1. 소화기 내시경 집담회 아주대학교 소화기 내과 신성재, 이경록, 황재철, 이기명, 이광재, 김진홍

2. CASE 김 O 규 M/60  C.C.: Known Gastric adenoma  P.Hx. : No known Pul tbc, viral hepatitis, DM, hypertension Alcohol: social Smoking: none  FHx. : N-C

3. Present illness 상기 환자는 타병원에서 시행한 내시경 상 Gastric adenoma 소견 보여 본원으로 전원됨.

4. Review of Systems  ROS : General weakness / Easy fatigue (-/-) Cough / Sputum (-/-), Dyspnea / chest pain (-/-), Abdominal discomfort (-) Indigestion(-) Dysphagia/ Anorexia / Nausea / Vomiting (-/-/-/-) Melena / Hematochezia (-/-) Wt loss (-)  P/E : BP 110/70 mmHg, PR 69/min RR 21/min, BT 36.5 ℃ Not so ill looking apperance Not pale conjunctivae/ anicteric sclera Clear breathing sound Regular heart beat without murmur Soft and flat abdomen without tenderness

5. Lababoratory Data  Lab. : CBC 5800/15.0/229,000 BUN/Cr 11.3/0.8 mg/dL, AST/ALT 12/18 IU/L T. pro/Alb 6.9/4.2 g/dL, T.bil 0.7 mg/dL PT/PTT 12.7/27 sec CEA 1.75 ng/ml

6. EGD (2007-03-09)  Dx: 1. EGC IIc in antrum, LC 2. EGC IIa +IIc in antrum PW 3. Gastric adenoma in antrum GC Antrum PW Antrum LC Antrum GC

7. Pathology  Antrum LC: Tubular adenoma with high grade dysplasia  Antrum PW: Tubular adenoma with high grade dysplasia  Antrum GC: Tubular adenoma with low grade dysplasia

8. ESD 03-21 (I)  Antrum PW- ESD  IT-knife  Total time: 49min  Size: 3.5 x3.5 cm  Marking   Incision   Dissection   Post ESD coagulation

9. ESD 03-21 (II)  Antrum GC-ESD  Marking: Soft coagulation  Incision: Dry cut mode  Dissection: Swift coagulation  Bleeding control: Soft coagulation by Hemostatic forceps  Antrum GC  Size: 4 x 3.5cm  Total time: 40 min

10. ESD 03-21(III)  Antrum LC-ESD  Incision: Flex-knife  Dissection: IT-Knife  Total time: 70 min  Size: 2.5 x 2.0 cm

11. Pathology (I)  Antrum PW: Adenoca, WD, SM 1 invasion, RM (-), Lymphatic invasion (+)

12. Pathology (II)  Antrum GC: H.pylori gastritis. No evidence of gastric adenoma Tubular adenoma with LGD in BxNo evidence of adenoma in ESD

13. Pathology (III)  Antrum LC: Adenoca, WD, Mucosa invasion, RM(-)

14. Abdominal CT  No evidence of gastric mass

15. Operation (2007-4-10)  Subtotal gastrectomy with B-II anastomosis - No residual tumor - RM(-) - LN (0/35)