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대한소화기학회> 대한소화기학회지> 2021 대한소화기내시경학회 진정내시경 임상진료지침

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2021 대한소화기내시경학회 진정내시경 임상진료지침

2021 Korean Society of Gastrointestinal Endoscopy Clinical Practice Guidelines for Endoscopic Sedation

박홍준 ( Hong Jun Park ) , 김병욱 ( Byung-wook Kim ) , 이준규 ( Jun Kyu Lee ) , 박예현 ( Yehyun Park ) , 박진명 ( Jin Myung Park ) , 배준용 ( Jun Yong Bae ) , 서승영 ( Seung Young Seo ) , 이재민 ( Jae Min Lee ) , 이지현 ( Jee Hyun Lee ) , 전형구 ( Hyung Ku Chon ) , 정준원 ( Jun-won Chung ) , 최현호 ( Hyun Ho Choi ) , 김명하 ( Myung Ha Kim ) , 박동아 ( Dong Ah Park ) , 정재흥 ( Jae Hung Jung ) , 조주영 ( Joo Young Cho )
  • : 대한소화기학회
  • : 대한소화기학회지 79권4호
  • : 연속간행물
  • : 2022년 04월
  • : 141-158(18pages)
대한소화기학회지

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진정은 내시경 검사를 받는 환자의 불안감과 공포를 줄여줄 수 있어 우리나라에서 진정내시경 검사 비율이 증가하고 있다. 최적의 진정이란 환자가 주관적으로 편안하게 느끼는 상태에서 기도 확보가 되어 자발적 호흡을 유지하는 상태이다. 환자는 의식이 있어 의료진과 협조가 이루어지는 상태가 유지되어야 한다. 이러한 장점에도 불구하고 진정내시경은 심폐우발증을 유발할 수 있다. 심폐우발증은 일시적으로 발생하고 대부분 후유증 없이 회복된다. 그러나, 심혈관계 허탈과 같은 심각한 우발증으로 진행되기도 한다. 따라서 진정 전 고위험군의 환자를 선별하고 세심한 환자 감시로 우발증을 감소시키기 위해 노력하는 것은 매우 중요하다. 또한 임상 의사는 응급 상황에 대처하기 위한 준비가 잘 되어 있어야 한다. 대한소화기내시경학회에서는 다른 나라의 진정내시경과 관련된 임상진료지침을 수용-개작하여 우리나라에서 처음으로 진정 내시경 임상진료지침을 마련하게 되었다. 본 임상진료지침은 현재까지 나와 있는 자료에 대한 객관적인 검토와 전문가들의 합의를 통하여 9개의 권고안으로 구성하였다. 본 임상진료지침은 임상 의사와 간호사, 의과대학 학생, 정책 결정자들이 진정내시경의 위험을 최소화하도록 노력하는 데 기여할 것으로 기대한다.
Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriate sedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneous breathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of the medical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Cardiopulmonary complications are usually temporary. Most patients recover without sequelae. However, they may progress to serious complications, such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications by meticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinical practice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using an adaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expert consensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policy makers with information on how to perform endoscopic sedation with minimal risk. (Korean J Gastroenterol 2022;79:141-155)

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  • : 의약학분야  > 내과학
  • : KCI등재
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  • : 월간
  • : 1598-9992
  • : 2233-6869
  • : 학술지
  • : 연속간행물
  • : 1968-2022
  • : 5875


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80권5호(2022년 11월) 수록논문
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KCI등재

1국내 내시경 수련의 현주소와 향후 방향

저자 : 주영은 ( Young-eun Joo )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 80권 5호 발행 연도 : 2022 페이지 : pp. 207-210 (4 pages)

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The training of trainees to perform endoscopies is challenging. There is no standardized training program in Korea. Trainees usually learn to perform endoscopies under the supervision of an educator, an expert endoscopist. However, most of educators have never received formal training. For high quality and effecting training, formal training program for educators is needed. Also, specific assessment tools measuring performance and improving training are required. The use of simulators for acquiring, maintaining, and assessing skills in endoscopy has grown over the past decade. Many data suggest that simulation training may accelerate the acquisition of specific technical skills in endoscopy early in training. If we include education using simulators in basic endoscopy education, it will be of great help to shorten the endoscopy training time and improve the endoscopy training environment. A significant portion of medical lawsuits against gastroenterologists in Korea are related to complications related to sedation. Therefore, endoscopy education should include contents related to sedation education. Also, systematic and thorough education program along with assessment tool measuring true competence of sedation in endoscopy is needed. Changes should be made at all levels to improve our endoscopy training system. (Korean J Gastroenterol 2022;80:207-210)

KCI등재

2소화기내과 전공의 및 전임의를 위한 복부초음파 교육

저자 : 천영국 ( Young Koog Cheon ) , 김영중 ( Youngjung Kim ) , 이준성 ( Joon Seong Lee )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 80권 5호 발행 연도 : 2022 페이지 : pp. 211-216 (6 pages)

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Ultrasound (US) is an essential diagnostic tool in almost every medical area. Therefore, abdominal US education for internal medicine residents was mandated by the Korean Association of Internal Medicine. However, US education for physicians has been conducted only in some university hospitals that directly perform abdominal US examinations in internal medicine, or some education is provided with the help of radiologists. US technology continues to become increasingly widespread, portable, and miniaturized. Furthermore, point-of-care US, i.e., US executed at the patient's bedside to obtain real-time objective information with diagnostic and clinical monitoring purposes or to guide invasive procedures, has been incorporated in many specialties. Despite the increasing role of US, there is no systemized abdominal US education program. Therefore, the authors are trying to develop a structured abdominal US education program through cooperation with related US organizations. (Korean J Gastroenterol 2022;80:211-216)

KCI등재

3소화기내과 전공의 및 전임의 수련 교육의 현실과 개선방안

저자 : 정우철 ( Woo Chul Chung )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 80권 5호 발행 연도 : 2022 페이지 : pp. 217-220 (4 pages)

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The Korean Society of Gastroenterology (KSG) and the Korean Society of Gastrointestinal Endoscopy (KSGE) have tried to promote high-quality patient care, and safety in the field of gastrointestinal (GI) diseases. In 2017, the training guidelines for GI fellows have been made, and the education board of KSGE revised 2 year- program of GI fellows. The guideline includes the total number of assigned patients, the number of GI endoscopy procedures, attendance of academic conferences, and research presentations. The traditional training model of GI fellowship is known as an “apprenticeship”. Unfortunately, it might increase confusion between what trainees are observing and prior information. Now, practical hands-on training system using simulator helps to provide a support program for GI fellowship education. In order to facilitate training program, trainers will need to carefully plan the teaching. Therefore, it improves knowledge and performance for trainers. What we should keep in mind is that this hands-on program has the goal of making a good gastroenterologist, not just making an endoscopist. At same time, the application of cognitive education in GI fellow training must be performed. On the other side, the privileging and credentialing for endoscopic subspecialty should be made. The provision of benefits could serve as an important foundation for maintaining GI specialist board system. (Korean J Gastroenterol 2022;80:217-220)

KCI등재

4십이지장스텐트 삽입 중 발생한 위천공

저자 : 고성우 ( Sung Woo Ko ) , 소훈섭 ( Hoonsub So ) , 방성조 ( Sung Jo Bang )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 80권 5호 발행 연도 : 2022 페이지 : pp. 221-224 (4 pages)

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Gastric outlet obstruction is a major symptom in patients with advanced pancreatic cancer. Endoscopic intervention is often challenging in severe strictures because the guidewire cannot pass beyond the stricture. Sometimes, the air itself cannot pass beyond the stricture, which can result in a severely distended stomach. Such a stomach is vulnerable to excessive air insertion or mechanical stress during endoscopic procedures, and endoscopists may encounter a higher rate of complications. Gastric perforation is rare but could be fatal. However, endoscopic management can show a favorable result if the perforation is noticed early. The authors report a case of the perforation of a gastric tear during duodenal stent insertion in a patient with a gastric outlet obstruction. (Korean J Gastroenterol 2022;80:221-224)

KCI등재

5위궤양으로 발현된 콜라겐 위십이지장염

저자 : 최인형 ( In Hyoung Choi ) , 조유경 ( Yu Kyung Cho ) , 박준영 ( Jun Young Park ) , 강동훈 ( Donghoon Kang ) , 박재명 ( Jae Myung Park ) , 최명규 ( Myung-gyu Choi )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 80권 5호 발행 연도 : 2022 페이지 : pp. 225-228 (4 pages)

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Collagenous gastroduodenitis is a rare gastrointestinal disease diagnosed histologically by subepithelial collagen deposition in the lamina propria. Its clinical presentation is diverse. The authors encountered a 17-year-old female patient who complained of epigastric pain. Endoscopy revealed several deep ulcers in the gastric body. The gastric mucosa around the ulcer showed diffuse fine nodularity in the shape of cobblestones with open-type atrophy. The duodenal mucosa showed nodular lesions similar to those of the gastric mucosa. The gastric ulcer healed completely with proton pump inhibitor treatment. The patient was followed up, showing no remarkable mucosal change of stomach or duodenum for several years. Collagenous gastroduodenitis was diagnosed by repeated histologic examinations. This paper reports a rare case of chronic collagen gastritis with deep gastric ulcer and its long-term clinical progress. (Korean J Gastroenterol 2022;80:225-228)

KCI등재

6비위관 자극으로 인한 대동맥식도누공: 증례 보고

저자 : 이상민 ( Sangmin Lee ) , 김육 ( Yook Kim ) , 김기배 ( Ki Bae Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 80권 5호 발행 연도 : 2022 페이지 : pp. 229-232 (4 pages)

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A 91-year-old woman who presented with melena and hypovolemic shock visited the emergency room. She received enteral nutrition by nasogastric tube in a bedridden state due to hip surgery. Gastroscopy initially suggested a simple ulcer that occurred after a nasogastric tube was placed for a long time, but the ulcer was deep, and the amount of instantaneous bleeding was considerable. Therefore, an aortoesophageal fistula was suspected. Angiography was performed instead of endoscopic hemostasis, followed by thoracic endovascular aortic repair (TEVAR). After the TEVAR procedure, the patient recovered without further gastrointestinal bleeding. Prompt judgment and communication between the endoscopist and the interventional physician are important for successful hemostasis in an aortoenteric fistula patient. (Korean J Gastroenterol 2022;80:229-232)

KCI등재

7간세포암종 환자에서 경동맥화학색전술 후 발생한 리피오돌 유도 폐렴

저자 : 남희철 ( Heechul Nam )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 80권 5호 발행 연도 : 2022 페이지 : pp. 233-236 (4 pages)

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8과민성장증후군 환자에 대한 대변 미생물총 이식 치료의 반응 예측: 장내 미생물총의 측면에서

저자 : 김대성 ( Dae Sung Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 80권 5호 발행 연도 : 2022 페이지 : pp. 237-239 (3 pages)

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KCI등재

12021 대한소화기내시경학회 진정내시경 임상진료지침

저자 : 박홍준 ( Hong Jun Park ) , 김병욱 ( Byung-wook Kim ) , 이준규 ( Jun Kyu Lee ) , 박예현 ( Yehyun Park ) , 박진명 ( Jin Myung Park ) , 배준용 ( Jun Yong Bae ) , 서승영 ( Seung Young Seo ) , 이재민 ( Jae Min Lee ) , 이지현 ( Jee Hyun Lee ) , 전형구 ( Hyung Ku Chon ) , 정준원 ( Jun-won Chung

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 79권 4호 발행 연도 : 2022 페이지 : pp. 141-158 (18 pages)

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진정은 내시경 검사를 받는 환자의 불안감과 공포를 줄여줄 수 있어 우리나라에서 진정내시경 검사 비율이 증가하고 있다. 최적의 진정이란 환자가 주관적으로 편안하게 느끼는 상태에서 기도 확보가 되어 자발적 호흡을 유지하는 상태이다. 환자는 의식이 있어 의료진과 협조가 이루어지는 상태가 유지되어야 한다. 이러한 장점에도 불구하고 진정내시경은 심폐우발증을 유발할 수 있다. 심폐우발증은 일시적으로 발생하고 대부분 후유증 없이 회복된다. 그러나, 심혈관계 허탈과 같은 심각한 우발증으로 진행되기도 한다. 따라서 진정 전 고위험군의 환자를 선별하고 세심한 환자 감시로 우발증을 감소시키기 위해 노력하는 것은 매우 중요하다. 또한 임상 의사는 응급 상황에 대처하기 위한 준비가 잘 되어 있어야 한다. 대한소화기내시경학회에서는 다른 나라의 진정내시경과 관련된 임상진료지침을 수용-개작하여 우리나라에서 처음으로 진정 내시경 임상진료지침을 마련하게 되었다. 본 임상진료지침은 현재까지 나와 있는 자료에 대한 객관적인 검토와 전문가들의 합의를 통하여 9개의 권고안으로 구성하였다. 본 임상진료지침은 임상 의사와 간호사, 의과대학 학생, 정책 결정자들이 진정내시경의 위험을 최소화하도록 노력하는 데 기여할 것으로 기대한다.

KCI등재

2만성 B형간염 면역관용기의 정의 및 치료

저자 : 홍영미 ( Young Mi Hong ) , 윤기태 ( Ki Tae Yoon )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 79권 4호 발행 연도 : 2022 페이지 : pp. 156-160 (5 pages)

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In the natural course of chronic hepatitis B, the immune tolerance phase is characterized by HBeAg positivity, very high levels of HBV DNA, and persistent normal alanine aminotransferase. The international guideline recommendation for patients in this phase is observation without antiviral treatment because of the low risk of disease progression and the lack of effective antiviral agents. However, recent retrospective studies have shown that progression to hepatic fibrosis and hepatocellular carcinoma may occur in patients who are in the immune tolerance phase. Despite the conceptual definition and clinical diagnostic criteria for this phase, it is difficult to accurately diagnose the true immune tolerance phase. Therefore, we should pay attention to the clinical evaluation and interpretation of the immune tolerance phase and understand the clinical situations in which antiviral treatments should be considered. (Korean J Gastroenterol 2022;79:156-160)

KCI등재

3Tauroursodeoxycholic Acid의 위점막 상피세포 NF-κB 신호 전달 억제 및 마우스 위염 예방 효과

저자 : 김수환 ( Su Hwan Kim ) , 김지원 ( Ji Won Kim ) , 고성준 ( Seong-joon Koh ) , 김상균 ( Sang Gyun Kim ) , 배정모 ( Jeong Mo Bae ) , 김정호 ( Jung Ho Kim ) , 박정환 ( Jeong Hwan Park ) , 장미수 ( Mee Soo Chang ) , 최기돈 ( Kee Don Choi ) , 강현우 ( Hyoun Woo Kang ) , 김병관 ( Byeong Gwan Kim

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 79권 4호 발행 연도 : 2022 페이지 : pp. 161-169 (9 pages)

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Background/Aims: Previous studies have reported the protective effects of tauroursodeoxycholic acid (TUDCA) on gastric epithelial cells in some animal models, but the precise mechanisms are unclear. This study examined the effects of TUDCA on NF-κB signaling in gastric epithelial cells. Moreover, the protective effects of TUDCA in experimental gastritis models induced by ethanol and NSAID were evaluated and compared with ursodeoxycholic acid (UDCA).
Methods: After a pretreatment with TUDCA or UDCA, human gastric epithelial MKN-45 cells were stimulated with tumor necrosis factor (TNF)-α to activate NF-κB signaling. A real-time PCR (RT-PCR) for human interleukin (IL)-1 mRNA was performed. An electrophoretic mobility shift assay (EMSA) and immunoblot analyses were carried out. In murine models, after a pretreatment with TUDCA or UDCA, ethanol and indomethacin were administered via oral gavage. Macroscopic and microscopic assessments were performed to evaluate the preventive effects of TUDCA and UDCA on murine gastritis.
Results: A pretreatment with TUDCA downregulated the IL-1α mRNA levels in MKN-45 cells stimulated with TNF-α, as assessed by RT-PCR. As determined using EMSA, a pretreatment with TUDCA reduced the TNF-α-induced NF-κB DNA binding activity. A pretreatment with TUDCA inhibited IκBα phosphorylation induced by TNF-α, as assessed by immunoblot analysis. TUDCA attenuated the ethanol-induced and NSAID-induced gastritis in murine models, as determined macroscopically and microscopically.
Conclusions: TUDCA inhibited NF-κB signaling in gastric epithelial cells and ameliorated ethanol- and NSAID-induced gastritis in murine models. These results support the potential of TUDCA for the prevention of gastritis in humans. (Korean J Gastroenterol 2022;79:161-169)

KCI등재

4위, 간 전암병변과 암에서 혈관내피세포와 조직에서의 ICAM-1의 발현

저자 : 캉리 ( Li Kang ) , 김문식 ( Moonsik Kim ) , 이유미 ( You Mie Lee )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 79권 4호 발행 연도 : 2022 페이지 : pp. 170-176 (7 pages)

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Background/Aims: Angiogenesis is essential for the outgrowth and metastasis of tumors. The structure and characteristics of tumor vasculature differ from those of normal vessels. We compared the characteristics of differentially expressed genes in endothelial cells (ECs) isolated from gastric and normal cells.
Methods: Previously, we had isolated pure tumor ECs (TECs) and normal ECs (NECs) from advanced gastric cancer (AGC) lesions and normal mucosal tissues, respectively. Using the oligomer chip platform of the Affymetrix GeneChip technology, genes that were expressed more than three-fold with a significance of p≤0.001 were measured. The intercellular adhesion molecule 1 (ICAM-1) was found to be overexpressed in the TECs compared to the normal gastric ECs. In this study, the upregulation of ICAM-1 was confirmed in cultured TECs by immunofluorescence.
Results: The expression of ICAM-1 was upregulated in the ECs, as well as in the stromal and immune cells, in early human gastric preneoplastic and hepatic fibrotic tissues. Upregulation of ICAM-1 was observed in the TECs, immune cells, and cancer epithelial cells in AGC and hepatocellular carcinoma (HCC). These results suggest that increased ICAM-1 expression in the ECs of the tissue microenvironment progressively contributes to the recruitment of immune cells to promote inflammation, leading to fibrosis and tumorigenesis.
Conclusions: Therefore, upregulated ICAM-1 in the tissues in premalignant gastric diseases or hepatic fibrosis and their malignant cancers could be a promising target for disease prevention and treatment. (Korean J Gastroenterol 2022;79:170-176)

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5젊은 환자에서 발생한 거대 악성 위장관 기질종양

저자 : 정윤진 ( Yun Jin Jeong ) , 황현승 ( Hyun Seung Hwang ) , 박용은 ( Yong Eun Park ) , 남경한 ( Kyung Han Nam ) , 오성진 ( Sung Jin Oh )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 79권 4호 발행 연도 : 2022 페이지 : pp. 177-181 (5 pages)

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Malignant gastrointestinal stromal tumors (GISTs) are rare neoplasms originating from the gastrointestinal tract that rarely occur in patients below 40 years of age. To our knowledge, there have been no previous reports of satellite and metastatic nodules in GIST. We present a case of a young patient with a huge malignant gastric GIST accompanied by spontaneous bleeding and satellite and metastatic nodules, successfully treated surgically, without preoperative chemotherapy administration. A 28-year-old man was admitted to Haeundae Paik Hospital with melena. A huge bulging gastric mass with ulceration and bleeding was observed on endoscopy. A subepithelial lesion on the stomach body, abutting the pancreatic body and tail, with regional lymph node enlargement was confirmed by EUS and CT. Radical total gastrectomy was performed, the invasion surrounding the pancreatic tail and spleen were surgically dissected, and enlarged lymph nodes around the celiac trunk and the common hepatic artery were removed. The pathology results showed a malignant GIST with two satellite nodules and a metastatic tumor nodule at the left paracardial lymph node site. After complete resection of the malignant GIST, adjuvant chemotherapy with imatinib was initiated. Follow-up CT and endoscopy performed 6 months after surgery confirmed no recurrence of the disease. (Korean J Gastroenterol 2022;79:177-181)

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6환상 췌장: 성인에서 상부위장관 출혈의 드문 원인

저자 : 권정아 ( Joung Ah Kweun ) , 강형목 ( Hyung Mook Kang ) , 김장언 ( Jang Eon Kim ) , 박성재 ( Sung Jae Park )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 79권 4호 발행 연도 : 2022 페이지 : pp. 182-186 (5 pages)

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Annular pancreas is a rare congenital anomaly in which a thin band of pancreatic tissue partially or completely surrounds the duodenum. It is challenging to diagnose due to its variable clinical presentation. Approximately two-thirds of patients have no symptoms in their lifetime, and most symptomatic cases are seen in neonates and infants. Symptomatic adult patients present with upper gastrointestinal symptoms, such as epigastric pain, vomiting, and postprandial fullness associated with gastric outlet obstruction. Complications associated with annular pancreas include peptic ulcer disease, pancreatitis, pancreatic head carcinoma, and biliary obstruction. Annular pancreas is also a rare cause of upper gastrointestinal bleeding in adults, but it should be considered as one of the differential diagnoses in patients presenting with a peptic ulcer and duodenal stricture. Here, we report the case of a 60-year-old man who presented with melena and was subsequently diagnosed with an annular pancreas. (Korean J Gastroenterol 2022;79:182-186)

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7장폐색을 일으킨 소장의 혈관종

저자 : 심정윤 ( Jeongyun Shim ) , 김은선 ( Eun Sun Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 79권 4호 발행 연도 : 2022 페이지 : pp. 187-190 (4 pages)

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8불응성 위마비에서 내시경 유문근절개술의 효용성

저자 : 부선진 ( Sun-jin Boo )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 79권 4호 발행 연도 : 2022 페이지 : pp. 191-193 (3 pages)

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9급성신손상을 동반한 올메사르탄 유발성 장병증 1예

저자 : 강무진 ( Moo Jin Kang ) , 민경화 ( Kyung Hwa Min ) , 김형욱 ( Hyung Wook Kim ) , 박수범 ( Su Bum Park ) , 강대환 ( Dae Hwan Kang ) , 최철웅 ( Cheol Woong Choi ) , 김수진 ( Su Jin Kim ) , 남형석 ( Hyeong Seok Nam ) , 유대곤 ( Dae Gon Ryu )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 79권 4호 발행 연도 : 2022 페이지 : pp. 194-194 (1 pages)

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