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김광하 대한상부위장관ㆍ헬리코박터학회 2020 Korean Journal of Helicobacter Upper Gastrointesti Vol.20 No.4
Endoscopic resection (ER) has been widely used as a curative treatment for early gastric cancers (EGCs). Especially endoscopic submucosal dissection has several merits such as high en bloc and curative resection rates for EGCs and preservation of the entire stomach. However, ER has the inevitable limitation that the possibility of newly developing gastric cancers in the preserved stomach is still present. Metachronous gastric cancer (MGC) is defined as a newly developed gastric cancer occurring at a previously uninvolved site ≥1 year after the index ER of EGCs. The incidence of MGC is 3.3~15.6% and increases over time after ER. Old age, male sex, current smoking, severe atrophy and intestinal metaplasia, persistent Helicobacter pylori (H. pylori) infection, differentiated-type histology, and multiple initial gastric cancers are risk factors of MGC. As H. pylori eradication could reduce the risk of MGC after ER of EGCs, H. pylori eradication is strongly recommended for the prevention of MGC after ER of EGCs. Most MGCs are found at an early stage on regular surveillance endoscopy after ER and successfully treated with ER, with excellent long-term outcomes.
Stricture Occurring after Endoscopic Submucosal Dissection for Esophgeal and Gastric Tumors
김광하,지삼룡,장재영,신성관,최기돈,이준행,김상균,성재규,최석채,전성우,장병익,허규찬,장동경,정성애,금보라,조진웅,최일주,정훈용,the Korean ESD Study Group 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.6
Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation.
김광하 대한상부위장관ㆍ헬리코박터학회 2021 Korean Journal of Helicobacter Upper Gastrointesti Vol.21 No.1
Esophageal squamous cell carcinoma is the seventh most common cancer and the sixth most common cause of cancer death worldwide. Esophageal squamous dysplasia is the only histopathology that predicts the development of esophageal squamous cell carcinoma. It is difficult to identify esophageal squamous dysplasia by conventional endoscopy; however, Lugol chromoendoscopy is useful for the diagnosis of such a lesion. In addition, advance endoscopic detection techniques, such as image-enhanced endoscopy (especially, narrow-band imaging), magnifying endoscopy, and endocytoscopy, are helpful in detecting esophageal squamous dysplasia. Similar to the treatment for early esophageal cancer, endoscopic resection such as endoscopic mucosal resection and endoscopic submucosal dissection is the choice of treatment for esophageal squamous dysplasia. This review discusses esophageal squamous dysplasia in detail, especially in terms of endoscopic diagnosis and clinical management.