Clinical Endoscopy

식도암의 병기결정에 있어서 내시경초음파검사의 유용성 : 예비보고 ( The Role of Endoscopic Ultrasonography in Staging of Esophageal Cancer : Preliminary Report ): Korean J Gastrointest Endosc 1993;13(3):539-543. Published online November 30, 1992

Abstract PDF: The prognosis of esophageal cancer is poor and strategies for treatment depend on the tumor stage at the time of diagnosis. Surgery is the main therapeutic modality in esophageal cancer and known as the only treatment for cure. Preoperatively it is most important to assess whether the primary tumor is completely resectable or not. Previous staging modality such as CT can not clearly define the depth of invasion and lymph node metastasis of esophageal cancer which is the most important factor in assessing the possibility of curative resection. Endoscopic ultrasonography is now considered as an useful method in evaluating staging and resectability of esophageal cancer. We compared the findings of endoscopic ultrasonography with pathology result to evaluate the accuracy of this new technique in staging of esophageal cancer in 4 esophageal cancer patients who received surgery among the 23 patients assessed by endoscopic ultrasonography due to esophageal cancer, The depth of invasion, lymph node metastasis, and staging was correct in 3 among 4 patients. We consider endoscopic ultrasonography is an useful technique in staging of esophageal cancer.

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위암의 심달도 판정에 있어서 내시경초음파검사상 오진된 예들의 병리조직학적소견의 검토 ( Pathologic Findings Affecting the Diagnostic Accuracy in Determining the Depth of Invasion of Gastric Cancer by Endoscopic Ultrasonography ( EUS ) ): Korean J Gastrointest Endosc 1993;13(3):545-549. Published online November 30, 1992

Abstract PDF: Endoscopic ultrasonography(EUS) has been used in assessing the depth of cancer invasion of the stomach. However, there are pathologic findings coexisting cancers which are unable to be detected by EUS resulting in mis-staging preoperatively. To find out the causes of mis-staging in determining the depth of cancer invasion, we analysed the pathologic findings of mis-staged cases of gastric cancer by EUS. (continue...)

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십이지장을 침습한 위선암 2예 ( Gastric Carcinoma Spread to the Duodenum ): Korean J Gastrointest Endosc 1993;13(3):551-553. Published online November 30, 1992

Abstract PDF: It has been thought for many years that gastric adenocarcinoma almost never crosses the pylorus. Rokitanski in 1861 made the classic statement that the pyloric served as a barrier to duodenal dissemination of gastric cancer. Although this theory was generally accepted, but direct spread of gastric carcinoma into the duodenum has been reported, most recently in 1965. We report two recent cases of gastric cancer spreading into the duodenum and review the literature.

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내시경적 용종절제술로 진단된 Gastritis Cystica Polyposa 2예 ( Two Cases of Gastritis Cystica Polyposa Diagnosed by Endoscopic Polypectomy ): Korean J Gastrointest Endosc 1993;13(3):555-559. Published online November 30, 1992

Abstract PDF: Gastritis cystica polyposa(GCP) is a polypoid cystic lesion showing all the histological features of the hyperplastic polyps and the cysts penetrating through the mucularis mucosae. Most reported GCP lesions were developed at gastraenterostomy stomas. It is rare that GCP develops without history of previous gastroenterostomy. In 1990, however, Kim et al reported a GCP presenting as a submucosal tume-like lesion in a 69-year-old man. Recently, we had experienced two consecutive cases of GCP diagnosed by endoscopic polypectomy. The first case was 49-year-old housewife without history of previous gastric surgery. Esophagogastroduodenoscopy(EGD) showed a 2.0x1.5x1.5cm sized lobulated polypoid lesion with a broad stalk on the anterior wall of the distal antrum. The second case was 45-year-old woman without history of previous gastric surgery. EGD revealed a 1.0 x 1.0 x l.0 cm sized polypoid lesion with a pedicle on the greater curvature aspect of the upper body and two duodenal ulcers with pseudodiverticulum formation. These lesions were endoscopically polypectomized and diagnosed as GCP by the histologic examination.

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교원질성 대장염 1예 ( A Case of Collagenous Colitis ): Korean J Gastrointest Endosc 1993;13(3):561-565. Published online November 30, 1992

Abstract PDF: Collagenous colitis was first deacribed by Lindstrom(1976). This disorder is now a recognized disease of colon associated with chronic watery diarrhea which shows the typical histologic findings of a thickened subepithelial collagenous band. A few cases with such disease has been reported in this country. We have recently observed a 52-year-old businessman with chronic watery diarrhea without abdominal and intermittent mucobloody stool for several years. He has lost about 4 kg of his body weight for these 6 months period. Physical examination, laboratory and radiological studis were unremarkable. Colonoscopy disclosed no gross abnormalities through the entire colon including the terminal ileum but found the pronounced thiekening(about 10um) of intercryptal subepithelial collagen and chronic inflammation in the lamina propria in the histologic examination.

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역행성담관조영술에 의한 담즙검사의 의의 ( Significance of Microscopic Examination of Bile Directly Collected during Endoscopic Retrograde Cholangiography ): Korean J Gastrointest Endosc 1993;13(3):567-572. Published online November 30, 1992

Abstract PDF: The usefulness of microscopic examination of pure bile directly collected from the biliary tract during endoscopic retrograde cholangiography and without hormonal stimulation was evaluated in 86 patients. Cholesterol monohydrate crystal and/or calcium bilirubinate granule were observed in the bile of 64% of GB stones, 88% of CBD stones and l00% of IHD stones. But only 4% of non stone control group were positive crystals examinations. According to this results, microscopic examinations:of bile samples collected during endoscopic retrograde cholangiography exhibited a sensitivity and a specificity for cholelithiasis recognition of 82.3% and 95.8%, respectively, with a positive and negative predictive value of 98.1% and 67.6%, respectively. We conclude that microscopic bile examinations of bile samples collected during ERC is useful to investigate in patients with suspected cholelithiasis.

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총수담관 결석을 동반한 담도 회충미입증의 내시경적 치료 1예 ( Endoscopic Treatment of Biliary Ascariasis with a Common Bile Duct Stone - A case report - ): Korean J Gastrointest Endosc 1993;13(3):573-576. Published online November 30, 1992

Abstract PDF: Biliary ascariasis is a rare complication of intestinal ascaris infestation. Retrograde migration of the adult worm through the papilla of Vater causes biliary colic, and may give rise to pancreatic and biliary obstruction, choledocholithiasis, cholecystitis, cholangitis, hemobilia, and if the worm lodges in intrahepatic bile ducts, to liver absceases. In the past, treatment of biliary ascariasis has usually involved the direct removal of ascaris throagh a surgical choledochatomy and subsequent saline lavage of the common duct through an indwelling T tube. Recently, the worm in the bile duct can be seen by ERCP and it can be removed during the endoscopic procedure. A 55-year-old woman with intermittent colicky right upper quadrant abdominal pain was admitted to out hospital. Abdominai sonogram disclosed an echogenic structure within a mildly dilated common bile duct and a high ehogenic structure with acoustic shadowing in the distal common bile duct(CBD), which suggests a CBD stone. ERCP after obtaining the sonogram revealed a thick, long, linear, smooth filling defect in the CBD with a distal CBD stone. A distal CBD stone was removed by sphinctetotomy and lithotripsy, then we directly extracted ascaris with a tripod forcep without any complication.

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간외담관의 다발성 유두상 선암 1예 : ERCP 소견을 중심으로 ( A Case of Multiple Papillary Adenocarcinoma of the Extrahepatic Bile Duct : Findings of ERCP ): Korean J Gastrointest Endosc 1993;13(3):577-579. Published online November 30, 1992

Abstract PDF: Among the primary carcinoma of the extrahepatic bile duct, papillary carcinoma is the least common form and usually located in the distal common bile duct. The cholangiographic findings of the papillary carcinoma is similar to translucency produced by stone. We report a case of multiple papillary adenocarcinoma of the extrahepatic bile duct of which the cholangiographic findings mimicking stones.

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췌장의 비기능성 소도세포종 1예 ( Nonfunctioning Pancreatic Islet Cell Tumor - A case report - ): Korean J Gastrointest Endosc 1993;13(3):581-585. Published online November 30, 1992

Abstract PDF: A case of nonfunctioning pancreatic islet cell tumor is described. A 34 years old female patient had intermittent epigastric pain and nausea for 6 months and she had nothing suggestive of neuroendocrine symtoms. Physcial examination showed an epigastric mass which wae deepseated, nontender, and well-demarcated. The routine upper endoscopic evatuation was negative. Abdominal ultrasonography and computed tomography showed a well-defined round solid mass with multifocal necrosis but did not revealed the origin of the lesion. Endoscopic retrograde pancreatography showed upward and rightward displacement of the proximal body portion of main pancreatic duct with nonvisualization of the secondary branches of pancreatic duct, suggesting that the mass originated from the pancreas. Resection of the mass with partial pancreatectomy and Roux-en-Y pancreaticojejunostomy was perfomed and the pathology was coafirmed as nonfunctioning pancreatic islet cell tumor containing somatostatin by immunohistochemical technique.

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담낭-대장누공을 유발한 황색 육아종성 담낭염 1예 ( Xanthogranulomatous Cholecystitis Complicated with Cholecystocolonic Fistula ): Korean J Gastrointest Endosc 1993;13(3):587-590. Published online November 30, 1992

Abstract PDF: Xanthogranulomatous cholecystitis is an uncommon inflammatory disease of the gall baldder characterised by a focal or diffuse destructive inflammatory process. The pathogenesis is uncertain, but an inflammatory response to extravasated bile due to acute inflammation and obstruction is likely. Macroscopically, the gall bladder wall is invariably thickened, and extensive adhesions to adjacent organs are frequent. Clinically, xanthogranulomatous cholecystitis can mimic gall bladder carcinoma and radiologic differential diagnosis is extremely difficult. Fistula to skin and duodenum was reported. We report the first case of cholecysto-colonic fistula due to xanthogranulomatous cholecystitis.

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내시경초음파검사로 종양의 위치가 진단된 인슐린종 1예 ( Localization of an Insulinoma by Endoscopic Ultrasonography ): Korean J Gastrointest Endosc 1993;13(3):591-594. Published online November 30, 1992

Abstract PDF: A 45-year-old woman with recurrent disturbances of consciousness for 4 years with hypoglycemia was hospitalized with the clinical suspicion of an insulinoma. The findings of transabdominal ultrasonography, computed tomography and angiography were negative. Transhepatic venous sampling for pancreatic hormone assay showed sudden step-up of serum level of insulin in the venous blood from the tail of the pancreas. Finally, an endoscopic ultrasonographic examination established with certainty the origin of the tumor from the tail of the pancreas, which was subsequently confirmed at operation. In conclusion, endoscopic ultrasonography is a useful and valuable procedure for the localization of insulinoma especially in patient with insulinoma of the pancreas that cannot be localized by conventional methods.

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복강경 담낭절제술 600예의 임상고찰 ( A Clinical Analysis of 600 Cases of Laparoscopic Cholecystectomy ): Korean J Gastrointest Endosc 1993;13(3):595-602. Published online November 30, 1992

Abstract PDF: To identify the efficacy of laparoscopic cholecystectomy, we retrospectively analyzed 600 cases of laparoscopic cholecystectomy who were treated at the Department of Surgery, Chung Ang University from September 1990 to December l992. We intentionally divided periods into 3 groups to observe the frequency of morbidity and mortality, early and late complications, duration of operation and postoperative hospitalization with accumulaton of surgical experiences and techniques. The most prevalent age group was 6th decades, male to female ratio was 1: 1.47 and associated diseases were hypertension, obesity, pulmonary tuberculosis in order of frequency and previous abdominal operations were appendectomy, TAH, C-section in order of frequency. The duration of operation was 38.6 minutes and postoperative hospitalization was 6.2 days. The most frequent pathologic diagnosis was chronic cholecystitis. The postoperative complications were noted in 15 cases(2.5%) including 5 cases of bleeding 4 cases of bile leakage. The number of patients who needed parenteral narcotics was decreased in later peiod. According to oral cholecystogram, opacification correlated with duration of operation of laparoscopic cholecystectomy.

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월례집담회 : IIb형 조기위암 1예: Korean J Gastrointest Endosc 1993;13(3):603-605. Published online November 30, 1992

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