개원의 :    31% 일반 :    7% 전공의 :    7% 공보의 :    4% 대학교수 :    2% Hardcover - 313pages 대한소화기내시경학회 부산·울산·경남지회는 그동안 “대한소화기내시경학회 부산·울산·경남지회 집담회”에서 발표된 주옥같은 증례들을 장기별, 질환별로 정리하여 내시경 진단에 도움을 줄 수 있는 증례집을 발간하게 되었습니다. 발간에 참여한 집필자들은 소화기질환의 연구, 진료, 교육에 탁월한 경험을 갖춘 지회 임원들로 구성되었으며, 부산·울산·경남의 의사들이 소화기내과진료 현장에서 얻은 귀한 경험을 함께 묶어 진료 일선에서 수고하시는 개원의사와 전공의, 전임의 선생님들의 진료에 도움을 드림과 동시에 그 동안의 “대한소화기내시경학회 부산·울산·경남지회 집담회”의 발자취를 정리하고자 하였습니다. 초창기의 집담회에서는 주로 상부 소화관 질환에 대한 증례들이 발표되다가 최근에는 하부 소화관 질환에 대한 증례도 발표되기 시작하였습니다. 집담회의 증례 발표에 참여하는 병원 수가 늘어나고 개인의원도 참여하면서 희귀하고 교육적으로 도움이 되는 증례들이 많이 발표되었습니다. 이에 증례 모음집의 필요성이 수년 전부터 대두되어 마침내 빛을 보게 되었습니다. 본서는 총 9편으로 구성되었습니다. 식도 질환, 양성 및 악성 위장 질환, 점막하종양, 십이지장 질환, 비종양성 및 종양성 대장 질환에 대해 증례로 시작하여 내시경 소견의 구체적인 해설, 미니 리뷰, 임상적 접근과 감별진단 등 내시경 진단과 관련된 내용을 전반적으로 수록하였습니다. 그리고 최근 이슈가 되고 있는 몇 가지 토픽에 대해서는 종설을 실어 본서가 소화기질환의 연구와 진료에 종사하시는 전문가는 물론 일차진료 현장의 개원의들에게도 도움을 드리고자 하였습니다. 아무쪼록 진료 일선에서 활약하는 많은 의료진들에게 미약하나마 도움이 되고 언제나 관심을 갖고 참고할 만한 증례집이 되기를 기대합니다.

PART 1 식도 질환

ChapterⅠ. 식도염

1. 칸디다 식도염 (Candida Esophagitis) ·····················2

2. 거대세포바이러스 식도염 (Cytomegalovirus Esophagitis) ············4

3. 헤르페스 식도염 (Herpetic Esophagitis) ····················6

4. 식도 결핵 (Esophageal Tuberculosis) ·····················8

5. 베체트병 (Behcet’s Disease) ·························10

6. 호산구성 식도염 (Eosinophilic Esophagitis) ··················12

7. 약인성 식도궤양 (Pill-induced Ulcer) ·····················14

8. Mallory-Weiss 열상 ·····························16

Chapter Ⅱ. 식도종양

1. 식도 이소성 피지선 (Heterotopic Esophageal Sebaceous Gland) ········20

2. 평활근종(Leiomyoma)····························22

3. 표재성 식도암 (Superficial Esophageal Cancer) O-IIa·············24

4. 표재성 식도암 (Superficial Esophageal Cancer) O-IIa+IIb···········26

5. 표재성식도암(Superficial Esophageal Cancer) O-IIc·············28

6. 표재성 식도암 (Superficial Esophageal Cancer) O-IIc+IIa ··········30

7. 진행성 식도암 (Advanced Esophageal Cancer) 1형 ··············32

8. 진행성 식도암 (Advanced Esophageal Cancer) 2형 ··············34

9. 진행성 식도암 (Advanced Esophageal Cancer) 3형 ··············36

10. 진행성 식도암 (Advanced Esophageal Cancer) 4형 ··············38

PART 2 위장 질환

ChapterⅠ. 위염 및 위궤양

1. 미란성 위염 (Erosive Gastritis)························44

2. 장형화생 (Intestinal Metaplasia) ·······················46

3. 방사선 위장염 (Radiation Gastritis)······················49

4. 호산구성 위염 (Eosinophilic Gastritis) ····················52

5. 급성 위점막 병변 (Acute Gastric Mucosal Lesion) ···············54

6. 거대 위궤양 (Giant Gastric Ulcer) ······················56

7. 위궤양 출혈 (Gastric Ulcer Bleeding) ·····················58

Chapter Ⅱ. 위암

1. 융기형 조기위암 (Protruded Type) I, 0’ I ···················62

2. 표면융기형 조기위암 (Superficial Elevated Type) Ⅱa, 0’ Ⅱa ··········64

3. 표면평탄형 조기위암 (Superficial Flat Type) Ⅱb, 0’ Ⅱb ············66

4. 표면함몰형 조기위암 (Superficial Depressed Type) Ⅱc, 0’ Ⅱc ·········68

5. 함몰형 조기위암 (Excavated Type) Ⅲ, 0’ Ⅲ ··················70

종설 : 함몰형 조기위암 병변의 관찰사항 ···················72

6. 소 위암과 미소 위암 (Small Gastric Cancer & Minute Gastric Cancer) ·····77

7. 1형 진행위암 (종류형성형) (Advanced Gastric Cancer, Borrmann 1) ······79

8. 2형 진행위암 (궤양국한형) (Advanced Gastric Carcinoma, Borrmann 2) ····81

종설 : 양성 위궤양과 악성 위궤양 ······················84

9. 3형 진행위암 (침윤궤양형) (Advanced Gastric Cancer, Borrmann 3) ······89

10. 4형 진행위암(미만침윤형), 스키루스 위암 (Advanced Gastric Cancer Borrmann 4,

Scirrous Cancer, Linitis Plastica Cancer) ··················91

종설 : Linitis Plastica의 내시경 소견 ····················94

11. 점액성 위선암 (Gastric Mucinous Adenocarcinoma)··············96

12. 위 편평상피세포암 (Gastric Squamous Cell Carcinoma) ············98

13. 위 악성 림프종 (Gastric Malignant Lymphoma) ···············100

14. MALT림프종 (MALT Lymphoma) ······················103

종설 : 위 MALT림프종 ··························105

15. 카포시 육종 (Kaposi Sarcoma)························108

16. 점막하종양형태위암(SMT-like Gastric Cancer)···············109

Chapter Ⅲ. 기타 위장 질환

1. 위선종 (Gastric Adenoma) ·························112

2. 위저선 폴립 (Fundic Gland Polyp) ······················114

3. Menetrier’ s disease ····························116

4. 고래회충유충증 (Anisakiasis) ························118

5. 위 결핵 (Gastric Tuberculosis) ·······················120

6. 위매독(Gastric Syphilis)··························122

7. 위농양(Gastric Abscess)··························124

8. 아밀로이드증 (Amyloidosis) ·························126

9. 알레르기성 자반증 (Henoch-Sch onlein Purpura) ···············128

10. 거대세포바이러스 위염 (Cytomegalovirus Gastritis) ·············130

11. 크론병 (Crohn’s Disease) ··························132

Chapter Ⅳ. 점막하종양

1. 유암종 (Carcinoid Tumor)··························136

2. 과립세포종 (Granular Cell Tumor)······················138

3. 염증성 섬유화 용종 (Inflammatory Fibrinoid Polyp) ·············140

4. 지방종 (Lipoma) ······························142

5. 심재성 낭성 위염 (Gastritis Cystica Profunda: GCP) ·············144

6. 중복 낭종 (Duplication Cyst) ························146

7. 이소성 췌장 (Ectopic Pancreas) ·······················148

8. 선근종 (Adenomyoma) ···························150

9. 위장관 간질 종양 (Gastrointestinal Stromal Tumor: GIST) ··········152

10. 신경초종 (Schwannoma) ··························154

11. 외인성 압박 (Extraluminal Compression) ··················156

종설 : 점막하종양의 진단적 접근 ······················158

PART 3 십이지장 질환

ChapterⅠ. 십이지장 질환

1. 유두부 선종 (Ampullary Adenoma) ·····················168

2. Brunner선 선종, 과오종 (Brunner Gand Adenoma, Hamartoma) ·······171

종설 : Brunner선 유래 질환 ························173

3. 이소성 위 점막 (Heterotopic Gastric Mucosa) ················176

4. 이소성 췌장 (Heterotopic Pancreas) ·····················178

5. 십이지장 암 (Duodenal Cancer) ·······················180

6. 십이지장 낭종 (Duodenal Cyst) ·······················182

7. 림프관종 (Lymphangioma) ·························184

8. 십이지장 정맥류 (Duodenal Varix) ······················186

9. 유암종 (Carcinoid Tumor)··························188

10. 췌관내 유두상 점액 종양 (Intraductal Papillary Mucinous Neoplasm: IPMN)··190

PART 4 대장 질환

Chapter Ⅰ. 비종양성 질환

1. 궤양성 대장염 (Ulcerative Colitis) ······················196

2. 크론병 (Crohn’ s Disease) ··························200

종설 : 염증성 장질환의 내시경적 접근 ···················204

3. 장형 베체트병 (Intestinal Behcet’s Disease) ·················209

4. 허혈성대장염(Ischemic Colitis)·······················213

5. NSAIDs 유발성 장염 (NSAIDs induced Enterocolitis)·············217

6. 위막성 대장염 (Pseudomembranous Colitis) ·················220

7. 장티푸스 장염 (Typhoid Fever) ·······················224

8. 결핵성 장염 (Intestinal Tuberculosis) ····················227

9. 아메바성 장염 (Amebic Colitis) ·······················231

10. 거대세포바이러스 대장염 (Cytomegalovirus Colitis)··············234

11. 아밀로이드증 (Amyloidosis) ·························238

12. 방사선 장염 혹은 직장염 (Radiation Enterocolitis or Proctitis) ········242

13. 호산구성장염(Eosinophilic Enterocolitis)··················246

14. 점막 탈출증 (Mucosal Prolapse Syndrome) ·················250

15. 첨규 콘딜로마 (Condyloma Acuminatum) ··················254

16. 대장 흑색증 (Melanosis Coli) ························256

17. 에스자결장 염전 (Sigmoid Volvulus) ·····················258

Chapter Ⅱ. 종양성 질환

1. 대장폴립의 형태학적 분류 (Kudo Classification) ···············262

2. 선종성 폴립 (Adenomatous Polyp)······················264

3. 악성 폴립 (Malignant Polyp) ························266

종설 : 대장 용종 추적검사 ·························268

4. 포이츠-예거 증후군 (Peutz-Jeghers Syndrome) ···············275

5. 진행성 대장암 (Advanced Colorectal Cancer) 1형(종류형) ···········278

6. 진행성 대장암 (Advanced Colorectal Cancer) 2형(궤양국한형) ·········281

7. 진행성 대장암 (Advanced Colorectal Cancer) 3형(궤양침윤형), 4형(미만침윤형) ·284

8. 림프종 (Lymphoma) ····························286

9. 전이성 대장암 (Metastatic Colon Cancer) ··················290

10. 대장지방종(Colonic Lipoma)························294

11. 충수 점액 낭종 (Appendiceal Mucocele) ···················297

12. 장 과립세포종 (Granular Cell Tumor: GCT) ·················300

13. 대장림프관종(Colonic Lymphangioma)···················303

14. 직장 유암종 (Rectal Carcinoid) ·······················307

15. 항문암 (Anal cancer) ····························310

Index ···································· 313