약물 방출 담도 스텐트

장성일 ( Sung Ill Jang ),이동기 ( Dong Ki Lee ) 대한췌장담도학회 2020 대한췌담도학회지 Vol.25 No.1

악성 담도 폐쇄 환자에서 담즙 배액술은 환자의 생존이나 삶의 질 향상을 위하여 필요하다. 과거에는 수술이 주된 치료법이었으나 최근에는 내시경이나 경피적으로 스텐트 삽입술이 주된 치료법으로 인정되고 있다. 담도 스텐트의 개통기간을 증가시키기 위하여 다양한 소재와 구조가 고안되고 개발되었다. 이러한 스텐트 개발에 있어 화학적으로 피막재질의 변화를 통하여 스텐트 내 종양 성장을 억제하여 스텐트 개통기간을 증가시키고자 항암담지스텐트가 대두되었다. 항암담지스텐트는 여러 동물실험과 임상시험을 통하여 안전성은 증명되었으나 유효성은 증명되지 못하였다. 현재까지 임상적 적용이 시도된 항암담지스텐트의 개발 과정과 문제점, 향후 연구방향에 대하여 논하고자 한다. Biliary drainage is necessary to improve the survival or quality of life of patients with malignant biliary obstruction. In the past, surgery was the primary treatment for biliary drainage, but recently, endoscopic or percutaneous stent implantation has been recognized as the main treatment. Various materials and structures have been devised and developed to increase the patency of the biliary stent. In the development of these stents, drug-eluting biliary stents with an anti-tumoral agent (DES) have emerged to increase the stent patency period by chemically inhibiting tumor growth in the stent through the change of the coating material. The DESs have been proved to be stable through several animal and clinical trials, but their effectiveness has not been demonstrated. We will discuss the development process, problems, and future directions of DES that has been clinically applied.

총담관결석 진료 가이드라인: 진단과 치료

장성일 ( Sung Ill Jang ),이동기 ( Dong Ki Lee ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.1

Common bile duct (CBD) stone is a biliary disease with an increasing incidence in Korea. Many advances have been made in diagnosis and treatment according to the development of imaging equipment and various devices to diagnose and treat CBD stones. The Korean Society for Pancreatobiliary Association has developed clinical practice guidelines for the diagnosis and treatment of CBD stones to assist clinicians in their management. The guidelines were divided into three parts: evaluation of CBD stones, endoscopic management of CBD stones, and endoscopic management of difficult and recurrent CBD stones. The purpose of this review is to summarize and present the diagnosis and treatment guidelines for CBD stones established in Korea. (Korean J Gastroenterol 2018;72:6-9)

증례 : 소화기 ; 생검으로 진단된 간의 혈관근지방종 1예

장성일 ( Sung Ill Jang ),박형순 ( Hyung Soon Park ),유정환 ( Jung Whan Yu ),배성창 ( Sung Chang Bae ),정재준 ( Jae Jun Chung ),백용한 ( Yong Han Paik ),김자경 ( Ja Kyung Kim ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3

저자들은 건강검진상 우연히 발견된 간내종물에 대해 생검을 시행하여 간의 혈관근지방종으로 진단된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Angiomyolipoma occurs most commonly in the kidneys; the liver is the second most frequent site of involvement. Hepatic angiomyolipoma is a rare, benign, mesenchymal neoplasm, composed mainly of blood vessels, smooth muscle cells, fat, and myelocomponents. Radiologic findings are non-specific because the various elements of these neoplasms vary in their proportion and distribution within the tumor. Thus, data obtained by imaging technologies such as computed tomography, ultrasonography, or magnetic resonance imaging tend to be merely suggestive; definitive diagnosis usually requires histologic confirmation. We report here a case of angiomyolipoma in an incidental tumor of the liver of a 53-year-old female. Tissue was removed from the tumor by ultrasonography-guided gun biopsy and subjected to immunohistochemical analysis. Data showed that tumor cells were positive for HMB-45 and SMA, but negative for cytokeratin, anti-hepatocyte antigen, and α-fetoprotein. The patient did not receive any treatment and is being followed up. (Korean J Med 79:295-300, 2010)

담낭 용종의 진단, 치료 및 추적 관찰의 최신 지견

장성일 ( Sung Ill Jang ),조재희 ( Jae Hee Cho ),이동기 ( Dong Ki Lee ) 대한소화기학회 2020 대한소화기학회지 Vol.76 No.3

A gallbladder (GB) polyp is an elevation of the GB mucosa that protrudes into the GB lumen. GB polyps have an estimated prevalence of 0.3-9.5% and can be divided into neoplastic (true) polyps and nonneoplastic polyps (pseudopolyps). Pseudopolyps are most commonly cholesterol polyps but also include focal adenomyomatosis and inflammatory polyps with no malignant potential. Neoplastic polyps, however, can be benign or malignant. Benign polyps are most commonly adenomas, while malignant polyps are usually adenocarcinoma. Transabdominal ultrasonography is the main radiological modality used for diagnosing and surveilling GB polyps. On the other hand, because it is difficult to diagnose GB polyps before surgery, alternative imaging modalities, such as endoscopic ultrasound, are being further evaluated. The current guidelines recommend cholecystectomy for GB polyps ≥ 10 mm in size as well as suboptimal sized GB polyps (6-9 mm) with other risk factors, including age >50, sessile, and symptoms. The quality of the evidence behind this practice is relatively low. Therefore, this review identifies the current gaps in the available evidence and guidelines and introduces methods that can help make decisions regarding patients who require a cholecystectomy or follow-up. (Korean J Gastroenterol 2020;76:102-107)

증례 : 소화기 ; 복강 내 종양으로 오인된 농양을 형성한 위궤양 천공 1예연세대학교 의과대학 강남세브란스병원 1소화기내과, 2영상의학과

유정환 ( Jung Hwan Yu ),장성일 ( Sung Ill Jang ),박정수 ( Jung Soo Park ),정교태 ( Kyo Tae Jung ),김주희 ( Joo Hee Kim ),김자경 ( Ja Kyung Kim ),이관식 ( Kwan Sik Lee ) 대한내과학회 2011 대한내과학회지 Vol.81 No.1

저자들은 복강 내 종양 의심 환자에서 위궤양 천공에 의한 복강 내 농양을 진단하고 약물치료만으로 완치된 예를 경험하여 이를 문헌고찰과 함께 보고하는 바이다. Gastric ulcer perforation usually results in panperitonitis, which requires surgical treatment. A peritoneal abscess also can occur with gastric ulcer perforation, but it is not a common complication of peptic ulcer disease. Here, we report a peritoneal abscess that mimicked a tumor and was caused by a gastric ulcer and provide a literature review. A 57-year-old woman was admitted to our hospital for evaluation of an abdominal mass found in another hospital, with no signs of infection. She underwent a left lobectomy of the liver due to choledocholithiasis. Abdominal computed tomography (CT) revealed a heterogeneous mass attached to the antrum of the stomach. At endoscopy, we confirmed that the gastric ulcer at the antrum of the stomach caused the abscess. After 4 weeks of antibiotics and proton pump inhibitor treatment, she was cured. In a patient with abdominal pain and a peritoneal abscess of unknown cause, the possibility of peptic ulcer perforation should be considered. (Korean J Med 2011;81:89-92)

악성 담관 협착에서 내시경적 담관내 고주파 소작술의 최신 지견

조재희 ( Jae Hee Cho ),장성일 ( Sung Ill Jang ),도민영 ( Min Young Do ),이동기 ( Dong Ki Lee ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.4

Malignant biliary strictures are caused by pancreatobiliary cancer and other metastatic malignancies. Most of them are unresectable at diagnosis with a dismal prognosis. Various new ablation methods have been introduced. Of them, ERCP-guided intraductal radiofrequency ablation (ID-RFA) appears to be the most promising minimally invasive endoscopic treatment by delivering a high-frequency alternating current to the target tissue, leading to coagulative necrosis. Thus far, many studies have provided evidence that ERCP-guided ID-RFA is a safe, feasible, and effective treatment modality for stent patency and overall survival. Compared to other ablation treatments, ERCP-guided ID-RFA has several advantages, including ease of delivery, controlled application of thermal energy, low cost, and fewer systemic side effects with an acceptable safety profile. Therefore, ERCP-guided ID-RFA can be considered an adjunctive treatment for the palliation of unresectable malignant biliary strictures. On the other hand, the decision of local ablation treatment should be individualized by multidisciplinary team support due to the lack of comparative studies. (Korean J Gastroenterol 2021;78:205-212)

개량형 유두괄약근절개도와 외국산 유두괄약근절개도를 이용한 내시경괄약근절개술의 유용성 및 안전성 검증을 위한 공개, 무작위, 다기관, 전향적 비교 연구

박세우 ( Se Woo Park ),장성일 ( Sung Ill Jang ),정문재 ( Moon Jae Chung ),조재희 ( Jae Hee Cho ),방승민 ( Seungmin Bang ) 대한소화기학회 2022 대한소화기학회지 Vol.79 No.1

목적: 전적으로 수입에 의존한 기존 유두절개도의 단점을 보완한 새로운 국산 제품(Optimos™, Taewoong, Goyang, Korea)을 개발하여 기존 절개도와 조작성, 편리성 및 안전성을 비교 평가하였다. 대상 및 방법: 2021년 4월부터 2021년 7월까지 세 개 기관에서 췌관담관 질환의 진단 및 치료를 위해 내시경적 역행성 담췌관조영술(ERCP)을 시행한 환자를 대상으로 연구를 진행하였다. 총 104명의 환자를 전향적으로 모집하여 Optimos™ 및 CleverCut™ 절개도 각 군 당 52명의 환자를 무작위 배정하였다. 연구의 일차 목표는 ERCP 후 발생할 수 있는 모든 급성 합병증(출혈, 천공, 감염 및 췌장염)의 발생 빈도와 중증도의 절개도 간 차이이고, 이차 목표는 담관의 선택적 삽관 성공률과 용이성 비교 평가이다. 결과: CleverCut™군은 최종 51명, Optimos™군은 최종 53명이 연구에 포함되었다. BMI를 제외한 모든 인구학적 항목에서 두 군 간 유의한 차이는 보이지 않았다. 최종 선택적 삽관 성공률은 CleverCut™군 50예(98.0%) 및 Optimos™군에서 49명(92.5%)이었다. 평균 삽관 시도 횟수는 CleverCut™군 1.6±1.3, Optimos™군 2.4±2.7로 두 군 간 유의한 차이는 없었으며, 평균 삽관 시간도 CleverCut™군 2.5±2.3, Optimos™군 3.4±3.0분으로 두 군 간 차이는 없었다. 유두절개술 후 경미한 출혈은 각각 7예(14.3%)와 6예(11.8%) 발생하였다. 췌장염은 Optimos™군에서만 2예(3.8%) 발생하였으며 경증 1예, 중등도 1예였다. 전반적인 시술자 만족도와 기구 조작성은 CleverCut™군이 Optimos™군에 비하여 우월한 결과를 보여 주었다. 결론: 국내에서 개발 및 제조한 Optimos™ 절개도는 CleverCut™ 절개도와 비교하여 임상적으로 안전하면서 효율적으로 선택적 삽관 및 유두 절개를 시행할 수 있음을 확인하였다. 그러나 추가적인 개선을 통해 사용자 편의성을 높일 수 있는 추가적인 노력이 필요하다. Background/Aims: Sphincterotomes are essential for endoscopic sphincterotomy (EST) and can also be used for cannulation in ERCP. A domestic new pull-type sphincterotome (Optimos™, Taewoong, Goyang, Korea) provides acceptable technical feasibility and safety, but there are no comparison results. Thus, this study compared the clinical performance and safety of Optimos™ sphincterotome to a conventional sphincterotome (CleverCut3™, Olympus, Tokyo, Japan) in patients who underwent ERCP. Methods: From April 2021 to July 2021, a randomized prospective comparative study was conducted on 104 consecutive patients who underwent ERCP in three medical centers. The primary endpoint was the clinical performance and safety of sphincterotomes during ERCP. Results: One hundred and four patients were assigned randomly to the Optimos™ group (n=51) or CleverCut3™ group (n=53). All demographic characteristics did not differ between the groups except the BMI. The technical success rate for cannulation, performance of EST, and total procedure time were similar in the two groups. The adverse events did not differ, even though two cases of post-ERCP pancreatitis occurred in CleverCut3™. On the other hand, in questionnaire analysis, CleverCut™ showed a better user’s convenience (median [interquartile range] 4.0 [3.0-4.0] vs. 3.0 [3.0-4.0], p=0.013) and manipulability (median [interquartile range], 4.0 [3.0-4.0] vs. 3.0 [3.0-4.0], p=0.039) than Optimos™, even though the other profiles did not reveal any differences. Conclusions: New domestic pull-type sphincterotome can offer comparable clinical performance and safety profiles to conventional sphincterotome, but it needs refinements to increase the user’s convenience and manipulability. Further improvement and innovation will be required to advance domestic medical devices. (Korean J Gastroenterol 2022;79:22-30)

내시경 유두절제술로 치료한 십이지장 주유두부의 신경내분비종양

윤홍진 ( Hong Jin Yoon ),정영학 ( Young Hak Jung ),최성은 ( Sung Eun Choi ),박정수 ( Jung Soo Park ),김용훈 ( Yong Hoon Kim ),김혜원 ( Hae Won Kim ),장성일 ( Sung Ill Jang ),이동기 ( Dong Ki Lee ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.4

Ampullary neuroendocrine tumor is rare but requires total resection for treatment. Traditionally, pancreatic duodenal resection has been recommended for treatment of ampullary neuroendocrine tumor. Because of the morbidity and mortality associated with surgical resection, endoscopic papillectomy is increasingly used in selected cases with low grade, no metastasis, and no invasion of the pancreatic or bile duct. We present a case of an ampullary neuroendocrine tumor which was successfully and completely resected via endoscopic papillectomy. Endoscopic papillectomy can be a viable alternative for the resection of neuroendocrine tumor at the major duodenal papilla in cases with high surgical risks. Korean J Pancreatobiliary 2014;19(4):204-209

내시경 초음파를 통해 파열 전 진단된 췌십이지장 동맥류 1 예

김용훈 ( Yong Hoon Kim ),김혜원 ( Hae Won Kim ),조장호 ( Jang Ho Cho ),이민영 ( Min Young Lee ),이경화 ( Kyoung Hwa Lee ),윤지은 ( Ji Eun Yun ),장성일 ( Sung Ill Jang ),이동기 ( Dong Ki Lee ) 대한췌담도학회 2013 대한췌담도학회지 Vol.18 No.4

췌십이지장 동맥류는 드물고 진단에 특징적인 신체 진찰 소견이 없어 초기 진단이 어렵다. 이전에는 대부분이 파열과 동시에 진단되었으나, 최근영상 검사의 발달로 우연히 발견되는 경우가 증가하고 있다. 췌십이지장 동맥류는 대부분이 파열되며, 파열시에는 치사율이 50% 에 달해 정확한 진단에 따른 치료가 중요하다.파열시에는 혈관 조영술이 진단과 치료를 위한 좋은 검사이나, 검진 상 발견되는 경우에는 췌장종괴와의 감별 위하여내시경 초음파가 진단에 도움을 줄 수 있다. 저자들은 복부통증을 주소로 내원하여 췌십이지장 동맥류를 전산화 단층촬영과 내시경 초음파를 통해 파열 전 진단하고 경피적 동맥색전술로 후유증 없이 치료한 1 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Pancreaticoduodenal artery (PDA) aneurysm is a rare disease without any distinct physical characteristics which makes detection extremely difficult unless ruptured. Although most lesions have been diagnosed with their rupture, rate of incidental discovery is increasing with the recent advances in imaging modality and by frequent medical examination. Ruptured PDA aneurysm can be fatal and has high rate of mortality, hence proper treatment based on precise diagnosis is crucial. Although angiography is a modality of choice both for diagnosis and treatment at the time of rupture, endoscopic ultrasound (EUS) can help differentially diagnose aneurysm from pancreatic mass. Authors have experienced a case of PDA aneurysm, which presented with abdominal pain and was diagnosed with computed tomography and EUS at an uncomplicated status. As the patient was treated by percutaneous arterial embolization without any complication, we report the case with the review of literature

증례 : 소화기 ; 췌장암과 감별하기 어려웠던 갑상선 유두암의 췌장 전이 1예

이지훈 ( Ji Hoon Lee ),이동기 ( Dong Ki Lee ),장성일 ( Sung Ill Jang ),최홍규 ( Hong Kyu Choi ),박찬익 ( Chan Ik Park ),윤지은 ( Ji Eun Yun ),홍순원 ( Soon Won Hong ) 대한내과학회 2014 대한내과학회지 Vol.87 No.2

갑상선 암의 췌장 전이는 드물다. 갑상선 암의 추적관찰을 위해 일반적으로 시행하는 방사선 요오드 스캔에서는 복부전이 민감도가 낮으며 양전자 방출 단층 촬영이나 전산화단층 촬영에서 발견된 췌장 종괴는 원발 췌장암과 감별이 어렵다. 최근 내시경 초음파가 활성화되면서 췌장 종괴의 진단에 있어 정확도가 높아졌으며 동시에 조직 검사까지 시행가능하여 유용한 검사로 사용되고 있다. 저자 등은 췌장암과 감별하기 쉽지 않았으나 조영 증강 내시경적 초음파 및 미세 바늘 세포 흡입술을 통해 진단된 갑상선 유두암의 췌장 전이 1예를 보고하는 바이다. Papillary thyroid cancer (PTC) has a good prognosis and a low incidence of distant metastases. It is extremely rare for PTC to metastasize to the pancreas. Only five cases have been previously reported worldwide. Most cases are discovered incidentally by abdominal computed tomography (CT) or positron emission tomography-CT (PET-CT) during follow-up studies after thyroidectomies. Pancreatic metastasis of PTC is usually unidentifiable by a whole-body I131 scan, a common follow-up modality. When a pancreatic mass is found in patients with PTC, it must be differentiated from pancreatic cancer. In previous reports, patients with pancreatic metastases of PTC underwent operations for therapeutic diagnosis or underwent fine needle aspiration biopsies (FNAB). However, it is unclear whether the benefit of an operation outweighs the risk. We experienced a case of PTC with pancreatic metastasis that was found on PET-CT. Contrast-enhanced endoscopic ultrasonography (EUS) was performed to evaluate the characteristics of the pancreatic mass and pathological confirmation was obtained cytologically via EUS-FNA. (Korean J Med 2014;87:187-192)