• Journal of Gastric Cancer
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• v.9 no.2
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• pp.39-45
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• 2009

Endoscopic resection has been established as one of the treatment options for selected cases of early gastric cancer in Korea. Yet the indications, best treatment methods, management of complications and follow-up methods after the procedure are still uncertain. Some large-scale multicenter studies have recently been reported in Korea. In this review, I will provide an overview of the recent published articles and future directions for endoscopic resection of early gastric cancer.

• Journal of Gastric Cancer
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• v.9 no.3
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• pp.71-77
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• 2009

Endoscopic resection is one of the curative options for early gastric cancer. However, based on large-scale data about the risk of lymph node metastasis in early gastric cancer, endoscopic resection has been attempted for the following: differentiated intramucosal gastric cancer, regardless of size and without ulcers; differentiated intramucosal cancer, 30 mm in size with ulcers; minute submucosal differentiated cancer <30 mm in size; and undifferentiated intramucosal cancer, <20 mm in diameter without venous or lymphatic involvement. However, undifferentiated early gastric cancer exhibits different biologic behavior from differentiated early gastric cancer. Thus, the application of endoscopic resection for undifferentiated early gastric cancer remains controversial. In this review, we discuss the application of endoscopic resection for undifferentiated early gastric cancer based on analysis of biologic behavior and data of endoscopic resection.

• Korean Journal of Head & Neck Oncology
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• v.30 no.1
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• pp.10-14
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• 2014

목 적 CO2 가스 삽입 없이 내시경 보조 갑상선 절제술, 특히 액와 절개를 이용하는 경우의 대부분은 기구 사용을 용이하게 하기 위하여 흉부 또는 유륜에 절개를 넣어 시행하는 것이 대부분이다. 본 연구는 후이개 절개를 통하여 추가적 절개 없이 내시경을 이용한 갑상선 절제술 및 중심 임파선 절제술이 가능한지의 여부를 사체연구를 통하여 확인해 보고자 한다. 방 법 사체 이용 해부 및 수술 후이개 내시경 보조 갑상선 절제술이 가능한지의 확인은 수술 시야 및 접근성, 수술 완성도, 그리고 주요 구조물의 보존 여부인 3가지 항목으로 평가하였다. 결 과 수술 시야는 기구를 다루고 수술을 하기에 충분하였으며, 추가 절개 없이 수술을 완성할 수 있었다. 절제된 갑상선 조직의 피막은 손상되지 않았으며, 잔존 갑상선 조직이 없음을 수술 부위를 통하여 확인하여, 수술의 완성도 여부를 평가할 수 있었다. 모든 사체에서 되돌이 후두신경 및 상 또는 하부갑상선의 보존을 확인하였으며, 주변 구조물들의 손상이 없음을 확인하였다. 결 론 로봇이 아닌 후이개 절개를 이용한 내시경 보조 갑상선 절제술은 시행 가능한 접근법 및 수술방법이라 사료된다.

• Journal of Veterinary Clinics
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• v.28 no.6
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• pp.555-561
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• 2011

Laparoscopic surgery is a well-established alternative to open surgery across disciplines. However, in veterinary medicine, laparoscopic surgery in dogs was rarely reported because of small abdominal size for multiple ports insertion. The concept of single-incision laparoscopic surgery (SILS) is to perform the entire laparoscopic operation through a single incision rather than conventional multiple small skin incisions. Indirect evidence of potential benefits of SILS, decreases operative morbidity related to reduction in port size, already exists. Therefore, this study was performed to evaluate the safety and feasibility of the modified form of SILS using flexible endoscope in Cholecystectomy before clinical adoption. A 2 cm single periumbilical incision was performed, and flexible endoscope was introduced into the abdominal cavity. A laparoscopic grasper was inserted into the abdominal cavity for the traction of gall bladder. Cystic duct and artery were ligated by 5 mm Hem-o-lok$^{(R)}$. Then, gall bladder was dissected and resected from the liver with 5 mm Autonomy Laparo-Angle Maryland dissector and endoscopic needle knife. Resected gall bladder was wrapped by using specimen pouch and was retrieved through abdominal incision from the cavity. All three gall bladders were successfully removed. Hematological changes were not observed during examination periods. No leakage sign was identified at necropsy. The flexible endoscope, as distinct from conventional rigid laparoscope, allows the visualization from various angles and the wide range of motion, result in less crowding.

• The Korean Journal of Gastroenterology
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• v.72 no.5
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• pp.271-273
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• 2018

내시경 시술 전 일시적으로 항응고제를 중단하는 것은 위장관 출혈의 위험과 혈전색전증의 위험 사이에 적절한 균형을 잡기 어렵기 때문에 논란의 여지가 많다. 와파린은 새로운 경구용 항응고제(direct oral anticoagulant agent, DOAC)보다 임상의에게 더 친숙하고, 효과를 쉽고 빠르게 전환시킬 수 있다는 장점이 있지만 복잡한 약역동학 특징과 좁은 치료적 범위 때문에 관리가 어렵다. 반면, DOAC는 약물의 모니터링 및 용량 조절 없이 정해진 용량으로 처방이 가능하며, 빠르게 작용하고, 반감기가 짧아 관리가 쉽지만 해독제가 없다는 단점이 있다. 이전 연구들에서 DOAC를 복용한 환자들은 와파린을 복용한 환자들보다 시술과 관련되지 않은 위장관 출혈의 위험이 높았다고 보고한 바 있다. 하지만 시술과 관련된 위장관 출혈 위험에 대하여는 알려진 바가 없는 실정이다. 미국이나 유럽 내시경 가이드라인들에서는 저위험 내시경 시술을 받는 환자들에서는 와파린과 DOAC를 유지하도록 권고하고 있으며, 고위험 시술의 경우에는 와파린를 사용하는 환자들에서 헤파린 교량 요법(heparin bridging)을 시행하도록 권고하고 있다. 임상적으로 DOAC를 사용하는 환자들 또한 혈전색전증을 예방하기 위하여 헤파린 교량 요법을 시행해볼 수 있는데, 와파린 및 DOAC의 헤파린 교량 요법과 관련된 출혈 및 혈전색전증 위험의 차이 또한 명확하지 않다. 따라서 저자들은 1) 와파린과 DOAC 치료를 받는 환자들에서의 출혈, 혈전색전증 및 사망의 위험을 비교하고자 하였으며, 2) 13종류의 고위험 내시경 시술 중에서 시술별 위험을 비교하고, 3) 헤파린 교량 요법이 합병증의 발생을 증가시키지 않는지 확인하고자 본 연구를 진행하였다. 일본 대규모 국가 입원 환자 데이터베이스를 이용하여 2014년 4월부터 2015년 5월까지 시술 전 와파린 또는 DOAC(rivaroxaban, apixaban, dabigatran, edoxaban)를 복용하고, 13종류의 고위험 내시경 시술을 시행받은 20세 이상의 성인 환자 총 16,977명을 확인하였다. 고위험 시술은 용종 절제술, 내시경 점막절제술, 내시경 점막하박리술, 협착 부위의 풍선확장술, 내시경 지혈술, 내시경 정맥결찰술, 내시경 주사 경화요법, 내시경 괄약근절개술, 내시경 초음파 유도하 미세침 흡인 검사, 경피적 위루술을 포함하였다. 일대일 성향 점수 매칭 분석(propensity score matching, 나이, 성별, 체질량 지수, 기저 질환, 병원의 규모, 시술의 종류, 약물의 종류를 매칭)을 시행하여 와파린군과 DOAC군에서 시술 위장관 출혈 및 혈전색전증, 사망의 발생을 비교하였다. 또한 경구항혈전제와 헤파린 교량 치료 시행 유무에 따라, DOAC 단독군, 와파린 단독군, DOAC와 헤파린 교량 요법군, 와파린과 헤파린 교량요법군으로 나누어, 하위군(subgroup) 분석을 시행하였다. 5,046쌍이 성향 점수 매칭 분석에 포함되었으며, 와파린군에서 DOAC군보다 통계적으로 의미 있게 위장관 출혈의 비율이 높았다(12.0% vs. 9.9% p=0.02). 혈전색전증 발생률(5.4% vs. 4.7%)과 입원중 사망률(5.4% vs. 4.7%)은 양 군에서 의미 있는 차이는 없었다. DOAC 종류별로 나누어 하위군 분석을 시행하였을 때, 와파린군은 rivaroxaban군에 비하여 위장관 출혈의 비율이 높았으며, rivaroxaban군, dabigatran군에 비하여 혈전색전증의 비율이 높았고, 입원 중 사망률에서는 의미 있는 차이는 없었다. 내시경 시술의 종류로 보정하였을 때 위장관 출혈 및 혈전색전증, 사망률은 DOAC 단독으로 치료한 환자에서보다 와파린과 헤파린 교량 요법(bridging) 또는 DOAC과 헤파린 교량 요법을 시행한 환자에서 높았다. 시술 종류 중에서는 위루관 삽입술에 비하여 내시경 점막하박리술, 내시경 점막절제술 및 내시경 정맥류결찰술, 내시경 주사경화요법을 시행한 환자에서 위장관 출혈의 위험이 가장 높았으며, 하부 내시경 점막절제술, 하부 용종 절제술, 내시경적 유두괄약근절제술 또는 내시경 초음파 유도하 미세침 흡인 검사는 중등도 위험을 보였다.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.851-854
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• 1999

Hemangioma in the esophagus is an uncommon tumor. There have only been about 30 cases reported in the world literatures. It occurs predominantly in men and although majority are asymptomatic, may cause bleeding and dysphagia. Hemangioma in the esophagus was diagnosed with a barium swallowed esophagography and endoscopy. The main treatment modes recommended are surgery and endoscopic resection. We experienced one case of cav ernous hemangioma occurring at the distal esophagus. The patient was a forty-six year old male with dysphagia and indigestion. Barium esophagogram showed a filling defect at the distal portion. Esophagoscopy showed a bluish polypoid mass. Surgical resection was per formed and the pathologic diagnosis was confirmed as cavernous hemangioma. Postoperative course was uneventful and the patient had been followed up without any problems.

• Journal of Gastric Cancer
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• v.10 no.1
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• pp.1-4
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• 2010

Purpose: Gastric epithelial dysplasia (GED) was defined as "unequivocally neoplastic epithelium that may be associated with or give rise to invasive adenocarcinoma" and GED also represents a direct precursor of intestinal type adenocarcinoma of the stomach. The recommended treatment guidelines for GED in the medical literature are endoscopic mucosal resection (EMR) or surgery for high grade dysplasia (HGD) and annual endoscopic surveillance with biopsy for low grade dysplasia (LGD) The aim of this study was to determine the treatment plan for GED that is diagnosed by endoscopic biopsy. Materials and Methods: We enrolled 148 patients who were treated by endoscopic mucosal resection (EMR) or endoscopiccsubmucosal dissection (ESD) for GED: there were 63 patients with HGD and 85 patients with LGD and all of them were diagnosed by endoscopic biopsy from January 2006 to December 2008. The results of the final histopathologic reports after EMR or ESD were compared with the results of the endoscopic biopsies. Results: The final histopathologic results of the 148 patients with GED showed 49 (33.1%) patients with adenocarcinoma, 40 (27.0%) patients with HGD and 59 (39.9%) patients with LGD. Among the 63 patients with HGD, 34 (54.0%) patients had adenocarcinoma, 20 (31.7%) patients had HGD and 9 (14.3%) patients had LGD. For the 85 patients with LGD, 15 (17.6%) patients had adenocarcinoma, 20 (23.5%) patients had HGD and 50 (58.8%) patients had LGD Conclusion: Complete resection, including EMR or ESD, is needed for patients with GED diagnosed by endoscopic biopsy and they have HGD. For patients with LGD, EMR or ESD may be needed in addition to endoscopic surveillance with biopsy for making the correct diagnosis and proper treatment because of the possibility of adenocarcinoma.

• Journal of Korean Society of Spine Surgery
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• v.25 no.4
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• pp.180-184
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• 2018

Study Design: Case report Objectives: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). Summary of Literature Review: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. Materials and Methods: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. Results: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. Conclusions: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.

• Journal of Digestive Cancer Research
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• v.2 no.1
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• pp.24-27
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• 2014

A 42-year-old female was referred to our department after find out submucosal tumor type lesion on cardia at local clinics. She experienced no specific symptom. On gastroscopy, two distinct neoplasms were detected. One of which was located in the cardia anterior wall of the stomach with the size of 2.0×1.1 cm, and the other one was localized in the cardia posterior wall of the stomach and its size was 1.5×1.2 cm. We performed endoscopic submucosal dissection. Pathological evaluation revealed the diagnosis of gastrointestinal stromal tumor (GIST) at the cardia anterior wall and malignant lymphoma from the mass localized cardia posterior wall of the stomach. We would like to report these rare synchronous tumors which were successfully treated by endoscopic resection in the same patient

• Journal of Digestive Cancer Research
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• v.3 no.1
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• pp.35-38
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• 2015

62-year-old patient who had past history of endoscopic submucosal dissection for early gastric cancer at September 2008, underwent endoscopic submucosal dissection of esophagus for early esophageal cancer at mid esophagus during health screening service. Because there was a high risk of lymph node metastasis at biopsy results, concurrent chemoradiotherapy was added to endoscopic submucosal dissection. There was a metachronous cancer at mid-esophagus at March 2013. He underwent endoscopic mucosal resection and photodynamic therapy. Concurrentchemoradiotherapy after endoscopic submucosal dissection is an effective treatment method.