Clinical Endoscopy

원저 : 위장관 ; 비궤양성 소화불량 환자에서 위점막 산도와 Helicobacter pylori 와의 관계 - phenol red 액을 이용한 색소 내시경 - ( Original Articles : Stomach & Intestine ; The pH of the Gastric Mucosal Surface and Helicobacter pylori Infection in Non-Ulcer Dyspepsia ): Korean J Gastrointest Endosc 1997;17(5):589-597. Published online November 30, 1996

Abstract PDF: Background
/Aims: The Helicobacter pylori(H. pylori) infection induces gastric mucosal injury through the various bacterial cytotoxins, the inflammatory reaction of the host and the increased gastric acid secretion. Urease is a kind of adaptive protein of H. pylori to survive in strong acid environment of the stomach, may increase the pH of the gastric mucosal surface and induces gastrin release by the feedback mechanism. This study was performed to evaluate whether 0.1% phenol red solution without urea is useful as a pH indicator of the gastric mucosa for the diagnosis of H. pylori infection in stomach and whether the pH of the gastric mucosal surface is changed by H. pylori infection. Methods: The gastric mucosa was stained by 0.1% phenol red solution without urea during endoscopy in 89 patients with non-ulcer dyspepsia. The patterns of staining of the gastric mucosa were divided into unstained, patchy regional and diffuse staining by the area of color change from yellow to red. The pH of the gastric mucosal surface was measured directly on the stained & unstained areas of the gastric mucosa by using pH meter and antimony pH electrode through the biopsy channel (Korean J Gastrointest Endosc 17: 589-597, 1997) (continue)

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원저 : 위장관 ; 소화성 궤양에 의한 출혈에서 내시경적 에피네프린 국소주입법과 에탄올 국소주입법의 비교 ( Original Articles : Stomach & Intestine ; Comparison of Endoscopic Injection with Hypertonic Saline - Epinephrine ( HSE ) and Absolute Ethanol for Bleeding Peptic Ulcers ): Korean J Gastrointest Endosc 1997;17(5):598-603. Published online November 30, 1996

Abstract PDF: Background
/Aims: The endoscopic injection therapy with hypertonic saline- epineph- rine(HSE) and absolute ethanol are the most widely and easily used procedure in the management of patients with bleeding peptic ulcers. We performed a prospective, randomized trial to compare the hemostatic efficacy between HSE and absolute ethanol injection therapy. Methods: During the period of 1993 to 1996, 60 patients who were identified as active bleeding or visible vessel were enrolled for this trial. The 60 patients were randomly divided into two groups(HSE group, 30 cases: ethhnol group, 30 cases). We performed endoscopic injection therapy with 3% saline and 1:10,000 epinephrine solution in HSE group, and with 99.5% absolute ethanol in ethanol group. The two groups were matched for sex, age, site of bleeding, endoscopic findings, initial hemoglobin, and concomitant illness at randomization. Results: Bleeding was initially controlled in 21(70%) of the HSE group and in 29(96.7%) of the ethanol group(p <0.05). Rebleeding occurred in 4(19%) of the HSE group and in 2(6.9%) of the ethanol group(p<0.1). The ethanl group achieved a better hemostatic effect for spurting hemorrhage(3/13 vs 9/10, p < 0.05). The emergent operations were undergone in 10(33.3%) and 2(6.7%) for HSE group and ethanol group respectively(p <0.01). The stay in hospital were less than in ethanol group(mean 9.5 vs 16.3, p<0.01). The death were noticed in 6 cases(20%) in HSE group and 1 case(3.3%) in ethanol group(p<0.05). Conclusions: This study shows that absolute ethanol injection is more efficaceous and better satisfactory method in peptic ulcer bleeding.(Korean J Gastrointest Endosc 17: 598-603, 1997)

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원저 : 위장관 ; 위 내시경상 양성 용종성 병변의 병리학적 고찰 및 분류 ( Original Articles : Stomach & Intestine ; Pathologic Classification and Evaluation of Gastric Benign Polypoid Lesions on Endoscopy ): Korean J Gastrointest Endosc 1997;17(5):604-613. Published online November 30, 1996

Abstract PDF: Background
/Aims: The detection rate of the gastric polyp tends to be increased according to development of endoscopic biopsy or polypectomy. However, some of the endosco- pically polypoid lesions are not true polyps, and these lesions actually show non-specific finding. Therefore, it is necessary to classify gastric polypoid lesion on endoscopy. Methods: For investigation of gastric benign polypoid lesions on endoscopy, we reviewed 544 gastric polypoid leisons and classified accordi.ng to Snover's criteria, from 1994 to 1996 of Soonchunhyang University Hospital. (Korean J Gastrointest Endosc 17: 604-611, 1997) (continue)

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원저 : 위장관 ; 측방 발육형 종양의 검토 ( Original Articles : Stomach & Intestine ; Characteristics and Management of Laterally Spreading Tumors ): Korean J Gastrointest Endosc 1997;17(5):615-623. Published online November 30, 1996

Abstract PDF: Background
/Aims: Many endoscopists in Korea lack an understanding of laterally spreading, or creeping tumors(LSTs) which characteristically grow laterally, as opposed to other polypoid lesions, and which show superficially elevated lesions. An LST is similar in color to the adjacent normal mucosa, so it is difficult to recognize, but it can be detected by chromoscopy. When it grows to over 2-3 cm in its largest diameter, it can have malignant foci. It is important not to overlook the lesion and to remove it in a timely manner. Methods: The authors experienced 9 cases of LSTs from Jan. 1996 to Jan. 1997. We reviewed those 9 cases clinically, endoscopically, and pathologically, and tried to establish the diagnostic and therapeutic key points. (Korean J Gastrointest Endosc 17: 615-623, 1997) (continue)

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원저 : 담도 췌장 ; 분할 췌의 임상적 의의 ( Original Articles : Biliary Tract & Pancreas ; The Clinical Significance of Pancreas Divisum ): Korean J Gastrointest Endosc 1997;17(5):624-631. Published online November 30, 1996

Abstract PDF: Background
/Aims: Pancreas divisum is a congenital anomaly caused by failure of fusion of the ventral and dorsal pancreatic anlagen during the sixth and seventh week of gestation. With widespread use of endoscopic retrograde cholangiopancreatography(ERCP), pancreas divisum is being detected with increasing frequency. Pancreas divisum is the most common congenital pancreatic anatomic variant, occuring in approximately 4.7 - 14% of necropsy series and has been demonstrated 1.3-6.7% of patients undergoing ERCP, The condition is seen least frequently in Asian(1-2%). It has been postulated that this anomaly may be a cause of obstructive pancreatic pain and pancreatitis on the basis of impaired drainage through the minor papilla. But there is a controversy as to whether pancreas divisum is associated with an increased incidence of pancreatitis. This study is performed to evaluate the clinical presentation and significance of pancreas divisum. Methods: 27 cases of pancreas divisum detected among 1,718 ERCP examinations performed from June, 1993 to December, 1996 at our institution were critically analyzed. Results: Overall incidence of pancreas divisum was 1.6%. Among them, 13 cases(48.1%) were classified as complete type, 14 cases(51.9%) were classified as incomplete type. There was a significantly high incidence of pancreatitis, 22.2% in pancreas divisum compared with 5.6% in fused pancreas. Pancreas divisum was misdiagnosed as pancreatic head mass on radiological imaging study in 4 cases(25%). Conclusions: Pancreas divisum may be predispose to development of pancreatitis, and that its presence may lead to misinterpretation of ultrasonographic and CT scan findings.(Korean J Gastrointest Endosc 17: 624-631, 1997)

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원저 : 담도 췌장 ; 담낭 담석으로 인한 복강경 담낭절제술시 총담관결석 동반 유무의 예측과 치료 ( Original Articles : Biliary Tract & Pancreas ; Prediction and Management of Choledocholithiasis in Patients Undergoing Laparoscopic Cholecystectomy due to Cholelithiasis ): Korean J Gastrointest Endosc 1997;17(5):632-639. Published online November 30, 1996

Abstract PDF: Background
/Aims: Endoscopic retrograde cholangiopancreatography(ERCP) or operative cholangiography is the procedure to demonstrate and remove stones of the biliary tree in patients undergoing laparoscopic cholecystectomy(LC) due to cholelithiasis. However, ERCP or operative cholangiography is an invasive procedure. The next question then is when and for what indication should ERCP or operative cholangiography be performed. The aims of this study were to assess whether prediction of common bile duct(CBD) stones by the noninvasive method such as liver function test and/or clinical findings is possible, and to investigate which method is more adequate for removal of CBD stones found on ERCP or operative cholangiography. Methods: A total 207 patients with symptomatic cholelithiasis scheduled for LC were enrolled from September 1993 to August 1996. Patients who were already found to have either extrahepatic or intrahepatic biliary stones on sonogram were excluded. Patients were classified into risk group and non-risk group. Patients who belong to the risk group were those having CBD dilatation by ultrasonography, history of jaundice or cholangitis, gallstone pancreatitis, or elevated transaminases. (Korean J Gastrointest Endosc 17: 632-639, 1997) (continue)

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원저 : 담도 췌장 ; 담관 낭종 23예에 대한 임상적 고찰 ( Original Articles : Biliary Tract & Pancreas ; A Clinical Analysis of Choledochal Cyst - Review of twenty three cases - ): Korean J Gastrointest Endosc 1997;17(5):640-647. Published online November 30, 1996

Abstract PDF: Background
/Aims: Choledochal cyst is an unusual but serious condition which most commonly affects Oriental people. And it is an unusual entity that has increasingly been encountered by ultrasonography and computed tomography scan, even if the symptoms are variable. Methods: We reviewed 23 patients with choledochal cyst who were treated at the Department of Internal Medicine, Pusan Paik Hospital from April, 1986 to April 1995. Results: 1) Age ranged from 14 years to 73 years, and sex ratio was 1:1.4 in male vs female. 2) The durations of symptoms varied from 4 days to several years. 3) The major clinical symptoms were right upper quardrant pain in 19 cases, jaundice in 4 cases, abdominal mass in 2 cases. One case had all of above three symptoms. 4) The diagnostic tools were ultrasonography(USG) in l7 cases, ERCP in 11 cases, abdominal CT in 11 cases, PTC in 6 cases and oral GB in ~1 case. The eight cases(61.5%) were confirmed as anomalous junction of the pancreaticobiliary ductal system(AJPBS) among the 13 cases who had performed ERCP. 5) The choledochal cysts were classified into type I to V according to the classification of Todani; Fifteen cases were type I, six cases type IVa, one case was type II and one case was type V, respectively. 6) Excision of choledochal cyst and Roux-en-Y hepaticojejunostomy was performed in 10 cases, and choledocho-jejunostomy in 4 cases, and Whipple's operation in 2 cases. 7) The associated diseases were CBD stone in 8 cases, cholecystitis in 6 cases, intrahepatic stone in 2 cases, GB cancer in 1 case, and colon cancer in 1 case. Conclusions: ERCP should be used when choledochal cyst is suspected by USG, aiming at demonstrating both AJPBS and enabling the morphologic classification. In addition, Surgical procedures including the excision of choledochal cyst and Roux-en-Y hepaticojejunostomy may be effective to reduce mortality and morbidity related to complication of choleclochal cyst. (Korean J Gastrointest Endosc 17: 640-647, 1997)

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원저 : 담도 췌장 ; 경피경간적 담도내시경을 이용한 거대 총담관결석의 전기수압쇄석술과 Endocoil 삽입 ( Original Articles : Biliary Tract & Pancreas ; Electrohydraulic Lithotripsy ( EHL ) of Large Common Bile Duct Stone and Endocoil Insertion with Percutaneous Transhepatic Choledochoscopy ): Korean J Gastrointest Endosc 1997;17(5):648-655. Published online November 30, 1996

Abstract PDF: Background
/Aims: Electrohydraulic lithotrypsy(EHL) under cholangioscopic control has been performed for difficult bile duct stones. The percutaneous transhepatic approach is technically easy and useful in diagnosis and treatment of bile duct obstruction and stones. Biliary stenting with self expanding metal stent is gaining increasingly wider acceptance as a palliative treatment of bile duct obstruction. Methods: Between Sep. 1994 and Sep. 1996, EHL under choledochoscopy by percutaneous transhepatic approach was performed in 30 cases(Male: 13, Female: 17). After PTBD with 7F pig tail catheter, the percutaneous transhepatic passage was dilated over guide wire with dilaters of increasing size up to 16Fr in 3-Sdays. In one week, after fistula had been estabilished, choledochoscopy was performed. Results: (1) Mean age was 61.3 years. Mean stone number was 2.5. And mean stone size was 1.6 x 2.3 cm. (2) Com.plete removal of the stone was achieved in all patients(100%). (3) There were no serious complications. (4) In six cases, Endocoils were implanted with successful decompression of obstructions and simultaneous removal of biliary stones located at both side of stricutre. Conclusions: Percutaneous transhepatic choledochoscopy is easy and safe and assists in the diagnosis and treatment of biliary stricture and the management of difficult CBD stone. (Korean J Gastrointest Endosc 17: 648-655, 1997)

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증례 : 위장관 ; 식도 이완불능증 환자에서 발생한 진행성 식도암 1예 ( Case Reports : Stomach & Intestine ; A Csse of Esophageal Carcinoma in a Patient with Primary Achalasia ): Korean J Gastrointest Endosc 1997;17(5):656-662. Published online November 30, 1996

Abstract PDF: Achalasia is believed to be a predisposing factor for the development of esophageal cancer. The prevalence rate of esophageal cancer is 1-7% among all patient with achalasia. The presumed mechanism responsible for the development of cancer are food stasis and gastroesophageal reflux. We experienced a case of esophageal carcinoma in a 47-year-old man,who had diagnosed as achalasia ten years ago. Esophagogram, esophagoscopy with biopsy and chest CT scanning can reveal esophageal carcinoma arising in patients with achalasia. (Korean J Gastrointest Endosc 17: 656-660, 1997)

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증례 : 위장관 ; 수술을 시행한 식도의 원발성 악성 흑생종 1예 ( Case Reports : Stomach & Intestine ; A Operated Case of Primary Melanoma of the Esophagus ): Korean J Gastrointest Endosc 1997;17(5):663-667. Published online November 30, 1996

Abstract PDF: Malignant melanoma is a malignant neoplasm originated from melanocyte. Primary malignant melanoma of the esophagus is a very rare disease comprising 0.1% of all primary neoplasms of the esophagus. As with other primary mucosal malignant melanoma, primary malignant melanoma of the esophagus has poor prognosis because of the tendency to present as an advanced neoplasm with aggressive biological behavior. We present an operated case of primary malignant melanoma of the esophagus confirmed by the adjacent squamous mucosa contained junctional nests of tumor cells showing focal pagetoid spread consistent with melanoma in situ, with a clinicopoatho- logical review of the literatures. (Korean J Gastrointest Endosc 17: 663-667,1997)

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증례 : 위장관 ; Buried Bumper Syndrome 1예 ( Case Reports : Stomach & Intestine ; A Case of Buried Bumper Syndrome ): Korean J Gastrointest Endosc 1997;17(5):668-673. Published online November 30, 1996

Abstract PDF: Percutaneous endoscopic gastrostomy is used for long-term nutritional support and can be performed with relatively few complications. Among the major and minor complications, migration and erosion of the internal bumper into or through the abdominal wall, so called buried bumper syndrome has been described more recently. We describe a patient in whom internal bumper eroded into stomach wall and was completely covered by gastric epithelium 45 days after gastrostomy placement. The gastrostomy tube itself was patent, and the end still protruded into the lumen of the stomach. But, endoscopy was failed to remove the gastrostomy tube and surgical exploration was required in our case. We experienced a case of buried bumper syndrome after percutaneous endoscopic gastrostomy and report with a review of literatures. (Korean J Gastrointest Endosc 17: 668-672, 1997)

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증례 : 위장관 ; 알콜성 간질환 및 스테로이드를 장기 복용한 환자에서 내시경하 위조직 검사상 발견된 분선충 감염 1예 ( Case Reports : Stomach & Intestine ; A Case of Strongyloides Stercoralis Infection Associated with Long-term Adminstration of Steroid in a Patient with Alcoholic Liver Disease ): Korean J Gastrointest Endosc 1997;17(5):675-679. Published online November 30, 1996

Abstract PDF: Strongyloides stercoralis is distinguished by a capacity, unusual among helminths to replicate within the human host, thereby permitting on going cycle of autoinfection due to internal production of internal larvae. It has a worldwide distribution but is much more common in tropical climates where the warm, moist soil offers an environment suited to the development of the larvae. In immunocompromised hosts who receiving corticosteroids, immunosupressive drugs, or radiotherapy in these with AIDS, large numbers of invasive strongyloides larvae can disseminate widely and be fatal. The presents case is a 76 year-old-woman presenting with vomiting and epigastric pain. The patient had a long history of adminstration of steroid and alcohol. A gastrofibroscopic biopsy and stool examination revealed rhabditoid larvae. The patient seems to have suffered from autoinfection with S. stercoralis. We report this case with the review of literatures. (Korean J Gastrointest Endosc l7: 675-679, 1997)

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증례 : 위장관 ; 급성 Anisakis 증 6예 ( Case Reports : Stomach & Intestine ; 6 Cases of Acute Anisakiasis ): Korean J Gastrointest Endosc 1997;17(5):680-683. Published online November 30, 1996

Abstract PDF: Anisakiasis is an accidental infection of human by larvae of marine mammals. It occurs when human ingest a raw or inadequately cooked saltwafer fish and squid infected with anisakis. The clinical symptoms are cramping abdominal pain, nausea, vomiting, diarrhea, tarry stool, and epigastric fulling sensation. We experienced six cases of acute gastric Anisakiasis and one case of duodenal Anisakiasis and all patients had a history of ingestion of raw sea fish and squid as "sashimi". Immediate endoscopic examination showed the whitish linear worm on stomach or doudenal bulb. Clinical symptoms was improved after removal by biopsy forcep. It is emphasized that endoscopic extraction of larva is the best procedure in manage of gastric or duodenal Anisakiasis. (Korean J Gastrointest Endosc 17: 680-683, 1997)

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증례 : 위장관 ; Gastritis Cystica Profunda 를 동반한 위의 염증성 섬유양 용종 1예 ( Case Reports : Stomach & Intestine ; Inflammatory Fibroid Polyp of the Stomach Associated with Gastritis Cystica Profunda ): Korean J Gastrointest Endosc 1997;17(5):684-689. Published online November 30, 1996

Abstract PDF: Inflammatory fibroid polyp(IFP) typically prescnts as a polypoid mass in the gastric antrum. Radiologically and endoscopically, it can be confused with polypoid carcinoma or submucosal stromal tumor. The histogenetic origin of IFP has been controversial, but it is considered as a reactive lesion of the myofibroblastic nature. IFP is rarely concomitant with gastritis cystica profunda(GCP) which is also one of the nonneoplastic inflammatory polyps. We report a case of IFP associated with GCP presenting as a large polypoid mass in the previously unoperated stomach of a 78-year-old woman. The mass was mainly located in the submucosa of the antrum and the cut surface exhibited a myxoid and glistening appearance with partial cystic change. Histologically, the mass showed marked proliferation of spindle cells, small blood vessels and many inflammatory cells, especially eosinophils. Also, there were many variable sized glands composed of gastric foveolar epithelia within the mass. In conclusion, the rarity of these two associated lesions in the present case may cause difficulty in diagnosis, and therefore recognition about these lesions is needed. In addition, this case supports the nature of IFP as being reactive rather than neoplastic,(Korean J Gastrointest Endosc 17: 684-688, 1997)

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증례 : 위장관 ; 장중첩증과 심한 빈혈을 일으킨 Brunner 선 과오종 1예 ( Case Reports : Stomach & Intestine ; A Case of Brunner's Gland Hamartoma with Severe Anemia and Intussusception ): Korean J Gastrointest Endosc 1997;17(5):691-695. Published online November 30, 1996

Abstract PDF: Brunner's gland hamartomas are rare duodenal tumors with characteristic pathologic featmes. The usual clinical presentation is nonspecific symptoms, obstructive symptoms, or intestinal bleeding. The majority of these tumors are less than 3 cm in diameter. In cases of larger size, the manifestations are usually intestinal obstruction or intestinal bleeding. The cases with massive gastrointestinal bleeding and severe anemia, requiring transfusion are rare. The diagnosis is made by radiologic studies and gastroduodenoscopy. The treatment of Brunner's gland hamartomas should be conservative, since they are not premalignant, However, the lesions originate in the submucosa, so the confimative diagnosis usually cannot be made by endoscopie biopey. For definitive diagnosis and relief of symptoms, the lesions must be removed surgically or endoscopically. Endoscopic excision is indicated if the tumar is pedunculated. We recently experienced a case of Brunner's gland hamartoma of about 5.5 cm in diameter with intestinal bleeding, requiring transfusion and intussusception. Preoperative diagnosis was submucosal tumor, such as lymphoma, with duodeno-duodenal intussusception. After surgical removal, the resected specimen showed the histologic features of Bruaner's gland hamartoma. (Korean J Gastrointest Endosc 17: 691-695, 1997)

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증례 : 위장관 ; 간세포암과 병발한 임상적으로 진단된 궤양성 대장염 1예 ( Case Reports : Stomach & Intestine ; A Case of Clinical Ulcerative Colitis with Concurrent Hepatocellular Carcinoma ): Korean J Gastrointest Endosc 1997;17(5):696-701. Published online November 30, 1996

Abstract PDF: Ulcerative colitis is a diffuse inflammatory disease which is characterized by the vascular congestion and superficial ulcerations in the mucosal and the submucosal layers of the rectum and colon. Extraintestinal manifestations such as arthritis, skin lesion, hepatobiliary and ocular diseases occur in a large number of patients with ulcerative colitis, though gastrointestinal symptoms of mucous and bloody stool, diarrhea and abdominal pain are frequently presented. The association of ulcerative colitis and hepatobiliary disease has been frequently reported in the western countries since the first description by Thomas C.H. in 1874. Fatty degeneration, chronic active hepatitis, cirrhosis, primary sclerosing cholangitis and hepatobiliary carcinoma are included in this list of complications. In the case of hepatobiliary carcinoma, however, the histological diagnosis has almost invariably been cholangiocarcinoma. We report a case of clinical ulcerative colitis with coneurrent hepatocellular carcinoma confirmed by the histologic examination of biopsy specimen in a 49 year old man with the relevant literatures. (Korean J Gastrointest Endosc 17: 696-701, 1997)

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증례 : 위장관 ; 혈변을 동반한 직장 국소성 림프양 증식증 1예 ( Case Reports : Stomach & Intestine ; A Case of Focal Lymphoid Hyperplasia of the Rectum Presented with Hematochezia ): Korean J Gastrointest Endosc 1997;17(5):702-709. Published online November 30, 1996

Abstract PDF: Pseudolymphoma or benign lymphoid hyperplasia is an unusual pathologic entity representing lymphoid hyperplasia, which is sometimes not easily classified as reactive or neoplasic. It occurs in a wide variety of sites, including the orbit, salivary glands, skin, thyroid, gastrointestinal tract and lung. Within the gastrointestinal tract, stomach, small intestine and large intestine, particulary rectum, can be involved, but intestine including rectum has been rarely reported in Korea to the best of our knowlege. We experienced a case of focal lymphoid hyperplasia of the rectum presented with hematochezia in a 33-year old male. It was diagnosed by histopathology with sigmoidoscopic biopsy and molecular genetic study. Rectal lesion as well as hematochezia was improved by prednisolone and mesalamine enema therapy. Hence, we report this case with a brief review of literatures. (Korean J Gastrointest Endosc 17: 702-707, 1997)

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증례 : 위장관 ; 크론병으로 인한 대장협착의 내시경적 풍선확장술 1예 ( Case Reports : Stomach & Intestine ; A Case of TTS Balloon Dilation of Colonic Crohn's Stricture ): Korean J Gastrointest Endosc 1997;17(5):711-715. Published online November 30, 1996

Abstract PDF: Chronic idiopathic inflamatory bowel disease, espcaially Crohn's disease, is frequently complicated with low gastrointestinal stricture. Besides medical treatment of active inflammation, there is no specific, conservative approach to this complication, Repetitive surgery with extensive resections, leading to short bowel syndrome, is often necessary. Balloons have been used for a variety of gastrointestinal stenoses including esophageal, small intestinal, and colonic stricture. Balloon dilation offers many theoretical advantages (safety, and patient comfort) over dilation with bougies. Especially, the availability of large diameter balloon dilators, which pass through the biopsy channel of standard endoscopes (through-the scope balloon or TTS balloon), has promised efficient direct-vision dilatation of strictures without the need of guide wires or fluoroscope. We report a case of colonic Crohn's stricture dilated successfully using TTS balloon catheter. (Korean J Gastrointest Endosc 17: 711-715, 1997)

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증례 : 담도 췌장 ; 원발성 경화성 담관염 환자에서 MR Cholangiography 와 CT Cholangiography 의 임상적 유용성 ( Case Reports : Biliary Tract & Pancreas ; Clinical Usefulness of Magnetic Resonance Cholangiagraphy and Computed Tomography Cholangiography in Primary Sclerosing Cholangitis ): Korean J Gastrointest Endosc 1997;17(5):716-722. Published online November 30, 1996

Abstract PDF: Primary sclerosing cholangitis(PSC) is rare disease which is characterized by inflammation and obliteration of bile duct leading to biliary cirrhosis and liver failure. The cause of PSC is unknown although a number of potential etiologic factor have been investigated. The diagonsis is confirmed by typical cholangiographic demonstration with clinical features. On endoscopic retrograde cholangiopancreatography(ERCP), multifocal strictures involving both intra and extrahepatic bile ducts are most common; they were diffusely distributed, short, and annular, alternating with normal or slightly dilated segments to produce a "beaded" appearance, the "pruned-tree" appearance due to diminished arborization of the intrahepatic duct, band-like stricture, and diverticular-like outpouching(s) are seen occasionally on cholangiography, and the report of primary sclerosing cholangitis in Korea is being increased due to increased use of ERCP. Recently, magnetic resonance cholangiography(MR cholangiography) and computed tomography cholangiography(CT cholangiography) are newly developed adjunctives for evaluation of patients with biliary disease(s). We performed MR cholangiography and CT cholangiography through the nasobiliary tube in two patients with PSC, in which typical intrahepatic bile duct changes of PSC were seen as in ERCP. Now, we report MR cholangiographic and CT cholangiographic findings in patients with PSC and suggest that these radiologic studies, especially MR cholangiography, can be used as an alternative methods for serial follow-up after definite diagnosis by ERCP. (Korean J Gastrointest Endosc 17: 716-722, 1997)

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증례 : 담도 췌장 ; 췌관내 회충 미입증으로 발생된 급성 췌장염 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Acute Pancreatitis due to Impaction of Ascaris lumbricoides into the Pancreatic Duct ): Korean J Gastrointest Endosc 1997;17(5):723-729. Published online November 30, 1996

Abstract PDF: Acute pancreatitis due to impaction of Ascaris lumbricoides into the pancreatic duct is very rare. Authors hnve experienced one case of pancreatic ascariasis. Patient was a 62-year-old female with epigastric pain. Abdominal USG and endoscopic retrograde cholangiopancreatography showed characteristic finding of pancreatic ascariasis. Ascaris was removed with palypectomy snare and acute pancreatitis was resolved completely. (Korean J Gastrointest Endosc 17: 723-728, 1997)

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