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We combined endoscopic submucosal dissection (ESD) and sentinel node navigation surgery with the purpose of achieving complete resection of early gastric cancer while preserving the organ and assessing pathological nodal status. A total of 13 patients with cT1( ≤ 3 cm)N0 early gastric cancer underwent combined ESD and sentinel node navigation surgery (ESN) at a single tertiary referral center. Sentinel node navigation surgery using indocyanine green was performed during ESD and all suspected sentinel nodes were removed laparoscopically and examined intraoperatively. ESN was converted to gastrectomy with D2 dissection if there was evidence of metastasis on frozen section. ESN was completed in 12 patients and in 1 patient was converted to gastrectomy after sentinel node navigation surgery. En bloc tumor resection was achieved in all cases. Two patients underwent additional gastrectomy because they had tumor-positive vertical margins. In all cases ESN was conducted without intraoperative or postoperative adverse events. ESN is a feasible minimally invasive procedure that allows en bloc tumor resection to be achieved while assessing the pathological status of the lymph nodes.

Schwannomas of the gastrointestinal (GI) tract are rare subepithelial tumors comprising approximately 3.3% to 12.8% of all mesenchymal tumors of the GI tract. On endoscopic ultrasound (EUS) they are seen as hypoechoic tumors arising most commonly from the 4th proper muscle layer. Although EUS helps to distinguish tumor characteristics, tissue sampling is required for differentiation with other more common tumors such as GI stromal tumors. Both EUS-guided fine needle aspiration and EUS-guided trucut biopsy (EUS-TCB) can be used for tissue sampling. However, only EUS-TCB allows core biopsy and a high yield of immunohistochemical staining. We report a case of a gastric schwannoma diagnosed by EUS-TCB.

Hypopharyngeal cancers are often diagnosed at an advanced stage and have a poor prognosis. Even when they are diagnosed at an operable stage, surgery often results in substantial morbidity and decreased patients' quality of life. Although the endoscopic diagnosis of early hypopharyngeal cancer is difficult, recent developments in advanced imaging endoscopy have enabled easier diagnosis of these lesions. Endoscopic resection of early hypopharyngeal cancer is a potential minimally invasive treatment that can preserve the function and quality of life of patients. Reports of this procedure are limited, however. We report a case of hypopharygeal cancer treated with endoscopic resection.

Purpose: The risk of nodal metastasis is low in EGCs that meet the criteria for ESD. However, the only definite diagnostic method for nodal metastasis is pathologic examination. We combined ESD and Sentinel node navigation surgery (SNN) with the purpose of achieving complete resection of the tumor while preserving the organ and assessing pathological nodal status. Materials and Methods: 26 patients with c T1N0M0 EGC who met the expanded indication criteria for ESD underwent ESN. ESN was performed separately in 20 patients, and simultaneously in 6. SNN was performed by endoscopically injecting ICG in all four quadrants of the submucosa around the tumor site. All suspected SNs were removed using the pick-up biopsy method and intra-operatively examined by frozen section, with HE staining. If the number of SNs harvested was less than 5, additional basin dissection was performed at the site of SNs. Patients were scheduled to convert to a gastrectomy with D2 dissection if there was evidence of metastasis found on frozen section during the procedure. Results: In 10 cases, cancer was confined to the mucosal layer, and in 16 cases cancer extended into the submucosal layer or deeper (14 submucosal cancers,1 proper muscle cancer). There was 13 case of differentiated cancer and 13 case of undifferentiated cancer. All cases were resected with free lateral margins (range, 1-8 mm). The median number of total obtained lymph nodes including SNs was 10.9 (range, 5-31). Lymph node metastasis (LNM) was not found in 0 lymph nodes obtained from SNN and basin dissection. ESN was conducted without intraoperative or postoperative adverse events in all cases. The final diagnosis of 1 patient with proper muscle invasion was pT2N1M0. LNM was found in 1 of 32 (station No. 9) nodes following total gastrectomy and D2 dissection, indicating skip metastasis. Conclusion: ESN is a feasible minimally invasive procedure that can achieve en-bloc tumor resection while assessing the pathologic status of the lymph nodes.

Gallbladder (GB) cancer occurs predominately as a biliary tract malignant tumor. It generally has a very poor prognosis, and early detection is often difficult. A variety of carcinogens have been implicated as an important cause for GB cancer. Benzene is a well-known carcinogen for hematologic malignancy, and its casual relationship with GB cancer has been suggested. We report a case of two patients who had operated a laundry cleaning facility together and later simultaneously got GB cancer after prolonged benzene exposure.

이 필수적이라 할 수 있다. 최근에는 대장내시경을 효과적이고 적절 하게 시행하기 위하여 대장내시경의 질 척도라는 개념이 확산되고 있 다. 이러한 질 척도에는 샘종 진단율, 샘종 간과율, 맹장 삽관율, 장정 결도와 내시경 후퇴시간 등이 이용되고 있으며 특히, 맹장 삽관율과 장정결도, 내시경 후퇴시간은 모두 샘종 진단율을 높이는 것과 연관 이 있다. 또한, 적절한 질 척도의 관리는 중간암의 발생을 줄이고 대 장폴립 절제술 후 적절한 추적 감시기간을 유지하는 데 중요한 역할 을 한다. 이에 국내에서도 대장내시경의 질 척도와 관련하여 병변 간과율, 장정결도 등에 대한 여러 연구들이 보고되고 있으나 대부분의 연구는 3차 의료기관에서 보고하는 연구들이며 1차 의료기관에서 시행되는 대장내시경의 질 척도에 관한 연구는 매우 부족한 실정이다. 특히, 국 내의 경우 2004년 대장암이 국가 암 검진 사업에 추가되면서 대장내 Analysis of Colonoscopy Quality in Clinical Practices of Korea: Cohort Study of Patients Referred to Tertiary Hospital after Colonoscopy Examinations

Mean operating time and estimated blood loss were 125 min (range 85-253) and 27 ml (range 5-71), respectively. Median hospitalization stay was 6 (range 4-10) days. Hybrid NOTES® was carried out without any intraoperative or postoperative adverse events in 15 cases. There were no recurrences or metastasis during follow up periods(556 days; range 156-850). Conclusions: Hybrid NOTES® could be a bridge between EMR/ESD and laparoscopic surgery in respect to therapeutic efficacy, and prevent extensive gastrectomy in patients with EGC.