크기가 큰 용종의 절제 - gie.or.kr

1 156 The Korean Society of Gastrointestinal Endoscopy Resection of Large Colorectal PolypsKim Sang WookDepartment of Internal Medicine of Chonbuk National University College of Medcine, Jeonju, KoreaB-IV. Room B .. 2 cm large polyp . 1. ? 1) 2 cm 1 3 cm Giant polyp pedunculated polyp sessile polyp snare.

2 2) (Difficult polyps) two haustral folds , lumen 1/3 , cecum , angulation .2 3 redunadncy angulation . 3) Malignant polyp malignant . pit pattern ulceration, induration, friability submucosal injection non lifting sign . non lifting sign invasive cancer.

3 4 5 marking . , non-lifting sign fibrosis infiltration . 4) .6 95% 5~10 5~6 . 2. 46 157 ( endoscopic mucosal resection, EMR) ( endoscopic submucosal dissection, ESD) .7 1) (EMR)EMR 15 mm snare.

4 30o .. ( saline 100 mL+10 g glycerin+5g fructose) epinephrine (1: 10,000) methylene blue mix . Stalk incision hyaluronic acid ( ) 1 vial 3% saline+ epinephrine methylene blue 10 cc . EMR snaring . snaring 6 snaring snare snaring snare .. Snare spiral snare 8 360 rotatable snare (Boston Scientific).

5 Snare snare snare . 2) (ESD)ESD en block flat sessile polyp snaring . ESD EMR knife .. ESD knife flex, IT, Hook knife . ESD knife flex knife . 1 mm . Hook knife . Olympus dual knife knife IT knife incision.

6 ESD marking incision . incision incision trimming incision . Electrosurgical unit ERBE VIO 300D incision endocut, 60 w, effect 2 mode dissection forced coagulation, 40 W . coagrasper soft coagulation mode . Hemoclip . water jet . 3) ESD snare EMR 360 incision trimming snare EMR.

7 Hyalurnoic acid dual knife incision trimming . base snare 2 cm snare .. 4) . Endoclipping endoloop polypectomy9: large pedunculated colonic polyp . Side viewing endoscopy polypectomy 10: 158 The Korean Society of Gastrointestinal Endoscopy . Double channel endoscopic polypectomy 11; grasping forcep snaring.

8 Novel spring action S O clip 12: spring hemoclip incision . incision trimming .. ulceration non lifting sign SM invasion . 1. Kedia P, Waye JD. Routine and advanced polypectomy techniques. Curr Gastroenterol Rep 2011;13:506 511. 2. Gallegos Orozco JF, Gurudu SR. Complex colon polypectomy. Gastroenterol Hepatol (N Y) 2010;6:375 382. 3. Fyock CJ, Draganov PV.

9 Colonoscopic polypectomy and asso-ciated techniques. World J Gastroenterol 2010;16:3630 3637. 4. Higaki S, Hashimoto S, Harada K, et al. Long term follow up of large flat colorectal tumors resected endoscopically. Endoscopy 2003;35:845 849. 5. Kudo S, Kashida H, Tamura T, et al. Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer. World J Surg 2000;24:1081 1090. 6.. ; 1999. 7. Monkemuller K, Neumann H, Fry LC, Ivekovic H, Malfertheiner P. Polypectomy techniques for difficult colon polyps. Dig Dis 2008;26:342 346. 8.. 2006. 9. Katsinelos P, Chatzimavroudis G, Papaziogas B, et al.

10 Endoclipping assisted resection of large colorectal polyps. Surg Laparosc Endosc Percutan Tech 2008;18:19 Frimberger E, von Delius S, Rosch T, Schmid RM. Colonoscopy and polypectomy with a side viewing endoscope. Endoscopy 2007;39(5):462 Valentine JF. Double channel endoscopic polypectomy technique for the removal of large pedunculated polyps. Gastrointest Endosc 1998;48:314 Sakamoto N, Osada T, Shibuya T, et al. endoscopic sub- mucosal dissection of large colorectal tumors by using a novel spring action S O clip for traction (with video). Gastrointest Endosc 2009;69:1370 4.