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내시경적 대장 점막 절제술의 실제

Endoscopic Mucosal Resection and Its Clinical Application in the Colon and Rectum

대한대장항문학회지 1999년 15권 1호 p.83 ~ 91
김현식 ( Kim Hyun-Sik ) - 송도병원 외과

박원갑 ( Park Won-Kap ) - 송도병원 외과
황도연 ( Hwang Do-Yeon ) - 송도병원 외과
김건욱 ( Kim Khun-Uk ) - 송도병원 외과
이광렬 ( Lee Kwang-Ryul ) - 송도병원 외과
유정준 ( Yoo Jung-Jun ) - 송도병원 외과
임석원 ( Lim Seok-Won ) - 송도병원 외과
이종균 ( Lee Jong-Kyun ) - 송도병원 외과

Abstract


Purpose: Endoscopic mucosal resection (EMR) or endoscopic piecemeal mucosal resection (EPMR) is a useful method for treating benign neoplastic lesions and selected cases of early colorectal cancers, especially those cancers with flat or depressed shapes. However, clinical data concerning EMR or EPMR are still lacking. Accordingly, we designed this study to review and analyze our cases for more information and in order to achieve more adequate and prudential application.

Methods: We performed 2609 colonoscopic polypectomies from January 1997 to December 1998. Among those, 77 lesions (3.0%) were treated by using the EMR or the EPMR technique. We analyzed those 77 lesions with special reference to size, configuration, and histologic diagnosis.

Results: The most common age group was the 5th decade. The male-to-female ratio was 1.75:1. The most common sites of the lesions were the rectum and the sigmoid colon. Most of the lesions were equal to or smaller than 15 mm in size (97.4%). Flat, elevated lesions were the most common type (39%), followed by sessile (31.2%) and depressed (18.2%) lesions in order. Adenomas and adenocarcinomas accounted for 51.9% (40/77) of the lesions and the malignancy rate was 9.1% (7/77). Three were submucosal cancers. Seventy-one percent of the carcinomas were less than 10 mm in size, and the only submucosal cancer was below 5 mm in size and was a depressed lesion.
Carcinoid tumors accounted for 15.6% of the lesions, and chronic nonspecific inflammation for 9.1%. An EPMR was performed on 4 lesions which were larger than 10 mm. There were no complications such as bleeding, perforation, or recurrence.

Conclusion: EMR and EPMR are useful endoscopic resection techniques, especially for sessile, flat, and depressed neoplastic lesions. Lesions up to 15∼20 mm in size are good candidates for EMR and those up to 40 mm for EPMR. At the same time, a carefully performed procedure is mandatory to prevent recurrence or complications such as bleeding or perforation.

키워드

Endoscopic mucosal resection;Endoscopic piecemeal mucosal resection;Early colorectal cancer
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