양재훈 정인섭 유창범 김진오 조주영 이준성 *진소영 이문성 심찬섭 순 천 향 대 학 교 의 과 1 9 7 4 소 화 기 내 병 클 리 닉 제65회 내시경 집담회 순천향대학교병원 소화기내과, *병리학교실 양재훈 정인섭 유창범 김진오 조주영 이준성 *진소영 이문성 심찬섭 INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

CASE 1 INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

과거력 : 고혈압으로 8년 전부터 medication중 가족력 : 특이소견 없음 66세 남자 주소 : for EMR 현병력 : 2000. 7 AGC로 OO병원에서 subtotal gastrectomy with gastrojejunostomy 시행받은 환자로 2004. 7.22 시행한 GFS상 2cm sized tubular adenoma 발견되어 EMR 시행위해 전원. 음주력 및 흡연력 : (-). 과거력 : 고혈압으로 8년 전부터 medication중 가족력 : 특이소견 없음 INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

AST/ALT : 22/22 U/L , T-Bill : 1.1 mg/dL, ALP : 66 U/L 검사실 소견 : CBC : 5,700-13.0/38.2-224000  AST/ALT : 22/22 U/L ,  T-Bill : 1.1 mg/dL, ALP : 66 U/L  Bun/Cr : 14.5/1.1 mg/dL                           CEA : 0.51 ng/ml (0-4.0 ng/ml) INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

Gastroscopy INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

Miniprobe EUS INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

EISD (Endoscopic incision and submucosal dissection) INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

EISD (Endoscopic incision and submucosal dissection) INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

Gross finding INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

Stereoscopic finding(specimen size: 41.28x43.52mm) INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

pathologic finding Pathologic diagnosis: tubular adenoma with gastritis cystica profunda

CASE 2 INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

시행한 상부위장관내시경 검사에서 다발성 위 용종이 의심되어 전원. 65세 여자 주소 : 상복부 불편감 현병력 : 일 주일 전부터 발생한 상복부 불편감을 주소로 개인의원에서 시행한 상부위장관내시경 검사에서 다발성 위 용종이 의심되어 전원. 음주력 및 흡연력: (-). 과거력 및 가족력: 특이소견 없음 INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

AST/ALT : 16/13 U/L , T-Bill : 0.5 mg/dL, ALP : 67 U/L 검사실 소견 : CBC : 5,900-11.2/33.8-219,000  AST/ALT : 16/13 U/L ,  T-Bill : 0.5 mg/dL, ALP : 67 U/L  Bun/Cr : 16.0/0.6 mg/dL                           CEA: 3.7 ng/ml INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

Gastroscopy INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

EUS INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

New device: Fork knife 특허출원번호: 10-2004-031248-2, Kachu medico. INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

The drawing of Fork knife

The suggestive indications of Fork knife on therapeutic endoscopy The treatment of early gastric cancer The treatment of early colon cancer variceal bleeding control Non-variceal bleeding control Precut of ampulla INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

Fork knife 의 장점 Fork knife 의 제한점 지혈, 박리가 용이 다양한 각도의 시술이 가능 짧은 시술시간 Fork knife 의 제한점 시술자의 숙련이 필요 약물주입시 개선이 필요 INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

The sequential technical method of Fork knife on EISD Handling Step 1: marking & injection Step 2: incision & dissection INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

The schematic technical method of Fork knife on EISD

EISD INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

EISD INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

Gross finding INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

Stereoscopic finding (specimen size: 52.54x42.49mm) INSTITUTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL

Pathologic finding Pathologic diagnosis: tubular adenoma with high grade dysplasia

Thank you for attention INSTITTE FOR DIGESTIVE RESEARCH - SOON CHUN HYANG UNIV. HOSPITAL