간경변증 환자의 생존율 예측에 있어 ΔMELD 측정의 유용성

은수훈 ( Soo Hoon Eun ),김연수 ( Yun Soo Kim ),장재영 ( Jae Young Jang ),천영국 ( Young Gook Cheon ),김영석 ( Young Seok Kim ),조영덕 ( Young Deok Cho ),이준성 ( Joon Sung Lee ),이문성 ( Moon Sung Lee ),김주현 ( Ju Hyun Kim ),심 대한간학회 2006 Clinical and Molecular Hepatology(대한간학회지) Vol.12 No.4

급성 췌장염 후 악화된 산역류 연관성 미만성 식도 경련

은수훈 ( Soo Hoon Eun ),이준성 ( Joon Seong Lee ),전창균 ( Chang Gyun Chun ),김연수 ( Yeon Soo Kim ),주현수 ( Hyun Soo Joo ),정현구 ( Hyun Ku Jung ),김경민 ( Kyung Min Kim ),정인섭 ( In Seop Jung ),고봉민 ( Bong Min Ko ),홍수진 ( 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.1

Diffuse esophageal spasm (DES) is a typical motility disorder of the esophagus thats manifested by episodic chest pain and dysphagia. Visceral hypersensitivity is considered to be an important pathophysiological mechanism in the development of noncardiac chest pain, the same as for functional gastrointestinal disorders. Recent studies have revealed that descending facilitation from the rostral ventromedial medulla maintains visceral pain in a model of experimental pancreatitis. We report here on a 24-year old male who suffered from retrosternal chest pain and dysphagia, and this was aggravated after acute pancreatitis. The initial endoscopic examination revealed reflux esophagitis. After 11 months, esophageal manometry showed the typical findings of diffuse esophageal spasm, while the endoscopic examination and 24 hr pH metry failed to reveal acid reflux. We performed endoscopic botulinum toxin injection that resulted in relieving his symptoms along with improved results on the balloon provocation test. We present here a case of aggravated reflux-associated DES after acute pancreatitis, along with a review of the literature. (Kor J Neurogastroenterol Motil 2007;13:76-80)

위종양성 병변에 대한 내시경 절개 점막하 박리법의 임상적 유용성

정윤호,은수훈,조수영,정인섭,유창범,이준성,이문성,김부성,심찬섭,Jung, Yoon-Ho,Eun, Soo-Hoon,Cho, Joo-Young,Jung, In-Seop,Ryu, Chang-Beom,Lee, Joon-Seong,Lee, Moon-Sung,Kim, Boo-Sung,Shim, Chan-Sup 대한위암학회 2006 대한위암학회지 Vol.6 No.2

목적: 최근 위선종 및 조기위암에 대해 새로운 내시경적 치료법인 내시경 절개 점막하 박리법은 기존의 내시경적 점막절제술 보다 더 넓은 적응증을 가지고 있지만 시술의 난이도가 높고 합병증의 위험이 있어 보편적으로 시술되고 있지 않다. 이에 내시경 절개 점막하 박리법으로 치료한 위의 종양성 병변의 치료 성적을 바탕으로 그 임상적 유용성을 알아보고자 하였다. 대상 및 방법: 내시경 절개 점막하 박리법을 시행한 164명의 환자들의 179개의 위종양성 병변에 대하여 완전절제 및 일괄절제 여부, 합병증, 재발 여부 등을 분석하였다. 결과: 179개의 병변은 조기위암 126예(70.3%), 선종 42예 (23.4%)였다. 병변의 침윤 깊이를 확인할 수 있었던 조기위암 420예는 각각 점막1층(sm1) 0.8% (1/120), 점막2층(m2) 38.3% (46/120), 점막3층(m3) 25% (57/120), 점막하1층(sm1) 11.7% (14/120), 점막하2층(sm2) 1.6% (2/120)이었다. 종양의 일괄절제율과 완전절제율은 각각 96.0%, 85.2%였다. 합병증은 천공 8예(4.4%), 출혈 38예(21.2%)가 발생하였으나, 천공 1예를 제외한 나머지는 비수술적으로 치료가 가능하였다. 결론: 본 연구에서 내시경 절개 점막하 박리법은 위종양성 병변의 근치적 치료에 비교적 안전하고 효과적인 술기이고, 향후 보다 장기간의 추적관찰을 통해 그 유용성이 검증되어야 할 것으로 생각한다. Purpose: Endoscopic incision and submucosal dissection (EISD) is a technique that is being implemented for the resection of gastric adenomas and early gastric cancer (EGC). Since EISD requires a high degree of skill and experience, and due to its association with a moderate risk of gastrointestinal bleeding, its use has been limited. The objective of this study is to investigate the clinical benefits of EISD based upon clinical data on the EISD procedure. Materials and Methods: This study was conducted at Soonchunhyang University Hospital and it included 179 gastric adenoma and early gastric carcinoma lesions from 164 patients who had undergone an EISD from February 2003 to May 2005. Results: Among the total of 179 lesions, the distributions of EGC and adenomas were 70.3% (126/179) and 23.4% (42/179) respectively. The sizes of lesions were divided into 10 mm or less, $11{\sim}20\;mm,\;21{\sim}30\;mm$ and greater than 31 mm and each rates are 10.0% (18/179), 46.3% (83/179), 30% (50/179) and 15.0% (28/179). Among 120 cases which could be measured depth of lesion in according to pathologic findings, m1 (0.8%, 1/120), m2 (38.3%, 46/120), m3 (25%, 57/120), sm1 (11.7%, 14/120), sm2 (1.6%, 2/120) were diagnosed as early stages of gastric cancer. The complete resection rate was 85.2% (150/176) and en-bloc resection rate was 96.0% (169/176). Complications as such as perforation and bleeding developed in 4.4%(8/179) and 21.2% (38/179), respectively. Conclusion: EISD is an effective in the endoscopic treatment for gastric adenoma and early gastric cancers. However, further evaluation of this method and long-term follow-up will be necessary for an evaluation of the recurrence rate after resection of a tumor.

위정맥류 치료에서 Histoacryl(R) (N-butyl-2-cyanoacrylate) 주입술의 장기성적 보고 -10년 경험-

주현수 ( Hyun Soo Joo ),장재영 ( Jae Young Jang ),은수훈 ( Soo Hoon Eun ),김상균 ( Sang Kyun Kim ),정인섭 ( In Seop Jung ),류창범 ( Chang Beom Ryu ),김영석 ( Young Seok Kim ),김진오 ( Jin Oh Kim ),조주영 ( Joo Young Cho ),김연수 ( 대한소화기학회 2007 대한소화기학회지 Vol.49 No.5

목적: 위정맥류는 출혈 시 대량출혈로 사망률이 높은 질환이며 Histoacryl(R) (N-butyl-2-cyanoacrylate) 주입술은 내시경 경화요법으로서 위정맥류의 효과적인 치료로 알려져 있으나 재출혈과 합병증에 관한 장기 연구는 많지 않다. 이에 저자들은 위정맥류 치료에서 Histoacryl 주입술의 장기 성적에 관하여 알아보고자 하였다. 대상 및 방법: 대상 환자들은 1994년 1월부터 2005년 1월까지 위정맥류로 Histoacryl(R) 주입술을 시행한 85명이었으며 이들 중 65명은 출혈 후 1주내, 7명은 출혈이 있고 나서 1주 후에 시술을 하였고 13명은 예방 치료를 시행하였다. Histoacryl(R)의 시술횟수는 1회 65명, 2회 15명, 3회 이상 5명(3회 4명, 5회 1명)이었고 주입한 Histoacryl(R)의 평균용량은 1.43 cc였으며, 평균 추적관찰기간은 24.5개월이었다. 결과: 성공적인 초치료율은 98.6%였고 재출혈률은 24.2%였으며, 재출혈 환자 중 76.2%가 1년 내에 발생하였다. 21명의 환자가 사망하였으며 치료 실패와 관련된 사망이 1명(1.4%)이었고, 그 외 사망원인으로는 간세포암종과 간기능부전이 대부분이었다. 합병증으로 폐색전증 2예, 비장색전증 1예 있었고 이 둘 모두 특별한 치료 없이 회복되었다. 간세포암종을 동반한 경우(p=0.051)와 Sarin 분류법에 따른 위정맥류의 위치에서 GOV2 (p=0.061)가 재출혈률이 높은 경향이 있었다. 결론: 위정맥류 치료에서 histoacryl 주입술은 높은 치료 성공률과 낮은 중요 합병증 발생률을 보여 효과적인 치료법으로 생각한다. Background/Aims: Gastric variceal bleeding is an infrequent but serious complication of portal hypertension. Endoscopic injection of Histoacryl(R) (N-butyl-2-cyanoacrylate) has been approved as an effective treatment for gastric variceal bleeding. The aim of this study was to evaluate the long-term efficacy and safety of the endoscopic injection of Histoacryl(R) for the treatment of gastric varices. Methods: Between January 1994 and January 2005, eighty-five patients with gastric varices received endoscopic injections of Histoacryl(R). Among these 85 patients, 65 received the procedure within 1 week after gastric variceal bleeding, and 13 received as a prophylactic procedure. According to the Sarin classification, 32 patients were GOV1 and 53 were GOV2. Most of the varices were large (F2 or F3, 75 patients). The average volume of Histoacryl(R) per each session was 1.43 ml. Among 85 patients, 72 patients were followed-up and the median duration was 24.5 months. Results: The rate of initial hemostasis was 98.6% and recurrent bleeding occurred in 29.2% (21 of 72). When rebleeding occurred, 76.2% was within 1 year after the initial injection. Treatment failure-related mortality rate was 1.4% (1 of 85). Twenty-seven patients died, mostly due to hepatocelluar carcinoma or liver failure. Two patients experienced pulmonary embolism and one experienced splenic infarction. They recovered without specific treatment. Rebleeding rate had a tendency to increase in patients with hepatocelluar carcinoma (p=0.051) and GOV2 (p=0.061). Conclusions: Histoacryl(R) injection therapy is a effective treatment method for gastric varices with high initial hemostasis rate and low major complications. (Korean J Gastroenterol 2007;49:320-326)

소화성 궤양에서 Helicobacter pylori 박멸의 장기적 효과에 대한 후향적 관찰

홍수진(Su Jin Hong),은수훈(Soo Hoon Eun),정준성(Joon Seong Jung),류권호(Kwon Ho Ryu),차상우(Sang Woo Cha),천갑진(Gab Jin Cheon),김진오(Jin Oh Kim),조주영(Joo Young Cho),이준성(Joon Seong Lee),이문성(Moon Sung Lee),심찬섭(Chan Sup Shi 대한내과학회 2002 대한내과학회지 Vol.63 No.1

목적: 소화성 궤양 환자에 있어 H. pylori 박멸은 재발 억제를 위해 시행되고 있으나 박멸 후 장기간 추적에 대한 국내 보고는 드문 실정이다. 본 연구에서는 소화성 궤양으로 H. pylori 박멸요법을 시행받고 박멸이 확인되었던 환자에서 H. pylori 재감염율, 궤양의 재발을 장기간 고찰하고자 하였다. 방법: 상부소화관 내시경검사상 H. pylori 양성인 소화성 궤양 환자 중 H. pylori 박멸요법을 시행하고 6주 이후에 박멸을 확인한 환자 763명 중 4년간 장기간 추적이 가능했던 환자 32명을 대상으로 상부소화관 내시경검사 소견, 13C-요소호기검사를 통한 H. pylori 감염 여부를 확인하여 기록하였다. 결과: 32명 중 남성은 22명, 여성은 10명이었고, 평균 연령은 51.7세 (29∼69세)였으며 내시경적 진단은 위 궤양 9명, 십이지장 궤양 12명, 위 궤양 및 십이지장 궤양 11명이었다. 4년간의 추적 기간 동안 H. pylori 재감염은 2명에서 있었고, 연간 재감염율은 1.6%였다. 32명의 환자 중 3명에서 궤양의 재발이 있어 9.4%의 재발율을 보였다. 결론: H. pylori의 연간 재감염율은 선진국의 재감염율과 유사한 1.6%였으며, H. pylori 박멸치료는 소화성 궤양의 재발 방지에 효과적인 유용한 치료방법으로 생각된다. Background: Eradication therapy for H. pylori infection is known to decrease the recurrence rate of peptic ulcer disease. The aim of this study was to evaluate longterm effect of H. pylori eradication on the recurrence of peptic ulcer disease and the reinfection rate after treatment in Korea. Methods: Between July 1996 and February 1997, 763 patients who were diagnosed peptic ulcer diseases and H. pylori infection after upper endoscopies in Soonchunhyang university hospital. Among those patients, we reviewed 32 patients who achieved eradication of H. pylori after eradication therapy and could be followed for up to 4 years by 13C-urea breath test or endoscopy. Results: The mean age of the patients was 51.7 years (range: 29∼68). Nine patients had gastric ulcer, 12 had duodenal ulcer and 11 had duodenal and gastric ulcer. An annual reinfection rate of H. pylori was 1.6% in our study. After H. pylori eradication, recurrence of peptic ulcer was detected in three patients (9.4%). Conclusion: In our study, the reinfection rate was similar to rates observed in developed countries. H. pylori eradication was effective for preventing recurrent peptic ulcers.(Korean J Med 63:23-28, 2002)

담낭절제술이 오디조임근의 운동에 미치는 영향

류권호 ( Kwon Ho Ryu ),이준성 ( Joon Seong Lee ),천영국 ( Young Koog Cheon ),송해정 ( Hae Jung Song ),김연수 ( Yeon Soo Kim ),은수훈 ( Soo Hoon Eun ),김상균 ( Sang Gyun Kim ),장재영 ( Jae Young Jang ),홍수진 ( Su Jin Hong ),김영석 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.1

목적 : 오디조임근에 대한 통상적인 짧은 시간동안 측정하는 내시경적 내압검사법은 전반적인 오디조임근의 운동을 대변할 수 없다. 이러한 제한점을 극복하고 오디조임근 운동에 대한 담낭절제술의 효과를 평가하기 위해, 경피경간 담도배액관을 유치하고 있는 간내 담석만 있는 환자에서 오디조임근 내압검사를 시행하였다. 대상 및 방법 : 26명의 환자를 대상으로 금식상태에서 오디조임근 경피경간 내압검사를 시행하였다. 17명은 담낭절제술을 시행받은 간내 담석 환자였고, 9명은 정상대조군으로 이전에 담도계의 수술을 받은 적이 없는 간내 담석 환자였다. 4명의 환자에서는 처음 내압검사를 시행한 후 1-2주 지나 경피경간 오디조임근 내압검사와 동시에 위소장 내압검사를 시행하였다. 결과 : 평균 기록 시간은 108±51분이었다. 오디조임근 기저압은 담낭절제술을 시행한 군과 시행하지 않은 군에서 차이가 없었다. 오디조임근의 위상파 수축의 평균횟수, 위상파 수축의 형태에 따른 분포에 있어 담낭절제술을 시행한 군과 정상대조군 간의 차이는 없었다. 오디조임근 위상파 수축의 고빈도 수축은 18명의 환자에서 총 40회 관찰되었다. 담낭절제술을 시행한 군에서 고빈도 수축간의 평균 간격은 40.1±21.9분으로 정상 대조군 69.9±19.0분에 비해 유의하게 짧았다(p<0.05). 담낭절제술을 시행한 군에서 고빈도 수축이 지속되는 평균 기간은 6.1±2.1분으로 대조군의 5.0±1.6분에 비해 길게 나타났다(p<0.05). 동시에 위소장 내압검사를 시행한 4명의 환자에서는 기록된 오디괄약근의 총 20회 고빈도 수축이 모두 십이지장의 MMC III기와 동시에 나타났다. 결론 : 담낭절제술 환자군에서 고빈도 수축 시간이 대조군에 비해 더 길고, 고빈도 수축 간의 간격은 대조군에 비해 짧았다. 또한, 오디조임근의 고빈도 수축과 십이지장 MMC III기가 연관성이 있게 나타나 이들간의 상호작용에 대한 연구가 필요할 것으로 생각한다. Background/Aims: The perendoscopic manometry of the sphincter of Oddi (SO) may not represent the overall SO motility. To assess the effect of cholecystectomy on SO motility, SO manometry was performed via the percutaneous transhepatic route. Methods: Percutaneous transhepatic SO manometry was performed in 26 patients with IHD stones. Seventeen patients had undergone cholecystectomy, and the others had not (the control group). We performed antroduodenal manometry simultaneously in 4 patients. Results: There was no significant difference of basal pressures, the mean frequency of phasic contractions, and the distribution of phasic contraction types of SO between the cholecystectomy group and the control group. Forty occasions of high frequency type phasic contractions were observed in 18 patients. The mean interval of high frequency contractions in the cholecystectomy group was shorter than that in the control group (40.1±21.9 vs. 69.9±19.0 min, respectively, p<0.05), and the mean duration of high frequency contractions in the cholecystectomy group was longer than that in the control group (6.1±2.1 vs. 5.0±1.6 min, respectively, p<0.05). Twenty high frequency contractions of SO coincided with duodenal MMC III on the antroduodenal manometry. Conclusions: A longer duration and shorter intervals of high frequency contractions were observed in the cholecystectomy group. High frequency contractions of SO were observed periodically without biliary pain and these coincided with duodenal MMC III. (Kor J Neurogastroenterol Motil 2007;13:61-67)

진단적 내시경적 역행성 담관조영술 중에 발생한 총수담관천공 1예

김은주,김인호,김홍수,이문호,김선주,정일권,박관석,박상홈,은수훈,김상균 대한소화기학회 2001 대한소화기학회지 Vol.37 No.3

Bile duct perforation caused by therapeutic procedures such as endoscopic sphincterotomy, guide-wire, and biliary stent were frequently reported. However, the case of bile duct perforation developed during diagnostic endoscopic retrograde cholangiogram (ERC) was very rare and there has been only one case report until now. A 57-year-old man was admitted for the evaluation of dilated bile duct. During the diagnostic ERC, he suddenly complained of severe right upper quadrant abdominal pain and cholangiogram showed dye leakage from the duodenal side of distal common bile duct where the tip of catheter was closely adhered. He was successfully treated with endoscopic retrograde bililary drainage for 4 weeks.

Cyclosporine과 Azathioprine으로 관해된 스테로이드 저항성 궤양성 대장염 1예

김은주,김홍수,이문호,김선주,정일권,박상홈,은수훈,김은나 대한소화기내시경학회 2001 Clinical Endoscopy Vol.22 No.2

Ulcerative colitis is chronic inflammatory disease of bowel without definite cause. Standard therapy of ulcerative colitis consists of aminosalicylates and glucocorticoid. In recent years, the effectiveness of cyclosporine in inflammatory bowel disease has been reported. Cyclosporine is useful in inducing remission in patients with acute exacervation phase who do not achieve remission with an intensive intravenous steroid therapy. We report a case of steroid-resistnat ulcerative colitis, treated with cyclosporine in 45-year-old man. Remission was not achieved with treatment of sulfasalazine and intensive intravenous glucocorticoid therapy for 10 days. We administered cyclosporine parenterally in dose of 4 mg/kg/day for 10 days. He improved dramatically without significant side effects of drug and avoided colectomy. He was discharged with oral cyclosporine and azathioprine and has been followed up outpatients department remained in clinically remission. Cyclosporine seems to be an effective treatment for patients with steroid-resistnat severe ulcerative colitis in whom colectomy seems inevitable.

내시경적 대장용종절제 후 지연발견된 천공을 내시경적 치료로 호전된 1 예

조주영,김진오,이문성,박현준,정현구,심찬섭,천갑진,은수훈,박형근,이준성 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.4

With the wide use of colonoscopy and develoment of technology, colon tumors and colon polyps are being found frequently and for the treatment of colon polyp, endoscopic polypectomy is used at present. The most common complications of endoscopic colon polypectomy are hemorrhage and perforation. Colon perforation is an abdominal emergency with high mortality. When colon perforation happens, surgical resection was being used at past. But when colon perforations are resulted from therapeutic colonoscopy, devoid of down stream obstacles with a perfectly prepared colon, and the patient's general condition is satisfactory, colon porforation is successfully treated by conservative measures. But, in delayed diagnosed perforation endoscopic treatment is controversial yet. We report here a case which sustained iatrogenic delayed diagnosed perforation of the sigmoid colon caused by polypectomy that was successfully treated by endoscopic clip therapy.

다발성 위 지방종증 1 예

조주영,이준성,김진오,이문성,박현준,정현구,심찬섭,진소영,천갑진,은수훈,박형근 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.6