진정내시경시 환자의 감시 및 관련 장비

문성훈 ( Sung-hoon Moon ),김형근 ( Hyung-keun Kim ),명대성 ( Dae-seong Myung ),윤순만 ( Soon Man Yoon ),문원 ( Won Moon ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.1

Sedation is an essential component for gastrointestinal endoscopy. It allows patients to tolerate unpleasant endoscopic procedures by relieving anxiety, discomfort, or pain. It also reduces patient`s risk of physical injury during endoscopic procedures, while providing the endoscopist with an adequate setting for a detailed examination. For the safety during endoscopic sedation, patient monitoring is crucial. Minimal monitoring requirements during endoscopic sedation are periodic assessment of blood pressure and application of continuous pulse oximetry. Continuous electrocardiography is recommended in selected patients with high risk for sedation or have cardiopulmonary diseases. Continuous supplemental oxygen is also recommended for endoscopic sedation. This study describes detailed monitoring and associated devices based on the current guidelines and recommendations from gastrointestinal society of America, Europe, and Korea. (Korean J Gastroenterol 2017;69:64-67)

간암 고주파 열 치료술 후에 발생한 횡경막 탈장

김종선 ( Jong Sun Kim ),김형상 ( Hyoung Sang Kim ),명대성 ( Dae Sung Myung ),이기훈 ( Gi Hoon Lee ),박강진 ( Kang Jin Park ),조성범 ( Sung Bum Cho ),주영은 ( Young Eun Joo ),최성규 ( Sung Kyu Choi ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.3

Because of its safety and treatment effectiveness, the popularity of radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC) has gradually increased. However, some serious complications of RFA such as hepatic infarction, bowel perforation, and tumor seeding have been reported. Recently, we experienced a case of diaphragmatic hernia after RFA for HCC. A 61-year-old man with alcoholic cirrhosis was diagnosed with a 1.0 cm sized HCC in segment (S) 5 and a 1.3 cm sized HCC in S 8 of the liver. He was treated by transarterial chemoembolization and RFA. After RFA, an abdominal CT revealed a diaphragmatic defect with herniating mesentery. Twenty-two months after the RFA, the chest CT showed the diaphragmatic defect with herniating colon and mesentery. Because he had no symptoms, and surgical repair for the diaphragmatic hernia would be a high risk operation for him, we decided to treat the patient conservatively. For its great rarity, we report this case with a review of the literature. (Korean J Gastroenterol 2013;62:174-178)

소화기내과 전임의 수련에 대한 COVID-19의 영향

신현필 ( Hyun Phil Shin ),차재명 ( Jae Myung Cha ),김범경 ( Beom Kyung Kim ),명대성 ( Dae-seong Myung ),문성훈 ( Sung-hoon Moon ),송명준 ( Myeong Jun Song ),윤승배 ( Seung Bae Yoon ),유인경 ( In Kyung Yoo ),이정훈 ( Jeong Hoon 대한소화기학회 2021 대한소화기학회지 Vol.77 No.5

목적: COVID-19 유행은 다양한 사회 문화적 변화를 야기하였지만, 소화기내과 전임의 교육에 대한 영향에 대한 연구는 거의 없었다. 이번 연구에서는 소화기내과 전임의 수련에 대한 COVID-19의 영향에 대해 조사하였다. 대상 및 방법: 2021년 2월 15일부터 3월 15일까지 국내 소화기내과 전임의들에게 온라인 기반 설문조사를 발송하였다. 설문은 소화기내과 전임의의 특성, COVID-19의 유행에 대한 인식도, COVID-19과 비대면 진료의 소화기내과 전임의 교육에 대한 영향에 대한 내용으로 구성되었다. 결과: 111건의 설문 결과들 중 94건의 설문 응답을 분석하였다. 소화기내과 전임의들은 COVID-19 유행에 대해 충분한 정보를 제공받고 있었으며(74.7%), 개인보호장구 착용에 대해 잘 교육받고 있었고, 충분히 제공받고 있었다(각각 74.7% 및 83.9%). 하지만, 외래 진료 스케줄과 환자 수는 각각 25.5%와 37.8%의 응답자들이 감소하였다고 응답하였고, 소화기 내시경 검사 세션과 환자 수도 각각 51.1%와 65.6%의 응답자들이 감소하였다고 응답하였다. 그 결과, 응답자들의 78.9%는 COVID-19의 유행으로 교육에 부정적인 영향을 받았다고 답변하였다. COVID-19 유행 동안에 도입된 비대면 진료가 각각 환자와 의사 측면에서 긍정적인 면이 있다고 답변한 응답자들은 불과 20.0%와 10.6%에 불과하였다. 게다가, 응답자들의 25.9%만이 수가가 적절하게 보상되더라도 비대면 진료를 이용하겠다고 응답하였으며, 68.2%의 응답자들은 비대면 진료가 교육에 부정적인 영향이 있다고 응답하였다. 결론: COVID-19 유행은 외래 진료 감소, 소화기 내시경 검사 감소, 온라인 컨퍼런스, 비대면 진료 도입을 통해 국내 소화기내과 전임의들의 교육에 부정적인 영향이 있었다. COVID-19와 같은 감염병 유행 시에 소화기내과 전임의 교육에 대한 대책 마련이 필요하다. Background/Aims: The coronavirus disease 2019 (COVID-19) outbreak caused numerous social and cultural changes, but few studies focused on their effects on gastroenterology (GI) fellowship training. This study evaluated the impact of COVID-19 on GI fellowship training. Methods: A web-based questionnaire was sent out to GI fellows in Korea between 15 February and 15 March 2021. The questionnaire included questions regarding the characteristics of GI fellows, perception of COVID-19 outbreak, impact of COVID-19 outbreak, and telemedicine on the education of a GI fellowship. Results: Among 111 answers, 94 respondents were analyzed. The GI fellows were provided with sufficient information about the COVID-19 outbreak (74.7%), well educated, and provided with personal protective equipment use (74.7% and 83.9%, respectively). On the other hand, outpatient schedule and volume decreased in 25.5% and 37.8% of respondents, respectively. Moreover, endoscopy sessions and volume decreased in 51.1% and 65.6% of respondents, respectively. As a result, 78.9% of respondents were concerned that the COVID-19 outbreak adversely affected their education. Telemedicine utilization was introduced during the COVID-19 outbreak, but only 20.0% and 10.6% of respondents agreed that telemedicine has benefits from the patient’s and doctor’s perspectives, respectively. In addition, only 25.9% of respondents were willing to continue telemedicine if adequately reimbursed, and 68.2% of respondents were concerned that it adversely affected their education. Conclusions: The COVID-19 outbreak has adversely affected GI fellowship training in Korea for outpatient clinics, gastrointestinal endoscopy, educational conferences, and telemedicine. This study highlights that GI fellowship training needs more attention in the COVID-19 outbreak. (Korean J Gastroenterol 2021;77:205-213)

대한소화기내시경학회 내시경 세척 및 소독 지침

김병욱 ( Byung-wook Kim ),손병관 ( Byoung Kwan Son ),김원희 ( Won Hee Kim ),명대성 ( Dae-sung Myung ),조영석 ( Young-seok Cho ),장병익 ( Byung Ik Jang ) 대한내과학회 2018 대한내과학회지 Vol.93 No.2

대한소화기내시경학회 내시경 세척 및 소독 지침

김병욱 ( Byung-wook Kim ),손병관 ( Byoung Kwan Son ),김원희 ( Won Hee Kim ),명대성 ( Dae-sung Myung ),조영석 ( Young-seok Cho ),장병익 ( Byung Ik Jang ) 대한내과학회 2017 대한내과학회지 Vol.92 No.3

Korean Society of Gastrointestinal Endoscopy (KSGE) issued its guidelines for endoscope reprocessing for the first time in 1995, and the version of the guidelines has been updated in August 2009, August 2012 and March 2015, respectively. Guidelines for endoscope reprocessing should be revised continuously because new disinfectants and devices are introduced. The current official version of the KSGE guidelines for endoscope reprocessing is explained herein to assist the reader in understanding of KSGE requirements for cleaning and disinfection of endoscopes. (Korean J Med 2017;92:239-244)

위장관 ; 위장관기질종양과 구별되는 위 신경초종의 초음파 내시경 특징

박형철 ( Hyung Chul Park ),손동준 ( Dong Jun Son ),오형훈 ( Hyung Hoon Oh ),옥찬영 ( Chan Young Oak ),김미영 ( Mi Young Kim ),정조윤 ( Cho Yun Chung ),명대성 ( Dae Seong Myung,),김종선 ( Jong Sun Kim ),조성범 ( Sung Bum Cho ),이 대한소화기학회 2015 대한소화기학회지 Vol.65 No.1

Background/Aims: Gastric schwannoma (GS), a rare neurogenic mesenchymal tumor, is usually benign, slow-growing, and asymptomatic. However, GS is often misdiagnosed as gastrointestinal stromal tumors (GIST) on endoscopic and radiological examinations. The purpose of this study was to evaluate EUS characteristics of GS distinguished from GIST. Methods: A total of 119 gastric subepithelial lesions, including 31 GSs and 88 GISTs, who were histologically identified and underwent EUS, were enrolled in this study. We evaluated the EUS characteristics, including location, size, gross morphology, mucosal lesion, layer of origin, border, echogenic pattern, marginal halo, and presence of an internal echoic lesion by retrospective review of the medical records. Results: GS patients comprised nine males and 22 females, indicating female predominance. In the gross morphology according to Yamada`s classification, type I was predominant in GS and type III was predominant in GIST. In location, GSs were predominantly located in the gastric body and GISTs were predominantly located in the cardia or fundus. The frequency of 4th layer origin and isoechogenicity as compared to the echogenicity of proper muscle layer was significantly more common in GS than GIST. Although not statistically significant, marginal halo was more frequent in GS than GIST. The presence of an internal echoic lesion was significantly more common in GIST than GS. Conclusions: The EUS characteristics, including tumor location, gross morphology, layer of origin, echogenicity in comparison with the normal muscle layer, and presence of an internal echoic lesion may be useful in distinguishing between GS and GIST.