Clinical Endoscopy

원저 : 식도 위장관 ; 식도정맥류 결찰술후 O-ring 탈락부위의 출혈에 대한 N-butyl-2-cyanoacrylate ( Histoacryl ) 의 지혈효과 ( Original Articles : Esophagus , Stomach & Intestine ; Hemostatic Effect of Histoacryl for Band - induced Esophageal Ulcer Bleeding ): Korean J Gastrointest Endosc 1997;17(2):119-124. Published online November 30, 1996

Abstract PDF: Background
/Amis: Endoscopic variceal ligation(EVL) is a method to manage esophageal varices bleeding and induces mechanical ligation and strangulation of varices by using elastic O-rings. The lower complication rate seen with EVL compared to sclerotherapy can be explained by the more limited degree of local tissue injury induced by EVL. Only the mucosal and submucosal layers are aspirated into cylinder attachment of the ligating devices, thus limiting injury to these layers. But, sometimes band induced ulcer shows massive bleeding. In these cases, endoscopic therapy is very difficult. This study was performed in order to find out the effectiveness of Histoacryl ingection for band-induced esophageal ulcer bleeding, Methods: We tried to control band-induced bleeding by injecting Histoacryl in 8 cases of band-induced ulcer bleeding. Results: This therapeutic trials show exellent control of bleeding in all cases without rebleeding. Conclusions: The cyanoacrylate tissue adhesive Histoacryl(N-butyl-2-cyanoacrylate) is a remarkable substance that transforms from its original liquid state into a solid state when mixed with a physiologic medium such as blood. Histoacryl undergoes an instantaneous polymerization reaction and hardens, thereby plugging the varix or bleeding vessel lumen. Rapid hemostasis of an active bleeding occurs and rebleeding of the treated lesion is prevented. We found out that Histoacryl injection is a safe and effective treatment for band-induced ulcer bleeding. (Korean J Gastrointest Endosc 17: 119-124, 1997)

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원저 : 식도 위장관 ; 위 MALT 림프종의 내시경 소견 ( Original Articles : Esophagus , Stomach & Intestine ; Endoscopic Findings of Gastric Mucosa - Associated Lymphoid Tissue ( MALT ) Lymphoma ): Korean J Gastrointest Endosc 1997;17(2):125-131. Published online November 30, 1996

Abstract PDF: Backgroud/Aims: Helicobacter pylori is found in more than 90% of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Regression of lymphoma after H. pylori eradication was reported. Therefore, early detection of gastric MALT lymphoma is important. On reported several endoscopic findings, nonspecific gastritis with erosion and ulceration were common and there is no typical endoscopic findings. Methods: Therefore we analyzed the endoscopic findings of 16 low-grade B-cell gastric MALT lymphoma confirmed by biopsy, PCR and immunostain and compared histologic change after eradicating H. pylori infection in patients who refused operation retrospectively from March 1995 to October 1996. Results: The male: female ratio was 7:9 and mean age was 43,7 years ald (23-71 yr), On endoscopic findings of gastric MALT lymphoma, irregular shaped geographic superficial ulcer was 7 cases (43.7%), diffuse mucosal nodularity was 4 cases (25.0%) and erosion was 3 cases (18.7%). The most common site of MALT lymphoma was antrum and angle. H. pylori was positive in 87.5% (14/16 cases) and eradication of H. pylori was done in patients who refused operation and histologic improvement after H. pylori eradication was found in 62.5% (5/8 cases). Conclusion: The most common endoscopic findings of gastric MALT lymphoma was irregular geographic superficial ulcer but diffuse mucosal nodularity and erosions were also common. Therefore, biopsy must be taken, especially on the antrum and angle although nonspecific lesion may be suspected. (Korean J Gastrointest Endosc 17: 125-130, 1997)

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원저 : 식도 위장관 ; 위저선 폴립의 임상 및 병리학적 분석 : 가족성 선종성 폴립증에 동반된 다발성 위저선 폴립과 산발적으로 발생된 위저선 폴립의 비교 ( Original Articles : Esophagus , Stomach & Intestine ; Fundic Gland Polyps : A Clinical and Pathologic Analysis with Special Reference to Familial Adenomatous Polyposis ): Korean J Gastrointest Endosc 1997;17(2):133-141. Published online November 30, 1996

Abstract PDF: Background
/Aims: The aims of this study are to clarify the morphology of fundic gland polyp (FGP) and to compare the features of FGP between familial adenomatous polyposis-associated group and sporadic development group. Methods: A total of 15 endo- scopic biopsy specimens of FGP from 13 patients were divided into three groups; Group A(3 cases; familial adenomatous polyposis family, multiple FGPs), Group B(3 cases; sporadic development, multiple FGPs) and Group C(7 cases; sporadic development, single FGP), and their endoseopic /microscopic features including mucin histochemistry and immunohistoc- hemistty(for PCNA) were compared. Results: FGPs were confined to the gastric body and fundus in all 3 groups, and measured 2-8 mm. Their numbers varied even in Group A and Group B, The difference was observed in their median age: 26 years in Group A and 55 years in Group B, respectively, but there were no differences in endoscopic, histologic, mucin histochemical and immunohistochemical(for PCNA) features. Micro-scopically, all FGPs were composed of fundic glands and scattered microcysts with a spectrum of disordered glandular architecture which ranged from convoluted gland to Y-shaped gland, to stellateshaped gland, and to irregular tortuous glancl with dilated lumen. Conclusions: We assume that diversity af morphologic features of FGP may develop from progression of hyperplastic/hamartomatous fundic glandular proliferation which may end up with microcyst formation as an evolutional change. Familial adenomatous polyosis-associated FGPs were not endoscopically and histologically distingishable from sporadic deveoped FGPs. (Korean J Gastrointest Endosc 17: 133-139, 1997)

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원저 : 간 ; 바이러스간염 환자에서 복강경소견과 조직학적 소견의 비교관찰 ( Original Articles : Liver ; Comparative Study between Laparoscopic and Histologic Findings in Patients with Viral Hepatitis ): Korean J Gastrointest Endosc 1997;17(2):143-150. Published online November 30, 1996

Abstract PDF: Background
/Aims: The authors compared laparoscopic changes of the diseased liver surface according to Shimadas classification with laparoscopic needle biopsy in order to clarify whether the two diagnostic criteria have consistency or discrepancy in each other. By serologicai tests the patients with chronic hepatitis B were 179 cases, chronic hepatitis C 22 cases and NBNC hepatitis 54 cases. Histologically the patients with non-specific reactive hepatitis were 35 cases, chronic lobular hepatitis 20 cases, chronic persistent hepatitis 18 cases, chronic active hepatitis 8~5 cases, subacute hepatic necrosis 32 cases, circumscribed hepatic necrosis 9 cases and liver cirrhosis 56 cases. Methods: We performed laparoscopy on 255 patients with chronic hepatitis and laparoscopic guided liver needle biopsy was done in all cases. Results: 1) Age incidence of chronic viral hepatitis was peak in chronic hepatitis C, and then that in chronic hepatitis B and NBNC heatitis in decreasing order. 2) Code numbers of liver surfaces were mainly numbers between 200 and 300 in chronic hepatitis B and NBNC hepatitis, but those of chronic hepatitis C were numbers between 300 and 400 which meant advanced patterns. 3) Comparing macroscopic fmdings of liver surfaces with histologic diagnosis by guided liver biopsy, the consistency of two criteria was 83.9% in all cases and the discrepancy was 16.1%. 4) Among the cases with diagnostic discrepancy, the patients showing macroscopically chronic hepatitis but histologically liver cirrhosis were predominant in chronic hepatitis B under the age of 40. In contrast to this, the cases showing surface changes of liver cirrhosis but histologically chronic hepatitis was mainly in chronic hepatitis C over the age of 40. Conclusions: The above results suggest that laparoscopy and guided liver biopsy may be very useful diagnostic tools to determine correct diagnosis, adequate treatment and prognosis. (Korean J Gastrointest Endosc 17: 143-150, 1997)

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증례 : 식도 위장관 ; Barrett's Esophagus 에서 발생한 식도 선암 - 1예 보고 - ( Case Reports : Esophagus , Stomach & Intestine ; Adenocarcinoma Arising from Barrett's Esophagus - A case report - ): Korean J Gastrointest Endosc 1997;17(2):151-154. Published online November 30, 1996

Abstract PDF: Barrett's esophagus is a metaplastic process in which the squamous epithelium of the lowet esophagus is replaced by columnar epithelium. Most cases are believed to be related to prolonged gastroesophageal reflux. Detection of Barretts esophagus is important in that it results in adenocarcinoma in about 10% of patients. We report a case of adenocarcinoma arising from Barrett's esophagus in a 56 year-old man, diagnosed incidentally at a physical check-up. Grossly, the esophagogastric junction was irregular and there were two small ulcers in the lower esophagus. Microscopically, ihe squamous epithelium of the lower hagus was replaced by specialized intesinal mucosa with a small focus of adenocarcinona confined to the submucosa in one area. Many separate dysplastic foci were also present in the nearby esophageal mucosa. (Korean J Gastrointest Endosc 17: 151-154, 1997)

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증례 : 식도 위장관 ; 식도 암육종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Carcinosarcoma of Esophagus ): Korean J Gastrointest Endosc 1997;17(2):155-161. Published online November 30, 1996

Abstract PDF: More than 17 different terms, including carcinosatcoma and pseudosarcoma, have been applied to the rare polypoid tumors of the esophagus that demonstrate both carcinomatous and sarcomatous components. The multiplicity in terminology seems related to the uncertain histogenesis of these tumors. A demonstration of the ultrastructure of the spindle cells (containing desmosomes and tonofilaments) is consistent with an epithelial origin. The patient was a 53 year-old man who had suffered from dysphagia and foreign body sensation in larynx. Endoscopic finding was a large polypiod mass with ulceroinfiltrative lesion at the level of 27cm from the incisor. Pathologic findings were that the covering epithelium showed well differentiated squamous carcinoma with invasive pattern and the stroma contained islands of sarcoma and squamousl cell carcinoma. Immunoreactivity to cytokeratin was not observed. Partial esophagectomy and esophagogastrostomy was done. We report a case of rare malignant esophageal carcinosarcoma. (Korean J Gastrointest Endosc 17: 155-159, 1997)

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증례 : 식도 위장관 ; 식도에 발생한 원발성 악성 흑색종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Primary Malignant Melanoma of the Esophagus ): Korean J Gastrointest Endosc 1997;17(2):163-166. Published online November 30, 1996

Abstract PDF: Primary malignant melanoma of tbe esophagus is extremely rare and its incidence is below 0.1%. The tumor is polypoid and tend to be large, which is covered with false membrane, friable, hemorrhagic, and necrotic. Hematogenous and lymphogenic metastasis are common. Resection of the tumor with an anastomotic procedure seems to be the treatment of choice, and postoperative irradiation may be useful. But, despite these measures, prognosis is poor, with a 5-year survival of 4.2%. We report a case of 58-year-old man with primary malig- nant melanoma of the epophagus, and review of the literature in presented related studies. (Korean J Gastrointest Endosc 17: 163-166, 1997)

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증례 : 식도 위장관 ; Menetrier 씨 병 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Menetrier's Disease ): Korean J Gastrointest Endosc 1997;17(2):167-172. Published online November 30, 1996

Abstract PDF: Menetrier' disease is a rare disease characterized, histologically, by epithelial hyperplasia involving the surface and foveolar mucous cells, accompanied by atrophic or normal oxyntic glands of the stomach. The 48 year-old man with epigastric discomfort and peripheral edema was admitted to St. Paul Hospital. Gastrofiberscopic examination revealed extremely thickened mucosal fold in fundus and body especially greater curvature of stomach, and microscopically there was marked hyperplasia of foveolae and cystic dilatation. Serum albumin concentration was decreased and clearance of a1-antitrypsin was markedly increased in the stool, suggesting the protein-losing enteropathy. He was diagnosed to Menetrier's disease and treated with H2 blocker, antacids, diuretics and albumin replacement.(Korean J Gastrointest Endosc 17: 167-172, 1997)

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증례 : 식도 위장관 ; 위하수증으로 위 부분절제술 후 발생한 조기 잔위암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; One Case of Early Gastric Stump Cancer Following Partial Gastrectomy for Gastroptosis ): Korean J Gastrointest Endosc 1997;17(2):173-179. Published online November 30, 1996

Abstract PDF: Gastric stump cancer is defined as cancers that develop in the gastric remnant after the gastric resection of nonmalignant lesions or malignant lesions. The interval between gastrectomy and the detection of gastric stump cancer must be over 5 years in nonmaligant lesions and 10 years in malignant lesions. Symptoms of gastric stump cancer are not specific, so, diagnosis is often delayed. Early detection and curative operation is very important in gasric stump cancer and follow-up endoscopic examination is the most importaint diagnostic tool to detect gastric stump cancer. Recently we experienced a case of early gastric stump cancer. We report review of the literature to remind the important of gastric stump cancer and the important of follow-up endoscopic examination. (Korean J Gastrointest Endosc 17: 173-177, 1997)

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증례 : 식도 위장관 ; 조기위암에 병발한 원발성 십이지장암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; Primary Duodenal Cancer Associated with Early Gastric Cancer : A Case of Double Primary Cancer ): Korean J Gastrointest Endosc 1997;17(2):181-185. Published online November 30, 1996

Abstract PDF: A case of resected primary duodenal cancer associated with early gastric cancer is reported. A 67-year-old male complaining of nausea and vomiting was admitted. Endo- scopic examination showed an ulcerative lesion withblood clot in the angle of the stomach and stricture in the duodenum. The stomach lesion was proven to be signet ring cell carcinoma by biopsy. Exploratory laparotomy was done and frozen specimen of duodenum was revealed to be malignant. Subtotal gastrectomy and pancreaticoduodenectomy with lymph node dissection were done and the specimen from stricture of duodenum was proven to be adenocarcinoma. The gastric cancer was limited to the mucosa and metastasis was not recognized in regional lymph node, Furthermore, there was normal mucosa between gastric cancer and duodenal cancer. Therefore, cancers in the stomach and duodenum were considered to be a case of double prim~iary cancer. (Korean J Gastrointest Endosc 17: 181-184, 1997)

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증례 : 식도 위장관 ; 조기위암으로 오인된 침윤성 진행성위암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; Infiltrative Advanced Gastric Cancer Simulating Early Gastric Cancer - Case report - ): Korean J Gastrointest Endosc 1997;17(2):187-193. Published online November 30, 1996

Abstract PDF: Advanced gastric cancer simulating early gastric cancer is increasing tendcncy due to development of diagnostic technology. A 64-year-old woman was admitted for epigastric discomfort. Endoscopy showed a small white mucus coated erosion and peripheral mucosal nodurarity on greater curvature side of antrum. Biopsy was resulted in adenocarcinoma. An upper GI series and abdominal sonography were normal. At surgery, advanced gastric carcinoma, Borrmann localized type IV in background of early gastric carcinoma, prepyloric antrum along the greater curvature with infiltration to the muscle layer and multiple lymphatic tumor emboli in serosa and perigastric adipose tissue and neural invasion and metastasis to 12 out of 28 perigastric lymph nodes with extranodal extension. 3 months later, distant metastasis such as cervical lymph node, pleural effusion, pericardial effusion, peritoneal seeding and ascites were noticed. (Korean J Gastrointest Endosc 17: 187-191, 1997)

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증례 : 식도 위장관 ; 대량출혈을 동반한 십이지장 이소성 췌장 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Ectopic Pancreas of the Duodenum with Massive upper Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1997;17(2):195-199. Published online November 30, 1996

Abstract PDF: Ectopic pancreas is commonly located at stomach, duodenum and jejunum. It is a relatively rare entity and is usually of no clinical importance which especially is a very rare source of massive upper gastrointestinal bleeding. We have recently experienced a case of an ectopic pancreas in the second portion of the duodenum which was proven to be a source of massive gastrointestinal bleeding by duodenoscopy and was confirmed by surgical exploration. (Korean J Gastrointest Endosc 17: 195-199, 1997)

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증례 : 식도 위장관 ; 십이지장에서 발생한 선근종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Adenomyoma of Duodenum ): Korean J Gastrointest Endosc 1997;17(2):200-203. Published online November 30, 1996

Abstract PDF: Adenomyoma of the gastrointestinal tract has been considered to be a form of pancreatic heterotopia. Heterotopic pancreatic tissue in the gastrointestinal tract is a relatively not uncommon abnormality, but adenomyoma is a rarely reported tumor and its ineidence is difficult to determine. Adenomyoma is similar to aberrant pancreas in both appearance and location, and cannot be differentiated endoscopically or radiographically. Histologically, adenomyoma is primarily composed of smooth muscle and undifferentiated duct like structures. It is usually of no clinical importance and incidentally detected, but according to its location and size of the mass, it may become a serious clinical problem. Its real importance lies in the recognition of its existence, to facilitate a timely diagnosis, We present a case of adenomyoma of the duodenum with a brief literature review. (Korean J Gastrointest Endosc 17: 200-202, 1997)

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증례 : 식도 위장관 ; 장간막림프절염과 동반된 Yersinia enterocolitica 장염 2예의 대장내시경 소견 ( Case Reports : Esophagus , Stomach & Intestine ; Colonoscopic Findings of the Yersinia enterocolitica Enterocolitis Associated with Mesenteric Adenitis ): Korean J Gastrointest Endosc 1997;17(2):205-210. Published online November 30, 1996

Abstract PDF: Although there have been several reported cases of enterocolitis caused by Yersinia enterocolitica, its colonoscopic findings have not been reported in Korea. We recently experienced two cases of Y. enterocolitica enterocolitis, where the colonoscopic examinations were performed. Two patients visited our hospital due to right lower quadrant pain. The thickened terminal ileum and right side colon with enlarged mesenteric nodes were observed on ultrasonography using graded compression method. Y. enterocolitica was isolated from stool in both cases, The colonascopy revealed nodular elevations, erosion., hyperemia, and edema on the terminal ileum and small hyperemic erosions or aphthoid ulcers on the colon, especially on the right side of the colon. In one of the cases, the aphthoid ulcers could be also seen on the sigmoid colon. Their clinical symptoms and signs improved 3-5 days after their visit without using antibiotics. We report these cases with a review of the relevant literature. (Korean J Gastrointest Endosc 17: 205-210, 1997)

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증례 : 담도 췌장 ; 내시경적 유두괄약근 절개술로 치료된 담도결석을 동반한 Choledochocele 4예 ( Case Reports : Biliary Tract & Pancreas ; Four Cases of Choledochocele Diagnosed by Endoscopic Retrograde Cholangio - Pancreatography ( ERCP ) and Treated with Endoscopic Sphincterotomy ( EST ) ): Korean J Gastrointest Endosc 1997;17(2):211-219. Published online November 30, 1996

Abstract PDF: Choledochocele is a kind of choledochal cyst and represents a prolapse or herniation of the intramural segment of the distal common bile duct into the duodenal lumen. It is rare congenital anomaly and, easlily overlooked due to non-specific clinical symptoms, signs, and non-characteristic radiologic features. The cause of choledochocele remains uncertain and it was suggested that thete are two distinct types in the pathogenesis of it, i.e., congenital and acquired. Recently, many cases of choledochocele were reported, which diagnosed by ERCP and safely treated with endoscopic unroofing and EST followed by continued observation as well as interval ERCP and/or endoscopic ultrasonography. We present here four cases of symptomaatic choledochoceles that had been managcd by end- oscopic therapy and continucd observation. (Korean J Gastrointest Endosc 17: 211-219, 1997)

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증례 : 담도 췌장 ; 간절제술 후 발생한 기관지 담도 누공 1예 ( Case Reports : Biliary Tract & Pancreas ; Bronchobiliary Fistula Secondary to Hepatic Resection - Treatment by endoscopic retrograde biliary drainage - ): Korean J Gastrointest Endosc 1997;17(2):220-225. Published online November 30, 1996

Abstract PDF: Bronchobiliary fistula (BBF) is a rare disorder, defined as opening of a passage between the bronchial tree and the biliary tract and presence of bile in the sputum (biloptysis). BBF usually occurs either in the congenital form or following multiple causes, including mainly thoracoabdominal trauma, liver abscess, parasitic liver disease, choledocholithiasis, and post operative biliary stenosis. The cardinal clinical features were respiratory symptoms, jaundice, and cholangitis. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. To date, surgery has been favored as the most efficient therapeutic option, although percutmeous approaches, and more recently, endoscopic sphincterotomy and stent insertion, have succeeded in resolving certain kind of BBF. We are reporting a case of BBF secondary to hepatic resection of hepatocelluar carcinoma which was managed by endoscopic retrograde biliary stenting for keeping optimal bile drainage and surgical operation for resection of recurred tumor and removal of subphrenic abscess, (Korean J Gastrointest Endosc 17: 220-224, 1997)

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