Clipping for the Prevention of Immediate Bleeding after Polypectomy of Pedunculated Polyps: A Pilot Study

부선진,변정식,박선영,유종선,Da Mi Lee,신성재,Dong Uk Kim,Geum Am Song 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.1

polypectomy. The purpose of this study is to investigate whether clipping before snare polypectomy of large pedunculated polyps is useful for the prevention of IPPB. Methods: This is a single arm, pilot study. We enrolled patients with pedunculated colorectal polyps that were 1 cm in size or more from 4 university hospitals between June 2009 and June 2010. Clips were applied at the stalk and snare polypectomy was then performed. The complications, including IPPB, were investigated. Results: Fifty six pedunculated polyps in 47 patients (Male:Female=36:11; age, 56±11 years) were included. The size of the polyp heads was 17±8 mm. Tubular adenoma was most common (57%). The number of clips used before snare polypectomy was 2±0.5. The procedure was successful in all cases. IPPB occurred in 2 cases (3.6%), and both of these were managed by additional clipping. Delayed bleeding occurred in another one case (1.8%), which improved with conservative treatment. No perforation occurred. Conclusions: We suggest that clipping before snare polypectomy of pedunculated polyps may be an easy and effective technique for the prevention of IPPB, and this should be confirmed in large scale, prospective, controlled studies.

불응성 위마비에서 내시경 유문근절개술의 효용성

부선진 대한소화기학회 2022 대한소화기학회지 Vol.79 No.4

.

소화기내과의 관점에서 바라보는 COVID-19

부선진 대한소화기학회 2020 대한소화기학회지 Vol.76 No.1

The World Health Organization (WHO) declared the worldwide pandemic of Coronavirus disease-2019 (COVID-19) On March 11, 2020, just three months after the first outbreak of COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 in China in December 2019. COVID-19 is a contagious disease that can affect anyone, anytime, anywhere, and has had a huge impact on our lives, including social, economic, educational, and cultural life. In this paper, I would like to explore the issues related to COVID-19 in the gastroenterology and share the experiences of domestic and overseas gastroenterologists, and ultimately to seek ways to effectively prepare for and cope with the pandemic era of COVID-19.

현성 소장 출혈 의심 환자에서 이중풍선 소장내시경 후 추적 관찰: 재출혈률을 중심으로

부선진,변정식,최기돈,예병덕,양동훈,윤순만,김경조,명승재,양석균,김진호 대한소화기내시경학회 2010 Clinical Endoscopy Vol.40 No.3

Background/Aims: Double balloon enteroscopy (DBE) is an effective modality for making the diagnosis and managing suspected small bowel bleeding. However, there is limited data on the follow-up results after DBE. The aim of this study was to evaluate the long-term clinical outcome after DBE in patients with suspected small bowel bleeding. Methods: We retrospectively analyzed the rebleeding rate of 60 consecutive patients (M:F=39:21, age: 13∼85 years) who underwent DBE because of suspected small bowel bleeding at Asan Medical Center during a 3 year period. Results: The median follow-up period was 552 days. Bleeding sources were detected by DBE in 41 patients. The cumulative rebleeding rate at 6, 12 and 24 months was 22%, 27% and 30%, respectively. There was no significant difference in the cumulative rebleeding rate between the patients with bleeding sources detected by the initial DBE and those without bleeding sources detected by the initial DBE. The cumulative rebleeding rate at 6 and 12 months was significantly higher for the patients with vascular or superficial mucosal lesions than for the patients with tumors or other lesions (p=0.013). Conclusions: The rebleeding risk after DBE is not low for patients with suspected small bowel bleeding. The rebleeding risk is especially high for patients with vascular or superficial mucosal lesions, and this may necessitate careful follow-up. 목적: 현성 소장 출혈 의심 환자에서 이중풍선 소장내시경(DBE)은 높은 병변 발견율을 보이지만, 추적 경과에 대한 연구는 부족하다. 저자들은 현성 소장 출혈이 의심되어 DBE를 시행한 환자들의 추적 경과를 분석하여 장기 유용성을 알아보고자 하였다. 대상 및 방법: 2005년 1월부터 2007년 12월까지 서울아산병원에서 현성 소장 출혈이 의심되어 DBE를 시행한 60명(13∼85세, 남:녀=39:21)을 후향적으로 분석하였다. 결과: DBE를 시행하기 전 중앙값 2회(1∼5회)의 출혈 병력이 있었고 입원 시 가장 낮았던 혈색소 수치는 7.9±2.1 g/dL였으며 수혈을 필요로 했던 경우는 49명(82%)이었다. 41명에서 출혈 의심 병변을 발견하여 68%의 병변 발견율을 보였는데 이 중 혈관병변이 12명, 표재성점막병변이 18명, GIST/림프종/폴립의 종양병변이 5명, 게실, 크론병 등의 기타병변이 6명이었다. 중앙값 552일의 추적 기간 동안 60명 중 17명(28%)에서 재출혈을 보였으며 6개월, 12개월, 24개월 누적 재출혈률은 각각 22%, 27%, 30%이었다. DBE로 출혈 의심 병변을 발견한 경우와 발견하지 못한 경우의 누적 재출혈률에서 유의한 차이는 없었다(p=0.295). 혈관병변 및 표재성점막병변의 경우 6개월, 12개월 누적 재출혈률은 각각 34%, 45%로 종양병변 및 기타병변의 0%, 0%에 비해 유의하게 높았다(p=0.013). 결론: 현성 소장 출혈에서 DBE 후 재출혈률은 병변 발견 여부에 관계없이 낮지 않으며, 혈관병변 및 표재성점막병변의 경우 내시경 지혈술 등 중재적 치료를 시행하더라도 높은 재출혈률을 보이므로 세심한 추적 관찰이 필요하다.

기관과 기관지내 다발성 점막 병변을 동반한 Churg-Strauss 증후군

부선진 ( Sun Jin Boo ),이광하 ( Kwang Ha Lee ),나승원 ( Seung Won Ra ),진영주 ( Young Joo Jin ),박경민 ( Gyung Min Park ),홍상범 ( Sang Bum Hong ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5

Churg-Strauss syndrome is a rare form of systemic necrotizing vasculitis that occurs exclusively in patients with asthma, and is associated with blood and tissue eosinophilia. The classic pathology findings in the lung include a combination of eosinophilic pneumonia, granulomatous inflammation and necrotizing vasculitis. However, there are few reports of tracheobronchial mucosal lesions in Churg-Strauss syndrome. We report a case of Churg-Strauss syndrome with multiple tracheobronchial mucosal lesions in a 33-year-old man with a history of bronchial asthma and allergic rhinitis. He had been diagnosed with community acquired pneumonia at another hospital and was treated with antibiotics. However, the chest radiographic findings were aggravated and showed multifocal consolidations in the whole lung fields. He was transferred to the Asan Medical Center. Fiberoptic bronchoscopy revealed multiple nodular mucosal lesions of the trachea and bronchi. The histopathology of the mucosal lesions revealed necrotizing bronchial inflammation with eosinophilic infiltration. Video Assisted Thoracic Surgery was performed. The wedge resected lung tissue revealed chronic eosinophilic pneumonia that was consistent with Churg-Strauss syndrome. Methylprednisolone (1 mg/kg q 8 hr) was prescribed and his symptoms resolved gradually. The chest radiographic findings improved significantly, and a follow-up fiberoptic bronchoscopy performed eight days later showed that the tracheobronchial mucosal lesions had resolved. The patient was prescribed oral prednisolone for 20 months after discharge. Currently, the patient is not taking steroids and is being followed up. (Tuberc Respir Dis 2008;65:405-409)

특발성 식도이완불능증 치료에서 경구 내시경 근절개술과 복강경 헬러 근절개술의 임상 성적 비교: 전향적, 다기관, 무작위 연구

부선진 ( Sun-jin Boo ) 대한소화기학회 2020 대한소화기학회지 Vol.75 No.1

양성자펌프억제제는 위암의 위험인자인가?

부선진 ( Sun-jin Boo ) 대한소화기학회 2022 대한소화기학회지 Vol.79 No.1

췌장 전이성 종양의 임상적 특징

부선진 ( Sun Jin Boo ),김명환 ( Myung Hwan Kim ),김유석 ( Yu Seok Kim ),류충헌 ( Choong Heon Ryu ),김홍준 ( Hong Jun Kim ),박도현 ( Do Hyun Park ),이상수 ( Sang Soo Lee ),서동완 ( Dong Wan Seo ),이성구 ( Sung Koo Lee ),김송철 ( So 대한소화기학회 2011 대한소화기학회지 Vol.57 No.6

Background/Aims: Histologically confirmed metastatic pancreatic cancers are infrequent. The aim of this study was to analyze clinical, therapeutic and prognostic features of pancreatic metastases. Methods: We retrospectively evaluated stage of primary malignancies, interval between diagnosis of primary tumors and detection of pancreatic metastases, treatment for metastases to the pancreas, survival rate, and prognostic factors in 31 patients with pancreatic metastases. Results: The mean age at the time of primary cancer diagnosis was 52.4±13.2 years. Primary cancers were renal cell carcinoma (n=16), non-small cell lung cancer (n=6), small cell lung cancer (n=3), colorectal carcinoma (n=2), osteosarcoma (n=1), gastric carcinoma (n=1), malignant melanoma (n=1), and thymic carcinoma (n=1). Pancreatic metastases were synchronous in six cases and metachronous in twenty five cases, with median interval time of 40.8 months (range 3-186) between the diagnosis of primary tumor and detection of pancreatic metastases. The median survival after the detection of the metastases was 16 months. In multivariate analysis, non-renal cell carcinoma as primary malignancy and positive symptom related to pancreatic metastases were associated with poor prognosis (hazard ratio [HR], 8.33; 95% CI, 2.1-33; p=0.003, and HR, 4.02; 95% CI, 1.27-12.7; p=0.018). Conclusions: Metastatic tumors to the pancreas have to be kept in mind when a patient with pancreatic mass has a history of other malignancy, even if treated several years before. In the absence of widely metastatic disease, aggressive diagnostic and therapeutic approach may offer the chance of long-term survival in selected patients. (Korean J Gastroenterol 2011;57:358-364)

식도의 이물: 치료와 합병증

부선진 ( Sun-jin Boo ),김흥업 ( Heung Up Kim ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.1

The most common cause of esophageal foreign bodies in adults is meat in Western countries and fish bones in Asian countries, including Korea. Although most ingested foreign bodies pass spontaneously through the esophagus without any clinical sequelae, some sharp foreign bodies, such as fish bones embedded in the esophagus, require treatment. Endoscopic management is the first choice in the treatment of esophageal foreign bodies because it is quite safe and effective. Major complications occur as a result of esophageal perforation; in particular, sharp foreign bodies, such as fish bones, are more likely to cause perforation. Complications include mediastinitis, paraesophageal abscess, pneumomediastinum, subcutaneous emphysema, pneumothorax, tracheoesophagal fistula, aortoesophageal fistula, aspiration, and asphyxia. Unnecessary delays should be avoided in endoscopic intervention for esophageal foreign bodies to prevent complications. (Korean J Gastroenterol 2018;72:1-5)

위장관 출혈로 발현한 전신 아밀로이드증 1예

임영협,부선진,현창림,정인호,문재철,정승욱,나수영,송현주,조유경,최은광,김흥업,송병철 대한내과학회 2013 대한내과학회 추계학술발표논문집 Vol.2013 No.1

서론: 아밀로이드증(amyloidosis)은 단백질 대사과정의 이상으로 저분자 물질로 구성된 섬유성 단백질인 유전분이 세포 외 조직에 축적되는 질환이다. 위장관은 드물지 않게 침범되는 장기지만 임상 양상이나 내시경 소견이 전형적이지 않기 때문에 진단하는 데 힘든 경우가 많다. 저자들은 반복적인 위장관 출혈로 내원하여, 위장관 및 심장 등 다발성 장기를 침범한 전신 아밀로이드증으로 진단한 증례를 경험하여 보고 하고자 한다. 증례: 특이 과거력 없는 54세 남자가 혈변을 주소로 입원하였다. 신체활력 증후는 혈압 130/80 mmHg, 맥박 76회/분, 호흡수12회/분, 체온 36.7였다. 말초혈액검사에서 백혈구 11,260 /mm3, 혈색소 16.3 g/dL, 혈소판 265,000 /mm3였다. 혈청학적 검사에서 알부민 4.3g/dL, 총 빌리루빈 0.71 mg/dL, AST/ALT 19/21 IU/L, ALP 74 IU/L, BUN/Cr 18.3/1.1 mg/dL이었다. 입원하여 시행한 상부위장관내시경에서 다수의 염증성 용종을 동반한 위 점막의 비후 소견이 위 전정부와 체부에서 관찰되었으며, 대장내시경에서는 출혈을 동반한 다발성 궤양들과 함께 병변 주위 점막의 발적과 혈종 등 비특이적인 소견이 관찰되었다. 위 및 대장에서 시행한 조직검사 결과에서는 만성 염증성 병변이외 특이 소견 없었다. 환자는 허혈성 장염 의심 하에 금식 및 수액 치료 후 증상 호전되어 퇴원하였다. 환자는 퇴원 후에 간헐적으로 혈변이 있었으며, 숨찬 증상이 발생하여 외래를 방문하였다. 심초음파에서는 좌심실과 우심실이 두꺼워져 있고 제한성 심근병증에 합당하여 침윤성 질환 감별을 위해서 다시 입원하였다. 입원 후 시행한 대장내시경에서 결장의 활동성 궤양은 호전 중이나 부분적으로 궤양의 흔적이 관찰되었고, 회장 말단부에서 활동성 궤양이 관찰되었다. 상부위장관내시경에는 이전 검사에 비해서 염증성 변화와 점막 비후가 악화된 소견을 보였다. 위 및 회장에서 시행한 조직검사 결과 hematoxylin과 eosin 염색에서 고유 점막층에서 무정형의 호산구성 침착물이 관찰되었고, Congo-red 염색에서는 오렌지색으로 관찰되지는 않았지만 편광현미경에서 이중굴절을 보이는 물질로 관찰되어 아밀로이드증으로 진단할 수 있었다. 류마티스 인자(rheumatic factor)와 항핵항체(antinuclear antibody)는 음성이었으며, κ light chain과 λ light chain은 각각 115.10 mg/L, 201.99 mg/L으로 상승 되어 있었다. 혈청 및 소변의 단백전기영동검사와 면역단백전기영동 검사에서는 이상소견 보이지 않았다. 이를 바탕으로 전위장관 및 심장 등 다발성 장기를 침범한 전신 아밀로이드증으로 진단할 수 있었으며, 스테로이드 치료 후 증상 호전되어 퇴원하였다.