내시경입문자를위한식도질환 성균관대학교의과대학내과이준행
Mucosa of the normal esophagus
Second physiologic narrowing 대동맥궁과좌기관지에의해형성되는 2-3 cm 부위를통칭 25 cm : 대동맥궁 27 cm : 좌측기관지 cf> 35 cm : 좌심방 정상식도내경 2.5 cm
Indentations of the esophagus Indentation by left atrium Indentation by left main bronchus (yellow arrow) Spinal indentation at 12 o clock
Far distal esophagus, Rosette 4-6 longitudinal symmetrical folds
Normal esophagogastric junction Diaphragm Phrenoesophageal ligament Ascending limb Descending limb Infradiaphragmatic fascia Squamocolumnar junction
Esophagus 3 cm PZ Esophagogastric junction (EGJ) = Proximal margin of gastric folds = Distal end of palisade zone = Pinchcock action (PCA) = Squamocolumnar junction Stomach
Dynamic nature of EGJ (1)
Dynamic nature of EGJ (2)
Hiatal hernia http://www.hosppract.com/issues/1998/11/cemitt.htm
Anatomy of sliding hiatal hernia Hernia sac Squamocolumnar junction = B-ring Diaphragmatic orfice Diaphragmatic orfice Ampulla A-ring B-ring
Paraesophageal hernia http://www.hosppract.com/issues/1998/11/cemitt.htm
Paraesophageal hernia gastric folds diaphragmatic opening hernia sac ulcer scar
Esophageal candidiasis
Esophageal candidiasis
CMV esophagitis, s/p allo PBSCT
CMV esophagitis in immunocompetent host
Herpetic esophagitis during adjuvant chemotherapy for rectal cancer
Herpetic esophagitis
Esophageal TB Incisor 27 cm Bx: inflammed granulation tissue
Esophageal tuberculosis: more cases
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
Non-confluent erosions LA-A LA-B LA-B
Non-confluent erosions LA-A LA-B
무증상역류성식도염 + sentinel polyp 2 년 2 년
Confluent erosion and hiatal hernia
LA-D
Sentinel polyp (F/35, asymptomatic) Sentinel, n [C] esp. old use or literary a person employed to guard something
Sentinel polyp - detected during screening endoscopy March 2004 March 2005
Sentinel polyp
AGC (PM cancer) mimicking sentinel polyp
EG junction in hiatal hernia A-ring= muscular ring Ampulla Gastro-esophageal junction B-ring= mucosal ring Diaphragm
Palisade zone for the diagnosis of BE PZ Normal Barrett esophagus Hiatal hernia Hiatal hernia + BE Choi DW. Korean J Gastroenterol 2002;17:245-248
Length of Barrett esophagus C (cm) M (cm) M: maximum length C: circumference length 표기예 : C3M5
Barrett esophagus
Barrett esophagus
Long segment Barrett s esophagus - a caucasian 2 years later
Barrett esophagus
Barrett adenocarcinoma (sm1 invasion) adenocarcinoma Squamocolumnar junction Proximal end of the gastric fold
식도 SMT - no change for 7 years 2003 2010
Granular cell tumor of the esophagus
Granular cell tumor of the esophagus
Esophageal SMT - lipoma
Esophageal carcinoid
Esophageal SMT with calcified rim - r/o duplication cyst
Esophageal papilloma
Esophageal papilloma
Esophageal papillomatosis
Zenker s diverticulum (M/62)
Mid-esophageal diverticulum
Esophageal foreign body
Esophageal foreign body - 굴껍질
Press-through pack (PTP)
Alkaline corrosive esophagitis
Lye stricture
Esophageal cancer after lye stricture Invasive SCC (M/D), 2x1.8 cm, PM, 0/24
식도암의내시경진단 성균관대학교의과대학내과이준행
맨위와맨아래를주의해야합니다.
Cervical esophageal cancer - 한달전내시경검사를받으셨다고하는데
EG junction cancer (M/D adenocarcinoma) - ESD 의뢰되었으나수술보냄, SM1 cancer 나옴
표재성식도암의내시경소견 점막의혼탁과조잡 혈관망의변화혹은소실 ( 점막하혈관상의소실 ) 점막발적 융기성병변 ( 높을수록심달도는깊어짐 ) 함몰성병변 식도의비정상적인연동운동 ( 고유근층으로의침범및종괴형성 )
Early esophageal cancer 0.7 cm - ESD was performed
Mucosal cancer (LP), 1.7 cm
Esophageal ESD - M/D squamous cell carcinoma (M2)
EEC, LP 암 9 cm - 외부에서는 Lugol void area 가없다고되어있었는데
Risk of lymph node metastasis in EEC - a single center experience at Samsung Medical Center (n=197) Kim. J Gastroenterol Hepatol 2008;23(4):619-625
Risk of lymph node metastasis in EEC - a multicenter study in Japan (n=1740) Kodama. Surgery 1998;123:432-439
표재성식도암의 growth pattern
M3, early esophageal cancer
M3, 2.1cm, lymphatic (+), LN 2/52
Esophageal cancer - 2 mm cancer 의 ESD 를위해의뢰되었으나 수술보냄 - 2x1.5cm, M/D SCC, muscularis mucosa 로나옴 ESD 안하길잘함
Early esophageal cancer type I - endolymphatic tumor emboli (+), LN 2/40
EEC, SM, LN (+)
Early esophageal cancer (SM3) - endolymphatic tumor emboli (+), LN (-)
젊은여성식도암 - SM cancer. LN (+) 1/42
Early esophgeal cancer - 2.4cm, SM invasion, LN (+) 2/46
Advanced esophageal cancer (M/71) - 3.5 cm, extension to adventitia, LN 0/59
Advanced esophageal cancer - extension to perimuscular adventitia, LN 3/62
식도암 + 위암
Esophageal cancer with liver mets
Esophageal melanoma - 식도수술후간전이
식도암인가위암인가? 답 : squamous cell carcinoma
식도암인가위암인가? 답 : squamous cell carcinoma
식도암인가위암인가? 답 : signet ring cell carcinoma
위암후식도암 / 식도암후위암 성균관대학교의과대학내과이준행
EGC after Ivor Lewis operation
Esophageal cancer s/p STG for EGC (M/70) 2002. 5. 20. Subtotal gastrectomy Adenocarcinoma (W/D), intestinal type 1.6x1.6 cm, muscularis mucosa, RM (-) 0/36 2002. 9. 1 st follow-up EGD 2004. 1. 2 nd follow-up EGD 2005. 1. 3 rd follow-up EGD 2005. 6. 4 th follow-up EGD: 식도암
Esophageal cancer after surgery for EGC
Esophageal cancer after surgery for EGC Invasive squamous cell carcinoma (M/D), 2.1x1.4 cm, extension to PM, RM (-), 0/24
식도암수술 4 년후 incisor 40cm 위암 2.5cm SM cancer
식도암 ESD 3 년후위암
내시경실력을키워서환자에게봉사합시다.