목적: 내시경 점막하 박리술(endosopic submucosal dissection, ESD)은 조기 위암의 새로운 치료방법으로 자리잡고 있으나 시술의 적응증에 관한 지침이 부족하다. 본 연구에서는 조기 위암의 치료에서 ESD의 적응증에 관한 국내 내시경의사들의 인식과 현황을 알아보고자 하였다. 대상 및 방법: 2009년 2월 7일 개최된 대한 소화기내시경학회-대한 병리학회 소화기병리 연구회 합동 심포지엄에 참석한 내시경의사들을 대상으로 ESD의 적응증에 관한 설문을 제시하고, 키 입력방식으로 취합된 결과를 분석하였다. 결과: 115명의 응답자 중 남자는 87명(75.6%)이고, 30대가 72명(62.6%)로 가장 많았으며, 내과전문의가 110명(95.6%), 3차 의료기관의 근무자는 81명(70.4%)이었다. ESD의 총 시술횟수는 50회 미만이 62명(53.9%), 50회 이상이 53명(46.1%)이었다. 응답자들은 절대 적응증에 해당하는 조기 위암의 치료에서 ESD를 수술과 동등한 치료로 동의하고 있었다(일치율 99.5%). 확대 적응증의 포괄적인 채택에 대한 의견 일치율은 절대 적응증에 비하여 낮지만(63.6%), ESD시술 횟수가 많을수록 적응증 확대에 동의하고 있으며(44.8% vs. 83.0% p=0.003), 임상에서는 환자의 선호도와 임상적 위험요인을 고려하여 선택적으로 시술하고 있었다(96.3%). 확대 적응증의 세부항목에 대한 일치율은 크기(71.5%), 궤양형 병변(53.5%), 점막하 침윤병변(48.6%), 미분화형 병변(25.2%) 순이었다. 대부분의 응답자들은 기존 적응증을 보완한 국내의 ESD적응증 수립이 필요하다고 응답하였다(98.1%). 결론: 조기 위암의 치료에서 기존의 절대 적응증에 해당하는 병변의 내시경 절제술은 보편적 치료로 인정받고 있으나, 적응증 확대에 대해서는 논란의 여지가 있다. 향후 장기 추적관찰결과를 바탕으로 한 국내 합의안 도출 및 지침마련이 필요하다.

Background/Aims: Endoscopic submucosal dissection (ESD) has become a widely accepted method for treating early gastric cancer (EGC) in Korea. However, there is not an established guideline for indications of ESD. The objective of this study was to assess the current status and practice patterns regarding indications for ESD in Korea. Methods: A 17-item questionnaire about indications for ESD in EGC was presented to the participants of the 2nd joint symposium of the Gastrointestinal Pathology Study Group of the Korean Society of pathologists. Keypad-based anonymous voting was carried out and the entire process was recorded. Results: Endoscopic submucosal dissection for EGC fulfilling the classical indications was widely accepted as an effective therapeutic strategy comparable to surgery (114/115, agreement 99.5%). In our survey, Japanese extended criteria for ESD was still debated (70/111, 63.6%), but most respondents had performed ESD selectively in EGC corresponding to the extended criteria (105/109, 96.3%). They agreed that the current criteria for ESD would possibly require a revision considering various clinical indicators. Conclusions: Our survey shows that there is still no consensus about indications for ESD in EGC. Therefore, more clinical outcome data with a long-term follow-up are needed to establish evidence-based consensus and guidelines for ESD indications in Korea.

Background/Aims: Endoscopic submucosal dissection (ESD) has become a widely accepted method for treating early gastric cancer (EGC) in Korea. However, there is not an established guideline for indications of ESD. The objective of this study was to assess the current status and practice patterns regarding indications for ESD in Korea. Methods: A 17-item questionnaire about indications for ESD in EGC was presented to the participants of the 2nd joint symposium of the Gastrointestinal Pathology Study Group of the Korean Society of pathologists. Keypad-based anonymous voting was carried out and the entire process was recorded. Results: Endoscopic submucosal dissection for EGC fulfilling the classical indications was widely accepted as an effective therapeutic strategy comparable to surgery (114/115, agreement 99.5%). In our survey, Japanese extended criteria for ESD was still debated (70/111, 63.6%), but most respondents had performed ESD selectively in EGC corresponding to the extended criteria (105/109, 96.3%). They agreed that the current criteria for ESD would possibly require a revision considering various clinical indicators. Conclusions: Our survey shows that there is still no consensus about indications for ESD in EGC. Therefore, more clinical outcome data with a long-term follow-up are needed to establish evidence-based consensus and guidelines for ESD indications in Korea.

Early gastric cancer, Endoscopic submucosal dissection, Indication