위선종과 조기위암에서 내시경 점막절제술의 연구 -완전절제율에 영향을 미치는 인자와 점막 절제술 전후의 조직학적 차이-

고강훈 ( Kang Hun Koh ),정혜진 ( Hey Jin Jung ),김상욱 ( Sang Wook Kim ) 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.1

Objectives: The endoscopic mucosal resection of gastric adenomas or early gastric cancers is now widely accepted as a useful radical treatment method. We studied that the rate of successful treatment by the endoscopic mucosal resection of gastric adenomas or early gastric cancers and the factors related to the rate of the complete resection. Methods: We analysed, retrospectively, 118 lesions in 114 patients diagnosed early gastric cancer or gastric adenoma at the Chonbuk National University Hospital from January, 2005 to June, 2006. Of the 118 lesions, there were 107 adenomas and 11 early gastric cancers. We tried to follow up the lesions of resection by the endoscopic biopsy later. Results: The lesions were diagnosed 107 adenomas, 6 early gastric cancers type IIa, 5 type IIb, and the rate of complete resection was 85%(91), 84%(5), 80%(4), each. The sites of the lesions were divided antrum, angle, body, pylorus and each 60 cases, 14 cases, 42 cases, 2cases was reported. The rate of complete resection for the site was each 83%(50), 85%(12), 81%(34), 100%(2). The size of the lesions was divided ≤10 mm, 11~15 mm, 16~20 mm, 21~25 mm, 26~30 mm, ≥31 mm and each 14 cases, 21 cases, 41 cases, 6 cases, 31 cases, 5 cases were reported. The rate of complete resection for the size was each 86%, 86%, 90%, 100%, 71%, 60%. Of the 14 cases which were diagnosed as high grade dysplastic adenoma, early gastric cancer was diagnosed in 4 cases after the biopsy by endoscopic mucosal resection. Conclusion : We concluded that the site, size and the other factors of the lesions were related to the rate of complete resection after endoscopic mucosal resection, and the abnormal gastric mucosal lesions should be diagnosed with the biopsy by endoscopic mucosal resection.

Recurrence after endoscopic resection of small rectal neuroendocrine tumors: a retrospective cohort study

Pattarajierapan, Sukit,Khomvilai, Supakij 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.3

Purpose: According to the European Neuroendocrine Tumor Society consensus guidelines, rectal neuroendocrine tumors (NETs) up to 10 mm in size and without poor prognostic factors could be safely removed with endoscopic resection, suggesting omitting surveillance colonoscopy after complete resection. However, the benefit of surveillance colonoscopy is still unknown. In this study, we aimed to report the outcomes after endoscopic resection of small rectal NETs using our surveillance protocol. Methods: This retrospective cohort study included patients who underwent endoscopic resection for rectal NETs sized up to 10 mm from January 2013 to December 2019 at our center. We excluded patients without surveillance colonoscopy and those lost to follow-up. We strictly performed surveillance colonoscopy 1 year after endoscopic resection, and every 2 to 3 years thereafter. The primary outcomes were tumor recurrence and occurrence of metachronous tumors during follow-up. Results: Of the 54 patients who underwent endoscopic resection for rectal NETs during the study period, 46 were enrolled in this study. The complete resection rates by endoscopic mucosal resection, precutting endoscopic mucosal resection, and endoscopic submucosal dissection were 92.3% (12 of 13), 100% (21 of 21), and 100% (12 of 12), respectively. There was no local or distant recurrence during the median follow-up of 39 months. However, we found that 8.7% (4 of 46) of patients developed metachronous NETs. All metachronous lesions were treated with precutting endoscopic mucosal resection. Conclusion: Surveillance colonoscopy is reasonable after endoscopic resection of small rectal NETs for timely detection and treatment of metachronous lesions. However, larger collaborative studies are needed to influence the guidelines.

직장유암종의 내시경 치료

김태오 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.24

Purpose: Endoscopic treatment for rectal carcinoids requires special techniques for deeper resection. There are various reports in the literature about endoscopic submucosal resection (ESMR) of small rectal carcinoids using different techniques. The aim of this study was to compare ESMR of rectal carcinoid tumors by endoscopic submucosal resection with ligation device (ESMR-L) with conventional endoscopic submucosal dissection (C-ESD). Methods: Indication for endoscopic resection was rectal carcinoid measuring less than lcm in diameter located within the submucosal layer. 23 patients with rectal carcinoid tumors underwent endoscopic tumor resection. Group 1 (n=14) carcinoid tumors were treated with ESD using a flex-knife with a conventional single-channel endoscopy. Group 2 (n=9) carcinoid tumors were treated by ESMR-L. Results: There were no significant differences between group 1 and 2 in the rate of complete resection (92.9%/100%, p=0.609), mean operating time (23.6 ± 14.5 min/ 14.4 ± 5.3 min, p=0.101), and complication associated with the procedure (14.3%/11.1%, p=0.668). Conclusions: Both ESMR-L and C-ESD have proven to be useful and safe procedures for complete resection of rectal carcinoid tumors less than 10 mm in diameter and had no serious procedure-related complication.

조기 위암의 내시경 치료 후 불완전 절제 시의 대책

공은정,방창석 대한의사협회 2022 대한의사협회지 Vol.65 No.5

Background: Endoscopic resection is indicated for early or superficial gastrointestinal neoplasms with a negligible risk of lymph node metastasis. This procedure could preserve the organ while allowing en bloc resection of tumors, irrespective of the size and location of the lesion. Histological evaluation of the resected specimen determines whether curative resection, which implies a favorable long-term outcome, was achieved. If the resected specimen reveals non-curative, additional treatment is necessary as it is strongly associated with recurrence. Current Concepts: Surgical resection is recommended after non-curative resection of gastrointestinal neoplasms. However, rather than surgical resection, additional endoscopic treatment can be recommended if non-curative resection is solely because of the positive involvement at the horizontal resection margin without any other findings compatible with the non-curative resection criteria. Discussion and Conclusion: Adopting precise indications of endoscopic resection is important to reduce the risk of non-curative resection. If curative resection is not achieved after endoscopic resection, additional treatment should be considered to prevent local recurrence as well as lymph node metastasis.

Risk factors for procedure-related complications after endoscopic resection of colorectal laterally spreading tumors

Hong, Ji-Yun,Kweon, Sun-Seog,Lee, Jun,Kim, Sang-Wook,Seo, Geom-Seog,Kim, Hyun-Soo,Joo, Young-Eun Wolters Kluwer Health 2018 Medicine Vol.97 No.41

<P><B>Abstract</B></P><P>Colorectal laterally spreading tumors (LSTs) are large and flat elevated neoplasms with diameters of at least 10 mm. Endoscopic resection of LSTs, with their large size and broad base, is difficult and dangerous compared with the resection of polypoid neoplasms. This study aimed to determine the risk factors for procedure-related complications including bleeding and perforation after endoscopic resection of LSTs.</P><P>Patients with colorectal LST undergoing endoscopic resection at 5 university hospitals in Honam Province of South Korea were enrolled, and their records about patients, lesions, and procedure parameters associated with the occurrence of complications were reviewed retrospectively. Logistic regression analysis was performed to identify risk factors for complications.</P><P>The frequency of comorbidities in bleeding group was significantly higher than in the no bleeding group. The frequency of bleeding was significantly higher in lesions with adenocarcinoma than in lesions with low or high-grade dysplasia. The frequency of bleeding was significantly higher in piecemeal resection than in en bloc resection. The frequency of perforation was significantly higher in endoscopic mucosal resection-precutting (EMR-P) than in endoscopic mucosal resection (EMR) or endoscopic submucosal dissection. The mean procedure duration was significantly longer in the perforation group than in the no perforation group. On multivariate analysis, patient comorbidity and histologic grade of the lesion were significant independent risk factors for bleeding, whereas EMR-P was a significant independent risk factor for perforation after endoscopic resection.</P><P>This study demonstrated that patient comorbidity and histologic grade of lesion were significant independent risk factors for bleeding, and EMR-P was a significant independent risk factor for perforation after endoscopic resection of colorectal LSTs.</P>

위암으로 내시경적 절제술 후 추가적인 위절제술을 시행 받은 환자들의 임상병리학적 특징

배정민(Jung Min Bae),김세원(Se Won Kim),김상운(Sang Woon Kim),송선교(Sun Kyo Song) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.2

Purpose: Recently, early gastric cancer has increased in Korea. Thus, endoscopic resection and laparoscopic gastrectomy has increased in early gastric cancer patients. But, endoscopic resection of early gastric cancer has many problems such as poor long-term survival data, diverse endoscopic techniques, ambiguous follow-up strategy, nonuniform pathologic interpretation and so on. We studied patients that received additional gastrectomy after EMR/ESD. We analyzed clinicopathological characteristics states before and after EMR/ESD. Methods: From 1998 to 2008, 56 patients received additional gastrectomy after EMR/ESD due to gastric cancer. We analyzed tumor characteristics, endoscopic resection type, reasons for gastrectomy, post-operative characteristics, etc., retrospectively from medical records. Results: The ratio of male to female was 2:1. Six patient tumors were larger than 2 ㎝ in size. Forty-five patients received EMR and 12 patients received ESD. Common macroscopic feature of endoscopic findings were superficial elevated and superficial depressed between 10 ㎜ and 20 ㎜. Forty patients received immediate gastrectomy due to incomplete endoscopic resection. Sixteen patients received additional gastrectomy during follow-up period after EMR/ESD. The most common reason of immediate gastrectomy was positive resection margin. The most common reason of follow-up gastrectomy was cancer recurrence. Three patients had advanced gastric cancer in follow up gastrectomy group. Two patients died due to gastric cancer in immediate gastrectomy group and followup gastrectomy group. Conclusion: Active effort for surgical treatment is needed when the gastric cancer characteristics of patients is inadequate for endoscopic resection. Uniform pathologic interpretation is essential for confirming completeness of endoscopic resection. Treatment and follow-up strategy after endoscopic resection is important due to recurrence and new cancer occurrence. Long-term and prospective randomized study should be performed to confirm safety and difficulty of endoscopic resection.

Factors Affecting Endoscopic Curative Resection of Gastric Cancer in the Population-Based Screening Era

Mun, Yoon Gwon,Choi, Myung-Gyu,Lim, Chul-Hyun,Lee, Han Hee,Kang, Dong Hoon,Park, Jae Myung,Song, Kyo Young Korean Society of Gastrointestinal Endoscopy 2018 Clinical Endoscopy Vol.51 No.5

<P><B>Background/Aims</B></P><P>Since population-based screening for gastric cancer in Korea was implemented, endoscopic treatment of early gastric cancer has become increasingly popular. This study investigates factors affecting endoscopic curative resection of early gastric cancer in population-based screening for gastric cancer. </P><P><B>Methods</B></P><P>We retrospectively reviewed data of patients with newly diagnosed gastric cancer who underwent treatment at Seoul St. Mary’s Hospital. All patients completed questionnaires about clinical information, including interval between surveillance tests for gastric cancer. </P><P><B>Results</B></P><P>Of 469 gastric cancer patients, 147 (31.3%) had undergone curative endoscopic resection, 260 (55.4%) had undergone curative surgical resection, and 62 (13.3%) underwent non-curative resection or were in an inoperable state. Patients with curative endoscopic resection had fewer alarm symptoms/signs than other groups. In multivariate analysis, regular surveillance endoscopy was the only factor predicting curative endoscopic resection (odds ratio [OR], 6.099; 95% confidence interval [CI], 2.532–14.933). In addition, patients undergoing gastric cancer screening had a significantly higher rate of endoscopic curative resection compared with subjects who had never been screened. (1-year interval: OR, 49.969; 95% CI, 6.340–393.827, 2-year interval: OR, 15.283; 95% CI, 1.833–127.406, over 2-year interval: OR, 10.651; 95% CI, 1.248–90.871). Shorter screening test intervals were associated with higher rates of endoscopic curative resection. </P><P><B>Conclusions</B></P><P>Regular surveillance testing was the independent factor predicting curative endoscopic resection of gastric cancer. </P>

Surgical outcomes of endoscopic versus open resection for the management of sinonasal malignancies

Balamurugan Rajendran 대한구강악안면외과학회 2020 대한구강악안면외과학회지 Vol.46 No.6

The purpose of this review is to assess the surgical outcomes of two different treatment modalities, endoscopic and open resection, for the management of sinonasal malignancies by comparing the effectiveness of these two methods. A wide search was carried out considering various electronic databases for English language articles from 2013 to 2018 using keywords such as sinonasal malignancies, endoscopic surgery, open resection for sinonasal malignancies, and endoscopic versus open surgery. One thousand articles were identified from the literature for screening. After a thorough systematic assessment and based on the selection criteria, 10 articles with 4,642 patients were included in this quantitative analysis. With a total of 4,642 patients, 1,730 patients were operated on using endoscopic resection and 2,912 patients were operated on using open resection. The endoscopic approach was found to have a shorter hospital stay compared to open surgical resection (P<0.05). The rate of positive margins and the recurrence rate for open surgical resection were both smaller compared to those for endoscopic resection (P>0.05), and the endoscopic approach had smaller complication rates and a higher survival rate compared to open resection (P>0.05). Though endoscopic resection and open surgical resection have comparable postoperative benefits, preoperative evaluation of cases presenting with sinonasal malignancies is necessary for determining the right treatment method to obtain the best possible results postoperatively.

밴드결찰술 및 올가미를 이용하여 내시경 점막절제술을 시행한 직장 유암종 3예

조영화,노지훈,구동영,유재훈,김기수,신영민,김성훈,박지은 대한소화기내시경학회 2010 Clinical Endoscopy Vol.41 No.1

Many reports have shown that endoscopic polypectomy or endoscopic mucosal resection can successfully remove tumor less than 1.0 cm in size. However, most carcinoid tumors in the rectum occur in the submucosal layer so that the entire tumor cannot be completely removed via endoscopic polypectomy or endoscopic mucosal resection. Endoscopic mucosal resection can also cause perforation of the intestinal wall and bleeding. Due to these reasons, instead of these two conventional methods, endoscopic mucosal resection using a ligation device is currently being used for the treatment of rectal carcinoid tumor. Recent studies that used this method have reported that endoscopic mucosal resection of rectal carcinoid tumor by band ligation and the snare resection technique is safe with minimal complications and this is quite useful to completely remove rectal carcinoid tumor. 유암종은 위장관 및 기관지 등의 신경 내분비세포에서 발생하는 종양이며 전체 유암종에서 직장 유암종이 차지하는 비율은 10% 정도이다. 아직은 직장 유암종에 대한 표준 치료가 확립되어 있지는 않으나 최근 내시경 시행 빈도의 증가 및 술기의 발달로 내시경 치료가 빈번히 시행되고 있다. 종양의 크기와 침습의 깊이에 따라 치료 방법이 주로 결정되며 종양의 크기가 1 cm 미만인 경우 단순한 용종절제술이나 고전적 내시경 점막절제술을 시행하여 치료에 성공하였다는 보고가 있다. 그러나 대부분의 직장 유암종은 직장의 점막하층에 발생하는 경우가 많으므로 용종절제술이나 고전적 내시경 점막절제술로는 완전한 절제가 불가능한 경우가 있으며 깊은 절제를 위해 내시경 점막하박리술을 시행하는 경우 장벽의 천공 및 출혈 등과 같은 부작용이 발생할 가능성도 있다. 이 같은 이유로 고전적인 술기가 아닌 밴드결찰술 및 올가미를 이용한 직장 유암종의 절제(endoscopic submucosal resection with EVL device)가 시도되고 있다. 밴드결찰술 및 올가미를 이용한 직장 유암종의 절제는 비교적 안전하고 시술에 의한 합병증의 발생 빈도가 적으며 무엇보다도 직장 유암종의 완전한 절제에도 유리하다는 보고가 늘고 있다. 저자들은 직장 유암종으로 진단된 3예에서 밴드결찰술 및 올가미를 이용하여 합병증 없이 완전 절제하여서 문헌 고찰과 함께 보고한다.

Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea

Yuri Kim,Ji Yong Ahn,Hwoon-Yong Jung,Seokin Kang,Ho June Song,Kee Don Choi,Do Hoon Kim,Jeong Hoon Lee,Hee Kyong Na,Young Soo Park 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.3

Background/Aims: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs. Methods: Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed. Results: Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group. Conclusions: cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.