Clinical Endoscopy

식도정맥류 출혈에 대한 내시경적 정맥류 결찰요법 ( Endoscopic Variceal Ligation for Treatment of Bleeding Esophageal Varices ): Korean J Gastrointest Endosc 1992;12(1):1-8. Published online November 30, 1991

Abstract PDF: Endoscopic injection sclerotherapy(EIS) is currently the most widely practiced method for treating and eradicating acutely bleeding esophageal varices in repeated sessions, but may be associated with some uadesirable local and systemic complications. Endoscopic variceal ligation(EVL), which consists of mechanical ligation and thrombosis of varices using elastic "0"- rings, has been recently developed as a non-operative alternative to EIS. We performed EVL in 16 patients who had recently bled from esophageal varices. Total 249 variceal ligations were performed during 71 separate EVL sessions. Three patients were actively bleeding at initial EVL; all of them were successfully controlled by emergency EVL. During the study period two patients died after initial EVL; one who refused te return for repeated EVL died from rebleeding, the other died from hepatic failure without any rebleeding. Rebleeding, following initiation of EVL, occured in 3 patients(l8.8%); two patients had bled from varices except previousiy ligated site and were successfully controlled by emergency EVL, remained one who refused any repeat endoscopy could not be confirmed the bleeding site. Varices were eradicated or reduced to grade I in 10(71.4%) of the 14 survivors by 14-28 ligations(mean, 19.5 ligations) in 3 -7 EVL sessions(mean, 5.4 sessions), During or after EVL, there were no complications, except transient mild dysphagia in 3 patients of 16 patients. These results indicated that EVL is a safe and effective method for treatmet of bleeding esophageal varices.

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후종격동농양을 유발한 식도천공 1예 ( A Case of Mediastinal Abscess following Esophageal Perforation ): Korean J Gastrointest Endosc 1992;12(1):9-12. Published online November 30, 1991

Abstract PDF: We recently experienced a case of an elderly patient with mediastinal abscess, which is a rare complication of esophageal perforation, in whom dyspnea, chest pain and odynophagia were main clinical symptoms after eating cooked fish. During evaluation, upper mediastinal widening, with air-fluid level, and eaophageal perforation plugged with pus were detected by chest X-ray films and endoscopic examinatien. After draining of pus(about 300 cc) through the perforation site by careful manipulation of endoscope, inner wall of abacess cavity communicating with esophagus could be observed through esophago-mediastinal fistula. For further management, drainage procedure of mediastinal abscess, esophageal diversion and feeding gastrostomy were done.

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식도의 과립세포 종양 1예 ( A Case of Granular Cell Tumor of the Esophagus ): Korean J Gastrointest Endosc 1992;12(1):13-17. Published online November 30, 1991

Abstract PDF: For many years, the histogenesis of the granular cell tumor was controversial and this resulted in the tumor being given more than 20 synonyms. Abrikossoff, reporting on the fiist granular cell tomor, favored a muscle origin, but other authora have postulated a fibroblastic or a histiocytic origin. Recently, the concept of Schwann cell origin, supported by electron microscopic studies and immunohistochemistry of S-100 protein, has gained wider recognition. Approximately 90 cases of esophageal granular cell tumor have been reported in the literature, representing about 2% incidence of all reported granular cell tumor, In Korea, only four cases of granular cell tumors were reported in the literatures including the cases occuring in the cecum, colon, and anus until now. Recently we experienced 46-years old women with granular cell tumor of the esophagus, which might be the second case in Korean literature.

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Steakhouse 증후군 4예 ( 4 Cases of Steakhouse Syndrome of the Esophagus ): Korean J Gastrointest Endosc 1992;12(1):19-23. Published online November 30, 1991

Abstract PDF: Acute food impaction of the esophagus is not an unusual problem on an emergency ward. It has been termed the Steakhouse syndrome or the Backyard barbecue syndrome, indicating that meet is the obstrueting bolus in the majority of cases. Most esophageal stenoaes are located distally, and this ie also the area where most food impations occur. The obstruction quickly becomes apparent to the patient when further swallowing of food or liquid is impossible. Various obstructive lesions or motility disorders of the esophagus have been implicated as etiological factors in acute food impaction. Common,disorders include reflux esophagitis with stricture, hiatal hernia, abnormal rings and postoperative strictures at anastomotic sites. Malignant stenoses have been very rarely described. Recently we experienced of 4 patients who suffered from acute dysphagia after they had ingestion of food such as beef, pork, chicken, and dog meat, repectively. All of them were diagnased as steakhouse syndrome due to acute food impaction of the esophageal after examinations of esophagogram and endoscopy. They had hiatal hernia, esophageal cancer, reflux esophagitis with stricture, and abnormal ring as underlying diseases, repectively. All of them were treated with endoseopic removal of foreign body by a Dormia basket.

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위암에서 전이된 다발성 결절양의 전이성 식도암 1예 ( A Case of Multiple Nodular Metastatic Esophageal Carcinoma from Stomach Cancer ): Korean J Gastrointest Endosc 1992;12(1):25-28. Published online November 30, 1991

Abstract PDF: Metastatic cancer of the esophagus is unusual, Toreson discovered 19 in 599 autopsies on carcinoma patients, an incidence of 3.2%, Most of the patients had primary tumors of the lung, stomach, larynx or breast. Contiguous spread of tumor into the esophagus may produce an ulcerative lesioin resembling primary cancer of the esophagus, as examplified by the direct extension of tumor from the gastric cardia. These tumors may produce esophageal symptoms, notable dysphagia, and present no particular problem to the endoscopist because the ulcerative tumor in the lumen of the eaophagus makes diagnosis easy. Unusuually these tumor will extend into the esophagus submucosally producing submucosal nodules or cicatricial stricture of the esophagus without ulceration inito the lumen. This increases the diagnostic problems because of the difficulty of obtaining a endoscopic biopsy. We experienced a case of multiple nodular metastatic esophageal carcinoma, which was submucosally extended from the stomach cancer, confirmed by endoscopic biopsy. So we report this case with brief review of the previous litera- tures.

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경피 내시경하 위루술 ( PEG ) 의 장기적 효율성 ( Long Term Efficacy of Percutaneous Endoscopic Gastrostomy ): Korean J Gastrointest Endosc 1992;12(1):29-35. Published online November 30, 1991

Abstract PDF: Since the introduction of Percutaneous Endoscopic Gastrostomy(PEG) into clinical practice by Ponsky in 1980, the endoscopic procedure for the placement of a gastrostomy feeding tube has been markedly developed in the world. In l986, PEG was first described in Korea, thereafter it is widely used in many Korean institutions. But until recently the clinical studies of the long term efficacy of PEG has almost not been reported. (continue...)

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내시경적 레이저 요법의 임상적경험 - 조기위암을 중심으로 - ( Clinical Application of Endoscopic Laser Therapy in Gastrointestinal Disese - Especially in early gastric cancer - ): Korean J Gastrointest Endosc 1992;12(1):37-43. Published online November 30, 1991

Abstract PDF: I tried the endoscopic laser therapy for the malignant and benign disease of the alimentary tract to evaluate efficacy in rejection of surgical treatment or inoperable state. I have experienced 16 cases of the laser therapy in my hospital from July 1990 to June 1991. The apparatus I used is the SLT contact Nd-YAG laser with the ceramic endoprobe of rounded or chisel or hollow type in each case. The irradiation was made at an output of 15-20 Watts within 1.5 seconds. Between the 2-4 weeks laser therapy, the treatment response was observed by rebiopsy, I treated 7 cases of early gastric cancer and post-laser follow-up study showed 70% negative for cancer cells by endoscopic biopsy. Failure of laser treatment was found in case of IIc type, Two cases of advanced gastric and I case of rectal cancer with severe obstruction were relieved by laser therapy. I also experienced 3 cases of esophageal or gastric polyp which were completely. resolved after irradiation. Besides, I could get hemostasis in 1 case of gastric ulcer bleeding with exposed vessels and 1 case of Mallory-Weiss syndrome. And a case of gastric bezoar was completely fragmentated after irradiation. As mentioned above, I achieved satisfactory results of 13 cases in 16 cases. Contact Nd - YAG laser treatment ean be applicated with excellent efficacy in any age, sex and severity of disease with or without complications and any site of lesions which can be reached within the endoscope. I suggest it is maybe highly promising medical technique in the future.

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위 림프종의 내시경적 소견 ( The Endoscopic Findings of Gastric Lymphoma ): Korean J Gastrointest Endosc 1992;12(1):45-51. Published online November 30, 1991

Abstract PDF: Gastric lymphoma occupies about 1-7% of gastric cancer and is the most common type of extranodal lymphoma. To evaluate the endoscopic morphologic characteristics of gastric lymphoma, we analysed the endoscopic findings in 45 patients with pathologically-proven gastric lymphoma. (continue...)

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위암과 동반된 Leiomyomatosis Peritonealis Disseminata 1예 ( A Case of Leimyomatosis Peritonealis Disseminata Combined with Advanced Gastric Cancer ): Korean J Gastrointest Endosc 1992;12(1):53-56. Published online November 30, 1991

Abstract PDF: Leiomyomatosis peritonealis disseminata is a rare benign condition characterised by the occurrence of multiple leimyomas scatterred throughout the peritoneal cavity, giving the clinical impression of a wide spread malignant tumor. The histopathology of leiomyomatosis peritonealis disseminata is that of a benign leiomyoma, probably originating from the multipotent subcoelomic mesenchymal cells. Three cases with malignant transformation were described among previous reported fifty cases. Many of the early reports described the disorder in premenopausal women, and now the histogenesis is considered to be a metaplastic change by abnormal tissue response to the relatively or absolutely elevated female sex hormone. We report a case of leiomyomatosis peritonealis disseminata, which was diagnosed by multiple scattered submucosal and subseroal leimyomas of stomach, small bowel and colon, combined with advanced gastric cancer in a 58 years old man, Multiple submucosal tumors of the stomach combined with advanced gastric cancer were demonstrated by fibergastroscopy, upper gastrointestinal barium study and abdominal ultrasonography. During radical subtotal gastrectomy multiple submucosal and subserosal tumors of stomach, and subserosal tumors of small bowel and colon were observed and these tumors were confirmed as leiomyoma without malignant potential.

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위에 발생한 삼중암 2예 ( Two Cases of Triple Gastric Cancer ): Korean J Gastrointest Endosc 1992;12(1):57-60. Published online November 30, 1991

Abstract PDF: Multiple gastric caner, now considered to be a sort of multiple primary cancer by Moertel's classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Although its incidence is rare and it has never been reported in Korea yet, the report of multiple gastric cancer is increasing with lengthened life survival and improved diagnostic method. We recently experienced two cases of triple gastric cancer, the one in 53-years-old male who had well differentiated adenocarcinoma(EGC IIb+c) on antrum, poorly differentiated adenocarcinoma on cardia and moderately differentiated adenocarcinoma on mid-body, and the other in 65-years-old female who had two poorly differentiated adenocarcinoma on cardia and anterior wall of low body and moderately differentiated adenocarcinoma (EGCIIc) on posterior wall of low body. Triple gastric cancer is rare, so we reported 2 cases of triple gastric cancer.

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십이지장 궤양을 동반한 진행성 위암 1예 ( A Case of Coexistence of Gastric Cancer and Duodenal Ulcer ): Korean J Gastrointest Endosc 1992;12(1):61-64. Published online November 30, 1991

Abstract PDF: For over a half centry, physicians have suspected that patients with duodenal ulcer are offered an insurance policy against gastric carcinoma. This may be used clinically so that gastric lesion in the presence of duodenal ulcer, are considered benign. However, the duodenal ulcer may coexit with gastric cancer, Although rare in incidence of coexistence of duodenal ulcer and gastric cancer, physician always should be alert in diagnosing of gastric lesion in the presence of the duodenal ulcer. Here, we present 60 years old woman with coexitence of duodenal ulcer and gastric cancer, diagnosed by endoscopy and treated surgically.

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Expandable Metallic Stent 를 이용한 담도협착 치료의 추적 성적 ( Biliary Endoprosthese by the Use of Expandable Metallic Stents ): Korean J Gastrointest Endosc 1992;12(1):65-70. Published online November 30, 1991

Abstract PDF: Expandable metallic stents(EMS) were implanted in 7 patients with malignant (4 cholangio- carcinnoma, 1 pancreatic cancer, 1 ampullary carcinoma and 1 lymph node metastasis) biliary stricutres and 17 patients with benign(13 intrahepatic strictures of primary intrahepatic stone patients, 2 postoperative stricutres, 1 ampullary stenosis followed by endoscopic sphineterotomy and 1 bilioenteric anastomosis) biliary stricutures. In the fifteen patients out of 17 patients with benign biliary stricture, relief of cholangitis, improvement of liver function or loss of pruritus was observed. But in the 2 patients with.biliary cirrhosis, no clinical improvement was noted. In the malignant strictures with cholangio-carcinoma, the occlusion of EMS occurred in 3 patients and the duration of stent patency was average 2 months in those patients.

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췌장의 점액성 낭선종 1예 ( A Case of Mucinous Cystadenoma of the Pancreas ): Korean J Gastrointest Endosc 1992;12(1):71-74. Published online November 30, 1991

Abstract PDF: The majority of the cysts developed in pancreas are inflammatory pseudocyst but neoplastic cysts are rarely encountered Especially, mucinous cystadenoma which was begun and originated from epithelial cell of pancreatic duct is difficult to differentiate from pseudocysts by preoperative clinical, laboratory and radiologic findings. Mucinous cystadenoma has a malignant potentiality, so complete excision of cystadenoma is the treatment of choice. Recently, we experienced one case of mucionus cystadenoma in 37 year-old female, we report it with a review of the literature.

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원발성 담낭암의 임상적 고찰 ( A Clinical Analysis on Primary Cancer of the Gall Bladder ): Korean J Gastrointest Endosc 1992;12(1):75-80. Published online November 30, 1991

Abstract PDF: Carcinoma of Gall bladder remains a terminal illness in most patients despite improved diagnostic capabilities, better perioperative care and a more aggresive surgical approch based on improved knowledge of this tumors natural histiory. Overall 5-year survival rates remain below 5%. This failure to significantly improve patient oucome is largely due to late recognition of gall badder cancer. Authors experienced 21 cases of gall bladder cancer confirmed by operation at the Kwang Ju Christian hospital from march 1983 to March 1991, and the results obtained were summarized as follows. (continue...)

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총수담관 막양구조 ( Web ) 4예 ( 4 Cases of Web of Common Bile Duct ): Korean J Gastrointest Endosc 1992;12(1):81-86. Published online November 30, 1991

Abstract PDF: The septum formation(web) of bile duct is an uncommon disease. Its rarity and vague symptoms result in delayed diagnosis. However, the increased use of endoscopic retrograde cholangiopancreatography(ERCP) and percutaneous transhepatic cholangiography(PTC) have resulted in greater awareness of this entity and understanding of its natural history as well as an increased frequency of diagnosis. We have experienced 4 cases of common bile duct web, which were associated with stones in the bile duct, confirmed by operation.

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내시경적 역행성 담도 췌관조영술 ( ERCP ) 로 진단된 우측간내담관의 자발적 천공 1예 ( A Case of Spontaneous Perforation of the Right Intrahepatic Duct - An ERCP Diagnosis ): Korean J Gastrointest Endosc 1992;12(1):87-90. Published online November 30, 1991

Abstract PDF: Spontaneous perforation of bile duct in adults is very rare, with less than 30 cases described in the literature to date. We repoit a case of a 65-year-old man who presented with severe colicky abdominal pain and fever, just like symptoms of peritonitis. ERCP provided a preoperative noninvasive confirmation of the diagnosis of the rupture of right intrahepatic duct. The patient was performed T-tube choledochotomy and drainage of retroperitoneal bile collection. The etiolgy, diagnosis, and treatment of spontaneous perforation of bile duct is discussed.

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내시경적 담도배액법 ( EBD ) 후 발생한 십이지장 천공 1예 ( A Case of Duodenal Perforation following Endoscopic Biliary Drainage ( EBD ) ): Korean J Gastrointest Endosc 1992;12(1):91-97. Published online November 30, 1991

Abstract PDF: Placement of an endoprosthesis for palliative decompression of biliary obstruction has been advocated as an effective alternative for interanl-external drainage catheters, of which the care and psychological impact of the external segment protruded through the skin has been a difficult problem. (continue...)

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내시경적 유두부 괄약근 절개술 전후의 Oddi 괄약근 운동검사 ( Manometry of Sphincter of Oddi before and After Endoscopic Sphincterotomy ): Korean J Gastrointest Endosc 1992;12(1):99-102. Published online November 30, 1991

Abstract PDF: We performed ERCP manometry of Sphincter of Oddi(SO) before and after endoscopic sphincterotomy(EST) for evaluation of the effect af EST on the SO. The subjects were postcholecystectomized common bile duct stone patients(n=l2) and EST was performed by major incision. The pressure gradient between common bile duct and duodenum before EST (8.6 + 3.9 mmHg) decreased significantly after EST(2.4 +1.7 mmHg). The length of SO before EST(8.8 + 0.8mmHg) decreased significantly after EST(2.5 + 0.8mm). But in each patient, the pressure gradient between common bile duct and duodenum remained in spite of the major incision. In conclusion, EST alters the function of the sphincter of the Oddi, but does not destroy its all protective function. The positive pressure in the bile duct is preserved in contrast to the absolute loss of pressure following surgical transduodenal sphincteroplasty.

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만성 장염전을 유발한 이동성 췌장 - 1예 보고 - ( Chronic Midgut Volvulus Due to Movable Pancreas - 1 case report - ): Korean J Gastrointest Endosc 1992;12(1):103-106. Published online November 30, 1991

Abstract PDF: Incomplete fixation of pancreas, which may be associated with a wide mobility of root of SMA, result in chronic midgut volvulus. Movable pancreas is an uncommon form of incomplete intestnal fixation and rotation. Herein, we present a caae of movable pancreas. A patient was a 32-year-old male with the complaint of colicky intermittent abdomnal pain. The abdominal ultrasonography and CT showed a movable pancreas. The head of pancreas was located in the left of the abdominal aorta during the inspiratory time and left decubitus position. At surgery, pancreas was mobile and the root of mesentery was very weak and fibrotic. Duodenum and mesentery were fixed by 0.7 mm Dacron patch along the right peritoneal gutter and the retroperitoneum from ligament of Treitz to the ileocecal attachment. Duodenojejunostomy was performed for the prevention of SMA syndrome. The symptoms disappeared and recovery was prompt. Following the procedure, the patient remains asymptomatic until 10 months after operation

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거대세포바이러스 대장염 1예 ( A Case of Cytomegalovirus Colitis ): Korean J Gastrointest Endosc 1992;12(1):107-110. Published online November 30, 1991

Abstract PDF: Cytomegalovirus colitis, invasive cytomegalovirus infection of colon, is an important opportunistic infection in immunosuppressed individuals. The clinical symptoms are abdominal pain, diarrhea, colionic hemorrhage and perforation. The endoscopic appearance show three characteristic features, 1) Focal or diffuse inflammatory changes: erythema, edema and erosion 2) Submucosal hemorrhagic spots 3) Clean-based, well demarcated ulcers(0.5-2 cm) We report a case of cytomegalovirus colitis in 41-year-old male with massive hematochezia, which confirmed by histopathologic findings in autopsy.

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대장내시경으로 관찰된 충수돌기 Mucinous Cystadenoma 1예 ( A Case of Appendiceal Mucocele ): Korean J Gastrointest Endosc 1992;12(1):111-114. Published online November 30, 1991

Abstract PDF: The appendiceal mucocele is a rare disease and very difficult to get the diagnosis preoperatively because of the rartity of classical symptoms. With progress in diagnostic procedures such as colonofiberscopy, preoperative diagnosis of appendiceal mucocele has become possible. We experienced a case of appendiceal mucocele in 50 years old male who was admitted due to vague RLQ discomfort, and was diagnosed by colonofiberscopy and surgical specimen obtained by right hemicolectomy. So we present this case with a review of literatures.

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월례집담회 : 내시경적 용종제거술로 확진 및 완치가 가능하였던 위의 염증성 섬유양 용종 1예: Korean J Gastrointest Endosc 1992;12(1):115-119. Published online November 30, 1991

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월례집담회 : 내시경적 박리생검술 ( Strip biopsy ) 을 이용한 위지방종의 치료: Korean J Gastrointest Endosc 1992;12(1):120-120. Published online November 30, 1991

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월례집담회 : Borrmann IV형 진행 위암으로 오인된 부식성 위염 1예: Korean J Gastrointest Endosc 1992;12(1):121-123. Published online November 30, 1991

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월례집담회 : 소아에서 발생한 조기위암 1예: Korean J Gastrointest Endosc 1992;12(1):124-125. Published online November 30, 1991

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