동종 조혈모세포이식 후 발생한 치명적 홍역 폐렴 1예

백창렬,이동건,최정현,정현화,조유경,박훈준,이승훈,박윤희,이교영,민우성,김춘추,신완식 대한감염학회 2001 감염 Vol.33 No.4

As a result of the enlarging pool of unvaccinated children and young adults, there has been an increase in measles in our countries. In these situation, it has been reported that measles associated pneumoinia is easily complicated with fatal respiratory failure, espycially in immunocompromised patients. Herein we report the case of lethal measles pneumonia after allogenic hematopoietic stem cell transplantation in adults proven by autopsy. Recently, one case of measles was encountered in 39-year-old female patients after allogenic bone marrow transplanted case (chronic myelogenous leukemia), who progressed into interstitial pneumonia pattern, despite treatment including antibiotics, immunoglobulin. The patient died of giant cell pneumonia compatible with that of measles which was comfirmed in the section of necropsy lung specimen. (Korean J Infect Dis 33:301∼309, 2001)

The Therapeutic Effect of Cyanoacrylate on Gastric Variceal Bleeding and Factors Related to Clinical Outcome

Paik, Chang Nyol,Kim, Sang Woo,Lee, In Seok,Park, Jae Myung,Cho, Yu Kyung,Choi, Myung Gyu,Chung, In Sik Lippincott WilliamsWilkins, Inc. 2008 Journal of clinical gastroenterology Vol.42 No.8

BACKGROUND: Cyanoacrylate has been recommended for the treatment of gastric variceal bleeding. GOAL: We aimed to evaluate the efficacy and safety of cyanoacrylate injection therapy in patients with gastric variceal bleeding, and to identify the factors predictive of failure, rebleeding, and survival after therapy. STUDY: One hundred twenty-one patients with gastric variceal bleeding who received cyanoacrylate injections were retrospectively reviewed. RESULTS: Treatment succeeded in 110 patients (90.9%). Rebleeding and mortality rate during 4-week were 13.2% and 11.6%. A stepwise logistic regression analysis indicated that only the Child-Pugh class was an independent predictive factor of treatment failure [Child-Pugh C vs. Child-Pugh A and B, odds ratio (OR), 5.0; 95% confidence interval (CI), 1.2-19.4; P=0.025]. The actuarial probability of a 4-week absence of rebleeding and survival after the initial therapy was 86.8% and 85.1%, respectively. A stepwise logistic regression analysis showed that a Child-Pugh class C and hepatocellular carcinoma were independent predictive factors for rebleeding (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively) and mortality (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively). Only 2 cases (2.7%) with serious complications, noted as cyanoacrylate embolisms, were observed. At 1-year follow up, the actuarial probability of remaining free of bleeding was 49.0% and hepatitis B virus infection was independent predictive factor of bleeding (OR, 5.3; 95% CI, 1.4-20.0; P=0.015). CONCLUSIONS: In short-term follow-up, cyanoacrylate injection is an effective treatment method for gastric variceal bleeding and the Child-Pugh class was only independent predictive factor of treatment failure and the Child-Pugh class and the hepatocellular carcinoma were risk factors for rebleeding and survival. In long-term follow-up, the presence of hepatitis B infection was risk factor for rebleeding.

한국인의 과민성 장 증후군 환자에서 소장세균과다증식증의 유병률

백창렬 ( Chang Nyol Paik ),최명규 ( Myung Gyu Choi ),남관우 ( Kwan Woo Nam ),권정현 ( Jung Hyun Kwon ),장재혁 ( Jae Hyuck Chang ),서정필 ( Jung Pil Suh ),이인석 ( In Seok Lee ),박재명 ( Jae Myung Park ),조유경 ( Yu Kyung Cho ) 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.1

목적 : 과민성장증후군 환자에서 소장세균과다증식증(small intestinal bacterial overgrowth, SIBO)이 중요한 병태생리로 대두되고 있다. 본 연구의 목적은 한국인 과민성 장 증후군 환자에서 호기검사를 이용한 SIBO 유병율과 과민성 장 증후군의 아형, 증상에 따른 유병율을 알아보고자 하였다. 대상 및 방법 : 건강한 성인 45명 (남자 19명, 평균 나이 40.8세)과 IBS 환자 37명(남자 19명, 평균 나이 42.2세)을 대상으로 하였다. 모든 참여자는 락툴로오스10 g을 복용한 후 180분 동안 15분마다 호기에서 수소와 메탄 농도를 측정하였다(락툴로오스 호기검사, LBT). 이들 중 33명(대조군 20명, 환자군 13명)은 최소한 7일 간격 이후 포도당 호기 검사(glucose breath test, GBT)를 시행하였다. 결과 : 1) 락툴로오스 투여 후 45분과 120분 사이에 측정된 수소 농도는 환자군에서 대조군보다 유의하게 높았다. 2) LBT에 의한 SIBO의 유병율은 환자군과 대조군에서 각각 48.7%와 26.5%로 유의한 차이가 있었다. 3) 과민성 장 증후군 아형에 따른 SIBO 유병율은 설사형 44.4%, 변비형 66.7%, 혼합형 33.3%으로 유의한 차이는 없었다. 4) GBT 양성율은 IBS 환자에서 7.1%, 대조군에서 20%로 차이가 없었다. 결론 : 락툴로오스 호기검사를 이용한 SIBO의 유병율은 과민성 장 증후군 환자에서 건강성인에 비해 유의하게 높아 한국인에서 SIBO는 과민성 장 증후군의 중요기전이라고 추정되었다. Background/Aims: Small intestinal bacterial overgrowth (SIBO) has been known as one of the important pathophysiologic findings in IBS patients. The purpose of this study is to evaluate the prevalence of SIBO by using a breath test (BT) in Korean patients with IBS. Methods: Forty nine controls and 39 IBS patients underwent a lactulose BT (LBT) every 15 minute for 180 minutes. At least 7 days later, the glucose BT (GBT) was performed every 10 minute for 120 minutes in 33 (patients: n=13, control: n=20) who had undergone the LBT. Results: 1) The H2 detected from 45 to 120 minutes in the LBT was significantly higher in the patients with IBS than that for the controls. 2) The prevalence of SIBO with LBT in the IBS patients was significantly higher than that in the controls (48.7% vs. 26.5%, respectively p<0.05). 3) The prevalence of SIBO with LBT in the subgroups of the IBS patients was 44.4% for the IBS-D, 66.7% for the IBS-C and 33.3% for the IBS-A (p=ns). 4) The positive rates of GBT in the control and IBS patients were 20% and 7.1%, respectively (p=ns). Conclusions: The prevalence of SIBO as diagnosed with using LBT was significantly higher in Korean patients with IBS, suggesting that SIBO was an important etiologic factor of IBS. (Kor J Neurogastroenterol Motil 2007;13:38-44)

3차 의료기관을 방문한 급성 상부위장관출혈 환자의 임상 양상

백창렬 ( Chang Nyol Paik ),이인석 ( In Seok Lee ),오정환 ( Jung Hwan Oh ),박재명 ( Jae Myung Park ),조유경 ( Yu Kyung Cho ),김상우 ( Sang Woo Kim ),최명규 ( Myung Gyu Choi ),정인식 ( In Sik Chung ) 대한소화기학회 2006 대한소화기학회지 Vol.50 No.1

서론: 급성 상부위장관출혈의 진단과 치료에서 응급내시경은 중요한 역할을 차지하고 있다. 저자들은 급성 상부위장관출혈 환자에서 응급내시경 검사 결과에 따라 내시경 또는 약물 치료를 시행한 후 지혈 성공률과 예후 인자에 대하여 연구하였다. 대상 및 방법: 상부위장관출혈로 내시경실을 방문하여 응급내시경을 검사하고, 내시경 소견에 따라 내시경 또는 약물 치료를 시행한 환자를 대상으로 임상경과를 관찰하였다. 지혈 성공 여부는 초기 지혈성공률(응급내시경 검사 후 24시간)과 최종 지혈성공률(퇴원일 또는 응급내시경 검사 후 14일)로 판정하였다. 결과: 2003년 8월부터 2005년 4월까지 318명의 환자에서 응급내시경을 시행하였다. 출혈의 주 원인은 소화성 궤양(50.9%), 정맥류(28.3%), 말로리바이스증후군(10.3%)이었다. 내시경 지혈술은 62.9% (200/318명)에서 시행하였다. 초기 지혈성공률과 최종 지혈성공률은 각각 86.2%, 94.0%이었다. 지혈에 실패한 4명(1.3%)은 수술하였고, 13명(4.1%)은 출혈과 연관되어 사망하였다. 다변량분석에서 초기지혈 성공률과 연관된 인자는 수혈량(OR 0.80, 95% CI 0.72-0.89, p<0.001)과 인공호흡기 장착상태(OR 0.03, 95% CI 0.01-0.31, p<0.001)였고 최종지혈 성공과 관련된 인자는 수혈량(OR 0.79, 95% CI 0.69-0.90, p<0.001)과 중환자실에서 출혈한 경우(OR 0.12, 95% CI 0.13-0.49, p<0.001)이었다. 결론: 급성 상부위장관출혈 환자에서 응급내시경 소견에 따른 초기 지혈성공률과 최종 지혈성공률은 각각 86.2%와 94.0%였다. 총수혈량이 많거나, 중환자실 재원상태 또는 인공호흡기 장착 시 출혈한 경우는 예후가 불량하므로 치료에 주의를 요한다. Background/Aims: Acute upper gastrointestinal bleeding (UGIB) is still responsible for significant morbidity in spite of various therapeutic advances. The aims of this study were to evaluate the success rate in managing UGIB and predicting factors that affected clinical courses. Methods: From August 2003 to April 2005, medical data (registered in a standard database categories) of 318 patients who underwent endoscopic examination to evaluate UGIB were analyzed. Early and final treatment success rates were evaluated on the next day and 14 days after the initial endoscopic procedures respectively (or the day of discharge). Results: Main causes of UGIB were peptic ulcer (50.9%), varices (28.3%), Mallory-Weiss syndrome (10.3%). Endoscopic treatments were tried in 200 patients (63.0%). Number of patients who underwent operation and deaths were 4 (1.3%) and 13 (4.1%), respectively. Early and final success rates were 86.2% and 94.0%. Independent prognostic factors related with early success rates were volume of transfusion (OR 0.80, 95% CI 0.72-0.89, p<0.001) and bleeding during the ventilator care (OR 0.03, 95% CI 0.01-0.31, p<0.001), whereas those factors related with final success rates were volume of transfusion (OR 0.79, 95% CI 0.69-0.90, p<0.001), bleeding during the stay in intensive care unit (ICU) (OR 0.12, 95% CI 0.13-0.49, p<0.001). Conclusions: Early and final success rates of bleeding control were 86.2% and 94.0% in acute UGIB. Volume of transfusion, bleeding during ICU state or ventilator state were important predictive factors of the treatment failure. (Korean J Gastroenterol 2007;50:26-35)

Helicobacter pylori 양성, 음성 환자에서 각종 상부위장관 질환과 나이에 따른 펩시노겐 1/2 비

백창렬 ( Chang Nyol Paik ),정인식 ( In Sik Chung ),남관우 ( Kwan Woo Nam ),권정현 ( Jung Hyun Kwon ),장재혁 ( Jae Hyuck Chang ),서정필 ( Jung Pil Suh ),박재명 ( Jae Myung Park ),조유경 ( Yu Kyung Cho ),이인석 ( In Seok Lee ),김상 대한소화기학회 2007 대한소화기학회지 Vol.50 No.2

목적: 혈청 펩시노겐 (PG) I/II 비는 위점막 위축의 표식 인자로 알려져 있다. 그러나 위점막의 위축은 Helicobacter pylori (H. pylori) 감염과 여러 상부위장관 질환, 연령에 따라서 차이를 보이고 있어 이들의 관련성은 명확하게 밝혀지지 않았다. 이번 연구는 여러 상부위장관 질환을 가진 환자에서 H. pylori의 감염 여부, 연령 등의 요인과 PG I/II 비와의 관련성을 알아 보고자 하였다. 대상 및 방법: 총 529명의 환자(남자 307명, 평균나이 57.2세)를 내시경 소견으로 4개의 질환군(위궤양 94명, 십이지장궤양 35명, 역류식도염 105명, 위축위염 295명)으로 분류하였다. H.pylori 감염은 IgG 항체가로 진단하였으며 PG는 라텍스응집면역비탁법을 이용하여 측정하였다. 결과: 모든 대상 환자에서 H. pylori 양성군이 음성군보다 PG II가 높았으며(24.0±14.7 ng/mL vs. 13.8±16.6 ng/mL, p<0.00) PG I/II 비는 낮았다(3.9±2.0 vs. 6.0±2.5, p<0.00). H. pylori 양성 위축위염에서 PG I/II 비는 개방형보다 폐쇄형에서 낮았다(3.0±1.4 vs. 3.8±1.7, p<0.01). H. pylori 양성군에서 PG I/II 비는 십이지장궤양과 역류식도염 환자보다 위축위염과 위궤양 환자에서 의의있게 낮았다(p<0.00, ANOVA, Turkey`s multiples comparison test). 위축위염의 평균 PG I/II는 H. pylori 양성인 경우 연령에 증가에 따라 감소하는 양상을 보였다(R2=0.9, p=0.01, linear regression analysis). 결론: 혈청 PG I/II 비는 H. pylori 감염 진단과 위점막 위축의 유용한 지표가 될 수 있으며, 연령 증가에 따른 위축위염의 진행은 H. pylori 감염과 관련이 있어 보인다. Background/Aims: Although previous reports suggested that pepsinogen (PG) I/II ratio was the index of gastric atrophy, PG I/II ratio was also related to other factors such as Helicobacter pylori (H. pylori) infection, various gastrointestinal diseases, and aging. The aim of this study was to evaluate the relationship between serum PG I/II ratio and age or upper gastro-intestinal diseases according to H. pylori infection status. Methods: A total of 529 individuals (307 male; mean age, 57.2 years) were divided into 4 groups (94 gastric ulcers, 35 duodenal ulcers, 105 reflux esophagitis, and 295 atrophic gastritis) according to endoscopic diagnosis. H. pylori infection was determined by H. pylori IgG antibody (ELISA) and PG was measured by latex immunoassay. Results: H. pylori infected patients showed markedly increased serum PG II levels (24.0±14.7 ng/mL vs. 13.8±16.6 ng/mL, p<0.001) and low PG I/II ratio (3.9±2.0 vs. 6.0±2.5, p<0.001) than non-infected subjects. In H. pylori infected patients, mean PG I/II ratios in the gastric ulcer and atrophic gastritis group were significantly lower than those of the duodenal ulcer and reflux esophagitis group (p<0.001, ANOVA, Turkey`s multiples comparison test). The mean ratio of open type atrophic gastritis was lower than that of close type atrophic gastritis (3.0±1.4 vs. 3.8±1.7, p<0.005). PG I/II ratio gradually decreased with age in H. pylori-infected patients with atrophic gastritis (R2=0.9, p=0.005, linear regression analysis). Conclusion: Serum PG I/II ratio reflects H. pylori infection and gastric atrophy. In the presence of H. pylori infection, gastric atrophy progresses with age. (Korean J Gastroenterol 2007;50:84-91)

Effects of Inducible Substrates on the Co - production of Glucoamylase and Exopolygalacturonase from Cryptococcus laurentii Y - 23

(Chang Hwa Kim),(Sang Kyoo Paik),(Hye Sun Yun),(Ing Nyol Jin),(Choon Bal Yu) 경북대학교 유전공학연구소 2000 遺傳工學硏究所報 Vol.14 No.-

Role of Glucose Breath Test for Small Intestinal Bacterial Overgrowth in Children and Adolescents With Functional Abdominal Pain Disorders in Korea

( Jin Lee ),( Chang-nyol Paik ),( Dae Bum Kim ),( Ji Min Lee ),( Yeon-ji Kim ),( Sik Kyung Choi ),( Yeon Jong Cho ) 대한소화기기능성질환·운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.1

Background/Aims Small intestinal bacterial overgrowth (SIBO) is expected in children and adolescents with functional abdominal pain disorders (FAPDs). This study is conducted to estimate the prevalence of SIBO and to investigate the role of SIBO in children and adolescents with FAPDs. Methods This prospective study enrolled children with FAPDs fulfilling the Rome IV criteria. A hydrogen-methane glucose breath test was used to diagnose SIBO. A survey of bowel symptoms using questionnaires, birth history, types of feeding, and the presence of allergy was conducted. Results Sixty-eight children and adolescents (range, 6-17 years; median, 12.5 years) were enrolled. SIBO was detected in 14 patients (20.6%). Age (≥ 12 years) (P < 0.003) and loose stool (P = 0.048) were significantly more common in children with SIBO than in children without SIBO. However, the history of allergies (P = 0.031) was less common in children with SIBO than those without SIBO. No significant differences were observed in other demographic findings. In multivariate analysis, age (≥ 12 years) was the independent factor predicting SIBO in children with FAPDs. Conclusions SIBO is not uncommon in children and adolescents with FAPDs. Among children aged above 12 years and diagnosed with FAPDs, SIBO is a suspected clinical target for treatment to relieve intestinal symptoms. A further study to investigate the association between intestinal bacteria and history of allergy is needed. (J Neurogastroenterol Motil 2022;28:78-85)

The characteristics of the positivity to the lactulose breath test in patients with abdominal bloating

Kim, Eun Jung,Paik, Chang-Nyol,Chung, Woo Chul,Lee, Kang-Moon,Yang, Jin Mo,Choi, Myung-Gyu Lippincott Williams Wilkins, Inc. 2011 European journal of gastroenterology & hepatology Vol.23 No.12

OBJECTIVES: The clinical utility in patients with bloating is still conflicting. We aimed to evaluate the positivity to lactulose breath test (LBT) in patients with bloating, and to assess the clinical characteristics according to the positivity or subtypes of LBT. METHODS: The patients with abdominal bloating undergoing LBT were investigated. Rome III positive irritable bowel syndrome (IBS) and bowel symptoms were surveyed according to the positivity or subtypes of LBT. RESULTS: The prevalence of IBS and the positivity to LBT was 23.8% (86 of 358) and 29.6% (106 of 358), respectively. The positivity to LBT and the prevalence in subtypes of LBT were not different according to the presence of IBS. The subtypes of LBT positive (+) patients were LBT (H2) with 61 (57.5%), (CH4)+ with 30 (28.3%), and (both) positive with 15 (14.2%). The LBT (H2)+ group was younger, and had higher symptomatic score for the bloating than that in the LBT negative (−) group. The LBT (CH4)+ group was older, and had higher scores of hard stool and strain than those of the LBT (−) group. In the fasting LBT (H2)+ group (n=37) diagnosed by increased baseline H2, the scores for abdominal discomfort, bloating, and flatus were higher than those for the LBT (H2)+ or LBT(−) groups. CONCLUSIONS: The subtypes of the positivity to LBT according to the gas produced or the fasting H2 may contribute to specificity or severity of abdominal symptoms regardless of the presence of IBS.

Case Report : Colon Ischemia Associated with Buerger`s Disease and Review of the Literature

( Kyeong Soo Lee ),( Chang Nyol Paik ),( Woo Chul Chung ),( Kang Moon Lee ),( Sung Hoon Jung ),( Jae Wuk Kawk ),( Ji Han Jung ),( Jun Hyun Baik ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.2

Buerger`s disease, or thromboangiitis obliterans, is a nonatherosclerotic inflammatory disease affecting the small- and medium-sized arteries and veins of the extremities (arms, hands, legs, and feet). It is most common in the Orient, Southeast Asia, India, and the Middle East, and usually affects men aged between 20 and 40 years, although it is becoming more common in women. It is well established that most such patients smoke heavily and experience an improvement in symptoms following smoking cessation. Mesenteric involvement in Buerger`s disease is extremely rare; however, we describe herein two cases of colon ischemia in patients who were previously diagnosed with lower-extremity Buerger`s disease. In one case, the patient developed colonic obstruction, and surgical resection was performed. Histopathologic findings were compatible with the chronic stage of Buerger`s disease. In the other case, angiography revealed abrupt occlusion of the inferior mesenteric artery with numerous collateral vessels, just like the corkscrew appearance found in the extremities. If patients with established Buerger`s disease of the extremities complain of gastrointestinal symptoms, early interventional diagnosis should be performed to prevent intestinal obstruction and gangrene. (Gut Liver 2010;4:287-291)

소화관 유암종의 임상 고찰과 전이 인자 분석

장재혁 ( Jae Hyuck Chang ),김상우 ( Sang Woo Kim ),정우철 ( Woo Chul Chung ),김영철 ( Young Chul Kim ),정찬권 ( Chan Kwon Jung ),백창렬 ( Chang Nyol Paik ),박재명 ( Jae Myung Park ),조유경 ( Yu Kyung Cho ),이인석 ( In Seok Lee 대한소화기학회 2006 대한소화기학회지 Vol.50 No.1

목적: 유암종은 발현 빈도는 낮지만 점막하종양을 형성하고 악성의 잠재력을 가지고 있다. 이번 연구에서는 소화관 유암종의 임상 양상을 살펴보고 전이와 관련된 인자를 찾아보고자 하였다. 대상 및 방법: 강남성모병원과 성빈센트병원에서 1996년 3월부터 2006년 8월까지 병리적으로 진단한 81명의 소화관 유암종 환자를 후향 조사하였다. 원발장기, 연령, 성별, 증세, 치료방법, 전이 예를 분석하였으며 전이에 미치는 인자를 육안 소견과 현미경 소견으로 나누어 분석하였다. 결과: 원발장기 분포는 직장 유암종이 58예(71.7%)로 가장 많았고 위 11예(13.6%), 십이지장 7예(8.6%), 충수, 소장, 대장, 담낭 순이었다. 평균 연령은 49세였고 50대가 33.3%로 가장 많았다. 남녀 비는 1.38로 남자가 많았다. 대부분 무증상과 복통 등의 비특이 증상을 호소하였다. 55예 (67.9%)에서 내시경 치료를 받았고 23예(28.4%)에서 수술치료를 받았다. 평균 15.6개월 동안 추적 관찰하였다. 10예 (12.3%)에서 전이가 있었고 8예는 진단 당시, 1예는 진단 3개월 후, 나머지 1예는 50개월 후 전이가 발견되었다. 전이와 관련된 인자로는 육안 소견에서 크기가 10 mm 이상(p<0.001), 표면의 중심 함몰 혹은 궤양이었고(p=0.009), 현미경 소견에서 고유근층 이상의 침범, 림프 혹은 정맥 침범, 유사분열 수 3개 이상, Ki-67 표지 지수 3 이상이었다(p<0.05). 유암종 크기와 표면의 중심 함몰 또는 궤양은 전이의 독립 예측인자였다(각각 p=0.002, p=0.035). 결론: 유암종 크기가 10 mm 이상, 표면의 중심 함몰 혹은 궤양, 고유근층 이상 침범, 림프 혹은 정맥 침범, 유사분열 수 3개 이상 등의 전이 인자가 있는 경우보다 적극적인 치료와 주의 깊은 추적관찰이 필요하다. Backround/Aims: Carcinoid tumors are submucosal tumors with metastatic potential. We tried to determine the clinical course of gastrointestinal (GI) carcinoid tumors and find the factors predicting metastasis. Methods: We reviewed the clinical records of 81 cases with GI carcinoid tumors. Involved organ, age, sex, symptoms, treatments, and metastatic patterns were reviewed. We evaluated the macroscopic and microscopic parameters to predict the metastatic potential of GI carcinoid tumors. Results: The common sites of GI carcinoids were rectum (71.7%), stomach (13.6%), and duodenum (8.6%). Mean age of the patients was 49 years old with a peak incidence of sixth decade. Male to female ratio was 1.38:1. Most symptoms were usually nonspecific. Fifty five patients (67.9%) received endoscopic treatments while 23 patients (28.4%) received surgical treatment. Patients were followed up for a mean period of 15.6 months. There were 10 cases (12.3%) of metastasis. There were significantly more metastasis in patients with tumor size >10 mm (p<0.001), central depression or ulcer (p=0.009) in macroscopic parameter, and with invasion below submucosa, lymphatic or venous invasion, number of mitosis >2, or Ki-67 labeling index >2 in microscopic parameter (p<0.05). Independent factors predicting metastasis were tumor size and central depression or ulcer in multivariate analysis (p=0.002 and p=0.035, respectively). Conclusions: Patients with tumor size >10 mm, central depression or ulcer, invasion below submucosa, lymphatic or venous invasion, mitosis >2, and Ki-67 labeling index >2 have higher metastatic potential. Those with risk factors predicting metastasis should be treated and followed carefully. (Korean J Gastroenterol 2007;50:19-25)