조기대장암의 임상 양상 및 치료 결과

권광안 ( Kwang An Kwon ),김유경 ( Yu Kyung Kim ),정문기 ( Moon Gi Chung ),박동균 ( Dong Kyun Park ),권오상 ( Oh Sang Kwon ),김선숙 ( Sun Suk Kim ),김연석 ( Yeon Suk Kim ),권소영 ( So Young Kwon ),구양서 ( Yang Suh Ku ),최덕주 ( Du 대한장연구학회 2005 Intestinal Research Vol.3 No.2

목적: 최근 조기대장암의 내시경 치료의 가능성에 대한 관심이 높아지고 있다. 이에 저자들은 조기대장암의 임상양상 및 치료결과에 대하여 알아보고자 하였다. 대상 및 방법: 1999년 7월부터 2004년 6월까지 대장암으로 진단 받은 969명 중 117명(120병소)의 조기대장암 환자의 의무기록을 후향적으로 조사하였다. 결과: 전체 대장암 중 조기대장암의 빈도는 12.1%였고 점막암이 80예, 점막하층암이 40예였다. 조기대장암에서 병변의 평균크기는 1.8 cm, 암조직의 평균크기는 1.1 cm였다. 병변의 평균크기는 점막하층암이 2.2 cm로 점막암의 1.7 cm보다 컸다(p=0.03). 육안적 분류로 편평형에서 점막하층암이 30%로 점막암의 15%보다 높은 경향을 보였다(p=0.07). 조직학적 분화도는 고분화선암이 77.5%였으며, 중등도 분화를 보인 경우는 점막하층암에서 63%로 점막암의 3%보다 유의하게 높았다(p<0.001). 조기대장암에 대한 치료는 점막암 80예중 초치료로 10예에서 수술을 시행하였고, 70예에서 내시경 절제를 하였으며, 이 중 2예에서 추가 수술적 절제를 시행하였다. 점막하층암 40예에서는 초치료로 19예에서 수술을 시행하였으며, 21예가 내시경 절제를 받았고 이 중 13예에서 추가 수술적 절제를 받았다. 결론: 본 연구에서 조기대장암의 빈도는 12.1%로 국내 과거 보고보다 증가하고 있으며, 조기대장암에서 내시경 치료를 고려하는 경우 크기가 2 cm 이상이며 중등도 분화도를 보이는 편평형 조기대장암에서는 점막하층암일 가능성을 고려하는 것이 치료에 도움이 될 것으로 생각한다. Background/Aims: Recently, it has been more interested in the early colorectal cancer (ECC) with possibility of endoscopic treatment. We evaluated the clinicopathological characteristics and the treatment results of the ECC. Methods: 120 cases of ECC from 969 patients with colon cancer were analyzed. The cases of concomitant advanced colon cancer were excluded. Results: 12.1% of total colon cancer was ECC. 80 and 40 cases were mucosal (M) and submucosal (SM) cancer, respectively. The size of lesion and cancer tissue of SM cancer was significantly larger than that of M cancer (lesion size, 2.2 vs. 1.7 cm, p=0.03; cancer size, 1.7 vs. 0.7 cm, p<0.001). The prevalence of flat type in SM cancer was higher than that of M cancer (30% vs. 15%, p=0.07). Moderately-differentiated type was more common in SM cancer than M cancer (63% vs. 3%, p<0.001). 15 cases received the additional operation (M cancer; 2, SM cancer; 13). The metastasis of lymph nodes was verified in 2 cases of SM cancer. Conclusions: The ECC with flat type, more than 2 cm in size and moderately-differentiated type had the possibility of SM cancer. Therefore endoscopic treatment in patients with those characteristics should be considered with caution. (Intestinal Research 2005;3:133-139)

담석성 췌장염 치료에서 내시경적 유두부 괄약근절개술의 임상적 유용성

박상흠(Sang Heum Park),권광안(Kwang An Kwon),김인호(In Ho Kim),김은주(Eun Joo Kim),정일권(Il Kwun Chung),김홍수(Hong Soo Kim),이문호(Moon Ho Lee),김선주(Sun Joo Kim) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3

Background/Aims : Gallstone pancreatitis has been classically treated by cholecystectomy to prevent recurrence of pancreatitis. However, for patients whose condition is not suitable to operation, endoscopic sphincterotomy (EST) without cholecystectomy was recently performed. Thus, we analyzed the result of EST without cholecystectomy in patients with gallstone pancreatitis and evaluated its clinical usefulness. Methods: Seventeen patients who were diagnosed as gallstone pancreatitis from January 1997 to January 2000 and treated by EST without cholecystectomy because of difficulties in operation were enrolled in this study. The patients were followed up by visiting outpatient department or interview by telephone. Results: The mean age was 64.4 years and the mean duration of follow-up was 15.5 months. According to modified Glasgow criteria, the disease status of 14 patients were mild and the other 3 patients were severe. The site of gallstones were gallbladder in 6 patients, common bile duct (CBD) in 2, and both in 6. Success rate of stone removal in CBD was 100%(11/11) and EST-related complication rate was 6%(1/11). During the follow-up period, there were no pancreatobiliary diseases. Conclusions: EST without cholecystectomy is a safe and useful therapeutic modality in patients with gallstone pancreatitis who had diffculties in operation. (Kor J Gastroenterol 2000;36:383 - 389)

폐쇄성 대장암의 고식적 치료

권한석(Han Seok Kwon),권광안(Kwang An Kwon),오재환(Jae Hwan Oh),백정흠(Jeong-Heum Baek) 대한외과학회 2006 Annals of Surgical Treatment and Research(ASRT) Vol.71 No.5

위장관 , 10일간의 동시치료가 10일간의 순차치료보다 헬리코박터 파일로리 제균율이 우월하다

김수영 ( Su Young Kim ),박동균 ( Dong Kyun Park ),권광안 ( Kwang An Kwon ),김경오 ( Kyoung Oh Kim ),김윤재 ( Yoon Jae Kim ),정준원 ( Jun Won Chung ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.5

Background/Aims: Because the efficacy of standard triple therapy for Helicobacter pylori eradication has declined, new regimens such as sequential therapy (ST) and concomitant therapy (CoCTx) have been introduced. The aim of this study was to compare the efficacy of 10-day ST and 10-day CoCTx for H. pylori eradication. Methods: We retrospectively reviewed the medical records of 316 patients with proven H. pylori infection. They were assigned to one of 2 regimens, ST (n=191) consisted of, lansoprazole 30 mg and amoxicillin 1 g for 5 days followed by lansoprazole 30 mg, metronidazole 500 mg, and clarithromycin 500 mg for 5 days, and CoCTx (n=125) consisted of lansoprazole 30 mg, amoxicillin 1 g, metronidazole 500 mg, and clarithromycin 500 mg for 10 days. All drugs were administered twice a day. Bacterial eradication was checked by using a 13C-urea breath test at least 4 weeks after completion of treatment. Results: The mean age and male to female ratio was 51.74 and 1.03, respectively. Baseline characteristics were not different in both groups. Ten day CoCTx group (94.4%, 118/125) showed better eradication rate than ST group (82.2%, 157/191) (p=0.002). Drug compliances were not statistically different between the two groups (p=0.19). Side effects were more frequently reported in the CoCTx group than in the ST group (p=0.03). Conclusions: Ten-day CoCTx was superior to ST in terms of eradicating H. pylori infection. Although the CoCTx producing more side effects than ST, CoCTx can be thought to be a promising alternative to ST as a treatment regimen for H. pylori eradication. (Korean J Gastroenterol 2014,64:260-267)

위장관 ; Helicobacter pylori 감염 여부에 대한 집합 세정맥 규칙적 배열의 유용성

나선영 ( Sun Young Na ),정준원 ( Jun Won Chung ),박현주 ( Hyun Joo Park ),김윤재 ( Yoon Jae Kim ),권광안 ( Kwang An Kwon ),함기백 ( Ki Baik Hahm ),최덕주 ( Duck Joo Choi ),정석후 ( Seok Hoo Jeong ),하민수 ( Min Su Ha ),김금하 ( Ge 대한소화기학회 2011 대한소화기학회지 Vol.58 No.5

Background/Aims: In the Helicobacter pylori (H. Pylori)-negative normal stomach, collecting venules are visible over all the gastric body as numerous minute points evaluated with standard endoscopy. This finding was termed regular arrangement of collecting venules (RAC), and its absence suggests H. pylori gastritis. The aim of this study was to evaluate the correlation between the RAC and rapid urease test. Methods: Two hundred sixty three consecutive adults undergoing upper digestive endoscopy and rapid urease test were included. The lesser curvature of the lower corpus was evaluated for the RAC pattern using a standard endoscope and different hemoglobin index. Two biopsies from the lesser curvature of the antrum and the greater curvature of the body were collected for rapid urease test. Results: H. pylori were detected in 51.3% (135/263) patients. Of the 57 patients with H. pylori-negative normal stomachs 53 patients (93%) had RAC. As a determinant of the normal stomach without H. pylori infection, the presence of RAC had 41.4% sensitivity, 97.0% specificity, 93.0% positive predictive value and 63.6% negative predictive value. Conclusions: RAC-positive finding by standard endoscopy showed high positive predictive value and specificity of H. pylori-negative normal stomach. RAC-positive finding by standard endoscopy could be an useful finding to predict H. pylori negativity. (Korean J Gastroenterol 2011;58:252-257)

급성 췌장염 회복기에 발생한 대장폐색

정낙소 ( Nak So Chung ),김연석 ( Yeon Suk Kim ),박철희 ( Cheul Hee Park ),김성용 ( Sung Yong Kim ),이미라 ( Mi Ra Lee ),권광안 ( Kwang An Kwon ),정문기 ( Moon Gi Chung ),박동균 ( Dong Kyun Park ),김선숙 ( Sun Suk Kim ),권소영 ( So 대한소화기학회 2005 대한소화기학회지 Vol.45 No.3

Complications of acute pancreatitis usually occur in pancreas and its contiguous organs. The prevalence of colonic invasion is rare, however, the consequence is fatal, with mortality above 50%. The initial symptoms and onset times are variable and major a

위장관 ; 메타분석: 한국에서 Helicobacter pylori 제균에 순차치료가 기존치료보다 우월하다

정준원 ( Jun Won Chung ),하민수 ( Min Su Ha ),윤성철 ( Sung Cheol Yun ),김정호 ( Jung Ho Kim ),이종준 ( Jong Jun Lee ),김윤재 ( Yoon Jae Kim ),김경오 ( Kyoung Oh Kim ),권광안 ( Kwang An Kwon ),박동균 ( Dong Kyun Park ),이동호 ( Do 대한소화기학회 2013 대한소화기학회지 Vol.62 No.5

Background/Aims: Conventional triple therapy (CT) for Helicobacter pylori infection fails in up to one-third of patients. Sequential therapy (ST) seem be more effective than CT in other countries. However, there is no systemic literature review that directly compares CT and ST in Korea. The aim of this study was to compare ST with CT for H. pylori infection in Korea. Methods: Six randomized, prospective controlled trials were used to compare 10-day ST and 7- to 14-day CT in treatment-naive patients with documented H. pylori infection in Korea. Pooled eradication rates and OR with 95% CI were calculated. Results: The intention-to-treat eradication rates of H. pylori involving 1,529 patients were 79.7% (95% CI, 76.8-82.5%) for ST (n=754) and 68.1% (95% CI, 64.8-71.4%) for CT (n=775) (OR, 1.838; p<0.001). The per-protocol eradication rate of H. pylori involving 1,366 patients was 86.4% (95% CI, 83.3-88.5%) for ST (n=682) and 76.0% (95% CI, 72.8-79.2%) for CT (n=684) (OR, 1.974; p<0.001). Conclusions: Ten-day ST was superior to CT in terms of eradicating H. pylori infection. Therefore, ST should be considered as a first-line therapy in Korea. However, ST did not achieve a sufficient eradication rate. More effective therapy should be developed. (Korean J Gastroenterol 2013;62:267-271)

헬리코박터 파일로리 제균에서 10일 사제 동시 치료와 Rebamipide, Ecabet 추가 요법의 치료성적의 비교

김준환 ( Joonhwan Kim ),김경원 ( Kyungwon Kim ),이준수 ( Jun Soo Lee ),김수영 ( Su Young Kim ),김경오 ( Kyung Oh Kim ),김윤재 ( Yoon Jae Kim ),권광안 ( Kwang An Kwon ),박동균 ( Dong Kyun Park ),정준원 ( Jun-won Chung ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.4

목적: Rebamipide와 ecabet sodium은 위점막을 보호하여 위염, 위궤양 치료에 사용되며, H. pylori의 증식과 생장을 억제하여 제균 치료에도 이용될 수 있다는 보고가 있다. 본 연구에서는 rebamipide와 ecabet sodium을 PPI, amoxicillin, metronidazole, clarithromycin로 이루어지는 사제 동시 치료에 각각 추가하여 H. pylori의 제균에 어떠한 영향을 미치는지 확인하고자 하였다. 대상 및 방법: H. pylori 제균 치료가 필요한 환자들을 대상으로 PPI를 포함한 non-bismuth 사제 동시 치료, rebamipide추가 치료, ecabet 추가 치료를 각각 시행하였다. 제균율은 치료 종료 4주 후 ¹³C-요소호기 검사를 통해 확인하였다. 결과: 사제 동시 치료군 총 118명 중 97명(82.2%), rebamipide추가 요법군 총 85명 중 77명(90.6%), ecabet sodium 추가요법군 총 74명 중 66명(89.2%)이 제균되었으며, 통계적 유의성은 없었다. 약물 순응도는 세 군에서 차이가 없었으며, 사제동시 치료군(32.2%)보다 rebamipide 추가 요법군(50.6%)에서 통계적으로 유의하게 높은 부작용률을 보였다(p=0.01). 또한 다변량 분석에서 치료 순응도가 감소할수록 H. pylori 제균 실패의 위험도가 유의하게 증가하는 것으로 나타났다(odds ratio 3.52, 95% confidence interval 1.00-12.32; p=0.05). 결론: 본 연구에서는 rebamipide와 ecabet sodium을 기존의 PPI를 포함한 사제 동시 치료에 추가하여도 제균율이 유의하게 증가하지 않았다. 이러한 결과는 높은 항생제 내성과 관련이 있다고 생각되며 향후 전향적인 연구로 확인이 필요해 보인다. 또한 환자의 약물 순응도가 높을수록 H. pylori 제균치료 성공률이 높으므로 동시 치료 처방 시 약물 순응도의 중요성을 환자에게 교육 및 강조할 필요가 있다. Background/Aims: Although some previous studies reported that a treatment combined with mucoprotective agent could improve the eradication rate in dual or triple therapy, there are other reports that question the efficacy of combining these drugs in concomitant therapy (CoCTx). The aim of this study was to investigate the effects of rebamipide or ecabet on the Helicobacter pylori (H. pylori) eradication combined with CoCTx. Methods: We retrospectively reviewed the medical records of 277 patients with proven H. pylori infection. They were assigned to one of 3 regimens for 10 days, twice daily: (a) CoCTx (n=118): lansoprazole 30 mg, amoxicillin 1 g, metronidazole 500 mg, and clarithromycin 500 mg; (b) CoCTx+rebamipide (100 mg) (n=85); (c) CoCTx+ecabet (1 g) (n=74). Results: The baseline characteristics were not significantly different. H. pylori eradication rates were 82.2% (97/118) in CoCTx, 90.6% (77/85) in CoCTx+rebamipide, and 89.2% (66/74) in CoCTx+ecabet (p=0.17), which were statistically insignificant. Overall adverse events were more frequently reported in the CoCTx+rebamipide (50.6%. 43/85) and CoCTx+ecabet (44.6%, 33/74) groups than in the CoCTx (32.2%, 38/118) (p = 0.03) group. Drug compliances were not different between three groups (CoCTx: 95.8%, 113/118; CoCT+rebamipide: 92.9%, 79/85; CoCTx+ecabet 98.6%,73/74) (p=0.209). Multivariate analysis showed that the risk of eradication failure was significantly increased with decreased drug compliance (odds ratio 3.52, 95% confidence interval 1.00-12.32; p=0.05). Conclusions: Addition of these mucoprotective agent was not superior to CoCTx alone for eradicating H. pylori infection with frequent adverse events. Rather, drug compliance is the most related factor affecting the eradication rate. Our data suggest the importance of drug compliance over the drugs used. (Korean J Gastroenterol 2018;71:204-212)

만성 간질환에서 혈중 Gelatinase (Matrix Metalloproteinase-2와 9)의 측정 의의

권오상,임도윤,권광안,정문기,박동균,김선숙,김연석,권소영,구양서,김유경,최덕주,김주현,황유진,변관수,이창홍 대한간학회 2003 Clinical and Molecular Hepatology(대한간학회지) Vol.9 No.3

목적: Gelatinase (MMP-2와 9)는 기저막의 주구성요인 type IV collagen을 분해하는 효소로, MMP-2는 간경변과 MMP-0은 간세포암의 진행과 연관이 있는 것으로 알려져 있다. 본 연구에서는 만성 간질환과 MMP-2와 9의 관계를 알아보고자 하였다. 대상과 방법: 간기능이 정상이고 간질환이 없는 건강 대조군 10예, 만성 간염 15예, 간경변 18예, 그리고 간세포암 25예를 대상으로 혈장을 채취하여 MMP-2와 9의 활성을 보기 위해 zymography를 시행하였다. 결과: 혈장 MMP-2의 활성은 간경변군에서 건강 대조군(p=0.009)과 만성 간염군(p=0.011)에 비해 증가되어 있었으나 간세포암군과는 차이가 없었다. 혈장 MMP-9의 활성은 간경변군에서 건강 대조군에 비해 증가되어 있었으나(p=0.035), 만성 간염군과 간세포암군과는 차이가 없었다. 간세포함이 없는 간경변군 15예와 간세포암을 동반한 간경변군 23예를 합친 총 간경변군 38예에서 MMP-2의 활성은 total bilirubin이 높을수록 (r=0.323, p=0.048) 그리고 Child-Pugh 점수가 높을수록(r=0.414, p=0.012) 증가되어 있었다. 총 간경변군에서 MMP-2와 MMP-9의 활성은 알코올 성 간경변군에서 HBV에 의한 간경변군 보다 현저히 증가되어 있었다(각각 p=0.009, p=0.002). 결론: 혈장 MMP-2의 활성은 간경변의 진단과 중증도에 유용한 표지자로 사용될 수 있을 것이다. 혈장 MMP-9의 활성은 간세포암에서의 유용성은 적으리라 생각되나 알코올성 간경변의 진단적 표지자로는 유용하리라 생각된다. MMP-2와 MMP-9의 활성은 간경변의 원인 별로 차이가 나는 것으로 생각되며 그 이유에 대한 연구가 필요하리라 생각된다. Background/Aims: Gelatinase (matrix metalloproteinase (MMP) -2 and 9) has an important role in the pathogenesis of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). In this study, we evaluated the relationship of gelatinase to chronic liver disease. Methods: Four groups of subjects were examined; healthy control (10 cases), chronic hepatitis (18 cases), LC (15 cases), and HCC (28 cases). The plasma of each subject was obtained, and the equal quantification of plasma protein was done. The plasma activities of MMP-2 and 9 were measured by zymography. Results: The activities of plasma MMP-2 in patients with LC were significantly higher than those in controls (p=0.009) and in patients with chronic hepatitis (p=0.011), but not different from those in patients with HCC. The activities of plasma MMP-9 in patients with LC were significantly higher than those in controls, but not different from those in patients with chronic hepatitis or HCC. In patients with LC (regardless of having HCC), the activities of MMP-2 correlated with total bilirubin (r=0.323, p=0.048) and Child-Pugh score (r=0.414, p=0.012). The activities of MMP-2 and 0 were higher in patients with LC (regardless of having HCC) caused by alcohol than caused by HBV (p=0.009 and 0.0002 for each one). Conclusions: The plasma activity of MMP-2 may be a useful marker for the diagnosis and determination of the severity of LC. The plasma activity of MMP-9 was not useful for HCC, but may be a marker for alcoholic LC. Further study is needed to determine why the plasma activity of gelatinase was higher in patients with LC caused by alcohol than by HBV.(Korean J Hepatol 2003;9:222-230)

신생아 및 영아 환아에서 상부위장관 내시경검사의 임상적 유용성

김은주,김홍수,이진우,이문호,김선주,백무준,이혜경,박상흠,권광안,정일권,민용식 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.6

Background/Aims: Endoscopic examination of upper gastrointestinal tract disease in infancy and childhood was introduced 2 decades ago. However, clinical indication, premedication, endoscopic features, and practical problems have been infrequently reported in neonate and infants, Therefore, the usef'ulness and problems of endoscopy in these pediatric patients was evaluated. Methods: Twelve pediatric patients who underwent endos-copic examination which involved a choledochoscope, bronchoscope, and gastrofibroscope included 8 neonates and 4 infants who suffered from gastrointestinal symptoms. Drugs for premedication were chloral hydrate, diazepam, midazolam and ketamine in single or combined administration. Results: Clinical manifestations were hematemesis (67%), melena (42%), vomiting (8%), weight loss (8%), fever (8%) and irritability (8%). Indica-tions for endoscopic examination were upper gastrointestinal Weeding (67%), upper gastrointestinal obstruction (8%), acute drug intoxication (8%), foreign bodies in the stomach (8%) and evaluation for varix (8%). Endo-scopic findings revealed a gastric ulcer (48%), acute gastric mucosal lesion (8/$lt;), external compression on the duodenum (8%), a gastric foreign body (8%), acute esophago-gastritis (8%) and esophageal and gastric varix (8%). Therapeutic endoscopy was performed in 2 patients, One case of hypoxia occurred during diagnostic endoscopy. Conclusions: Endoseopic examination of the upper gastrointestinal tract is a useful and safe proce-dure to detect diseases in neonates and infants if it is done by experienced endocopists and in the circumstances of adequate premedication.