슬라이드 1

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지윤 엽
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1 내시경입문자를위한식도질환 성균관대학교의과대학내과이준행

2 Mucosa of the normal esophagus

3 Second physiologic narrowing 대동맥궁과좌기관지에의해형성되는 2-3 cm 부위를통칭 25 cm : 대동맥궁 27 cm : 좌측기관지 cf> 35 cm : 좌심방 정상식도내경 2.5 cm

4 Indentations of the esophagus Indentation by left atrium Indentation by left main bronchus (yellow arrow) Spinal indentation at 12 o clock

5 Far distal esophagus, Rosette 4-6 longitudinal symmetrical folds

6 Normal esophagogastric junction Diaphragm Phrenoesophageal ligament Ascending limb Descending limb Infradiaphragmatic fascia Squamocolumnar junction

7 Esophagus 3 cm PZ Esophagogastric junction (EGJ) = Proximal margin of gastric folds = Distal end of palisade zone = Pinchcock action (PCA) = Squamocolumnar junction Stomach

8 Dynamic nature of EGJ (1)

9 Dynamic nature of EGJ (2)

11 Hiatal hernia

12 Anatomy of sliding hiatal hernia Hernia sac Squamocolumnar junction = B-ring Diaphragmatic orfice Diaphragmatic orfice Ampulla A-ring B-ring

13 Paraesophageal hernia

14 Paraesophageal hernia gastric folds diaphragmatic opening hernia sac ulcer scar

15 Esophageal candidiasis

16 Esophageal candidiasis

17 CMV esophagitis, s/p allo PBSCT

18 CMV esophagitis in immunocompetent host

19 Herpetic esophagitis during adjuvant chemotherapy for rectal cancer

20 Herpetic esophagitis

21 Esophageal TB Incisor 27 cm Bx: inflammed granulation tissue

22 Esophageal tuberculosis: more cases

23 LA classification Grade A One or more mucosal breaks, no longer than 5 mm, that do not extend between the tops of two mucosal folds Grade B One or more mucosal breaks, more than 5 mm long, that do not extend between the tops of two mucosal folds Grade C One or more mucosal breaks, that are continuous between the tops of two or more mucosal folds, but which involve less than 75% of the circumference Grade D One or more mucosal breaks, that involve at least 75% of the oesophageal circumference

24 Non-confluent erosions LA-A LA-B LA-B

25 Non-confluent erosions LA-A LA-B

26 무증상역류성식도염 + sentinel polyp 2 년 2 년

27 Confluent erosion and hiatal hernia

28 LA-D

29 Sentinel polyp (F/35, asymptomatic) Sentinel, n [C] esp. old use or literary a person employed to guard something

30 Sentinel polyp - detected during screening endoscopy March 2004 March 2005

31 Sentinel polyp

32 AGC (PM cancer) mimicking sentinel polyp

33 EG junction in hiatal hernia A-ring= muscular ring Ampulla Gastro-esophageal junction B-ring= mucosal ring Diaphragm

34 Palisade zone for the diagnosis of BE PZ Normal Barrett esophagus Hiatal hernia Hiatal hernia + BE Choi DW. Korean J Gastroenterol 2002;17:

35 Length of Barrett esophagus C (cm) M (cm) M: maximum length C: circumference length 표기예 : C3M5

36 Barrett esophagus

37 Barrett esophagus

38 Long segment Barrett s esophagus - a caucasian 2 years later

39 Barrett esophagus

40 Barrett adenocarcinoma (sm1 invasion) adenocarcinoma Squamocolumnar junction Proximal end of the gastric fold

41 식도 SMT - no change for 7 years

42 Granular cell tumor of the esophagus

43 Granular cell tumor of the esophagus

44 Esophageal SMT - lipoma

45 Esophageal carcinoid

46 Esophageal SMT with calcified rim - r/o duplication cyst

47 Esophageal papilloma

48 Esophageal papilloma

49 Esophageal papillomatosis

50 Zenker s diverticulum (M/62)

51 Mid-esophageal diverticulum

52 Esophageal foreign body

53 Esophageal foreign body - 굴껍질

54 Press-through pack (PTP)

55 Alkaline corrosive esophagitis

56 Lye stricture

57 Esophageal cancer after lye stricture Invasive SCC (M/D), 2x1.8 cm, PM, 0/24

58 식도암의내시경진단 성균관대학교의과대학내과이준행

59 맨위와맨아래를주의해야합니다.

60 Cervical esophageal cancer - 한달전내시경검사를받으셨다고하는데

61 EG junction cancer (M/D adenocarcinoma) - ESD 의뢰되었으나수술보냄, SM1 cancer 나옴

62 표재성식도암의내시경소견 점막의혼탁과조잡 혈관망의변화혹은소실 ( 점막하혈관상의소실 ) 점막발적 융기성병변 ( 높을수록심달도는깊어짐 ) 함몰성병변 식도의비정상적인연동운동 ( 고유근층으로의침범및종괴형성 )

63 Early esophageal cancer 0.7 cm - ESD was performed

64 Mucosal cancer (LP), 1.7 cm

65 Esophageal ESD - M/D squamous cell carcinoma (M2)

66 EEC, LP 암 9 cm - 외부에서는 Lugol void area 가없다고되어있었는데

67 Risk of lymph node metastasis in EEC - a single center experience at Samsung Medical Center (n=197) Kim. J Gastroenterol Hepatol 2008;23(4):

68 Risk of lymph node metastasis in EEC - a multicenter study in Japan (n=1740) Kodama. Surgery 1998;123:

69 표재성식도암의 growth pattern

70 M3, early esophageal cancer

71 M3, 2.1cm, lymphatic (+), LN 2/52

72 Esophageal cancer - 2 mm cancer 의 ESD 를위해의뢰되었으나 수술보냄 - 2x1.5cm, M/D SCC, muscularis mucosa 로나옴 ESD 안하길잘함

73 Early esophageal cancer type I - endolymphatic tumor emboli (+), LN 2/40

74 EEC, SM, LN (+)

75 Early esophageal cancer (SM3) - endolymphatic tumor emboli (+), LN (-)

76 젊은여성식도암 - SM cancer. LN (+) 1/42

77 Early esophgeal cancer - 2.4cm, SM invasion, LN (+) 2/46

78 Advanced esophageal cancer (M/71) cm, extension to adventitia, LN 0/59

79 Advanced esophageal cancer - extension to perimuscular adventitia, LN 3/62

80 식도암 + 위암

81 Esophageal cancer with liver mets

82 Esophageal melanoma - 식도수술후간전이

83 식도암인가위암인가? 답 : squamous cell carcinoma

84 식도암인가위암인가? 답 : squamous cell carcinoma

85 식도암인가위암인가? 답 : signet ring cell carcinoma

86 위암후식도암 / 식도암후위암 성균관대학교의과대학내과이준행

87 EGC after Ivor Lewis operation

Esophageal cancer s/p STG for EGC (M/70) 2002. 5. 20. Subtotal gastrectomy Adenocarcinoma (W/D), intestinal type 1.6x1.

88 Esophageal cancer s/p STG for EGC (M/70) Subtotal gastrectomy Adenocarcinoma (W/D), intestinal type 1.6x1.6 cm, muscularis mucosa, RM (-) 0/ st follow-up EGD nd follow-up EGD rd follow-up EGD th follow-up EGD: 식도암

89 Esophageal cancer after surgery for EGC

90 Esophageal cancer after surgery for EGC Invasive squamous cell carcinoma (M/D), 2.1x1.4 cm, extension to PM, RM (-), 0/24

91 식도암수술 4 년후 incisor 40cm 위암 2.5cm SM cancer

92 식도암 ESD 3 년후위암

93 내시경실력을키워서환자에게봉사합시다.

슬라이드 1

슬라이드 1 위식도접합부 - 짧은구간, 긴관찰이필요한부분 이준행 성균관대학교의과대학삼성서울병원내과 2018-3-25. 내시경학회세미나 위식도접합부내시경해부학 이준행 성균관대학교의과대학삼성서울병원내과 Normal esophagogastric junction Diaphragm Phrenoesophageal ligament Ascending limb Descending limb