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윤순만 ( Soon Man Yoon ),차재명 ( Jae Myung Cha ) 대한소화기학회 2019 대한소화기학회지 Vol.73 No.1
Since the residency training program in internal medicine changed from a four-year to a three-year program in 2017 in Korea, issues of an optimal training program for the gastrointestinal (GI) fellowship has arisen. Currently, the evaluation criteria for a GI fellowship in Korea include the following; 1) the total number of assigned patients during the training period, 2) the number of GI endoscopy procedures, 3) attendance at academic conferences, and 4) research presentations. However, competency-based training should be introduced in the GI fellowship training program. The current issues of GI fellowship training in Korea include the following; 1) reorganization of the GI fellowship education system and consideration of an optimal training period following the introduction of the three-year internal medicine residency training program, 2) development of a standardized, competency-based GI fellowship training program, 3) provision of a support program for instructors in GI fellowship education, 4) introduction of a mentor-mentee system, 5) introduction of an accreditation system for GI fellowship, 6) supplementation of a GI sub-specialty qualification system, and 7) provision of benefits to GI sub-specialists. (Korean J Gastroenterol 2019;73:7-9)
윤순만 ( Soon Man Yoon ) 대한장연구학회 2009 Intestinal Research Vol.7 No.1
대장선종의 내시경 절제술 이후 발생 가능한 대장암을 줄이기 위해 추적 대장내시경 검사가 요구된다. 실제로 한 개 이상의 대장선종을 제거 받은 환자의 경우 3-5년 내 추적내시경을 시행한 결과 약 20-30%에서 이시성 병변(metachronous lesion)이 발견되었으며,1-5 약 20%의 환자들은 직경이 10 mm 이상, 융모성분이 25% 이상, 또는 고도 이형성을 갖는 것으로 정의되는 진행성 선종이 발견되었고,1-6 비록 적은 비율이지만 침습적 대장암 또한 발생하였다.3,7-12 만약 이러한 진행성 대장종양의 발생을 예측할 수 있다면 발생 위험이 높은 환자들을 선별하여 추적 내시경 검사를 더 엄격하게 시행할 수 있을 것이다. 본 연구13는 대장선종을 제거 받은 환자에게 있어서 진행성 대장종양의 발생 위험인자를 평가하고자 총 8개의 북미 연구그룹의 자료를 통합 분석하였다. 초기 대장내시경에서 대장선종을 제거 받은 총 9,167명의 환자가 포함되었으며 연령은 평균 62세(22-80세)였다. 평균 추적기간은 47.2개월(36.9-59.0개월)이었으며 추적기간 중 진행성 대장종양(진행성 선종이나 침습암)이 1,082명(11.8%)에서 발생하였으며 이중 58명(0.6%)은 침습암으로 진단되었다. 이시성 진행 선종의 발생은 초기 대장내시경에서 발견된 선종의 개수가 5개 이상인 경우(24.1%; standard error, 2.2), 선종의 크기가 20 mm 이상인 경우(19.3%; standard error, 1.5)에 증가하였다. 또한 다분량 분석결과 고령(p<0.0001 for trend), 남자(odds ratio, 1.40; 95% CI, 1.19-1.65), 이전 선종의 개수와 크기(p<0.0001 for trend), 융모 성분의 존재(OR, 1.28; 95% CI, 1.07-1.52), 그리고 대장의 근위부에 위치한 경우(OR, 1.68; 95% CI, 1.43-1.98)가 진행성 대장종양 발생의 위험인자였다. 하지만 고도 이형성(highgrade dysplasia)의 경우 선종의 다른 특성들을 모두 배제한 이후에는 진행성 대장종양의 발생과 관련이 없었다. 저자들은 대장선종의 절제술 이후에도 진행성 대장종양의 발생은 비교적 흔하며 이러한 위험인자로는 고령, 이전 선종의 개수와 크기가 가장 강한 상관관계가 있는 것으로 결론짓고 있다.
십이지장 궤양 출혈의 내시경 지혈술 후 발견된 분리췌장
최용혁 ( Yong Hyeok Choi ),윤순만 ( Soon Man Yoon ),김은비 ( Eun Bee Kim ),오영민 ( Youngmin Oh ),김근모 ( Keunmo Kim ),이지선 ( Jisun Lee ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.4
Peptic ulcer bleeding is treated using endoscopic hemostasis using clips or bands. Pancreas divisum (PD), a congenital anomaly of the pancreas, usually has no clinical symptoms; however, pancreatitis may occur if there are disturbances in the drainage of pancreatic secretions. We report an unusual case of PD accompanied by acute pancreatitis, following endoscopic band ligation for duodenal ulcer bleeding. A 48-year-old woman was admitted to our hospital due to melena. An upper endoscopy revealed a small ulcer with oozing adjacent minor papilla. An endoscopic band ligation was performed on this lesion. Acute pancreatitis developed suddenly 6 hours after the band ligation and improved dramatically after removal of the band. Magnetic resonance cholangiopancreatography was performed, revealing complete PD. Endoscopic band ligation is known as the effective method for peptic ulcer bleeding; however, it should be used carefully in duodenal ulcer bleeding near the minor duodenal papilla due to the possibility of PD. (Korean J Gastroenterol 2017;69:248-252)
김정욱 ( Jong Wook Kim ),윤순만 ( Soon Man Yoon ),명승재 ( Seung Jae Myung ) 대한장연구학회 2011 Intestinal Research Vol.9 No.2
Endoscopic detection of gastrointestinal cancer currently depends in large part on white light images, which show mucosal surface changes in real time. Molecular imaging is a rapidly growing new field in gastrointestinal endoscopy, which could provide additional information about molecular expression of cells and processes involved in cancer biology. It uses the molecular signature of cells for minimally-invasive, targeted imaging of gastrointestinal pathologies. Exogenous fluorescent agents serve as molecular beacons and include labeled peptides and antibodies, and probes with tumor-specific activation. An advantage of molecular imaging in digestive tract is the opportunity to apply such agents topically, overcoming the hurdles for delivery of these agents to the region of involvement, including immunogenic reaction and potential toxicity. Recently developed molecular targets include proteolytic enzymes, endothelial-specific markers, and apoptosis reporters. Molecular imaging has the potential to greatly impact on future endoscopy in gastroenterology. (Intest Res 2011;9:90-96)
폴립 절제 후 추적대장내시경검사 진료지침 개정안 2022
김수영 ( Su Young Kim ),곽민섭 ( Min Seob Kwak ),윤순만 ( Soon Man Yoon ),정윤호 ( Yunho Jung ),김정욱 ( Jong Wook Kim ),부선진 ( Sun-Jin Boo ),오은혜 ( Eun Hye Oh ),전성란 ( Seong Ran Jeon ),남승주 ( Seung-Joo Nam ),박선영 ( Seon 대한소화기학회 2022 대한소화기학회지 Vol.80 No.3
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: 1) adenoma ≥10 mm in size; 2) 3-5 (or more) adenomas; 3) tubulovillous or villous adenoma; 4) adenoma containing high-grade dysplasia; 5) traditional serrated adenoma; 6) sessile serrated lesion (SSL) containing any grade of dysplasia; 7) serrated polyp of at least 10 mm in size; and 8) 3-5 (or more) SSLs. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC. (Korean J Gastroenterol 2022;80:115-134)
김기배 ( Ki Bae Kim ),김형우 ( Hyoung Woo Kim ),이준수 ( Jun Su Lee ),윤순만 ( Soon Man Yoon ) 대한소화기학회 2020 대한소화기학회지 Vol.76 No.6
Vitamin D contributes to bone metabolism and acts as an immune modulator for both innate and adaptive immunity. The serum level of vitamin D has been associated with inflammatory diseases, such as inflammatory bowel disease (IBD). In epidemiologic studies, IBD patients have been shown to have low levels of vitamin D. The suboptimal circulating levels of vitamin D in IBD patients may be caused by low exposure to sunlight, dietary malabsorption, and the impaired conversion of active metabolites (1,25[OH]<sub>2</sub>D). Recent studies have demonstrated that vitamin D deficiency in IBD can increase the chance of disease recurrence, IBD-related hospitalization or surgery, and deterioration of quality of life. Supplementation with vitamin D is therefore thought to reduce the risk of flare-ups and the improvement of the quality of life in IBD patients. This review aims to summarize the latest knowledge on the effects of vitamin D deficiency on IBD and the possible benefits of vitamin D supplementation in IBD patients. (Korean J Gastroenterol 2020;76:275-281)