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대한소화기학회> 대한소화기학회지> 소화기내과 전공의 및 전임의를 위한 복부초음파 교육

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소화기내과 전공의 및 전임의를 위한 복부초음파 교육

Abdominal Ultrasound Education for Gastroenterology Residents and Fellows

천영국 ( Young Koog Cheon ) , 김영중 ( Youngjung Kim ) , 이준성 ( Joon Seong Lee )
  • : 대한소화기학회
  • : 대한소화기학회지 80권5호
  • : 연속간행물
  • : 2022년 11월
  • : 211-216(6pages)
대한소화기학회지

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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)

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간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
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  • : 1598-9992
  • : 2233-6869
  • : 학술지
  • : 연속간행물
  • : 1968-2023
  • : 5891


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81권0호(2023년 01월) 수록논문
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KCI등재

1소장질환에서의 기구보조 소장내시경의 이용: 전문가 합의문

저자 : 이한희 ( Han Hee Lee ) , 김진수 ( Jin Su Kim ) , 궁현정 ( Hyeon Jeong Goong ) , 이신희 ( Shin Hee Lee ) , 오은혜 ( Eun Hye Oh ) , 박지혜 ( Jihye Park ) , 김민철 ( Min Cheol Kim ) , 남광우 ( Kwangwoo Nam ) , 양영주 ( Young Joo Yang ) , 김태준 ( Tae Jun Kim ) , 남승주 ( Seung-joo Nam ) , 문희

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 81권 0호 발행 연도 : 2023 페이지 : pp. 1-16 (16 pages)

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The introduction of device-assisted enteroscopy (DAE) in the beginning of the 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of small bowel diseases, DAE has the unique advantages of allowing the observation of the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how it is to be performed and what technical factors should be taken into consideration. In response to these needs, the Korean Association for the Study of Intestinal Diseases has developed an expert consensus statement on the performance of DAE by reviewing current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points. (Korean J Gastroenterol 2023;81:1-16)

KCI등재

2급성 간부전의 현황 및 관리

저자 : 김진동 ( Jin Dong Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 81권 0호 발행 연도 : 2023 페이지 : pp. 17-28 (12 pages)

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Acute liver failure (ALF) is a rare disease condition with a dynamic clinical course and catastrophic outcomes. Several etiologies are involved in ALF. Hepatitis A and B infections and indiscriminate use of untested herbs or supplemental agents are the most common causes of ALF in Korea. Noninvasive neurological monitoring tools have been used in patients with ALF in recent times. Ongoing improvements in intensive care, including continuous renal replacement therapy, therapeutic plasma exchange, vasopressor, and extracorporeal membrane oxygenation, have reduced the mortality rate of patients with ALF. However, liver transplantation is still the most effective treatment for patients with intractable ALF. There is a need for further research in the areas of better prognostication and precise selection of patients for emergency transplantation. (Korean J Gastroenterol 2023;81:17-28)

KCI등재

3한국인의 위 점막연관림프조직 림프종의 t(11:18) 전위 돌연변이의 임상 영향 평가와 활용 전망: 단일기관 후향 분석

저자 : 정하나 ( Hana Jung ) , 신다윗 ( Da Wit Shin ) , 정대영 ( Dae Young Cheung ) , 이한희 ( Han Hee Lee ) , 김진일 ( Jin Il Kim ) , 박수헌 ( Soo-heon Park ) , 김태정 ( Tae Jung Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 81권 0호 발행 연도 : 2023 페이지 : pp. 29-35 (7 pages)

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목적: 위 점막연관림프조직 림프종(위 MALT 림프종)은 헬리코박터 파일로리 감염과 관련이 있으며 일부에서는 t(11:18) 돌연변이가 동반되어 있다.
대상 및 방법: 전자의무기록 검색을 이용하여 2004년 1월부터 2020년 12월까지 가톨릭대학교 여의도성모병원에서 위 MALT 림프종으로 진단받은 환자를 연속적으로 등록하여 후향 분석하였다.
결과: 의무기록에서 찾은 77명의 위 MALT 림프종 환자 중 기록이 완결된 65명을 대상으로 분석하였다. 헬리코박터 파일로리는 66.2% (43/65)에서 감염 양성이었다. T(11:18) 돌연변이에 대한 유전자 검사는 41명에서 시행되었으며 31.7% (13/41)에서 동반되어 있었다. T(11:18) 돌연변이가 동반된 경우 제균 치료 후 관해에 도달한 경우는 23.1% (3/13)으로 t(11:18)이 동반되지 않았던 75% (21/28)에 비해 유의하게 낮은 수준이었다(p-value=0.009). 특히, 헬리코박터 음성이면서 t(11:18)가 동반된 경우 83.3% (5/6)에서 관해 도달을 위해 방사선 치료가 필요하였고 16.7% (1/6)에서만 제균 치료만으로 관해 도달이 가능하였다. 다만, 분석 대상이 적어 통계적 유의성을 확인할 수는 없었다.
결론: 헬리코박터 음성과 t(11:18)의 존재는 항생제 치료 실패의 위험 인자였다.


Background/Aims: The gastric extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (gastric MALT lymphoma) are mostly related to Helicobacter pylori infections. However, chromosomal aberration involving translocation t(11;18) is also frequently reported in these patients.
Methods: The study was a retrospective review and analysis of electronic medical records to assess the factors which affect complete remission (CR) in patients with gastric MALT lymphoma. Based on the medical records, subjects with gastric MALT lymphoma were enrolled consecutively from January 2004 to December 2021.
Results: Among the 77 subjects who were found with gastric MALT lymphoma in the database, 65 cases with complete records were analyzed. Of these, 66.2% (43/65) were H. pylori positive. Genetic analyses for t(11:18) were done on 41 subjects. The t(11:18) chromosomal translocation with MALT1:BIRC3 fusion was found in 31.7% (13/41) of the subjects. With H. pylori eradication therapy, 75% (21/28) of the subjects without t(11:18) achieved CR. However, only 23.1% (3/13) subjects with t(11:18) could achieve CR (p-value= 0.009). In the H. pylori-positive group, 85.7% (18/21) subjects without t(11:18) achieved CR with eradication therapy, but 71.4% (5/7) subjects with t(11:18) failed to achieve CR (p-value=0.004). In the H. pylori-negative group, 42.3% (3/7) of the subjects without t(11:18) achieved CR with eradication therapy. However, 83.3% (5/6) of H. pylori-negative subjects with t(11:18) failed to achieve CR with eradication therapy and needed additional radiotherapy (p-value=0.396).
Conclusions: H. pylori negativity and the presence of t(11:18) were both risk factors for failure to achieve CR with H. pylori eradication therapy as the first line of treatment. (Korean J Gastroenterol 2023;81:29-35)

KCI등재

4만성췌장염 환자에서 내시경역행담췌관조영술 시 발생한 주췌관 내 유도선 감입: 증례 보고

저자 : 김소영 ( Soyoung Kim ) , 소훈섭 ( Hoonsub So ) , 정석원 ( Seok Won Jung ) , 방성조 ( Sung Jo Bang )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 81권 0호 발행 연도 : 2023 페이지 : pp. 36-39 (4 pages)

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The guidewire is an essential accessory in ERCP. Although rare, guidewires can cause complications, such as subcapsular hepatic hematoma, perforation, knotting, fracture, and impaction, during ERCP. This report describes a guidewire impaction during the endoscopic treatment of a patient with symptomatic chronic pancreatitis. The methods used to treat guidewire impaction are not well known. In the present case, the impacted guidewire was retrieved by inserting another guidewire and dilating the space adjacent to it. Endoscopists should check for the free movement of the guidewire before stent deployment. Additionally, it is important to ask for help from experienced senior staff to overcome any challenges during the procedure. In conclusion, endoscopists should be aware of the possibility of a guidewire impaction during ERCP. (Korean J Gastroenterol 2023;81:36-39)

KCI등재

5Small Cell Type Undifferentiated Carcinoma of Gall Bladder with Pas Positive Hyaline Globule Masquerading as Liver Mass: A Case Report and Literature Review

저자 : Raman K. Gupta , Vishal K. Chorasiya , Vivek Vij , Manav Wadhawan , Ajay Kumar , Nalini Bansal

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 81권 0호 발행 연도 : 2023 페이지 : pp. 40-45 (6 pages)

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An undifferentiated carcinoma (UC) of the gall bladder behaves aggressively and has a grave prognosis. Small cell type undifferentiated carcinoma of the gall bladder is a rare variant. This paper reports a case of UC of gall bladder with PAS-positive diastase- resistant eosinophilic hyaline globules present as liver mass (on imaging) in a male patient. The microscopic findings of the liver and gall bladder after a right tri-segmentectomy showed an un-differentiated malignant neoplasm composed of cells with round to oval nuclei, prominent nucleoli, and scanty neoplasm. No definite cell pattern was identified with these neoplastic cells. A section from the gall bladder revealed a tumor arising from the lining epithelium and infiltrating through the muscularis. This tumor was infiltrating the adherent liver tissue directly and forming a mass of undifferentiated malignant cells. The focal area within the tumor mass showed the presence of PAS-positive, diastase-resistant, eosinophilic hyaline globules within the neoplastic cells. The immunohistochemistry test was diffusely positive for perinuclear anti-neutrophil cytoplasmic antibodies and negative for chromogranin, vimentin, Desmin, alpha-fetoprotein, leukocyte common antigen, CD34, and bcl2. When the clinical and radiological data are inconclusive, careful analysis of the histological and immunophenotypic features is needed to make the final diagnosis of UC of the gall bladder. The biological behavior and prognosis of this tumor remain unclear because of its rarity. Further studies will be needed to understand the characteristics of this deadly tumor and to establish an effective therapy for it. (Korean J Gastroenterol 2023;81:40-45)

KCI등재

6Diagnosis of Bowel Endometriosis Using Endoscopic Ultrasound-guided Fine Needle Aspiration

저자 : Ana Catarina Carvalho , Ricardo Cardoso , Francisco Pires , Sofia Ventura , Francisco Portela , Paula Ministro , Américo Silva

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 81권 0호 발행 연도 : 2023 페이지 : pp. 46-51 (6 pages)

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Endometriosis is a relatively common gynecological condition in women of reproductive age. The rectosigmoid region is the most commonly affected segment when the gastrointestinal tract is involved. A differential diagnosis of colorectal neoplasia is difficult because of the similar clinical, endoscopic, and radiology findings. A 42-year-old female presented with abdominal distention and was subsequently diagnosed with a large bowel obstruction in the rectum. A temporary colostomy was performed, and endoscopy revealed a rectal mass obstructing the rectum. The biopsy showed normal mucosa, and it was difficult to exclude rectal malignancies even after the imaging workup. Endoscopic ultrasound demonstrated a hypoechoic lesion below the rectal mucosa, and fine needle aspiration confirmed the diagnosis of bowel endometriosis. Bowel endometriosis is a challenging diagnosis. Endoscopic ultrasound- guided fine-needle aspiration is useful for acquiring adequate samples for histological confirmation and a definitive diagnosis of bowel endometriosis. (Korean J Gastroenterol 2023;81:46-51)

KCI등재

7양성자 펌프 억제제로 호전된 환상 췌장

저자 : 김준성 ( Joon Sung Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 81권 0호 발행 연도 : 2023 페이지 : pp. 52-54 (3 pages)

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8급성췌장염의 치료를 위한 초기 수액주입속도의 결정

저자 : 문성훈 ( Sung-hoon Moon )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 81권 0호 발행 연도 : 2023 페이지 : pp. 55-57 (3 pages)

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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)

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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)

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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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