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단일 기관에서 경험한 바렛식도암의 임상적 고찰

The Clinical Characteristics and Outcomes of Barrett’s Cancer at a Single Institution in Korea

김경미|김재준|이종철|이준행|김범진|이풍렬|심영목|김상중
대한소화기내시경학회 (The Korean Society Of Gastrointestinal Endoscopy)|2009.02|Clinical Endoscopy|제38권 제2호|pp. 68-74

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참고문헌

키워드

선암AdenocarcinomaBarrett’s esophagus바렛식도
주제분류내과학

초록

목적: 위식도역류질환이 흔해지면서 바렛식도의 증가가 예견되며, 이와 더불어 바렛식도암에 대한 관심이 고조되고 있다. 본 연구에서는 단일기관에서 바렛식도암으로 판명된 환자들을 대상으로 내시경 소견과 기타 임상 소견을 살펴보았다. 대상 및 방법: 1995년 1월부터 2008월 8월까지 삼성서울병원에서 식도 선암으로 진단받은 환자 39명 중 조직병리검사에서 바렛식도암으로 최종 진단된 11예(28%)의 환자를 대상으로 임상 양상, 치료, 병리조직학적 소견, 재발 여부, 생사 여부에 대하여 후향적으로 조사하였다. 결과: 바렛식도암은 남녀의 비는 10：1이었고, 평균 연령은 64세였다. 2000년 이후에 대부분의 환자가 진단을 받았으며, 2008년에는 8월까지 3예(27.3%)가 진단되었다. 주소는 상복부 통증이 3예(27.3%), 건강 검진에서 발견이 3예(27.3%), 위식도 역류 증상으로 내원한 경우가 2예(18.2%)였다. 내시경적 소견에서 모두 조기식도암이었으며 IIa 형이 4예(36.4%), IIb 형이 2예(18.2%)였다. 종양의 평균 크기는 장경 1.2 cm, 단경 0.8 cm이고, 점막내암이 6예(54.5%), 점막하 침윤이 동반된 경우가 5예(45.5%)였다. 림프절 전이는 1예(9.1%)에서 확인되었다. 내시경 점막하 박리법으로 치료한 1예(9.1%)를 제외하고, 나머지 환자들은 외과적 절제술을 시행하였다. 중도 탈락된 1예(9.1%)를 제외하고는 재발이나 전이의 증거가 없었다. 결론: 저자들은 지난 13년간 11예의 바렛식도암을 경험하였으며, 최근에는 빈도가 증가하는 추이를 보이고 있다. 서구와 같은 폭발적 증가 이전에 바렛식도에 대한 경각심을 불러 일으키고 체계적인 감시를 위한 내시경적 조직검사 방법이나 이형성 등급 판정의 표준화 그리고 치료방침에 대한 논의가 필요하리라 생각한다.

Abstract

Background/Aims: The prevalence of Barrett’s esophagus might also be changing along with changes in the epidemiology of GERD, and the incidence of Barrett’s cancer is expected to increase even more. The aim of this study is to evaluate the clinicopathologic features and outcome of the patients with Barrett’s cancer and who were seen at a single institution over a period of 13 years. Methods: The records of 39 patients with the esophageal adenocarcinoma and who were treated at Samsung Medical Center from January 1995 to August 2008 were reviewed. Among them, 11 patients (28%) with histologically-confirmed Barrett’s cancer were included in the study. The clinicopathological features, endoscopic manifestations and treatment outcome were evaluated. Results: The male to female ratio was 10：1. The mean age was 64 years. Most of the patients were diagnosed with Barrett’s cancer after 2000, and there were three such patients (27.3%) in 2008. The frequent chief complaints were epigastric pain (27.3%) and chronic acid reflux symptom (18.2%). Three patients (27.3%) were detected incidentally during screening endoscopy. The macroscopic types based on the endoscopic findings were as follows: 4 lesions with a type IIa appearance (36.4%) and 2 with a type IIb appearance (18.2%). The mean tumor size was 1.2 cm at the longest dimension and 0.8 cm at the shortest dimension. Tumor was located in the mucosal layer in six cases (54.5%) and the 5 cases (45.5%) showed submucosal invasion. Lymph node metastasis was found in one case (9.1%). All the cases underwent surgery, except one case for which the tumor was removed by endoscopic submucosal dissection. There was no recurrence during the follow up period. Conclusions: As the incidence of Barrett’s cancer is increasing, a standard surveillance program that includes the endoscopic biopsy method, the grading system for the dysplasia and the treatment modality should be established.

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