Clinical Endoscopy

원저 : 식도 위장관 ; 연소성 용종의 임상 및 내시경학적 분석 ( Original Articles : Esophagus , Stomach & Intestine ; Clinical and Endoscopic Analysis of Juvenile Polyps ): Korean J Gastrointest Endosc 1997;17(4):485-493. Published online November 30, 1996

Abstract PDF: Background
This study was undertaken to review cases of juvenile polyps with respect to clinical and endoscopic features. Methods: Of the 544 cases of colonoseopic polypectomies performed from Jan. 1 to Jan. 1997, 14 cases(2.6%) involved juvenile poiyps. Those 14 cases were analyzed with special consideration given to colonoscopic aspects. Results: The most common age groups were the fifth and the sixth decades, comprising 50%. There were two children below 10 years of age. Males were predominant in the ratio of 1.3:1. Rectal bleeding was the most common symptom, and 4 cases were asymptomatic. Mediumsized(6-10 mm) polyps were the most common, 7 eases(50%), and large(>1 cm) polyps were the next most common, 5 cases(35.7%). The first predilection of site was the rectum, 8 cases(57.1%); the second was the sigmoid colon with 5 cases(35.7%). Grossly, pedunculated polyps were the largest in number, accountieg for 64.3% of the cases; the others were all subpedunculated. In 9 cases(64.3%), the preoperative macroscopic diagnoses were consistent with the final diagnoses; in the other cases, the polyps were initially diagnosed as being adenomatous. Adenomatous and inflammatory polyps were associated with 3 cases, who were all men. White spots were noticed around the polyp base in 4 cases (28.6%); the clinical significance of those should be investigated further. All 14 patients underwent polypectomy by endoscopic snare resection without any complications. Conclusions: Colonoscopy should be the main tool for diagnosis and treatment of juvenile polyps. Juveoile polyps should be taken into account in cases of rectal bleeding and need to be differentiated from adenomatous polyps. Endoscopic polypectomy is an adequate procedure for the treatment of a solitary juvenile paiyp. (Korean J Gastrointest Endosc 17: 485-493, 1997)

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원저 : 식도 위장관 ; 대장경 전처치제로서 Fleetⓡ 와 Colonlyteⓡ 의 비교 ( Original Articles : Esophagus , Stomach & Intestine ; A Comparison of Fleet with Colonlyteⓡ for Precolonoscopic Preparation ): Korean J Gastrointest Endosc 1997;17(4):494-500. Published online November 30, 1996

Abstract PDF: Backgronnd/Aims: Recent reports have suggested that precolonoscopy bowel preparation is easier to tolerate if a small volume solution is used. The aim of this study was to compare oral sodium phosphate with polyethylene glycol solution in terms of the quality of colon cleansing, ease of preparation, and gastrointestinal intolerance. Methods: Sixty one patients were prospectively randomized to receive either a standard 4-liter polyethylene glycol solution or a 90 ml oral sodium phosphate preparation. Before and after bowel preparation all patients were weighted, and serum electrolytes were measured. Patients were asked to record the effects of the preparation and to give it a "discomfort rating" on a scale from 1 to 5. Surgeons were blinded to the preparation used and rated the quality of bowel cleansing on a scale of 1 to 5. Results: The smaller volume of oral sodium phosphate was not associated with any clinically significant problem,caused no increase in the incidence of side effects, was preferred by patients, and was effective in colonic cleansing. The incidence of sleep disturbance, abdominal pain, nausea, vomiting, anal discomfort, chest pain, chilling and dizziness associated with oral sodium phosphate was similar to that with polyethylene glycol lavage. Abdominal distension was more common with polyethylene glycol lavage and statistical difference was seen(P<0.01). There were no clinically significant changes in any biochemical parameters and vital signs caused by precolonoscopic preparation except asymptomatic hyperphosphatemia in the sodium phosphate group that was not statistically different. The decreased body weight was seen with Colonlyte that was statistically different(P <0.01). Conclusion: The overall quality of bowel preparation with oral sodium phosphate was similar to that with polyethylene glycol lavage. Patients tolerated preparation with oral sodium phosphate to be somewhat easier than polyethylene glycol lavage. Therefore, we conclude that the use of oral sodium phosphate as a precolonoscopy bowel preparation is clinically useful. (Korean J Gastrointest Endosc 17: 494-500, 1997)

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원저 : 담도 췌장 ; 십이지장 유두주위 게실과 담석의 연관성 ( Original Articles : Biliary Tract & Pancreas ; Association of Periampullary Diverticula with Primary Choledocholithiasis but not with Secondary Choledocholithiasis ): Korean J Gastrointest Endosc 1997;17(4):501-506. Published online November 30, 1996

Abstract PDF: Background
/Aims: Several endoscopie studies found an association between periam- puilary diverticula and biliary calculi, however, the results of the reports are inconsistent when considering the anatomical location of the stones. The aims of our study are to evaluate the association between periampullary diverticula and gallstones according to their location iand to clarify the origin of the common bile duct stones by analyzing the composition of the stones. Methods: During a period of 10 months, 611 of 632 consecutive cases of endoscopic retrograde cholangiopancreatography(ERCP) were prospectively en- rolled. The data of periampullary diverticula and gallstones were analyzed according to the location of the stones. The stones available were initially grouped on the basis of their grass marphology and cross-sectional appearance, and finally analyzed by quantitative infrared spectroscopy. (Korean J Gastrointest Endosc 17: 501-506, 1997) (continue)

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원저 : 담도 췌장 ; 담도계 담석과 십이지장 유두 주위부 게실과의 관계 ( Original Articles : Biliary Tract & Pancreas ; The Relationship between Biliary Calculi and Juxtapapillary Duodenal Diverticuli ): Korean J Gastrointest Endosc 1997;17(4):507-512. Published online November 30, 1996

Abstract PDF: Background
/Amins: Juxtapapillary duodenal diverticuli are often associated with biliary stones. The aim of this study was to investigate the prevalence of juxtapapillary duodenal diverticuli in biliary stones. Methods: Three hundred and thirteen patients underwent endoscopic retrograde cholangiopancreatography were studied prospectively. Results: Seventy-five patients had juxtapapillary duodennl diverticuli(24%). The occurrence of diver- ticuli increased with age and more commomly in female patients. The prevalence of diver- ticulii was higher in patients with commom bile duct stones(35.6% vs 17.6%; P 0.002) and gallbladder stones(33.3% vs 17.6%; P=0,001) than in patients without biliary stones (17.6%). Conclusions: We conclude that biliary stones are associated with juxtapapillary diverticuli. (Korean J Gastrointest Endosc 17: 507-512, 1997)

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증례 : 식도 위장관 ; Behcet 씨병에 의한 식도궤양 및 내시경 소견 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Esophageal Ucerations in Behcet's Disease its Endoscopic Finding ): Korean J Gastrointest Endosc 1997;17(4):513-517. Published online November 30, 1996

Abstract PDF: Behcet's disease is a chronie inflammatory symptom complex consisting of recurrent oral ulcer, genital ulcer, ocular lesion or skin lesion. Intestinal involvement in Behcet's disease most commonly affects the ileocecal region in the patient with gestrointestinal symptoms, But esophageal involvement in Behcet's disease is very uncommon, most commonly affects the midesophagus with localized ulcerative lesion. A 38-Year-old woman with refractory and recurrent oral and genital ulcer was admitted because of aggravation of pharyngodynia and dysphagia. Gastrofiberscopic examination showed multiple, small sized ulcers on oral cavity and mid-to-distal esophagus. She was treated with steroid. (Korean J Gastrointest Endosc 17: 513-516, 1997)

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증례 : 식도 위장관 ; 식도와 S상 결장에 병발한 림프관종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Lymphangiomas of the Esophagus and Sigmoid Colon ): Korean J Gastrointest Endosc 1997;17(4):519-522. Published online November 30, 1996

Abstract PDF: Lymphangiomas are benign tumors of lymphatic vessels, which can occur anywhere the lymphatics exist. The lymphangioma of the esophagus is exceedingly rare. Seven cases had reported in the world and there is no case report about the lymphangioma of the esophagus in our country. So we present one case of lymphangiomas that coexist in esophagus and sigmoid colon. This kind of case don't have been reported yet. (Korean J Gastrointest Endose 17: 519-522, 1997)

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증례 : 식도 위장관 ; 식도이완 불능증 환자에서 발생한 폐농양 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Lung Abscess in an Achalasia Patient ): Korean J Gastrointest Endosc 1997;17(4):523-528. Published online November 30, 1996

Abstract PDF: Esophagea1 achalasia is a disease of unkown etiology characterized by abscenee of per- istalsis in the body of the esophagus and failure of the lower esaphageal sphincter to relax in response to swallow. The cause has been suggested by the lack or abscence of ganglion cell in Auerbach's plexus. About 10% of patients with achalasis develop pulmonary complication such as aspiration pnuemonia, pulmonary fibrosis, pulmonary tuberculosis, culosis, bronchiectasis, lung abscess and bronchial asthma. Although aspiration pneumonia is the most common pulmonary complication in patients with achalasia, lung abscess is the extremely rare complication. A 48 years old female, who has experienced dysphagia and regurgitation for several years, is hospitalized because of high fever, cough and sputurn for 2 weeks. Lung abscess in apicoposterior segment of left upper lobe is observed in X-ray and chest CT. The findings of esophagogram, esophagogastroscopy and esophageal manometry are consistent with achalasia. We report a case of lung abscess associated with achalasia. (Korean J Gastrointest Endosc 17: 523-528, 1997)

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증례 : 식도 위장관 ; 척추 측만에 의한 압박 부위를 한 번 생검후 발생한 식도 파열 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Esophageal Perforation by an Endoscopic Biopsy ): Korean J Gastrointest Endosc 1997;17(4):529-532. Published online November 30, 1996

Abstract PDF: The esophagus or stomach can be perforated during diagnostic upper endoscopy in 0.03 to 0.1 percent. Instrumentation injury, as a whole, is probably the most common single cause of all cases of esophageal perforation. Most of the esophageal perforation result from either therapeutic maneuvers(dilation, sclerotherapy, foreign-body removal etc.) or underlying esophageal lesion(such as strictures or diverticular or neoplasm). Endoscopic perforation of the esophagus may be obvious immediately or within a few hours. Cervical pain, subcutaneous emphysema, fever, tachycardia, and characteristic radiographic appearances make the diagnosis easy, but some distal esophageal injuries are subtler, An immediate esophagogram should be obtained if peirforation is suspected. To select an appropriate course of management, precise delineation of location and the extent of perforation is necessary. The esophageal perforation can be managed conservatively by close observation, esophageal rest, and antibiotic coverage, but the mortality rate of medical treatment is near 12%. Causes of death are sepsis and multisystem organ failure. So we report a case of esophageal perforation by an endoscopic biopsy. (Korean J Gastrointest Endosc 17: 529-532, 1997)

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증례 : 식도 위장관 ; 식도와 십이지장에 병발한 중복암 1예 - 십이지장 선암과 식도 편평상피 세포암 - ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Concurrent Esophageal and Doudenal Double Primary Cancer ): Korean J Gastrointest Endosc 1997;17(4):533-539. Published online November 30, 1996

Abstract PDF: The occurrence of double primary cancer of the esopbagus and duodenum is considered very rare. Moreover, it is difficult to manage this type of double cancer because esophageal cancer has a biologic tendency to early metastasis. We report a case of double primary cancer, which we have synchronously confirmed esophageal squamous cell carcinoma and duodenal adenocarcinoma with gastrofiberscopic biopsy, and then treated them by gastrojejunostomy and systemic chemotherapy. (Krean J Gastrointest Endosc 17: 533-538, 1997)

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증례 : 식도 위장관 ; 위 및 전 소장을 침범하고 말단 회장 천공을 동반한 Behcet 병 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Behcet's Disease Involving Stomach and Entire Small Intestine Tereminal Ileum Perforation ): Korean J Gastrointest Endosc 1997;17(4):541-547. Published online November 30, 1996

Abstract PDF: Behcet's syndrome is a multisystemic, chronic inflammatory disease with triad of oral ulcer, genital ulcer and inflammatory ocular lesion. Intestinal Behcet's disease accounts for 1-2% of Behc'ets disease and most commonly affects the ileocecal region as ulcerations. A 70-year-old male patient was admitted to this hospital because of melena for 5 days. There was a history of recurrent aphthous stomatitis and genital ulcer. Colonoscopy showed multiple, irregularly, rnarginated, ellipsoid ulcers surrounded by hyperemic mucosa with vessel exposure on terminal ileum. Esophagogastroduodenoscopy showed multiple, round punched out ulcers on antrum and duodenal bulb. He was taken the near total small bowel resection, right hemicolectomy and ileotransverse colostomy because of hemorrhage and terminal ileal perforation. Three days after operation, melena reappeared and esopbagogastoduodenascopy revealed bleeding from duodenal ulcers and impending perforation of antral ulcer. He was reoperated with antrectomy, truncal vagotomy and gastroduodenostomy. Resected small bowel was 510 cm in length and there were multiple small round transverse ulcers surrounded by hyperemic edematous elevated rnucosa. Three 'punch-out ulcers' were also found on resected gastric antrum. So, we report a case of gastrointestinal Behcet's disease involving stomach, duodenum, jejunum and ileum with terminal ileum perforation. (Korean J Gastrointest Endosc 17: 541-547, 1997)

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증례 : 식도 위장관 ; 대장의 과형성성 용종증을 동반한 위장의 과형성성 용종증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Hyperplastic Polyposis Associated with Colonic Hyperplastic Polyposis ): Korean J Gastrointest Endosc 1997;17(4):548-555. Published online November 30, 1996

Abstract PDF: Gastric polyps are uncommon. The incidence of gastric polyps has been reported between 0.4% and 2.0%. Two histologically distinct forms of gastric polyps are hyperplastic polyps and adenomatous polyps. Hyperplastic polyps are multiple in up to a half of cases. When the polyps number is more than 50, the term "Hyperplastic polyposis" is applied and such cases are even more rare. Polypoid lesions of the stomach have heen reported in many of the polyposis syndromes, such as Familial polyposis coli, Gardners syndrome, Peutz-Jeghers syndrame, Juvenile polyposis and Cowdens disease. Only 1 case of gastric hyperplastic polyposis associated with colonic hyperplastic polyposis has been reported. The patient under study is not included in any polyposis syndrome and has no familial tendency, We report a case of gastric hyperplastic polyposis with colonic hyperplastic polyposis with literatures reviews. (Korean J GAtrointest Endosc 17: 548-553, 1997)

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증례 : 식도 위장관 ; 궤양성 대장염 치료 중 합병된 거대세포바이러스 대장염 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Cytomegalvirus Colitis Developed during the Treatment of Ulcerative Colitis ): Korean J Gastrointest Endosc 1997;17(4):557-560. Published online November 30, 1996

Abstract PDF: Cytomegalovirus colitis has been reported infrequently in patients with underlying inflammatory bowel disease, and usually in those who are taking corticosteroid drugs. It has been implicated as a possible exacerbating factor of ulcerative colitis. We experienced a case of cytomegalovirus colitis developed in patient with ulcerative colitis during corticosteroid therapy. So we report the case with a brief review of literatures. (Korean J Gastrointest Endosc 17: 557-560, 1997)

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증례 : 식도 위장관 ; 대장내시경으로 진단된 게실염에 의한 장중첩증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Diverticulitis Associated with Intussuseption Diagnosed by Colonofiberscopy ): Korean J Gastrointest Endosc 1997;17(4):561-567. Published online November 30, 1996

Abstract PDF: Intussusception is defined as the telescoping of one segment of the gastrointestinal tract into an adjacent one. The incidence of the adult intussusception is low. It constitutes approx- imately 5% of all intussusception and accounts for 5% of all cases of intestinal obstruction in adult. The clinical feature in adults is not typical. General symptoms and signs of intestinal obstruction dominate the clinical feature of intussusception in adult. The classic appearance of intussusception on barium studies is the coil spring appearance as contrast is trapped between the intussusceptum and intussuscipiens. Ultrasound and CT scan shows a target-like lesion. Colonofiberscopy shows a round invaginated mass with congested mucosa and by air inflation, round mass is decreased in size and is changed in shape. Differential diagnosis can be made by colonofiberscopy because the most common cause of colonic intussusception in adult is a primary colon cancer. A case of diverticulitis associated with intussusception diagnosed by colonofiberscopy in a 72 years old man was presented with brief review of the literature. (Korean J Gastrointest Endosc 17: 561- 566, 1997)

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증례 : 식도 위장관 ; 대장암으로 오인된 장결핵 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Intestinal Tuberculosis Presenting a Tumor-like Mass ): Korean J Gastrointest Endosc 1997;17(4):569-573. Published online November 30, 1996

Abstract PDF: Intestinal tuberculosis is a secondary infection from swallowing of infected sputum of pulmonary tuberculosis patient. The diagnosis is usually difficult there are no specific radiological signs and false negatives are often found in biopsy material obtained by colonoscopy since the process is mainly submucous. A lesion which is visualized on colonoscopic examination is rather confusing in that one will find a firm tumor mass occupying the lumen of the bowel which is most suggestive of carcinoma. We experienced a case of intestinal tuberculosis presenting a ulcerofungating mass occupying the lumen of the ascending colon, confirmed by colonoscopc biopsy in a 36-year-old man. He received anti-tuberculosis medication far 18months. The mass initially found totally disappeared as shown by a follow-up colonoscopy. (Korean J Gastrointest Endosc 17: 569-573, 1997)

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증례 : 담도 췌장 ; 급성 췌장염을 동반한 췌장의 Mucinous Ductal Ectasia 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Mucinous Ductal Ectasia of the Pancreas Presented with Acute Pancreatitis ): Korean J Gastrointest Endosc 1997;17(4):574-581. Published online November 30, 1996

Abstract PDF: We have experienced a case of mucinous ductal ectasia of the pancreas. The patient visited hospital with the symptoms of acute pancreatitis. The plasma levels of amylase and lipase checked at hospital were elevated. Abdominal ultrasonography and CT scan showed cystlike, intrapancreatic defects localized in the uncinate process of pancreatic head, On duodenoscopy, bulging ampulla of Vater and patulous papillary orifice were seen. Mucin leaked out of the patulous opening. Endoscopic retrograde pancreatography was performed and the localized, grape-like cyatic dilatation of the side branch of a main pancreatic duct on the uncinate process was shown. The main pancreatic duct was also dilated and had multiple filling defects in it. Whipple' s operation was performed and the histologic diagnosis was a benign intraductal papillary mucinous neoplasm of the pancreas. (Korean J Gastrointest Endosc 17: 574-580, 1997)

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