Clinical Endoscopy

21년간 위루술관을 통해 영양섭취를 해온 부식성 식도협착증 환자의 부지확장술 치험 1예 ( Bougie Dilatation of a Patient with Esophageal Lye Stricture Fed with Gastrostomy Tube for 21 Years - A case report - ): Korean J Gastrointest Endosc 1993;13(4):653-656. Published online November 30, 1992

Abstract PDF: The patient was a 51 year-old woman suffering fraen dysphagia due to upper esoyhageal lye stricutue whieh had developed as a result of a suicide attempt 21 years ago. Shortly after that, she underwent feeding gastrostomy and has lived in the gastrostomy state for 2l years. After admission, she underwent a barium esophagoram which revealed a near total obstruction at the cricoid cartilage level. Bougie dilatation with American Dilation System was tried on day 3. But the spring tip marked guide wire which was to be used with the American Dilation System could not be passed through the stricuture. Therefore, we performed a bougie dilatation using angiographic guide wire M(H-AG-35in-150 cm) with success. On day 14, she underwent a barium esophagogram which revealed her improved condition, and she was discharged on day 16.

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소화성궤양 출혈에서 내시경적 국소주사의 지혈효과 ( Hemostatic Effect of Endoscopic Injection Sclerosis for Bleeding Peptic Ulcer ): Korean J Gastrointest Endosc 1993;13(4):657-662. Published online November 30, 1992

Abstract PDF: Twenty-five patients presenting with severe hemorrhage from benign peptic ulcers were randomized to either endoscopic injection sclerosis using a combination of hypertonic saline- epinephrine solution and 5% ethanolamine or to hypertonic-saline epinephrine solution only. Only high risk patients with active bleeding or endoscopic stigmata of recent hemorrhage of ulcers were considered. A median duration of hospital admission and median transfusion requirements between the two types of treated groups were not significant difference. The initial hemestatic effects of HS-E solution injection group(n=l5) or combination of HS- E solution and 5% ethanolamine injection group(n=l0) were 93%, 90% respectively. The rebleeding rate of HS-E solution injection group(n =15) or combination of HS-E solution and 5% ethanolamine injection group(n=10) were 33%, 30%, respectively. So, both HS-E solution therapy group and comination of HS-E solution & 5% ethanolamine injection group were effective in initial hemostasis for bleeding peptic ulcer patients. However, for the further evaluation of therapeutic effect and comparison of rebleeding rate between the two types of therapy, we think that it will be indispensable to collect more cases and to compare with control group.

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소화성궤양 출혈에 대한 Hypertonic Saline - Epinephrine 용액의 내시경적 국소주사의 지혈효과 ( Hemostatic Effect of Endoscopic Local Injection of Hypertonic Saline - Epinephrine Solution in Peptic Ulcer Bleeding ): Korean J Gastrointest Endosc 1993;13(4):663-672. Published online November 30, 1992

Abstract PDF: To date several agents have been used to achieve hemostasis in patients with bleeding peptic ulcers using endoscopic sclerotherapy techniques. In this study, the efficacy of endoscopic local injections of hypertonie saline-epinephrine(HS-E) solution, consisting of 9 volume of 3% sodium chloride and 1 volume of 1: 1000 epinephrine, on the base of the ulcer around bleeding vessel was assessed. During the period between April 1989 and July l992, 127 patients were admitted to the study. Ninety-six of these patients underwent endoscopic treatmeat(endoscopic treatment group), while the other 31 cases received conservative treatment only(conservative treatment group). (continue...)

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소아 H. pylori 위염의 혈청학적 진단 : 정상 학동기 아동과 위장관 증상 환아에서의 유병실태 및 혈청학적 진단의 정확도에 관한 연구 ( Serologic Diagnosis of Helicobacter pylori Gastritis in Children : Seroepidemiology of H. pylori in Normal School Children and Diagnostic Accuracy of IgG GAP Test in Children with Gastrointestinal Symptoms ): Korean J Gastrointest Endosc 1993;13(4):673-684. Published online November 30, 1992

Abstract PDF: For the detection of Helicobacter pylori infection, endoscopic biopsy related tests auch as urease test, culture, and histology with special staining of bacteria are most widely used standard methods and most accurate. (continue...)

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철 결핍성 빈혈을 동반한 위 해면상 혈관종 ( A Case of Cavernous Hemangioma of Stomach ): Korean J Gastrointest Endosc 1993;13(4):685-687. Published online November 30, 1992

Abstract PDF: A 44-year-old woman who comlpained of dizziness and generalized weakness was admitted. The hemoglobin was 6.6g/dL, hematocrit 25.5%, and serum ferritin 2.14 ng/mL Stool occult blood was positive and microcytic hypochromic anemia was found on periyheral blood smear. Gastroscopic examination showed about 2 x 1 cm sized hemispherical sebmucosal tumor on antrum. The patient underwent operatioh for confirmatory diagnosis and treatment. The final pathologic diagnosis of the resected lesion was hemangioma of stomach. Cavernous hemangioma of stomach is a rare disease.Mostly, it has a benign course clinically, but early diagnosis is important because massive hemorrhage and anemia by chronic blood loss can occur. We report a case of hemangioma of stomach with review of literature.

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위결핵 1예 ( A Case of Gastric Tuberculosis ): Korean J Gastrointest Endosc 1993;13(4):689-692. Published online November 30, 1992

Abstract PDF: Gastric tuberculosis is a rare disease and the diagnoeis of gastric tuberculosis is based on either positive histological or bacteriological study. We experienced a case of gastric tuberculosis with pleural effuaion in 59 year-old woman, diagnosed by the histological study of the endoscopic biopsy specimen. Follow up endoscopic finding revealed marked improvement of gastric lesion after anti-tubercadoua medication. We reported the case with review of literature.

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심한 위 출혈을 일으킨 위 아니사키스증 1예 ( A Case of Gastric Anisakiasis Causing Severe Gastric Ulcer Bleeding ): Korean J Gastrointest Endosc 1993;13(4):693-696. Published online November 30, 1992

Abstract PDF: Anisakiasis is a parasitic infectious disease caused by eating raw, infected fish. It causes severe abdominal pain-like acute abdomen, but not fatal. Anisakiasis was firstly reported by van Thiel et al. in 1960 in Netherlands and it has subsequently been reported in the Netherlands, Japan, the United states, Korea as well as other nations. Because Koreans like eating raw fish, the anisakiasis of the stomach was occasionally reported, but the case of severe gastric bleeding was very rare. So we report one case of gastric ulcer bleeding due to gastric anisakis larva proven by endoscopy and gastric resection.

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대량출혈을 동반한 만성 위 아니사키스증 1예 ( A Case of Chronic Gastric Anisakiasis with Massive Bleeding ): Korean J Gastrointest Endosc 1993;13(4):697-700. Published online November 30, 1992

Abstract PDF: Aniskiasis is caused by the accidental infestation of human by larvae of marine mammals found in saltwater fish and squid. The clinical picture may be severe enough to stimulate an acute surgical abdomen. More commonly, colicky pain, diffuse abdominal tenderness, nausea, vomiting, fever, and leukocytosis are seen. Gastroscopically, 2-to 4-cm larvae can be seen penetrating the mucosa. More characteristically, the larvae burrow into the mucosa of the stomach. Here they produce eosinophilic granulomatous tumors with edema, thickening, and induration which may be mistaken for gastric canceer. The pathalogic changes are thought to be the result of a hypersensitivity reaction. We report a case of chronic gastric anisakiasis, which was diagnosed as submucosal tumor with massive bleeding.

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내시경으로 진단된 위암의 갑상선 및 유방으로 전이한 1예 ( A Case of Endoscopically Diagnosed Gastric Cancer with Metastasis to Thyroid and Breast ): Korean J Gastrointest Endosc 1993;13(4):701-705. Published online November 30, 1992

Abstract PDF: Metastatic malignant tumors involving the thyroid gland are not as unusual as was once believed. They may in fact be more common than primary cancer of the thyroid, especially if careful screening is performed at autopsy. The origins of primary neoplasms that metasta size to the thyoid are myriad, but reports obviously indicate predminantly cancers of the kidney, breast, and lung and malignant melanoma. Occasienally, metastatic lesions from several gastrointestinal neoplasms such as colo-retal and esophageal carcinoma are seen, but metastasis from gastric cancer is very rare. We have seen one case of thyroid cancer metastasized from the stomach cancer. It simultaneously spread to the breast also and confirmed with gastrofiberscopic biopsy, fine needle aspiration cytology of the thyroid and excisonal biopsy of the breast. We report this case with reriew of literature.

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Intra - operative Endoscopy 를 이용한 소장 혈관 이형성증 치험 2예 ( Two Cases of Angiodysplasia in Small Bowel : Intra - operative Endoscopic Transillumination Technique ): Korean J Gastrointest Endosc 1993;13(4):707-711. Published online November 30, 1992

Abstract PDF: Angiodysplasia of small bowel is uncommon and frequently undiagnosed and presents a taxing surgical problem. It is usually diagnosed for unexplained gastrointestinal bleeding. For the surgeon, the main technical problem is that the lesion is impalpable, and invisible to the naked eye, so it usually cannot be identified unless bleeds actively at the time of surgery. Arteriography gives a little information about wax and wane pattern of bleeding in the lesion. Endoscopy is often unfruitful because the majority of lesions are submucosal and rarely exceed a few millimeters in diameter. Transillumination of the intestinal wall from inside of the lumen to the outside in a dark room can define the precise vascular anatomy of the wall. The delicate lesion of the angiodysplasia can be identified by this transillumination method. We described a simple intraoperstive endoscopic translllumination technique used successfully to identify an angiodysplasia in the small bovwel prior to the bowel resecion. This report summarized our experience and review of literature.

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정상 대장내시경 검사시 점막 생검의 의의 ( The Significance of Mucosal Biopsy in Normal Colonoscopy ): Korean J Gastrointest Endosc 1993;13(4):713-718. Published online November 30, 1992

Abstract PDF: Many patients of gastroenterology clinics complain symptoms requiring colonic investigations. Radiological examinations may fail to detect early inflammatory bowel diseases and small neoplasms or polyps. And therefore colonoscopies are performed in preference to barium enema. Recently several reports raised a question regarding whether biopsy is necessary in a macroscopically normal colon. To determine what proportion of apparently normal colons is histologically abnormal, to measure the thickness of subepithelial basement membrane(SEBM) in normal colons, and to see whether the thiekness varies according to the different areas of the large bowel we prospectively analyzed 100 consecutive subjects with normal laboratory findings and normal mucosa on colonoscopy. Significant histologic abnormalities were not detected in all 100 cases. Thickness of SEBM (mean+SD) was 1.6+0.4 um at hepatic flexure, 1.6+0.4um at splenic flexure and 1.7+0.4 pm at sigmoid colon. The SEBM was significantly thicker at the sigmoid colon than at the hepatic flexure. Range of thickness of normal SEBM was 0.8 to 2.5 pm(mean+2SD). Maximum thickness of SEBM was 3 pm. The result of this study suggests that doing colonoscopic biopsies in all normal colons do not seem to be essential in Koreans yet.

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직장 및 S상결장에서 발견된 용종성 질환의 의의 ( Clinical Significance of Polypoid Lesions in Rectosigmoid Colon : Correlation with Proximal Colonic Lesions ): Korean J Gastrointest Endosc 1993;13(4):719-724. Published online November 30, 1992

Abstract PDF: Recently the incidence of colonic disease increases in Korea. Because a large proportion of polyps and cancer occur in the rectosigmoid colon, fecal occult blood test and sigmoidoscopy have been used widely in screening test. (continue...)

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대장미소용종 ( 5 mm 이하 ) 의 내시경적 및 조직학적 검토 - 6 mm 이상의 용종과 비교하여 - ( Diminutive Colonic Polyps ( Less than 5 mm in diameter ) : Endoscopic and Histologic Study ): Korean J Gastrointest Endosc 1993;13(4):725-732. Published online November 30, 1992

Abstract PDF: A series of 241 polyps from 127 patients endoscopically removed during the period from march 1991 through July 1992 at our department were analysed. The following items were studied. 1) Incidence, age, and sex distrlbution of the patients 2) Number of the calonic polyps 3) Histologic classification and polyp size 4) Anatomic distribution and polyp size 5) Gross types and polyp size 6) Hietopathologic types and polyp size In conclusion, colonic diminutive polyps should not be ignored or overlooked clinically. The majority were neoplastic polyps. It is suggested that diminutive polyps should be removed endoscopically if possible

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담석성췌장염 진단의 내시경적 초음파 단층촬영술의 유용성 ( Endoscopic Ultrasonography in Gallstone Pancreatitis ): Korean J Gastrointest Endosc 1993;13(4):733-737. Published online November 30, 1992

Abstract PDF: Gallstone pancreatitis is caused by migration of gallstones through the common bile duct and ampulla of Vater, where ohetruction or impaction may occur. Early detection and endoscopic treatment of impacted gallstones are very important for the amelieration of pancreatitis. Pancreatic imagings, such as conventional ultrasonography, computerised tomography(CT) and endoscopic retrograde cholangiypancreatography(ERCP) have beea used for the diagnosis of gallstone pancreatitis. But these imaging net are often unsatisfactory fordetection of the impacted gallstones in the common bile duct ampulla of Vater. Especially ERCP has been contraindicated in acute pancreatitis. Endoscopic ultrasonography(EUS), which was recently developed, has been known as highly accurate diagnostic tool in the diagnosis of biliary and pancreatic disease. The high resolution of EUS is capable of showing unique morphological detail in gallstone pancreatitis. We report 3 cases of gallstone pancreatitis which Was accurately diagnosed by EUS and successfully treated by endoscopic treatment.

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경피담도경으로 진단한 담도 Fascioliasis 1예 ( A Case of Biliary Fascioliasis Diagnosed by Percutaneous Cholangioscopy ): Korean J Gastrointest Endosc 1993;13(4):739-741. Published online November 30, 1992

Abstract PDF: Fasciola hepatica is a parasite of cattle, sheep and other herbivorous mammals and lives in the bile ducts and occasionally liver parenchyma. Fasioliasis is characterized by hyperplasia or proliferation of the biliary epithelium, dilatation of biliary passages, leukocyte infiltration and periductal fibrosis. Man is thought to be infected incidentally. Numerous cases of hepatic fasioliasis have been reported in the medical litherature. In Korea, about 10 cases of human infection has been recorded in the literature. We report a case of biliary fascioliasis diagnosed by percutaneous cholangioscopy.

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복강경을 통한 담낭절제술 ( Korea University Experience in Laparoscopic Cholecystectomy ): Korean J Gastrointest Endosc 1993;13(4):743-749. Published online November 30, 1992

Abstract PDF: Surgical advance on the general surgical department as minimal access procedure was changed into the laparoscopic cholecystectomy from open cholecystectomy for treatment of cholelithiasis. Laparoscopic cholecystectomy is far less invasive, less painful, less expensive, less complicative, high cosmetic and high eonservative procedure, and reduced hospitalization than open surgery. (continue...)