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

2. CASE 엄 O 회 M/59  C.C.: Known esophageal cancer  P.Hx. : No known Pul tbc, viral hepatitis, DM, hypertension Alcohol: 2-3 병 /day x 30yrs Smoking: 0.5 갑 /day x 30 yrs  FHx. : N-C

3. Present illness 상기 환자는 heavy alcoholics 로 1999 년 alcoholic liver cirrhosis 진단 후 HEP, Esophageal varix bleedings 등으로 타병원 입원치료 도중 시행한 내시경상 Esophageal cancer 소견 보여 본원으로 전 원됨.

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 ℃ Chronic ill looking apperance Not pale conjunctivae/ anicteric sclera Clear breathing sound Regular heart beat without murmur Soft and flat abdomen without tenderness Fluid wave/shifting dullness (+/+)

5. Lababoratory Data  Lab. : CBC 5450/11.9/75,000 BUN/Cr 6.2/0.5 mg/dL, AST/ALT 30/25 IU/L T. pro/Alb 6.1/2.4 g/dL, T.bili 1.1 mg/dL PT/PTT 17.7/40 sec HBs Ag/Ab (-/+), anti-HCV (-) CEA 2.58 ng/ml αFP 3.7 ng/ml

6. EGD Esophageal cancer in UI 28cm

7. Pathology Squamous cell cancer

8. EUS R/O SM invasion

9. Abdominal U/S Liver cirrhosis with splenomeagly, Ascites

10. 외부 Abdominal & Chest CT Esophageal varix, Liver cirrhosis, Ascites

11. Photodynamic Therapy  PDT after photosensitizer injection (2 days later)  Photogem, 2mg/kg, cylindrical diffuse probe, 630nm, 150 J/cm 2

12. F/U EGD after 2days Ulceration & remnant tissue after PDT

13. F/U EGD after 1 months No evidence of recurrence

14. Abdo & Chest CT after 9 months No recurrence or metastasis of esophageal cancer

15. F/U EGD after 1 years No evidence of recurrence

16. Photodynamic Therapy (PDT) Injection of photosensitizer 24-72 h Drug selectively retained by cancer cells Light Source Drug sat’d tumor exposed to light Cancer cell destroyed!!! Light activates drug; oxygen excited

17. Photodynamic Therapy (PDT)  Photosensitizer: Hematoporphyrin 유도체 - Porfimer sodium (photofrin) - 5-aminolevulnic acid (5-ALA) - Meta-tetrahydroxyphenychorin (mTHPC)  Laser systems & Applicators - Diodide laser - Cylindrical diffuse probe  Light dosages : 120~300 J/cm2  Side effect: Stricture (30%), Photosensitivity