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문희석,성재규,정현용,강대영 대한소화기내시경학회 2009 Clinical Endoscopy Vol.38 No.4
Gastric lipoma is a typical benign submucosal tumor that is usually asymptomatic and it is generally detected incidentally when performing upper GI endoscopy. However, depending on its size and location, an atypical gastrointestinal lipoma can cause abdominal pain, diarrhea, constipation, intestinal obstruction, intussuception and life-threatening gastrointestinal bleeding. This tumor is diagnosed and differentiated from other malignant and submucosal tumors on the basis of its characteristic findings at endoscopy and on computed tomography, magnetic resonance imaging and endoscopic ultrasonography. We report here on the case of a 58-year-old female with epigastric discomfort and melena; a 4.5×4 cm ulcero-fungating mass was detected on the anterior wall of the gastric antrum. Surgical subtotal gastrectomy was performed and the lesion was diagnosed as gastric lipoma. 양성 종양인 위 지방종은 점막하 종양형태를 띠며 무증상으로 상부위장관내시경 검사에서 우연히 발견되는 경우가 많다. 하지만 발생 위치와 크기에 따라 상복부 통증, 설사, 변비, 장폐색증, 장중첩증, 위장관 출혈 등의 다양한 증상을 일으킬 수 있다. 또한 다른 점막하 종양과 악성종양과의 감별을 위해서 지방종에서 보이는 특징적인 내시경적인 소견뿐 아니라 복부 CT 및 MRI 촬영과 같은 방사선학적인 검사 그리고 내시경 초음파(EUS) 등을 시행하고 있다. 저자들은 상복부 통증과 흑색변으로 내원한 58세 여자에서 발견된 상부 위장관 출혈을 동반한 거대 위 지방종으로 진단된 1예를 경험하여 문헌 고찰과 함께 보고한다.
Improving the Endoscopic Detection Rate in Patients with Early Gastric Cancer
문희석 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.4
Endoscopists should ideally possess both sufficient knowledge of the endoscopic gastrointestinal disease findings and an appropriate attitude. Before performing endoscopy, the endoscopist must identify several risk factors of gastric cancer, including the patient’s age, comorbidities, and drug history, a family history of gastric cancer, previous endoscopic findings of atrophic gastritis or intestinal metaplasia, and a history of previous endoscopic treatments. During endoscopic examination, the macroscopic appearance is very important for the diagnosis of early gastric cancer; therefore, the endoscopist should have a consistent and organized endoscope processing technique and the ability to comprehensively investigate the entire stomach, even blind spots.