Clinical Endoscopy

원저 : 식도 위장관 ; 식도암 조기 진단에 대한 색소내시경의 유용성 ( Original Articles : Esophagus , Stomach & Intestine ; Usefulness of Chromoscopy Using Lugol Solution for Detection of Superficial Esophageal Cancer ): Korean J Gastrointest Endosc 1996;16(6):921-927. Published online November 30, 1995

Abstract PDF: Background
/Aims: Esophageal cancer is not an uncommon cancer in Korea, however, the prognosis still remains very poor with a 5 year survival rate bemg less than l0% mainly becauae of the delayed diagnosis. Although chromoscopy with lugol solution has been received to diagnose the esophageal cancer in an early stage without difficulty, its clinical use has not been popular yet in Korea. This study was performed prospectively to evaluate the usefulness of the chromoscopy for the detection of superficial esophageal cancer in risk patients for esophageal cancer. Methods: Ninety-five patients were selected among persons who received gasiroscopy at Asan Medical Center between Jan. 1996 and May 1996 and were prospectively included for chromoscopy. Inclusion criteria for the chromoscopy were patients older than 60 years of age with smoking history of more than 30 packyears, and/or past or family history of cancers. After conventional endoscopic examination, lugol solution was sprayed to stain the glycogen granules in the epithelial cells. The size of unstained lesion was measured and stainability was classified into 5 grades. All lesions unstained were biopsied for histological diagnosis. (Korean J Gastrointest Endose 16: 821-927, 1996) (continue...)

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원저 : 식도 위장관 ; 조기위암의 근치적 치료로서의 내시경적 점막절제술 ( Original Articles : Esophagus , Stomach & Intestine ; Endoscopic Mucosal Resection ( EMR ) as a Curative Treatment of Early Gastric Cancer ): Korean J Gastrointest Endosc 1996;16(6):928-935. Published online November 30, 1995

Abstract PDF: The endoscopic mucosal resection(EMR) is proposed by some Japanese investigators as a curative therapy of early gastric cancer(EGC) because of its minimal invasiveness and excellent results. To evaluate the possible role of EMR as a curative treatment modality of EGC, we retrospectively analyzed l9 casea with EGC initially treated by EMR in Seoul National University Hospital from December 1993 and January 1996. 1) The histologic diagnosis prior to EMR was adenocarcinoma in 12 cases(63%) and adenomatous polyp in 7 cases(38%), which were confirmed as adenocarcinoma after EMR. 2) The histologic curative resection was done in 7 cases(37%). Two cases of them showed recurrence of the gastric cancer and were treated by radical surgery. The other five cases have been closely observed by regular endoscopic examination without recurrence for the maximal period of 1~3 months. 3) Histoiogically inadequate resection(positive cancer cell in resection margin, submucosal cancer infiltration, or no cancer tissue in resected specimen) was done in 12 cases(73%). But two surgically resected cimens of them have no residual cancer cells, and there was no cancer cells in the follow-up biopsy of the other two patients. There 4 cases were seemed to he examples of buring effect of EMR 4) After excluding five depressed lesions greater than 1 cm is long diameter, nine lesions were curatively treated by EMR. So successful EMR rate for strictly indicated lesions wsa 64% 5) There was no signifieant complication related to the procedure. We thnnk that endoscopic mucosal resection has a potential role as a curative treatment modality in a highly selected patient with darly gastric cancer (Korean J Gastrointest 16: 928~934, 1996)

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원저 : 식도 위장관 ; 십이지장 유두주위 게실의 임상적 특성 ( Original Articles : Esophagus , Stomach & Intestine ; Clinical Characteristics of Periampullary Diverticulum ): Korean J Gastrointest Endosc 1996;16(6):937-944. Published online November 30, 1995

Abstract PDF: Background
/Aims: Periampuilary diverticulum has been known to be associated with various bilio-pancreatic diseases such as choledocholithiasis and disturbs performing selective cannuiation of ERCP and EST. This present study aims to investigate anatomical morphology of periampullary diverticulum and to determine whether periampullary diverticulurn influences difficulty and complication performing of ERCP and to analyse the relationship between periampullary diverticulum and choledocholithiasis. Methods: We reviewed records of chart and diverticular pictures in 1389 cases of underwent ERCP and evaluated the incidence, size, direction, location of periampullary diverticulum and its influence against performing of ERCP and investigated its relationship with bilio-pancreatic diseases such as choledocholithiasis. (Korean J Gastrointest 16: 937~944, 1996) (continue..)

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원저 : 식도 위장관 ; 대장 정결액의 세포학적인 검사에 의한 대장암의 진단 ( Original Articles : Esophagus , Stomach & Intestine ; Cytolagic Diagnosis of Colon Cancer by Colon Cleansing Solution ): Korean J Gastrointest Endosc 1996;16(6):945-951. Published online November 30, 1995

Abstract PDF: Colorectal cancer consists of 8.2 percent of all malignancy in korea, and shows more increaing tendency. Despite the advances in the detection of calorectal cancer no single screening technique has achieved both high degree of diagnostic accuracy and minimal patient morbidity. We studied 24 patients, who underwent colonoscopy, with clinical suspicious colon cancer at Presbyterian Medical Center between Jan and Sep.1995, and evaluated the diagnostic feasibility of colon lavage cytology using oral cleansing solution. (Korean J Gastrointest 16: 945~951, 1996) (continue...)

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원저 : 식도 위장관 ; 대장관 내압 상승으로 유발된 허혈성 대장염 15예의 분석 ( Original Articles : Esophagus , Stomach & Intestine ; Analysis of 15 Cases of Ischemic Colitis Induced by Increased Abdominal Pressure ): Korean J Gastrointest Endosc 1996;16(6):952-961. Published online November 30, 1995

Abstract PDF: It was suggested that temporary vascular insufficiency within the wall of the colon causes iachemic colitis. So, motivated by this fact, we studied and analyzed 15 cases of iachemic colitis, which were confirmed by the diagnostic criteria of Nagasako(1982), through 32 months from January, 1993 to August, 1995 at Our Lady of Mercy Hospital, Incheon. ( Korean J Gastrointest 16: 952~959, 1996) (continue)

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증례 : 식도 위장관 ; 양잿물에 의한 식도협착에서 식도풍선확장술과 일시적 EsophaCoilTM 인공식도관 삽관술의 병합요법 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Esophageal Stricture by Lye that Treated with Esophageal Endoscopic Endoprosthesis ): Korean J Gastrointest Endosc 1996;16(6):963-968. Published online November 30, 1995

Abstract PDF: Swallowing caustic materials may produce full-thickness burn and loss of esophageal function. Caustics, both acid and alkalis, can corrode and destroy living tissue. Full-thickness burn of esophiageal epithelium causes severe stricture which frequently requires surgical repair. Recently, non-operative dilatation of luminal stenosis has been utilized. Esophageal endoscopic endoprosthesis has been used widely in malignant esophageal stricture but not in benign stricture. In recurrent benign esophageal stricture following repetitive balloon dilatation, we experienced a case of an 18-year old woman with severe stricture which was successfully managed by esophageal endoprosthesia So we report this case with the review of the literature. (Korean J Gastrointest Endosc 16: 963~968, 1996)

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증례 : 식도 위장관 ; 식도에 발생한 점막교 4예 ( Case Reports : Esophagus , Stomach & Intestine ; 4 Cases of Mucosal Bridges in the Esophagus ): Korean J Gastrointest Endosc 1996;16(6):969-975. Published online November 30, 1995

Abstract PDF: Mucosal bridge, endoscopically observed, is a cord-like mucosal connection across the lumen. The bridge is very elastic and stretches easily, unlike granulation tissue. Mucosal bridges of the esophagus have been occasionally described in various circumstances, particularly in congenital or acquired origin as the inflammatory diseases. The occurrence of mucosal bridges due to inflammatory process may arise anywhere from the esophagus to the colon. It has been more frequently reported in the colon than in the esophagus, stomach, and duodenum. We experienced four cases of esophageal mucosal bridges and three of them were accompanied by esophageal diverticulum. We report these cases with a review of relevant literatures. (Korean J Gastrointest Endose 16: 969-974, 1996)

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증례 : 식도 위장관 ; 다발성 조기위암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Multiple Early Gastric Cancer ): Korean J Gastrointest Endosc 1996;16(6):977-981. Published online November 30, 1995

Abstract PDF: Early gastric cancer(EGC) is defined as carcinoma limited to the mucosa or submucosa, regardless of whether metastasis to lymph nodes have occurred, and the frequency of lymph node metastasis varies from 7 to 18%. The incidence of early gastric cancer has been increasing recently, probably with advance in the diagnostic procedure. Multiple gastric cancer, now cosidered to be a sort of multiple primary cancer by Moertels classification, is a special type of cancer in which two or more tumor lesions arise independently from the stomach. Multiple carcinoma was found in about 8.3% of 500 early gastric cancer cases at the National Cancer Center Hospital in Japan. In 77% of these, two lesions roexisted in the stomach. Coexistence of three lesions were found in 20% and more than four lesions in 3%. We report a case of multiple early gastric cancer of different histologic types in which two adenoma coexisted in the stomach. (Korean J Gastrointest Endosc 16: 977-981, 1996)

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증례 : 식도 위장관 ; 레이저응고술을 이용하여 성공적으로 치료한 위 모세혈관 확장증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Successful Laser Photocoagulation in Gastric Telangiectasias ): Korean J Gastrointest Endosc 1996;16(6):982-987. Published online November 30, 1995

Abstract PDF: The routine of endoscopy in the evaluatien of gastrointestinal bleeding demonatratd that telangiectasia in the upper gastrointestinal tract may be responsible for the chronic recurrent bleeding. If the bleeding lesion within the reach of the endoscaiye, it is amenahle to endoscopic therapy, One of the several treatment modalities that has been employed is laser photocoagulation. We report a case of ef fective laser therapy in a 63-years old woman presented with a about 3 years history of recurrent upper gastrointestinal bleeding and persistent iron deficieney anemia in gaatic multiple telangeictasias. An upper gastrointestinal endoscopy demonstrated variable sized multiple bleeding telangectatic lesions in the entire stomach. Nd-YAG laser photocoagulation was appligd in 0.5 seconds pulse of 60-70W power(2300 joules and total 7 sessions). All legions in the stomach were treated. Local epinephrine injection prior to laser treatment was carried out in the telangiectatie lesions greater than 1 cm. Follow-up endoscopy 5 months after laser treatment demonstrated no telangiectatic lesions in the stomach and no episodes of upper gastrointestinal bleeding were noted and the other symptoms improved. (Korean J Gastrointest Endosc 16: 982-986, 1996)

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증례 : 식도 위장관 ; 위 평활근모세포종 ( Leiomyoblastoma ) 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Leiomyoblastoma ): Korean J Gastrointest Endosc 1996;16(6):989-993. Published online November 30, 1995

Abstract PDF: Leiomyoblastoma is uncommon and has been known as a neoplasm of smooth muscle origin. However, with recent pragress in immunohistochemical staining techniques, many clinicopathological discrepancies have been pointed out about the origin of leiomyoblastoma. We present here a case of gastric leiomyoblastoma did not expressed desmin and neuron specific enolase, and was thought to be of unknown derivation. (Korean J Gastrointest Endosc 16: 980-993, 1996)

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증례 : 식도 위장관 ; 대장용종증 동반이 없는 위에서 발견된 과오종 4예 ( Case Reports : Esophagus , Stomach & Intestine ; Four Cases of Gastric Hamartomatous Polyps without Polyposis Coli ): Korean J Gastrointest Endosc 1996;16(6):994-999. Published online November 30, 1995

Abstract PDF: Hamartoma is a very rare congenital tumor. A few cases of hamartomatous pol yps in the stomach were reported. Most of harrurtomatous polyps in the stomach occur in patients of polyposis coli. We have experienced four cases of gastric hamartomatous polyps without polyposis coli. There are some differences between previously reported cases and ours. In our casee, the distribution of age is from fourth to ninth decade, men and women ratio is 1: 1. The number of polyps are one in three cases and two in one case. The size of polyps is from 5mm to 12 mm. The location of polyps are various, but most common in antrum. We have experienced four cases which were different from previously reported ones and report them with a brief review of literatures. (Korean J Gastrointest Endosc 16: 994-998, 1996)

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증례 : 식도 위장관 ; 원발성경화성담관염 (原發性硬化性膽管炎) 을 동반한 궤양성대장염 (潰梁性大腸炎) 환자 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Primary Sclerosing Cholangitis with Ulcerative Colitis ): Korean J Gastrointest Endosc 1996;16(6):1001-1007. Published online November 30, 1995

Abstract PDF: Sclerosing cholangitis is cholestatic disease, characterized by progressive fibrotic inflammation and obliteration af intrahepatic bile ducts and extrahepatic bile ducts and sometimes associated with ulcerative colitis. The pathogenesis of this disease is not understood well. In this disease, however, have been proposed infectious agent, endotoxin of bacteria and immunological event. In Europe and U.S.A., the incidence of sclerosing cholangitis associated with ulcerative colitis was between 2,4 and 4.0 percent. The association is strongest in patients with pancolitis, with a prevalenee of 5.5 percent, compared with patients with disease confined to the distal colon, with a prevalence of 0.5 percent. But, in Korea, it has not been reported sclerosing cholangitis associated with ulcerative colitis. A 30-year old man was diagnosed as an ulcerative colitis 9 years ago and has been followed up, intermittently. Recently, he has experienced hematochezia and dizziness. Colonoscopy showed active ulcerative colitis(pancolitis), blood chemistry elevated alkaline phosphatase and y-GTP. ERCP and liver biopsy specimen revealed sclerosing cholangitis. we concluded that this case was a sclerosing cholangitis as a complication of ulcerative colitis and the first case report of primary sclerosing cholangitis with ulcerative colitis in Korea, Hence, we reported a case of primary sclerosing cholangitis with ulcerative colitis with a review of literatures. (Korean J Gastrointest Endosc 16: 1001-1o07, 1996)

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증례 : 식도 위장관 ; 소장에 다발성 장중첩증을 유발한 전이성 악성 피부 흑색종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of the Multiple Intussusceptions of Small Bowel by Metastatic Malignant Melanoma ): Korean J Gastrointest Endosc 1996;16(6):1008-1015. Published online November 30, 1995

Abstract PDF: We present herein the case of 31-year-old man with disseminated malignant melanoma in whom a multiple metastasis into jejunum causing multiple intussusceptian. At laparotomy, multiple variable sized metastatic melanoma were noted on proximal and distal jejunum. To our knowledge, there was no report about multiple intussusceptions by malignant melanoma in Korea. (Korean J Gastrointeat Endosc 16: 1008-1013, 1996)

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증례 : 식도 위장관 ; 직장의 림프용종 ( Case Reports : Esophagus , Stomach & Intestine ; Lymphoid Polyp in the Rectum ): Korean J Gastrointest Endosc 1996;16(6):1017-1021. Published online November 30, 1995

Abstract PDF: Lymphoid polyp is a rare disease in the colorectal area. It occurs commonly in the rectum. It is a nonepithelial benign tumor. Because of the benignancy of its nature, it has other names as well, such as benign lymphoma or rectal tonsil. A lymphoid polyp can be differentiated from a malignant lymphoma by the proliferation of normal lymphoid tissue which has a prominent follicular pattern and a clearly defined germinal center. A lymphoid polyp can regress spontaneousely without any treatment. There is no recurrence or malignant transformation. Recently, the authors experienced a case of lymphoid polyp in the rectum. We report a case of lymphoid polyp in the rectum diagnosed by piecemeal polypectomy. (Korean J Gastrointest Endosc 16: 1017-1020, 1996)

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증례 : 담도 췌장 ; 결석을 동반한 간외담관 기형 1예 ( Case Reports : Biliary Tract & Pancreas ; A Rare Case of Extrahepatic Bile Duct Anomaly Associated with Multiple Stones ): Korean J Gastrointest Endosc 1996;16(6):1023-1028. Published online November 30, 1995

Abstract PDF: Congenital anomaly of the extrahepatic biliary system is relatively common, especially vascular variations are much more frequent than anatomic variations. The normal anatomical structure is encountered in only 35 percent of individuals, many of these variations have little or no clinical improtance, but some cases induce symptoms and signs or may lead to incorrect diagnosis and inappropriate management. These are very important to correct diagnosis of biliary variations observed during ultrasonography, cholangiography and endoscopic retrograde cholangiopancreatography(ERCP) and to accurate management by surgeon or endoscopist since accidental section or ligation of aberrant structures can lead to serious complications. We experienced a very rare case of extrahepatic bile duct anomaly confirmed by ERCP. The right and left extrahepatic ducts were connected at the level of the pancreatic segment of the common bile duct and the cystic duct drains to the right extrahepatic duct. There were several stones in the distal portion of the left extrahepatic duct and gallbladder. (Korean J Gastrointeet Endosc 16: 1023-1028, 1996)

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증례 : 담도 췌장 ; 담낭 이중조영술이 수술전 진단에 유용했던 담낭 질환 2예 ( Case Reports : Biliary Tract & Pancreas ; Two Cases of Gallbladder Diseases Diagnosed with Double Contrast Study of the Gallbladder ): Korean J Gastrointest Endosc 1996;16(6):1029-1038. Published online November 30, 1995

Abstract PDF: With the developement of the conventional abdominal ultrasound, many asymptomatic gallbladder diseases are noted. The combined diagnostic modalities using abdominal ultrasound, endoscopic ultrasound and endoscopic retrograde cholangiopanereatography are useful for the diagnosis of gallbladder diseases, especially polypoid lesions. But, diagnostic accuracy or ability is not satisfactory for the detection of early gallbladder cancer, among which there are increasing trends of flat or superficial type. Many efforts were tried to diagnose these lesions through the variable methods by direct access to the gallbladder, such as percutaneous transhepatic cholecystoscopy(PTCCS). With the advent of cystic duct cannulation method, endoscopic cholecystoduodenal stenting or nasocholecystic drainage come to be available for the treatment of acute suppurative cholecystitis. Via this route, double contrast study with barium sulfate and CO2 showed fine reticular mucosal structures of the gallbladder and increased diagnostic accuracy af the flat type cancer. We report 2 cases of gallbladder diseases with early cancer confined to the mucosa and adenomyomatous hyperplasia. They were diagnosed by the double contrast method of gallbladder that was firstly introduced domestically by us after endoscopic cannulation of cystic duct and pla~eement of the catheter to the gallbladder. (Korean J Gastrointest Endosc 16: 1029-1038, 1~996)

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증례 : 담도 췌장 ; 췌장의 Retention Cyst ( Case Reports : Biliary Tract & Pancreas ; A Case of Retention Cyst of the Pancreas ): Korean J Gastrointest Endosc 1996;16(6):1039-1045. Published online November 30, 1995

Abstract PDF: A 38-year-old woman was admitted for evaluation of cyst-like lesion of the pancreas, which was incidentally found on physical check up. She has been well until the lesion was found except epigastric pain. On endoscopic retrograde pancreatogram, pancreatic head portion revealed a 2 x 2 cm sized cystic mass with marginal calcification. There was no definitive communication between pancreatic duct and cyatic mass, but amylase level of cystic content was increased. Surgical excision was performed, Microspically, the cystic wall showed flat lining epithelium with dense fibrosis and dysplastic calcification accompanied by chronic pancreatitis of adjacent pancreatic tissue. (Korean J Gastrointest 16: 1039~1043, 1996)

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