Clinical Endoscopy

원저 : 식도 위장관 ; 식도정맥류 출혈시 내시경적 경화요법과 고무밴드 결찰요법의 치료 효과 ( Original Articles : Esophagus , Stomach & Intestine ; Comparison of Endoscopic Sclerotherapy & Band Ligation for the Treatment of Esophageal Variceal Bleeding ): Korean J Gastrointest Endosc 1997;17(1):1-7. Published online November 30, 1996

Abstract PDF: Background
/Aims: Endoscopic sclerotherapy is an accepted treatment for the patients with esogeal variceal bleeding, but endoscopic varicea1 band ligation, introduced by Stiegmann et al in 1986, is a new form of endoscopic treatment method, and may be safer. This study is performed to compare the effectiveness and safety of the two techniques. Methods: We compared endoscopic sclerotherapy and endoscopic ligation in 10~8 patients who had recently bled from esophageal varices. We assessed the hemostatic efficacy for bleeding varices, the number of sessions of treatments needed to eradicate varices, the incidence of complications, rebleeding rate and survival rate of the patients by two techniques. Results: Active bleeding was well controlled by sclerotherapy in all of six patients, and ligation in all of five patients by the initial treatment. The mean number of treatment sessions required to achieve eradication did not significantly differ between sclerotherapy and ligation(2.4+0.8 vs 1.8+ 1.0 sessions). Complications were less comman in ligation than sclerotherapy; chest discomfort(5.6% vs 29.6%), fever(3,7% vs 16.7%), esophageal ulcer(0% vs 5.6%), esophageal stricture(0% vs 3.7%). The rate of recurrent bleeding was significantly lower in the patients treated with ligation(p<0.05). The overall rate of survival was significantly higher in the patients treated with ligation(p<0.05), The days of hospitalization was significantly shorter in the patients treated with ligation than sclerotherapy(14.8+-7.0 vs 21.0+-9.7 days). Conclusions: The patients with esophageal variceal bleeding treated with endoscopic ligation have fewer treatment-related complications, lower rates of rebleeding and better survival rates. (Korean J Gastrointest Endosc 17: 1-7, 1997)

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원저 : 식도 위장관 ; 위암에서 내시경적 초음파단층술의 유용성에 대한 평가 ( Original Articles : Esophagus , Stomach & Intestine ; Evaluation of Endoscopic Ultrasonography in Gastric Carcinoma ): Korean J Gastrointest Endosc 1997;17(1):8-14. Published online November 30, 1996

Abstract PDF: Background
Endoscopic Ultrasonography(EUS), a combination of endoscopy and ultrasonography is one of the most useful tools for diagnosis of digestive system diseases. EUS is useful in staging the primary tumor invasion and regional lymph node metastasis because of its ability to image the gut wall and adjacent structures in unique detail. We performed a study preoperatively for assessing the accuracy and limitation of EUS in gastric carcinoma. Methods: In 75 patients(Male 54, Female 21, Mean age 62.3 years) with a gastric carcinoma confirmed by endoscopic biopsy, we performed EUS preoperatively. The results were compared with the postoperative histopathologic staging. Results: 1) In assessing the depth of tumor invasion, EUS accuracy on depth of invasion was 76.0% and overstaging and understaging were 14.7% and 9.3%, respectively. 2) In assessing the lymph node metastasis, the accuracy rate of EUS was 65.3%. A rate of false-positive diagnosis was 27.3%, and a rate of false-negative diagnosis was 24.5%. 3) In assessing the incidence of lymph node metastasis for each T stage, the involve rate was 10.5% in pT1, 36.4% in pT2, 95.7% in pT3, 100% in pT4. Conclusions: EUS is the most accurate diagnostic methods presently available to determine tumor infiltration depth and lymph node metastasis. (Korean J Gastrointest Endosc 17: 8-14, 1997)

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원저 : 담도 췌장 ; 복강경 담낭 절제술에 있어서 내시경적 역행성 담췌관 조영술의 역할 ( Original Articles : Biliary Tract & Pancreas ; The Role of Endoscopic Retrograde Cholangiopancreatography in Laparoscopic Cholecystectomy ): Korean J Gastrointest Endosc 1997;17(1):15-22. Published online November 30, 1996

Abstract PDF: Background
/Aims: Perioperative endoscopic retrograde cholangiopancreatography (ERCP) and en copic sphincterotomy (EST) offer the ability to remove common bile duct (CBD) stones and it ean make laparoscopic cholecystectcqny possible instead of open cholecystectomy. Although ERCP accurately detects CBD stones, the associated financial costs and potential morbidity argue against its indiscriminate use. Thus, we undertook the current retrospective study to analyze our own experience in the identification of preoperative indicators of CBD stones in patients managed by laparoscopic cholecystectomy. Methods: Between October 1994 and October 1996, 503 laparoscopic cholecystectomy were performed at Samsung Medical Center. We analyzed the value of serum biochemical tests and findings of ultrasonography in patients ted by laparoscopic cholecystectomy. Results: A total of 117 patients underwent perigperative ERCP; 113 patients underwent preoperative ERCP with 2/113 (1.8%) failing to cannulate the ampulla; 21 patients (18.0%) had choledocholithiasis; and all patients with CBD stones were cleared by EST without major complications. The indication of ERCP for prediction of CBD stones were categorized as 4 groups; abnormal liver function tests (LFT) and duct dilatation in ultrasonography 61.9% (13/22), only abnormal liver function tests 13.6% (6/44), only duct dilatation in ultrasonography 5,9% (1/17), and normal liver function tests with normal findings in ultrasonopaphy 2.9% (1/35) in this study. In patients with CBD stones, there was no significant difference to predict CBD stones in total bilirubin, alkaline phosphatase, and alanine aminotransferase. Gallstone pancreatitis patients who had hyperamylasemia and abnornal LFT that were resolved or resolving before ERCP revealed no CBD stones (0/10, 0%). Conclusions: ERCP before laparoscopic cholecystectomy is needed in selected patients who have abnormal liver function and/or CBD dilatation on ultrasonography. Gallstone pancreatitis that is resalving or resolved clinically may not require preoperative ERCP. ERCP with EST and laparoscopic cholecystectomy is a safe and effective method for the management of symptomatic eholelithiasis and choledocholithiasis. (Korean J Gastrointest Endosc 17: 15~22, 1997)

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원저 : 담도 췌장 ; 간외담관 담석증에서의 초음파내시경의 진단적 유용성 ( Original Articles : Biliary Tract & Pancreas ; Effectiveness of Endoscopic Ultrasonography in Detecting the Extrahepatic Choledocholithiasis ): Korean J Gastrointest Endosc 1997;17(1):23-31. Published online November 30, 1996

Abstract PDF: Backgroud/Aims: Ultrasonography is the easiest, fastest procedure for the diagnosis of choledocholithiasis, but the diagnostic failure are mostly because of the intrapancreatic level of this condition and the absence of bile duct dillatation. Endoscopic ultrasonography is a promising procedure for the diagnosis of extrahepatic cholestasis due to noninvasiveness and accuracy in the digestive gas interposition. The aim of this study was to prospectively compare the diagnostic accuracy of endoscopie ultrasonography with abdominal ultrasonography and endoscopic retrograde cholangiography in 66 patients with suspected choledocholithiasis. Methods: All of the patients had abdominal ultrasonography, endoscopic ultrasonography ~and endoscopie retrograde cholangiography within 72 hours and final diagnosis was determined by endoseopic retrograde cholangiography with sphincterotomy. Results: (l) Choledocholithiasis was confirmed in 45 patients: Thirteen patients had nondilated common bile ducts and 20 patients had stones with diamerer < 1 cm. (2) Endoscopic ultrasonography was more sensitive(95.5%) than abdominal ultrasonography (44.4%: P<0.0001) and similar to endoscopic retrograde cholangiography (97.8%). Specificity was same as 100% in 3 diagnostic tools. (3) Endoscopic ultrasonography was superior to abdommal ultrasonography for the diagnosis of choledocholithiasis with nondilated common bile duct(100% vs 15.3%, P<0.0001) and with less than 1cm sized small stone(100% vs 10.0%, P<0.0001). Endoscopic ultrasonography results did not depend on stone diameter or common bile duct dilatation. Conclusions: Endoscopic ultrasonography could be an accurate and safe diagnostic tool for the diagnosis of choledocholithiasis and could be promising especially in the cases with difficult cannulation of bile duct and gal1 stone pancreatitis. (Korean J Gastrointest Endosc 17: 23-31, 1997)

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원저 : 담도 췌장 ; 췌담도계 질환에서 관내 내시경 ( Intraductal endoscope ) 의 유용성 ( Original Articles : Biliary Tract & Pancreas ; Usefulness of Intraductal Endoscopy for Pancreaticobiliary Disease ): Korean J Gastrointest Endosc 1997;17(1):32-40. Published online November 30, 1996

Abstract PDF: Background
/Aims: The aim of this study was to evaluate the usefulness of intraductal endoscopy in pancreaticobiliary tract disease by means of percutaneous cholangioscopy(PCS), peroral cholangioscopy(POCS) and peroral pancteatoscopy(POPS). Methods: PCS was performed in 33 patients, including 24 patients with biliary tract stones, and 8 patients with malignant biliary tract disease, and one with villous adenoma of common bile duct(CBD), POCS was performed in 5 patients, including two with cholangiocarcinoma, two with icteric hepatoma and one with benign stenosis of bile duct. POPS performed in 6 patients, ineluding 3 patients with chronic pancreatitis, two with pancreatic cancer and one with mucinous ductal ectasia. Results: 1. Complete removal of the stones was achieved in 22 of 24 patie~nts(91.7%). 2. Accuracy rate of forceps biopsy in PCS was achieved 13 fo 14 patients(92.9%). 3. Success rate of therapeutic PCS was 100%. 4. Accuracy rate of forceps biopsy in POCS was achieved 3 of 5 patients(60%). 5. Diagnostic gain of POPS was achieved 5 of 6 patients(83.3%). 6. There was no serious complications with only mild complications in 3 patients, including mild bleeding in 2 patients and cholangitis in only one. Conclusions: Intraductal endoscopy of biliary tract, including PCS and POCS were useful diagnostic and therapeutic methods with advantages of direct visualization of intraductal disease and POPS using ultrathin pancreatoscope could provide direct assessment of the pancreatic duct. (Korean J Gastrointest Endosc 17: 32-40, 1997)

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증례 : 식도 위장관 ; 유경성 식도 지방 육종 1예 보고 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Pedunculated Liposarcoma in Esophagus - A case report - ): Korean J Gastrointest Endosc 1997;17(1):41-47. Published online November 30, 1996

Abstract PDF: Liposarcoma in esophagus is rare, moreover the pedunculated form is very rare. We experienced a case of liposarcoma in a 36-year-old man who had intermittent swallowing difficulty for 7 months. Endoscopy and esophagography revealed that a smooth longitudinal tumor mass occupied the esophageal lumen. Esophagotomy and surgical excision was done. The tumor was 4 cm in length and 3 cm in average diameter with an obvious stalk measuring 3.5 cm in length and 1.5 cm in diameter. Microscopic examination disclosed a lipoma with focal ulceration and liposarcomatous change infiltrating into interstitial fibrous tissue at its distal end. (Korean J Gastrointest Endosc 17: 41-46, 1997)

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증례 : 식도 위장관 ; 생선뼈에 의해 형성된 기관 식도루에서 Fibrinogen - thrombin glue 로 치유된 기관 식도루 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Tracheoesophageal Fistula Caused by Fish Bone Induced Trauma with Complete Healing by Using the Fibrinogen - thrombin Glue ): Korean J Gastrointest Endosc 1997;17(1):49-54. Published online November 30, 1996

Abstract PDF: Tracheoesophageal fistula is a rare disease of abnormal communication between esopha- gus and respiratory system. The common causes are the acquired origins in adult such as trauma, infection of the adjacent organs, malignant tumor, and foreign body. Among the traumatic origins, chemical drug, the procedure of the dilatation on the stenotic area, blunt trauma(fall, collisions), penetrating trauma(bullet, knife), and pressure injury are much more common than others. Recently, trauma and foreign body in the esophagus and bronchus are becoming the main cause of the tracheoesophageal fistula, however the frequency of the development of tracheoesophageal fistula caused by the infectious diseases is getting decreased. Fibrinogen-thrombin glue stimulates the healing process of the wound and the ulcer. We treated a 52-year-old male patient with nan-inalignant tracheoesophageal fistula, who had symtoms of pharyngolaryngeal and chest discomfort concomitant with a paroxysmal cough on swallowing food which were caused by fish bone. The diagnosis of tracheoesophageal fistula was made by the esophagogram, chest CT, and esop aecopy. By using the therapeutic endoscopy with an injection of the fibrinogen-glue, the tracheoesopeal fistula was obliterated completely with dramatic symptomatic improvement. Here we conqluded that this method would be the one of the best methods for the treatment of tracheoesophageal fistula. (Korean J Gastrointest Endosc 17: 49-54, 1997)

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증례 : 식도 위장관 ; 만성복통을 주증상으로 한 면역기능이 정상인 소아에서 발생한 식도 캔디다증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Esophageal Candidiasis Presenting Recurrent Abdominal Pain in an Immunocompetent Child ): Korean J Gastrointest Endosc 1997;17(1):55-58. Published online November 30, 1996

Abstract PDF: Candida albicans is the most common cause of infectious esophagitis and usually is an opportunistic infection in immunocompromised patients. Dysphagia and odynophagia are the usual presenting complaints and, importantly, oral lesions are absent in 50 percent of patients. The role of gastrointestinal endoscopy in diagnosing fungal infections of the esophagus is primary. It is the most definitive and often the only method of detecting esophageal candidiasis. Accurate endoscopic diagnosis by biopsy or brushing leads to the initiation nf effective therapy. We have experienced a case of esophageal candidiasis in an 11-year-old girl who was immunologically normal and whose main symptoms were epigastric abdominal pain and nausea for 4 months. The endoscopic and pathologic findings of esophageal candidiasis were presented. (Korean J Gastrointest Endosc 17: 55-58, 1997)

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증례 : 식도 위장관 ; 상부위장관 출혈을 동반한 십이지장 평활근종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Duodenal Leiomyoma Presenting with Upper Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1997;17(1):59-65. Published online November 30, 1996

Abstract PDF: Leiomyoma is a neoplasm of smooth muscle relatively common in the stomach, but very rare in the duodenal location. Recurrent bouts of severe melana remain the most frequent presenting symptom for leiomyoma. A 69-year-old man presented to us with a 4-day history of melena. Endoscopy revealed norinal mucosa covered ovoid elevated lesion with central linear depression and ulcer at the second portion of duodenum. Endoscopic biopsy showed chronic inflammation only. Duodenal mass was excised through a duodenotomy. Pathological diagnosis was leiomycena. (Korean J Gastrointest Endosc 17: 59-63, 1997)

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증례 : 식도 위장관 ; 십이지장 유두부에 발생한 악성 Carcinoid 종양 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Malignant Carcinoid Tumor of the Ampulla of Vater ): Korean J Gastrointest Endosc 1997;17(1):67-71. Published online November 30, 1996

Abstract PDF: Carcinoid tumor of the ampulla of Vater comprises about 2.0-8.9% of the gastrointestinal earcinoid tumors and 3-5.5% of the duodenal tumor. The climcal manifestations of the carcinoid tumor of the ampulla of Vater are jaundice, hemorrhage, obstruction of duodenurn, or carcinoid syndrome. But the symptoms of carcinoid tumor are nonspecific and diagnosis is delayed until far advanced state, usually. Recently we experienced one case of carcinoid tienor in a 33-year-old woman who had epigastric pain and intermittent melena, so we report it with a review of the literature (Korean J Gastroinfest Endosc 11: 67-71, 1997)

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증례 : 식도 위장관 ; 십이지장 제2부에 전이된 자궁경부암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of the Cervical Carcinoma Involving the Second Portion of the Duodenum ): Korean J Gastrointest Endosc 1997;17(1):72-77. Published online November 30, 1996

Abstract PDF: In Korea, careinoma of the cervix is the most common malignancy in women annually affecting 25 per every 100,000 female. The widespread use of the Papanicolaou smear has resulted in earlier detection of the tumor and a reduction in the number of patients with advanced disease, but the incidence of cervix. carcinoma is still the fifth most common malignancy in the world. Cervical carcinoma spreads to the small bowel primarily by direct extension from involved lymph nodes, most commonly from peraaortic or mesenteric nodes to the serosa of the bowel. But, the involvement of small bowel by cervical carcinoma is so rare, and shows a maximum incidence of small bowel involvement of less than 1.5%. We report a patient with squamous cell carcinoma of the cervix metastases to the second portion of the duodenum in whom the diagnosis was made by endoscopic biopsy of the lesion. (Korean J Gaistrointest Endosc 17: 72-76, 1997)

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증례 : 식도 위장관 ; 교원성 대장염 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Collagenous Colitis ): Korean J Gastrointest Endosc 1997;17(1):79-84. Published online November 30, 1996

Abstract PDF: The term "collagenous colitis" was coined by Lindstrom in 1976 to describe the patient with chronic watery diarrhea who had normal rectal mucosa by proctoscopy but who had a thick subepithelial collagenous deposit on biopsy, and now collagenous colitis is recognized as one of the more common causes of chronic diarrhea of obscure origin. But in this country only a few case has been reported. We have seen a 68-year-old man with chronic watery diarrhea with abdominal pain. Physical examination, laboratory and radiologic studies were no abnormal finding. Colonoscopy disclosed grossly normal mucosa through the entire colon but by histologic examination there are chronic inflammation in the lamina propria and thickened subepithelial collagen layer. Symptoms and pathologic findings of patient improved after treatment with sulfasalazine and prednisolone. (Korean J Castraintest Endosc 17: 79-84, 1997)

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증례 : 담도 췌장 ; 유두괄약근 절개술후 황달이 개선된 담관 점액성 낭선종 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Biliary Mucinous Cystadenoma : Improved Jaundice after EST ): Korean J Gastrointest Endosc 1997;17(1):85-91. Published online November 30, 1996

Abstract PDF: Biliary cystadenoma is a rare biliary ductal neoplasm that usually arises in the liver and less frequently in the extrahepatic bile ducts. Clinical manifestations are non-specific; hence preoperative diagnosis depends heavily on imaging. Computed tomography, ultrasonography, angiography and cholangiogram are useful diagnostic procedures in biliary cystic tumor, but definite diagnosis depends on histologic diagnosis. Surgical resection often yields excellent results. Surgical procedures used to treat cystadenomas include: aspiration, drainage, marsupialization, and excision. If there is no evidence of metastasis, complete resection of these tumors is necessary for a complete cure. We experienced an 80-year-old man who complained of jaundice and RUQ pain. He was diagnosed as biliary mucinous cystadenoma, We confirmed our diagnosis by cholangioscopic biopsy, and performed endoscopic sphincterotomy(EST). So, we report this case and have reviewed the relevant literature as a part of our report for the subject case. (Korean J Gastrointest Endosc 17: 85-90, 1997)

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증례 : 담도 췌장 ; 십이지장 유두부 암을 동반한 간문부 담관암 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Hilar Cholangiocarcinoma Combined with Carcinoma of the Ampulla of Vater ): Korean J Gastrointest Endosc 1997;17(1):93-98. Published online November 30, 1996

Abstract PDF: Hepatie hilar ductal carcinoma is relatively rare, but the prognosis is known to be poor because an early diagnosis is difficult. Because the majority of patients are already infiltrated into adjacent organ by itself at the diagnosis, the rate of resectability is low. The best method of treatment is curative resection, and the range of tumor invasion is very important. The preoperative diagnosis is difficult because the cholangiography may be normal in cases of superficial invasion. Multifocal lesions within the biliary tract may be identified in as many as 10 percent of patients, Especially, the papillary type has the best prognosis and is associated with multiple tumors within the bile duct. We report a case that percutaneous transhepatic cholangiogram showed normal distal common bile duct, but the hepatic hilar confluence and ampulla of Vater lesion was confirmed as adenocarcinoma. (Korean J Gastrointest Endosc 17: 93-98, 1997)

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증례 : 담도 췌장 ; 원발성 경화성 담관염에서 발생했다고 추정되는 담관암종 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Cholangiocarcinoma Suggested as Developing in the Patient with Primary Sclerosing Cholangitis ): Korean J Gastrointest Endosc 1997;17(1):99-104. Published online November 30, 1996

Abstract PDF: Primary sclerosing cholangitis is a chronic disease of unknown cause, characterized by inflammation and fibrosis of the biliary tree with diffuse multifocal stricture formation. With increasing knowledge of primary sclerosing cholangitis, it is now recognized that in the setting of inflammatory bowel disease, cholangiocarcinoma is a complication of primary sclerosing cholangitis. We recently experienced a case of 41 year old female patient who had Crohns disease associated with primary sclerosing cholangitis and cholangioearcinoma. We report a case of primary sclerosing cholangitis with cholangiocarcinoma with literature review. (Korean J Gastrointest Endosc 17: 99~104, 1997)

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증례 : 담도 췌장 ; 내시경적 역행성 췌담도 조영술로 진단한 Fascioliasis 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Fascioliasis Diagnosed by ERCP ): Korean J Gastrointest Endosc 1997;17(1):105-110. Published online November 30, 1996

Abstract PDF: Fascioliasis is a zoonotic disease caused by Fasciola hepatica, a liver fluke, for which human acts as an accidental host. Fascioliasis, while common in some tropical countries, is rare in Korea. Endoscopie retrograde cholangiopancreatography(ERCP) has been described in only a very few cases as a useful technique for the diagnosis of fascioliasis. We report a case of fascioliasis diagnosed by ERCP, after endoscopic sphinchterotomy adult worms were removed by Dormia basket. (Korean J Gastrointest Endosc 17: 105-109, 1997)

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