식도편평상피암의 내시경 점막하 박리술 치료 = Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma

국문 초록 (Abstract)

식도암은 가장 공격적인 암 중 하나로, 사망률이 높고 예후가 불량한 질환이다. 2020년에는 전 세계적으로 604,100명의 발병과 544,076명의 사망을 기록하며, 식도암은 7번째로 흔한 암이면서 6번째로 높은 암 사망 원인으로 보고되었다[1]. 식도암은 진행된 상태에서 발견되는 경우가 많고 이때 시행되는 수술 및 화학방사선 요법은 침습적이며, 예후는 좋지 않다. 협대역 영상(narrowband imaging, NBI)을 통해 식도편평상피신생물 (esophageal squamous neoplasia)과 식도편평상피암(esophageal squamous cell carcinoma, ESCC)을 비교적 정확하게 진단할 수 있다[2]. 점 형태의 혈관 및 배경 착색(background coloration)은 이러한 병변을 진단하는 데 유용한 소견으로 알려져 있으며[3], 요오드 염색은 ESCC를 진단하는 데 높은 민감도를 보이지만 특이도는 낮다. 그러나 염색 후 2–3분 뒤 나타나는 핑크색 sign은 암과 비암성 병변을 구별하는 데 유용하며, 88%의 민감도와 95%의 특이도를 보였다[4]. 이러한 연구 결과를은 병변들이 현재 내시경으로 치료되고 있다. 표재성 식도암(superficial esophageal cancer)은 점막 혹은 점막하층에 국한된 식도암으로 정의된다. 한편, 조기 식도암(early esophageal cancer)이라는 용어도 혼용되어 사용되고 있으나, 일반적으로 조기 식도암은 암의 침윤이점막층에 국한되고 림프절 전이가 없는 식도암을 의미하므로 표재성 식도암과는 차이가 있다[5]. 표재성 식도암을 치료하는 주된 내시경적 방법으로 내시경 점막하 박리술(esophageal submucosal dissection, ESD)이 사용되고 있으며, 전체 일괄 절제(en bloc resection)율과 국소 재발률이 내시경 점막 절제술(esophageal mucosal resection, EMR)보다 우수하다고 보고되고 있다[6]. 비록 ESD가 최소 침습적 치료법이지만, 합병증 위험이 동반될 수 있으므로 적응증을 결정하는 데 적절한 판단이 필요하다. 따라서 식도 ESD를 안전하게 시행하기 위해 알아야 할 적응증, 치료 성적 및 치료 방법과 합병증, 추적 관찰에 관한 전반적인 사항을 기술하고자 한다.

다국어 초록 (Multilingual Abstract)

Endoscopic submucosal dissection (ESD) is a predominantly used technique for superficial esophageal cancer treatment. The primary advantages of esophageal ESD include its high en bloc resection rate and the precise pathological assessment it confers. This procedure enables local primary tumor resection while accurately assessing risk factors for lymph node metastasis, including tumor depth, vascular invasion, and invasion type. Esophageal ESD will play a crucial role in minimally invasive and effective esophageal cancer treatments. In this article we discuss esophageal ESD regarding its indications, treatment outcomes, techniques, potential complications, and follow-up guidelines to ensure its safe and effective application.

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