박리성 올가미로 지혈한 대장의 거대 용종양 동정맥기형 1예

지정선 ( Jeong Seon Ji ),이보인 ( Bo In Lee ),김병욱 ( Byung Wook Kim ),최황 ( Hwang Choi ),조세현 ( Se Hyun Cho ),최규용 ( Kyu Yong Choi ),정우철 ( Woo Chul Chung ),이강문 ( Kang Moon Lee ),채현석 ( Hyun Suk Chae ),정인식 ( In S 대한장연구학회 2004 Intestinal Research Vol.2 No.1

Arteriovenous malformation is well known cause of lower gastrointestinal bleeding in elderly patients. This is relatively uncommon in people younger than 50 years of age. Endoscopically, it generally appears as bright red flat or elevated bright red lesion. A polypoid appearance is extremely uncommon. We report a case of large polypoid arteriovenous malformation of colon in 81-year-old male patient. He has complained of hematochezia for 4 days. During colonoscopy, a 3.5 cm sized semipedunculated polypoid mass in the proximal transverse colon was detected. For prevention of bleeding, detachable snare was applied and biopsy was done. 3 days later, follow up colonoscopy was done. There was no hemorrhege. We performed endoscopic mucosal resection. Polypoid arteriovenous malformation of colon was comfirmed by microscopic findings. Histologically, section of excised polyp shows ulceration, hemorrhage and the dilated, irregularly thick walled blood vessels in the mucosa and submucosa.

크론병 환자에서 의사별 치료 행태의 차이

최황 ( Hwang Choi ),김상우 ( Sang Woo Kim ),이강문 ( Kang Moon Lee ),이보인 ( Bo In Lee ),정대영 ( Dae Young Cheung ),김민국 ( Min Kuk Kim ),정현정 ( Hyun Jung Jung ),김형근 ( Hyung Keun Kim ),지정선 ( Jeong Seon Ji ),박수헌 ( So 대한장연구학회 2009 Intestinal Research Vol.7 No.1

Background/Aims: The incidence and prevalence of Crohn’s disease are increasing in Korea. However, the guidelines for the management of Crohn``s disease have not been established in Korea. In the current study we determined the difference in the treatment methods between physicians in Korea for Crohn’s disease. Methods: We retrospectively analyzed the use of medical and surgical treatment modalities in 92 patients with newly diagnosed Crohn``s disease. We compared the treatment strategies among 4 physicians at 3 different institutions. Results: Prednisone, 5-aminosalicylates, antibiotics, immunomodulators, infliximab, and surgery were prescribed or preformed in 64%, 92%, 24%, 35%, 9%, and 22% of the patients, respectively. The surgical procedures included 12 bowel resections and 8 fistulectomies. The prescription rates for 5-aminosalicylates, prednisone, antibiotics, and infliximab did not differ, but of the use of immunomodulators was significantly different between physicians (p=0.012). The mean interval between diagnosis and the start of immunomodulators was 14 months, and was not different between physicians. The median dosage of immunomodulators was 50 mg per day, and was not different between physicians. Conclusions: A difference in medical treatment strategies for Crohn’s disease between physicians exists in Korea. Specifically, there was a significant difference in the use of immunodulators between physicians. The development of treatment guidelines for Crohn’s disease, together with efforts to decrease the inter-physician difference for treating Crohn’s disease are needed. (Intest Res 2009;7:41-46)

혈변 환자에서 대장내시경의 역할

김영욱 ( Young Wook Kim ),최황 ( Hwang Choi ),김기준 ( Gi Jun Kim ),류승지 ( Seung Jee Ryu ),박성민 ( Sung Min Park ),김준성 ( Joon Sung Kim ),지정선 ( Jeong Seon Ji ),김병욱 ( Byung Wook Kim ),이보인 ( Bo In Lee ),최명규 ( Myung 대한소화기학회 2016 대한소화기학회지 Vol.67 No.2

목적: 혈변 환자 평가를 위해 대장내시경이 꼭 시행되어야 하는 것이 아님에도 불구하고, 일반적으로 국내에서 의사들은 혈변을 주소로 내원한 환자들에게 대장내시경을 권고하고 있다. 이번 연구는 혈변 평가를 위해 시행된 대장내시경의 진단적 가치를 확인하고자 하였다. 대상 및 방법: 총 321명의 혈변 환자를 대상으로 후향적으로 대장내시경 결과를 검토하였다. 결과: 치핵이 가장 흔한 진단이었고(217예, 67.6%) 선종은 그다음으로 흔한 발견 병소였다(93예, 29.0%). 악성 종양(18예, 5.6%)은 모두 구불결장 이하 범위에서 확인되었다. 결장염 및 직장염, 급성 치열, 직장 유암종, 숙변 궤양 등은 임상적 추정 및 구불결장경에 의한 진단이 가능하며, 정확한 진단을 위한 대장내시경의 추가적 이득은 없었다. 결론: 대장내시경이 유발하는 부작용 및 비용을 고려할 때 혈변 평가에 있어 구불결장경 이상의 이득은 제한적이다. 그러므로 혈변 평가에 있어 우선 구불결장경을 고려하여야 한다. Background/Aims: Although colonoscopy is not indicated in patients with hematochezia, many surgeons, internists, and physicians are recommending colonoscopy for these patients in Korea. The aim of this study is to evaluate the diagnostic value of colonoscopy for patients with hematochezia. Methods: We retrospectively reviewed the data of colonoscopy between January 2010 and December 2010. A total of 321 patients among 3,038 colonoscopies (10.6%) underwent colonoscopy to evaluate the cause of hematochezia. The patients with previous colorectal surgery (2) or polypectomy (5) were excluded. We analyzed endoscopic diagnoses. Advanced neoplastic polyps were defined as adenomas with villous histology or high grade dysplasia, or adenomas more than 10 mm in diameter. Results: Hemorrhoid was the most common diagnosis (217 cases, 67.6%). Polyps were detected in 93 patients (29.0%), but advanced neoplastic polyps were found in only 14 cases (4.4%). Colorectal cancers were diagnosed in 18 patients (5.6%) including 14 rectal cancers. There was no cancer located above sigmoid-descending junction. Diverticuli were detected in 41 patients (12.8%) but there was only one case of suspected diverticular bleeding. Colitis was diagnosed in 24 patients (7.5%). Other lesions included acute anal fissure, rectal tumor, stercoral ulcer, and radiation proctitis. Conclusions: The colonoscopy had little value in patients with hematochezia because the most pathologic lesions were located below sigmoid colon. The first choice of diagnosis in patients with hematochezia is sigmoidoscopy.

소장 협착의 내시경적 감별

최황 ( Hwang Choi ),최규용 ( Kyu Yong Choi ),이보인 ( Bo In Lee ),김민국 ( Min Kuk Kim ),정현정 ( Hyun Jung Jung ),지정선 ( Jeong Seon Ji ),김태호 ( Tae Ho Kim ),오정환 ( Jung Hwan Oh ),이강문 ( Kang Moon Lee ),김상우 ( Sang Woo 대한장연구학회 2007 Intestinal Research Vol.5 No.1

Background/Aims: The diagnosis of small bowel stricture was made by operation. Capsule endoscopy has been useful for diagnosis of small bowel diseases but has limited value in cases with stricture. Double balloon endoscopy is the useful method to visualize the entire small bowel. The aims of this study are to evaluate the feasibility of double balloon endoscopy and to differentiate the endoscopic findings in patients with small bowel stricture. Methods: Between March 2004 and February 2007, fifteen consecutive patients were referred for the evaluation of small bowel stricture. Small bowel strictures were suspected in small bowel series and CT in eleven patients. Capsule endoscopies were performed in six patients and entrapped in three patients. Double balloon endoscopy (EN-450P5/20, Fujinon, Japan) was performed with midazolam (median 5 mg, range 5-10 mg) and meperidine (median 50 mg, range 50-100 mg). All lesions except one were found within 60 minutes. One patient had been excluded because of false-positive finding of capsule endoscopy. Clinical and endoscopic findings were compared between strictures of Crohn’s disease (group I, n=6) and those of other causes (group II, n=8). Results: Double balloon endoscpies were performed with good tolerance without side effect. Age, chief complaints, duration of symptom, and initial hemoglobin and serum albumin levels were not different between two groups. The proportion of male sex was higher in group I than group II (100%, 38%, respectively; p=0.031). The strictures below 0.5 cm in diameter were 83% in group I and 13% in group II (p=0.026). The arrangement of stricture in group I was more eccentric than that in group II (100%, 17%, respectively; p=0.015). The location of stricture, appearance of surrounding mucosa, associated ulcer, and ulcer margin were not different between two groups. Conclusions: Endoscopic differentiation using double balloon endoscopy can be made easily and safely in patients with small bowel stricture. The strictures of small bowel in patients with Crohn``s disease were narrower and more eccentric than thosein patients with other diseases. (Intest Res 2007;5:38-44)

위장관 ; 한국인에서 위저선용종과 결장암의 상관관계: 16년간 후향적 고찰

황선미 ( Sun Mee Hwang ),김병욱 ( Byung Wook Kim ),채현석 ( Hiun Suk Chae ),이보인 ( Bo In Lee ),최황 ( Hwang Choi ),지정선 ( Jeong Seon Ji ),최규용 ( Kyu Yong Choi ),정인식 ( In Sik Chung ),맹이소 ( Lee So Maeng ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.1

Background/Aims: There is an ongoing debate on the relationship between gastric fundic gland polyps and increased incidence of colorectal neoplasia in Caucasians. However, there was no report on the relationship between gastric fundic gland polyp and colorectal neoplasia in Korea. The aim of this study was to identify the characteristics of gastric fundic gland polyps and whether a relationship exists between fundic gland polyps and colorectal neoplasia in Korean population. Methods: Persons who underwent an esophagogastroduodenoscopy and colonoscopy from 1992 to 2007 at the Health Promotion Center of Incheon St. Mary`s Hospital, The Catholic University of Korea were reviewed retrospectively. The relationship between gastric fundic gland polyps and colorectal neoplasia were analyzed. Results: Among 22,451 subjects, fundic gland polyps were found in 328 subjects (1.5%). Fundic gland polyps were more common in women than in men (odds ratio of 6.25; 95% CI of 4.68-8.34). The odds ratios for colorectal neoplasia in all subjects with gastric fundic gland polyps were 0.56 (95% CI of 0.33-0.95) and men who were 50 years of age or older had an odds ratio of 2.81 (95% CI of 1.03-7.66) as compared to the control group. However, age and sex-adjusted odds ratios for all gastric fundic gland polyps were 0.73 (95% CI of 0.42-1.26), for men 1.78 (95% CI of 0.80-3.98), and for women 0.37 (95% CI of 0.16-0.87). Conclusions: Surveillance colonoscopy in patients with fundic gland polyps can be performed in the same manner as general population in Korea. (Korean J Gastroenterol 2011;58:20-24)

충수 개구부 및 주변부에 국한된 염증 소견은 급성충수염을 의미하는가?

허민 ( Min Huh ),이보인 ( Bo In Lee ),최규용 ( Kyu Yong Choi ),김경미 ( Kyoung Mee Kim ),지정선 ( Jeong Seon Ji ),김병욱 ( Byung Wook Kim ),최황 ( Hwang Choi ),조세현 ( Se Hyun Cho ),정우철 ( Woo Chul Chung ),이강문 ( Kang Moon 대한장연구학회 2006 Intestinal Research Vol.4 No.1

목적: 대장내시경 검사 중 우연히 발견된 충수 개구부의 염증 소견으로 충수염을 진단하는 경우가 있다. 그러나 이 소견이 항상 충수염을 의미하는지는 불확실하다. 대상 및 방법: 1996년 8월부터 2005년 1월까지 가톨릭대학교 성모자애병원에서 실시한 대장내시경 검사에서 충수 개구부 및 주변부에 국한된 염증소견을 보인 18명의 환자를 후향적으로 분석하였다. 대장내시경 검사 후 6개월 내 충수염 절제술을 받고 병리소견에서 충수염이 확인된 경우를 충수염으로 정의하였으며 충수절제 표본에서 염증소견이 없거나 검사 후 6개월 이상 충수염이 발병하지 않은 경우를 충수염 음성으로 하였다. 결과: 남녀 비는 1.3:1, 평균연령은 48세(29-72)였다. 주 증상은 우하복부 통증(4예, 22%), 무증상(4예, 22%), 묽은 변(3예, 17%) 등이었다. 육안적 분류로는 부종발적형이 7예(39%), 배농형 4예(22%), 단순발적형 3예(16.7%), 미란발적형, 미란형, 배농결절형, 분변매복형이 각 1예였다. 추적 기간이 6개월 이상이었던 16예 중 7예(44%)는 대장내시경 검사 5-79일 후 충수절제술을 실시하였으며 이 중 4예(25%)만이 급성충수염으로 진단되었고 1예는 충수염을 동반하지 않은 충수주위농양으로 확인되었다. 나머지 2예에서는 충수에 이상소견이 발견되지 않았다. 수술을 받지 않은 9예(56%) 중 6예는 병변의 원인을 알 수 없었으며 나머지 3명은 각각 크론병, 베체트병, 궤양성대장염으로 진단되었다. 우하복부 통증과 충수염, 충수 개구부 배농과 충수염과는 유의한 상관관계가 없었다. 병변이 충수 개구부 주변까지 확장되었던 4명은 모두 충수염이 아니었지만 통계적 유의성은 없었다. 결론: 대장내시경 검사에서 발견되는 충수 개구부 및 주변부 국한 염증 소견은 다양한 원인 질환을 시사하며 반드시 충수염을 의미하지는 않는다. 임상 소견 및 경과에 따른 정확한 진단이 요구된다. Background/Aims: Colonoscopy may be helpful in the diagnosis of appendicitis occasionally. However, it is unclear that isolated inflammation at the appendiceal orifice is always suggestive of acute appendicitis. Methods: Eighteen consecutive patients with colonoscopic findings of the isolated inflammatory lesion in the area of the appendiceal orifice were included. Surgical- pathology-proven appendicitis within 6 months after the colonoscopy were defined as ‘true-appendicitis’. Results: Of the 18 patients, 16 patients were followed up for more than 6 months. Seven patients underwent appendectomy within 5-79 days after the colonoscopy. Of these, 4 patients (25%) had true-appendicitis, one periappendiceal abscess without appendicitis, two normal appendices. Nine patients did not take appendectomy. Of these, no definite etiology was defined in 6. Of the rest, one patient revealed Crohn`s disease, one Behcet`s disease and one cecal involvement of distal ulcerative colitis later. Conclusions: Isolated inflammation at the appendiceal orifice does not always suggest acute appendicitis but diverse etiologies. The diagnosis of appendicitis should not be made only by colonoscopic findings but also by clinical course and other imaging studies. (Intestinal Research 2006;4:39-44)

골수형성 이상증후군 환자에서 조기위암에 대한 내시경 점막하 박리술

임은주 ( Eun Joo Lim ),심은희 ( Eun Hui Sim ),김병욱 ( Byung Wook Kim ),김종인 ( Jong In Kim ),김준성 ( Joon Sung Kim ),지정선 ( Jeong Seon Ji ),최황 ( Hwang Choi ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.3

Endoscopic submucosal dissection (ESD) has been successfully performed in thrombocytopenic conditions such as in patients with liver cirrhosis but successful ESD for early gastric cancer (EGC) in hematologic diseases has rarely been reported. A 52-year-old male patient, who had previously been diagnosed with myelodysplastic syndrome 2 years ago, was admitted to our hospital for ESD of EGC. ESD was performed successfully in this patient after platelet concentrates transfusion on the day of ESD. ESD might be an option for the treatment of EGC in thrombocytopenia due to hematologic diseases when optimal supportive managements are applied. (Korean J Gastroenterol 2015;65:173-176)

Establishment of MMTV/c-Neu/CYP1B1 Transgenic mice for carcinogenesis test

Ki-Yoon Kim(김기윤),Kyung-Nan Min(민경난),Min-Kyung Kim(김민경),Kyung-Jin Kwon(권경진),Jeong-In JI(지정인) 환경독성보건학회 2006 한국독성학회 심포지움 및 학술발표회 Vol.- No.-

비스테로이드성 소염진통제의 장기 사용으로 유발된 하행십이지장 협착 1 예

박수헌,김진일,임동준,정인식,김재광,정규원,선희식,최규용,지정선,정현화,백창렬,노치호,민도준,한준열 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.2

In endoscopic clinical research studies of patients who take NSAIDs, 10% to 20% of patients develop gastric ulcers and 4% to 10% develop duodenal ulcers. Ulcers associated with chronic NSAIDs use are typically painless and are located in the prepyloric region of the stomach. These characteristics make NSAIDs potential causes of gastric outlet obstruction. There were multiple cases of single or multiple strictures that were found in the esophagus, small bowel and colon. Most of duodenal strictures were confined to bulbar area. Only one case of duodenal second portion diaphragmlike stricture was reported in association with acetylsalicylic acid. We experienced one case of chronic NSAIDs induced duodenal 2nd portion stricture in ankylosing spondylitis and rhemathoid arthritis patient and reported with a review of literature.