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Bon Voyage！

2014 NCC 隨記 Day 5. 今天最大收獲想必就是親眼看了這邊的老大Dr. Saito親自操刀做了一台colon ESD. Tumor location 在sigmoid colon. Type 0-Is with central depression. Sano NBI type IIIB over the depression area. Kudo Pit pattern is type Vi-severe under Magnifying Crystal violet. 所以內視鏡的診斷其實是Deep SM inva nsion,. 2014 NCC 隨記 Day 5. 2014 NCC 隨記 Day 4. 早上看胃鏡時，看到幾個 early cancer. 其中一個early cancer 是 type IIc. 我問了Dr Mori他覺得侵犯深度是mucosal layer 還是已經是deep SM layer. 他說他認為是mucosal layer，因為雖然有converging fold，但fold 沒有swelling. 2014 NCC 隨記 Day 4.

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Bon Voyage！ | ckjames.blogspot.com Reviews

<META> DESCRIPTION

2014 NCC 隨記 Day 5. 今天最大收獲想必就是親眼看了這邊的老大Dr. Saito親自操刀做了一台colon ESD. Tumor location 在sigmoid colon. Type 0-Is with central depression. Sano NBI type IIIB over the depression area. Kudo Pit pattern is type Vi-severe under Magnifying Crystal violet. 所以內視鏡的診斷其實是Deep SM inva nsion,. 2014 NCC 隨記 Day 5. 2014 NCC 隨記 Day 4. 早上看胃鏡時，看到幾個 early cancer. 其中一個early cancer 是 type IIc. 我問了Dr Mori他覺得侵犯深度是mucosal layer 還是已經是deep SM layer. 他說他認為是mucosal layer，因為雖然有converging fold，但fold 沒有swelling. 2014 NCC 隨記 Day 4.

<META> KEYWORDS

1 bon voyage！

2 很快地要進入第一週的最後一天了

3 其實這個case並不是一個標準做esd治療的case

4 開刀應該是第一選擇

5 張貼者： jameschiang

6 jameschiang

7 標籤： ncc

8 這邊很多case都是外院refer過來的

9 且fold 沒有fusion

10 他還順手拿了一本圖譜，告訴我什麼是fold fusion

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bon voyage！,很快地要進入第一週的最後一天了,其實這個case並不是一個標準做esd治療的case,開刀應該是第一選擇,張貼者： jameschiang,jameschiang,標籤： ncc,這邊很多case都是外院refer過來的,且fold 沒有fusion,他還順手拿了一本圖譜，告訴我什麼是fold fusion,converging的話，每個fold 都會走到lesion旁,而這融合的fold往往下方就是tumor,經歷了第一次的東京沙丁魚地鐵,之前來東京玩以及上週和怡在東京時

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Bon Voyage！ | ckjames.blogspot.com Reviews

https://ckjames.blogspot.com

2014 NCC 隨記 Day 5. 今天最大收獲想必就是親眼看了這邊的老大Dr. Saito親自操刀做了一台colon ESD. Tumor location 在sigmoid colon. Type 0-Is with central depression. Sano NBI type IIIB over the depression area. Kudo Pit pattern is type Vi-severe under Magnifying Crystal violet. 所以內視鏡的診斷其實是Deep SM inva nsion,. 2014 NCC 隨記 Day 5. 2014 NCC 隨記 Day 4. 早上看胃鏡時，看到幾個 early cancer. 其中一個early cancer 是 type IIc. 我問了Dr Mori他覺得侵犯深度是mucosal layer 還是已經是deep SM layer. 他說他認為是mucosal layer，因為雖然有converging fold，但fold 沒有swelling. 2014 NCC 隨記 Day 4.

INTERNAL PAGES

ckjames.blogspot.com

1

2014 NCC 隨記 Day 1 - Bon Voyage！

http://ckjames.blogspot.com/2014/07/2014-ncc-day-1.html

2014 NCC 隨記 Day 1. 一開始帶我們的是Dr. Matsuda，松田尚久醫師. 我們原本的指導醫師Dr. Saito去希臘開會，要星期三才回來. Dr Matsuda人很nice, 英文也相當流利. 在這邊就是回歸成clerk了，只能用眼睛看，用耳朵聽，用嘴巴問. 他們就會給一點點midazolam, 可能給個3 5mg，達到conscious sedation. 今天最讓我印象深刻的是有一個case，到了cecum，在withdrawal中，看到了一顆polyp. 最後他在A colon作reverse，拉回到靠近hepatic flexure的地方時. 最後Dr Matsuda就以A colon reverse的方式完成了EMR. Dr Matsuda說大部分情況下，只要他覺得手中的scope沒有looping，感覺很free. 2014 NCC 隨記 Day 1. 訂閱：張貼留言 (Atom). Travel範本. 由 Blogger.

2

2014 NCC 隨記 Day 5 - Bon Voyage！

http://ckjames.blogspot.com/2014/07/2014-ncc-day-5.html

2014 NCC 隨記 Day 5. 今天最大收獲想必就是親眼看了這邊的老大Dr. Saito親自操刀做了一台colon ESD. Tumor location 在sigmoid colon. Type 0-Is with central depression. Sano NBI type IIIB over the depression area. Kudo Pit pattern is type Vi-severe under Magnifying Crystal violet. 所以內視鏡的診斷其實是Deep SM inva nsion,. 也因這層關係，Dr.Saito決定幫病人做所謂的 Diagnostic ESD. Dr Saito說，在他們醫院，如果判斷不是deep SM invasion. 由其是後半段的剝離，看起來的確有一小部分的腫瘤有侵犯到 SM layer. Gastrointest Endosc. 2012 Mar;75(3):663-7. 下午則是看Dr. Sakamoto用double balloon的colonoscopy來做檢查. 2014 NCC 隨記 Day 5.

3

2014 NCC 隨記 Day 2 - Bon Voyage！

http://ckjames.blogspot.com/2014/07/2014-ncc-day-2.html

2014 NCC 隨記 Day 2. To determine negative margin. 由他們的其中一位總醫師 Dr. Mori來執行. 今天也再次看 Dr.Matsuda如何評估colon tumor侵犯深度. 接著染上indigo carmine 0.4%來看Pit pattern. 就要先用水沖掉，再染Crystal violet 0.05%. 區分是 Pit Vi (mild), Vi (severe) or Vn. Dr Oda幫大家上了一堂如何診斷early gastric cancer的課. 2014 NCC 隨記 Day 2. 訂閱：張貼留言 (Atom). 我卻不以性命為念，也不看為寶貴，只要行完我的路程，成就我從主耶穌所領受的職事，證明神恩惠的福音。（徒 20:24）. Travel範本. 由 Blogger.

4

2014 NCC 隨記 Day 3 - Bon Voyage！

http://ckjames.blogspot.com/2014/07/2014-ncc-day-3.html

2014 NCC 隨記 Day 3. 因為位置在posterior wall high body, 接近cardia的地方. 很容易出血，dissect 沒兩下就出血，然後就要一直止血. 位置在LC side of antrum, 有involve 到angle. 主治醫師是Dr. Abe，看起來很年輕，估計也就大約35-40歲而已. 某幾個較不容易dissect的角度，Dr. Abe就的出手. 三位女醫師 from Russia，2位Taiwan). Dr Tanaka and Dr.Inoki坐我們對面. 我說：Our hospital is unique, we use two-man technique to perform colnoscopy. I never seen two-man colnosocpy! 唉唉怎麼說才好呢，我們怕 two-man 這種技術在這世界上失傳啊，所以就由我們來守護吧 . 2014 NCC 隨記 Day 3. 訂閱：張貼留言 (Atom). Travel範本. 由 Blogger.

5

2014 NCC 隨記 Day 4 - Bon Voyage！

http://ckjames.blogspot.com/2014/07/2014-ncc-day-4.html

2014 NCC 隨記 Day 4. 早上看胃鏡時，看到幾個 early cancer. 其中一個early cancer 是 type IIc. 我問了Dr Mori他覺得侵犯深度是mucosal layer 還是已經是deep SM layer. 他說他認為是mucosal layer，因為雖然有converging fold，但fold 沒有swelling. 但其實我一開始還是沒看懂，後來再問一次，才知道 fold convergin 和fold fusion不同. Tumor有involve angle，觀察angle的線條也是平滑，因此沒有deep SM侵犯的跡象. 我說我們一般發現的都是ulcerative mass，都是advanced cancer. Dr takamaru說沒錯，因為advanced cancer中間都是necrotic tissue. 但在early ca則不用，一般都是在cancer處biopsy一片，然後在周邊四個方向做biopsy，. Dr Oda說如果小於1.5公分的食道早期癌，他會選擇用 EMR-C切除. 2014 NCC 隨記 Day 4.

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Bon Voyage！

2014 NCC 隨記 Day 5. 今天最大收獲想必就是親眼看了這邊的老大Dr. Saito親自操刀做了一台colon ESD. Tumor location 在sigmoid colon. Type 0-Is with central depression. Sano NBI type IIIB over the depression area. Kudo Pit pattern is type Vi-severe under Magnifying Crystal violet. 所以內視鏡的診斷其實是Deep SM inva nsion,. 2014 NCC 隨記 Day 5. 2014 NCC 隨記 Day 4. 早上看胃鏡時，看到幾個 early cancer. 其中一個early cancer 是 type IIc. 我問了Dr Mori他覺得侵犯深度是mucosal layer 還是已經是deep SM layer. 他說他認為是mucosal layer，因為雖然有converging fold，但fold 沒有swelling. 2014 NCC 隨記 Day 4.

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