Clinical Endoscopy

원저 : 식도정맥류의 내시경적 Over Tube 및 Free Hand 결찰법의 비교 ( Original Articles : The Comparison of Endoscopic Variceal Band Ligation ( EVL ) with and without Over Tube ): Korean J Gastrointest Endosc 1994;14(4):391-396. Published online November 30, 1993

Abstract PDF: Endoscopic variceal band ligation requires the incertion of over tube. Since adopting EVL, we encountered pharyngeal trauma and complaints of severe pain during over tube insertion. So We compared the safety and efficacy of EVL according to the method of scope insertion, as over tube and free hand method. We studied 49 patients who require EVL due to grade 3 esophageal varices. The group l consist of 26 patients who undergone EVL without over tube and group 2 consist of 23 patients who undergone EVL with over tube. There were no differences in basal arterial oxygen saturation by pulse oxymeter, basal heart rate and EKG by EKG monitor, hemoglobin concentration, and Child class between 2 groups. The changes of arterial oxygen saturation and EKG were not different between 2 groups during EVL. And the symptom score and speed of single band ligation were similar in over tube and free hand method of EVL. The complication induced by scope insertion methods is minor pharyngeal trauma only in over tube group. We suggest that over tube method of EVL can be replaced by free hand method in patients who complain of severe pain during over tube insertion, and with anatomical abnormality of oropharynx and urgent cases in which require good vision.

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원저 : 식도 정맥류에 대한 내시경적 정맥류 결찰 요법의 임상적 고찰 ( Original Articles : Endoscopic Variceal Ligation for Treatment of Bleeding Esophageal Varices ): Korean J Gastrointest Endosc 1994;14(4):397-401. Published online November 30, 1993

Abstract PDF: The endoscopic variceal ligation(EVL) has been adopted as a new treatment for acute hemorrhage from esophageal varices that ranks the highest mortality rate in upper gastrointestinal tract bleedings. This treatment method has good effects for the urgent treatment and eradication of varices from acute variceal bleeding in repeated sessions. We enrolled 34 patients with an acute or chronic variceal bleeding episode at the time of admission in this study from Apr. 8, 1992 to June. 2, 1994. Among 34 patients, there were 31 males and 3 females, at ages between 45-66(mean: 52 years). The incidence of symptoms on admission was 10 in tarry stool, 9 in hematemesis 8 in ascites, 4 in hepatic encephalopathy and 3 in nonspecific symptoms. Varices were eradicated or reduced to grade I in 30(88.2%) of the 34 patients by 4-25 bands (mean: 10.8 bands) in 1-7 EVL sessions(mean: 3.1 sessions). After EVL, there are complicated by active bleeding in 3 patients, dysphagia in 3 patienta and transient chest discomfort in 5 patients but subsided during 24 hours. These results indicated that EVL is a safe method for treatment of bleeding from esophageal varices.

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원저 : 악성종양에 의한 폐쇄성황달 및 폐쇄 상하부에 담관결석이 동반된 환자에서 Coil형 팽창성금속도관 ( Endocoil ) 삽관을 통한 치료 ( Original Articles : Successful Management by a New Self-expandable and Removable Metallic Coil Stent Insertion in a Case with Malignant Obstructive Jaundice Associated with CBD Stones at Below and Above the Stricture ): Korean J Gastrointest Endosc 1994;14(4):402-408. Published online November 30, 1993

Abstract PDF: Endoscopic retrograde biliary drainge is a useful method of palliative treatment of malignant biliary obstruction with respect to safety, rapidity in decompression of obstruction. However, despite of efforts to prolong patency of the stents, the main long term complication of current-widely used plastic endoprosthesis is to tendency for the stents to become clogged by sludge leading to recurrent jaundice and cholangitis, finally, obstruction of stents. Recently, in an effort to improve the patency of stent, variety of self-expandable metallic endoprosthesis have developed and which can be compressed into and inserted through small lumen catheter with large-bored lumen in expandable state. However, most of these open mesh of self-expandable stents allows tumor in growth which causes reobstruction, and additionally it is nearly impossible to retrieve the inserted prosthesis. Recently developed coil metal stent(Endocoil, Intent Co.), which, unlikely other previous metallic stent, has possibility of retrieving prosthesis and prevention of tumor ingrowth. We experienced a case of 52-year old male sufferd from malignant biliary obstruction due to recurrence of cancer at peripancreatic lymph nodes and combined with common bile duct stones on both proximal and distal side of the stricture, in whom Endocoil was implanted with sucessful decompression of obstruction and simultaneous removal of biliary stones located at both side of stricture.

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증례 : 위내시경검사로 발생된 타액선 종창 5예 ( Case Reports : Five Cases of Salivary Gland Swelling Developed after Upper Gastrointestiinal Endoscopy ): Korean J Gastrointest Endosc 1994;14(4):409-413. Published online November 30, 1993

Abstract PDF: As upper-gastrointestinal endoscopy has been more widely used for the diagnosis and treatment of upper gastrointestinal diseases, some complications such as bleeding, perforation, arrhythmia, aspiration pneumonia, infection, and drug reaction of premedication were reported. Also a few case of salivary gland swelling complicated by endoscopy was described, but the precise mechanism of this benign complication is not well-known. The hypothesized mechanisms for salivary gland swelling are 1) air distension of blind branchial cleft remmants, 2) compression of its duct between the mylohyoid and hyoglossus muscles from pressure above, during a time of increased salivary flow from oral stimulation, 3) forward and downward dislocation of gland by the force that occurs when endoscope pushes the tongue, and 4) reaction to topical anesthesia less likely. Here we report 5 cases of salivary galnd swelling with a review of the literature, explaining possible mechanism of each case.

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증례 : 다발성 식도 게실에 발생한 점막교 1예 ( Case Reports : A Case of Multiple Esophageal Diverticula with Mucosal Bridges ): Korean J Gastrointest Endosc 1994;14(4):414-417. Published online November 30, 1993

Abstract PDF: Mucosal bridge, endoscopically observed as a cord-like mucosal connection across the lumen, looking like a bridge, may infrequently arise anywhere from the esophagus to the colon. Mucosal bridges have been more frequently reported in the colon than in the esophagus, stomach, and duodenum. The causes of the mucosal bridge are congenital origin or acquired origin as the inflammatory diseases. We experienced a 49-year-old male patient who had multiple esophageal diverticula with mucosal bridges. We report this case with a review of relevant literatures.

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증례 : 식도 평활근종 2예 ( Case Reports : Two Cases with Leiomyoma of the Esophagus ): Korean J Gastrointest Endosc 1994;14(4):418-424. Published online November 30, 1993

Abstract PDF: Leiomyoma is the most common benign tumor of the esophagus, but it still occurs rarely as compared with the incidence of carcinoma in this area. Most of leiomyomas may manifest itself with unusual and inconsistent symptoms, and found incidentally during endoscopic or radiographic examination. Those who menifested symptoms are included as dysphagia and vague pain mostly. We experienced recently two cases with esophageal leiomyoma who underwent successful surgical resection and endoscopic enucleation, respectively.

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증례 : Behcet 병에 의한 식도 궤양 1예 ( Case Reports : A Case of Esophageal Ulcerations in Behcet's Disease ): Korean J Gastrointest Endosc 1994;14(4):425-429. Published online November 30, 1993

Abstract PDF: Trminal ileum and cecum are the most frequently involved portions of the gastrointestinal tract in Behqet's disease. Esophageal involvement in Behqet's disease is very uncommon and only a few cases have previously been reported. We have observed a case with this disease. A 25-year-old female patient who was diagnosed as having Behqet's disease 7 years before had dysphagia and weight loss of about 10 kg for 4 months. Esophagogastroduodenoscopic examination revealed diffuse ulceration and mucosal nodularities in esophagus which suspected esophageal cancer. But repeated biopsies showed lymphocytic infiltration around vessels in ulcerative lesions. She was treated with conservative managements.

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증례 : 투명한 Ligating Device 를 이용한 내시경적 식도정맥류 결찰요법 ( Case Reports : Endoscopic Variceal Ligation by Use of Transparent Endoscopic Elastic Band Ligating Device ): Korean J Gastrointest Endosc 1994;14(4):430-436. Published online November 30, 1993

Abstract PDF: Endoscopic variceal ligation(EVL) is effective in both emergent and elective treatment of esophageal varices and can be used as a safe alternative to sclerotherapy. However, as yet no transparent ligating device is widely available, the endoscopic view through the present commercial ligating device is so narrow that it is often difficult to both approach the target and accurately define and position the bleeding site. To assess the benifit of transparent EVL device, total 143 patients, 632 sessions, underwent EVL treatment. In 545 sessions the non-transparent, conventional-type ligating devices (Stigmann-Goff ligating devices) were used, whereas in 87 sessions the transparent ligating devices used. 35 patients underwent EVL under active bleeding conditions; in 29 patients a conventional ligation devices, whereas in 6 patients a transparent ligating devices were used. The remaining l08 patients were either electively treated by EVL. The visual fields decreased to 20-30% with the conventional devices, but no change of visual fields were noted with the transparent devices. In electively treated cases by EVL, the times need to ligate one band were not significantly different in the conventional devices (average, 18.5 sec) compared with that in the transparent devices (average, 16.7 sec), but in active bleeding conditions it took a significantly longer times in the conventional devices (mean, 30.7 sec) compared with that in the transparent devices (average, 19.4 sec). The hemostatic success rates in active bleeding conditions were 89.7%(26/29) using the conventional devices, 100%(6/6) using the transparent devices. In conclusion this newly developed transparent ligating device provides an improved visual field and shortens ligating time, especially in active bleeding condition. Therefore EVL using transparent device is more effective method in treatment of esophageal varices, especially active bleeding conditions.

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증례 : 위정맥류에서 Histoacryl 주입으로 유발된 문맥 및 비정맥 혈전증 1예 ( Case Reports : A Case of Portal and Splenic Vein Thrombosis Developed by Complication of Histoacryl Injection Therapy in Gastric Varix ): Korean J Gastrointest Endosc 1994;14(4):437-441. Published online November 30, 1993

Abstract PDF: Liquid tissue adheisve, Histoacryl (n-butyl-2-cyanoacrylate) has been used for the treatment of gastric variceal bleeding. The techniques are as follows: 0.5cc Histoacryl mixed with Lipiodol per each injection are used. 3 to 4 injections are usually required for large variceal convolutes under the fluoroscopic visualization after the injection of Histoacryl. Complications of sclerotherapy with Histoacryl are bleeding, perforation, stenosis and embolism depending on the concentration and amount used, as well as the intensity of the treatment. Here we describe a case report developing portal and splenic vein thrombosis as a side effect after Histoacryl injection therapy for the treatment of gastric varix bleeding, A 59-year-old male patient with liver cirrhosis was admitted due to acute gastric varix bleeding. The control of gastrie variceal bleeding was achieved by several injections of 0.7c mixture of 0.5cc histoacryl and 0,8cc Lipiodol. However, simple X-ray and ultrasonography revealed the elements of Histoacryl-lipiodol mixture in the portal and splenic vein.

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증례 : 내시경적 " O " -ring 결찰술을 이용한 용종절제술 5예 ( Case Reports : Five Cases of Polypectomy using Endoscopic " O " -ring Ligation ): Korean J Gastrointest Endosc 1994;14(4):442-449. Published online November 30, 1993

Abstract PDF: Endoscopic polypectomy was firstly introduced by Tsuneoka in 1969, and till now this method has been widely used for the treatment of benign and malignant polyps with the advent of technical improvement. This method is a very important modality as secondary prevention of malignancy because polyps in gastraintestinal tract are now being considered as precancerous lesion. Polypectomy with snare and electrocautery is mainly used for pedunclated polyps (eg. Yamada Class III, IV), but sessile polyps pose technical difficulty and occasionally cause serious gastrointestinal hemorrhage when resection margin adjacent polyp base. We performed polypectomy with "O"-ring used in endocopic variceal ligation (EVL) to make sessile polyp as semipedunclated form, and also to control bleeding, and then successfully remove it with conventional snare polypectomy. We report these 5 cases with the review of the literature.

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증례 : 9년간의 장기 추적 관찰로 악성화가 증명된 위선종 1예 ( Case Reports : A Case of Malignant Transformation of Gastric Tubular Adenoma Proven by 9-year Follow-Up ): Korean J Gastrointest Endosc 1994;14(4):450-457. Published online November 30, 1993

Abstract PDF: The association of gastric tubular adenoma and adenocarcinoma is already well known. Then, are those two pathologic lesions merely incidentally coexisting or does the one evolve to the other? That is a longstanding controversy. Nowadays, as is the case with the colonic tubular adenoma, the hypothesis that gastric tubular adenoma may be a precancerous lesion is generally accepted. However the direct evidences are rare. We report a clear case proving the potential of direct malignant transformation of gastric tubular adenorna through the 9-year close endoscopic follow-up. The developed cancer is well differentiated, surrounded with background tubular adenoma and limited to the submucosal layer.

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증례 : 위에 원발한 융모상피암 1예 ( Case Reports : A Case of Primary Gastric Choriocarcinoma ): Korean J Gastrointest Endosc 1994;14(4):458-464. Published online November 30, 1993

Abstract PDF: Gastational choriocarcinoma is a malignant neoplasm of trophoblast. It may occur after hydatidiform mole, spontaneous abortion, normal pregnancy, and even an ectopic pregnancy. Extragenital choriocarcinoma is a rare tumor which attracts interest because of its controversial pathogenesis. It has been reported to occur within the lung, mediastinum, breast, prostate, thymus, pineal, nose, liver, bladder, and biliary tree, as well as most parts of the gastrointestinal tract. We experienced a case of primary choriocarcinoma of stomach with a metastasis to the liver of a 54-year-old man. So, we present a case with a review of literature.

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증례 : 원발성 위 소세포암 1예 ( Case Reports : A Case of Small Cell Carcinoma in the Stomach ): Korean J Gastrointest Endosc 1994;14(4):465-470. Published online November 30, 1993

Abstract PDF: Primary extrapulmonary small cell carcinoma(SCC) is appearing with increased frequency in the literature. These tumors have been described in the esophagus, stomach, pancreas, larynx, hypopharynx, salivary gland, nasal cavity & paranasal sinus, thymus, small & large bowel, uterine cervix, endometrium, breast, prostate, urinary bladder and skin. Small cell carcinoma of the stomach is extremely rare and a total 9 cases have been reported in the English literature. Like SCC in the lung, SCC in the alimentary tract has a aggresive behavior and prognosis of the patient is poor. We are reported a case of advanced gastric cancer diagnosed as small cell type by endoscopic biopsy. Grossly, the lesion of small cell carcinoma of the stomach, located in the upper body and gastric angle, is ulcerated with irregular margin and dirty surface covered with blodd clots and exudates.

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증례 : 폐 결핵에 속발된 십이지장결핵 1예 ( Case Reports : A Case of Tuberculosis of the Duodenum Associated with Pulmonary Tuberculosis ): Korean J Gastrointest Endosc 1994;14(4):471-475. Published online November 30, 1993

Abstract PDF: Intestinal tuberculosis has been known since antiquity. After about 1950's, effective antituberculous chemotherapy and an improved standard of living resulted in a steady decline in all forms of tuberculosis. However, intestinal tuberculosis has been reported with impressive frequency in developing countries including Korea. Disease affecting the duodenum is reported to be rare and isolated duodenal tuberculosis sparing the rest of the intestine is uncommon. We experienced a case of tuberculosis of duodenal bulb associated pulmonary tuberculosis. The diagnosis was made on the basis of the histological study of the endoscopic biopsy specimen. We have confirmed the healing of the duodenal lesion by the follow-up endoscopy after 9 months treatment of antituberculous medication.

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증례 : 악성 변화를 동반한 십이지장 팽대부의 융모성 선종 1예 ( Case Reports : A Case of Villous Adenoma of the Ampulla of Vater with Malignant Change ): Korean J Gastrointest Endosc 1994;14(4):476-481. Published online November 30, 1993

Abstract PDF: Ampullary adenoma is a benign neoplasm with malignant potential that arises from the glandular epithelium of the ampulla of Vater. When the tumor is confined to the ampulla, abdominal sonogram and CT scan can show dilatation of the common bile duct or pancreatic duct, but the mass itself may not be seen. And even biopsies are done, the confirmation of malignant change is frequently missed, and it may be impossible to assess the presence of carcinoma in situ or invasive carcinoma without complete exicision of the lesion. So complete surgical resection is recommended because of extensive growth of the ampullary adenoma and its malignant potential. Recently, we experienced a case of about 0.8 x 1.0 cm sized tumor of the ampulla of Vater that was diagnosed as villous adenoma on endoscopic biopsy, and malignant change was found on resected surgical specimen.

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증례 : 경피경간 담낭배액술 및 경피적 복막 배액술로 치유된 담낭천공 1예 ( Case Reports : A Case of Gallbladder Perforation Treated By Percutaneous Transhepatic Cholecystic Drainage and Percutaneous Peritoneal Drainage ): Korean J Gastrointest Endosc 1994;14(4):482-488. Published online November 30, 1993

Abstract PDF: Perforation of gallbladder is a serious complication of acute cholecystitis with alarmingly high mortality rate. These high mortality and morbidity rates were caused by delay in prompt diagnosis and adequate therapy. Especially, mortality and morbidity rates rise markedly in the elderly patient with severe systemic illness. In the patients of gallbladder perforation who are poor candidate for general anesthesia and major operation, percutaneous cholecystic drainage procedure is good alternatives. We experienced a case of gallbladder perforation which was treated successfully by non-operative percutaneous transhepatic cholecystic drainage(PTCCD) in 65-year-old female. She couldn't be a candidate for cholecystectomy or operative chlecystostomy because of severe adhesion of gallbladder to adjacent organ and tissue due to previous gallbladder empyema. We decided to take non-operative percutaneous transhepatic cholecystic drainage and percutaneous peritoneal drainage of abdominal abscess. Thereafter, we examined gallbladder by percutaneous transhepatic cholecystoscopylPTCCS)and rule out gallstone and gallbladder malignancy. So, we presented the case with the brief review of the literatures.

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증례 : 전대장경검사로 진단된 편충증 5예 ( Case Reports : Colonoscopic Diagnosis of Whipworm Infection ): Korean J Gastrointest Endosc 1994;14(4):489-493. Published online November 30, 1993

Abstract PDF: Trichuriasis is an intestinal infection of human beings caused by Trichuris trichiura, more commonly known as whipworm because of its whip-like appearance. It is characterized by the invasion of the colonic mucosa by the adult trichuris. It is prevalent throughout the world, especially in tropical areas. Diagnosis is made typically by the identification of characteristic barrel-shaped eggs in the feces, although adult worms may be seen rarely at sigmoidoscopy or colonoscopy. We report five cases of whipworm infection that was diagnosed on colonoscopic examination.

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증례 : 동종골수이식후 발생한 중증 장관 이식편대 숙주반응으로 사망한 1예 ( Case Reports : A Case of Intestinal GVHD after Allogeneic Bone Marrow Transplantation for Treatment of Severe Aplastic Anemia ): Korean J Gastrointest Endosc 1994;14(4):494-499. Published online November 30, 1993

Abstract PDF: Bone marrow transplantation has become an accepted treatment for malignancy(particulary leukemia and lymphoma), aplastic anemia, and certain inborn errors of metabolism. In addition to the problem of severe, prolonged myelosuppression, bone marrow transplantation is associated with several unusual complications. Among the complications such as GVHD, graft rejection, interstitial pneumonia and veno-occlusive disease, involvement of the gastrointestinal tract by GVHD is associated with high graft failure and mortality. Intestinal GVHD is usually manifest clinically as voluminous secretory diarrhea accompanied by abdominal cramping, ileus, nutritional depletion, and, at times, hemorrhage. We experienced a case of severe intestinal GVHD after allogeneic marrow transplantation for treatment of severe aplastic anemia. He received bone marrow from his elder sister, HLA-matched multiparous woman and suffered from large amount of watery diarrhea with skin rash 34 days after transplantation. 1n spite of prednisolone therapy the symptom was progressed. After sigmoidoscopic mucosal biopsy, intestinal GVHD was confirmed and we tried methylprednisolone pulse therapy. Skin lesion was improved but the amount of diarrhea was increased with intermittent abdominal cramping. We tried ALG(anti-lymphocyte globulin) and conservative management but the patient did not respond the therapy. He succumbed to pneumonia and acute respiratory insufficiency complicated with GVHD, 70days after transplantation.

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증례 : 용종 형태로 발생한 대장의 동정맥 기형 1예 ( Case Reports : A Case of Arteriovenous Malformation of the Colon ): Korean J Gastrointest Endosc 1994;14(4):500-504. Published online November 30, 1993

Abstract PDF: Arteriovenous malformations occur predominantly in the cecum and ascending colon and is not associated with vascular lesions of the skin, central nerveous system. or lung Arteriovenous malformations involving gastrointastinal tract is often to be found to be cause of the recurrent painless bleeding without specific past history and family history and usually diagnosed by selective mesenteric arteriography or colonoscopy, But because of small size of the lesion and local occurence, diagnosis of the arteriovenous malformation is very difficult. Authors exprienced a case of arteriovenous maltormation in the colon. The patient had a history of repeated gastrointestinal bleeding, and were diagnosed by colonoscopy and were treated with colonoscopic resection.

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