Clinical Endoscopy

원저 : 식도정맥류 출혈에 대한 내시경적 정맥류 결찰요법의 임상적 고찰 ( Original Articles : Endoscopic Variceal Ligation for Treatment of Esophageal Varices ): Korean J Gastrointest Endosc 1994;14(3):325-330. Published online November 30, 1993

Abstract PDF: Endoscopic injection sclerotherapy(EIS) has been widely used in treating and eradicating acutely bleeding esophageal varies, but may be associated with some undesirable local and systemic complications. Endoscopic variceal ligation(EVL), which consists of mechanicai ligation and thrombosis of varices using elastic o-band, has been recently developed as a non operative alternative to EIS. We performed EVL in 65 patients who had bled from esophageal varices between November 1991 and September 1993. Total 274 sessions were performed and 774 o-bands were used. Six patients were actively bleeding and all of them were successfully controlled by emergency EVL. During the follow-up period, five patients who had combined hepatoma died. Varices were eradicated or reduced grade I in 43(71.6%) of the 60 survivals by 8-36 ligations(mean 15.6 ligation) in 2-13 EVL sessions(mean 5.6 sessions). During follow up period, five patients had recurred from grade 0 to grade 2 or 3 in 106-260 days(mean 182.6 days), and then eradicated by repeated EVL. During or after EVL, there were no complications, except mild substernal distress and mild dysphagia in 17 and 7 patients respectively. These results showed that EVL is a safe and effective method for eradication of bleeding esophageal varices.

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원저 : 식도정맥류 출혈의 내시경적 결찰요법의 임상적고찰 ( Original Articles : Clinical Evaluations for Endoscopic Variceal Ligation in Esophageal Varices Bleeding ): Korean J Gastrointest Endosc 1994;14(3):331-338. Published online November 30, 1993

Abstract PDF: Endoscopic injection sclerotherapy(EIS) has been shown to be the most effective simple method for control of bleeding and eradication of varices. This method has been aceepted widely as a standard treatment of bleeding esophageal varices. However, EIS may be associated with undesirable local and systemic complications. (continue...)

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원저 : 대장용종 절제후 점막표시물질로서 India Ink 의 유용성 ( Original Articles : Endoscopic India Ink Marking of the Colonic Mucosa ): Korean J Gastrointest Endosc 1994;14(3):339-342. Published online November 30, 1993

Abstract PDF: It is now generally accepted that most, if not all, colon cancers originate within previ- ously benign adenomas. Endoscopic polyp resection and regular follow up endoscopic examination are essential for prevention of carcinoma fro benign adenoma. However, small colorectal polyps are difficult to recognize during follow up endoscopic examinations because of the lack of reliable endoscopic landmarkers. Endoscopic Indiaink marking of the colon was first described by Ponsky and King in l975. The method has subsequently been advocated by expert as the best available means to mark the site of a colonic lesion. We prospectively studied the effectiveness of India ink as a long term colonic mucosal marker. Twelve patients who were diagnosed as colorectal polyp had a India ink marking with standard sclerotherapy needle. All patients who were followed at 6 months interval (mean duration 13 months) continue to display intensely stained mucosa at the original sites. No side effects or complications were encountered. India ink appears to be a safe and effective long term marker for colonic mucosal lesions.

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증례 : 내시경적 역행성 담췌관 조영술로 진단된 선천성 체관변이 9예 ( Case Reports : Nine Case of Congenital Variants of the Pancreatic Duct Diagnosed by ERCP ): Korean J Gastrointest Endosc 1994;14(3):343-348. Published online November 30, 1993

Abstract PDF: Although variation is the rule with pancreatic duct morphology, certain variants occur as a result of altered embroological development. These ductal configurations, most striking deviations from the normal configuration, may be classfied according to alterations of embryological development. These congenital variants of pancreatic duct may be important for several reasons. First, the pseudomass effect of ductal anomalies can be mistaken for carcinoma by the inexperienced radiologists. Second, whether or not the anomaly is important, it is present in many patients with recurrent pacreatitis. Original descriptions were based on small sampling of postmortem studies and surgical specimen, but more recently the advent of endoscopic retrograde cholangiopancreatography(ERCP) has confirmed of the work of early anastomists and increased awareness of these variants. To evalute of frequency, characteristics of associated disease and clinical significance of pancreatic anomalies, we have reviewed of 5330 case of ERCP filmes which were undertaken between July, 1973 and August, 1993. Having reviewed of ERCP filmes, we found out 9 case of pancreatic duct variants. Among them, 7 cases were classified as ductal duplication anomalies, 4 cases of number variation, most, bifuricaiton and 3 cases of form variation, which were composed of loop, spiral and terminal N. Three cases of fusion anomalies were also noted, which were 2 cases of panceratic divisum and 1 case of incomplete pancreatic divisum. The associated diseases were 6 cases of bile duct and galbladder stones and 3 cases of pancreatic cancer. We could not find out the case of congenital anomalies as cause of obstructive pain and pseudomass effect.

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증례 : 항암화학요법과 방사선 병합요법으로 완전관해를 보인 위분문부로 벽내전이된 식도암 1예 ( Case Reports : A Case of Esophageal Cancer Showing Intramural Metastasis to the Stomach in Complete Remission with Preoperative Chemoradiotherapy ): Korean J Gastrointest Endosc 1994;14(3):349-356. Published online November 30, 1993

Abstract PDF: Esophageal carcinoma is a rare malignant neoplasm consisting of about 1.5% of the whole gastrointestinal tract neoplasm and has poor prognosis of which survival rate is below 5%. The squamous cell carcinoma of the esophagus could be multicentric in character and may have occured in 9.5-27% of incidence. The most common site is head and neck region. The metastasis of esophageal carcinoma occur through hematogenous, lymphatic spread, direct invasion and rarely intramural metastasis. Of theses, intramural metastasis has been occured in 7-14.3% of incidence and its presence has been regared to poor prognostic factor due to early regional or distant metastasis. Surgery, chemotherapy, radiotherapy alone or combination of these has been used as treatment modalities of esophageal cancer, but combination chemoradiotherapy with or without op- eration is prefered method than other at present. Authors report a case of esophageal carcinoma showing intramural metastasis to the gastric wall, which had the complete remission with preoperative chemoradiotherapy.

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증례 : 내시경적 결찰술에 의한 Dieulafoy 병의 치료 3예 ( Case Reports : Endoscopic " 0 " Band Ligation Treatment for 3 Cases with Dieulafoy Lesion ): Korean J Gastrointest Endosc 1994;14(3):357-364. Published online November 30, 1993

Abstract PDF: Dieulafoy lesion is very small and easily overlooked as a course of massive, often recurrent hemorrhage that results from the crosion of a submucosal artery, typically in the gastric cardia or fundus. The clinical picture of Dieulafoy lesion is quite uniform: patients commonly present with massive hemorrhage and melena without any relevant history. The diagnostic procedure of choice in patients with severe gastrointestinal bleeding is emergency endoscopy. The lesion is rare but potentially life threatening source of upper gastrointestinal bleeding. Before the endoscopic era, the prognosis for patients with these lesions was quite poor. However, recent reports have described the success of endoscopic therapy in the management of Dieulafoy lesion. We performed emergency endoscopy in 3 patients who had massive or recurrent episode of upper gastrointestinal bleeding, identified to the Dieulafoy lesion. We tried to Endoscopic "0" band ligation, successfully in hemostasis and prevention of recurrence.

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증례 : 내시경적 검사 및 상부 위장관 조영술상 특징적인 소견을 보인 소아 전정부 격막 1예 ( Case Reports : Antral Web with Characteristic Appearance in Gastroscopic and Barium Study in an Eight-year-old Girl ): Korean J Gastrointest Endosc 1994;14(3):365-368. Published online November 30, 1993

Abstract PDF: Antral web (prepyloric mucosal diaphragm) is a rare gastric anomaly that disturbs the gastric outlet and has sometimes been a diagnostic problem to the radiologist and the endoscopist. It is composed of mucosa that enclose a membrane of submucosa and located at the antrum on variable distances from the pylorus. Web is congenital in origin but may be secondary to chronic peptic ulcer disease. Obstructive symptoms may not occur when diaphragmatic aperture is larger than 1 centimeter in diameter. The diagnosis of web relies on the history, barium study and gastroscopic findings but it may be noticed after laparotomy. We experienced an antral web which demonstrated characteristic endoscopic and radiologic findings in an eight-year-old girl. These typical distinguishable findings in endoscopic and barium study in this case can remind of the antral web in patients with gastric outlet obstruction symptoms. Antral web or pyloric web, although rare, should be considered in the differential diagnosis of upper gastrointestinal obstructive symptoms in patients of any age.

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증례 : 십이지장을 침습한 위선암 3예 ( Case Reports : Three Cases of Gastric Carcinoma Spread to the Duodenum ): Korean J Gastrointest Endosc 1994;14(3):369-373. Published online November 30, 1993

Abstract PDF: It has been thought for many years that gastric adenocarcinoma almost never crosses the pylorus. Although this theory was generally accepted, several studies have refuted it. We report three cases of gastric adenocarcinoma direct spreading into the duodenum that was diagnosed by endoscopic duodenal biopsy and review the literature.

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증례 : 만성 혈액투석환자에서 발생한 출혈성 혈관이형증 1예 ( Case Reports : A Case of Hemorrhagic Angiodysplasia of the Duodenal Bulb in a Patient under Chronic Hemodialysis ): Korean J Gastrointest Endosc 1994;14(3):374-379. Published online November 30, 1993

Abstract PDF: Upper gastrointestinal tract angiodysplasia is rare, but it is an important cause of upper gastrointestinal bleeding. We experienced a case of hemorrhagic angiodysplasia of duodenal bulb in a patient under chronic hemodialysis due to chronic renal failure. Repeated upper GI endoscopy revealed an angiodysplasia at the posterior wall of the duodenal bulb. It was successfully treated by bipolar electrocoagulation. We report a case of angiodysplasia in chronic renal failure patient with the review of the literatures.

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증례 : 화농성 심낭염 , 간농양 및 농흉을 야기한 총담관 거대결석 치유 1예 ( Case Reports : A Case of Large Bile Duct Stones Complicated by Pyogenic Pericarditis , Liver Abscess , and Pyothorax ): Korean J Gastrointest Endosc 1994;14(3):380-385. Published online November 30, 1993

Abstract PDF: The complications of bile duct stone are cholangitis, pancreatitis, obstructive jaundice, liver abscess, and secondary biliary cirrhosis. Liver abscess may produce pyothorax, peritonitis, subphrenic abscess, and pyogenic pericarditis. The case studies of pyogenic pericarditis secondary to pyogenic liver abscess are rarely reported. Stones greater than 20mm in diameter are difficult or impossible to remove with a standard basket or balloon after sphincterotomy. There are several nonsurgical treatment options for large bile duct stone: mechanical lithotripsy, endoprosthesis, extracorporeal shock-wave lithotripsy (ESWL), electrohydraulic lithotripsy, contact dissolution therapy, and laser lithotripsy. We experienced a case of large bile duct stone which complicated by pyogenic pericarditis, liver abscess, and pyothorax. He treated with antibiotics, closed thoracostomy, partial pericardiectomy, and removal of bile duct stones by extracorporeal shock-wave and mechanical lithotripsy after endoscopic sphincterotomy and nasobiliary drainage.

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