Clinical Endoscopy

원저 : 식도 위장관 ; 식도정맥류 출혈에 있어서 내시경적 다연발 정맥류 결찰요법의 임상적 의의 ( Original Articles : Esophagus , Stomach & Intestine ; Clinical Significance of Multi - Band Ligation for Esophageal Variceal Bleeding ): Korean J Gastrointest Endosc 1996;16(4):551-560. Published online November 30, 1995

Abstract PDF: Endoscopic esophageal variceal ligation(EVL) was first introduced by Stiegmann and colleagues in 1986, and it has since grown to he became an extremely popular modality throughout the world as well as Korea. Endoseopic variceal ligation(EVL), which consists of mechanical ligation and thrombosis of varices using elastic O-rings, has been recently developed as a non-operative alternative to endapic injection sclerotherapy(EIS). EVL is minimally operator-dependent and is also associated with fewer local and systemic complications than sclerotherapy. However, the conventional device has only one O ring, and thus the inner cylinder has to be exchanged after each ligation, So, it is a time-consurning procedure that requires the use of an overtube which has somtimes caused tearing of the esophageal mucosa. To save time and control variceal bleeding, multi-band ligation(MBL) was developed. These ligators have five or six O rings, and serial ligation is now possible without exchanging the cylinder or withdrawing the endoscope. (Korean J Gastrointest Endosc 16: 551~ 560, 1996) (continue...)

1,567 View
7 Download

원저 : 식도 위장관 ; 출혈위험성이 높은 식도정맥류에 대한 예방적인 내시경적 정맥류 결찰요법 ( Original Articles : Esophagus , Stomach & Intestine ; Prophylactic Endoscopic Variceal Ligation for Esophageal Varices with High - risk of Hemorrhage ): Korean J Gastrointest Endosc 1996;16(4):561-567. Published online November 30, 1995

Abstract PDF: Prophylactic treatment of varices is an appealing concept because 50% of patients who experience variceal bleeding will die within the first 6 weeks of the first bleeding. However, the majority of trials which have evaluated prophylactic therapy gave failed to demonstrate advantage, We tried prophylactic endoscopic variceal ligation(EVL) in 10 patients, to evaluate the safety and effect of prophylactic EVL for esophageal varices with high-risk of hemorrhage. The eradication rate was 100% without bleeding and mortality, the mean session for eradication of varices 1.9, the number of bands per person 16.9 and the number of bands per session 8.9. Although mild chest pain(5.3%) and chest discomfortness(31.6%) were observed, no serious complication related with EVL resulted from 19 EVL sessions. The patients were followed for a mean of 327.0 days(85-708), during which recurrent esophagea1 varices were found in a case at 260 days from last session, but no bleeding nor death was occured. No late complication of EVL was documented. In conclusion, prophylactic EVL is safe and may be effective for esophageal varices with high-risk of hemorrhage. But, the large controlled-trial should be required, (Korean J Gastrointest Endosc 16: 561~567, 1996)

1,522 View
2 Download

원저 : 식도 위장관 ; Mallory - Weiss 증후군 출혈의 내시경적 금속 Clip 지혈술의 유용성 ( Original Articles : Esophagus , Stomach & Intestine ; The Usefulness of Endoscopic Hemoclipping in the Management of Mallory - Weiss syndrome ): Korean J Gastrointest Endosc 1996;16(4):568-573. Published online November 30, 1995

Abstract PDF: Mallory-Weiss syndrome is a laceration in the region of the gastroesophageal junction due to vomiting, retching, coughing preceding hematemesis in alcoholic patient. Bleeding from Mallory-Weiss tears stop spontaneously without specific therapy in 80-90 percent of patient, but rebleeding is uncommonly occurring in 2 to 5 percent of patients. Thus most patients require only supportive care. Rarely endoscopic therapy or operative therapy may be required. We conducted an uncontrolled study to evaluate an improved metallic clip(Olympus hemoclip) for the endoscopic treatment of Mallory-Weiss syndrome. Initial hemostasis was achieved in all patients with active bleeding. No complications resulted from this treatment. Clips did not impair healing of teared mucosa. We conclude that endoscopic hemoclip placement is a highly effective and safe method for treating uncontrolled Mallory-Weis syndrome. (Korean J Gastrointest Endosc 16: 568~572, 1996)

1,401 View
3 Download

원저 : 식도 위장관 ; 대장내시경 검사 시간에 따른 대장정결 효과와 적응도에 대한 전향적 연구 ( Original Articles : Esophagus , Stomach & Intestine ; Prospective study of Efficacy of Colonic Cleansing and Patients Acceptance according to the Time of Colonoscopy ): Korean J Gastrointest Endosc 1996;16(4):575-584. Published online November 30, 1995

Abstract PDF: Because most of modern peoples are busy with many their task according to specialization and complexity of society, it is impportant to determine optimal and comfortable time of colonoscopy. So this study was designed to compare efficacy of colonic cleansing and patient acceptance according to the time of colonoseopy. Among 140 peoples who underwent colonoscoyy in Busan St. Benedict Hospital between March 1995 to August 1995, two groups of 70 peoples were randomly assigned to undergo colonoscopy either at A.M. or ~P.M. The results were as follows: 1) In view of efficacy rate of colonic cleansing, the group at P.M, was superior to the group at A.M.. 2) In view of patients acceptance and side effects, the group at P.M. showed better acceptance and less side effects than the group at A.M.. In conclusion, this study showed that the colonoscopy at P.M. is better than at A.M., especially when patient is poor systemic condition or low acceptance to colonoscopic cleansing preparation. However, it may be also acceptable undergoing colonoscopy at A.M. if patient condition is good and patient is busy with his task, (Korean J Gastrointest Endosc 16: 575-584, 1996)

1,356 View
4 Download

원저 : 담도 췌장 ; Oddi 괄약근 운동 이상 환자 16예의 임상 양상 ( Original Articles : Biliary Tract & Pancreas ; The Clinical Characteristics of 16 Patients with Sphincter of Oddi Dyskinesia ): Korean J Gastrointest Endosc 1996;16(4):585-590. Published online November 30, 1995

Abstract PDF: We evaluated the clinical characteristics of patients with SO dyskinesia(n=16) who were confirmed by ERCP manometry during past 5 years. They were 14 male and 2 female and mean age was 52-year-old(range, 32-75). According to the criteria suggested by Hogan and Geenen, 13 patients were classified into biliary type and 3 patients into pancreatic type. Among the patients with biliary type(n=13), 12 patients fulfilled the criteria for group II dysfunction of SO and 1 patient for group III. Among the patients with pancreatic type(n=3), all fulfilled the criteria for group II. The manometric abnormalities were increased basal pressure(n=4), tachyoddia(n=7), increased retrograde propagation(n=3), tachyoddia and increased retrograde propagation(n=l), and tachyoddia and increased basal pressure(n=l). As treatment, 12 patients received conventional endoscopic sphincterotomy and 3 patients received endoscopic pancreatic sphincterotomy in addition to conventional endoscopic sphincterotomy. Satisfactory results (complete absence or marked reduction of pain) were obtained in 13(87%) out of 15 patients by endoscopic treatment. In conclusion, SO dyskinesia is not so common disease and the detection of patients with SO dyskinesia may increase by frequent application of ERCP manometry. (Korean J Gastrointest Endosc 16: 585-590, 1996)

1,380 View
2 Download

원저 : 담도 췌장 ; 내시경적 역행성 췌담관 조영술후 췌장염 발생에 대한 임상적 고찰 ( Original Articles : Biliary Tract & Pancreas ; Clinical Study of Endoscopic Retrograde Cholangiopancreatography ( ERCP ) Induced Pancreatitis ): Korean J Gastrointest Endosc 1996;16(4):591-600. Published online November 30, 1995

Abstract PDF: Background
/Aims: Pancreatitis is one of the major complications of ERCP. The purpose of this study is to evaluate the incidence rate and risk factors of ERCP- induced pancreatitis. Method: We analysed 99 consecutive patients(45 males and 44 females) undergoing ERCP from March to September, 1994. The level of serum amylase was measured and clinical assessment of pancreatitis was performed before, 24 hour, 48 hour, and 72 hour after ERCP. We defined clidical pancreatitis as combination of elevated amylase level over 2 days with abdomial pain and tenderness. (Korean J Gastrointest Endosc 16: 591-600, 1996) (continue..)

1,304 View
4 Download

증례 : 식도 위장관 ; Mallory - Weiss 증후군 출혈의 고무밴드 결찰 지혈술의 유용성 ( Case Reports : Esophagus , Stomach & Intestine ; The Usefulness of Endoscopic O-ring Band Ligation in the Management of Mallory - Weiss Syndrome ): Korean J Gastrointest Endosc 1996;16(4):601-607. Published online November 30, 1995

Abstract PDF: Mallory-Weiss syndrome is a laceration in the region of the gastroesophageal junction due to vomiting, retching, coughing preceding hematemesis in alcoholic patient. Bleeding from Malloly-Weise tears stop spontaneously without specific therapy in 80-90% of patient, but rebleeding occurs in 2 to 5% of patients. Thus most patients require only supportive care. Rarely endoscopic therapy or operative therapy may be required. We performed endoscopic mucosal ligation using intraluminal negative pressure with band ligation for uncontrolled Mallory-Weiss syndrome. In conclusion, Endoscopic O-ring band ligation in uncontrolled intractable Mallory-Weiss syndrome is safe and effective method, but its important that accurate endoscopic O-ring band ligation an bleeding site in laceration area. We experienced endoscopic O-ring band ligation in 6 cases of Mallory-Weiss syndrome. (Korean J Gastrointest Endosc 16: 601-607, 1996)

1,371 View
2 Download

증례 : 식도 위장관 ; 위장관 출혈을 보였던 독성표피융해 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Toxic Epidermal Necrolysis Concomittantly Presented with GI Bleeding and Its Gastrofiberscopic Findings ): Korean J Gastrointest Endosc 1996;16(4):608-613. Published online November 30, 1995

Abstract PDF: Toxic epidermal necrolysis (T~EN) is a severe mucocutaneous disease characterized by epidermal necrosis possibly extended to the entire body surface and involving multiple internal organs. Digestive tract may be involved too, but there is few report about gastrointestinal lesion in patient with TEN. Recently we experienced a case of TEN with gastrointestinal bleeding in previously healthy 32-year-old woman. The condition developed three days after the initiation of treatment with NSAID and progressed caudally, involving 60 percent of the skin surfaces. During a period of admission gastrointestinal bleeding was noticed. The gastrofiberscopy showed diffuse superficial mucosal lesion with oozing from swollen friable and erythematous mucosa. The skin lesion was progressed inspite of withdrawal of causative agents. The patient was expired due to combined septic shock 10 days later. We report this case with gastrofiberscopic findings and a brief review of literature. (Korean J Gastrointest Endosc 16: 608~ 612, 1996)

1,325 View
0 Download

증례 : 식도 위장관 ; 양성 위궤양에 의한 위결장 누공 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Caae of Gastrocolie Fistula Secondary to Benign Gastric Ulcer ): Korean J Gastrointest Endosc 1996;16(4):615-619. Published online November 30, 1995

Abstract PDF: Gastrocolic fistula is a rare lesion which is caused most commonly by carcinoma of colon or stomach. The less common causes of gastrocolic fistula are follows: trauma, faulty gastrocolic anastomosis during gastrectomy, benign gastric ulcer, syphilis, carcinoid tumor, tuberculosis, intraperitoneal abscess, lymphoma, perforated diverticulum of colon, and ulcerative colitis. The locations of fistulae are mostly between greater curvature of stomach and distal half of the transverse colon. In the case of penetrating benign gastric ulcer and gastrcolic fistula, it is usually associated either with asipirin or with prolonged steroid administration. A 36-year-old male who had an unusual gastrocolic fistula secondary to non-surgically treated benign gastric ulcer is presented. The exitence of a gastrocolic fistula was dernonstrated by radiological examination of the colon and the stomach. In this patient, the colonoscope passde through the fistula and the stomach could be examined. Careful preparation was carried out preoperatively with intravenous fluids and blood transfusions. Resection of the distal stomch, fistulous tract, and segment of the transverse colon was then accamplished. (Korean J Gastrointest Endosc 16: 615-619, 1996)

1,356 View
1 Download

증례 : 식도 위장관 ; 용종절제술을 시행한 위유암종 치험 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case with Gastric Carcinoid Tumor Removed by Endoscopical Procedure ): Korean J Gastrointest Endosc 1996;16(4):620-627. Published online November 30, 1995

Abstract PDF: Gastric carcinoid tumors were previously believed to be rare lesions, representing less than 2% of all carcinoid tumors and less than 1% of all stomach neoplasms. More recent studies have demonstrated that they may constitute as much as l0-30% of carcinoid tumors. We recently experienced a 35-years old businessman with gastric carcinoid tumor who camplained of postprandial epigastric discomfort. Gastrofiberscope showed protruding mass with central depression and erasion which was located on greater curvature of lower body and its size was 1 x 1 cm. Gastroendoscopic biopsy was per formed. It was identified to carcinoid tumor(Argyrophilic tumor). EUS(endoscopic ultrasonography) revealed that the lesion was limited to submucosa without evidence of any metastasis to adjacent lymph node. The carcinoid tumor was successfully removed by endoscopic polypectomy. Gastrofiberscope and EUS 9months after polypectomy showed that the lesion was nearly normal mucosa without submucosal thickening. (Korean J Gastrointest Endosc 16: 620-625, 1996)

1,308 View
1 Download

증례 : 식도 위장관 ; 원발성 십이지장 선암 3예 ( Case Reports : Esophagus , Stomach & Intestine ; 3 Cases of Primary Adenocarcinoma of the Duodenum ): Korean J Gastrointest Endosc 1996;16(4):629-637. Published online November 30, 1995

Abstract PDF: Primary adenocarcinoma of the duodenum is a rare disease, representing 0.35% of all gastrointestinal neoplasm and 0.042% of all malignant neoplasm. Since Ham-burger described the first duodenal caricinoma in 1746, the incidence has shown an increasing tendency. Compared with upper gastrointestinal contrast studies, the gastroduodenoscopy has gained an increasing popularity as an invesitigative tool in recent years. But the diagnosis is usually made at a very late stage because the symptoms are often non-specific, which contributes to delayed diagonsiss and poorer prognosis. We have experienced two cases of the primary carcinoma of the duodenal bulb and one case of carcinoma of the second portion, which were diagnosed by biopsy with gastrofiberoscopic endoscopy and operative finding. So we report three csses with a brief review of literature. (Korean J Gastrointest Endosc 16: 629-635, 1996)

1,306 View
0 Download

증례 : 식도 위장관 ; 십이지장을 침범한 Henoch - Shoenlein Purpura 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Henoch - Shoenlein Purpura with Duodenal Involvement ): Korean J Gastrointest Endosc 1996;16(4):639-643. Published online November 30, 1995

Abstract PDF: Henoch-Shonlein(H-S) purpura, or anaphylactoid purpura is a hypersensitivity vasculitis characterized by palpable purpura usually on buttock and low extremities; arthralgia mostly polyarhtralgia in the absence of frank arthritis; gastraintestinal involvement with colicky abdominal pain, nausea, vomiting, diarrhea, constipation and bleeding; and renal involvement, manifested chiefly by hematuria and proteinuria. Gastrointestinal involvement is seen in 70 percent of pediatric patients and one third of adult patients. Any portion of the gastrointestinal tract distal to the esophagus maybe involved, but most frequently affected sites are jejunum and ileum. We report one case of H-S purpura with duodenal involvement observed in 16, male patient. (Korean J Gastrointest Endosc 16: 639~649, 1996)

1,647 View
1 Download

증례 : 식도 위장관 ; 십이지장구부에 발생한 용종양 위상피화생 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Polypoid Gastric Metaplasia in Duodenal Bulb ): Korean J Gastrointest Endosc 1996;16(4):644-649. Published online November 30, 1995

Abstract PDF: Gastric metaplasia of the duodenum, defined as the presence of groups of gastric mucosal cell within normal duodenal epithelium, is an almost constant feature of duodenal ulcer. The pathogenesis of gastric metaplasia is unclear, but acid and Helicobacter pylori infection are contributory factors to the development of gastric metaplasia. Generally, endoscopic finding of gastric metaplasia in duodenum is typically patchy distribution in duodenal bulb, but polypoid gastric metaplasia in duodenum is very rare. We report that the patient who complaints of abdominal pain has a villous, polypoid gastric metaplasia in duodenal bulb without duodenal ulcer. (Korean J Gastrointest Endosc 16: 644~848, 1996)

1,777 View
2 Download

증례 : 식도 위장관 ; 복부외상에 의한 장허혈증 1예 보고 ( Case Reports : Esophagus , Stomach & Intestine ; Bowel Ischemia by Blunt Abdominal Trauma ): Korean J Gastrointest Endosc 1996;16(4):651-657. Published online November 30, 1995

Abstract PDF: The intestine is the third most commonly injured abdominal organ in blunt trauma. But we had a paucity of experience with these injuries. We experienced bowel ischemia in 55 year-old woman after motor-vehicle accident. She complained nausea, vomiting and weight, loss after traffic accident. We found mucosal hyperemia and intraluminal stenosis of duodenal second portion by the gastroscopy. So, we performed hypotonic duodenography and SMA and celiac angiograpby. Hypotonie duodenography showed a luminal narrowing from duodenojejunal junction to proximal jejunum and proximal dilatation, and SMA angiography showed 10 cm segment hypervascular staining of contrast medium in proximal portion. Therefore we performed jejunal loop segmentectomy. After operation she was discharged without complication. (Korean J Gastrointest 16: 651~657, 1996)

1,483 View
0 Download

증례 : 식도 위장관 ; 소장 폐색을 보였던 위석 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Small Intestinal Obstruction Due to a Fragment of Gastric Phytobezoar ): Korean J Gastrointest Endosc 1996;16(4):658-665. Published online November 30, 1995

Abstract PDF: Phytobezoar is rare disease in the stomach and small bowel of the patient without underlying previous gastroenterologic pathology. Because it usually occurs secondarily to peptic ulcer surgery, poor mastication, diabetes mellitus, hypothyroidism and connetive tissue disease. In morden medicine, phytobezoars found in the stomach and/or intestines in humans, are known to be associated with considerable morbidity and even mortality. Patients with gastric bezoar present with chronic postprandial epigastic pain, nausea, and vomitihg. It is diagnosed by endoscopic examination or radiologic study and treated by surgical removal or non-surgical methods including conservative treatment, enzymatic dissolution, and endoscopic removal. We have experienced a case of small intestinal obstruction due to a fragment of gastric bezoar of the patient without underlying etiologic cause. So we report the case with a brief review of literatures. (Korean J Gastrointest Endosc 16: 658-668, 1996)

1,357 View
0 Download

증례 : 식도 위장관 ; 다발성 소결절성 복막중피종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Multiple Small Nodular Peritoneal Mesothelioma ): Korean J Gastrointest Endosc 1996;16(4):667-673. Published online November 30, 1995

Abstract PDF: Peritoneal mesothelioma is a rare disease which arises from the mesothelial lining cells in the peritoneum and spreads to the peritoneal wall, omentum and other abdomina1 organs. Aabestos is one etiologic factor and the other factors are genetic cause, radiation, exposure to toxic materials and recurrent yeritonitis. We experienced a case of multiple small nodular peritoneal mesothelioma after exposure to asbestos for over 20 years. He was a sailor and had worked in the engine department of the ship, in which he wrapped up the pipe of engine in asbestos. This person came to our hospital because of inconvenience due to a distended abdomen. Tumor markers were all within normal limits and there was no evidence of tuberculosis in the abdomen and chest. The CT findings of the abdomen were as follows: There was abundant ascites in the abdominal cavity and multiple small nodules on the parietal peritoneum and especially on the lower abdomen. The omentum thickened diffusely. It was difficult to distinguish from peritoneal mesothelioma and peritoneal carcinomatosis or intestinal tuberculosis. The laparoscopic findings were as follows: There were multiple small nodules on the parietal peritoneum and omentum. The small nodules were a gray white color and uneven compared to tuberculous peritonitis. Therefore, we observed the malignant mesothelial cells by means of the light microscope and electron microscope and concluded that this case was peritoneal mesothelioma. (Korean J Gastrointest Endosc 16: 667~673, 1996)

1,385 View
0 Download

증례 : 담도 췌장 ; 췌관경 소견이 특징적이었던 Mucinous Ductal Ectasia 2예 ( Case Reports : Biliary Tract & Pancreas ; Two Cases of Mucinous Ductal Ectasia of the Pancreas which Showed Characteristic Pancreatoscopic Findings ): Korean J Gastrointest Endosc 1996;16(4):674-679. Published online November 30, 1995

Abstract PDF: We report two cases of mucinous ductal ectasia of the pancreas which showed characteristic pancreatoscopic findings. They also showed characteristic duodenoscopic findings such as patulous ampullary orifice and mucus leakage from the papilla, and underlying pathology was hyperplasia in one case and adenoma in the other case, The insertions of pancreatoscope into the main pancreatic duct were easy without previous sphincterotomy and whitish frog egg-like mucosa was noted in one case and finger-like papillary projection was noted in the other case. (Korean J Gastrointest Endosc 16: 674-678, 1996)

1,413 View
1 Download

증례 : 담도 췌장 ; 담도경검사법 ( Cholangioscopy ) 으로 확진된 폐쇄성황달을 동반한 간세포암 3예 ( Case Reports : Biliary Tract & Pancreas ; Hepatocellular Carcinoma with Obstructive Jaundice Confirmed by Percutaneous Transhepatic Cholangioscopy ( PTCS ) and Peroral Cholangioscopy ( POCS ) ): Korean J Gastrointest Endosc 1996;16(4):681-691. Published online November 30, 1995

Abstract PDF: Jaundice associated with hepatocellular carcinoma usually occurs in the later stages due to the advanced underlying liver cirrhosis or tumor infiltration of the liver parenchyme. In the rare cases, obstructive jaundice presents as the ininitial manifestation of hepatocellular carcinoma. The possible mechanisms of bile duct obstruction associated with hepatocellular carcinoma include extrinsic compression of bile duct by extensive tumor infiltration of the liver or enlarged lymph node, direct tumor invasion of the biliary duct system, and bile duct obstruction by tumor thrombus, necrotic debris, or blood clots. We experienced three cases with hepatocellular carcinoma in whom obstructive jaundice were caused by intraductal involvement of the tumor, which were confirmed by percutaneous transhepatic cholangioscopy(PTCS) and peroral cholangioscopy(POCS). PTCS and POCS finding showed multiple, irreguarly shaped, yellowish soft tissue(chicken fat) and blood clots and, round protruded mass in the ble duct. Biopsy specimens revealed pathologically hepatocelluar carcinoma. (Korean J Gastrointest Endosc 16: 681-689, 1996)

1,326 View
0 Download

증례 : 담도 췌장 ; 췌장암과 감별진단이 어려웠던 성인에서 발생한 췌아세포종 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Pancreatoblastoma in an Adult ): Korean J Gastrointest Endosc 1996;16(4):693-699. Published online November 30, 1995

Abstract PDF: Pancreatoblastoma is a rare tumor, which usually affects infants and young children. We report a case of pancreatoblastoma in a 51-year-old man. To our knowledge, this is the first case of pancreatoblastoma occurred in an adult in Korea. A 2,5 * 3.5 cm sized pancreatic mass was detected on routine examination. An enhanced computed, tamography scan showed a slightly low density solid mass in the body of the pancreas. An abrupt occlusion of the main pancreatic duct and filling defect at the body was noted in the endoscopic retrograde pancreatogram. On operation, a well circumscribed yellowish white mass with whitish capsule was found without adhesion. Histologic examination revealed that the tumor was made up predominantly of medium sized round to polygonal cells having finely granular cytoplaam arranged in solid sheet and acinar structure. Squamoid corpuscles with ovoid to elongated cells were also scattered. The patient is doing well postoperatively. In the review of the literature, the tumor may be biologically different in the older and younger age group. (Korean J Gastrointest Endosc 16: 693-697, 1996)

1,318 View
1 Download

Previous issues