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급성 관상 동맥 증후군으로 오인된 식도 벽내 혈종 1예
유대곤 ( Dae Gon Ryu ),최철웅 ( Cheol Woong Choi ),강대환 ( Dae Hwan Kang ),김형욱 ( Hyung Wook Kim ),정동일 ( Dong Il Jeong ),김완철 ( Wan Chul Kim ),신재규 ( Jae Gyu Shin ),임태원 ( Tae Won Lim ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.4
Intramural hematoma of the esophagus is a rare condition that can be spontaneous or secondary to trauma, toxic ingestion, or intervention. If it is the spontaneous type, it usually presents initially with epigastric pain, hematemesis or dysphagia. We present a case of intramural hematoma of the esophagus mimicking acute coronary syndrome. A 63-year-old man presented with severe acute chest pain. He has four coronary stents that were inserted five years ago, from a different hospital, and is on dual antiplatelet agents. Coronary angiography was performed immediately under the suspicion of acute coronary syndrome, and we found that there was no obvious clogging of the coronary arteries. Next, chest computed tomography was performed due to suspected aortic dissection, and the result was also negative. Four days later, endoscopy was performed and intramural hematoma covered with large ulcers was diagnosed. (Korean J Gastroenterol 2017;69:239-242)
췌장 Simple Mucinous Cyst 내 Hemosuccus Pancreaticus 1예
조일억 ( IL Eok Jo ),강대환 ( Dae Hwan Kang ),최철웅 ( Cheol Woong Choi ),김형욱 ( Hyung Wook Kim ),김수진 ( Su Jin Kim ),남형석 ( Hyeong Seok Nam ),유대곤 ( Dae Gon Ryu ) 대한소화기학회 2017 대한소화기학회지 Vol.70 No.6
Hemosuccus pancreaticus is an unusual gastrointestinal hemorrhage through the main pancreatic duct. We report a rare case of hemosuccus pancreaticus due to a simple mucinous cyst of the pancreas. A 52-year-old man who had been followed-up for a sus-pected branch duct intraductal papillary mucinous neoplasm (IPMN) visited the emergency room due to hematochezia. Endoscopy showed active bleeding from the ampulla. Computed tomography revealed hemorrhage in a 2.0-cm cystic mass in the pancreatic body. The patient was diagnosed with hemosuccus pancreaticus caused by bleeding into the main pancreatic duct from suspected IPMN. Elective laparoscopic distal pancreatectomy was performed. The histopathological diagnosis was a simple mucinous cyst with squamous metaplasia based upon the pathological finding involving the absence of ovarian-type stroma. In conclusion, it should be recognized that a pancreatic cyst including simple mucinous cyst may cause hemosuccus pancreaticus, and these cysts should be viewed as neoplastic and approached similarly as other mucinous pancreatic neoplasms. (Korean J Gastroenterol 2017;70:301-303)
양성 식도 수술 문합부 협착에 대한 확장 치료의 임상 결과
최철웅 ( Cheol Woong Choi ),강대환 ( Dae Hwan Kang ),김형욱 ( Hyung Wook Kim ),박수범 ( Su Bum Park ),김수진 ( Su Jin Kim ),남형석 ( Hyeong Seok Nam ),유대곤 ( Dae Gon Ryu ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.2
목적: 식도 절제술 후 발생하는 양성 식도 협착은 드물지 않은 합병증이다. 양성 식도 문합부 협착은 여러 번의 확장 치료가 필요하다고 알려져 있다. 본 연구에서는, 수술 후 발행한 식도 문합부 협착 환자에서 확장 치료(내시경 풍선 확장 또는 부우지 확장)의 임상 결과를 분석하고, 불응성 협착과 관련된 위험인자를 알아보고자 하였다. 대상과 방법: 2009년 1월부터 2016년 5월까지, 식도 수술 문합부 협착으로 진단되어 확장 치료를 시행 받은 환자의 의무기록을 후향적으로 분석하였다. 결과: 연구 기간 동안에 21명의 양성 식도 문합부 협착 환자에 대해서 확장시술을 시행하였다. 환자의 성별은 남자가 17명(80.1%), 환자의 평균나이는 68.2±7.2세였다. 첫 진단 때, 협착의 직경은 협착 정도가 5 mm 미만인 경우가 10명(47.6%), 6-10 mm가 8명(38.1%), 11 mm 이상인 경우가 3명(14.3%)이었다. 협착의 길이는 평균 6.4 mm(표준편차 8.1mm)였다. 확장 치료 후 발생하는 중요 합병증은 없었다. 불응성 식도 협착은 7명(33.3%)이었고, 관련된 인자는 협착의 길이(>10 mm)와 당뇨였다. 결론: 양성 식도 수술 문합부 협착 환자에서 확장 치료는 안전한 치료법이며, 협착의 길이가 10 mm보다 작은 경우에 효과적이었다. Background/Aims: Benign esophageal stricture after esophagectomy is not an infrequent complication. Anastomotic esophageal stricture requires frequent multiple dilations. We aimed to evaluate the clinical outcomes of dilation therapies using an endoscopic balloon or bougie dilator and analyzed the risk factors associated with refractory stricture. Methods: Between January 2009 and May 2016, the medical records of 21 patients treated with endoscopic balloon dilation or bougie dilation for esophageal anastomotic strictures were retrospectively reviewed. Results: During the study periods, a total of 21 patients were diagnosed with esophageal anastomotic stricture and included for analysis (17 male; mean age, 68.2±7.2 years at the first procedure). The mean stricture length was 6.4±8.1 mm. The refractory stricture was found in 28.6% of patients, and successful relief of dysphagia was achieved in 71.4% of patients. The major complication associated with dilations was absent. Factors associated with refractory stricture were stricture length (> 10 mm, p<0.049) and diabetes mellitus (p=0.035). Additive bougie dilations achieved clinical success in 4 out of 7 patients. Conclusions: Dilation with endoscopic balloon or bougie dilator was an effective and safe procedure for benign anastomotic esophageal strictures of less than 10 mm in length. (Korean J Gastroenterol 2017;69:102-108)
출혈을 동반한 위 지방종의 내시경적 점막 절제술을 이용한 내시경적 제거
이정욱 ( Jung Wook Lee ),김수진 ( Su Jin Kim ),최철웅 ( Cheol Woong Choi ),강대환 ( Dae Hwan Kang ),김형욱 ( Hyung Wook Kim ),박수범 ( Su Bum Park ),남형석 ( Hyeong Seok Nam ),유대곤 ( Dae Gon Ryu ) 대한내과학회 2020 대한내과학회지 Vol.95 No.6
Most upper gastrointestinal lipomas occur in the duodenal second portion, and gastric lipomas are rare. Most lipomas are usually asymptomatic, but symptoms such as abdominal pain, intussusception, ulceration, and intestinal obstruction may occur depending on the size and location and, rarely, can cause bleeding. Endoscopic polypectomy, endoscopic mucosal resection, and surgical resection are the treatments of choice for lipomas with intestinal obstruction or bleeding. Upper gastrointestinal bleeding from lipoma is mostly of duodenal origin and very rarely from the stomach. Here, we report a case of successful treatment of gastric lipoma with massive bleeding by endoscopic resection. (Korean J Med 2020;95:398-403)
내시경 절제술 적응증이 되는 조기 위암에서 림프절 전이 예측을 위한 전산화단층촬영술의 유용성
김수진 ( Su Jin Kim ),김태언 ( Tae Un Kim ),최철웅 ( Cheol Woong Choi ),강대환 ( Dae Hwan Kang ),김형욱 ( Hyung Wook Kim ),박수범 ( Su Bum Park ),남형석 ( Hyeong Seok Nam ),유대곤 ( Dae Gon Ryu ) 대한소화기학회 2017 대한소화기학회지 Vol.70 No.1
목적: 본 연구는 내시경 절제술의 적응증에 해당하는 조기 위암의 림프절 병기 설정에서 복부 전산화단층촬영술의 유용성을 평가하고, 정확도에 영향을 주는 인자에 대해 알아보고자 하였다. 대상 및 방법: 2009년 3월부터 2016년 3월까지 수술 전 복부 전산화단층촬영술을 시행하고 위 절제술 및 림프절 곽청술을 시행 받은 환자들 중 내시경 절제술의 적응증에 조기 위암을 가진 268명의 환자들을 대상으로 하였다. 결과: 내시경 절제술의 적응증에 해당하는 조기 위암의 전산화단층촬영술 림프절 병기의 정확도는 86.1% (235/268명)였다. 전산화단층촬영술에서 림프절 전이가 의심되는 환자들에서 수술 후 병리 결과 림프절 전이가 없었다. 림프절 전이는 확대적응증에 해당하는 조기 위암을 가진 7명의 환자에서 확인되었으며, 이들 모두 전산화단층촬영술에서 림프절 비대는 없었다. 궤양 및 궤양반흔이 전산화단층촬영술 위양성과 관련이 있었다(odds ratio 3.56; 95% confidence interval 1.56-8.15). 결론: 내시경 절제술 적응증에 해당하는 조기 위암의 림프절 병기 평가로 복부 전산화단층촬영술의 신뢰도는 제한적이었다. Background/Aims: This study evaluated the value of abdominal computed tomography (CT) in preoperative N staging of early gastric cancers (EGCs) within standard and expanded indications of endoscopic resection (ER) and investigated the factors affecting accuracy. Methods: Between March 2009 and March 2016, a total of 268 patients with EGC within the standard and expanded indications of ER underwent preoperative abdominal CT and surgical gastrectomy with lymph node (LN) dissection. Preoperative N staging of CT was compared with the pathologic result. Results: The accuracy of N staging for EGCs within the standard and expanded indications was 86.1% (235/268). There was no LN metastasis in patients with cN1 in CT staging. LN metastasis was found in 7 patients with EGCs that met the expanded ER indication and cN0 in CT staging. According to the univariate analysis, ulcers, including scars, were associated with the false positive of lymph node metastasis in abdominal CT (odds ratio 3.56; 95% confidence interval 1.56-8.15). Conclusions: The present study suggests that the value of abdominal CT is limited for nodal staging of EGCs that meet the ER indication. (Korean J Gastroenterol 2017;70:21-26)