내시경적 점막절제술을 이용한 위점막병변의 진단과 치료

Abstract

The correct histological diagnosis of gastric mucosal lesions, especially adenoma or dysplasia, is very important due to its well-recognized precancerous lesion. The histological examination of forceps biopsy. which is the usual diagnostic method, has a limited accuracy because it does not represent the entire lesion. In contrast, the endoscopic mucosal resection (EMR) is considered to be more accurate since it can potentially achieve removal of the entire lesion. The aim of this study is to compare these two methods in the diagnosis of precancerous lesion. 1) The age of twelve patients, which consist of eight males and four females, ranged from thirty-six to sixty-nine years old (mean : 55.5 years of age) 2) The twelve patients were diagnosed using EMR : two patients were tubular adenoma, five were dysplasia, and two were ectopic pancreas and three were adenocarcinoma. In addition, eight lesions (67%) were completely resected, with the mean size of 10 mm(4 to 16 mm) 3) The diagnosis using forceps biopsy indicated the same result as EMR, except five tubular adenomas : Two cases were diagnosed as severs dysplasia and one with adenocarcinoma. Out of five tubular adenomas stated above, three (60%) cases diagnosed with forceps biopsy were different from EMR. 4) There were no significant complications related to EMR. These results suggest that the diagnosing precancerous lesion such as adenomas on the basis of forceps biopsy is generally unreliable. The precancerous lesion should be completely resected by EMR to obtain the final diagnosis as well as definite treatment.