• Clinical Endoscopy
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• 제56권1호
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• pp.1-13
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• 2023

The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventional ABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, they cannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary due to financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damage caused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternative to the ABTM, owing to the SBTM's advantages. Since the 1960s, many GI endoscopy training simulators have been developed and numerous studies have been published on their effectiveness. While previous studies have focused on the simulator's validity, this review focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GI endoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into an improved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace the ABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.

• Nuclear Medicine and Molecular Imaging
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• 제43권4호
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• pp.309-316
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• 2009

목적: $^{18}$F-FDG PET/CT는 다양한 장관내 악성 종양을 발견하는데 높은 민감도를 보이고 있다. 하지만 $^{18}$F-FDG가 다양한 형태로 장관 내 생리적, 병리적 섭취증가를 보이기 때문에 그 특이도는 낮다. 이 연구는 장관 내 국소적인 $^{18}$F-FDG 섭취증가를 보일 때 생리적 섭취와 병리적 섭취를 감별하는 데 있어 추가 지연(dual time point) $^{18}$F-FDG PET/CT의 임상적 유용성을 알아보고자 하였다. 대상 및 방법: 2007년 1월부터 2008년 6월까지 장관 내 국소적인 섭취증가를 보여 추가 지연 촬영 $^{18}$F-FDG PET/CT를 실시한 132명(남:여=77:55, 나이 62.8$\pm$11.6세)을 대상으로 하였다. $^{18}$F-FDG 정맥 주사 후 50-60분 후에 조기 영상을 촬영하였고, 정맥 주사 후 4-5시간에 국소 섭취 증가 부위를 포함하고 있는 복부 부위에 대해 추가 지연 촬영을 실시하였다. 초기 영상에서 보였던 국소적 섭취가 지연 영상에서 보이지 않거나 이동하였을 경우에는 생리적 섭취증가로 간주하였고, 지연 영상에서 지속적으로 관찰되는 섭취증가에 대해서는 대장내시경과 병리조직 검사를 실시하였다. 지연 영상에서 지속적으로 관찰되는 장관 내 섭취에 대해서는 각각 Suvmax값과 조기 영상과 지연 영상의 Syvmax값의 차이($\Delta$%Suvmax)를 계산하였다. 결과: 132명의 환자에서 153개의 국소적 섭취증가병소를 관찰할 수 있었다. 이 중 72개 병소에서는 지연 영상에서 섭취 증가가 사라져 생리적 섭취로 판단할 수 있었다. 조기 영상에서만 보였던 생리적 섭취는 맹장을 포함한 오름 결장에서 가장 많이 관찰되었다. 지연 영상에서도 지속적으로 섭취증가를 보인 81개 병소에서 61개는 악성 종양으로 확진되었고, 14개는 양성 질환으로 확인 되었다. 나머지 6개의 병소는 대장내시경에서 특이소견을 보이지 않아 생리적 섭취로 확인되었다. 악성 종양은 $\Delta$%Suvmax가 20.8%$\pm$18.7%로 통계적으로 유의하게 증가하였고, 반대로 리 악성에서는 3.7%$\pm$24.2%로 감소하였다. 가장 유용한 진단적 가치를 주는 요소는 $\Delta$%Suvmax 임을 확인하였고, 악성과 비악성 질환을 감별하는데 임계수를 -5%로 정하였을 때 가장 좋은 민감도, 특이도, 정확도를 보였다. 결론: $^{18}$F-FDG PET/CT를 이용한 추가 지연 촬영은 생리적 섭취와 병리적 섭취를 감별하는데 있어 검사의 특이도를 높이고 불필요한 검사를 줄일 수 있는 유용한 비침습적 방법으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권5호
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• pp.2401-2405
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• 2016

Background: Both colorectal cancer (CRC) and diverticular disease (DD) are common in the affluent West, and their prevalence is also increasing in the rest of the world with economic development. Both diseases have common epidemiologic characteristics; increasing incidence, more common with advancing age and related to specific dietary changes. However, studies of associations between the two have generated mixed results with some showing positive correlations, whilst others have shown no or negative links. Most of these studies have been from the West with study populations that were predominantly Caucasians. Here the focus was on DD and colorectal neoplasms, including CRC, in Brunei. Materials and Methods: All patients who had undergone complete colonoscopy between 2011 and 2014 were identified and retrospectively reviewed. Patients under the age of 18 years old or had previous colonic surgeries (including previous CRC resection) were excluded. Results: The total number of colonoscopies included in the study was 2,766 (mean age $53.2{\pm}14.8$ years old, male 51.8%), of which DD, CRC and colonic polyps were detected in 17.3%, 4.7% and 28.2% respectively. The proportions of DD, polyps and CRC increased proportionally with age (<30 years, 30-49, 50-69 and ${\geq}70$). Overall, there was no association between the presence of DD and CRC (3.6% vs. 5.0%, p=0.179) but there was a significant association between CRC and left sided DD (p=0.034 by trend). There were also a significant association between presence of DD and polyps (36.1% vs. 28.2%, p=0.001), in particular with right-sided and pan-DD (p=0.001 for trend). Conclusions: Our study showed that the prevalence of DD, CRC and polyps increases with age. There were significant associations between presence of left-sided DD with CRC and right-sided or pan-DD with colonic polyps. This suggests shared risk factors. Further studies are required to assess links in other countries of the Asian Pacific region.

• Journal of Preventive Medicine and Public Health
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• 제36권3호
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• pp.279-288
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• 2003

Objectives : Evidence for an effect of rerroductive factors on colorectal carcinogenesis is not yet consistent. Little research has been conducted to investigate whether reproductive factors were associated with colorectal adenomas that are the precursors of colorecta1 cancer, We evaluated the relationships between reproductive factors and the degree of dysplasia of the colorectal adenoma and cancer as colorectal adenoma-carcinoma sequence. Methods : For this study, 241 adenoma cases with histopathologically confirmed incident colorectal adenoma, 76 cancer cases with colorectal cancer and 1677 controls were collected from Our Lady of Mercy Hospital, The Catholic University of Korea, during 1994-1999. Before colonoscopy, information on demographic characteristics, reproductive factors, life style habits and dietary intake were obtained by interviewed questionnaire. Adjusted OR and 95% CI were estimated by using polytomous logistic regression model, Potential confounders that were selected based on the goodness of fit Statistics and interaction between risk factors were considered in this adjustment. The Wald statistic was calculated to test the heterogeneity of the odds ratios for each case. Results .: Postmenopausal women with natural menopause were found to be positively associated with the risk of mild dysplasia adenoma (multivariate-adjusted OR : 2.59, 95% CI=1.1-0.2). Parity was found to be negatively associated with the risk of colorectal lancer (age-adjusted OR : 0.40, 95% CI=0.2-0.9), but did not significantly decrease the risk of colorectal cancer (multivariate-adjusted OR : 0.95, 95% CI=0.3-2.9). Me associations were seen between a9e at menarche, breast feeding, induced abortion, oral contraceptive use, menopausal types, menopausal age or hormone replacement therapy (HRT and the degree of dysplasia of the colorectal adenoma and cancer. However, none of these associations differed' significantly between the degree of dysplasia of the colorectal adenoma and cancer. Conclusions : These findings suggest that postmenopausal women with natural menopause may experience increased risk of mild dysplasia adenorna among colorectal adenoma-carcinoma sequence.

• Asian Pacific Journal of Cancer Prevention
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• 제17권2호
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• pp.631-638
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• 2016

Radiation proctitis is a common complication after radiotherapy for pelvic malignant tumors. This study was conducted to assess the efficacy of novel almagate enemas in hemorrhagic chronic radiation proctitis (CRP) and evaluate risk factors related to rectal deep ulcer or fistula secondary to CRP. All patients underwent a colonoscopy to confirm the diagnosis of CRP and symptoms were graded. Typical endoscopic and pathological images, risk factors, and quality of life were also recorded. A total of 59 patients were enrolled. Gynecological cancers composed 93.1% of the primary malignancies. Complete or obvious reduction of bleeding was observed in 90% (53/59) patients after almagate enema. The mean score of bleeding improved from 2.17 to 0.83 (P<0.001) after the enemas. The mean response time was 12 days. No adverse effects were found. Moreover, long-term successful rate in controlling bleeding was 69% and the quality of life was dramatically improved (P=0.001). The efficacy was equivalent to rectal sucralfate, but the almagate with its antacid properties acted more rapidly than sucralfate. Furthermore, we firstly found that moderate to severe anemia was the risk factor of CRP patients who developed rectal deep ulcer or fistulas (P= 0.015). We also found abnormal hyaline-like thick wall vessels, which revealed endarteritis obliterans and the fibrosis underlying this disease. These findings indicate that almagate enema is a novel effective, rapid and well-tolerated method for hemorrhagic CRP. Moderate to severe anemia is a risk factor for deep ulceration or fistula.

• Asian Pacific Journal of Cancer Prevention
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• 제17권11호
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• pp.4885-4892
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• 2016

Background: Chinese and Korean Americans have lower colorectal cancer (CRC) screening rates than other racial/ ethnic groups, which may be explained by a low level of CRC knowledge and a high level of misconceptions. This study explores the role of knowledge in CRC screening among these groups. Methods: Chinese (N=59) and Korean (N=61) Americans older than 50 were recruited from the Washington D.C. Metropolitan area. They completed a detailed survey and participated in focus groups to discuss their knowledge on CRC and CRC screening. Seventeen physicians, community leaders, and patient navigators participated in key informant interviews. Using a mixed methods approach, data were analyzed quantitatively and qualitatively. Results: Participants lacked knowledge about CRC and CRC screening. More than half did not know that screening begins at age 50 and there are several types of tests available. More than 30% thought CRC screening was not necessary if there were no symptoms or there was nothing they could do to prevent CRC. Focus group findings suggested understanding about CRC was limited by an inadequate source of linguistically and culturally relevant health information. For example, many participants considered CRC a western condition mainly caused by unhealthy diet. This led to under-estimations about their susceptibility to CRC. Knowledge was positively associated with self-reported screening. Participants who had higher knowledge scores were more likely to report ever having had a colonoscopy and confidence in ability to have CRC screening. Conclusions: Mixed-methods analysis provides multi-faceted perspectives on CRC knowledge and its influence on screening. Study findings can help inform interventions to increase CRC screening among Chinese and Korean Americans.

• 한국의료질향상학회지
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• 제15권1호
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• pp.89-100
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• 2009

문제: 소화기병검사실에서 대장내시경 검사의 부도건수가 최근 월 200명 정도로 예약인원의 16%에 달한다. 이는 본원 외래진료 부도율이 평균 10%인 것과 비교할 때 상당히 높은 결과이므로 대장내시경 예약환자를 대상으로 부도율 관리를 위한 활동이 필요하였다. 목적: 외래 및 입원환자의 부도건수 및 부도환자의 특성을 분석하고, 개선활동을 통하여 대장내시경 검사의 부도율을 줄인다. 의료기관: 서울 아산병원. 질 향상 활동: 부도관리를 위한 개선활동으로 SMS 횟수를 2주전, 4일전, 1일전 3회로 변경하고, 내용도 각 시기마다 차별화하였다. 대장내시경 검사 예약을 하고 기다리는 환자를 대상으로 처방일 순, 예약 날짜순서 등 필요한 항목 순으로 볼 수 있는 리스트가 필요하여 예약대기 프로그램을 개발하였고, 처방일로부터 2주 이내 자동예약을 금지하였다.(7월 10일부터 시작) 예약대기명단에 있는 환자를 대상으로 전화로 예약 변경을 하여 2주 이내에는 예약의 빈자리가 없도록 하였다. 미리 부도를 예측하여 추가로 예약하던 방법에서 정원조정을 하여 정원 외 추가 예약을 하지 않았다. 입원환자 일정관리를 위하여 일정관리 프로그램을 개발하여 타과의뢰 회신을 하는 전임의가 직접 날짜를 전산에 입력하여 회신과 동시에 검사실, 담당주치의, 담당 간호사가 모두 일정을 확인할 수 있도록 하였으나 프로그램이 늦어져 9월 12일부터 시행하였다. 개선효과: 부도건수가 개선 전 8주 동안 385건(예약인원 대비 16%) 에서 개선 후 6주의 평가기간 동안 256건(예약인원대비 14.1%)으로 129건이 감소하였으며, 검사 1-2일전 일정 변경 연락 환자 감소 및 검사 비용 수납 환자의 부도건수가 감소하였다. 대장내시경 검사 예약대기 프로그램 운영 및 예약 변경 전화 활동으로 2달씩 기다리던 환자의 예약일을 약 한 달 정도 단축하여 줄 수 있었다. 검사 정원 관리의 결과로 검사 예약 시 예약기준이 명확해지고, 부적절한 예약으로 인한 검사지연 등이 확실히 줄었다. 또한 입원환자 일정관리 프로그램 적용으로 입원환자의 검사일정과 관련된 전화업무는 확실히 줄어들 것으로 예상된다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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• pp.7831-7836
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• 2015

Background: Colorectal cancer (CRC) is one of the most common malignancies of the gastrointestinal tract. The aim of this study was to assess the general knowledge of CRC in individuals living in Rasht, Iran, using a population-based cross-sectional telephone survey. Materials and Methods: A total of 1557 participants between 18 and 80 years of age were interviewed using random sampling from the telephone directory. Knowledge of risk factors, symptoms, diagnosis, and prevention of CRC was assessed using a validated questionnaire. Results: The mean knowledge level of the 1,557 respondents (average age 46 y) was $13.5{\pm}4.29$ (maximum possible score = 26), and 46.4% (722/1,557) of the subjects achieved grades lower than the mean score. The mean scores for knowledge of symptoms and risk factors were $3.97{\pm}1.83$ (range: 0-7) and $5.17{\pm}1.65$ (range: 0-9), respectively. Older age, higher education, and employment were significantly associated with better scores for recognition of risk factors and warning symptoms. The majority of subjects correctly identified weight loss (70.2%; 1,093/1,557) and rectal bleeding (63.3%; 986/1,557) as symptoms of CRC, and that smoking (85.9%; 1,337/1,557) and a low-fiber diet (73.4%; 1,143/1,557) were risk factors. Approximately half of the subjects noted increasing age, genetic background and fried food as other risk factors. A considerable number (54.8%; 853/1,557) identified colonoscopy as a screening method for detecting CRC in asymptomatic patients. However, a third of the subjects in the target group for screening (${\geq}50y$) were not interested in undergoing screening, primarily due to a lack of symptoms. Conclusions: Our results suggest that the knowledge of CRC is poor among the public, and therefore greater attempts should be made to increase awareness. Public education emphasizing the risk factors and symptoms of CRC, as well as the importance of regular screening regardless of the presence of symptoms, may help to reduce CRC morbidity and mortality.

• Tuberculosis and Respiratory Diseases
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• 제56권2호
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• pp.216-220
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• 2004

폐전이에서 공동성 폐병변이 관찰되는 경우가 흔하지 않으며, 다른 양성 폐병변과 감별이 필요하다. 저자들은 다발성 공동성 폐병변을 주소로 내원한 환자에서 굴곡성 기관지내시경 검사를 통한 조직검사상 전이성 폐암을 진단하였고 원발성 병변인 담관암을 진단하여 전신적인 항암약물을 시행한 경험이 있어 이에 보고하는 바이다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제10권1호
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• pp.76-80
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• 2007

소아암에서 장관계 악성 종양 특히, 대장암은 극히 드문 질환이다. 그러나, 대장은 소아 장관계 상피세포암이 가장 호발하는 부위이며, 반지세포암은 성인과는 달리 소아 대장암 중에서 가장 흔한 조직형태 중 하나이다. 국내에서는 소아 대장에서 발생한 반지세포암에 대한 보고는 아직 없었다. 반지세포암은 점액이 세포내에 풍부하고 핵이 한쪽으로 치우쳐 있는 특징적 고리모양의 암 세포가 전체 암 세포의 50% 이상을 차지하는 조직 소견으로 진단된다. 저자들은 복통, 체중감소, 요통, 좌측 대퇴부 통증, 혈변으로 내원한 11세 남아에서 내시경 조직검사 소견으로 확진된 복강내 침습, 혈액 및 림프성 전이가 진행된 소아 대장에서의 전이성반지세포암을 경험하였기에 보고하는 바이다.