Clinical Endoscopy

원저 : 식도 위장관 ; 식도정맥류에 대한 내시경적 결찰요법의 치료효과 및 장기 추적관찰 ( Original Articles : Esophagus , Stomach & Intestine ; Efficacy and Longterm Follow-up of Endoscopic Variceal Ligation on Esophageal Varix Bleeding ): Korean J Gastrointest Endosc 1996;16(5):707-714. Published online November 30, 1995

Abstract PDF: Hemorrhage from esophageal varices is a catastrophic complication of portal hypertension. Endoscopic variceal ligation(EVL) is a newly developed technique that may replace Endoscopic injection sclerotherapy(EIS). But there are a few reports of longterm follow-up of EVL in Korea. We analysed 42 patients to evaluate longterm effect of EVL for esophageal varices. Total 689 variceal ligations were performed during 117 separate EVL sessions. Control rate of acute bleeding was 90.5%(38 of 42 patients). Four patients who were failed on control of acute bleeding were taken EIS with successful bleeding control. The eradication rate of esophageal varix was 76.2%(32 of 42 patients), the mean session for eradication of varix was 3,0(2-6), the number of bands per person was 16.0(5-41), and the number of bands per session was 6.0(4-11). Rebleeding after initiation of EVL occured in 1l of 42 patient(26,2%). 81.8% of rebleeding occurred 6 months later after EVL was done. The mortality rate and survival rate after varix eradication during follow-up period(after 6-45 months, mean: 15.5 months) was each 14.3%(6/42) and 85.7%(36/ 42). The causes of death were hepatic failure (3/6), esophageal variceal bleeding(2/ 6) and hepatic encephalopathy(l/6). After EVL, the~re were no serious treatment-re lated complications: except mild complications: mild chest pain in 5 patient(12.0%), mild substernal pain in 7 patients(16.6%). These results suggest that EVL is a safe and effective method for treatment of variceal bleeding control and eradication of esophageal varices with least serious complication. But regular periodic examination(interval of 4-6 months) and repeat EVL after eradication of varices should be required becuse of recurrence of varix and rebleeding. (Korean J Gaatrointest Endosc 16: 707~714, 1996)

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원저 : 식도 위장관 ; 양성 식도 협착에 대한 사바리 길리아드 확장술과 발룬 확장술의 비교 ( Original Articles : Esophagus , Stomach & Intestine ; A Comparison Between Savary - Gilliard and Balloon Dilatation in Benign Esophageal Stricture ): Korean J Gastrointest Endosc 1996;16(5):715-723. Published online November 30, 1995

Abstract PDF: The balloon dilatation or Savary-Gilliard dilatation was performed in 59 patients with benign esophageal stricture in Chungnam National University Hospital from September 1990 to August 1995. We reviewed the effect and the safty of each therapeutic method and the results were as foillows: 1) The cause of stricture were corrosive stricture(28 cases, 49,4%), anastomotic stenosis after gastroesophageal surgery(26 cases, 44.1%), stricture after endoscopic variceal sclerotherapy(3 cases, 5.1%), esophageal web(1 case, 1.7%) or stricture complicated by reflux esophagitis(l case). 2) The overall cure rate of balloon dilatation was 50%(l2/24 cases) and that of Savary-Gilliard dilatation was 77.1%(27/35 cases). The Savary-Gilliard dilatation group had a better result than the balloon group. 3) The perforation after Savary-Gilliard dilatation occurred in 4 cases~(6.7%). One case was treated surgically and three cases wiere treated medically. But there was no fatal complication. 4) The overall cure rate of anastomotic stenosis was 84.6%(32/38 cases) and that of corrosive stricture was 46.4%(13/28 cases). 5) The cure rate of Savary-Gilliard dilatation in corrosive esophageal stricture was 64.7%(ll/17) and that of balloon dilatation was 18.1%(2/11). 6) According to site of stricture, the cure rate of dilatation was 84.2% (32/38) in thoracic esophagus, 42.8%(3/7) in cervical esophagus and 28,5%(4/14) in multiple or long segmented stricture. (Koreen J Gastrointest Endosc 16: 715~723, 1996) (continue...)

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원저 : 식도 위장관 ; 대장결핵의 내시경적 고찰 ( Original Articles : Esophagus , Stomach & Intestine ; Endoscopic Findings of Colonic Tuberculosis ): Korean J Gastrointest Endosc 1996;16(5):724-732. Published online November 30, 1995

Abstract PDF: The purpose of this paper is to review the colonoscopic fingings of twenty two patients with colonic tuberculosis which were diagnosed by colonoscopic finding, histopathology, and follow-up observation after antituberculosis chemotherapy at Pusan National University Hospital from January 1992 to December 1994. The results were as follows: 1) The male to female ratio was 1: 1.2, and the average age of the patients was 39.4 years with a slight predominance in women. The age of peak incidence was the 4th decade 40.9%). 2) Abdominal pain(95%), diarrhea(63%), and weight loss(50%) were the most common clinical findings. Others were constipation, melena, and palpable abdominal mass. The location of the pain was right lower abdomen, epigastrium, central abdomen, and left lower abdomen in decreasing order. 3) Hematologic findings showed decrease in hemoglobin level, increase in ESR, and positive CRP(61.5%). The white blood cell counts were mostly normal. 4) The stool examination showed positive occult blood in 7 cases among 18 cases (38.9%). Acid-fast bacteria was observed in stool of one case. 5) On colonoscopy, the lesion sites were ileoeecal valve(75%), ascending colon(72.7 %), terminal ileum(52.6%), cecum(42.9%), transverse colon(31.8%), descending colon (27.3%), sigmoid colon(9%), and rectum(9%) in decreasing order of frequency. Most of them involved ileocecal area. 6) On colonoscopy, the shape of ulcer revealed circular(41%), fusion(36%), and irregular pattern(18%). It found skipped area in 9 cases, pseudopolyp in 8 cases, patency of ileocecal valve in 5 cases, and severe deformity of ileocecal valve in 6 cases. 7) Microscopic finding of biopsy specimens revealed noncaseating granulomatous inflammation in 12 cases, and nonspecific ulcerative inflammation in 10 cases. In conclusion the diagnostic yield may be greatly enhanced by obtaining multiple target biopsies frorn tbe deep portion of the ulcer bed and margins. Judged from the colonoscopic finding and clinical improvement after antituberculosis chemotherapy, more accurate diagnosis can be acquired. (Korean J Gastrnintest Endosc 16: 724~733, 1996)

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원저 : 담도 췌장 ; 췌장질환의 진단에 있어 초미세 췌관경 검사 ( Ultrathin - caliber Pancreatoscopy ) 의 유용성 ( Original Articles : Biliary Tract & Pancreas ; Clinical Usefulness of Ultrathin - caliber Pancreatoscopy on Diagnosis of Various Pancreatic Diaeases ): Korean J Gastrointest Endosc 1996;16(5):733-741. Published online November 30, 1995

Abstract PDF: Although ERCP has been widely used to diagnose and occasionally treat chronic pancreatitis, it is not always easy to differentiate between malignancy and benign disease by ERCP alone. So peroral pancreatoscopy(PPS) using mother and baby type scopes was developed and several types of peroral pancreatoscopes with various diameters have been used at several institutes. To assess the clinical usefulness of ultrathin-caliber pancreatoscopy on diagnosis of various pancreatic diseases, we performed peroral pancreatoscopy with PF 8P (Olympus, external diameter: 0.8 mm) in 12 cases(6 cases of chronic pancreatitis, 5 cases of pancreatic tumor, and 1 case of mucinous ductal ectasia) of pancreatic diseases. The pancreatoscope was successfully inserted into main pancreatic duct in 11 cases and permitted satisfactory endoscopic observation. The endoscopic findings of chronic pancreatitis were smooth stenosis, protein plug, and stones in pancreatic duct. Peroral pancreatoscopic findings of pancreatic cancer were characteristically seen as stenosis with irregular mucosal protrusion. In the mucin-producing tumor cases, the lesions were generally not clearly visualized due to the presence of copious amount of mucin. We conclude that pancreatoscopy is a valuable alternative or supplementary procedure to diagnostic imaging method of arriving at a more definite diagnosis in difficult cases. But several limitations, such as poor visual field, absence of biopsy channel and controllable tip, and poor durability of endoscope will be overcomed to serve as essential diagnosic tool for pancratic diseases. (Korean J Gastrointest 16: 733~739, 1996)

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증례 : 식도 위장관 ; 상부 위장관 출혈로 발현된 고립성 위 신경 섬유종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Solitary Gastric Neurofibroma Presenting as Hematemesis and Melena ): Korean J Gastrointest Endosc 1996;16(5):743-748. Published online November 30, 1995

Abstract PDF: Gastric neurofibroma is rare and its exact incidence is unknown. We experienced a case of solitary gastric neurofibroma. A 49-year-old woman was admitted because of hematemesis and melena. Neither cafe-au-lait spots in skin nor superficial tumor were found. Gastrofibroscopic examination and UGI series showed a 3 * 4 cm sized luminal protruding mass with adjacent bridging mucosal fold and cental ulceration on the anterior wall of lower body. Mass excision was performed. Grossly, the mass was 4.5 * 3.0 * 2.0 cm sized, well circumscribed submucosal tumor with homogenous cut surface, Microscopically, each of the tumor cells had oval shaped nucleus and spindle shaped cytoplasm. Nuclear atypism and frequent mitosis were not observed. We report a rare case of solitary gastric neurofibroma with review of the literatures. (Korean J Gastrointest Endosc 16: 743~748, 1996)

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증례 : 식도 위장관 ; 상부 위장관 출혈을 야기한 십이지장에 전이된 간세포성 간암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Duodenal Metastasis of Hepatocellular Carcinoma Presenting Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1996;16(5):749-755. Published online November 30, 1995

Abstract PDF: Extrahepatic metastasis of Hepatocellular carcinoma(HCC) to the gastrointestinal tract is uncommon. Because most of metastases to the gastrointestinal tract have no clinical manifestations, they are usually found incidentally at the time of an autopsy or a laparotomy, We experienced a case of duodenal metastasis of HCC, which presented UGI bleeding. A 59 years old male was admitted to our hospital due to generalized jaundice, which lasted for about a week. From the third day of admission, he had episodes of hematemesis and melena. An abdoinal CT scan demonstrated multiple, variable sized low-density masses in the entire liver with portal vein thrombosis and conglomerated lymph nodes. An esophagogastroduodenoscopy showed a protruded submucosal mass-like lesion with multiple ulceration in the duodenal bulb. We confirmed the duodenal mass-like lesion to be hepatocellular carcinoma by a biopsy and a histoimmunochemical study. (Korean J Gastrointest Endosc 16: 749~754, 1996)

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증례 : 식도 위장관 ; 조기위암 수술 후 문합부에 발생한 원발성 위방선균증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Actinomycosia after Gastrectomy for Early Gastric Cancer ): Korean J Gastrointest Endosc 1996;16(5):757-760. Published online November 30, 1995

Abstract PDF: Primary gastric actinomycosis is an extremely rare disease and less than 20 cases are reported in literature. We experienced a case of gastric actinomycosis in the 63-year-old woman who had subtotal gastrectomy for early gastric cancer(type IIc) 7 month ago. Endoscopic biopsy from elevated lesion on stoma was found to show the neutrophilic infiltration and sulfur granule. She placed on tetracycline for 30 days. Follow up endoscopy showed no abnormality. We report this case with literature review. (Koresn J Gastrointest Endosc 18: 757~ 760, 1996)

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증례 : 식도 위장관 ; 유문동 격막 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Antral Web in a Child ): Korean J Gastrointest Endosc 1996;16(5):761-764. Published online November 30, 1995

Abstract PDF: Antral web is a very rare cause of vomiting in child, known to be a congenital disorder caused by incomplete recanalization of embryonic foregut, and in almost cases treated surgically. Author experienced a case of antral web in a 4-year-old boy who had suffered from severe abdominal pain for 2 months, in whom erosive duodenitis was noted on endoscopic examination. The patient became symptomfree after 1 week of conservative treatment for duodenitis. No specific therapy was not required for the antral web. Author concluded that surgical treatment is indicated for the clinically severe cases. (Korean J Gastrointest Endosc 16: 761-764, 1996)

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증례 : 식도 위장관 ; 대장에 발생한 낭성 림프관종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case Report of Cystic Lymphangioma of Colon ): Korean J Gastrointest Endosc 1996;16(5):765-771. Published online November 30, 1995

Abstract PDF: Lymphangioma is a benign tumor of lymphatic origin. Lymphangioma can occur anywhere in the body and only rarely affects the intestinal tract. Most intestinal lymphangiomas are asymptomatic and detected incidentally at autopsy or surgery. Occasionally, they may be large enough to present as a mass to cause obstruction or intussusception. Recently, we examined a case of a 27-year-old woman who complained right upper quadrant abdominal pain, increased bowel sound and weight loss. By surgical resection after the double contrast barium enema and colonoscopy, we could confirm cystic lymphangioma of the transverse colon. So we report this case with brief review of relevant literature. (Korean J Gastrointest Endose 16: 765~769, 1996)

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증례 : 식도 위장관 ; 대장내시경 검사를 통해 확인된 Yersinia Enterocolitica 장염 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Yersinia enterocolitica Enterocolitis and Mesenteric Lymphadenitis Diagnosed by Colonoscopy ): Korean J Gastrointest Endosc 1996;16(5):773-779. Published online November 30, 1995

Abstract PDF: Yersinia enterocolitica is an important pathogen that causes a spectrum of clinical illnesses from simple gastroenteritis to invasive ileitis and colitis. Also it is important to differentiate endoscopic findings involving terminal ileum between inflammatory bowel diseases and infectious colitis. There were few reports about Y. enterocolitica infection confirmed by culture and serology in Korea. We report the first case, in Korea, of terminal ileitis and mesenteric lymphadenitis by Y. enterocolitica confirmed by colonoscopy, biopsy, tissue cultures, and serology in a 42-year-old woman complained vague abdominal discomfort and loose stool. (Korean J Gastrointest Endosc 16: 773~779, 1996)

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증례 : 식도 위장관 ; 심층성 낭포성 대장염 - 증례 보고 - ( Case Reports : Esophagus , Stomach & Intestine ; Colitis Cyatica Profunda - Case report - ): Korean J Gastrointest Endosc 1996;16(5):780-785. Published online November 30, 1995

Abstract PDF: Colitis Cystica Profunda(CCP) is an uncommon disease in Korea, and little knowledge exists about CCP, including knowledge about its incidence and prevalence. However, it may be speculated that the disease will be diagnosed more often due to advancement in diagnostic tool and growing interest. CCP is essentially the same disorder as Solitary Rectal Ulcer Syndrome(SRUS), but it has been reported separately because of its external appearances such as broad shaped polyps or nodules. Both CCP and SRUS are called MPS. Of importance is that a submucosal-cyst-containing lesion needs to be differentiated from mucus- producing adenocarcinoma. This differentiation is obvious from the CCP histologic features, such as fibromuscular obliteration of lamina propria and submucosal cysts. In light of these facts, it is important to obtain a sufficient biopsy specimen to examine accurately. It is not uncommon for CCP to be accampanied by rectal prolapse or incomplete intussusception, so diagnostic approaches of these associated disorders should be done at the same time. The authors have recently experienced one case of CCP associated with rectal prolapse. The case was treated effectively and is reported in this paper along with a review of the literature on this subject. (Korean J Gastrointest Endosc 16: 780~784, 1996)

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증례 : 식도 위장관 ; Segmental Non-familial Colonic Polyposis 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case Report of Segmental Non-Familial Colonic Polyposis ): Korean J Gastrointest Endosc 1996;16(5):787-792. Published online November 30, 1995

Abstract PDF: Segmental non-familial colonic polyposis was first reported by Chiang et al. in 1992. It is characterized by segmental distributlion of colonic polyposis usually confined to the descending colon, absence of family history of polyposis, large bowel malignancy, inflammatory bowel disease, or other pre-malignant colonic conditions. We experienced a nineteen-year-old male, who suffered from 2 years watery diarrhea about five to ten times a day, intermittent hematochezia, and weight loss of 12 kg in a year. He had no family history of colonic polyps, colon cancer, or inflammatory bowel disease. Colon study showed variable sized multiple colonic polyps on the rectum and sigmoid colon. Colonoscopy showed that 0.5 to 1.5 cm sized multiple polyps were scattered from the 6cm site to the 30cm site above the anal verge and the intervening mucosa between polyps was edematous. Colonoscopic biopsy revealed hyperplastic, adenomatous, and mixed hyperplastic and adenomatous polyps, After partial colectomy, we discovered 169 polyps from the resected specimen. After operation, diarrhea and abdominal pain had disappeared. We experienced a case of segmental non-familial polyposis and report it with review of the literatures related to it. (Korean J Gastrointest Endosc 16: 787~792, 1996)

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증례 : 식도 위장관 ; Formalin 도포요법으로 치료한 출혈성 방사선 직장염 1예 - 증례 보고 - ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Formalin Therapy for Hemorrhagic Radiation Proctitis ): Korean J Gastrointest Endosc 1996;16(5):793-799. Published online November 30, 1995

Abstract PDF: Hemorrhagic radiation proctitis is infrequently seen in patients receiving pelvic irradiation. The treatment of hemorrhagic ralation proctitis is often difficult. Many patients need reyeated hospitalizations and blood transfusions. Occasionally patiets will develop severe or recurrent rectal bleeding. In case of massive bleeding requiring excessive transfusion, colonic diversion by construction of a colostomy or excision of the diseased segment may be inevitable. However, surgical procedures in these patients are associated with a high mortality and morbidity. Moreover, medical therapy is usually ineffective. Recently formalin therapy has been introduced as a simple and effective treatment for hemorrhagic radiation proctitis. We experienced a 69 year-old woman patient who developed severe homorrhagic proctitis 1 year after radiotherapy for carcinoma of the cervix. She had not improved by conservative management and required blood tranafusions and repetitive hospitalizations. After local application of a 4% formalin solution in the diseased rectum under caudal anesthesia, the bleeding immediately stopped and the patient was discharged from the hospital, and no recurrence has been observed until now. (Korean J Gastrointest Endosc 16: 793~ 798, 1996)

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증례 : 담도 췌장 ; 담낭-십이지장-대장루 1예 ( Case Reports : Biliary Tract & Pancreas ; Cholecysto - Duodeno - Colic Fistula : Report of One Case ): Korean J Gastrointest Endosc 1996;16(5):801-806. Published online November 30, 1995

Abstract PDF: Biliary-enteric fistula is in 0.5% to 5% of patients undergoing biliary tract surgery. The most common cause of biliary-enteric fistula is gallstones and their complications, Much less common causes are complieation of peptic ulcer, malignancy, trauma, and rarely, Crohns, disease. The most common type of biliary-enteric fistula is cholecysto-duadenal. Cholecysto-colic, cholecysto-gastric, and choledocho-duodenal fistula are reported much less frequently. The combination of cholecysto-duodenal fistula with cholecysto-colic fistula is a very rare. Symptoms are generally nonspecific, so diagnosis has depended on plain film of abdomen and barium studies. Recently, endoscopic examination and cannulation of the fistula for precise radiographic delineation will help to make a diagnosis. A 78-year-old man was admitted our hospital because of epigastric discomfort, indigestion, nausea and vomiting for 10 days. He was confirmed as cholecysto-duodeno-colic fistula by gastroduodenoscopy, colonoscopy, and endoscopic cholangio-graphic techniques. So, we report a case of cholecysto-duodeno-colic fistula of the patient with a review of relevant literatures. (Korean J Gastrointest Endosc 16: 801~806, 1996)

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증례 : 담도 췌장 ; 극미세 췌관 내시경으로 진단된 점액성 췌관 확장증 1예 ( Case Reports : Biliary Tract & Pancreas ; One Case of Mucinous Ductal Ectasia Diagnosed with Ultrathin Pancreatoscopy ): Korean J Gastrointest Endosc 1996;16(5):807-815. Published online November 30, 1995

Abstract PDF: Mucinous ductal ectasia(MDE) is a newly described entity of mucinous neoplasm of pancreas with characteristic endoscopic and pancreatographic findings. It is charaeterized by a patulous duodenal papilla extruding mucus and a pancreatogram showing dilatation with amorphous filling defects, communication of the mass with the pancreatic duct. MDE is intraductal lesion consisting of dilated "cystified" ducts lined by mucin-producing columnar cells. The lesion is usually located in the head or uncinate process. When the radiographic appearance of the ERCP cannot provide sufficient information for definite diagnosis, additional endoscopic visualization is desirable. With the advent of pancreatoscopy, an endoscopic procedure is now available that has proven to enhance diagnostic accuracy. The 0.8-mm ultrathin pancreatoscope allows macroscopic diagnosis under direct vision. Endoscopic sphincterotomy is not required, and insertion into the pancreatic duct is feasible in most cases with the aid of guidewires. Major indications are unclear filling defects on ERCP, strictures of uncertain origin, and duct cut-offs. A limitation of this procedure are the lack of angulation, insufficient illumination, fragility of endoscopic equipment, and nonspecific findings. In addition, biopsy while directly viewing the lesion is impossible at present. We experienced one case of MDE who presented with the symptom of weight loss. Ultrathin pancreatoscopy was useful for the direct visualization af pancreatic duct in the differential diagnosis of filling defects of main pancreatic duct. (Korean J Gastrointest Endose 16: 807-813, 1996)

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