Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Three Cases of Endoscopic Mucosal Resection of Rectal Carcinoid Tumor by Band Ligation and the Snare Resection Technique

밴드결찰술 및 올가미를 이용하여 내시경 점막절제술을 시행한 직장 유암종 3예

  • Jo, Young-Hwa (Department of Internal Medicine, Dongeui Medical Center) ;
  • Roh, Ji-Hun (Department of Internal Medicine, Dongeui Medical Center) ;
  • Goo, Dong-Young (Department of Internal Medicine, Dongeui Medical Center) ;
  • Yoo, Jae-Hoon (Department of Internal Medicine, Dongeui Medical Center) ;
  • Kim, Ki-Soo (Department of Internal Medicine, Dongeui Medical Center) ;
  • Shin, Young-Min (Department of Internal Medicine, Dongeui Medical Center) ;
  • Kim, Sung-Hoon (Department of Internal Medicine, Dongeui Medical Center) ;
  • Park, Ji-Eun (Department of Internal Medicine, Dongeui Medical Center)
  • Received : 2009.05.14
  • Accepted : 2010.06.06
  • Published : 2010.07.30
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Abstract

Many reports have shown that endoscopic polypectomy or endoscopic mucosal resection can successfully remove tumor less than 1.0 cm in size. However, most carcinoid tumors in the rectum occur in the submucosal layer so that the entire tumor cannot be completely removed via endoscopic polypectomy or endoscopic mucosal resection. Endoscopic mucosal resection can also cause perforation of the intestinal wall and bleeding. Due to these reasons, instead of these two conventional methods, endoscopic mucosal resection using a ligation device is currently being used for the treatment of rectal carcinoid tumor. Recent studies that used this method have reported that endoscopic mucosal resection of rectal carcinoid tumor by band ligation and the snare resection technique is safe with minimal complications and this is quite useful to completely remove rectal carcinoid tumor.

유암종은 위장관 및 기관지 등의 신경 내분비세포에서 발생하는 종양이며 전체 유암종에서 직장 유암종이 차지하는 비율은 10% 정도이다. 아직은 직장 유암종에 대한 표준 치료가 확립되어 있지는 않으나 최근 내시경 시행 빈도의 증가 및 술기의 발달로 내시경 치료가 빈번히 시행되고 있다. 종양의 크기와 침습의 깊이에 따라 치료 방법이 주로 결정되며 종양의 크기가 1 cm 미만인 경우 단순한 용종절제술이나 고전적 내시경 점막절제술을 시행하여 치료에 성공하였다는 보고가 있다. 그러나 대부분의 직장 유암종은 직장의 점막하층에 발생하는 경우가 많으므로 용종절제술이나 고전적 내시경 점막절제술로는 완전한 절제가 불가능한 경우가 있으며 깊은 절제를 위해 내시경 점막하박리술을 시행하는 경우 장벽의 천공 및 출혈 등과 같은 부작용이 발생할 가능성도 있다. 이 같은 이유로 고전적인 술기가 아닌 밴드결찰술 및 올가미를 이용한 직장 유암종의 절제(endoscopic submucosal resection with EVL device)가 시도되고 있다. 밴드결찰술 및 올가미를 이용한 직장 유암종의 절제는 비교적 안전하고 시술에 의한 합병증의 발생 빈도가 적으며 무엇보다도 직장 유암종의 완전한 절제에도 유리하다는 보고가 늘고 있다. 저자들은 직장 유암종으로 진단된 3예에서 밴드결찰술 및 올가미를 이용하여 합병증 없이 완전 절제하여서 문헌 고찰과 함께 보고한다.

Keywords

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