Clinical Endoscopy

원저 : 식도 위장관 ; 내시경적 식도정맥류 결찰술 시행시 안전하고도 간편한 Overtube 삽입법 ( Original Articles : Esophagus , Stomach & Intestine ; A Novel Method for Overtube Placement in Endoscopic Variceal Ligation ): Korean J Gastrointest Endosc 1995;15(4):659-663. Published online November 30, 1994

Abstract PDF: Endoscopic variceal ligation (EVL) is effective for the management of bleeding esophageal varices, and its use is widespread now. EVL necessitates the use of overtubes. Two primary techniques have been used for overtube placement; one is with endoscope, and the other is with bougie dilator. Overtube placement with endoseope is not without risk. There are reportd of esophageal or pharyngeal laceration or perforation. Overtube placement with bougie dilator circumvents this risk, but it is rather cumbersome to use. The authors devised a safe and easy method for overtube placement, and applied it to a number of patients to test its safety and convenience. First, overtube-dilator assembly was prepared as follows. A Rigiflex achalasia dilator (balloon 30mm OD, 10cm length; Microvasive Co) was lubricated and inserted into the overtube. A tenth of the balloon tip was protruded out of the overtube, then the balloon was insufflated with air at 10-15 psi. Second, standard endoscopy was performed, followed by placement of guide wire in the stomach. Overtube-dilator assembly was lubricated and introduced over the wire as a rail. Once the overtube was properly positioned, the balloon was deflated, and the balloon and wire were removed as a whole, which completed overtube placement. For 65 patients with esophageal variceal bleeding, 82 procedures of EVL were performed using the new technique. Overtube-dilator assembly was easy to prepare and handle. This technique added little time to the procedure and minimizes patients discomfort. No patient suffered major complications such as bleeding, laceration or perforation. This novel method for overtube placement was safe and convenient for use in EVL. It can also be applied to other procedures using overtube such as endoscopic foreign body removal. (Kor J Gastrointest Endosc 15: 659-663, 1995)

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원저 : 식도 위장관 ; 위내시경상 관찰되는 발적소견과 표층성위염에 관한 병리조직학적 검토 ( Original Articles : Esophagus , Stomach & Intestine ; Correlation of Endoscopic Redness with Histological Findings in Superficial Gastritis ): Korean J Gastrointest Endosc 1995;15(4):664-669. Published online November 30, 1994

Abstract PDF: Superficial gastritis has been classified as a type of chronic gastritis, since a report of Schindler in GASTRLTIS, 1947. Howev~er, Benedict reported that superficial gastritis is only acute gastritis or shows normal mucosa histologically. The com mon endopical findings of chronic superficial gastritis were adherent mucus, edema, redness. The common redness which were encounterd are patchy redness and comb-like redness(Kammrotung). We studied the relationship between the redness of superficial gastritis and acute inflammatory changes histologically. Each case of superfieial gastritis was biopsied to redening and non-redening mucosa respectively. We collected 24 cases with 48 biopsy specimens. The results are as follows: Acute inflammatory changes were found only one case in redness and none in non-redness groups. There was no difference in acute inflammatory changes in two groups. The degree of mucosal atrophy were 62.5%, 66.7% in normal mucosa, 12.5%, 16.7~% in mild atrophy, 25%, 12.5% in moderate atrophy, 0%, 4.l% in severe atrophy with respect to redness and non-redness mucosa respectively. There was no difference in degree of mucosal atrophy in two groups. Mucosal atrophies were higher in older ages above 41 years old than below 40 and with increasing age, there was increasing tendency of mucosal atrophy. In conclusion, There was no relationships between mucosal redness and acute in flammatory changes histologically and also between mucosal redness and degree of atrophy. (Kor J Gastrointest Endosc 15: 664-689, 1995)

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원저 : 식도 위장관 ; 거대 위정맥류출혈에 있어서 Detachable Snares 와 O-형 고무밴드를 이용한 내시경적 결찰요법 ( Original Articles : Esophagus , Stomach & Intestine ; Endoscopic Ligation of Large Gastric Varices Using a Detachable Snares and Rubber Bands ): Korean J Gastrointest Endosc 1995;15(4):670-677. Published online November 30, 1994

Abstract PDF: Bleeding from gastric varices greater than 2cm in diameter represents a major limitation for endoscopic hemostasis. The endoscopic injection sclerotherapy (EIS) using conventional sclerosing agents is not satisfactory for the control of acute bleeding from gastric varices which have large diameter, fast blood flow and abundant collateral circulations. Endoscopic ligation using small rubber bands, known to be alternative to EIS, never obliterate large gastric varices greater than 2 cm in diameter. Obliteration therapy using Histoacryl (n-buty1-2-cyanoacrylate), known to be more satisfactory, has some drawback such as embolization. We per formed endoscopic ligation using detachable snares and rubber bands in 22 patients who had recently bleeding from gastric varices larger than 2 cm in diameter. For ligation of gastric varices larger than 2 cm in diameter, the detachable snares were used, and then for ligation of adjacent small gastric varices, rubber bands were used. In seven patients active bleedings were noted at initial endoscopy; 6 of them were successfully controlled by endoscopic ligation using detachable snares and rubber bands, but one patient who was uncontrolled by it died from bleeding and multiple organ failure. In remaining 15 patients, there were no active bleeding but red color signs on large gastric varices; all of them were successfully controlled by endoscopic ligation using detachable snares and rubber bands. Early rebleeding, fol lowing initial treatment, occurred in two patients (9.5%). So overall hemostatic rate of endoscopic ligation using the detachable snares and the rubber bands was 86.4% (19/22). Varices were nearly eradicated in 18 (85.7%) of the 21 survivors by ligation of 1-3 detachable snares (mean, l.3 snares) and 4-30 rubber bands (mean, 16,2 bands) in 2-6 sessions (mean, 3.2 sessions). During or after ligation, there were no serious complications, except transient epigastric pain or discomfort in 14.7% and fever in 1.3%. These results suggest that endoscopic ligation therapy with detachable snares and rubber bands is a safe and effective method for treatment of acute bleeding of gastric varices, especially gastric varices larger than 2 cm in diameter, which can not he controlled by conventional scleratherapy or variceal band ligation. (Kor J Gastrolntest Endosc 15: 670-677, 1995)

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원저 : 담도 췌장 ; Oddi 괄약근 운동 검사의 재연성 ( Reproducibility ) 에 관한 연구 : 경피적 경로를 통한 측정 ( Original Articles : Biliary Tract & Pancreas ; Reproducibility of Percutaneous Sphincter of Oddi Manometry ): Korean J Gastrointest Endosc 1995;15(4):678-685. Published online November 30, 1994

Abstract PDF: To assess the reproducibility of Sphincter of Oddi(SO) manometry, percutaneous manometry of SO was performed repeatedly in 10 subjects with biliary diseases(9 intrahepatic stone cases and 1 bile duct cancer case). Time interval for measurement of SO manometry was 3 to 7(mean 5) days. Mean manometric parameters of SO phasic contraction in the 1st and 2nd studies were not significantly different. However, as a result of manometric records, a diagnosis of dyskinesia was made in the 1st study from 4 patients(tachyoddia in 3 cases and increased retrograde propagation in one case). Among them, the diagnosis was reproduced in the 2nd study from 2(tachyoddia in 2 cases) out of 4 patients. In conclusion, abnormal manometric findings were poorly reproducible. Thus, more prolonged measurement of SO manometry or a dynamic test which stimuli or inhibit the SO activity may be necessary for accurate diagnosis of biliary dyskinesia and better reproducibility of SO manometry. (Kor J Gastrointest Endosc 15: 678-685, 1995)

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원저 : 담도 췌장 ; 원발성 담낭암에 있어서 복강경검사의 의의 ( Original Articles : Biliary Tract & Pancreas ; Peritoneoscopy in Primary Gallbladder Cancer ): Korean J Gastrointest Endosc 1995;15(4):686-695. Published online November 30, 1994

Abstract PDF: Primary gallbladder cancer is a highly malignant tumor and is characterized by early metastasis and rapid progression of disease. Since the majority of patients have unresectable disease, laparotomy, instead of providing relief of symptoms, often adds to the morbidity and needs to be avoided in patients with advanced disease. Clinical features, peritoneoscopic findings, and comparison of peritoneoscopy with radiologic studies were reviewed in 29 patients, who underwent peritoneoscopy, with primary gallbladder cancer at Severaace Hospital, College of Medicine, Yonsei University between Aug. 1982 and Mar. 1994. (continue...)

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원저 : 담도 췌장 ; 내시경적 담관결석 제거술의 임상적 고찰 ( Original Articles : Biliary Tract & Pancreas ; Endoscopic Removal of Bile Duct Stones ): Korean J Gastrointest Endosc 1995;15(4):697-703. Published online November 30, 1994

Abstract PDF: From January 1988 to December 1994, endoscopic sphincterotomy with stone extraction was attempted in 395 patients with common duct stones at Yeungnam University Hospital. Endoscopic sphincterotomy was successful in 389 patients(98.5 %), and clearance of the duct was achieved in 364 patients with an overall success rate of 92.2%. After sphincterotomy, stone extraction by basket or balloon was undertaken in 298 patients without lithotripsy, and stones could be extracted after fragmentation of stones in 19 patients. In 47 patients, stones were passed into duo denum spontaneously. There were 6 cases of sphincterotomy failure due to large periampullary diverticulum or previous gastrojejunostomy. In patients with success ful sphincterotomy, endoscopic stone extraction was failed in 25 cases due to 14 large stones, 5 bile duct strictures, 4 impacted stones, and 2 cases of technical fail ure. Complications were developed in 13 patients(3.3%); 8 pancreatitis and 5 bleedings. All of them were improved with medical therapy only. Despite relatively high success rate and low complications of the endoscopic management of choledocholithiasis, there were significant difficulties in removing large stones. Developement of more effective and inexpensive methods of lithotripsy, and the search for rapidly effective solvent dissolving stones were needed. (Kor J Gastrointest Endosc 15: 697-703, 1995)

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증례 : 식도 위장관 ; 악성 식도협착에서의 금속제 확장형 Wallstent 인공식도삽관술 ( Case Reports : Esophagus , Stomach & Intestine ; Self - expanding Wallstent for Palliative Treatment of Malignant Esophageal Stenosis ): Korean J Gastrointest Endosc 1995;15(4):704-711. Published online November 30, 1994

Abstract PDF: The main objective of palliative treatment of malignant esophageal stenosis is rapid restoration of passage of fluid and solids. Endoscopic intubation with plastic endoprosthesis may lead to prompt relief of dysphagia and is a effective procedure for the palliative treatment of malignant esophageal stenosis. However, the insertion procedure, which necessitates prior dilatation, is traumatic and associated with considerable risk for perforation and bleeding. Tumor overgrowth, stent migration and stent blockage are frequent complications. Recently, self expanding metal stents woven in the form of tubular mesh made from surgical grade stainless steel alloy filaments(Wallstent), have been developed to offer possible advatage over conventional plastic tubes. The small diameter of introducer system carrying the compressed stent(18Fr) allows a relatively easy insertion procedure that dose not require prior dilatation. This stent is pliable. self-expanding and flexible in the longitudinal axis. We experienced a case of a 74-year-old male with malignant esophageal stenosis in whom self-expanding Wallstent was implanted with successful oral nutrition and much improvement of dysphagia. (Kor J Gastrointest Endosc 15: 704-709, 1995)

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증례 : 식도 위장관 ; EEMR 튜브를 이용한 조기식도암의 근치적 절제 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Early Esophageal Cancer Treated by Endoscopic Mucosal Resection Using a EEMR Tube ): Korean J Gastrointest Endosc 1995;15(4):713-719. Published online November 30, 1994

Abstract PDF: Although esophageal cancer has been recognized as difficult to treat, its long-term survival statistics are significant lower than those of other gastrointestinal cancers, Postoperative 5-year survival of the early esophageal cancer which invasion is limited to the mucosa is close to 100%. So, early detection of esophageal cancer has been extremely significant. Progress in the endoscopic technique has enabled to make not only early detection but also curative endoscopic resection of the early esophageal cancers. The indication for curative endoscopic resection of esophageal cancer are as follows: mucosal cancer apart from gross invasion to the muscularis mucosae without nodal involvement and less than 2 cm * 2 cm in size of lesion. EEMR tube(endoscopic esophageal mucoaal resection tube), which was designed by Makuuchi in 1991, is widely used for resection of early esophageal cancers. We report a case of patient with early esophageal cancer, who was admitted due to complation of postprandial epigastric pain, diageosed by endoscopy, endoscopic ultra sonography and chest computerized tomography, and successfully resected by using EEMR tube. (Kar J Gastrointest Endosc 15: 713~ 718, 1995)

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증례 : 식도 위장관 ; 수술 및 화학요법으로 치험한 중복암 1예 - 위 선암과 식도 편평상피 세포암 - ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Concurrent Esophageal and Gastric Double Primary Cancer Treated by Surgery and Chemotherapy ): Korean J Gastrointest Endosc 1995;15(4):721-727. Published online November 30, 1994

Abstract PDF: Double primary cancer of the stomach and esophagus has been revealed a very low incidence in the world except Japan and reported only 6 cases in Korea. Furthermore, it is difficult to manage this type of double cancer because esophageal cancer has a biologic tendency to early metastasis. This paper is concerned with a case of double primary cancer, which we have synchroniously confi~rmed esophageal squamous cell carcinoma and gastric adenocarcinoma with gastrofiberscopic biopsy, and then treated them by radical resec tion and systemic chemotherapy. (Kor J Gastrointest Endosc 15: 721-727, 1995)

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증례 : 식도 위장관 ; 위에 발생한 림프관종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case Report of Gastric Lymphangioma ): Korean J Gastrointest Endosc 1995;15(4):728-733. Published online November 30, 1994

Abstract PDF: Lymphangioma of the stomach is known to be extremely rare, benign tumor, reported only 13 cases now, worldwidely, The lesions are soft, sponge like, and pinkish colored and filled with watery fluid exudates. The histologic examination reveals that lymphangiomas are composed of endothelium-lined spaces that contain a eosinophilic protein-rich fluid. They usually present as polypoid lesions because they are originated from submucosal layer. By endoscopy, they appear as smooth, soft, polypoid submucosal mass. The endoscopic ultrasonographic findings of gastric lyrnphangioma were cystic mass with multi-septation originated from submucosal layer of the stomach. Recently, We experienced a case of lymphangioma associated with early gastric cancer of the stomach. So we report this case with brief review of world literature. (Kor J Gastrointest Endosc 1S: 728-~781, 1995)

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증례 : 식도 위장관 ; 간세포성 분화를 보이는 위의 선암종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Hepatoid Adenocarcinoma of Stomach ): Korean J Gastrointest Endosc 1995;15(4):735-740. Published online November 30, 1994

Abstract PDF: A 54-year old woman was received subtotal gastrectomy. Gastroscbpy showed Bormann type III tumor located in the antrum, incisura angularis and body. Preoperative serum AFP was 1910ng/mL. Endoscopic biopsy revealed adenocarcinoma, but after subtotal gastrectomy, the tumor contained histologic features resembling hepatocellular carcinoma with lymphatic invasion and venous invasion. So we reported it as a hepatoid adenocarcinoma. (Kor J Gastrointest Endosc 15: 735-740, 1995)

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증례 : 식도 위장관 ; 중복유문 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Double Pylorus ): Korean J Gastrointest Endosc 1995;15(4):741-746. Published online November 30, 1994

Abstract PDF: The double pylorus is a rare condition consisting of a double communication between gastric antrum and duodenal bulb. Some investigators postulate that the doubling of the pyloric channel is a congenital phenornenon, but others believe that it is an acquired lesion. A 72 year-old-man was admitted to this hospital because of epigastric pain for 1 month. Upper G-I series revealed thickened rnucosal folds of pylorus and duodenal bulb and dilated, deformed duodenal bulb filled with barium materials. Endoscopic findings also showed two ovoid large openings of the pyloric channel divided by smooth thickened septum and multiple gastroduodenal ulcers. We thought that this case was an acquired lesion. The relevant literatures on the subject were reviewed. (Kor J Gastrointest Endosc 15: 741-746, 1995)

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증례 : 식도 위장관 ; 내시경적 용종절제술로 치유한 십이지장의 Brunner's Gland 선종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Brunner's Gland Adenoma Treated by Endoscopic Polypectomy ): Korean J Gastrointest Endosc 1995;15(4):747-753. Published online November 30, 1994

Abstract PDF: The Brunner's gland adenoma is characterized by a nodular proliferation of histologically normal Brunner's gland, accompanied by ducts and scattered stromal elements. First descrived by Salvioli in 1876, the tumor is relatively rare, with 119 cases reported by 1977, The most common benign tumor of the small bowel is the adenoma, 25% of which occur in the duodenum. They make up 30% to 50% of all hyperplastic polyps of the duodenum. Most frequently these tumors are discovered in patients in the fourth to sixed decades of life, though the age in reported caes ranges from l 1 days to 80 years. The benign tumors of the duodenum 30% to 50% contain elements of Brunner's gland and 10.6% of them are adenomas of Brunner's gland. We report a case of Brunner's gland adenoma treated by endoscopic polypectomy in 63 year-old woman, and reviewed the literatues of adenoma of the Brunne'r gland. (Kor J Gastrointest Endosc 15: 747-751, 1995)

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증례 : 식도 위장관 ; 대장암에 의한 위 결장루 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastrocolic Fistula Secondary to Colon Cancer ): Korean J Gastrointest Endosc 1995;15(4):755-763. Published online November 30, 1994

Abstract PDF: Gastrocelic fistula of malignant origin is a rare complication, usually due to gastric or colon cancer. Possible other etiologic factors resulting in gastrocolic fistula are peptic ulcer, trauma, carcinoid tumor, intestinal tuberculosis, Crohn's disease, lymphoma, intraabdominal abscess, diverticulitis and etc. At the present, earlier diagnosis and treatment of gastric and colon cancer may explain the low frequency of malignant gastrocolic fistula than the past but the review of Korean literatures revealed only two reports of gastrocolic fistula secondary to gastric cancer and another from benign gastric ulcer. Yet, there has been no report of fistula due to colon cancer. We experienced a case of colon cancer with postural dizziness, fecal eructation who was diagnosed as gastrocolic fistula by endoscopy, barium enema, UGI series and finally underwent operation. Therefore, we report this case with the review of literatures. (Kor J Gastrointest Endosc 15: 755-761, 1995)

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증례 : 식도 위장관 ; 대장 림프관종의 내시경소견 ( Case Reports : Esophagus , Stomach & Intestine ; Endoscopic Characteristics of Lymphangioma of Colon ): Korean J Gastrointest Endosc 1995;15(4):765-773. Published online November 30, 1994

Abstract PDF: Lymphangioma of the large bowel is a rare benign tumor which is composed of numerous small or large thin-walled lymphatie spaces contained fibrous tissue, smooth muscle and aggregates of lymphoid tissue. Lymphangioma never demonstrated any potential for malignant degeneration. There are three types; l. simple capillary lymphangioma, 2 cavernous lymphangioma and 3 cystic lymphangioma. Endoscopically, lymphangioma appears as a compressible smooth, round, or oval submucosal tumor covered with pale intact mucosa. The surfaces is smooth and the superficial color is the same as the surrouding mucosa or slightly more yellowish. There are change of dimension and shape during propagation of the peristaltic wave and on compression. Recently, authors experienced 4 cases of lymphangioma of large intestine which has been revealed by typical colonoscopic findings and/or endoscopic ultrasound, and confirmed by surgical resection and colonscopic snare polypectomy. 3 of 4 cases show cystic lymphangioma and one case shows carvenous lymphangio~rna. We report these cases with review of literatures. (Kor J Gastrointest Endosc 15: 765- 772, 1995)

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증례 : 식도 위장관 ; 거대 보초 용종을 동반한 가족성 용종증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Familial Adenomatous Polyposis ( FAP ) with A Large Sentinel Polyp ): Korean J Gastrointest Endosc 1995;15(4):775-782. Published online November 30, 1994

Abstract PDF: Familial adenomatous polyposis(FAP) is a rare hereditary disorder characterized by the development of hundreds to thounds polyps throughout the colon and rectum. Moreover, several extracolonic manifestations are seen. Recently, this disease is recognized as a adenomatous polyposis syndrome which can involve the entire astrointestinal tract. Several reports have demonstrated a high incidence of gastroduodenal polyps in patients with familial adenomatous polyposis. These colon polyps can be eventually developed as colon cancer, if not be treated. So early diagnosis is needed and prophylactic surgery should be erformed. We experienced a case of familial adenomatous polyposis with a large sentinel polyp on the sigmoid colon, presenting hematochezia and mucoid diarrhea. He was early treated before progression to carcinoma by total colectomy, rectal mucosectomy and J pouch ileoanal anastomosis. (Kor J Gastrointest Endosc 15: 775-782, 1995)

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증례 : 담도 췌장 ; 외상후에 발생한 Biloma 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Posttraumatic Biloma ): Korean J Gastrointest Endosc 1995;15(4):783-787. Published online November 30, 1994

Abstract PDF: Biloma is defined as an extraductular collection of bile within a defined capsular space. Biloma usually occurs secondary to traumatic or iatrogenic injury including abdominal surgery, percutaneous catheter drainage, and transhepatic cholangiography. The diagnostic methods include clinical history and physical examination, abdominal ultrasound, abdominal CT scan, hepatobiliary scintigraphy, endoscopic cholangiography and percutaneous aspiration, Though definite treatment by percutaneous radiographic catheter drainage and endoscopic drainage with sphincterotomy are now feasible in many instances, surgical drainage is often needed. We report a case of posttraurnatic biloma which was developed after car accident. Liver scan and endoscopic cholangiography showed typical features of biloma in this patient. (Kor J Gastrointest Endonc l5: 783-787, 1995)

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증례 : 담도 췌장 ; 원발성 경화성 담관염 2예 ( Case Reports : Biliary Tract & Pancreas ; Two Cases of Primary Sclerosing Cholangitis ): Korean J Gastrointest Endosc 1995;15(4):788-795. Published online November 30, 1994

Abstract PDF: Prirnary sclerosing cholangitis, a chronic progressive cholestatic hepatobiliary disorder of unknown etiology, is characterized by inflammation, scarring and obliteration of bile duct leading to biliary cirrhosis and liver failure. Because histologic finding has only a limited role in the diagnosis, the gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricutre or beading. The natural history is extremely variable. We report two cases of primary sclerosing cholangitis diagnosed by repeated endoscopic retrograde cholangiographies. They were followed up for 7 and 2 years, respectively. (Kor J Gastrointest Endosc 15: 788-794, 1995)

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증례 : 담도 췌장 ; 담낭에 발생한 이소성 위점막증 1예 ( Case Reports : Biliary Tract & Pancreas ; Gastric Heterotopia in the Gallbladder ): Korean J Gastrointest Endosc 1995;15(4):797-802. Published online November 30, 1994

Abstract PDF: Heterotopia (of Ectopia) is defined as the occurrence of normal tissue in an abnormal location. Heterotopic gastric mucosa has been found throughout the length of the gastrointestinal tract from oral cavity to the rectum. Curiously, it is extremely rare in the gailbladder, but when it occurs, it tends to cause symptoms of acute cholecystitis in patients under 20 years of age, and chronic cholecystitis and gallstones in older patients. The heterotopic mucosa results in an intramural mass, a polyp or multiloculated gallbladder. A firm diagnosis of gastric heterotopia is based on the presence of fundic or pyrolic mucosa replete with parietal and chief cells. A clear distinction from intestinal rnetaplasia should be made, but at times may be difficult. Potential complications include mucosal ulceration, obstruction, and hemorrhage. Treatment is cholecystectomy. We report a case of gastric heterotopia in the gallbladder of a 35-year-old-man. Ultrasonography showed fatty change of liver with a 1.5 cm-sized polypoid lesion in the gallbladder. Endoscopic retrograde cholangiography showed a small filling defect, revealed by pooling of the dye in the center, in the body of gallbladder. Laparoscopic cholecystectomy was performed. A sessile polypoid leision with central umbilication was seen in the upper body of gallbladder, without gallstones. The microscopic finding of polypoid lesion consisted of gastric pyloric glands with parietal and chief cells. The surrounding mucosa revealed ordinary gallbladder epithelium without any metaplastic change. We report a case of this condition in which there was a separate loculus lined by gastric epithelium. (Kor J Gastrointest Endosc 1~5: 797-802, 1995)

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증례 : 담도 췌장 ; 상부위장관 출혈로 나타난 출혈성 췌장가성낭종 ( Case Reports : Biliary Tract & Pancreas ; Pancreatic Pseudocyst Causing Gastrointestinal Hemorrhage ( Hemosuccus pancreaticus ) ): Korean J Gastrointest Endosc 1995;15(4):803-809. Published online November 30, 1994

Abstract PDF: Hemorrhage into a pancreatic pseudocyst is a rare, but increasingly recognized as a cause of massive gastrointestial bleeding. Bleeding pseudocysts may rupture into the stomach, duodenum, common bile duct, and splenic vein, or can be decompressed via the duct of Wirsung. Also it will result in upper gastrointestinal bleeding. This represents a life-threatening and frequently unrecognized complication of pancreatic disease. Proper diagnostic workup and prompt surgical management afford the patient the best chance for survival . We report a patient with pseudocyst bleeding into the gastrointestinal tract via the duct of Wirsung and discuss the current diagnostic and therapeutic approach. (Kor J Gastrointest Endosc 15: 803-807, 1995)

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증례 : 담도 췌장 ; 담관 낭종과 췌관결석이 동반된 분할 췌 ( pancreas divisum ) 1예 ( Case Reports : Biliary Tract & Pancreas ; Pancreas Divisum , Choledochal Cyst and Pancreatic Stones in a 50-year-old Man ): Korean J Gastrointest Endosc 1995;15(4):811-817. Published online November 30, 1994

Abstract PDF: A 50-year-old man presented with acute pancreatitis. Abdominal CT showed cystic dilatation of common bile duct and diffuse dilatation of pancreatic duct. ERCP showed pancreas divisum, choledochal cyst and pancreatic duct stones. Minor papilla sphincterotomy and insertion of nasopancreatic tube were performed for drainage of dorsal pancreatic duct. And then, he underwent Whipples operation for excision of choledochal cyst and decompresion of dorsal pancreatic duct. (Kor J Gastrointest Endosc 15: 811-816, 1995)

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