조기위암의 내시경치료

최기돈 ( Kee Don Choi ) 대한내과학회 2011 대한내과학회지 Vol.81 No.1

Endoscopic resection has become accepted as a standard treatment in selected patients with early gastric cancer (EGC) with negligible risk of lymph node metastasis. Endoscopic resection preserves the stomach and therefore improves quality of life compared with surgery. And it allows accurate histological staging of the tumor, which is critical in deciding whether additional treatment is necessary. The endoscopic submucosal dissection (ESD) method has been widely used with higher en bloc resection and complete resection rates than conventional endoscopic mucosal resection (EMR) with acceptable complication rates. Long-term clinical outcomes of these techniques are promising in terms of disease-free and overall survival. Recently, the expanded indication of endoscopic resection for early gastric cancer has been proposed because of technical advances of ESD. Long-term outcome data of the expanded indication are needed for the clinical application of the expanded criteria of ESD. (Korean J Med 2011;81:40-46)

크론병에서 Infliximab 치료의 효과와 안전성 - 단일 기관에서의 경험

최기돈 ( Kee Don Choi ),송호준 ( Ho Jun Song ),김주성 ( Joo Sung Kim ),정현채 ( Hyun Chae Jung ),송인성 ( In Sung Song ) 대한소화기학회 2005 대한소화기학회지 Vol.46 No.1

십이지장 궤양 출혈로 발현한 CD 56+ NK/T 세포 림프종

유지희 ( Ji Hee Yu ),최기돈 ( Kee Don Choi ),고영화 ( Young Wha Koh ),최원정 ( Won Jung Choi ),송호준 ( Ho June Song ),이진혁 ( Gin Hyug Lee ),정훈용 ( Hwoon Yong Jung ),김진호 ( Jin Ho Kim ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.3

Extranodal NK/T-cell lymphoma is a recently recognized distinct entity within the World Health Organization classification of lymphoid tumors. It is relatively prevalent in Asian and South American populations. It most commonly occurs in the nasal or paranasal areas and less frequently in the skin, the soft tissue, and the gastrointestinal tract. Among these, extranodal NK/T-cell lymphoma of the gastrointestinal tract has shown an aggressive clinical course. We report a case of CD56+ extranodal NK/T-cell lymphoma presenting as a duodenal ulcer bleeding. A 62-year-old male patient presented with melena and abdominal pain. Endoscopic examination of the upper gastrointestinal tract showed the duodenal ulcer covered by blood clot. Pathologic examination revealed the diffuse infiltration of atypical lymphocytes with an angiocentric growth pattern, which was positive for CD3, CD56, and granzyme. The patient showed rapid deteriorating clinical course and died on day 14 after admission. Thus, we report this case with the review of literatures. (Korean J Gastroenterol 2009;54:174-179)

종격동 기종과 공기후복막증이 발현된 신경성 식욕부진

김태협 ( Tae Hyup Kim ),최기돈 ( Kee Don Choi ),김민경 ( Min Kyung Kim ),김순주 ( Soon Joo Kim ),송호준 ( Ho June Song ),정훈용 ( Hwoon Yong Jung ),김진호 ( Jin Ho Kim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.3

Since anorexia nervosa is a multi-systemic disorder, as well as a psychiatric disorder, it needs a multidisciplinary approach. It causes many medical problems, including irregular menstruation, hematologic problems, decreased bone density, electrolyte imbalance, and dysrhythmias. Sometimes, this disorder also causes rare, unexpected complications, including abnormal air collections, such as pneumomediastinum, retropneumoperitoneum, or subcutaneous emphysema. The cause of these phenomena is unknown, although fragile parenchymal tissue that is disrupted easily when the local pressure is increased by coughing, vomiting, or defecation is a suggested cause. We experienced a case of anorexia nervosa complicated with abnormal air collections. After we excluded other possible causes, such as perforation of the gastrointestinal tract, and ordered the patient to undergo a short fast and inhale oxygen, the abnormal air collections resolved. We report this case because of its rarity and benign course. (Korean J Med 76:338-342, 2009)

과망간산칼륨으로 인한 부식성 식도염

노진희 ( Jin Hee Noh ),최기돈 ( Kee Don Choi ) 대한소화기학회 2020 대한소화기학회지 Vol.75 No.2

소장 병변 진단에서 이중풍선소장내시경과 소장조영술의 비교

조지윤 ( Ji Yun Jo ),변정식 ( Jeong Sik Byeon ),최기돈 ( Kee Don Choi ),박혜원 ( Hye Won Park ),이진혁 ( Gin Hyug Lee ),명승재 ( Seung Jae Myung ),정훈용 ( Hwoon Yong Jung ),양석균 ( Suk Kyun Yang ),홍원선 ( Weon Seon Hong ),김진 대한소화기학회 2006 대한소화기학회지 Vol.48 No.1

목적: 소장 질환의 진단과 치료에서 이중풍선소장내시경의 역할은 아직 정립되어 있지 않다. 이번 연구에서는 소장질환이 의심되는 환자에서 소장조영술과 이중풍선소장내시경의 진단 가치를 비교 분석해 보고자 하였다. 대상 및 방법: 2005년 1월부터 2005년 5월까지 소장 병변이 의심되는 환자들을 대상으로 하였다. 연구에 포함된 환자들에 대해 이중풍선소장내시경과 소장조영술을 모두 시행하였고 그 결과를 비교하였다. 결과: 모두 18명(남:여=12:6, 14-82세)의 환자가 포함되었다. 이중풍선소장내시경과 소장조영술을 시행한 적응증은 원인 불명 위장관 출혈 10예, 원인 불명 복부 통증 5예, 만성 설사 2예, 복부 전산화단층촬영에서 소장벽 비후가 있었던 1예였다. 원인 불명 위장관 출혈 10예 중 소장조영술에서 정상이었던 4예에서 이중풍선소장내시경을 통해 궤양이나 미란과 같은 의미 있는 병변을 찾을 수 있었다. 나머지 6예는 두 검사에서 진단의 차이가 없었다. 원인 불명 복통이 있었던 5예 중 3예는 림프종, 공장 협착, 베체트 병으로 두 검사에서 같은 진단을 내릴 수 있었다. 한편, 2예에서는 서로 다른 소견을 보였는데, 소장조영술에서 크론병을 의심하였던 1예는 이중풍선소장내시경에서 정상으로 확인하였고, 소장조영술에서 악성 병변으로 생각하였던 1예는 이중풍선소장내시경에서 원인 미상의 만성 양성 궤양으로 추정되었으나 확진하지는 못했다. 만성 설사가 있었던 2예 중 1예는 두 검사에서 모두 크론병으로 진단하였고, 나머지 1예는 소장조영술에서 장결핵이 의심되었으나 이중풍선소장내시경을 통해 림프관확장증으로 확진하였다. 복부 전산화단층촬영에서 이상 소견을 보였던 1예는 두 검사 모두 정상이었다. 결론: 이중풍선소장내시경은 소장 질환의 진단에서 소장조영술보다 우수하였으며 향후 소장 질환의 진단과 치료에 중요한 역할을 담당할 것으로 생각한다. Background/Aims: The role of double balloon enteroscopy (DBE) is still evolving. The aim of this study was to compare the diagnostic yield of DBE with that of small bowel series (SBS). Methods: We enrolled patients with suspected small bowel disease consecutively, and performed both DBE and SBS in all patients. Results: Eighteen patients (M:F=12:6, 14-82 years) were included. Indications for small bowel evaluation were obscure gastrointestinal bleeding (10), abdominal pain (5), diarrhea (2) and abnormal CT finding (1). Of 10 obscure gastrointestinal bleeding patients, 6 showed the same findings in both studies. However, 4 showed negative findings in SBS while DBE detected erosions or ulcerations. Of 5 abdominal pain patients, 3 showed the same results in both studies. However, 2 demonstrated different results. One was suspected of early Crohn`s disease in SBS, but proved to be normal in DBE, and the other was suspected of malignancy in SBS but was suspected of benign ulcers in DBE. Of 2 chronic diarrhea patients, one was diagnosed as Crohn`s disease in both studies. The other was suspected of tuberculosis in SBS but diagnosed as lymphangiectasia by DBE with biopsy. One patient with jejunal wall thickening in CT proved to be normal in both DBE and SBS. There were no serious complications associated with DBE and SBS. Conclusions: DBE is better than SBS in terms of diagnostic accuracy. DBE may become an important method for the evaluation of small bowel diseases. (Korean J Gastroenterol 2006;48:25-31)

내시경초음파 유도하 미세침 흡인생검으로 진단된 위점막하 종양 유사 부비장

안지용 ( Ji Yong Ahn ),정훈용 ( Hwoon Yong Jung ),김도훈 ( Do Hoon Kim ),최기돈 ( Kee Don Choi ),송호준 ( Ho June Song ),이진혁 ( Gin Hyug Lee ),김진호 ( Jin Ho Kim ),황희상 ( Hee Sang Hwang ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.6

Accessory spleen can be mistaken as a gastric subepithelial mass, and may not be differentiated in CT or endoscopic ultrasonography (EUS). A gastric subepithelial mass was detected on routine endoscopy in a 39-year old woman with history of splenectomy. In subsequent CT and EUS, the subepithelial mass was located on the fourth layer of the stomach. To make a definite diagnosis, EUS-guided fine needle aspiration (FNA) was performed, and a splenic tissue was demonstrated in histologic examination. EUS-guided FNA can be beneficial in the diagnosis of accessory spleen which mimics a gastric subepithelial mass. (Korean J Gastroenterol 2012;59:433-436)

원인불명 현성 위장관 출혈에서 이중풍선 소장내시경 양성 소견의 예측 인자

정준원 ( Jun Won Chung ),변정식 ( Jeong Sik Byeon ),최기돈 ( Kee Don Choi ),최귀숙 ( Kwi Sook Choi ),김병규 ( Benjamin Kim ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),김진호 ( Jin Ho Kim ) 대한장연구학회 2006 Intestinal Research Vol.4 No.2

목적: 원인불명 위장관 출혈에서 이중풍선 소장내시경의 진단율은 60.0-76.0% 정도로 보고되고 있다. 그러나 어떤 임상적 특징을 보이는 환자에서 출혈 병소를 찾을 가능성이 높은지에 대해서는 잘 알려져 있지 않다. 저자들은 현성 원인불명 위장관 출혈에서 이중풍선 소장내시경의 병변 진단 예측 인자에 대해 살펴보고자 하였다. 대상 및 방법: 흑색변이나 혈변으로 상부 위장관 내시경과 대장내시경 시행 후 원인을 찾지 못해 이중풍선 소장내시경을 시행한 현성 원인불명 위장관 출혈 환자 28명(남:여=16:12, 13-82세)을 대상으로 하였다. 의무기록을 통해 이중풍선 소장내시경으로 원인 병변을 찾은 환자들과 못 찾은 환자들의 임상 및 검사실 소견을 비교 분석하였다. 결과: 28명 중 21명(75.0%)에서 이중풍선 소장내시경으로 원인 병변을 찾을 수 있었으며, 혈관이형성, 다양한 궤양, 종양 등이 포함되었다. 병변을 찾은 군의 연령은 50.5±20.4세로 못 찾은 군의 52.4±19.8세와 차이가 없었고, 남녀비도 차이가 없었다(12:9 vs. 4:3). 내원 시 혈역학적 불안정, 마지막 흑색변 및 혈변에서 이중풍선 소장내시경 시행까지의 시간, 수혈량 및 혈색소 수치도 두 군 사이에 차이가 없었다. 출혈 병력 횟수는 병변을 찾은 군에서 2.1±1.1회, 못 찾은 군에서 1.4±0.5회로 출혈 횟수가 많은 경우 병변 진단율이 높은 경향을 보였으나 통계적 유의성은 없었다. 과거력상 첫 출혈 시점부터 이번 출혈까지의 출혈 유병 기간은 병변을 찾은 군에서 196.8±238.5일로 못 찾은 군의 15.5±13.7일에 비해 유의하게 길었다(p=0.04). 결론: 현성 원인불명 위장관 출혈에서 출혈의 유병 기간은 이중풍선 소장내시경을 통한 병변 진단을 예측할 수 있는 유용한 임상 지표였다. 따라서 오랜 기간에 걸쳐 여러 차례 출혈을 보인 환자에서 이중풍선 소장내시경은 우선적으로 고려될 수 있을 것으로 생각한다. Background/Aims: The most frequent indication of double balloon endoscopy (DBE) is obscure gastrointestinal bleeding (OGIB). The aim of the study was to evaluate the clinical factors predicting the detection of bleeding focus by DBE in patients with overt OGIB. Methods: Twenty eight patients (male:female=16:12, 13-82 years) with overt OGIB who underwent DBE were enrolled. Medical records were reviewed and analyzed. Results: Bleeding focus was found in 21 patients (75.0%). Age, gender, time interval between the last blood passage and DBE, transfusion amount, hemodynamic instability, and the number of past bleeding episodes were not different between patients whose bleeding focus was found by DBE and those whose bleeding focus was not found. Duration of bleeding was significantly longer in patients whose bleeding focus was found by DBE than those whose bleeding focus was not found (196.8±238.5 vs. 15.5±13.7 days, p=0.04). Conclusions: Duration of bleeding may be a useful clinical parameter which predicts the detection of bleeding focus by DBE in overt OGIB. (Intestinal Research 2006;4:95-100)

기능성 소화불량증 치료에 관한 임상진료지침

지삼룡 ( Sam Ryong Jee ),정혜경 ( Hye Kyung Jung ),민병훈 ( Byung Hoon Min ),최기돈 ( Kee Don Choi ),이풍렬 ( Poong Lyul Rhee ),강영우 ( Young Woo Kang ),이상인 ( Sang In Lee ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.2

Functional dyspepsia (FD) is defined as the presence of symptoms thought to originate in the gastroduodenal area, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Based on the available evidence and consensus opinion, thirteen consensus statements for the treatment of FD were developed using the modified Delphi approach. Proton pump inhibitor, prokinetics, and histamine 2 receptor antagonists are effective for the treatment of FD. Mucosal protecting agents, fundus relaxant, and drugs for visceral hypersensitivity can improve symptoms in FD. Antacids and antidepressants may help improving symptoms in FD. Comparing endoscopy with ``test and treat`` of Helicobacter pylori, endoscopy may be more effective initial strategy for managing patients with FD in Korea given high incidence of gastric cancer and low cost of endoscopy. Helicobacter pylori eradication can be one of the therapeutic options for patients with FD. Psychotherapy is effective for those who have severe symptoms and refractoriness. Further studies are strongly needed to develop better treatment strategies for Korean patients with FD. (Korean J Gastroenterol 2011;57:67-81)

반복적인 십이지장 출혈로 내원한 십이지장 결핵 1 예

양종인(Jong In Yang),강정묵(Jung Mook Kang),임종필(Jong Pil Im),최기돈(Kee Don Choi),김주성(Joo Sung Kim),정현채(Hyun Chae Chung),송인성(In Sung Song) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.6

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