위 상피하 종양의 내시경적 치료

주문경,박종재 대한상부위장관ㆍ헬리코박터학회 2015 Korean Journal of Helicobacter Upper Gastrointesti Vol.15 No.1

Most of subepithelial tumor (SET) in stomach is incidentally found during esophagogastroduodenoscpic examination. Even small gastric SETs less than 2.0 cm might have malignant potential, thus ambiguous cases should be removed and pathologically confirmed for optimal diagnosis and treatment. As endoscopic techniques are developed, endoscopic removal of gastric SETs has been reported increasingly. The endoscopic procedures for resection of gastric SETs include classic methods such as snare polypectomy or incisional enucleation, and more progressive and standard technique such as endoscopic submucosal dissection. For gastric SETs originated from deeper layer including muscularis mucosa, novel procedures such as endoscopic submucosal tunnel dissection and endoscopic full-thickness resection (EFTR) are now being introduced, and cooperation with laparoscopic approach such as laparoscopy-assisted EFTR might be an alternative option to overcome shortcomings of endoscopic procedures only and ensure more safe and complete resection.

라미부딘 내성으로 바이러스 돌파현상을 보인 환자에서 비대상성 변화의 관찰 간경변증과 만성 간염군 간의 비교

주문경,연종은,김지훈,이순재,서상준,정영걸,김정한,임형준,변관수 대한소화기학회 2007 대한소화기학회 추계학술대회 Vol.2007 No.-

Endoscopic Approach for Major Complications of Bariatric Surgery

주문경 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.1

As lifestyle and diet patterns have become westernized in East Asia, the prevalence of obesity has rapidly increased. Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB), are considered the first-line treatment option in patients with severe obesity. However, postoperative complications have increased and the proper management of these complications, including the use of endoscopic procedures, has become important. The most serious complications, such as leaks and fistulas, can be treated with endoscopic stent placement and injection of fibrin glue, and a novel full-thickness closure over-the-scope clip (OTSC) has been used for treatment of postoperative leaks. Stricture at the gastrojejunal (GJ) anastomosis site after RYGB or incisura angularis in SG can be managed using stents or endoscopic balloon dilation. Dilation of the GJ anastomosis or gastric pouch may lead to failure of weight loss, and the use of endoscopic sclerotherapy, novel endoscopic suturing devices, and OTSCs have been attempted. Intragastric migration of the gastric band can be successfully treated using various endoscopic tools. Endoscopy plays a pivotal role in the management of post-bariatric complications, and close cooperation between endoscopists and bariatric surgeons may further increase the success rate of endoscopic procedures.

포스터 발표 : 복막투석을 시행하는 환자에서 Listeria monocytogenes에 의한 복막염 1예

주문경,이재원,현영율,최혜민,부창수,고강지,조상경,조원용,김형규 대한신장학회 2006 춘계학술대회 초록집 Vol.25 No.1

상부 위장관 스텐트 삽입술의 이해 -적응증 및 추적 관리-

주문경,박종재,Joo, Moon-Kyung,Park, Jong-Jae 한국호스피스완화의료학회 2009 한국호스피스.완화의료학회지 Vol.12 No.2

상부 위장관 스텐트 삽입술은 근치적 수술이 불가능한 상부 악성 종양에 의한 상부 위장관 협착 환자의 폐쇄 증상 완화를 위한 보존적 치료로서 확립되었으며 내시경 개발 기술이 발달하고 임상 경험이 축적됨에 따라서 여러 상부 위장관 질환에서 스텐트 삽입술을 보다 편리하고 안전하게 시행할 수 있게 되었다. 그러나 스텐트 삽입술 이후에는 동통, 출혈, 천공과 같은 조기 합병증이나 스텐트 일탈, 스텐트 폐쇄 등의 후기 합병증이 발생할 수 있으므로 사후 관리 또한 중요하다. Self expandable metal stent (stent) implantation of upper gastrointestinal (UGI) tract is now widely accepted for the palliation of obstructive symptoms caused by inoperable malignant UGI obstruction. With the technical progress and accumulation of clinical experiences, it became possible to perform the procedure easily, safely and effectively. However, clinicians should pay attention to the post-procedural care, because early or late complications such as ulceration, pain, bleeding, food impaction, perforation, migration or in-stent tumor growth could occur. In this review, several topics about stent placement in the UGI tract are discussed, such as major indications for stenting, kinds of stents, and post-procedural management.

秋に向かって

주문경 덕성여자대학교 일어일문학회 1986 語り合い Vol.3 No.-

복막투석 환자에서 Listeria Monocytogenes에 의한 복막염

주문경 ( Moon Kyung Joo ),고강지 ( Gang Jee Ko ),조원용 ( Won Yong Cho ),김형규 ( Hyoung Kyu Kim ),권보성 ( Bo Sung Kwon ),장진수 ( Jin Su Jang ),박재연 ( Jae Youn Park ),김승영 ( Seung Young Kim ),김진남 ( Jin Nam Kim ),노경호 ( 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.5

Peritonitis in continuous ambulatory peritoneal dialysis is a major cause of technical failure in peritoneal dialysis. The major pathogen is gram positive bacteria, and other main pathogens include gram negative bacteria, mixed infection and fungal infection actively involved in the order named. Coagulate-negative Staphylococcus, Streptococcus, Staphylococcus aureus and Enterococcus cause most of the gram positive bacterial infections, and cases with other pathogens are very rare. We hereby report a case of peritonitis by Listeria Monocytogenes that was not responsive to the usual antibiotics for CAPD-associated peritonitis. A 58-year-old male who has been treated with CAPD for 17 years visited our hospital for abdominal pain, fever and turbid peritoneal fluid. He was diagnosed as diabetes mellitus 20 years ago. White blood cell and neutrophil count increased at the initial peritoneal fluid analysis, so we diagnosed him as CAPD-associated peritonitis. Antibiotic therapy was initiated with intraperitoneal injections of cefazolin/tobramycin, which were soon changed to vancomycin/ceftazidime. However, vancomycin/ceftazidime regimen was also proven ineffective. On the sixth hospital day, L. Monocytogenes was cultured in the peritoneal fluid sampled on the first visiting day. So we accordingly changed the antibiotics for ampicillin/sulbactam, which led to clinical and laboratory improvement. In the cases of CAPD associated peritonitis in immunosuppressive patients such as the elderly, caused either by diabetes or by taking immunosuppressive agent, if they do not respond to the usual antibiotics, we should consider the possible infection by unusual pathogens. Gram positive rod in peritoneal fluid is a supporting evidence of peritonitis by L. monocytogenes. (Korean J Nephrol 2006;25(5):857-861)

최근 12년간 발생한 자발성 세균성 복막염의 균주와 항생제 내성의 변화

주문경 ( Moon Kyung Joo ),연종은 ( Jong Eun Yeon ),이순재 ( Sun Jae Lee ),서상준 ( Sang Jun Suh ),정영걸 ( Young Kul Jung ),김정한 ( Jeong Han Kim ),김지훈 ( Ji Hoon Kim ),임형준 ( Hyung Joon Yim ),변관수 ( Kwan Soo Byun ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1

목적: 자발성 세균성 복막염(Spontaneous Bacterial Peritonitis, 이하 SBP)은 간경변증의 주요 합병증으로 최근 치료방법의 개발 등으로 예후가 향상되었으나 예방적 항생제의 사용이나 침습적 시술 등으로 인하여 원인 균주 및 항균제 내성균 비율의 변화가 보고되고 있다. 이번 연구에서는 최근 12년간 SBP로 진단된 예의 원인균 및 항균제 내성 균주비율의 변화에 대하여 고찰하고자 하였다. 방법: 1996년 1월부터 2007년 8월까지 본원에서 SBP로 진단된 예 중 복수 배양검사에서 양성인 113예의 의무 기록을 후향적으로 분석하였다. 1996년 1월부터 2001년 12월까지는 기간 A, 2002년 1월부터 2007년 8월까지는 기간 B로 분류하였다. 결과: 전체 12년간 SBP로 진단된 410예 중 113예에서 복수 배양 양성이었고(배양 양성율: 27%), 이 중 37예는 기간 period A, 76예는 기간 B에 속하였다. 병원 획득 SBP는 기간 B에서 유의하게 증가하였으나 기타 다른 대상 환자의 특성은 두 기간 사이에 유의한 차이는 없었다. 그람 음성균은 78%, 그람 양성균은 19%였으며 역시 두 기간 사이에 유의한 차이는 없었다. 가장 흔한 동정 균주는 E.coli (60%)였으며, 그 외에는 Klebsiella pneumoniae (12%), Viridans streptococcus (4%) 순이었다. Ampicillin과 ciprofloxacin 내성균의 비율은 두 기간 사이에 유의한 차이는 없었으나 cefotaxime 내성균 비율은 기간 B에서 유의하게 증가하였고 (3% 대 26%, p=0.002), E.coli 중 ESBL 생성 균주는 기간 A에서 동정되지 않았으나 기간 B에서 14예가 동정되었다(0% 대 32%, p=0.002). 일차 치료 항균제로 대다수의 환자에서 cefotaxime을 사용하였고, 이차 치료 항균제 중 carbapenem은 기간 B에서만 12예에서 사용되었다(0% 대 55%, p=0.007). 원내 사망률은 양 시기간에 유의한 차이는 없었고, 다변량 분석 결과 ESBL 생성 균주는 원내 사망을 예측하는 유의한 인자였다(OR: 4.14, 95% CI: 1.09-15.07, p=0.037). 결론: 최근 12년간 본원에서 발생한 SBP 환자를 시기별로 비교하였을 때 복수에서 배양된 균주는 이전과 큰 차이가 없었으나 이전 6년과 비교하여 최근 6년간 병원 획득 SBP의 비율, cefotaxime 내성 비율, E.coli에 대한 ESBL 생성 균주의 비율은 유의하게 높았으며 ESBL 생성 균주는 원내 사망에 대한 유의한 위험인자였다. Background/Aims: Recently, the prognosis for spontaneous bacterial peritonitis (SBP) has improved; however, the causative microorganisms and antibiotic resistance rates are changing. We evaluated the changing pattern of causative agents and antibiotic resistance rates of SBP over a 12-year period. Methods: We retrospectively analyzed 113 patients who were diagnosed with SBP and in whom ascites cultures were positive between 1996 and 2007. The 12-year period was subdivided into 6-year terms (period A, 1996~2001; and period B, 2002~2007). Results: One hundred thirteen of 410 cases of SPB had positive ascites cultures. Thirty-seven cases were from period A and 76 cases were from period B. Hospital-acquired SBP was more common during period B. Gram negative microorganisms were isolated from 78% of SBP cases, and the most common microorganism was E.coli (60%). The resistance rates for ampicillin and ciprofloxacin were similar between the two periods, but resistance to cefotaxime was more frequent in period B (3% vs. 26%, p=0.002), and ESBL-producing E.coli was only cultured in period B (0% vs. 32%, p=0.002). Most of the initial antibiotics used were cefotaxime; carbapenem was used as a secondary antibiotic only in period B (0% vs. 55%, p=0.007). ESBL-producing microorganisms were the only predictor of in-hospital mortality based multivariate analysis (OR: 4.14, 95% CI: 1.09-15.07, p=0.037). Conclusions: No change in pattern of microorganisms in the ascites of patients with SBP was noted during the 12-year period under study, but there was a significant increase in the incidence of hospital-acquired SBP, resistance to cefotaxime, and ESBL-producing E.coli when comparing the outcomes of periods A and B. ESBL-producing microorganisms were the only predictor of in-hospital mortality. (Korean J Med 75:68-76, 2008)

약제 연관 소화성궤양의 임상 진료지침 개정안 2020

주문경 ( Moon Kyung Joo ),박찬혁 ( Chan Hyuk Park ),김준성 ( Joon Sung Kim ),박재명 ( Jae Myung Park ),안지용 ( Ji Yong Ahn ),이봉은 ( Bong Eun Lee ),이정훈 ( Jeong Hoon Lee ),양효준 ( Hyo-joon Yang ),조유경 ( Yu Kyung Cho ),방창 대한소화기학회 2020 대한소화기학회지 Vol.76 No.3

The Korean guidelines for nonsteroidal anti-inflammatory drug (NSAID)-induced peptic ulcers were previously developed under co-work with the Korean College of Helicobacter and Upper Gastrointestinal Research and Korean Society of Gastroenterology at 2009. On the other hand, the previous guidelines were based mainly on a literature review and expert opinions. Therefore, the guidelines need to be revised. In this study, a guideline development committee for drug-induced peptic ulcers was organized under the Korean College of Helicobacter and Upper Gastrointestinal Research in 2017. Nine statements were developed, including four for NSAID, three for aspirin and other antiplatelet agents, and two for anticoagulants through de novo processes based on evidence-based medicine, such as a literature search, meta-analysis, and the consensus was established using the modified Delphi method. The primary target of this guideline was adult patients taking long-term NSAIDs, aspirin, or other antiplatelet agent and anticoagulants. The revised guidelines reflect the consensus of expert opinions and are intended to assist relevant clinicians in the management and prevention of drug-induced peptic ulcers and associated conditions. (Korean J Gastroenterol 2020;76:108-133)

약제 유발 소화성궤양과 헬리코박터 제균 치료

주문경 ( Moon Kyung Joo ) 대한소화기학회 2020 대한소화기학회지 Vol.76 No.5

Non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin are the most frequently prescribed drugs worldwide, and their long-term use often leads to peptic ulcers (PUs) along with serious complications, such as bleeding and perforation. Helicobacter pylori (H. pylori) infection is a significant risk factor for developing NSAID-related PU and ulcer bleeding during long-term aspirin use. In a revised version of the Clinical Guidelines for Drug-induced Peptic Ulcer, two statements regarding H. pylori eradication are recommended. 1) Patients scheduled for long-term NSAID therapy should be tested and treated for H. pylori infection to prevent PU and its complications. 2) Patients with a history of PU receiving long-term low-dose aspirin (LDA) therapy should undergo treatment for H. pylori infection to prevent PU and its complications. On the other hand, unlike NSAID-naïve patients, the preventive effects of H. pylori eradication in chronic NSAID users are unclear. In addition, anti-ulcer drugs, such as proton pump inhibitors, may be necessary for maintenance therapy after H. pylori eradication in a subset of long-term LDA users, particularly if the patients are taking concomitant antiplatelet agents or anticoagulants. (Korean J Gastroenterol 2020;76:227-231)