Clinical Endoscopy

원저 : 식도 위장관 ; 출혈성 식도정맥류의 내시경적 경화요법 및 결찰요법시행후 위정맥류의 발생양상 ( Original Articles : Esophagus , Stomach & Intestine ; The Influence of EIS or EVL to Gastric Varices in Bleeding Esophageal Varices ): Korean J Gastrointest Endosc 1996;16(1):1-7. Published online November 30, 1995

Abstract PDF: Background
Esophageal variceal hemorrhage is the most life threatening complication of portal hypertension secondary to chronic progressive liver disease such as liver cirrhosis. Recently, endoscopic injection sclerotherapy(EIS) and endoscopic variceal ligation(EVL) have been known to be the most effective, simple and safe methods. Gastric varices are sometimes associated with esophageal varices in patients with portal hypertension. However the role of endoscopic sclerotherapy in the treatment of gastric varices has not been adequately evaluated, and the fate of coexisting gastric varices after eradication of esophageal varices is not clearly known. Methods: EIS or EVL was preformed in 174 patients with variceal hemorrhage in CHUNG-NAM NATIONAL UNIVERSITY HOSPITAL from September 1990 to December 1993. Among the total 174 patients, 50 patients were followed for at least 1 year. Forty four patients were treated with EIS, and 6 witb EVL. We assesed the influence of EIS or EVL on coexisting gastric varices and the development of gastric varices after EIS or EVL in 50 patients. (Kor J Gaatrointest Endosc 16: 1~7, 1996)

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원저 : 식도 위장관 ; 식도정맥류 환자에서 식도운동과 산청소능 ( Original Articles : Esophagus , Stomach & Intestine ; Esophageal Motility and Acid Clearance in Patients with Esophageal Varices ): Korean J Gastrointest Endosc 1996;16(1):8-14. Published online November 30, 1995

Abstract PDF: The presense of the esophageal varices might have a partial machanical obstruction and cushion effect on esophageal lumen due to blood within the varices. It may affect on the motility and acid clearance in the esophagus. The aim of this study was to evaluate the acid clearance and the esophageal motility according to the degree of the varices in patients with esophageal varices. We have performed esophageal manometry and acid clearance test in 41 patients with esophageal varices. Esophageal motility disorder was abserved in 29.4% of patients with esophageal varices. The number of swallowing for acid clearance was significantly increased in patients with esophageal varices than control group(23.5 +- 14.1 Vs 6.1 +- 1.6, p=0.004). However, there was no significant corelation with form, location, and redcolor sign of the varices. In conclusion, patients with esophageal varices accompanied esophageal motility disorders and delayed acid clearance. This results might be a useful referance data for changes in esophageal motility before and after treatment of esophageal varices.(Kor J Gaetrointest Endosc 16: 8~14, 1996)

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원저 : 식도 위장관 ; 조기위암과 위선종에 대한 내시경적 점막절제술의 임상병리학적 검토 ( Original Articles : Esophagus , Stomach & Intestine ; Clinicopathologic Evaluation of Endoscopic Mucosal Resection of Early Gastric Carcinomas and Gastric Adenomas ): Korean J Gastrointest Endosc 1996;16(1):15-24. Published online November 30, 1995

Abstract PDF: The endoscopic mucosal resection is a useful method of both accurate diagnosis and treatment of gastric mucosal lesion and has been accepted as a standard procedure of early gastric cancer. Over the 3 year period from 1992 to 1994, 57 adenomas and 10 early gastric carcinomas were resected endoscopically at the St. Mary's hospital of Catholic University Medical College. The purpose of this study was to clarify the technical limitations of endoscopic mucosal resection with respect to size, location, methods. (continue...)(Kor J Gastrointest Endosc 16: 15~24, 1996)

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원저 : 식도 위장관 ; 상부 소화관 내시경에 있어서 산소 비포화도에 대한 고찰 ( Original Articles : Esophagus , Stomach & Intestine ; Arterial Oxygen Desaturation during Non-sedated Diagnostic Gastrointestinal Endoscopy ): Korean J Gastrointest Endosc 1996;16(1):25-29. Published online November 30, 1995

Abstract PDF: We studied arterial oxygen desaturation, using a pulse oximeter, in 132 patients undergoing diagnostic upper gastrointestinal endoscopy to obtain predictive factors of the change. The baseline arterial oxygen saturation (SaO2) level was 98.8+- 1.2%. During the procedure, oxygen desaturation (SaO2>95%) was found in 90.2% of the patients, Mild oxygen desaturation (95>SaO2>90%) was found in 9.8% of the patients, and there was no severe oxygen desaturation(SaO2<90%). Age(P=0.52), gender(P =0.48), smoking(P =0.71), body mass index(P =0.32), and endoscopy time(P = 0.68) was not related to the degree of oxygen desaturation. These results suggest that oxygen desaturation, which may rarely induce serious cardiopulmonary events, is not frequently observed during non-sedated diagnostic upper endoscopy. (Kor J Gastrointest Endosc 16: 25-29, 1096)

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원저 : 식도 위장관 ; Behcet 장염에서 궤양병변의 내시경적 분류에 따른 임상경과의 예측에 관한 연구 ( Original Articles : Esophagus , Stomach & Intestine ; Prediction of the Clinical Course According to the Macroscopic Type by Colonoscopy in Behcet's Colitis ): Korean J Gastrointest Endosc 1996;16(1):30-39. Published online November 30, 1995

Abstract PDF: The intestinal lesion of Behcet's colitis shows aphthoid or punched-out ulceration. But these morphological characteristics are variable and the clinical course of Behcet's colitis is also diverse. There have been many case reports since 1962, but there is few study for clinical course or for morphological characteristics of intestinal lesion of Behcet's colitis. So we retrospectively investigated the clinical course of Behcet's colitis according to colonoscopic findings. Thirty-two patients with Behcet's colitis were investigated retrospectively from January 1984 to July l994. The patients who had at least two major stigmata of Behcet's syndrome with intestinal lesions were included, and whose colonoscopic films were available and whose follow-up studies were done. The studies used at their follow-up were colonoscopy and/or barium enema. In our study the patients ranged in age from 15 to 64 years old, with mean age of 37 years old; 28% were in 3rd decade. The mean follow-up period was 33 months. (Kor J Gastrointest Endosc16; 30~88, 1996)

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원저 : 담도 췌장 ; 성인에서의 담관 낭종과 췌담관 합류 이상 ( Original Articles : Biliary Tract & Pancreas ; Choledochal Cyst and Anomalous Union of Pancreaticobiliary Duct in the Adult ): Korean J Gastrointest Endosc 1996;16(1):41-48. Published online November 30, 1995

Abstract PDF: Background
/Aims: Choledochal cyst is a congenital dilatation of extra- or intrahepatic bile duct . Recently, anomalous union of pancreaticobiliary duct(AUPBD) is supposed to be one of the major causes of choledochal cyst. The aims of this study are to assess the association ratio of AUPBD in choledochal cyst and whether the AUPBD in choledochal cyst have a clinical significance. Methods: The study subjects were 35 adult patients who were diagnosed by ERCP in Asan Medical Center from August, l990 to July, 1995. We have classified the type of choledochal cyst and AUPBD according to Todani and Kimura, respectively. (Kor J Gastrointest Endosc 6: 41~48, 1996)

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원저 : 담도 췌장 ; 담도계 질환에 있어서 경구적 담도경 검사법의 이용 ( Original Articles : Biliary Tract & Pancreas ; Application of Peroral Cholangioscopy in Biliary Diseases ): Korean J Gastrointest Endosc 1996;16(1):49-54. Published online November 30, 1995

Abstract PDF: Retrograde transpapillary cholangioscopy can be safely performed by use of a mother-baby-scope system after endoscopic sphincterotomy. Improved endoscopes are now available and may lead to a better acceptance of this technique. Cholangioscopy is complementary to cholangiography for differential diagnosis of various types of bile duct lesions. From march 1992 to September 1994, we performed 15 cases of peroral cholangioscopy for evaluation of bile duct lesions. Indications of peroral cholangioscopy were 6 cases of benign biliary diseases and 9 cases of malignant biliary diseases. In benign diseases, two cases of extrahepatic bile duct stones, 1 case of intrahepatic duct stone with stricture, 2 cases of benign elevated lesions of bile duct and 1 case of occluded expandable metallic stent were involved. In malignant diseases, 7 cases of primary bile duct cancer, 2 cases of hepatocellular carcinoma with bile duct invasion were involved. By use of peroral cholangioscopy with biopsy, differential diagnosis of bile duct lesion was possible. As a complication, severe abdominal pain and hypotension was developed in one case during the procedure and in another case, cholangitis was developed after the procedure. In conclusion, peroral cholangioscopy is a safe and useful procedure in various types of biliary diseases especially in the differential diagnosis of malignancy. (Kor J Gastrointest Endose 16: 49~54, 1996)

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증례 : 식도 위장관 ; 내시경적 " O " -형 밴드 결찰술로 제거된 식도 과립세포종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Endoscopically Removed Granular Cell Tumor of the Esophagus ): Korean J Gastrointest Endosc 1996;16(1):55-61. Published online November 30, 1995

Abstract PDF: The first case report of granular cell tumor was by Abrikossoff in 1926, the tumor has been named with more than 20 different synonyms. It is found usually in the tongue, oral cavity, and the skin. It occurs rarely in the esophagus. Esophageal granular cell tumor is a benign lesion which can be diagnosed by endoscopic biopsy. Large symptomatic lesion can be removed by polypectomy. A 29-year-old female visited our hospital for intermittent epigastric pain and anterior chest discomfort. Endoscopy showed a 0.6 *0.4 cm whitish yellow nodule in the mid-esophagus, 25 cm from the incisor teeth. Endoscopic polypectomy was performed with "O"-type rubber band for endoscopic variceal ligation(EVL). A case of esophageal granular cell tumor conformed by S-100 protein stain is reported with the review of literature. (Kor J Gastrointest Endosc 16: 55~59, 1996)

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증례 : 식도 위장관 ; 인두로 전이된 식도암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Esophageal Cancer with Metastasis to the Pharynx ): Korean J Gastrointest Endosc 1996;16(1):63-67. Published online November 30, 1995

Abstract PDF: Generally, esophageal cancer metaetasizes to lymph node, lung, liver but metastasis to another digestive organ is very rare. A 51 year old man who had experienced dysphagia for 1 month was diagnosed as an esophageal cancer. After combined radiation therapy and chematherapy(5-FU, cisplatinum), he still had dysphagia. After implanta tion of self-expandable metallic esophageal stent, he could swallow solid food. Recently, he experienced pharyngeal pain for 1 month. Endoscopy showed multiple nodules in right pyriform sinus. Biopsy specimen revealed squamous cell carcinoma. Because the distance between esophageal cancer and pharyngeal nodule is more than 10 cm and computed tomography of the neck shows normal esophageal wall no cervical lymphadenopathy, we concluded that this case was an esophageal cancer with metastasis to the pharynx. Hence, we reported a case of esophageal cancer with pharyngeal metastasis with a review of literatures. (Kor J Gastrointest Endosc 16: 63~67, 1996)

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증례 : 식도 위장관 ; 소화관문합부 반흔성협착 환자에서 담도용 침형절개도를 이용한 내시경적 절개확장술 ( Case Reports : Esophagus , Stomach & Intestine ; Endoscopic Incision Therapy by Needle Knife Papillotome in the Treatment of Postoperative Anastomotic Stenosis ): Korean J Gastrointest Endosc 1996;16(1):68-75. Published online November 30, 1995

Abstract PDF: Endoscopic incision therapy was applied to two patients with postoperative anast-omotic stenosis. Radial diathermy incision was performed by needle knife papillot-ome using cutting current. Tne anastomotic stenosis was characteristic of short fibrotic segment and frequent restenosis after dilatation. An sufficient caliber and smooth, supple wall at the site of the stenosis was produced by incisional therapy by needle knife papillotome using cutting current. Clinical symptoms and endoscopic findings were improved after endoscopic incision. It is concluded that endoscopic incisional therapy seems to be safe and effective method for the treatment of anastomotic stenosis after gastrointestinal operation (Kor J Gastrointest Endosc 16: 68~74, 1996)

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증례 : 식도 위장관 ; 점막절제술 후 절제면에 대한 지혈용클립을 이용한 봉합 ( Case Reports : Esophagus , Stomach & Intestine ; Endoscopic Clip Ligation on Mucosal Defect after Endoscopic Mucosal Resection ): Korean J Gastrointest Endosc 1996;16(1):77-81. Published online November 30, 1995

Abstract PDF: The main complications associated endoscopic mucosal resection are bleeding and perforation and the rate of complication is increasing in larger size of mucosal resection. We used a new method of endoscopic clipping technique for ligation on the large mucosal defect after endoscopic mucosal resection. A 53-year-old female patient visited our hospital because of epigastric pain. Endoscopic examination revealed a type IIa EGC(early gastric cancer) below angle. The endoscopic mucosal resection was performed and the size of resected specimen was 2.7x2.5cm. The mucosal defect was ligated with 6 hemoclips(Olympus, MD-850) after approximation of both resected margins by grasping forceps(Olympus, FG-4L). Follow up endoscopic examination revealed good quality of ulcer healing. The Endoscopic clipping technique might also be useful for treatment of minor perforation.(Kor J Gastrointest Endosc 16: 77~81, 1996)

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증례 : 식도 위장관 ; Mucormycosis 에 의한 위궤양 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Ulcer Associated with Mucormycosis ): Korean J Gastrointest Endosc 1996;16(1):82-87. Published online November 30, 1995

Abstract PDF: Mucormycosis is an uncommon, frequently fatal, opportunistic fungal infection. Rhinocerebral and pulmonary involvement are the most common forms and usually occur in immunecompromised patients. Gastrointestinal involvement is extremely rare, the stomach being the most frequently involved site among them. When gastric mucormycosis presents as an invasive fungal infection the prognosis is extremely poor. Alternatively when the fungus may colonize the gastric mucosa without invasion of the blood vessels, the prognosis is good. Early diagnosis and tirnely institution of aggressive treatment is essential for the patients with mucormycosis. We report a 72-year-old man of gastric mucormycosis confirmed by histologic examination of endoscopic biopsy specimen. The patient was admitted. to intensive care unit under the diagnosis of adult respiratory distress syndrome and sepsis. He has been suffered from 5 years of end stage renal disease and 4 months of pulmonary tuberculosis and managed by continuous ambulatory peritoneai dialysis and anti-tubereulosis medications. On the 5th hospital day, esophagogastroduodenoscopy was underwent to remove the pieces of thermometer accidentaly broken, which revealed the 1.0 cm ulcerative lesion on the posterior wall of the upper body of stomach. The base of ulcer was coated with whitish-yellow dirty exudates and slightly irregular and the margin was nodular. The mucosae were friable and easily bled with light touch. The histologic examination of biopsy specimen revealed the multiple non-septated fungal hyphae branching right-angle. (Kor J Gastrointest Endosc 16: 82-85, 1996)

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증례 : 식도 위장관 ; 반복적 장폐쇄 증상을 보인 Crohn병 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Crohn's Disease with Repeated Bowel Obstruction ): Korean J Gastrointest Endosc 1996;16(1):89-93. Published online November 30, 1995

Abstract PDF: Crohn's disease is a rare inflammatory bowel disease in Korea which requires a differential diagnosis with intestinal tuberculosis. In the early stages of Crohn's diseaae, the combiation of bowel wall edema and spasm produces intermittent obstructive manifestations, so the usual subjective symptoms were appeared long standing diarrhea, low grade fever and abdominal pain and distension. We recently experienced a case of Crohn's colitis with repeated bowel obstruction in female adult who underwent surgical resection.(Kor J Gastrointest Endose 16:89-93, 1996)

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증례 : 식도 위장관 ; 장관을 침범한 Henoch - Schoenlein Purpura 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Henoch - Schoenlein Purpura Involving G-I Tract ): Korean J Gastrointest Endosc 1996;16(1):94-101. Published online November 30, 1995

Abstract PDF: Henoch-Schonlein purpura or Anaphylactiod purpura is rare syndrome in adults characterized by a symmetrical, non traumatic, nonthrombocytopenic, painless purpuric rash, arthritis, nephritis, gastrointestinal manifestation. G-I tract involvement is characterized by abdominal pain, G-I bleeding. Although the small bowel is more frequently involved, cases of esophageal, gastroduodenal and colorectal localization have been rarely reported. Recently, we have experienced a case of Henoch-schonlein purpura with renal, skin, extensive gastrointestinal involvement in a 53 year-old male patient who complained of pain, purpura, generalized abdominal pain, dyspnea. The endoscopic findings of duodenum and colon in a patient with Henoch-Schonlein purpura are presented. (Kor J Gastrointest Endosc 18: 94-99, 1996)

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증례 : 담도 췌장 ; 췌장에 발생한 인슐린종 ( Insulinoma ) 의 초음파 내시경 경험 5예 ( Case Reports : Biliary Tract & Pancreas ; Experiences of Endoscopic Ultrasonography in the 5 cases with Pancreatic Insulinoma ): Korean J Gastrointest Endosc 1996;16(1):103-113. Published online November 30, 1995

Abstract PDF: Of the various endocrine tumors affecting the pancreas, insulinomas and gastrinomas are the most common. In order to facilitate surgery, the localization of tumor is important. However, at the first time of presentation, the localization of tumor was often difficult by CT or ultrasonography because the tumor was relatively too small. The introduction of endoscopic ultrasonography has allowed high-resolution imaging of the pancreas that distinguishes structures as small as 2 to 3 mm in diameter. Thus, it has became easier to detect the lesion site of pancreatic endocrine tumor by endoscopic ultrasonography. We report the 5 patients who had pancreatic insulinoma which were detected and localized by endoscopic ultrasonography. (Kor J Gastrointest Endosc 16: 103-109, 1996)

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월례집담회 : 식도궤양을 동반한 Behcet 씨 병 1예: Korean J Gastrointest Endosc 1996;16(1):115-119. Published online November 30, 1995

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월례집담회 : 진성 암육종 1예: Korean J Gastrointest Endosc 1996;16(1):121-123. Published online November 30, 1995

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월례집담회 : Strongyloidiasis 1예: Korean J Gastrointest Endosc 1996;16(1):124-127. Published online November 30, 1995

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월례집담회 : 장중첩을 동반한 Inflammatory Fibroid Polyp: Korean J Gastrointest Endosc 1996;16(1):129-131. Published online November 30, 1995

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월례집담회 : 대장내로 일탈된 금속제 확장형 EsophaCoilTM 인공식도관의 대장내시경에 의한 제거술: Korean J Gastrointest Endosc 1996;16(1):132-137. Published online November 30, 1995

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