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- 저자 : the Korean ESD Study Group (검색결과 4 건)
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최주영,정성애,심기남,조원영,금보라,변정식,허규찬,장병익,장동경,정훈영,공경애,the Korean ESD Study Group 대한의학회 2015 Journal of Korean medical science Vol.30 No.4
The objective of this study was to conduct a meta-analysis to determine risk factors thatmay facilitate patient selection for radical resections or additional resections after apolypectomy. Eligible articles were identified by searches of PUBMED, Cochrane Libraryand Korean Medical Database using the terms (early colorectal carcinoma [ECC], lymphnode metastasis [LNM], colectomy, endoscopic resection). Thirteen cohort studies of 7,066ECC patients who only underwent radical surgery have been analysed. There was asignificant risk of LNM when they had submucosal invasion (≥ SM2 or ≥ 1,000 μm) (oddsRatio [OR], 3.00; 95% confidence interval [CI], 1.36-6.62, P = 0.007). Moreover, it hasbeen found that vascular invasion (OR, 2.70; 95% CI, 1.95-3.74; P < 0.001), lymphaticinvasion (OR, 6.91; 95% CI, 5.40-8.85; P < 0.001), poorly differentiated carcinomas (OR,8.27; 95% CI, 4.67-14.66; P < 0.001) and tumor budding (OR, 4.59; 95% CI, 3.44-6.13;P < 0.001) were significantly associated with LNM. Furthermore, another analysis wascarried out on eight cohort studies of 310 patients who underwent additional surgeriesafter an endoscopic resection. The major factors identified in these studies includelymphovascular invasion on polypectomy specimens (OR, 5.47; 95% CI, 2.46-12.17;P < 0.001) and poorly or moderately differentiated carcinomas (OR, 4.07; 95% CI, 1.08-15.33; P = 0.04). For ECC patients with ≥ SM2 or ≥ 1,000 μm submucosal invasion,vascular invasion, lymphatic invasion, poorly differentiated carcinomas or tumor budding,it is deemed that a more extensive resection accompanied by a lymph node dissection isnecessary. Even if the lesion is completely removed by an endoscopic resection, anadditional surgical resection should be considered in patients with poorly or moderatelydifferentiated carcinomas or lymphovascular invasion.
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Stricture Occurring after Endoscopic Submucosal Dissection for Esophgeal and Gastric Tumors
김광하,지삼룡,장재영,신성관,최기돈,이준행,김상균,성재규,최석채,전성우,장병익,허규찬,장동경,정성애,금보라,조진웅,최일주,정훈용,the Korean ESD Study Group 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.6
Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation.
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Current Guidelines in the Management of Upper Gastrointestinal Subepithelial Tumors
Jin Woong Cho,the Korean ESD Study Group 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.3
Subepithelial tumors are frequently found in asymptomatic patients in Japan and Korea where cancer screening tests routinely include endoscopy. Most lesions are asymptomatic and clinically insignificant. However, carcinoid tumors, lymphomas, glomus tumor and gastrointestinal stromal tumors (GISTs) are malignant or have the potential to become malignant. Inflammation due to parasitic infestation by Anisakis and poorly differentiated adenocarcinomas in the stomach rarely present as subepithelial lesions. In contrast to the frequency of gastric GIST in the gastrointestinal system, they are uncommon in the duodenum and very rare in the esophagus. The prognosis of patients with GISTs in the stomach is relatively good compared with GISTs in other organs. Along with the location of the tumor, its size and mitotic count are major factors that determine the malignant potential of GIST. Small (<2 cm) asymptomatic GISTs usually have benign clinical course. GIST is the most common subepithelial tumor to occur in the stomach. Although various methods are employed to diagnose GISTs, the risk of GIST metastasis cannot be accurately predicted before lesions are completely resected. Recently, new endoscopic diagnostic methods and treatment techniques have been developed that allow the diagnosis and resection of lesions located in the muscularis propria, without any complications. These endoscopic methods have different indications depending on regions where they are performed.
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Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist’s View
조진웅,최석채,장재영,신성관,최기돈,이준행,김상균,성재규,전성우,최일주,김광하,지삼룡,이완식,정훈용,Korean ESD Study Group 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.6
One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred.
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