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확장이 없는 총담관 결석의 진단에서 내시경초음파검사의 유용성
이정환 ( Jung Hwan Lee ),김유선 ( You Sun Kim ),류수형 ( Soo Hyung Ryu ),이상렬 ( Sang Ryul Lee ),이수연 ( Su Yeon Lee ),박종혁 ( Jong Hyeok Park ),문정섭 ( Jeong Seop Moon ),김형훈 ( Hyung Hun Kim ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.2
Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the most accurate modality in diagnosis of choledocholithiasis. However, it carries some complications. Endoscopic Ultrasonography (EUS) is less invasive than ERCP and used for the diagnosis of choledocholithiasis. Recent studies showed that a usefulness of EUS for the diagnosis of small choledocholithiasis without common bile duct (CBD) dilatation. For such a reason, ERCP is being replaced by EUS in the diagnosis of bile duct stones. The aim of this study was to investigate the accuracy of EUS for the diagnosis of choledocholithiasis without CBD dilatation. Methods: A total of 66 patients with suspected choledocholithiasis without CBD dilatation were enrolled. EUS were performed in all cases within 48 hours after computed tomography (CT) or ultrasonography (US). Final diagnosis was obtained by ERCP or clinical course (minimum 6 months follow-up). We analyzed the accuracy of US, CT, and EUS, respectively. Results: CT and US were performed in 51 and 15 cases, respectively. CBD stones were detected in 23 (35%) patients by ERCP. EUS showed 100% sensitivity, 95% specificity, 92% positive predictive value, and 100% negative predictive value for identifying CBD stones. CT or US showed 26%, 93%, 67%, and 70%, respectively. There were no EUS-related complications. Conclusions: EUS was more effective than CT or US and as accurate as ERCP for the diagnosis of small choledocholithiasis without CBD dilatation. Thus, EUS may help to avoid unnecessary diagnostic ERCP and its complication. (Korean J Gastroenterol 2010;56:97-102)
송정훈 ( Jung Hoon Song ),허진국 ( Jin Gook Huh ),김유선 ( You Sun Kim ),이진호 ( Jin Ho Lee ),장원철 ( Won Cheol Jang ),옥경선 ( Kyung Sun Ok ),류수형 ( Soo Hyung Ryu ),이정환 ( Jung Hwan Lee ),문정섭 ( Jeong Seop Moon ) 대한장연구학회 2008 Intestinal Research Vol.6 No.2
Background/Aims: Although colonic diverticular disease is less common in Koreans than in Western people, its incidence has been on the increase in Korea. We investigated the clinical characteristics and related complications of colonic diverticular disease in Koreans. Methods: We retrospectively reviewed the medical records of 9,006 patients who underwent colonoscopy at the Seoul Paik hospital between July 2002 and January 2008. Results: Of the 9,006 patients, there were 654 cases (7.3%) of colonic diverticulosis (472 men, 182 women). The mean age of the patients was 54.6±12.0 years. The right colon was involved in 535 cases, the left colon was involved in 86 cases and both the left and right colon was involved in 33 cases. Among the patients, a single diverticulum was seen in 253 cases and two or more diverticuli were seen in 401 cases. Related complications were diverticulitis (11 cases, 1.7%) and diverticular bleeding (3 cases, 0.5%). Conclusions: The incidence of colonic diverticular disease in Korea shows an increasing trend. Colonic diverticular lesions are frequently found in the right colon. (Intest Res 2008;6:110-115)
권민정 ( Min Jung Kwon ),류수형 ( Soo Hyung Ryu ),조수연 ( Soo Yeon Jo ),곽철훈 ( Chul Hoon Kwak ),윤원재 ( Won Jae Yoon ),문정섭 ( Jeong Seop Moon ),이혜경 ( Hye Kyung Lee ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.6
Oral metastatic tumor, which is uncommon and represents less than 1% of malignant oral neoplasms, usually arises from a primary mucosal or cutaneous cancer located in the head and neck regions. Metastasis of hepatocellular carcinoma (HCC) to the oral cavity, especially to gingiva, is extremely rare. A 50-year-old man, who was a chronic alcoholic and hepatitis B virus carrier, presented with abdominal distension and weight loss for the past 3 months. Three-phased contrast-enhanced abdominal CT revealed numerous conglomerated masses in the liver, suggesting huge HCCs arising in the background of liver cirrhosis with a large amount of ascites. He complained of recurrent profuse bleeding from the left upper gingival mass. A facial CT revealed an oral cavity mass destructing the left maxillary alveolar process and hard palate, which was diagnosed as metastatic HCC by an incisional biopsy. Herein, we report a case of metastatic HCC to the gingiva. (Korean J Gastroenterol 2016;68:321-325)
국내 유통 중인 음료식품과 속쓰림과의 관련성에 관한 연구
김영관 ( Young Kwan Kim ),문정섭 ( Jeong Seop Moon ),류수형 ( Soo Hyung Ryu ),이정환 ( Jung Hwan Lee ),김유선 ( You Sun Kim ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.2
목적: 국내에 유통되는 음료식품에 의한 속쓰림 발생의 빈도를 조사하고 음료식품이 속쓰림을 일으키는 기전을 규명하고자 하였다. 대상 및 방법: 2004년 11월부터 2005년 6월까지 속쓰림을 주소로 서울백병원에 내원한 382명의 환자를 대상으로 설문지를 통하여 35종류의 음료식품에 의한 속쓰림의 빈도를 조사하여 점수화하였다. 각 음료의 수소이 온지수, 적정산, 삼투질농도를 측정하여 속쓰림 점수와의 관련성을 검정하였다. 결과: 속쓰림 점수가 가장 높은 음료는 커피(1.15)와 소주(1.12)였으며 가장 낮은 음료는 우롱차(0.17)와 당근주스(0.18)였다. 과실채소음료의 적정산이 속쓰림과 관련성이 있었다(r=0.78; p=0.023). 탄산음료는 가장 낮은 수소이온지수를 보였으나 속쓰림 점수와의 관련성은 없었다(r=?0.54; p=0.460). 주류는 수소이온지수가 높을수록 속쓰림 점수가 높았으며(r=0.84; p=0.037) 삼투질농도와는 역의 관계가 있었다(r=?0.86; p=0.028). 무카페인커피는 일반커피보다 속쓰림 점수가 의미 있게 낮았으며(p<0.001) 일반우유는 저지방우유보다 속쓰림 점수가 더 높게 나타났다(p=0.008). 결론: 이번 논문은 속쓰림을 호소하는 환자들에게 적절한 음료식품을 선택할 수 있도록 정보를 제공하여 치료에 도움을 줄 수 있을 것이다. Background/Aims: The aim of this study was to investigate the frequency of heartburn produced by beverages available in Korea and to clarify the mechanism causing heartburn. Methods: We measured pH, titratable acidity, and osmolality of 35 beverages in vitro and correlated them with the severity of heartburn reported by questionnaire in 382 patients from November 2004 to June 2005. Results: Coffee (1.15) and soju (1.12) showed the highest heartburn score, while oolong tea (0.17) and carrot juice (0.18) showed the lowest heartburn score among all beverages. Titratable acidity of citrus juices correlated with heartburn (r=0.78; p=0.023). Soft drinks had the lowest pH, which was unrelated with heartburn scores (r=?0.54; p=0.460). Increasing pH among alcoholic beverages was correlated with heartburn scores (r=0.84; p=0.037), and osmolality was inversely associated with heartburn scores (r=?0.86; p=0.028). The heartburn score of decaffeinated coffee was significantly lower than that of regular coffee (p<0.001). Regular milk caused more heartburn than low-fat milk (p=0.008). Conclusions: Our findings provide dietary information that helps to select appropriate beverages to the patients with heartburn. (Korean J Gastroenterol 2010;55:109-118)
대장 혈관이형성증에 대한 아르곤 플라즈마 응고 소작술 이후 생긴 자발성 세균성 복막염
정혜진 ( Hye Jin Jung ),류수형 ( Soo Hyung Ryu ),박경식 ( Kyoung Sik Park ),윤원재 ( Won Jae Yoon ),김진남 ( Jin Nam Kim ),김유선 ( You Sun Kim ),문정섭 ( Jeong Seop Moon ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.2
Spontaneous bacterial peritonitis (SBP) is the most common infection in liver cirrhosis patients, and is not a result of surgery or intra abdominal infection. Argon plasma coagulation (APC) is an endoscopic procedure used with a high frequency electrical current for control of bleeding from gastrointestinal vascular ectasias including angiodysplasia and gastric antral vascular ectasia. This procedure is known to be safe because it uses a noncontact method. Therefore, tissue injury is minimal and up to two to three millimeters. However, we experienced a case of SBP occurring immediately after performance of APC for control of severe bleeding from angiodysplasia in the colon in a patient with liver cirrhosis and hepatocellular carcinoma. (Korean J Gastroenterol 2014,64:115-118)
직장 카르시노이드 종양에서 Ki-67 발현의 예후적 중요성
홍수민 ( Su Min Hong ),김유선 ( You Sun Kim ),문정섭 ( Jung Seop Moon ),김진남 ( Jin Nam Kim ),오명기 ( Myoung Ki Oh ),권선옥 ( Sun Ok Kwon ),정성연 ( Seong Yeon Jeong ),홍성우 ( Seong Woo Hong ),강윤경 ( Yun Kyung Kang ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.2
Background/Aims: Rectal carcinoid tumors can be resected with endoscopy, and it is important to assess their prognostic factors. We evaluated the potential of Ki-67 expression as a prognostic factor in rectal carcinoid tumors. Methods: We retrospectively reviewed the medical records of 37 patients with rectal carcinoid tumors who got endoscopic resection from January 2001 to January 2011 at Inje University Seoul Paik Hospital. We analyzed their endoscopic and histologic findings, Ki-67 expression, clinical outcome, and prognosis. Results: The mean age (±SD) of the patients was 56.3±10.7 years, and the male : female ratio was 3.6:1. The mean tumor size was 0.5±0.4 cm, 33 patients showed grade 1 tumors (89.2%) and the average Ki-67 expression was 0.7±1.2%. Thirty five patients underwent endoscopic mucosal resection, and two required endoscopic submucosal dissection. Eight patients had positive margins after resection, but no cases of lymphovascular invasion were identified. The median follow-up duration was 21.4±25.4 months, and no recurrences were observed. Conclusions: In low grade rectal carcinoid tumors which are lack of central depression on colonoscopy, the expression of a molecular marker of malignant potential, Ki-67, was low. Therefore, endoscopic resection seemed to be a safe and effective treatment for these tumors.
국소성 분절성 사구체 경화증 환자에서 독성 거대결장으로 발현된 거대세포바이러스 대장염
강풍 ( Pung Kang ),김유선 ( You Sun Kim ),정성모 ( Sung Mo Jung ),김은순 ( Eun Soon Kim ),이정환 ( Jung Hwan Lee ),문정섭 ( Jeong Seop Moon ),고행일 ( Haeng Il Koh ) 대한내과학회 2002 대한내과학회지 Vol.63 No.6
Cytomegalovirus is a frequent opportunistic pathogen in immunosuppressed patients and CMV colitis is one of its major complications. It usually presents as gastrointestinal ulceration with bleeding or perforation, but it can also take less common forms re
명희준 ( Hee Jun Myung ),류수형 ( Soo Hyung Ryu ),유중호 ( Chung Hao Liu ),유정훈 ( Jung Hoon Yoo ),김서현 ( Seo Hyun Kim ),김승혁 ( Seung Hyuk Kim ),윤원의 ( Won Eui Yoon ),박태영 ( Tae Young Park ),문정섭 ( Jeong Seop Moon ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.4
The rupture of a pyogenic liver abscess (PLA) with peritonitis is a rare occurrence but a surgical emergency with a high mortality rate in the case of gas-forming PLA. Rare cases of ruptured PLA that recovered completely with only medical treatment have been reported. This paper reports a case of a large PLA rupture with peritonitis. In this case, surgical intervention was too risky because of the patient’s age and poor general condition. The patient recovered fully with appropriate antibiotic therapy and sufficient percutaneous drainage. Therefore, medical treatment may be considered an alternative option in cases of a ruptured large PLA with peritonitis if surgical intervention is too risky. (Korean J Gastroenterol 2021;77:190-193)
위장관 ; 장내시경 장정결제로서 Sodium Phosphate 정제와 2 L Polyethylene Glycol with Ascorbic Acid의 무작위 대조군 연구
이연호 ( Yun Ho Lee ),정성연 ( Seong Yeon Jeong ),김유선 ( You Sun Kim ),정혜진 ( Hye Jin Jung ),권민정 ( Min Jung Kwon ),곽철훈 ( Cheol Hun Kwak ),배송이 ( Song I Bae ),문정섭 ( Jeong Seop Moon ),김지원 ( Ji Won Kim ),김수환 ( Su 대한소화기학회 2015 대한소화기학회지 Vol.65 No.1
목적: PEG (polyethylene glycol)는 안정적인 장정결제로 인정받아 왔지만, 환자의 순응도가 좋지 않아 장 정결이 제대로 되지 않을 수 있다는 단점이 있다. 이 연구에서는 sodium phosphate (NaP) 정제와 PEGA (PEG with ascorbic acid)를 사용하는 대장 정결법의 효용성과 순응도를 알아보고자 하였다. 대상 및 방법: 다기관, 전향적 무작위 대조 연구이며, 1차 연구 목적은 대장내시경 전처치에서 NaP 정제와 PEGA 방법의 대장 정결도를 비교하는 것이고, 2차 목적은 대장 내시경 시행 직전 조사한 설문을 이용하여 양 군 간의 환자의 순응도와 만족도를 비교하는 것이다. 결과: 총 189명 중 사전 무작위 배정을 통해서 NaP 정제(n=96) 또는 PEGA (n=93) 방법을 통해 장정결한 뒤 대장내시경을 시행하였다. 양 군 간에 BBPS는 NaP 정제군에서 평균 8.3 (SD, ±1.12)이었고, PEGA군에서는 평균 8.4 (SD, ±0.96)로 나타나 통계적으로 유의한 차이는 없었다(p=0.441). 양 군 간의 폴립 및 선종의 발견율 또한 유의한 차이가 나지 않았다(p=0.079, 0.790, respectively). 반면 NaP 정제를 복용한 환자의 2.0%가 복용해야 할 분량을 다복용하지 못하였고, PEGA군에서는 8.6%가 복용하지 못하였다(p=0.045). 또한 만족도는 NaP 정제군에서 평균 7.9 (SD, ±1.63)였고, PEGA군에서는 평균 7.4 (SD ±1.53)로 나타나 유의한 차이를 보였다(p=0.022). 결론: NaP 정제를 이용해 대장 정결을 하는 것은 PEGA 방법과 비교하여 정결도, 폴립(선종)의 발견율, 부작용 발생에 큰 차이가 없으면서 순응도 및 만족도가 더 높은 방법이다. Background/Aims: Performance of polyethylene glycol solution (PEG) is often unsatisfactory as bowel preparation agent for colonoscopy. In order to provide equivalent efficacy with better patient tolerance, sodium phosphate tablet (SPT) has been developed. This study was carried out to compare the efficacy and compliance of two bowel preparation methods: PEG with ascorbic acid (PEGA) vs. SPT preparation. Methods: A multicenter, randomized controlled trial was performed. Primary efficacy variable was overall quality of colon cleansing assessed by Boston bowel preparation scale (BBPS) during colonoscopy. Patient`s satisfaction and adverse events were evaluated by means of symptom questionnaire completed by each patient immediately before colonoscopy. Results: A total of 189 patients were randomly assigned to undergo pre-colonoscopic bowel preparation with either SPT (n=96) or PEGA (n=93). Overall BBPS score was 8.3±1.12 in the SPT group and 8.4±0.96 in the PEGA group (p=0.441). Among the 189 patients, 90 had polyps (47.6%) and 50 had adenomas (26.5%). The polyp/adenoma detection rate was 54.2% (n=52)/27.1% (n=26) for SPT group and 40.9% (n=38)/25.8% (n=24) for PEGA group (p=0.079 and 0.790, respectively). More number of patients were unable to take the prescribed dose of PEGA compared with the SPT regimen (8.6% vs. 2.0%, p=0.045). Overall satisfaction score was 7.9±1.63 in the SPT group and 7.4±1.53 in the PEGA group (p=0.022). Conclusions: Degree of colon preparation, polyp/adenoma detection rate and adverse effect were similar between SPT group and PEGA group. Patient compliance and satisfaction were greater in the SPT group.
김형훈 ( Hyung Hun Kim ),김유선 ( You Sun Kim ),옥경선 ( Kyung Sun Ok ),류수형 ( Soo Hyung Ryu ),이정환 ( Jung Hwan Lee ),문정섭 ( Jeong Seop Moon ),이혁상 ( Hyuck Sang Lee ),이혜경 ( Hye Kyung Lee ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.6
Chronic non-granulomatous jejunoileitis is a rare disease characterized by malabsorption, abdominal pain, and diarrhea that causes shallow ulcers in the small bowel. The etiology of chronic non-granulomatous jejunolieitis remains unknown. A 69-year-old man complained of abdominal pain and lower extremity edema. A 99m-Tc albumin scan showed increased radioactivity at the left upper quadrant, suggesting protein-losing enteropathy. A small bowel follow-through did not disclose any lesions. Wireless capsule endoscopy revealed several small bowel ulcers and strictures. A jejunoileal segmentectomy with end-to-end anastomosis was performed, and the histologic examination revealed non-granulomatous ulcers with focal villous atrophy. Ruling out all other possible diagnoses, we diagnosed our patient with chronic non-granulomatous ulcerative jejunoileitis. Postoperatively, the patient`s abdominal pain and lower extremity edema improved, and the serum albumin normalized. This is the first case of chronic non-granulomatous ulcerative jejunoileitis localized by wireless capsule endoscopy and treated successfully with segment resection. (Korean J Gastroenterol 2010;56:382-386)