Clinical Endoscopy

원저 : 식도 유두종의 임상적 양상 ( Original Articles : Clinical Feature of Esophageal Papilloma ): Korean J Gastrointest Endosc 1995;15(1):1-5. Published online November 30, 1994

Abstract PDF: In human, Human Papilloma Virus(HPV) is associated with benign squamous tumors in a variety of body sites. But the relationship between HPV infection and malignant epithelial lesions is not clear. Esophageal squamous papilloma is relatively rare tumor but it is reported with increasing frequency recently. We reviewed twenty six patients of esophageal papilloma diagnosed by endoscopic biopsy from 1990 to 1994. The results are as follows; The peak age is fifth decade, men and women ratio is 1: 1.2. Most papillomas located in distal esophagus and have no specific symptoms related to papilloma. All case are sessile form and no malignant change in follow up endoscopy.

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원저 : 식도 정맥류 출혈에 대한 내시경적 결찰요법의 치료효과 ( Original Articles : Efficacy of Endoscopic Variceal Ligation on Bleeding Esophageal Varices ): Korean J Gastrointest Endosc 1995;15(1):6-11. Published online November 30, 1994

Abstract PDF: Endoscopic injection sclerotheraphy(EIS) was an effective method for treatment of bleeding esophageal varices. However, it might be associated with some undesirable complications. Endoscopic variceal ligation(EVL) is a recently developed method for control of active variceal bleeding and eradicating esophageal varices with similar efficacy and minimal risk of complications compare to EIS. We performed EVL in 40 patients who had recently bled from esophageal varices. Total 198 variceal ligations were performed during 64 separate EVL session. Control rate of acute bleeding was 90%(36 of 40patients) and 4 patients died after EVL because of failure of bleeding control. Rebleeding following initiation of EVL occured in 5 patients-three patients were successfully controlled by EVL, one patient was controlled but eradication was impossible and one patient died. Varices were eradicated or reduced to grade I in 31(86.1% ) of 36 survivors by 1-9 ligation(mean 5.0) in l-4 EVL sessions(mean 1.6). After EVL, there were mild complications-mild substernal discomfort in 4 patients, mild dysphagia in 2 patients and fever in 2 patients. These results suggest that EVL is a safe and effective method for treatment of bleeding and eradication of esophageal varices with less complication.

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원저 : 소화성궤양에 의한 출혈에서 내시경적 Fibrin Glue 및 Hypertonic Saline Epinephrine ( Original Articles : Comparison of Hemostatic Effect of Endoscopic Injection with Fibrin Glue ( FG ) and Hypertonic Saline - epinephrine ( HSE ) for Peptic Ulcer Bleeding - A prospective randomized trial - ): Korean J Gastrointest Endosc 1995;15(1):12-25. Published online November 30, 1994

Abstract PDF: Endoscopic injection therapy using various different agents(ethanol, polidocanol, epinephrine with and without hypertonic saline, etc.) is considered as the least expensive and effective technique to obtain hemostasis in peptic ulcer bleeding, however most of these agents induce tissue necrosis or degeneration. Theoretically the injection of fibrin glue in peptic ulcer bleeding may be safer than that of other agents, however, to date, there have been no data from randomized clinical trials on the comparison of the efficacies between these agents. To compare the hemostatic efficacy between FG[Beriplast P, Behring, Germany] and HSE[3% saline and epinephrine(1: 10,000)], we conducted a prospective, randomized, clinical trial among one hundred twenty-seven patients with peptic ulcer bleeding from March, 1992 to December, 1993 and in whom a visible vessel or active bleeding was identified.

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원저 : 주사 경화요법에 실패한 위정맥류 출혈의 n-butyl-2-cyanoacrylate ( Histoacrylⓡ ) 치료효과 ( Original Articles : The Effect of Histoacrylⓡ for Gastric Variceal Bleeding Which Failed by Ethanolamine Oleate Injection Sclerotherapy ): Korean J Gastrointest Endosc 1995;15(1):27-32. Published online November 30, 1994

Abstract PDF: Treatment modalities of gastric variceal bleeding are endoscopic injection sclero- therapy, endoscopic variceal ligation, combined above two method, operation, TIPS, and percutaneous transhepatic embolization. Recently, Histoacryl was introduced as a new sclerosant of acute variceal bleeding failed by others. So, we studied 18 cases of acute gastric variceal bleeding uncontrolled by EIS using Ethanolamine oleate. Intravariceal injection of Histoacryl is considered as a safe and effective method for hemostasis of intractable acute gastric variceal bleeding uncontrolled by other sclerosants. But, it is important that endoscopist should be in harmony with assistant at injection of Histoacryl. And its shooting speed should be fast because of clogging within the catheter. It is necessary to do long term study for evaluation of eradication effect in acute gastric variceal bleeding.

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원저 : 간경변증 환자에서 상부소화관 출혈에 대한 임상적 고찰 ( Original Articles : Upper Gastrointestinal Bleeding in Liver Cirrhosis : clinical and endoscopic findings ): Korean J Gastrointest Endosc 1995;15(1):33-39. Published online November 30, 1994

Abstract PDF: It is well known that the main source of upper gastrointestinal(UGI) bleeding in patients with liver cirrhosis is the variceal rupture of esophagus. But, peptic ulcer disease, congestive gastrophathy, and gastric varices are frequently found by endoscopic examination in patients with liver cirrhosis. These lesions are related to UGI bleeding. It is necessary to verify the causes of bleeding in liver cirrhosis, and evaluate the influencing factors related with UGI bleeding, and define the endoscopic findings of bleeding in liver cirrhosis. We reviewed the records of 145 episodes of UGI bleeding in cirrhosis, with endoscopy performed within 24 hours of entry, and report here the bleeding sites, influencing factors related with UGI bleeding, and endoscopic findings. The most common bleeding site was the esophageal varices(66.9%). Other bleeding lesions included gastric ulcer(8.3%), congestive gastrophathy(6.9%), undetermined origin(6.9%), duodenal ulcer(6.2%), gastric varices(2.1%), esophageal varices+gastric ulcer(1.4%), and esophageal varices+duodenal ulcer(1.4%). Endoscopic features of bleeding esophageal varices were identified as Spurting(2.1%), Oozing(11.3%), Red plugh(10,3 %), White plugh(14.4%), and Red-color sign(61.9%). In bleeding esophageal varices, gradeIV varices(41.2%) had a significantly higher association with bleeding than gradeI varices(2.1%), gradeII varices(22.7%), and gradeIII varices(34.0%). Endoscopic features of bleeding gastric ulcer were identified as Spurting(8.3%), Oozing(25.0%), Blood clots(58.3%), and Exposed blood vessels on ulcer base(41.7%). Endoscopic features of bleeding duodenal ulcer were identified as Oozing(44.4%), Blood clots(55.6 %), and Exposed blood vessels on ulcer base(55.6%). We found no difference in the bleeding sources according to etiology of cirrhosis(P>0.05). Bleedings due to the variceal rupture of esophagus were more frequently found in Child class B(71.2%) and C(75.0%) than A(34.8%)(P<0.05).

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원저 : 내시경적으로 절제된 위용종 126예의 임상적 및 조직학적 고찰 ( Original Articles : Clinical and Histological Analysis of 126 Cases of Gastric Polyps ): Korean J Gastrointest Endosc 1995;15(1):40-45. Published online November 30, 1994

Abstract PDF: The gastrointestinal polyp is a premalignant lesion in varying degree. According to the size, the pathology and the location of polyps, it should be removed. Polyps in the gastrointestinal tract can be removed by surgical excision, electrosurgery, cryotherapy, regional radiotherapy and laser therapy with some limitations. Considerable advance in therapeutic endoscopy as well as in diagnostic endoscopy along with newly developed instruments has now made it possible to excise gastrointestinal polyps by means of high frequency generator. We have underwent endoscopic polypectomy, strip biopsy and "O" ring ligation on gastric polyps in 112 patients who visited in this hospital from July l988 to January 1994, and the clinical characteristics including histopathology has been evaluated. Removed polyps were variable in size from less than 0.5 cm up to 4cm. Finally, we concluded that endoscopic polypectomy is a safe and relativly simple procedure and postpolypectomy complication can be considerably reduced by conservative antiulcer therapy.

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원저 : 소화성궤양 출혈의 에탄올 경화요법의 효과와 궤양 기저부 형태에 따른 지혈 치료의 필요성 ( Original Articles : Efficacy and Need of Sclerotherapy with Ethanol Injection on the Bleeding Peptic Ulcer ): Korean J Gastrointest Endosc 1995;15(1):46-53. Published online November 30, 1994

Abstract PDF: The peptic ulcer is the most common cause of the upper gastrointestinal bleeding. We evaluated the efficacy of the sclerotherapy by endoscopic injection of ethanol for the bleeding peptic ulcer patients. We also evaluated the need of the sclerotherapy on the bleeding peptic ulcer according to the bleeding stigmata on the ulcer base. We classified the bleeding stigmata on the ulcer base with 4 group: active bleeding(21/345, 6%), visible vessel(122/345, 35%), red spot(97/345, 28%), no stigmata(105/345, 31%). The patients who manifested hernatemesis, melena, or both initially, were diagnosed as benign gastric ulcer(BGU, 179 patients) and duodenal ulcer(BDU, 166 patients). The median age was 57 year-old in the BGU patients and 37 year-old in the BDU patients. The sclerotherapy was performed to the 109 patients(58 BGU and 51 BDU patients), 96 patients(96/109, 89%) show permanent hemostasis. The hemostasis rate was 77% with active bleeding in the BGU patients, 75% with active bleeding in the BDU patients. There was no significant difference between sclerotherapy and observation group with visible vessel and red spot on the ulcer base of the bleeding peptic ulcer patients. Conclusively, the endoscopic sclerotherapy was very useful and effective treatment method for the bleeding peptic ulcer, but we suggested that all the bleeding peptic ulcer patients should not have done the sclerotherapy.

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원저 : 악성 폐쇄성 황달환자에서 코일 ( coli ) 형 금속배액관 삽관술 ( Original Articles : Metallic EndoCoilTM Stent Application for Patients with Malignant Obstructive Jaundice ): Korean J Gastrointest Endosc 1995;15(1):54-62. Published online November 30, 1994

Abstract PDF: We report our experience in five patients with malignant obstructive jaundice with a new self expandable metallic stent, a coil spring made from nickel-titanium alloy. Endoscopic biliary drainage(EBD) is a safe and effective noninvasive biliary drainage method and is indicated with malignant obstructive jaundice. In order to avoid being limited by the size of the instrumentation channel of the endoscope, expandable stents have been developed. The main problems with these expandable metal stents are tumor ingrowth leading to reobstruction, migration of the stent from its original position, and epithelial trauma by the distal hard edges of the stent. The new super-elastic metallic coil stent which has a very strong radial force (EndoCoil'" stent, Instent Co.) was developed to solve the above mentioned problems. The stent which is constricted over an introducing catheter is inserted by transduodenal approach. It expands spontaneously after release to its original 8 mm diameter. During the last 6.5 rnonths, 5 stents were inserted in patients with cholangiocarcinoma, pancreatic carcinoma and cancer of the ampulla of Vater to releave jaundice. Clinical improvement was achieved in all the patients except in one who died from multiple organ metastasis. After a mean follow-up of 6 month., patients had no evidence of biliary reobstruction. Although follow-up is short, these results are encouraging, and this new metallic stent seems to have several advantages over the current commercially available ones.

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증례 : 악성 식도협착에서의 금속제 확장형 EsophaCoilTM 인공식도삽관술 ( Case Reports : Self - Expanding EsophaCoilTM Esophageal Prosthesis for Malignant Esophageal Stenosis ): Korean J Gastrointest Endosc 1995;15(1):63-71. Published online November 30, 1994

Abstract PDF: Endoscopic endoprosthesis is well established as a cheap, fast and durable procedure for palliation of malignant dysphagia. But the placement of conventional endoprosthesis is difficult and is associated with significant complications such as hemorrhage, perforation and dysfunction of the prosthesis. Recently, self -expand- able metal prosthesis have also been utilized for malignant esophageal stenosis, and palliation of this modality seems to be more effective than other modalities. However the main problems with these metal stents are tumor ingrowth leading to reobstruction, migration, and eophageal trauma by the distal, hard skirt of the stent. EsophaCoil stent is a simple coil with close loops made from a single flat wire of nickel titanium alloy. The radial force of this material is much stronger than stainless steel, expansion time is faster and the stent is able to dilate even extremely resistant strictures. This new metalic stent seems to have several advantages over the current commnerically available ones. We report our experiences with this EsophaCoil stent and review of literature.

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증례 : 상부위장관 출혈을 동반한 위 기생충성 호산구성 육아종 1예 ( Case Reports : A Case of Parasitic Eosinophilic Granuloma of the Stomach Presenting with Upper Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1995;15(1):73-78. Published online November 30, 1994

Abstract PDF: The localized eosinophilic granulomatous lesions of the stomach are rare benign tumorous conditions resembling submucosal tumors. They can be divided into two types. One is an inflammatory fibroid polyp. The other is an eosinophilic granuloma due to migration of Anisakis-type larva in the alimentary tract. The latter is usually found in the gastric body and anterior wall of the angle, and appears as a submucosal tumor. Histologically, the granuloma exhibits a characteristic lamellated structure consisting of a necrotic center with or without the worm, surrounded by layers of granulation tissue and eosinophilic infiltration. The present case is a 50 year-old male presenting with an episode of profuse melena. An emergency esophagogastroduodenoscopy revealed a 2x1.5cm sized, irregularly shaped ulcerative lesion with elevated margins and prominent folds convergence. Despite the endoscopic injection of hypertonic saline-epinephrine solution due to a recent bleeding stigmata, the patient experienced a rebleeding during hospitalization, The locally excised specimen showed an eosinophilic granuloma having a central necrosis. Although the larval body of Anisakis was not found, the lesion was diagnosed as a parasitic eosinophilic granuloma of the stomach.

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증례 : 급성 봉소염성 위염 2예 ( Case Reports : Two Cases of Acute Phlegmonous Gastritis ): Korean J Gastrointest Endosc 1995;15(1):79-83. Published online November 30, 1994

Abstract PDF: We had experienced 2 cases of acute phlegmonous gastritis confirmed by endoscopy, microbiological study and surgical pathologic findings. The first was a 61- year-old female who had been diagnosed as the communicating hydrocephalus and the other was a healthy 60-year-old female. Enterococcus fecalis & Klebsiella pneumoniae, Enterococcus fecalis & E.coli were cultured from the gastric tissue and juice obtained by endoscopy in each patient. In both patients, endoscopic findings showed numerous large ulcers and edema with necrotic material and exudate over the whole stomach. Operation findings were markedly edematous and overall ulcerative mucosa in one patient, and hyperemic outlet stricture in the other. Pathologic findings were acute necrotizing inflammation, involving the mucosa and submucosal layer, consistent with acute phlegmonous gastritis. After operation and antibiotics therapy, the patients were rapidly improved. We reported 2 cases of acute phlegmonous gastritis with the review of literature.

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증례 : 십이지장 궤양을 동반한 진행 위암 3예 ( Case Reports : Three Cases of Coexistence of Gastric Cancer and Duodenal Ulcer ): Korean J Gastrointest Endosc 1995;15(1):85-90. Published online November 30, 1994

Abstract PDF: Both duodenal ulcer and gastric cancer are common, and it is well known that the pathophysiology of the two is different. The presence of a duodenal ulcer is believed to protect against the development of a gastric malignancy. However gastric cancer may occur in the presence of active or chronic duodenal ulcer disease. Although rare in incidence of coexistence of duodenal ulcer and gastric cancer, physician must be alert to the strange association of duodenal ulcer and gastric cancer. Here, we present 3 cases with coexistence of duodenal ulcer and gastric cancer, diagnosed by endoscopy.

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증례 : 총담관의 담낭관 개구부에서 발생한 선종 1예 ( Case Reports : A Case of Adenoma of the Common Bile Duct Originating at the Cystic Duct Opening ): Korean J Gastrointest Endosc 1995;15(1):91-97. Published online November 30, 1994

Abstract PDF: Adenoma is a benign epithelial lesion with malignant potential and can be found at any site of the gastrointestinal tract. Adenoma of the common bile duct is a rare and unusual cause of bile duct obstruction. We report a case of tubulovillous adenoma of the common bile duct at the cystic duct opening. A 1.8X1.2X1 cm sized, round and lobulated mass was noted on abdominal sonogram, CT scan and endoscopic retrograde cholangiogram, and it was confirmed and treated by surgical resection.

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증례 : 점액성 담도폐쇄를 일으킨 총간관의 융모성 선종 1예 ( Case Reports : Mucin - secreting Villous Adenoma of The Common Hepatic Duct Causing Mucoid Biliary Obstruction ): Korean J Gastrointest Endosc 1995;15(1):99-104. Published online November 30, 1994

Abstract PDF: Obstructive jaundice of the bile duct resulting from tumor-producing copious, thick mucin, causing ductal obstruction and dilatation, has been reported very rarely. Also, the benign bile duct neoplasm is extremely rare. We report a case of a mucin-secreting villous adenoma of common hepatic duct causing obstructive jaundice and cholangitis. The patient was a 72-year-old male and had a 3 yeared history of common hepatic mass unchanged remarkably in size. The abdominal ultrasonogram and computed tomography revealed well circumscribed, more than 2cm sized mass on the CHD and ductal dilatation. We were able to get an interesting cholangioram showing irregular, nodular, ill defined filling defect in the extrahepatic bile duct, different from US and CT findings, And it was just caused by thick, copious mucin from the tumar. This case was confirmed as mucin-secreting villous adenoma after surgery.

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증례 : 특발성 혈소판 감소성 자반증 환자에 시행한 복강경 비장절제술 ( Case Reports : Laparoscopic Splenectomy for Patients with Idiopathic Thrombocytopenic Purpura ): Korean J Gastrointest Endosc 1995;15(1):105-109. Published online November 30, 1994

Abstract PDF: The success and rapid spread of laparoscopic cholecystectomy have prompt the application of laparoscopic approach to abdominal surgical problems. As better in- strumentation is introduced, more complicated surgical procedrues will be performed. In some hematologic disorders, splenectomy was required to cope with these disorders. So laparoscopic splenectomy also has been perfomed inspite of several specific difficulties for handling and mobilization of a parenchymatous organ and the retrieval of the specimen. We experienced a case of idiopathic thrombocytopenic purpura which was treated safely and successfully by laparoscopic splenectomy in 35-year-old female. This technique allows the patient to return to normal activity sooner than with open splenectomy.

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증례 : 복강경 직시하 간생검으로 확인된 간자반병 1예 ( Case Reports : A Case of Peliosis Hepatis , Diagnosed by Peritoneoscopic Liver Biopsy ): Korean J Gastrointest Endosc 1995;15(1):110-117. Published online November 30, 1994

Abstract PDF: Peliosis hepatis is characterized by the presence in the liver of blood-filled cavities, which may or may not be lined with sinusoidal cells. The individual cysts or cavities usually do not exceed several centimeters in diameter. The cysts are typically continuous with adjacent, more normal sinusoids, and they sometimes can be seen in continuity with hepatic venous tributaries. The lesion is usually diagnosed by gross or microscopic examination. When suspected, it can be diagnosed by percutaneous liver biopsy. In the past, peliosis hepatis is primarily associated with wasting diseases, such as tuberculosis, malignancy, and chronic suppurative infection. However, recently peliosis hepatis is seen most commonly in association with the administration of anabolic steroids or HIV infection. We report a case of peliosis hepatis that is diagnosed by peritoneoscopic live biopsy and not associated with known disease.

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증례 : 조기직장암의 내시경적 치료 - 부분 용종절제술 및 박리생검술 - ( Case Reports : Endoscopic Therapy for Early Rectal Cancer - Piecemeal polypectomy and strip biopsy resection technique - ): Korean J Gastrointest Endosc 1995;15(1):119-125. Published online November 30, 1994

Abstract PDF: The incidence of colorectal cancer has been increased gradually and it was about 6.9% of all malignancies in Korea. Early diagnosis was recognized as the most important factor influencing the prognosis of colorectal cancer and the incidence of early colorectal cancer was increasing. Thus great change was observed in the treatment of early colorectal cancer, endoscopic therapy as well as curative surgical resection is being accepted. We report a case of effective and safe endoscopic therapy for early rectal cancer in 5S-year-old male patient. He presented with rectal prolapse and bleeding of a year's duration. A large polypoid mass with fine nodular surface and thick, short stalk was seen in the rectum at 4cm above the anal verge during flexible sigmoidoscopy. After the histologic examination of specimen obtained by bite biopsy, CT scan of pelvic cavity and ultrasonogram of abdomen, the tumor was removed safe and completely by 2 sessions of piecemeal polypectomies and strip biopsy. He has been well without symptoms and signs of recurrence of rectal cancer for 20 months.

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