Clinical Endoscopy

원저 : 식도정맥류에 대한 내시경적 결찰요법의 장기 추적관찰 ( Original Articles : Longterm Follow-up after Endoscopic Variceal Ligation for Esophageal Varices ): Korean J Gastrointest Endosc 1995;15(3):427-736. Published online November 30, 1994

Abstract PDF: Endoscopic variceal ligation is an accepted new form of safe treatment for esophageal varices. But, there are a few reports of long-term effect of EVL. We analysed 60 patients to evaluate long-term effect of EVL for esophageal varices. The eradication rate was 96.5%, the mean session for eradication of varices 3.0, the number of bands per person 21.5 and the number of bands per session 7.2, Child-Pugh classes(A: B: C) of patients were improved in 25, not changed in 30, deteriorated in 2 cases by EVL(34:19:4 at postEVL vs 20:19:21 at baseline, p<0.01). No serious treatment-related complication resulted from 167 EVL sessions. The patients were followed for a mean of 10.5 months, during which recurrence rate of varices was 14.5%, rebleeding rate 16.4%, and mortality rate 12,7%. The period from last session to recurrence was 4-19 months(mean 9.6). No late complication of EVL was documented. In conclusion, EVL is a safe and effective for hemostasis and eradication of esophageal varices. Thus it can improve liver function and reduce bleeding-related mortality in patients with liver cirrhosis. But the regular periodic examination for recurrence after an eradication of varices should be required.

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원저 : 식도 정맥류의 내시경적 Ethanolamine Oleate 경화요법이 분문부 위정맥류에 미치는 영향 ( Original Articles : The Effects of Esophageal Varix Eradication on Pericardial Gastric Varix by Endoscopic Injection Sclerotherapy with Ethanolamine Oleate ): Korean J Gastrointest Endosc 1995;15(3):437-447. Published online November 30, 1994

Abstract PDF: Bleeding from esophageal or gastric varix is the most critical and life-threatening complication of portal hypertension and the most common cause of deaths in the patients with cirrhosis. In the management of variceal bleeding, the various therapeutic interventions including operation and nonoperative procedure were tried, but neither of management was successfully achieved. Between February 1992 and November 1994, we performed endoscopic injection sclerotherapy(EIS) in 35 cirrhotic patients who had recently bled from esophageal varices and had a past history of esophageal variceal bleeding in Chonbuk National Univesity Hospital. Among 35 patients, 32 were male and 3 were female. The underlying severity of liver disease was graded A, B or C according to modification of Child-Pugh classification. EIS was repeated every 1 week until the esophageal varices had been complete obliterated and removed. To investigate the effects of esophageal varix eradication by EIS on combined peri- cardial varix, endoscopic examinations were performed both before procedure and after complete EIS sessions and this study was performed to examine a changes of combined pericardial varices after EIS procedure for the treatment of esophageal varices bleeding secondary to portal hypertesion. We reviewed medical records and compared changes or sizes of pericardial varices before and after EIS procedure. Mean follow up peiod was 61 days. Total number of 162 EIS for variceal eradication were performed. Mean session for eradication of esophageal varices was 4.6 per person, mean amount of injected sclerosant was 8.3cc(1-18cc), mean duration of EIS was 39 days, and mean follow up was 62 days after complete EIS procedure. In total 162 EIS procedure, complications associated with EIS including substernal discomfort 53.7%(n=87), substernal chest pain 45.7%(n=74), fever 4.9%(n=8), dysphagia 14.2%(n=23) and pleural effusion 3.1%(n=5), were transient and not required specific management. During the follow-up period, complete disapperance of pericardial varix or reduction of size was appeared in l8 cases(51.4%) among total 35 patients. No significant changes of variceal size before and after procedure were l6 cases(45.7%) and only 1 case(2.9%) was more aggravated. So, these results suggest that EIS procedure of esophageal varix on pericardial varix seems either to improve or to maintain the severity of the pericardial gastric varix without aggravation.

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원저 : 고압성 하부식도괄약근증의 식도내압과 초음파 내시경소견 ( Original Articles : Esophageal Manometric and Endoscopic Ultrasonographic Findings in Hypertensive Lower Esophageal Sphincter ): Korean J Gastrointest Endosc 1995;15(3):449-457. Published online November 30, 1994

Abstract PDF: The hypertensive lower esophageal sphincter(LES)(mean LES pressure>45mmHg; LES relaxation>75%;normal peristalsis) is an uncommon primary esophageal motor disorder associated with chest pain, dysphagia and globus sensation. We carried out this study to evaluate clinical features, esophageal pressure profiles, endoscopic ultrasonographic findings, and assess the effect of oral nifedipine(30 mg/day for 8 weeks) in patients with hypertensive LES(mean age 53.8 years, M: F:=2:7) and l3 controls(mean age 47.5 years, M:F=4:9), Chief complaints were chest pain(77.8%), dysphagia(33.3%) and globus sensation(22.2%). Esophageal manometry showed a significant(p<0.01) increase in LES pressure and higher trend of residual pressure and body contraction amplitude in patients compared with controls. Two cases of nutcracker esophagus and one case of nonspecific esophageal motor disorder were associated with hypertensive LES patients by eeophageal manometry. Five patients were examined by endoscopic ultrasonography(EUS). Three of them showed a normal ultrasonic structure of the wall of the gastro-esophageal junction. Focal and/ or diffuse thickening of muscularis propria were observed in remaining 2 patients. Oral nifedipine significantly decreased the LES pressure and alleviated most of dysphagia and chest pain in patients with normal EUS finding. In conclusion, hypertensive LES was a heterogenous esophageal motor disorder characterized by high LES pressure, residual pressure and body contraction amplitude. The clinical relevance of endoscopic ultrasonographic finding is yet to be determined, but it may be speculated that nifedipines lack of effect on esophageal pressure profiles in some patients is responsible for thickening of muscularis propria in the area of lower esophageal sphincter. Collecting further data regarding treatment response according to EUS finding is required to validate our speculation.

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원저 : 소화성 궤양 출혈의 내시경적 Hypertonic Saline - Epinephrine ( HS-E ) 용액 국소주사의 지혈효과 ( Original Articles : Hemostatic Effect of Endoscopic Injection with Hypertonic Saline - Epinephrine ( HS-E ) Solution in Petic Ulcer Bleeding ): Korean J Gastrointest Endosc 1995;15(3):458-464. Published online November 30, 1994

Abstract PDF: Peptic ulcer bleeding is the most common cause of upper gastromtestinal bleeding. The efficacy of local injection of hypertonic saline-epinephrine(RS-E)solutiom around the base of the bleeding vessels under endoscopy was assessed, During the period between January 1991 and August 1994, 83 patients with active bleeding or stigmata of recent hemorrhage in peptic ulcers were included to this study. The major cause of bleeding in this study consisted of gastric ulcers(60) and duodenal ulcers(23). Twenty patients rebled and seven required emergency surgery and two patients were died. Definitive hemoatasis was achieved in 74(89.3%). Two patients rebled due to mucosal ischemia induced by HS-E injection, other significant complication was not found. We conclude that the endoscopic injection with hypertonic saline-epinephrine solution is one of the effective and safe therapeutic modality in peptic ulcer bleeding.

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원저 : 표면평탄형 조기위암 ( EGC IIb ) 의 내시경적 소견 ( Original Articles : The Endoscopie Findings of Superficial Flat Type Early Gastric Cancer ( EGC IIb ) ): Korean J Gastrointest Endosc 1995;15(3):465-470. Published online November 30, 1994

Abstract PDF: Early gastric cancer(EGC) has been proved to be a malignant tumor with favorable prognosis in contrast to the advanced one, thus early diagnosis has always been the emphasis regardless its type. In particular, diagnosis of superficial flat type EGC(IIb) is extremely difficult on gross inspection. The aim of this study is to review the clinical features of the patients with EGC type IIb, with special reference to the endoscopic appearance of tumor. We reviewed the medical records and endoscopic findings of 13 patients which were thereafter surgically resected and pathologically proven EGC type IIb at SNUH from 1989 to 1993. The depressed lesion was observed most frequently in EGC type IIb. The endoscopic suggestion of EGC type IIb were given initially with mucosal bleeding and discoloration. In 3 cases (20%), tumor extended to the submucosa and in only 1 case, lymph node metastasis was found. Four patients(30.9%) had another coincidental EGC or peptic ulcer. Every possible effort is needed not to omit the resectable cancer when the mucosal bleeding and discoloration is observed. Careful observation is recommended not to overlook coincidental lesions.

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원저 : 내시경을 통한 십이지장 용종의 임상적 고찰 ( Original Articles : Clinical Study on Duodenal Polyps Prevalence Submitted to Upper Gaatrointestinal Endoscopy ): Korean J Gastrointest Endosc 1995;15(3):471-477. Published online November 30, 1994

Abstract PDF: Retrospective studies of duodenal polyps have shown a prevalence of 0.3-4.6% in patients referred to upper gastrointestinal endoscopy, and histologic classification have been inconsistent. A prospective consecutive study was carried out in 3,871 patients referred to diagnostic endoscopy, Sixteen patients had polyps in the first part of duodenum, for a prevalence 0.41%(0.28-0.53%, 95% confidence interval). Fourteen polyps were either inflammatory(thirteen polyps) or ectopic gastric mucosa(one polyp). Two hyperplasitc polyps were founded. All polyps were benign and sessile, and most of polyps(75%) were solitary.

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원저 : 조기대장암의 내시경소견 분석 ( Original Articles : Analysis of Endoscopic Features of Early Colon Cancer ): Korean J Gastrointest Endosc 1995;15(3):479-485. Published online November 30, 1994

Abstract PDF: The prevalence of colon cancer is increasing in Korea and the principal strategy of its management is early detection and surgical resection. For the early detection of colon cancer, endoscopic evaluation is important and the ability to find out early stage small lesion is needed for the endoscopist. To find out encloscopic features of early colon cancer, we reviewed 17 cases of early colon cancer who have admitted to Seoul National University Hospital from January 1982 to December 1993. 1)59% of the lesions were located in rectum and the size ranged from 0.7cm to 9cm, all of the 17 cases showed polypoid mass contour and the surface of them had erosion, hyperemia, ulceration and easy touch bleeding tendency. 2) Colon cancer was diagnosed by endoscopic gross findings in 41% and endoscopic biopsy could confirm colon cancer in 70%. However, barium enema could diagnose only 41% of early colon cancer. 3) Five cases were operated under the diagnosis of colonic adenoma which were large(>3 cm) villous type or contained severe dysplasia 4) Submucosal tumor infiltration was found in 10 cases and 65% had associated adenoma 5) Lymph node involvement was none and there was no recurrence in 47 month follow up period after various surgical treatments.

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증례 : 식도근절개술로 치료한 식도이완불능증에서 발생한 Barrett 식도궤양 1예 ( Case Reports : A Case of Barrett's Esophageal Ulcer following Esophagomyotomy for Achalasia ): Korean J Gastrointest Endosc 1995;15(3):486-493. Published online November 30, 1994

Abstract PDF: We report a patient who developed a Barrett,s esophageal ulcer 10 years after esophagomyotomy for achalasia. A-59-year-old female was admitted to the hospital with dysphagia for 2 months. In 1982, she had undergone a modified Heller esophagomyotomy for achalsia. After esophagogram, esophageal manometry, 24hr esophageal pH monitoring, esophagoscophy achalasia and Barrett,s esophageal ulcer was diagnosed. So, she had been treated with omeprazole and sucralfate and has been followed up in a asymtomatic state currently. In Barrett,s esophagus, there is a metaplasia of the normal stratified squamous mucosa to columnar epithelium, caused by the reflux of acid. It appears in approximately 10% of patients with chronic gastroesophageal reflux and is associated with increased probability of adenocarcinoma of the esophagus. Among the predis- posing factors of gastroesophageal reflux, there is treatment of esophageal achalsia by forceful dilatation or by the esophagomyotomy. The resultant ralaxation of lower esophageal sphinter, combined with deficient propulsive esophageal peristalsis, predisposed to gastroesophageal reflux. Actually an increased incidence of gastroesophageal reflux, esophagitis and stricture are well-known complications after esophagomyotomy. But in spite of higher risk of gastroesophageal reflux after esophagomyotomy the development of Barrett,s mucosa has been rarely reported and only recently recognized. Diagnosis of Barrett,s esophagus in such patients is difficult and the cumulative effects of achalasia and Barrett's esophagus predispose these patient to higher risk of developing esophageal carcinoma. So, high index of awareness and regular endoscopic surveillance are required.

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증례 : 식도 소세포암과 위선암이 병발한 원발성 중복암 1예 ( Case Reports : Synchronous Double Primary Cancer of Esophageal Small Cell Carcinoma and Gastric Adenocarcinoma ): Korean J Gastrointest Endosc 1995;15(3):495-500. Published online November 30, 1994

Abstract PDF: Double primary cancer means that more than two cancers with different origin exist independently in an individual. The diagnosis of double primary cancer was determined by following criteria. Each of the tumors must present a definite picture of malignancy, and each must be distinct, and the probability of one being a metastasis of the other must be excluded. Small cell carcinoma has a distinct biological behavior such as, early invasion and metastasis, a rapid clinical course, and significant sensitivity to chemotherapy. Small cell carcinoma in the esophagus is relatively rare, and rarer when it is combined with other malignant disease. We have experienced a case of double primary cancer, a 70-year-old man with esophageal small cell carcinoma and gastric adenocarcinoma, which were diagnosed by gastrointestinal endoscopic biopsy. A review of the Korean medical literature failed to reveal any previously described case of esophageal small cell carcinoma with gastric adenocareinoma. We report this case with review of literatures.

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증례 : 조기위암 형태의 위유암종 1예 ( Case Reports : A Case of Gastric Carcinoid Tumor Simulating Early Gastric Cancer ): Korean J Gastrointest Endosc 1995;15(3):501-507. Published online November 30, 1994

Abstract PDF: The endoscopic diagnosis of gastric carcinoid has been considered difficult. Reported cases of this tumor diagnosed by endoscopic examination are rare. And the gastric carcinoid with massive upper gastrointestinal bleeding is a rare disease entity. We experienced a case of gastric carcinoid admitted to the hospital because of hematemesis, melena and syncope. And it was diagnosed by endoscopic biopsy, although it resembled type IIa+IIc early gastric cancer at endoscopic examination. To our knowledge, this is the first case report of gastric carcinoid tumor mimicking early gastric cancer. So we report this case with a review of relevant literatures.

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증례 : 위에서 발견된 원발성 신경내분비 소세포암 1예 ( Case Reports : A Case of Primary Small Cell Neuroendocrine Carcinoma in the Stomach ): Korean J Gastrointest Endosc 1995;15(3):509-514. Published online November 30, 1994

Abstract PDF: Primary small cell neuroendocrine carcinoma in stomach is known to be very rare and only the twelve cases have been reported in the English literature. This tumor appears to be analogous to small cell carcinoma and carcinoid tumors of the lung, and is characterized by a very aggressive clinical course. Recently, we have experienced a 68-year-old man with primary small cell neuroendocrine carcinoma in the stomach, which had liver metastasis and peritoneal seeding. A positive Grimelius stain was present and immunohistochemical studies revealed positivity for neuron-specific enolase in the tumor. For its rarity, we report this case with review of literatures.

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증례 : 유문부협착을 동반한 위결핵 1예 ( Case Reports : A Case of Pyloric Obstruction Due to Gastric Tuberculosis ): Korean J Gastrointest Endosc 1995;15(3):515-521. Published online November 30, 1994

Abstract PDF: Gastric tuberculosis is a rare disease. It usually occurs secondarily to another lesions and mainly in the lungs. Only a few cases of primary gastric tuberculosis have been reported in the literature. Most commonly, gastric tuberculosis lesion locates in the lesser curvature side of the antrum. Therefore the clinical picture is similar to the peptic ulcer. A 24-year-old women visited to the Inha university hospital complaining of vomiting and epigastric discomfort. Gastrofiberscopy showed multiple polypoid mass around the pylorus with stenotic pyloric channel. Subtotal gastrectomy was performed and histologic examination revealed chronic granulomatous inflammation with caseation necrosis. That is compatible with tuberculosis. The patient was taken antituberculosis medication without complication. So we report the case of pyloric obstruction due to gastric tuberculosis with review of the literature.

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증례 : 원발성 십이지장 구부선암 3예 ( Case Reports : Three Cases of Primary Adenocarcinoma of the Buodenal Dulb ): Korean J Gastrointest Endosc 1995;15(3):523-530. Published online November 30, 1994

Abstract PDF: Duodenal tumor is relatively rare disease, accounting for about 0.3% of all carcinomas of the gastrointestinal tract. Although radiological and endoscopic examinations have become popular, we are not so familiar with the duodenal tumors as those of the other gastrointestinal tumors. The absence of precise symptoms and the rarity of primary malignant neoplasms in this localization are frequently the reason for the late diagnosis. And so, often the true nature and localization of the tumor are only determined during surgery or autopsy. But, recently, duodenal bulb is examined with ease and pathologic diagnosis is possible following the diffusion of panendoscopy. We have experienced three cases of primary duodenal bulb carcinoma, which diagnosed by biopsies with gastrofibroscopic endoscopy. So we report the cases with a brief review of literature.

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증례 : 십이지장에서 발생한 평활근육종 1예 ( Case Reports : A Case of Duodenal Leiomyosarcoma ): Korean J Gastrointest Endosc 1995;15(3):531-537. Published online November 30, 1994

Abstract PDF: Leiomyosarcoma of small intestine is an uncommon tumor, comprising less than 20 percent of all primary malignant tumors of small intestine. Duodenal leiomyosarcoma is rare disease which amount to about 20 percent of all small bowel malignancy but potentially curable tumors often diagnosed at an advanced age, so its five-year survival following resection approximates 50% in reported series. Recently, several cases of leiomyosarcomas of duodenum were diagnosed by hypotonic duodenograhy in Korea. We experienced a woman with duodenal leiomyosarcoma that was diagnosed by endoscopic duodenal biopsy and received currative resection of the tumor(Whipple's operation). We report the case with review of the literatures.

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증례 : 소장 내시경으로 진단된 공장 평활근 육종 출혈 1예 ( Case Reports : A Case of Bleeding from Jejunal Leiomyosarcoma Diagnosed with Small Bowel Enteroscopy ): Korean J Gastrointest Endosc 1995;15(3):539-544. Published online November 30, 1994

Abstract PDF: In the evaluation of the source of occult bleeding, it is mandatory that the small bowel be investigated. But, the small bowel is the area where endoscopic approach is most difficult. The endoscopic evaluation of the small intestine has rapidly evolved over the last 10 years and now includes many of the diagnostic and therapeutic capabilities of standard endoscopic procedures. Various techniques have been developed, including fiberoptic sonde enteroscopy, retrograde ileoscopy, intraoperative enteroscopy, "push" enteroscopy using a pediatric colonoscope, and video enterocopy. Therefore, the small bowel enteroscope has shown great promise in the evaluation of obscure or persistent gastrointestinal bleeding. We have experienced a case of bleeding from jejunal leiomyosarcoma, which diagnosed with small bowel enteroscopy. So we report the case with a brief review of literature.

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증례 : 식욕과항진으로 오진된 소아 십이지장 격막 1예 ( Case Reports : A Case Report of Duodenal Diaphragm Misdiagnosed as a Bulimia ): Korean J Gastrointest Endosc 1995;15(3):545-551. Published online November 30, 1994

Abstract PDF: Duodenal diaphragm is a rare congenital anomaly among the congenital duodenal obstructions. Its symptom and sign usually appear since birth if obstruction is complete. The clinical manifestations of incompletely obstructive duodenal diaphragm are intermittent vomiting, abdominal pain and poor weight gain. Diagnosis may be delayed in this case. Authors experienced a case of incomplete duodenal diaphragm with a central hole. A 29 months old girl presented failure to thrive, intermittent episodes of bloating, abdominal discomfort and occasional vomiting. The patient vomited every 10-14 days, then the abdominal pain and distention were relieved. She overate for about 10 days until the next projectile vomiting. The vomitus frequently contained food ingested several days previously. Plain x-ray films of abdomen showed marked gastric distention. Upper gastrointestinal series revealed marked distention of the duodenum with windsock configuration and radiolucent line at the third portion of the duodenum. On gastroscopic examination, gastric bezoar impacting the pyloric canal and antrum was noted. At operation, we found mucosal membrane in the third portion of the duodenum and bezoar(Chinese cabbage) above the membrane. Side-to-side duodeno-jejunostomy was performed and bezoar was removed. She was discharged on the 13th postoperative day without any complication.

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증례 : 대장 흑피증 3예 ( Case Reports : 3 Cases of Melanosis Coli ): Korean J Gastrointest Endosc 1995;15(3):553-561. Published online November 30, 1994

Abstract PDF: Colonic lesions by irritant laxative abuse are devided into melanosis coli, cathartic colon, soap or chemical colitis. Melanosis coli is the brownish or black discoloration of the colon because of the accumulation of lipofuscin pigment in macrophages located in lamina propria and associated with anthraquinone containing laxative abuse. The site of this lesion is more common in cecum and proximal colon, but whole colon can be involved. This lesion is occurred between 4 months and 13 months from initiation of drug medication, and the lesion is benign because the pigments disappear by withdrawning the laxatives. A number of cases were reported in our country, all of the cases were associated with prolonged administration of anthraquinone type laxatives. We presents two cases of melanosis eoli that had administrated aloe to treat the chronic constipation during long terms, and one case of melanosis coli that had not administrated laxatives or a specific drug with chronic constipation. All of three cases were confirmed by colonoscopy.

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증례 : 용종절제술로 진단된 대장림프관종 3예 ( Case Reports : Three Cases of Colonic Lymphangioma Diagnosed by Colonoscopic Polypectomy ): Korean J Gastrointest Endosc 1995;15(3):563-569. Published online November 30, 1994

Abstract PDF: Lymphangiomas are made up of multiple lymphatic channels lined by benign-appearing endothelial cells. The lesions can occur anywhere in the body but most commonly affect head, neck and axilla. It rarely involves the gastrointestinal tract and particularly lymphangioma of the colon is very rare. Histologically, it is classified three types as simple or capillary, cavernous, and cystic. We experienced three cases of cavernous lymphangioma of the ascending colon. Case 1, 56-year-old male, had lymphangioma accompanied by ulcerating cancer of the cecum. Case 2, 51-year-old female, had lymphangioma of cecum. Case 3, 41-year-old male had lymphangioma at ileocecal valve. All cases could be diagnosed by colonoscopic snare polypectomy.

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월례집담회 : 급격한 내시경소견의 변화와 임상경과를 보인 원발성 위 T-세포 림프종: Korean J Gastrointest Endosc 1995;15(3):571-573. Published online November 30, 1994

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월례집담회 : MALT-임파종 1예 - Mucosa Associated Lymphoid Tissue - Lymphoma -: Korean J Gastrointest Endosc 1995;15(3):574-577. Published online November 30, 1994

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월례집담회 : 가족성 과오종 환자에서 발생한 평대주위부 선암: Korean J Gastrointest Endosc 1995;15(3):579-581. Published online November 30, 1994

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월례집담회 : 대장암에 의한 장협착 환자에서의 Ultraflex 삽관술 1예: Korean J Gastrointest Endosc 1995;15(3):582-585. Published online November 30, 1994

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