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담낭의 용종성 병변의 감별 진단에 있어 초음파 내시경의 역할
천영국 ( Young Koog Cheon ) 대한췌장담도학회 2020 대한췌담도학회지 Vol.25 No.1
EUS는 통상적인 US보다 좋은 영상을 제공하기 때문에 콜레스테롤 용종과 다른 악성 용종과의 감별에 도움을 준다. 그러나 10 mm 이하의 작은 용종성 병변에서는 치료를 결정함에 있어 결정적인 역할을 하는 데는 아직 제한점이 있다. 담낭의 용종성 병변에서 비악성, 악성 그리고 악성화 가능성이 있는 용종성 병변들을 감별하고자 다양한 소견을 통한 점수제 방법과 조영제를 이용한 조영증강 EUS 검사 등의 새로운 검사기법들의 시도가 이루어지고 있어 담낭용종성 병변의 감별과 치료에 도움이 되고 있다. Although most gallbladder (GB) polyps are benign, some early carcinomas of the GB share the same appearance as benign polyps. Currently, GB polyps larger than 1 cm should be surgically removed because of the increased risk of malignancy. Distinguishing between nonneoplastic, neoplastic, and potentially malignant lesions is a major diagnostic dilemma, and the therapeutic options for these lesions remain controversial. Endoscopic ultrasonography (EUS) is considered to be superior to conventional US for imaging GB lesions, because EUS can provide highresolution images of small lesions with higher ultrasound frequencies. However, differential diagnosis remains difficult, especially for small GB polyps. Thus, various diagnostic methods using EUS have been introduced to overcome difficulty for differential diagnosis between neoplastic and non-neoplastic polyps. Contrastenhanced harmonic EUS is useful for observing microvascular patterns and additional enhancement images of GB polyps. This is needed a post-recording analysis due to a short enhancement time. Real-time color Doppler-EUS provides the Doppler flow of vessels without a time limit.
특집-급성 췌장염의 최신 지견 : 급성 췌장염의 중증도 평가
천영국 ( Young Koog Cheon ) 대한내과학회 2013 대한내과학회지 Vol.85 No.2
급성 췌장염의 중증에 대한 위험인자들로는 고령, 비만, 그리고 장기부전이다. 입원 당시 경미한 경우와 중증 급성췌장염과 감별하는 데 도움을 주는 검사들에는 APACHE-II 점수가 8점 이상, 혈청 헤마토크리트(< 44는 경미한 췌장염을 의미)가 있다. APACHE-II 점수가 입원 후 첫 48시간 이내에 계속 증가하는 것은 중증급성 췌장염으로의 발전을 의미한다. 첫 72시간 이내에 CRP가 150 mg/dL 이상인 것은 췌장괴사가 존재함을 의미한다. 중증급성 췌장염에 대한 중요한 지표는 장기부전(특히 다기관 장기부전)과 췌장괴사이다. 조영증강 CT는 간질성 췌장염과 괴사성 췌장염을 구분하는데 가장 유용한 검사로서 특이 발병 후 2-3일 뒤 가장 유용하다. 괴사성 췌장염과 동반된 지속성 다기관 장기 부전의 사망률은 36% 이상으로 높다. 그러므로 지속되는 장기부전이 있거나 심한췌장염을 의미하는 징후 즉, 소변감소, 지속성빈맥, 그리고 힘든 호흡증 등이 있다면 중환자실로 전원하여 집중적 치료가 필요하다. 이와 같이 급성 췌장염 환자에서의 중증도 파악 및 평가는 매우 중요하다. Older age (> 55), obesity (BMI > 30), organ failure at admission, and pleural effusion and/or infiltrates are risk factors for severity that should be noted at admission. Tests at admission that are also helpful in distinguishing mild from severe acute pancreatitis include APACHE-II score ≥ 8 and serum hematocrit (a value < 44 strongly suggests mild acute pancreatitis). An APACHE-II score that continues to increase for the first 48 h strongly suggests the development of severe acute pancreatitis. In general, an APACHE-II score that increases during the first 48 h is strongly suggestive of the development of severe pancreatitis. Contrast-enhanced CT scan is the best available test to distinguish interstitial from necrotizing pancreatitis, particularly after 2-3 days of illness. Mortality of sustained multisystem organ failure in association with necrotizing pancreatitis is generally > 36%. Transfer to an intensive care unit is recommended if there is sustained organ failure or if there are other indications that the pancreatitis is severe including oliguria, persistent tachycardia, and labored respiration. The early severity assessment is very important to appropriate treatment of acute pancreatitis. (Korean J Med 2013;85:116-121)
천영국 ( Young Koog Cheon ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2
Pancreas transplantation is the most effective cure for type I diabetes because it is able to restore normal glucose homeostasis. Over the last 2 decades, improvements in immunosuppressive therapy have been paralleled by a marked decrease in surgical complications, by superior antimicrobial prophylaxis and therapy, and by better techniques for diagnosing and treating pancreas graft rejection. The result has been a steady increase in the number of pancreas transplants. However, differently from heart, lung and liver transplantation, pancreas transplantation cannot be considered a life-saving procedure and the advantages in the long term should be carefully considered and balanced with the morbidity and mortality associated to the surgical procedure and the side-effect of immunosuppression. (Korean J Med 2011;80:164-166)
천영국 ( Young Koog Cheon ) 대한내과학회 2008 대한내과학회지 Vol.75 No.6
The advent of endoscopic retrograde cholangiopancreatography (ERCP) three decades ago had a dramatic impact on the treatment of common bile duct (CBD) stones. The advantages of ERCP over open surgery led to its widespread dissemination ad the predominant method of treating choledocholithiasis. After sphincterotomy, 85% to 90% of CBD stones can be removed with a Dormia basket or balloon catheter. These techniques are described as having both advantages and disadvantages. Methods for managing difficult stones include mechanical lithotripsy (ML), intraductal shock wave lithotripsy, such as electrohyhydroulic lthotripsy (EHL), laser-induced shock wave lithotripsy (LISL), extracoporeal shock wave lithotripsy, chemical dissolution, and biliary stenting. The local expertise and availability of equipment determines the choice of method used. In general, EHL or LISL is used for impacted CBD stones including stones in Mirizzi syndrome refractory to ML. ESWL is best suited for intrahepatic stones. Using currently bile duct stones still require surgical intervention. (Korean J Med 75:633-641, 2008)
진행성 간문부담관암 환자에서 내시경 담도배액술 단독 치료와 경피경간 담도배액술을 병행한 담도경하 광역동치료의 생존율의 비교 연구
천영국 ( Young Koog Cheon ),조영덕 ( Young Deok Cho ),백승훈 ( Seung Hoon Baek ),차상우 ( Sang Woo Cha ),문종호 ( Jong Ho Moon ),김연수 ( Yun Soo Kim ),이준성 ( Jun Seong Lee ),이문성 ( Moon Sung Lee ),심찬섭 ( Chan Sup Shim ) 대한소화기학회 2004 대한소화기학회지 Vol.44 No.5
Background/Aims: Photodynamic therapy (PDT) has a promising effect on non-resectable hilar cholangiocarcinoma. The aim of this study was to compare overall survival of PDT plus biliary drainage versus biliary stent alone in advanced hilar cholangiocarcino
위 편평선종 및 조기위암에서 내시경적 점막절제술 후 절제부위에서 발생한 융기형 병변에 관한 임상적 고찰
천영국,유창범,고봉민,김진오,조주영,이준성,이문성,진소영,심찬섭,Cheon Young Koog,Ryu Chang Beom,Ko Bong Min,Kim Jin Oh,Cho Joo Young,Lee Joon Seong,Lee Moon Sung,Jin So Young,Shim Chan Sup 대한위암학회 2001 대한위암학회지 Vol.1 No.1
Purpose: Several studies of an endoscopic mucosal resection(EMR) have been reported, but reports about benign protruding lesions that arise at the scar of EMR for early gastric cancer (EGC) or a gastric adenoma are rare. The purpose of this study was to elucidate endoscopic and histological characteristics of benign protruding lesions which arise at the scar of an EMR for EGC and a gastric flat adenoma. Materials and Methods: In 101 lesions (73 gastric flat adenomas and 28 EGCs) from 96 patients, 16 lesions developed new protruding lesions that arose at the scar of the EMR. We retrospectively analyzed the endoscopic findings of initial and protruding lesions, and several other clinical factors (H. pylori infection, eradication therapy, and proton pump inhibitor (PPI) or H2-blocker use). Results: 1. The mean duration until detection of the protruding lesion was 8.9 months ($1.5\∼27$). Protruding lesions arose at the scar of the EMR in 1 of 28 EGCs ($3.6\%$) and from 15 of 73 gastric flat adenomas ($20.5\%$). All of the patients were men. 2. With respect to the endoscopic findings, the shapes of the protruding lesions were as follows: 10 Yamada (Y) I, 4 Y-II, 1 Y-III, and 1 flat lesion. Histological examination of the protruding lesions revealed regenerating hyperplasia in 5 lesions, intestinal metaplasia in 5, and both in 6. 3. The incidence of these lesions was higher in cases of tubular adenomas with focal high-grade dysplasia than in cases of tubular adenomas without dysplasia (p<0.05). 4. The incidence of H. pylori infection was higher in patients ($81.7\%$) who developed a protruding lesion than in those ($51.8\%$) who did not develop (p=0.029); also, the incidence of use of PPI was higher in those patients (p=0.045). However, eradication therapy for H. pylori and duration of use of PPI or H2-blocker showed no difference between groups. Conclusions: It may be possible that the potential hyperplasia that may reside in normal mucosa surrounding EGC or a gastric adenoma might awaken during the healing process of the EMR ulcer and develop to benign protruding lesions. And, H. pylori and PPI might also be related to the development of the protruding lesions.
내시경 초음파 세침흡인생검에 확진된 담관암 양상 간문부 결핵성 육아종
윤현성 ( Hyun Sung Yoon ),천영국 ( Young Koog Cheon ),이태윤 ( Tae Yoon Lee ),심찬섭 ( Chan Sup Shim ),이응준 ( Eung Jun Lee ),이윤석 ( Yoon Serk Lee ),한혜승 ( Hye Seung Han ) 대한내과학회 2013 대한내과학회지 Vol.85 No.4
Hepatic tuberculosis is usually associated with active pulmonary or miliary tuberculosis. The occurrence of an isolated hepatic mass-forming tuberculosis with no evidence of tuberculosis elsewhere is rare. We report a case of a 31-year-old male with a solitary hepatic granuloma mimicking a mass-forming intrahepatic cholangiocarcinoma. Ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography of the abdomen showed a malignant tumor-like lesion. We then conducted endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) for confirmation of the hepatic hilar mass, which was found to be a hepatic tuberculosis granuloma as the final diagnosis. (Korean J Med 2013;85:396-400)
2개의 내시경을 이용한 금속 스텐트 삽입술을 통해 치료한 들창자 증후군
김준재 ( Jun Jae Kim ),천영국 ( Young Koog Cheon ),이태윤 ( Tae Yoon Lee ),심찬섭 ( Chan Sup Shim ) 대한내과학회 2015 대한내과학회지 Vol.89 No.4
Afferent loop syndrome is a rare complication of pancreaticoduodenectomy, and the endoscopic approach is difficult due to the surgically altered anatomy. Herein, we report a case of afferent loop obstruction treated by endoscopic metal stent insertion using two endoscopes. A 57-year-old male who had undergone the Whipple operation 7 months prior for pancreatic head cancer presented with abdominal pain and jaundice. Abdominal computed tomography showed afferent loop obstruction due to recurrent metastatic pancreatic cancer. First, we attempted to insert the stent using percutaneous transhepatic approaches following percutaneous transhepatic biliary drainage, but these failed. We therefore accessed the obstruction site using a relatively thin endoscope and then exchanged this endoscope for another with a large working channel, through which the self-expandable metal stent was passed. The stent was inserted successfully. This method will increase the success rate of endoscopic treatment. (Korean J Med 2015;89:428-432)