶Á÷°Ë»ç 1-2Á¡, ÀÌ ÈÄ´Â Àç¹ßÀÇ½É ¼Ò°ßÀÌ ÀÖÀ» ¶§ Á¶Á÷°Ë»ç
4) WLE¿Í NBI·Î Àüü ½Äµµ °üÂûÇÏ¿© synchronous/metachronous º´¼Ò°¡ °üÂûµÇ¸é lugol¡¯s solution µµÆ÷ÇÏ°í Á¶Á÷°Ë»ç 1-2Á¡. ´Ù¹ß¼º lugol voiding lesionµéÀÌ º¸ÀÌ´Â °æ¿ì¿¡´Â 1 cm ÀÌ»óÀ¸·Î Å©°Å³ª »ó´ëÀûÀ¸·Î ¿°»öÀÌ ¶Ñ·ÇÀÌ ´ú µÇ´Â°Å³ª ¾ÈµÇ´Â º´¼Ò¿¡¼­ ¼±ÅÃÀû Á¶Á÷°Ë»ç 1-2Á¡.


¹Ù·¿ ½Äµµ (Barrett esophagus)

1) 1 cm ¹Ì¸¸ÀÇ ¹Ù·¿½Äµµ°¡ ÀÇ½ÉµÇ¸é »çÁøÀ» Àß Âï¾îµÎ°í °á°úÁö¿¡ ¾ð±ÞÇÏÁö ¾Ê´Â´Ù. ÀÓ»óÀû ÀÇÀÇ°¡ ¾ø´Â ¼Ò°ßÀ¸·Î °£ÁÖÇÑ´Ù.
2) 1 cm - 3 cmÀÇ ¹Ù·¿½Äµµ°¡ ÀÇ½ÉµÇ¸é »çÁøÀ» Àß Âï¾îµÎ°í Á¶Á÷°Ë»ç¸¦ 2°³ Á¤µµ ½ÃÇàÇÏ°í °á°úÁö¿¡ r/o short segment Barrett's esophagus·Î ¾´´Ù.
3) 3 cm ÀÌ»óÀÇ ¹Ù·¿½Äµµ°¡ ÀÇ½ÉµÇ¸é »çÁøÀ» Àß Âï¾îµÎ°í Á¶Á÷°Ë»ç¸¦ 2(4)°³ Á¤µµ ½ÃÇàÇÏ°í °á°úÁö¿¡ r/o long segment Barrett's esophagus·Î ¾´´Ù.
4) Dysplasia°¡ Àְųª ÀǽɵǸé Àü¹®°¡¿¡°Ô ÀÇ·ÚÇÑ´Ù.
5) Dysplasia°¡ ¾øÀ¸¸é 1³â ÈÄ ÃßÀû³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇÑ´Ù. ÃßÀû³»½Ã°æ¿¡¼­ ÀÚ¼¼È÷ °üÂûÇÏ¿© Ưº°È÷ ÀǽɵǴ °÷ÀÌ ¾øÀ¸¸é Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾Ê¾Æµµ ÁÁ´Ù.

* Âü°í: EndoTODAY ¹Ù·¿ ½Äµµ


½Äµµ¾Ï. RT Àü clipping

½Äµµ¾Ï RT Àü clippingÀ» ¿äû¹ÞÀ¸¸é À§¾Ï°ú ºñ½ÁÇÏ°Ô º´¼Ò °æ°è 1cm ÁöÁ¡¿¡ Ŭ¸³À» 2°³¾¿ À§Ä¡½Ãŵ´Ï´Ù. Proximal marginº¸´Ù 1 cm proximal¿¡ µÎ °³, distal marginº¸´Ù 1 cm distal¿¡ µÎ °³.

½Äµµ¾Ï proximal marginº¸´Ù 1cm »ó¹æ°ú distal marginº¸´Ù 1cm ÇϹ濡 °¢°¢ clipÀ» µÎ°³¾¿ applyÇÏ¿´°í Á÷ÈÄ¿¡ RT¸¦ À§ÇÑ simulation CT¸¦ Âï¾î¼­ Ä¡·á ¹üÀ§¸¦ °áÁ¤ÇÏ¿´½À´Ï´Ù.


[À§ Á¶Á÷°Ë»ç]

³»½Ã°æ ÃßÁ¤Áø´Ü¿¡ µû¶ó ¸î °³ÀÇ Á¶Á÷°Ëü¸¦ ¾ò¾î¾ß ÁÁÀ»Áö Á¤ÇØÁø ±ÔÄ¢Àº ¾ø½À´Ï´Ù. Àú´Â °³ÀÎÀûÀ¸·Î ¾ç¼ºÀ§±Ë¾ç, Á¶±âÀ§¾Ï¿¡¼­´Â 3°³ Á¤µµ, ÁøÇ༺ À§¾Ï¿¡¼­´Â 6-8°³ Á¤µµ, SMT¿¡¼­´Â 2°³ Á¤µµÀÇ Á¶Á÷°Ë»ç¸¦ ÇØ ÁֽʽÿÀ´Ù. Á¶±âÀ§¾Ï¿¡¼­ ³Ê¹« ¸¹Àº Á¶Á÷°Ë»ç¸¦ ÇÏ¸é ³»½Ã°æ Ä¡·á¿¡ ¹æÇØ°¡ µÉ ¼ö ÀÖ½À´Ï´Ù. ÁøÇ༺ À§¾ÏÀº Á¶Á÷ ±«»ç°¡ ½ÉÇÑ °æ¿ì°¡ ÀÖÀ¸¹Ç·Î »ó´ëÀûÀ¸·Î ¸¹Àº ¼öÀÇ Á¶Á÷ °Ëü°¡ ÇÊ¿äÇÕ´Ï´Ù.

ÃÖ±Ù ÁøÇ༺ À§¾ÏÀº ¿©·¯ markerÀÇ °³¹ß·Î °ú°Åº¸´Ù Á¶Á÷°Ë»ç°¡ ´õ ¸¹ÀÌ ÇÊ¿äÇÕ´Ï´Ù. ÃÖ¼ÒÇÑ 6°³, °¡´ÉÇϸé 8°³ÀÇ Á¶Á÷°Ë»ç¸¦ ºÎŹÇÕ´Ï´Ù.

CAP and NCCN Guidelines recommendations state that, when possible, a minimum of 5 biopsy specimens and optimally, 6 to 8, should be obtained to account for intratumoral heterogeneity of HER2 in GEA and to provide sufficient tumor specimens for diagnosis and biomarker testing (Âü°í¹®Çå: Bartley AN et al., Arch Pathol Lab Med. 2016;140:1345-1363)

À§¾Ï ȯÀÚÀÇ Ã¹ ³»½Ã°æ Á¶Á÷°Ë»ç¸¦ ó¹æÇÒ ¶§ À§¾ÏÀÇ subtype ºÐ·ù¿Í Ãß°¡ Ä¡·á¸¦ À§ÇÏ¿© ¸î °¡Áö marker °Ë»ç¸¦ ÇØ Áֽñ⠹ٶø´Ï´Ù. Á¶±âÀ§¾ÏÀ¸·Î ÆǴܵǴ °æ¿ì´Â 2 °¡Áö, ÁøÇ༺ À§¾ÏÀ¸·Î ÆǴܵǴ °æ¿ì´Â 3°¡ÁöÀÔ´Ï´Ù. 2023³â 9¿ù 1ÀϺÎÅÍ palliative settingÀÇ À§¾Ï 1Â÷ Ç×¾ÏÄ¡·á¿¡¼­ ¸é¿ªÄ¡·áÁ¦ÀÎ OPDIVO (nivolumab)¸¦ º¸ÇèÀ¸·Î »ç¿ëÇÒ ¼ö ÀÖ°Ô µÇ¾ú½À´Ï´Ù. ÀÌ¿¡ µû¶ó ¿ì¸® º´¿ø¿¡¼­µµ AGC¿¡¼­´Â PD-L1 28-8 °Ë»ç¸¦ Çϱâ·Î ÇÏ¿´½À´Ï´Ù.

2022³â 12¿ù ±âÁØ SMC¿¡¼­ ÁøÇàµÇ°í ÀÖ´Â À§¾Ï Ç×¾ÏÄ¡·á algorithm (°è¼Ó º¯°æµÇ°í ÀÖ½À´Ï´Ù)

* Âü°í: EndoTODAY Á¶Á÷°Ë»ç

* Âü°í: EndoTODAY À§¾Ï 11 - ÁøÇ༺ À§¾ÏÀÇ Á¶Á÷°Ë»ç½Ã H&E °Ë»ç¿¡ ´õÇÏ¿© c-erbB-2 °Ë»ç (»ï¼º¼­¿ïº´¿ø ÄÚµå BP3A12)¸¦ ÇÔ²² ó¹æÇØ Áֽñ⠹ٶø´Ï´Ù.


[Á¶±âÀ§¾Ï/À§¼±Á¾ ³»½Ã°æ Ä¡·á ÈÄ ÃßÀû°Ë»ç]

1) Á¶±âÀ§¾Ï EMR/ESD: 3³â±îÁö ÃßÀû ³»½Ã°æ¸¶´Ù scar¿¡¼­ Á¶Á÷°Ë»ç (1-2Á¡) → 3³â ÈĺÎÅÍ´Â Àç¹ß ÀÇ½É ¼Ò°ßÀÌ ÀÖÀ» ¶§¸¸ Á¶Á÷°Ë»ç (´Ü, Á¶±âÀ§¾Ï EMR/ESD ÈÄ Ã¹ ÃßÀû ³»½Ã°æ¿¡¼­´Â antrum GC¿Í midbody GC¿¡¼­ °¢°¢ Á¶Á÷°Ë»ç¸¦ ÇÏ¿© Giemsa stainingÀ» ÀÇ·ÚÇÑ´Ù.)
2) ¼±Á¾À̳ª À§½Å°æ³»ºÐºñÁ¾¾ç EMR/ESD: ½Ã¼ú ÈÄ Ã¹ ÃßÀû ³»½Ã°æ¿¡¼­´Â scar¿¡¼­ Á¶Á÷°Ë»ç (1-2Á¡) → ÀÌÈÄ¿¡´Â Àç¹ß ÀÇ½É ¼Ò°ßÀÌ ÀÖÀ» ¶§¸¸ Á¶Á÷°Ë»ç (´Ü, ¼±Á¾ EMR/ESD ÈÄ antrum GC¿Í midbody GC¿¡¼­ °¢°¢ Á¶Á÷°Ë»ç¸¦ ÇÏ¿© Giemsa stainingÀ» ÀÇ·ÚÇÑ´Ù.)
3) ¼±Á¾ APC: Àç¹ß ÀÇ½É ¼Ò°ßÀÌ ÀÖÀ» ¶§¸¸ Á¶Á÷°Ë»ç

* Âü°í: EndoTODAY ESD ÈÄ ³»½Ã°æ ¼Ò°ß


[Helicobacter] Giemsa stainingÀ» À§ÇÑ Ç︮ÄÚ¹ÚÅÍ Á¶Á÷°Ë»ç À§Ä¡

À§ÀüÁ¤ºÎ ´ë¸¸ ȤÀº ¼Ò¸¸¿¡¼­ 1Á¡ + À§Ã¼ÁߺΠ´ë¸¸¿¡¼­ 1Á¡.

ÇÑ °÷¿¡¼­¸¸ Á¶Á÷À» ¾òÀ» °æ¿ì´Â À§Ã¼ÁߺΠ´ë¸¸¿¡¼­ 1Á¡À» äÃëÇÕ´Ï´Ù.


À§¿° ³»½Ã°æ ºÐ·ù - ÀÌÁØÇàÀÇ À§¿° ³»½Ã°æ ºÐ·ù (last update: 2017-4-20)

À§¿°ÀÇ ³»½Ã°æ ºÐ·ù¹ýÀº Schindler ¹ý, Sydney ¹ý ±×¸®°í ÀϺ» À§¿° ºÐ·ù µîÀÌ ÀÖ½À´Ï´Ù. ¾î´À Çϳª ¿ì¸®³ª¶ó Çö½Ç¿¡ ¸ÂÁö ¾Ê½À´Ï´Ù. ¿ì¸® °íÀ¯ÀÇ ºÐ·ù¹ýÀÌ ÇÊ¿äÇѵ¥ ¾ÆÁ÷ ÀÌ ºÐ¾ß¿¡ ´ëÇÑ ³íÀÇ´Â ºÎÁ·ÇÕ´Ï´Ù. °á±¹ Á¦ ½ºÅ¸ÀÏ·Î ½º½º·Î ¸¸µé¾î ¾²´Â ¼ö¹Û¿¡ ¾ø¾ú½À´Ï´Ù. 'ÀÌÁØÇà À§¿° ³»½Ã°æ ºÐ·ù'¸¦ »ý°¢Çغ¾´Ï´Ù.

1) 'ºñƯÀÌÀû À§¿° (nonspecific gastritis)'Àº °¡Àå ÇöÀúÇÑ ¼Ò°ßÀ» ¹ÙÅÁÀ¸·Î Áø´Ü¸íÀ» ¾´´Ù. ºÎÁ·ÇÏ´Ù°í ´À²¸Áö´Â °æ¿ì¿¡´Â µü ÇÑ °¡Áö Áø´Ü¸íÀ» µ¡ºÙÀδÙ. ¿¹¸¦ µé¸é '¸¸¼º À§Ã༺ À§¿°'Àε¥ È­»ý¼º º¯È­µµ ¹«½ÃÇϱ⠾î·Á¿î Á¤µµ¶ó¸é '¸¸¼º À§Ã༺ È­»ý¼º À§¿° (chronic atrophic (and) metaplastic gastritis)'À̶ó°í ¾´´Ù.

³»½Ã°æ ¼Ò°ß³»½Ã°æ Áø´Ü
Erythema (hyperemia)Chronic superficial gastritis
Erosions (flat or raised)Chronic erosive gastritis
Atrophic changesChronic atrophic gastritis
Metaplastic changesChronic metaplastic gastritis
Hypertrophic changesChronic hypertrophic gastritis
HematinsChronic superficial gastritis

2) 'ƯÀÌÀû À§¿° (specific gastritis)'Àº °¢ÀÚÀÇ ±â¼ú¹ý¿¡ µû¸¥´Ù.

3) Single erosionÀº ¾ÏÀ» ¹èÁ¦ÇØ¾ß Çϱ⠶§¹®¿¡ µû·Î °ü¸®ÇÑ´Ù.

4) ±âŸ

- ¾²Áö ¸»¾Æ¾ß ÇÒ Áø´Ü¸í: ÃâÇ÷¼º À§¿°, ´ãÁó ¿ª·ù¼º À§¿°

- ¿°Áõ ¼Ò°ßÀÌ °ÅÀÇ ¾ø´Â °æ¿ì 'Á¤»ó'À̶ó´Â Áø´ÜÀ» ºÙÀδÙ.

* Âü°í: EndoTODAY À§¿°

2017³â 4¿ù 15ÀÏ ±Ý¿äÀÏ Àú³á 6½Ã-8½Ã


À§±Ë¾ç - ½ÊÀÌÁöÀå ±Ë¾çÀº ¾Æ·¡¸¦ Âü°íÇϽʽÿÀ.

óÀ½ ¹ß°ßÇÑ active/healing stage gastric ulcer: Á¶Á÷°Ë»ç 3°³ + Ç︮ÄÚ¹ÚÅÍ Giemsa Á¶Á÷°Ë»ç (ÀüÁ¤ºÎ 1°³ + À§Ã¼ºÎ 1°³)

óÀ½ ¹ß°ßÇÑ scar stage gastric ulcer: Á¶Á÷°Ë»ç 3°³ + Ç︮ÄÚ¹ÚÅÍ Giemsa Á¶Á÷°Ë»ç (ÀüÁ¤ºÎ 1°³ + À§Ã¼ºÎ 1°³)

Active/healing stage gastric ulcerÀÇ Ã¹ ÃßÀû ³»½Ã°æ¿¡¼­ º¸ÀÌ´Â ulcer scar: Á¶Á÷°Ë»ç 3°³ + Ç︮ÄÚ¹ÚÅÍ Giemsa Á¶Á÷°Ë»ç (ÀüÁ¤ºÎ 1°³ + À§Ã¼ºÎ 1°³)
- Âü°í 1: UBT ó¹æÀÌ ÀÖ´õ¶óµµ Ç︮ÄÚ¹ÚÅÍ Á¶Á÷°Ë»ç´Â ÇØ ÁÖ¼¼¿ä. Dual check °³³äÀÔ´Ï´Ù.
- Âü°í 2: ÃÖÃÊ °Ë»ç¿¡¼­ Ç︮ÄÚ¹ÚÅÍ À½¼ºÀ̾ú´õ¶óµµ ù ÃßÀû ³»½Ã°æ¿¡¼­´Â Ç︮ÄÚ¹ÚÅÍ Á¶Á÷°Ë»ç¸¦ ÇØ ÁÖ¼¼¿ä. ÃÖÃÊ °Ë»çÀÇ false positive¸¦ °í·ÁÇØ¾ß ÇÕ´Ï´Ù.
- Âü°í 3: ESD ÈÄ Hp Á¦±ÕÄ¡·á¸¦ ÇÑ È¯ÀÚÀÇ ÃßÀû ³»½Ã°æ¿¡¼­´Â Ç︮ÄÚ¹ÚÅÍ Á¶Á÷°Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù. ESD ÈÄ Hp Á¦±ÕÄ¡·á °á°ú ÆÇÁ¤Àº UBT·Î ÇÕ´Ï´Ù.
- Âü°í 4: ¼ÒÈ­¼º ±Ë¾çÀÌ ¾ø¾ú°í ´ÜÁö Hp À§¿°¶§¹®¿¡ ¼±º°±Þ¿© 100/100À¸·Î Hp Á¦±ÕÄ¡·á¸¦ ÇÑ È¯ÀÚÀÇ ÃßÀû ³»½Ã°æ¿¡¼­´Â Ç︮ÄÚ¹ÚÅÍ Á¶Á÷°Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù. Hp À§¿° ¼±º°±Þ¿© 100/100 Á¦±ÕÄ¡·á °á°ú ÆÇÁ¤Àº UBT·Î ÇÕ´Ï´Ù.

±Ë¾ç Ä¡·á 1³â ÈÄ ÃßÀû ³»½Ã°æ: Á¶Á÷°Ë»ç 3°³ (Ç︮ÄÚ¹ÚÅÍ °Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù)

±Ë¾ç Ä¡·á 2³â ÈÄ ÃßÀû ³»½Ã°æ: ƯÀÌ ¼Ò°ß ¾ø´Â Æò¹üÇÑ ±Ë¾ç ¹ÝÈçÀ̶ó¸é Á¶Á÷°Ë»ç, Ç︮ÄÚ¹ÚÅÍ °Ë»ç ¸ðµÎ ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù.

* Âü°í: EndoTODAY ¼ÒÈ­¼º±Ë¾ç

* Âü°í: FAQ À§±Ë¾ç¿¡¼­ Helicobacter Á¦±ÕÄ¡·á ÈÄ ÃßÀû°Ë»ç


ÃâÇ÷¼º ±Ë¾çÀÇ Forrest ºÐ·ù

Forrest classification


AGML (acute gastric mucosal lesion)

³»½Ã°æ½Ç¿¡¼­ AGMLÀ» ¸¸³ª¸é °¡Àå ½ÉÇÑ °÷¿¡¼­ Á¶Á÷°Ë»ç¸¦ 3Á¡ Á¤µµ ½ÃÇàÇսô٠(H&E ¿°»ö). Helicobacter pylori °Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù.


À§¾Ï. ¼ö¼ú Àü clipping

À§¾Ïº´¼Ò°¡ À§Ã¼Áߺο¡ ÀÖÀ» ¶§¿¡´Â subtotal gastrectomyÀÇ ÀýÁ¦¸éÀ» Á¤Çϱ⠾î·Æ±â ¶§¹®¿¡, ¼ö¼ú Àü ³»½Ã°æ Ŭ¸®ÇÎÀÌ ÇÊ¿äÇÕ´Ï´Ù. º´¼ÒÀÇ proximal edge º¸´Ù 1 cm »ó¹æ¿¡ 2°³ÀÇ Å¬¸³À» ³ª¶õÈ÷ ºÙ¿©¼­ À§Ä¡½ÃÅ°´Â ¹æ¹ýÀ» ±ÇÇÕ´Ï´Ù. ÀÌ·¸°Ô ÇÏ¿´À» ¶§ ¼ö¼úÀå¿¡¼­ °¡Àå Àß ¸¸Á®Áø´Ù°í ÇÕ´Ï´Ù.


Cardia Á÷ÇϺΠÀ§¾Ï¿¡ ´ëÇÑ proximal gastrectomy¸¦ À§ÇÏ¿© clippingÀ» ÇÒ ¶§¿¡´Â ¿øÀ§ºÎ¿¡ µÎ °³ÀÇ clippingÀ» ÇÕ´Ï´Ù. ±×·¯³ª ±ÙÀ§ºÎ¿¡µµ µÎ °³ÀÇ clippingÀ» ÇØ µÎ¸é ±ÙÀ§ºÎ ÀýÁ¦º¯¿¬À» Á¤Çϴµ¥µµ µµ¿òÀÌ µË´Ï´Ù.

EGC W/D SM1 cancer

¾Æ·¡´Â fundus neuroendocrine tumor (Á¶Á÷°Ë»ç¿¡¼­ endolymphatic tumor emboli°¡ ÀÖ¾úÀ½)¿¡ ´ëÇÑ proximal gastrectomy Àü clipping ½ÃÇàÇÑ Áõ·ÊÀÔ´Ï´Ù.


À§¾Ï ¼ö¼ú ÈÄ ³»½Ã°æ¿¡¼­ À½½Ä¹°ÀÌ ³²À½ (subtotal gastrectomy)

1) À§¾Ï ¼ö¼ú ÈÄ ÀÜÀ§¿¡´Â ÃæºÐÇÑ ±Ý½Ä ÈÄ¿¡µµ ¾à°£ÀÇ À½½ÄÀÌ ³²¾ÆÀÖ°Ô µÇ´Âµ¥ ÀÌ´Â ºñÁ¤»ó ¼Ò°ßÀ̶ó±â º¸´Ù´Â Á¤»ó ¼ö¼ú ÈÄ ¼Ò°ßÀ̶ó°í ÇÒ ¼ö ÀÖ½À´Ï´Ù.
2) ºñ·Ï ¾î´À Á¤µµÀÇ À½½ÄÀÌ ³²¾ÆÀÖ´Ù°í ÇÏ´õ¶ó°í ¹®Çպθ¦ ÃæºÐÈ÷ °üÂûÇÒ ¼ö ÀÖ´Â °æ¿ì´Â °Ë»ç¸¦ ½ÇÇàÇÑ °ÍÀ¸·Î ÇÏ°í °á°ú¸¦ ÀÔ·ÂÇØ ÁֽʽÿÀ .
3) À½½Ä¹°ÀÌ ³²¾ÆÀÖ´Â °æ¿ì À½½Ä¹° ¶§¹®¿¡ ¿ÏÀüÇÑ °Ë»ç°¡ µÇÁö ¸øÇßÀ½À» ¸í±âÇØ ÁֽʽÿÀ.
4) ÇØ´ç°úÀÇ ¿ä±¸°¡ ÀÖÀ» °æ¿ì ´Ù½Ã °Ë»ç¸¦ ½ÃÇàÇÒ ¼ö ÀÖ½À´Ï´Ù.

* Âü°í: EndoTODAY À§¾Ï ¼ö¼ú ÈÄ ³»½Ã°æ ¼Ò°ß


»óºÎÀ§Àå°ü Á¡¸·ÇÏÁ¾¾ç (SMT, submucosal tumor; SET, subepithelial tumor)

ÀÛÀº SMT/SET¿¡ ´ëÇÑ Á¶Á÷°Ë»ç´Â ³Ê¹« ÀÚÁÖ ½ÃÇàµÇ°í ÀÖ½À´Ï´Ù. À°¾È ¼Ò°ßÀÌ ³ª»ÚÁö ¾ÊÀ¸¸é 0.5-1cm ÀÌÇÏÀÇ SMT/SET¿¡ ´ëÇؼ­´Â Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾Ê¾Æµµ ÁÁ½À´Ï´Ù. Á¶±ÝÀÌ¶óµµ varix°¡ Àǽɵǰųª cystic structure¿¡¼­´Â Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¸¿½Ã´Ù. 0.5cm ÀÌÇÏÀÇ tiny SMT°¡ ÀǽɵǴ Á¤µµÀÏ ¶§¿¡´Â ³»½Ã°æ °á°úÁö¿¡ ±× ³»¿ëÀ» ±â¼úÇÏÁö ¾Ê¾Æµµ ÁÁ½À´Ï´Ù.

1) ù ³»½Ã°æ °Ë»ç¿¡¼­´Â Á¶Á÷°Ë»ç¸¦ 2Á¶°¢ ½ÃÇàÇØ ÁÖ¼¼¿ä. ´Ù¸¸ 1-2 cm ¹Ì¸¸ÀÇ Ç¥¸éÀÌ Á¤»óÀÎ Á¡¸·ÇÏÁ¾¾ç Àǽɺ´¼Ò°¡ fundus, cardia, high body¿¡ À§Ä¡Çϸé Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾Ê¾Æµµ ÁÁ½À´Ï´Ù. Á¶±ÝÀÌ¶óµµ vascular structure³ª cyst°¡ ÀǽɵǸé Á¶Á÷°Ë»ç¸¦ ÇÏ¸é ¾ÈµË´Ï´Ù.

SMT Àǽɺ´¼Ò Á¶Á÷°Ë»ç ÈÄ ±Í°¡ Àü ´ë·®ÃâÇ÷À» º¸¿´´ø Áõ·Ê. ÀÌ ºÎÀ§´Â »ý°¢º¸´Ù vascular originÀÌ ¸¹À¸¹Ç·Î ±ØÈ÷ ÁÖÀÇÇØ¾ß ÇÕ´Ï´Ù. SMT °°Àºµ¥ Á¶Á÷°Ë»ç¸¦ ÇÏ¿© Áß¿äÇÑ Áø´ÜÀ» ºÙÀÎ °æ¿ì´Â »ý°¢º¸´Ù ¸¹Áö ¾Ê½À´Ï´Ù.

vascular Çϰųª cysticÇϸé Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¸»¶ó´Â À¯¸íÇÑ editorial (Eckardt. GIE 2005;62:209-212)

2) ÃßÀû ³»½Ã°æ °Ë»ç¿¡¼­ Å©±â³ª ¸ð¾çÀÇ º¯È­°¡ ¾øÀ¸¸é Á¶Á÷°Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù.

ÀÛÀº SMT°¡ º¯È­°¡ ¾øÀ¸¸é Á¶Á÷°Ë»ç Àç°ËÀº ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù.

ÀÌ·± SMT¸¦ ¸Å³â Á¶Á÷°Ë»ç ÇÒ ÇÊ¿ä´Â ¾ø½À´Ï´Ù. Ç¥¸éÀÌ ³Ê¹«³ª Á¤»óÀÔ´Ï´Ù.

* Âü°í: EndoTODAY À§Á¡¸·ÇÏÁ¾¾ç


À§ MALT ¸²ÇÁÁ¾

1) Initial ³»½Ã°æ: º´¼Ò¿¡¼­ Á¶Á÷°Ë»ç 2°³ (MultipleÀÌ¸é °¡Àå ´ëÇ¥ÀûÀÎ º´¼Ò 2-3°÷¿¡¼­ 2°³¾¿ Á¶Á÷°Ë»ç) + Ç︮ÄÚ¹ÚÅÍ Giemsa staining °Ë»ç (ÀüÁ¤ºÎ + À§Ã¼ºÎ)

2) Á¦±ÕÄ¡·á ÈÄ Ã¹ ÃßÀû ³»½Ã°æ: º´¼Ò¿¡¼­ Á¶Á÷°Ë»ç 2°³ (MultipleÀÌ¸é °¡Àå ´ëÇ¥ÀûÀÎ º´¼Ò 2-3°÷¿¡¼­ 2°³¾¿ Á¶Á÷°Ë»ç) + Ç︮ÄÚ¹ÚÅÍ Giemsa staining °Ë»ç (ÀüÁ¤ºÎ + À§Ã¼ºÎ)
* UBT ó¹æÀÌ À־ Ç︮ÄÚ¹ÚÅÍ Giemsa staining °Ë»ç (ÀüÁ¤ºÎ + À§Ã¼ºÎ)´Â ½ÃÇà.

3) Ç︮ÄÚ¹ÚÅÍ°¡ ¼º°øÀûÀ¸·Î Á¦±ÕµÈ °ÍÀÌ È®ÀÎµÈ ÀÌÈÄÀÇ ÃßÀû ³»½Ã°æ: º´¼Ò¿¡¼­ Á¶Á÷°Ë»ç 2°³ (MultipleÀÌ¸é °¡Àå ´ëÇ¥ÀûÀÎ º´¼Ò 2-3°÷¿¡¼­ 2°³¾¿ Á¶Á÷°Ë»ç). À°¾ÈÀûÀ¸·Î ´Ù ÁÁ¾ÆÁ³À¸¸é °¡Àå ÇöÀúÇß´ø °÷ 1-2°÷¿¡¼­ 2°³¾¿.
* Ç︮ÄÚ¹ÚÅÍ Giemsa staining °Ë»ç¸¦ ¹Ýº¹ÇÒ ÇÊ¿ä´Â ¾ø½À´Ï´Ù.


Hp À½¼º MALT ¸²ÇÁÁ¾ ȯÀÚ·Î RT ÈÄ È£ÀüµÈ ȯÀÚÀÔ´Ï´Ù.

±×·±µ¥ ÃßÀû³»½Ã°æ °Ë»çÀÇ °á°ú°¡ MALToma·Î¸¸ µÇ¾î ÀÖ½À´Ï´Ù. °á°ú¸¸ º¸¸é "Àç¹ßÀΰ¡?" ÀǽÉÇÒ ¼ö ÀÖ½À´Ï´Ù. MALT ¸²ÇÁÁ¾À̾úÀ¸³ª Ä¡·á ÈÄ È£ÀüµÈ ȯÀÚÀÇ ³»½Ã°æÀ» ÇÒ ¶§¿¡´Â 'Remission after treatment for MALToma' ȤÀº 'MALToma in remission'À¸·Î impressionÀ» ºÙ¿©Áֽñ⠹ٶø´Ï´Ù.

* Âü°í: EndoTODAY À§ MALToma


4. ½ÊÀÌÁöÀå

[½ÊÀÌÁöÀå±Ë¾ç]

óÀ½ ¹ß°ßÇÑ active/healing stage duodenal ulcer: Ç︮ÄÚ¹ÚÅÍ Á¶Á÷°Ë»ç (ÀüÁ¤ºÎ 1°³ + À§Ã¼ºÎ 1°³) + ½ÊÀÌÁöÀå Á¶Á÷°Ë»ç´Â optional (º¸ÅëÀº ÇÏÁö ¾Ê½À´Ï´Ù¸¸, Á¶±ÝÀÌ¶óµµ ¾Ç¼ºÁúȯÀÌ ÀǽɵǸé 2-3°³ ÇØ ÁÖ¼¼¿ä.)

óÀ½ ¹ß°ßÇÑ scar stage duodenal ulcer: Ç︮ÄÚ¹ÚÅÍ Á¶Á÷°Ë»ç (ÀüÁ¤ºÎ 1°³ + À§Ã¼ºÎ 1°³). ½ÊÀÌÁöÀå Á¶Á÷°Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù.

Á¦±ÕÄ¡·á 1³â ȤÀº ±× ÀÌÈÄ ÃßÀû ³»½Ã°æ¿¡¼­ ±Ë¾ç Àç¹ßÀÇ Áõ°Å°¡ ¾øÀ¸¸é ½ÊÀÌÁöÀå Á¶Á÷°Ë»ç³ª Ç︮ÄÚ¹ÚÅÍ Á¶Á÷°Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù.




5. ´ëÀå

´ëÀå³»½Ã°æ +/- ¿ëÁ¾ÀýÁ¦¼ú' Àü anti-thrombotics Áß´Ü

´ë·«ÀûÀÌ°í ÀϹÝÀûÀÎ ÇÁ·ÎÅäÄÝÀÔ´Ï´Ù. °³º° ȯÀÚ¿¡¼­´Â ´ã´ç ÀÇ»çÀÇ ÆÇ´Ü¿¡ µû¶ó ÀûÀýÈ÷ Á¶ÀýÇؼ­ Àû¿ëÇØ Áֽñ⠹ٶø´Ï´Ù.

ÀÓ»ó°­»ç ¼±»ý´Ôµé²². ´ëÀå³»½Ã°æ ½Ã Ç×Ç÷ÀüÁ¦ »ç¿ë Áß´Ü ¾È¿¡ ´ëÇÏ¿© ÃÖ±Ù ³íÀÇ°¡ ÀÖ¾ú½À´Ï´Ù. º¸³»µå¸®´Â ÇÁ·ÎÅäÄÝ°ú °°ÀÌ ½ÉÀåÁúȯ, ³úÇ÷°üÁúȯÀÇ °íÀ§Ç豺À̰ųª ¾Æ½ºÇǸ°À» Á¦¿ÜÇÑ Ç×Ç÷¼ÒÆÇ (clopidogrel, ticagrelor, prasugrel...), Ç×ÀÀ°íÁ¦ (warfarin, NOAC....) ¿¡ ´ëÇؼ­´Â ±âÁ¸¿¡ ÇØ¿À´ø °Íó·³ ÇØ´ç°ú ÇùÁø ÀÇ°ßÀ» µû¸£±â·Î ÇÏ¿´°í, ´ëÀå³»½Ã°æÀ» ¹Þ°ÔµÇ´Â ÀúÀ§Ç豺 ȯÀÚµéÀº ¾Æ½ºÇǸ°À» Áß´ÜÇÏÁö ¾Ê¾Æµµ ´ëÀå³»½Ã°æ with ¿ëÁ¾ÀýÁ¦¼ú (´Ü 1cm ¹Ì¸¸ÀÇ ¿ëÁ¾)Àº °¡´ÉÇÏ´Ù·Î ¼öÁ¤ÇÏ¿´½À´Ï´Ù. ¸¸¾à ÀúÀ§Ç豺 ȯÀÚ¿¡ ´ëÇÏ¿© Àǻ簡 ÆÇ´ÜÇÏ¿© ¾Æ½ºÇǸ°À» ²÷°íÀÚ ÇÑ´Ù¸é 4ÀÏ Áß´ÜÀ» ±ÇÀ¯Çϱâ·Î ÇÏ¿´½À´Ï´Ù. Ç×Ç÷ÀüÁ¦ Àç½ÃÀÛÀº ÇÁ·ÎÅäÄÝÀ» ÂüÁ¶ÇϽñ⠹ٶø´Ï´Ù. °¨»çÇÕ´Ï´Ù. 2017-3-28. ¼ÒÈ­±â³»°ú ±èÅÂÁØ


º´µ¿È¯ÀÚ ´ëÀå³»½Ã°æ Àüóġ

´ëºÎºÐÀÇ º´µ¿ ȯÀÚ¿¡¼­ ³»Àå³»½Ã°æ Àüóġ´Â ¿Ü·¡¿Í µ¿ÀÏÇÏ°Ô Clicool 3L ¸¦ ó¹æÇÕ´Ï´Ù. ´Ü, CRF³ª ESRD ȯÀÚ¿¡¼­´Â Colonlyte 4L¸¦ º¹¿ëÇϵµ·Ï ÇÕ´Ï´Ù.

Clicool 3L º¹¿ë ÈÄ ÀåÁ¤°áÀÌ ÁÁÁö ¾ÊÀº °æ¿ì¿¡´Â Colyte-F 2L¸¦ Ãß°¡º¹¿ëÇÕ´Ï´Ù.

Æò¼Ò º¯ºñ°¡ ½ÉÇÑ È¯ÀÚ¿¡¼­´Â °Ë»ç ÀüÀÏ Àú³á¿¡ ÀåÁ¤°áÁ¦¿Í ´õºÒ¾î bisacodyl Á¾àÀ» »ðÀÔÇصµ ÁÁ½À´Ï´Ù.

* Âü°í: EndoTODAY ÀåÁ¤°á


Á÷Àå°æ(sigmoidoscopy)¿¡¼­ ´ëº¯ÀÌ ³²¾Æ ÀÖÀ½

Sigmoidoscopy´Â ´ëÀå³»½Ã°æº¸´Ù ¾à°£ ´ëÀåÁ¤°áÁ¦¸¦ Åõ¿©ÇÏ°í ½ÃÇàÇÏ´Â °Ë»çÀÔ´Ï´Ù. µû¶ó¼­ ´ëº¯ÀÌ ³²¾ÆÀÖ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ³»½Ã°æ½Ç¿¡¼­´Â Á¶±Ý ´ëº¯ÀÌ ³²¾ÆÀÖ´Ù´Â ÀÌÀ¯·Î Yal enema¸¦ ¿©·¯¹ø ¹Ýº¹ÇÑ ÈÄ °Ë»çÇϱ⵵ ÇÕ´Ï´Ù. ±×·¯³ª YalÀ» ¾²´õ¶óµµ ¿ÏÀüÈ÷ ±ú²ýÇØÁö´Â ¾Ê´Â °æ¿ìµµ ¸¹½À´Ï´Ù.

Sigmoidoscopy´Â Ưº°ÇÑ ¸ñÀûÀÌ À־ ½ÃÇàÇÏ´Â °Ë»çÀÔ´Ï´Ù. ºñ·Ï ¾à°£ÀÇ º¯ÀÌ ³²¾ÆÀÖ´õ¶óµµ °Ë»çÀÇ ¸ñÀûÀ» ´Þ¼ºÇÏ¿´´Ù¸é Yal enema¸¦ ¹Ýº¹ÇÏÁö ¾Ê´Â °ÍÀÌ ÁÁ½À´Ï´Ù. ¾Æ·¡ ȯÀÚ´Â Àü¸³¼±¾ÏÀ¸·Î ¼ö¼ú ¹× RT ÈÄ radiation proctitis ¿©ºÎ¸¦ º¸±â À§ÇÑ °Ë»ç¿´½À´Ï´Ù. ÀÌ Á¤µµ º¯ÀÌ ³²¾Æ ÀÖ´õ¶óµµ °Ë»ç ¸ñÀûÀº ´Þ¼ºÇÑ °ÍÀÔ´Ï´Ù. 'Radiation proctitis ¾øÀ½' Á¤µµÀÇ °á·ÐÀ¸·Î °Ë»ç¸¦ ¸¶Ãĵµ ¹«³­ÇÒ °Í °°½À´Ï´Ù.

* Âü°í: EndoTODAY ´ëÀå³»½Ã°æ »ðÀÔ¹ý


´ëÀå³»½Ã°æ¿¡¼­ cecal intubationÀÌ µÇÁö ¾ÊÀº °æ¿ì ȤÀº rectum¿¡ º´¼Ò°¡ ÀÖ°í ´õ ÀÌ»ó °Ë»çÇÏÁö ¸øÇÑ °æ¿ì µî

Colonoscopy¸¦ ½ÃµµÇÏ¿´À¸³ª cecal intubationÀÌ µÇÁö ¾ÊÀº °æ¿ì°¡ ÀÖ½À´Ï´Ù. (1) ´ëÀå loop µîÀ¸·Î ³¡±îÁö »ðÀÔµÇÁö ¸øÇÑ °æ¿ì, (2) Áß°£¿¡ obstructionÀ» º¸ÀÌ´Â º´¼Ò°¡ ÀÖ¾î ´õ ÀÌ»ó ÁøÇàÇÏÁö ¸øÇÑ °æ¿ì, (3) Áß°£¿¡ °Ë»çÀÇ ¸ñÀû¿¡ ÇØ´çÇÏ´Â º´¼Ò°¡ ¹ß°ßµÇ¾î ´õ ÀÌ»ó °Ë»çÇÒ ÇÊ¿ä°¡ ¾ø¾ú´ø °æ¿ì µîÀÌ ÀÖ½À´Ï´Ù. ÀÌ·± °æ¿ì °£È¤ ó¹æÀ» sigmoidoscopy·Î º¯°æÇϽô ºÐÀÌ °è½Ã´Âµ¥ ¹Ù¶÷Á÷ÇÏÁö ¾Ê½À´Ï´Ù. ±×³É colonoscopy¸¦ ½ÃÇàÇÑ °ÍÀ¸·Î ±â·ÏÀ» ³²°ÜÁֽñ⠹ٶø´Ï´Ù. Cecum±îÁö º¸Áö ¸øÇÑ ÀÌÀ¯¸¦ ³²±â¸é ±×¸¸ÀÔ´Ï´Ù. Sigmoidoscopy·Î ¹Ù²ã ó¹æÇÏÁö ¸¶½Ê½Ã¿À.

Colonoscopy¿Í sigmoidoscopy´Â °Ë»çÀÇ ¸ñÀû, Àüóġ, ½Ã¼ú ÈÄ Á¶Ä¡ µîÀÌ ÀüÇô ´Ù¸¥ °Ë»çÀÔ´Ï´Ù. ±í°Ô º¸Áö ¸øÇÏ¿´´Ù´Â ȤÀº ±í°Ô º¸Áö ¾Ê¾Ò´Ù´Â ÀÌÀ¯·Î ó¹æÀ» º¯°æÇÏ¸é ³»½Ã°æ ½Ã¼ú ÀüÈÄ ¿©·¯°¡Áö°¡ ÀÌ»óÇÏ°Ô ²¿ÀÔ´Ï´Ù. ȯÀÚ¿¡°Ô ±ÝÀüÀû ÀÌÀ͵µ º°·Î Å©Áö ¾Ê½À´Ï´Ù. ¾ÆÁÖ ÀÛÀº ±ÝÀüÀû ÀÌÀÍÀÌ ÀÖÀ»Áö ¸ð¸£°ÚÀ¸³ª, Ä¡·á°úÁ¤¿¡ Å« È¥¼±°ú À§ÇèÀÌ ¹ß»ýÇÑ´Ù´Â °ÍÀ» »ý°¢Çϸé ó¹æÀ» ¹Ù²Ù´Â °ÍÀº ȯÀÚ¿¡°Ô ÇØ°¡ µÇ´Â ÀÏÀÏ ¼öµµ ÀÖ½À´Ï´Ù.

Colonoscopy¸¦ sigmoidoscopy·Î ó¹æº¯°æÇÏ´Â °ÍÀ» ±ÝÇÕ´Ï´Ù.

* Âü°í: EndoTODAY ´ëÀå³»½Ã°æ »ðÀÔ¹ý


Ulcerative colitis Áø´Ü°ú ¸ð´ÏÅ͸µÀ» À§ÇÑ Á¶Á÷°Ë»ç protocol

2022 Winter School ±è¿µÈ£ ±³¼ö´Ô °­ÀÇ

2023³â UC °á°ú ÀÔ·Â form


Crohn's disease

2023³â Å©·Ðº´ °á°ú ÀÔ·Â form


´ëÀå³»½Ã°æ¿¡¼­ LST°¡ ¹ß°ßµÇ¾úÀ» ¶§

3 mm ÀÌÇÏ´Â cold biopsy·Î Á¦°ÅÇÒ ¼ö ÀÖÀ¸³ª À̺¸´Ù Å©¸é cold biopsy·Î Á¦°ÅÇÑ ÈÄ residual tumor°¡ ¸¹ÀÌ ³²½À´Ï´Ù.

4-7 mm ´Â cold snaringÀ¸·Î Á¦°ÅÇÒ ¼ö ÀÖ½À´Ï´Ù. Snare·Î Á¦°ÅÇϸé snare polypectomy·Î ó¹æÇÒ ¼ö ÀÖ½À´Ï´Ù. Cold snaring ÇÒ ¶§¿¡´Â tentingÀ» ÇÏÁö ¾Ê¾Æ¾ß ÇÕ´Ï´Ù.

LST°¡ ¹ß°ßµÇ°í one stage·Î Á¦°ÅÇϱ⠾î·Á¿î »óȲÀ̸é Á¶Á÷°Ë»ç¸¦ 1-2Á¡¸¸ ÇÏ°í submucosal injectionÀ» ÇÏÁö ¸»¾Æ¾ß ÇÕ´Ï´Ù. Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾Ê°í »çÁø¸¸ Àß Âï¾îµÎ°í ±³¼ö´Ô²² ÀÇ·ÚÇصµ µË´Ï´Ù.

* Âü°í: EndoTODAY LST Á¶Á÷°Ë»ç


´ëÀå¿ëÁ¾ÀýÁ¦¼ú ÈÄ ¿¹¹æÀû clipping

¿ëÁ¾ÀýÁ¦¼ú ÈÄ ¿¹¹æÀû clippingÀÇ È¿°ú´Â ÀÔÁõµÇ¾î ÀÖÁö ¾Ê½À´Ï´Ù. ±ØÈ÷ ¿¹¿ÜÀûÀÎ °æ¿ì(active bleedingÀÌ Á¶ÀýµÇÁö ¾ÊÀ» ¶§, exposed vesselÀÌ º¸ÀÏ ¶§ µî)¸¦ Á¦¿ÜÇÏ¸é ¿¹¹æÀû clippingÀº ÇÊ¿äÇÏÁö´Â ¾Ê½À´Ï´Ù.


Endoscopic tattooing with ICG

1) Indocyanine green
- The stock solution of ICG was prepared by dissolving 25 mg of powdered ICG in 2 ml of the solvent (sterilized water) provided by the manufacturer.
- For each injection, 1 ml of the suspension was used.

2) Guideline
- ¼ö¼ú ¿¹Á¤ 1ÁÖ ¾È¿¡ ½ÃÇà
- º´º¯°ú 1 cm ¶³¾îÁ®¼­ 2°÷¿¡ ÃæºÐÇÑ ¾çÀ» ÁÖ»çÇÑ´Ù. ¸ÕÀú saline ÁÖ»ç·Î blebÀ» ¸¸µé°í °¢ bleb¿¡ ICG ¿ë¾× 1cc¾¿ ÁÖ»çÇÑ´Ù. ½Ã¼úÀ» ¸¶Ä£ ÈÄ »çÁøÀ» ³²±ä´Ù.
- º´¼Ò°¡ ÀÛÀ¸¸é º´¼Ò ¿·¿¡ ÁÖ»çÇÏ°í º´¼Ò°¡ Å©¸é º´¼Ò distal¿¡ ÁÖ»çÇÑ´Ù.

3) Technique


- The needle should be inserted at an oblique angle to the bowel wall to avoid penetrating the serosa.
- 2 ml of normal saline solution was injected tangentially into the submucosal layer to form a submucosal elevation.
- Then the syringe used for the saline solution was replaced by another syringe containing ICG, and 0.5-1.0 cc per injection was injected. Subsequently, the ICG syringe was replaced by the first syringe of saline, and about 2 ml of the saline solution was added to push out the ICG remaining in the needle device

4) Caution
ICG cannot be used in patients with allergy to iodine.

5) Complication
- preoperative adverse reactions : fever, abdominal pain, or allergy symptoms
- during surgery : focal peritonitis, inflammatory pseudotumor, abscess, or adhesion
- postoperative complications : adhesion, ileus


Àå°áÇÙ (Intestinal tuberculosis)ÀÌ ÀÇ½ÉµÉ °æ¿ì Á¶Á÷°Ë»ç ó¹æ

1) (Çغκ´¸®°ú °Ëü) BL1A112A. colon »ý°Ë 1~3°³ → Æ÷¸£¸»¸° Åë
2) (Çغκ´¸®°ú °Ëü) BG510101. Mycobacterium tuverculosis,nested PCR (°Ëü P17 colon) → ºó Åë¿¡ »ý°ËÁ¶Á÷¸¸ ³Ö¾îÁÖ¼¼¿ä. (´ÙÀ© ±¸Á¶È­ Çü½Ä¿¡ Á¶Á÷°Ë»ç¸¦ ÇÑ °ÍÀ¸·Î ÀÔ·ÂÇØÁÖ¼¼¿ä. °Ëü °¹¼ö´Â zero·Î).
3) (Áø´Ü°Ë»çÀÇÇаú °Ëü) BL4112. AFB stain and culture ó¹æ (°Ëü others(specify)) → Saline Åë (´ÙÀ© ±¸Á¶È­ Çü½Ä¿¡ Á¶Á÷°Ë»ç¸¦ ÀÔ·ÂÇÒ ÇÊ¿ä´Â ¾ø½À´Ï´Ù. BL4112 ÄÚµå·Î Á÷Á¢ ó¹æ¿¡ ÀÔ·ÂÇØÁÖ¼¼¿ä)

* Âü°í: Á¶Á÷°Ë»ç Çϱâ Àü ¹Ì¸® °£È£»ç¿¡°Ô Á¤º¸¸¦ Áà¾ß Æ÷¸£¸»¸°Åë¿¡ °Ëü°¡ ¸ðµÎ ´ã±â´Â °ÍÀ» ¸·À» ¼ö ÀÖ½À´Ï´Ù. ²À ¹Ì¸® ¼ÒÅëÇϼ¼¿ä.

* Âü°í: EndoTODAY °áÇÙ¼º À§ÀåÁúȯ


º¹ºÎ ¼ö¼ú ÈÄ screening colonoscopy

Q: º¹ºÎ ¼ö¼ú ÈÄ screening colonoscopy¸¦ ¿øÇϴ ȯÀÚ¿¡°Ô ¾ðÁ¦ °Ë»ç¸¦ Çϵµ·Ï ±ÇÇØ¾ß ÇÒ±î¿ä?

A: ȯÀÚÀÇ »óÅ¿¡ µû¶ó, ¼ö¼úÀÇ Á¾·ù¿¡ µû¶ó º¯¼ö°¡ ¸¹½À´Ï´Ù. Ç÷º¯À̳ª º¹Åë µî Áõ»ó Æò°¡¸¦ À§ÇÑ ´ëÀå³»½Ã°æÀº ´ëºÎºÐÀÇ °æ¿ì ¼ö¼ú Á÷ÈÄ¶óµµ ½ÃÇàÇÒ ¼ö ÀÖ½À´Ï´Ù. ±×·¯³ª ¹«Áõ»ó ¼ºÀÎÀÇ screening colonoscopy´Â ¼ö¼ú 6°³¿ù ÀÌÈÄ¿¡ ¹Þµµ·Ï ±ÇÇÏ´Â °ÍÀÌ ¾ÈÀüÇÒ °Í °°½À´Ï´Ù.




6. ±âŸ ´Ù¾çÇÑ »óȲ

[³»½Ã°æ °Ë»ç¸¦ ÇÏÁö ¸øÇÑ °æ¿ìÀÇ ±â·Ï]

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¹°·Ð ¾ÆÁÖ µå¹® ¿¹¿Ü »óȲÀÌ ÀÖ½À´Ï´Ù. ¿¹¸¦ µé¾î bowel preparationÀÌ ³Ê¹« ¾È ÁÁ¾Æ¼­ ¾Æ¿¹ ¾È ÇÏ´À´Ï¸¸ ¸øÇÑ °æ¿ìÀÔ´Ï´Ù. À§¿¡ À½½ÄÀÌ ³Ê¹« ¸¹¾Æ¼­ °Ë»ç¸¦ ¸øÇÑ °æ¿ìµµ ¸¶Âù°¡ÁöÀÔ´Ï´Ù. ÀÌ·± »óȲ¿¡¼­ °Ë»ç¸¦ ÇÑ °ÍÀ¸·Î ½Ç½ÃÇÒ ¼ö ¾ø½À´Ï´Ù ("fail ó¸®"). Àǹ«±â·ÏÀº ²À ³²±â¼Å¾ß ÇÕ´Ï´Ù. ±×¸®°í °¡±ÞÀû »çÁøÀº ³²±â½Ã±â ¹Ù¶ø´Ï´Ù.

°Ë»ç°¡ failÇÑ °æ¿ì Àǹ«±â·ÏÀº '¿Ü·¡ ¼­½Ä'À» ¿­¾î ±â·ÏÀ» ³²±æ °ÍÀ» ±ÇÇÕ´Ï´Ù. ºñ·Ï ÁøÂ¥ ¿Ü·¡ Áø·á¸¦ º» °ÍÀº ¾Æ´Ï¹Ç·Î ½Ç½Ã´Â ÇÒ ¼ö ¾ø°í Àӽà ÀúÀå¹Û¿¡ ¸øÇÏÁö¸¸ ÇöÀç·Î¼­´Â ±×°ÍÀÌ ÃÖ¼±ÀÔ´Ï´Ù. ´õ ÁÁÀº ±â·Ï ¹æ¹ýÀ» ¸¸µé¾î º¸°Ú½À´Ï´Ù¸¸, ´çºÐ°£Àº '¿Ü·¡ ¼­½Ä'¿¡ ±â·ÏÀ» ³²±â½Ã±â ¹Ù¶ø´Ï´Ù.

Fail ó¸®ÇÑ °æ¿ìÀÇ ±â·Ï ¿¹.


PEG À§·ç¼ú

½Å°æ°ú, ÀçÈ°ÀÇÇаú, À̺ñÀÎÈÄ°ú µî¿¡¼­ PEG ÀÇ·Ú°¡ ¿Â °æ¿ì¿¡´Â PEG¿¡ ´ëÇÑ contraindicationÀÌ ¾øÀ¸¸é °¡±ÞÀû PEG¸¦ ½ÃÇàÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. PEG¸¦ ²À ÇÊ¿äÇÑ °æ¿ì·Î ÇÑÁ¤ÇÏ´Â °ÍÀº ¿©·¯ Áø·á°ú¿Í °¥µîÀ» ºúÀ» »ÓÀÔ´Ï´Ù. ³»°ú ÀÇ»çÀÇ ÀÔÀå¿¡¼­ definite contraindicationÀÌ ÀÖÀ¸¸é ÀÇ·ÚÇϽŠÀÇ·áÁø¿¡°Ô ¸íÈ®È÷ ¼³¸íÇÏ°í PEG¸¦ ½ÃÇàÇÏÁö ¾ÊÀ¸¸é µË´Ï´Ù. À¯¿¬ÇÏ°Ô ´ëÀÀÇսôÙ.

* Âü°í: EndoTODAY PEG


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* Âü°í: EndoTODAY ±â»ýÃæÇÐ


º´µ¿È¯ÀÚ ³»½Ã°æ ½Ã º¸È£ÀÚ µ¿¹Ý ¿©ºÎ (¾÷¹«¿¬¶ô. 2017-4-21. ³»½Ã°æ½ÇÀå ÀÌÁØÇà)

1) Áø´Ü À§Àå³»½Ã°æ: ÁøÁ¤(¼ö¸é) ¿©ºÎ¿Í ¹«°üÇÏ°Ô º¸È£ÀÚ ¾øÀÌ °¡´ÉÇϳª ȯÀÚ »óÅ°¡ ¾ÈÁ¤ÀûÀÌÁö ¾ÊÀ» °æ¿ì´Â º´µ¿¿¡¼­ Áø·á°ú ÀÚü ÆÇ´ÜÀ¸·Î º¸È£ÀÚ°¡ µ¿¹ÝÇϵµ·Ï Á¶Ã³ÇØ Áֱ⠹ٶø´Ï´Ù.

2) Ä¡·á³»½Ã°æ: ÁøÁ¤(¼ö¸é) ¿©ºÎ¿Í ¹«°üÇÏ°Ô º¸È£ÀÚ ÇÊ¿äÇϳª, ±ÞÇÑ °æ¿ì´Â º¸È£ÀÚÀÇ À¯¼±¿¬¶ôó È®º¸ ÈÄ ½Ã¼ú °¡´ÉÇÕ´Ï´Ù.

3) Ãé´ãµµ ³»½Ã°æ: ÁøÁ¤(¼ö¸é) ¿©ºÎ¿Í ¹«°üÇÏ°Ô º¸È£ÀÚ ÇÊ¿äÇϳª ±ÞÇÑ °æ¿ì´Â º¸È£ÀÚÀÇ À¯¼±¿¬¶ôó È®º¸ ÈÄ ½Ã¼ú °¡´ÉÇÕ´Ï´Ù.




[FAQ]

[2016-3-26. ÀÌÁØÇà ÆíÁö]

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±×·¯³ª ³»½Ã°æ °æÇèÀÌ ÂªÀº °Ë»çÀÚ¿¡°Ô´Â ´Ù¾çÇÑ »óȲ¿¡¼­ Âü°íÇÒ ¼ö ÀÖ´Â ¹«³­ÇÑ ¸Þ´º¾óÀÌ ÀÖ´Ù¸é ÆÇ´Ü È¤Àº ¾Öµå¸³ÀÌ ½¬¿öÁú °Í °°½À´Ï´Ù. Quick reference¶ó°í³ª ÇÒ±î¿ä...

ÀüÀûÀ¸·Î °³ÀÎÀû ÀÇ°ßÀÔ´Ï´Ù. º´¿øÀÇ °ø½Ä ÀÔÀå ¾Æ´Õ´Ï´Ù. ¿©ÇÏÆ° Á» ´õ ´Ùµë¾îº¸·Á°í ÇÏ¿À´Ï ¿©·¯ºÐÀÇ ¸¹Àº Çǵå¹é ºÎŹÇÕ´Ï´Ù.

[2016-3-28. ¾Öµ¶ÀÚ ÆíÁö]

¾È³çÇϽʴϱî óÀ½ ¸ÞÀÏ µå¸³´Ï´Ù. °æ³²ÀÇ °ËÁø¼¾ÅÍ¿¡ ÀÖ´Â ¸ð ¼ÒÈ­±â³»°ú ÀÇ»çÀÔ´Ï´Ù. ÀÛ³â Æç·Î¿ì ±â°£ºÎÅÍ ¸ÞÀÏÀ» ¼ö½Å¹Þ±â ½ÃÀÛÇÏ¿© °¡²û¾¿ Àо°¡´Ù°¡ ¿ÃÇØ ·ÎÄ÷Π³ª¿À¸é¼­ ¸ÅÀϸÅÀÏ ¸ÞÀÏÀ» Àо±â ½ÃÀÛÇÏ¿´½À´Ï´Ù. ±ÝÀÏ ÀÌ ³»¿ëÀº Á¤¸» À¯ÀÍÇÏ°í ƯÈ÷ Æç·Î¿ì ¼±»ý´Ôµé²² µµ¿òµÉ °Í °°¾Æ¼­ Á¦°¡ ÈĹè´ÔµéÇÑÅ× ÀüÆÄÇÏ¿´½À´Ï´Ù. ±³¼ö´Ô ÀÔÀå¿¡¼­´Â ´ç¿¬ÇÑ °ÍÀ¸·Î »ý°¢µÇÁö¸¸ ±×µ¿¾È Çò°¥¸®°í ¾Ö¸ÅÇß´ø °Íµé ½Ã¿øÇÏ°Ô Á¤ÇØÁּż­ °¨»çÇÕ´Ï´Ù. ÂüÁ¶ÇÏ¿© Àß °Ë»çÇϵµ·Ï ÇÏ°Ú½À´Ï´Ù. Ç×»ó °Ç°­ÇϽʽÿÀ.^^


[References]

1) EndoTODAY ³»½Ã°æ ¹è¿ì±â ÃʽÉÀÚ ±³½Ç

2) EndoTODAY ºÐ·ù¹ý

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