이중풍선 소장내시경

고봉민 ( Bong Min Ko ),이문성 ( Moon Sung Lee ) 대한장연구학회 2007 Intestinal Research Vol.5 No.1

소장 종양과 용종증: 접근 방법과 관리

고봉민 ( Bong Min Ko ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.6

Although small bowel the mainly occupies the most part of the gastrointestinal tract, small intestine tumors are rare, insidious in clinical presentation, and frequently represent a diagnostic and management challenge. Small bowel tumors are generally classified as epithelial, mesenchymal, lymphoproliferative, or metastatic. Familial adenomatous polyposis and Peutz-Jeghers syndrome are the most common inherited intestinal polyposis syndromes. Until the advent of capsule endoscopy (CE) and device-assisted enteroscopy (DAE) coupled with the advances in radiology, physicians had limited diagnostic examination for small bowel examination. CE and new radiologic imaging techniques have made it easier to detect small bowel tumors. DAE allows more diagnosis and deeper reach in small intestine. CT enteroclysis/CT enterography (CTE) provides information about adjacent organs as well as pictures of the intestinal lumen side. Compared to CTE, Magnetic resonance enteroclysis/enterography provides the advantage of soft tissue contrast and multiplane imaging without radiation exposure. Treatment and prognosis are tailored to each histological subtype of tumors. (Korean J Gastroenterol 2018;72:277-280)

헬리코박터 파이로리 치료 실패 후 레보플록사신을 이용한 3차 구제요법의 기간에 따른 제균율

노형민 ( Hyung Min Noh ),홍수진 ( Su Jin Hong ),한재필 ( Jae Pil Han ),박경우 ( Kyung Woo Park ),이윤나 ( Yun Nah Lee ),이태희 ( Tae Hee Lee ),고봉민 ( Bong Min Ko ),이준성 ( Joon Seong Lee ),이문성 ( Moon Sung Lee ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.5

Background/Aims: This study evaluated the eradication rate of levofloxacin-containing rescue therapy by treatment duration in patients in whom previous first- and second-line treatment failed. Methods: Fifty-five patients with persistent Helicobacter pylori infection after first-line therapy and second-line therapy were studied in a single referral academic center. We compared the eradication rates by the treatment duration of third-line therapy. Results: Of 55 patients, 12 (21.8%) received rescue therapy for seven days, 24 (43.6%) received rescue therapy for 10 days, and 19 (34.5%) received rescue therapy for 14 days. The eradication rates of therapy with levofloxacin were 65.5% in the 55 enrolled patients and 73.5% in the 49 patients who underwent follow-up testing. In cases where follow-up testing was performed, the eradication rate of 7-day therapy was 58.3%, of 10-day 68.2%, and of 14-day therapy 93.3%. Eradication rate of 14-day therapy was higher than 7-day (p=0.06) and 10-day (p=0.108), but chance could not be ruled out in the difference among groups. Conclusions: This study showed somewhat increasing of H. pylori eradication rate by extending the duration of levofloxacin-containing rescue therapy to 14 days. (Korean J Gastroenterol 2016;68:260-264)

위 편평선종 및 조기위암에서 내시경적 점막절제술 후 절제부위에서 발생한 융기형 병변에 관한 임상적 고찰

천영국,유창범,고봉민,김진오,조주영,이준성,이문성,진소영,심찬섭,Cheon Young Koog,Ryu Chang Beom,Ko Bong Min,Kim Jin Oh,Cho Joo Young,Lee Joon Seong,Lee Moon Sung,Jin So Young,Shim Chan Sup 대한위암학회 2001 대한위암학회지 Vol.1 No.1

Purpose: Several studies of an endoscopic mucosal resection(EMR) have been reported, but reports about benign protruding lesions that arise at the scar of EMR for early gastric cancer (EGC) or a gastric adenoma are rare. The purpose of this study was to elucidate endoscopic and histological characteristics of benign protruding lesions which arise at the scar of an EMR for EGC and a gastric flat adenoma. Materials and Methods: In 101 lesions (73 gastric flat adenomas and 28 EGCs) from 96 patients, 16 lesions developed new protruding lesions that arose at the scar of the EMR. We retrospectively analyzed the endoscopic findings of initial and protruding lesions, and several other clinical factors (H. pylori infection, eradication therapy, and proton pump inhibitor (PPI) or H2-blocker use). Results: 1. The mean duration until detection of the protruding lesion was 8.9 months ($1.5\∼27$). Protruding lesions arose at the scar of the EMR in 1 of 28 EGCs ($3.6\%$) and from 15 of 73 gastric flat adenomas ($20.5\%$). All of the patients were men. 2. With respect to the endoscopic findings, the shapes of the protruding lesions were as follows: 10 Yamada (Y) I, 4 Y-II, 1 Y-III, and 1 flat lesion. Histological examination of the protruding lesions revealed regenerating hyperplasia in 5 lesions, intestinal metaplasia in 5, and both in 6. 3. The incidence of these lesions was higher in cases of tubular adenomas with focal high-grade dysplasia than in cases of tubular adenomas without dysplasia (p<0.05). 4. The incidence of H. pylori infection was higher in patients ($81.7\%$) who developed a protruding lesion than in those ($51.8\%$) who did not develop (p=0.029); also, the incidence of use of PPI was higher in those patients (p=0.045). However, eradication therapy for H. pylori and duration of use of PPI or H2-blocker showed no difference between groups. Conclusions: It may be possible that the potential hyperplasia that may reside in normal mucosa surrounding EGC or a gastric adenoma might awaken during the healing process of the EMR ulcer and develop to benign protruding lesions. And, H. pylori and PPI might also be related to the development of the protruding lesions.

대장 아메바종 1예

김환열 ( Hwan Yeol Kim ),고봉민 ( Bong Min Ko ),권계원 ( Kye Won Kwon ),홍수진 ( Soo Jin Hong ),유창범 ( Chang Beom Ryu ),김진오 ( Jin Oh Kim ),조주영 ( Joo Young Cho ),이준성 ( Joon Sung Lee ),이문성 ( Moon Sung Lee ),심찬섭 ( Ch 대한장연구학회 2003 Intestinal Research Vol.1 No.1

Amebiasis is observed worldwide. Usual symptoms of amebiasis include bloody stool, diarrhea, abdominal pain, fever and weight loss. Severe form of amebiasis is associated with perforation, pseudopolyp, peritonitis, toxic megacolon and ameboma. An ameboma represents a localized amebic infection with organized granulation tissue and is almost found in cecum and rectum. We report a case of ameboma of rectum detected incidentally without specific symptom, with review of relevant literature. (Intestinal Research 2003;1:68-71)

소장내시경으로 진단된 메켈게실

정윤호 ( Yun Ho Jung ),고봉민 ( Bong Min Ko ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.1

대장점막암의 내시경적 완전 절제술 후 재발암 1예

김환열 ( Hwan Yeol Kim ),고봉민 ( Bong Min Ko ),권계원 ( Kye Won Kwon ),홍수진 ( Soo Jin Hong ),유창범 ( Chang Beom Ryu ),김영석 ( Young Seok Kim ),이문성 ( Moon Sung Lee ),심찬섭 ( Chan Sup Shim ),김부성 ( Boo Sung Kim ) 대한장연구학회 2003 Intestinal Research Vol.1 No.2

Early colon cancers were resected endoscopically in many cases. But problems with recurrences and remnants of tumors have occured. We reported a case of recurrent cancer on 9 months after endoscopic resection for mucosal cancer of colon, with review of relevant literature. (Intestinal Research 2003;2:201-204)

상부위장관내시경을 통한 대장 전처치의 효과와 순응도에 대한 연구

맹주희 ( Ju Hee Maeng ),고봉민 ( Bong Min Ko ),이문성 ( Moon Sung Lee ),나현식 ( Hyun Sik Na ),윤효중 ( Hyo Joong Yoon ),한상훈 ( Sang Hun Han ),김상균 ( Sang Gyune Kim ),홍수진 ( Su Jin Hong ),유창범 ( Chang Beom Ryu ),김영석 ( Y 대한소화기학회 2007 대한소화기학회지 Vol.50 No.2

목적: 대장내시경 전처치제로 쓰이는 인산 나트륨은 불쾌한 맛 때문에 복용 때 환자들에게 복통, 오심, 구토, 수면장애 등을 일으킬 수 있다. 상부위장관내시경과 대장내시경을 동시에 실시하는 환자의 경우 상부위장관내시경 검사 때 전처치제를 투여하여 이러한 증상을 완화시켜 줄 수 있을 것이다. 이번 연구는 대장 전처치를 위하여 인산 나트륨을 상부위장관내시경을 통하여 투여한 후 대장의 정결도와 환자의 증상, 순응도, 만족도 등에 대해 대조군 연구를 시행하였다. 대상 및 방법: 2005년 3월부터 2006년 2월까지 순천향대학교 부천병원에서 상부위장관내시경 및 대장내시경을 시행한 환자로 경구투여군 환자는 일반적인 방법으로 45 mL의 인산 나트륨을 저녁에 복용하고 대장내시경을 시행하는 아침에 45 mL를 복용하였다. 반면에 내시경투여군 환자는 아침에 상부위장관내시경을 통하여 인산 나트륨 90 mL를 물 180 mL에 희석하여 십이지장 하행부에 주입하였다. 4시간 후에 내시경 시술자는 장정결의 정도를 평가하였고, 환자들에게 장 정결제 복용 후 나타나는 증상과 순응도, 선호도에 대해 질문하였다. 결과: 내시경투여군에서 오심(p=0.01), 수면장애(p=0.00)가 경구투여군에 비해 적게 일어났다. 환자들의 장 정결에 대한 순응도는 내시경투여군에서 보다 좋았다. 그러나 대장 정결도와 회맹부까지의 삽입 시간에는 차이가 없었다. 내시경투여군 환자에서 과거에 기존의 방법으로 인산 나트륨을 복용해 보았던 환자들은 내시경을 통한 대장 정결법을 선호하였다. 결론: 상부위장관내시경과 대장 내시경을 동시에 시행하는 경우 상부위장관내시경을 통한 장 정결제의 투여는 장 정결제 복용에 따른 환자의 불편함을 해소할 수 있는 장점이 있었으나, 충분한 양의 물을 제대로 복용하지 않은 경우 발한 혹은 심계 항진 등이 발생할 수 있다. 따라서 장 정결제 복용이 어려워 검사가 불가능한 경우 세심한 관찰과 함께 시도해 볼 수 있다. Background/Aims: Bowel preparation for colonoscopy remains an unpleasant experience because oral solutions have unpleasant tastes and may provoke abdominal pain, nausea, vomiting, and sleep disturbance. Duodenoscopic bowel preparation is an alternative method for patients who are unwilling to take oral preparation solution or for those who are supposed to have both gastroscopic and colonoscopic examination on the same day. We assessed the effectiveness and tolerance of duodenoscopic bowel preparation. Methods: Patients in group OA (orally administered) ingested 45 mL of sodium phosphate (NaP) in the evening before the day of procedure and in the morning on the day of colonoscopy, whereas patients in group EA (endoscopically administered) were prepared for the procedure by duodenoscopic infusion of 90 mL of NaP diluted with 180 mL of water into the second portion of the duodenum. After 4 hours, we assessed the overall quality of colonic cleansing, using a range of excellent to inadequate. The patients completed a questionnaire on their preparation-associated symptoms, tolerance, and preference. Results: In group EA, sleep disturbance (p<0.05) and nausea (p<0.05) occurred less frequently than in group OA. Overall, the tolerance rating for preparation was higher in group EA. However, the quality of colonic cleansing and cecum intubation time was not different between the two groups. Patients in group EA who had ingested NaP in the past preferred duodenoscopic bowel preparation. Conclusions: Duodenoscopic bowel preparation may play a role in colonic cleansing especially for patients who are scheduled to undergo gastroscopic and colonoscopic examination on the same day and for those who are unwilling to ingest NaP. (Korean J Gastroenterol 2007;50:78-83)

스텐트 삽입과 항암요법 후 근치적 절제술을 시행했던 폐쇄성 국소 침윤 공장 선암

김형기 ( Hyung Ki Kim ),고봉민 ( Bong Min Ko ),박종규 ( Jong Kyu Park ),홍수진 ( Su Jin Hong ),문종호 ( Jong Ho Moon ),이준성 ( Joon Seong Lee ),이문성 ( Moon Sung Lee ),김부성 ( Boo Sung Kim ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.1

Small bowel adenocarcinoma is a relatively rare malignancy. In Korea, 13.1% of small bowel adenocarcinoma occurs in the jejunum. The absence of effective screening methods and relatively obscure symptoms contribute to the higher percentage of advanced cases at the time of diagnosis. Although curative resection is the mainstay of treatment, it is often impossible. Chemotherapy and radiotherapy have shown a disappointing treatment result for advanced staged small bowel adenocarcinoma. We report a 54-year-old woman with locally invasive jejunal cancer who underwent curative resection after stent insertion with enteroscopy and chemotherapy. (Korean J Gastroenterol 2010;56:54-58)

대장의 측방발육형 종양에서 내시경적 분할점막절제술 후 추적 대장내시경의 유용성

김환열 ( Hwan Yeol Kim ),고봉민 ( Bong Min Ko ),차상우 ( Sang Woo Cha ),권계원 ( Kye Won Kwon ),홍수진 ( Soo Jin Hong ),유창범 ( Chang Beom Ryu ),김영석 ( Young Seok Kim ),문종호 ( Jong Ho Moon ),김진오 ( Jin Oh Kim ),조주영 ( Joo 대한장연구학회 2003 Intestinal Research Vol.1 No.2

목적: 대장의 측방발육형 종양은 대장 벽을 따라 낮고 넓게 자라는 표면형 종양으로 악성변화율이 높고, 크기에 비하여 점막하 침윤의 빈도는 많지 않기 때문에 내시경적 점막절제술에 의한 치료가 시행되고 있다. 이에 본 연구에서는 내시경적 분할점막절제술후 추적 대장내시경의 시기 및 결과에 대하여 조사하였다. 대상 및 방법: 2001년 3월부터 2003년 8월까지 32개월간 순천향대학교 부천병원 소화기병 센터에서 대장내시경상 측방발육형 종양으로 진단받은 31예 중 크기가 20 mm 이상으로 내시경적 분할 점막절제술을 시행한 21예를 대상으로 하였다. 이중 추적검사 가 시행되지 않은 4예와 수술을 시행한 2예를 제외한 15예를 대상으로 조사하였다. 평균 추적기간은 10.3개월(2-18개월)이었다. 결과: 여자가 14예로 남자의 7예 에 비해 많았고, 평균 연령은 56.9세였다. 조직학적 소견에서 10예(47.6%)가 선암, 관상-융모상 선종이 7예(33.3%), 융모상 선종이 1예(4.8%), 관상 선종이 3예 (14.3%)였다. 내시경적 분할 점막절제술후 추적 대장내시경을 처음 시행한 시기는 평균 2.2개월(1-5개월)이었으며, 총 15예 중 5예(33.3%)에서 추적 기간중 절제 부위에서 재발이 관찰되었다. 선암 2예에서 2개월후 관상선종이, 관상-융모상 선종 1예에서 2개월후 조직검사상 고도 세포 이형성이, 관상 선종 1예에서 5개월후 조직 검사상 선종성 용종이, 국소적 고도 세포 이형성이 동반된 관상 선종 1예에서 4개월 후 조직검사상 관상 선종이 관찰되었다. 이 5예에서 추가적인 내시경적 치료를 시행하였고, 이후 추적 대장내시경상 현재까지 이상 소견은 관찰되지 않았다. 결론: 대장의 측방발육형 종양중 크기가 직경 20 mm 이상이어서 내시경적 분할점막 절제술을 시행한 경우에는 절제부위의 재발율이 높으므로 내시경적 절제술 이후에 도 주기적인 추적 대장 내시경의 시행이 필요하고 최소한 절제후 1년 이내에 시행해야 한다고 생각한다. Background/Aims: Laterally spreading tumors (LST) of the colon are defined as tumors over 10 mm in diameter that are low in height and grow superficially. These tumors are highly malignant and usually mucosal lesions, therefore endoscopic mucosal resection is desirable. We analysed retrospectively the result of endoscopic piecemeal mucosal resection (EPMR) in LSTs larger than 20 mm in diameter. Methods: 21 patients with LSTs larger than 20 mm in diameter were treated using EPMR. The resection sites were examined for residual or recurrent lesions by follow-up colonoscopy. Results: Of the 21 patients who underwent EPMR, 2 patients performed surgical resection and 4 patients were lost during follow-up period. Residual or recurrent lesions were detected in 5 of these 15 patients after EPMR. After additional endoscopic therapy, no more residual or recurrent lesions were detected. Conclusions: After EPMR for large LSTs, it is necessary to strictly follow-up at least within 1 year. (Intestinal Research 2003;2:186-191)