크론병과 유사한 내시경 소견의 거대세포바이러스 대장염

허철웅 ( Cheal Wung Huh ),윤영훈 ( Young Hoon Youn ),정다현 ( Da Hyun Jung ),김도환 ( Do Whan Kim ),고보건 ( Bo Gun Kho ),김지현 ( Jie Hyun Kim ),박효진 ( Hyo Jin Park ),이상인 ( Sang In Lee ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.4

Cytomegalovirus (CMV) colitis is common among immunocompromised patients, and often diagnosed by pathologic confirmation because it is associated with a diverse spectrum of clinical and endoscopic features. However, Crohn`s disease has no definitive diagnostic criteria, but longitudinal ulcers and cobble stone appearance are accepted as typical endoscopic features of Crohn`s disease. An 83 year-old male with a history of radiotherapy for hypopharyngeal cancer visited our hospital with a complaint of melena for 1 week. His colonoscopic exam showed multiple longitudinal ulcers along the entire colon. Most of the ulcers were longer than 4 cm, these endoscopic findings were suspected as typical endoscopic features of Crohn`s disease. Pathologic reports revealed multiple inclusion bodies with CMV on immunohistochemistry. He was finally diagnosed as having CMV colitis, and received a 3 week-course of intravenous ganciclovir. A colonoscopic follow-up showed complete healing of the multiple longitudinal ulcers, and he is doing well now without further treatment. (Korean J Gastroenterol 2012;59:303-307)

위선종의 내시경 치료

허철웅 ( Cheal Wung Huh ),김병욱 ( Byung-wook Kim ) 대한소화기학회 2017 대한소화기학회지 Vol.70 No.3

Gastric adenoma (dysplasia) is a precancerous lesion. Therefore, managements of gastric adenomas are important for preventing the development of gastric cancers and for detecting gastric cancers at earlier stages. The Vienna classification divides gastric adenomas into two categories: high-grade dysplasia and low-grade dysplasia. Generally, endoscopic resection is performed for adenoma with high-grade dysplasia due to the coexistence of carcinoma and the potential of progression to carcinomas. However, the treatments of adenoma with low-grade dysplasia remain controversial. Currently two treatment strategies for the low-grade type have been suggested; First is the `wait and see` strategy; Second is endoscopic treatment (e.g., endoscopic mucosal resection, endoscopic submucosal dissection, or argon plasma coagulation). In this review, we discuss the current optimal strategies for endoscopic management of gastric adenoma. (Korean J Gastroenterol 2017;70:115-120)

헬리코박터 파일로리 감염 진단의 최신 지견

허철웅 ( Cheal Wung Huh ),김병욱 ( Byung-wook Kim ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.5

Accurate diagnosis of Helicobacter pylori (H. pylori) infection is mandatory for the effective management of many gastroduodenal diseases. Currently, various diagnostic methods are available for detecting these infections, and the choice of method should take into account the clinical condition, accessibility, advantage, disadvantage, as well as cost-effectiveness. The diagnostic methods are divided into invasive (endoscopic-based) and non-invasive methods. Non-invasive methods included urea breath test, stool antigen test, serology, and molecular methods. Invasive methods included endoscopic imaging, rapid urease test, histology, culture, and molecular methods. In this article, we provide a review of the currently available options and recent advances of various diagnostic methods. (Korean J Gastroenterol 2018;72:229-236)

단일기관에서의 식도 호산구증가증에 대한 경험

조기원 ( Ki Won Cho ),허철웅 ( Cheal Wung Huh ),정다현 ( Da Hyun Jung ),윤영훈 ( Young Hoon Youn ),박효진 ( Hyojin Park ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.1

Background/Aims: Esophageal eosinophilia occurs in many conditions, including eosinophilic esophagitis (EoE) and proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), which have been increasingly recognized in Western countries. There have been only a few reports in Korea. Here, we evaluated the clinical and endoscopic characteristics of patients with esophageal eosinophilia from our experience. Methods: Nineteen patients were diagnosed with esophageal eosinophilia based on typical symptoms, endoscopic features, esophageal eosinophilia with ≥15 eosinophils/high power field, and response to medication by PPI. Symptoms, endoscopic and pathological findings were evaluated. Results: Of the 19 patients, 2 patients were diagnosed with EoE, 7 patients were diagnosed with PPI-REE, and 10 patients were undetermined due to loss to follow-up. Among these 19 patients, dysphagia was present in 11, and heartburn, dyspepsia and reflux in 8. Sixteen patients had common endoscopic features, such as longitudinal furrows, concentric rings, strictures, and white plaques; however, 3 patients had normal findings. Nine patients underwent endoscopy at the time of follow-up. Two patients had complete resolution, and 3 had partial resolution. However, 4 patients showed no endoscopic changes. All patients showed symptom improvements. Conclusions: The clinical and endoscopic characteristics of both groups in Korea were undistinguishable. However, after treatment, endoscopic findings were different between the two groups. Large-scale studies are warranted to confirm our findings. (Korean J Gastroenterol 2018;72:10-14)

내시경적 절제술로 치료된 직장 Mucosa-associated Lymphoid Tissue 림프종 1예

윤백현 ( Baek Hyun Yoon ),허철웅 ( Cheal Wung Huh ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.6

A primary extranodal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct clinical-pathological entity that develops in diverse anatomic locations. However, colorectal involvement is rare. The authors encountered a case of a MALT lymphoma of the rectum in a 69-year-old woman who complained of up to 3 kg weight loss during 3 months. A colonoscopy demonstrated a 1.0×1.0 cm sized subepithelial tumor (SET) at the lower rectum. The patient underwent an endoscopic mucosal resection with ligation for the SET. Pathological analysis revealed marked small to medium-sized lymphocytic infiltration. Immunohistochemistry revealed neoplastic cells positive for CD20 and bcl-2. A polymerase chain reaction detected immunoglobulin H gene rearrangement. Finally, rectal MALT lymphoma was diagnosed. Computed tomography and positron emission tomography scans showed that there was no lymph node metastasis or other organ involvement. A bone marrow biopsy was found to be negative for any neoplastic process. Therefore, the Ann Arbor stage was IeB. Helicobacter pylori (H. pylori) was not detected in the gastric biopsy specimens. Thus far, she has had no relapse since the endoscopic resection. The incidence of rectal MALT is very rare, and treatment is unclear. This paper reports a case of rectal MALT lymphoma treated successfully with only an endoscopic resection. (Korean J Gastroenterol 2021;78:344-348)

증례 : 박리성 올가미 결찰을 이용하여 내시경적으로 제거한 대장 지방종 1예

정다현 ( Da Hyun Jung ),윤영훈 ( Young Hoon Yoon ),허철웅 ( Cheal Wung Huh ),윤지현 ( Ji Hyun Yoon ),김우정 ( Woo Jeung Kim ),김지현 ( Jie Hyun Kim ),이상인 ( Sang In Lee ) 대한내과학회 2012 대한내과학회지 Vol.83 No.2

대장 지방종은 대장에서 가장 흔한 간엽조직 종양으로, 소장, 위, 식도에서도 발생할 수 있다. 대부분의 경우 증상이 없어 치료가 필요하지 않고, 대장내시경이나 수술을 통해 우연히 발견되는 경우가 많지만, 크기가 큰 경우에는 복통, 출혈, 폐색, 장중첩 등과 같은 합병증을 동반할 수 있어 제거를 고려하여야 한다. 2 cm가 넘는 지방종의 경우, 내시경 절제시 합병증 발생률이 높기 때문에 수술적 제거가 권장되고 있으나 최근 내시경적 용종 절제술, unroofing 기법 및 박리성 올가미를 이용하여 단계적으로 지방종을 내시경적으로 제거한 예가 보고되었다. 저자들은 7 cm 크기의 거대 대장 지방종을 unroofing 기법과 박리성 올가미를 사용하여 반복적 교액을 통해 단계적으로 크기를 줄여 내시경적으로 제거한 1예를 경험하였기에 보고한다. Colonic lipomas are the most common tumors of mesenchymal origin in the large intestine. These tumors are typically found in the colon, but are also discovered in the small bowel, stomach, and esophagus. Most gastrointestinal lipomas are asymptomatic and are discovered incidentally during endoscopy or surgery. Large lipomas can cause abdominal pain, gastrointestinal bleeding, obstruction, and intussusceptions and therefore require resection. Surgical resection is typically only considered for the removal of giant lipomas > 2 cm because of concerns regarding the high complication risk of endoscopic resection. New techniques that use endoscopic snare polypectomy with endoloops or endoscopic resection with an endoloop after an unroofing technique have recently been reported. We herein report a case of a 7-cm giant colonic lipoma that was removed by an endoscopic unroofing technique and repetitive endoloop ligation and strangulation.

성인에서 발견된 양측 내엽형 폐분리증 1예

고보건 ( Bo Gun Kho ),고명주 ( Myoung Ju Koh ),김우정 ( Woo Jeung Kim ),김희욱 ( Hee Wook Kim ),허철웅 ( Cheal Wung Huh ),정혜문 ( Hye Moon Chung ),김형중 ( Hyung Jung Kim ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.2

Pulmonary sequestration is a rare congenital anomaly of the lung in which it is separately supplied from the aorta or one of its branches. Bilateral pulmonary sequestration is very rare, particularly in adults. In bilateral pulmonary sequestration, resection of both sides is usually recommended if both sides are infected and symptomatic. We report the case of a 37-year-old female patient with bilateral intralobar pulmonary sequestration treated by staged bilateral lower lobectomy.