Clinical Endoscopy

원저 : 식도 위장관 ; 상부식도의 이소성 위점막에 대한 임상적 고찰 ( Original Articles : Esophagus , Stomach & Intestine ; Isolated Heterotopic Gastric Mucosa of the Upper Esophagus ): Korean J Gastrointest Endosc 1997;17(6):737-742. Published online November 30, 1996

Abstract PDF: Background
Isolated heterotopic gastric mucosa of the upper esophagus(HGME), often referred to as inlet patch, is an asyptomatic benign lesion. It may, however, cause retrosternal chest pain and dysphagea, and rarely produce complications such as ulceration and stricture. It may be suspected on characteristic finding of endoscopy, and the diagnosis is usually proved by biposy. We studied several characteristics of HGME. Method: From January 1996 to May 1997, endoscopy was performed on 2000 consecutive patients (1068 male, 932 female). HGME was seen 25 patients(12 male, 13 female) among 2000 patients. Result: Prevalence of HGME is 1.25%. There was no significant difference of the prevalence of HGME between male and female. HGME was presented as a velvety and salmon-pink patch with a distict border from the normally pale squamous cell mucosa of the esophagus, and was seen as multiple lesions in 8 patients among 25 patients. Thirty three locailzed gastric mucosal patches, varying in size 3 mm to 30 mm in the longest diameter, were detected within or just below of upper esophageal spincter in all the twenty five patients. Biopsy specimens taken from the miucosal patches demonstrated gastric mucosa. Among 25 patients with HGME, four patients complained foreign body sensation on throat or heartburn, without other diseases such as GERD, gastritis or peptic ulcer. Conclusion: Further studies of a large scale about pathogenesis, prevalence, and complication of HGME will be required. (Korean J Gastrointest Endosc 17: 737-742, 1997)

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원저 : 식도 위장관 ; 위절제술 후 발생한 내시경적 역류성 위염 및 식도염 - 임상적 의미와 술식에 따른 차이 - ( Original Articles : Esophagus , Stomach & Intestine ; Endoscopic Alkaline Reflux Gasitritis and Esophagitis in Gastroresected Patients ): Korean J Gastrointest Endosc 1997;17(6):743-749. Published online November 30, 1996

Abstract PDF: Background
/Aims: The reflux alkaline gastritis and esophagitis are important late complications after gastric surgery. Endoscopy is primary diagnostic tool for them. But, the clinical significance of gastritis and esophagitis diagnosed by endoscopy is not well known. We evaluated the correlation between the alkaline reflux gastritis and esophagitis and their symptoms and we also examined their prevalence according to types of surgery. Methods: The 111 gastroresected patients who had had upper endoscopy by one endoscopist were evaluated. We reviewed all their medical records, and interviewed 54 patients by telephone to evaluate symptoms. Results: Endoscopic reflux alkaline gastritis was observed in 38 patients(45%) with Billroth- II gastrectomy and in 4 patients(33%) with Bil]roth- I gastrectomy. But, there was no symptomatic difference between group with and without endoscopic reflux gastritis. Moreover, none of them had typical reflux gastritis symptom complex including billous vomiting. In all patients with total gastrectomy and loop esophagojejunostomy, endoscopic reflux esophagitis was observed. But, there was no case af endoscopic reflux esophagitis in the patients with total gastrectomy and Roux-en-Y anastomosis. There was significant symptomatic correlation between group with and without endoscopic reflux esophagitis. T'he incidence of reflux esophagitis had no difference between Billroth- II gastrectomy and Billroth- I gastrectomy. Conclusion: The endoscopic alkaline reflux gastritis had poor symptematic correlation. In the case of total gastrectomy, for the prevention of reflux esophagitis, Roux-en-Y anastomosis is better than loop esophagojejunostomy. (Korean J Gastrointest Endosc 17: 743-749, 1997)

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원저 : 식도 위장관 ; 일차성 식도 이완 불능증에서 내시경적 보툴리늄 독소 주입 치료의 평가 ( Original Articles : Esophagus , Stomach & Intestine ; Clinical Trial of Endoscopic Botulinum Toxin Injection for the Treatment of Primary Achalasia ): Korean J Gastrointest Endosc 1997;17(6):750-759. Published online November 30, 1996

Abstract PDF: Primary achalasia is a disorder of swallowing in which the lower esophageal sphincter fails to relax. Traditional treatment methods are balloon dilatation and myotomy, but these methods have critical complications and even fatal including esophageal perforation, gastroesophageal reflux, and continuing dysphagia. Botulinum toxin, which has been used for dystonias of skeletal muscles, is presented as a new alternative treatment method for achalasia, aimed to lowering of LES pressure by Pasricha et al. They also reported that endoscopic botulinum toxin injection into LES was effective, safe, and simple method without any significant complication. We report 7 cases of primary achalasia treated with endoscopic botulinum toxin injection, who showed clinical improvement without any complication. We compared results of pre-treatment with those of post-treatment using botulinum toxin in the aspects of clinical, radiological, manometrical recording in these cases. Symptomatic improvement was shown in 4 cases(57.1%), symptom score was decreased from 7.43+- 0.53 to 4.43+- 2.51(p=0.03), The luminal diameter at esophagogastric junction increased from a mean of 3.21+-> 0,99 mm to 5.14+- 0.90 mm (p=0.015), and luminal diameter at esophageal body decreased from a mean of 40.29+- 19.37 mm to 32.71+-15.45 mm (p=0.015). In follow up manometric recording, peristaltic waves at the body were recovered in 2 cases(28.6%), gastroesophageal pressure gradient(AP) was non-significantly decreased from 6.30+-4.0 mmHg to 3.12+-4.47 mmHg (p=0.45). One patient complained of transient chest pain within one hour after the botulinum toxin injection, but she did not need any medication. We concluded that botulinum injection was a simple, safe, and effective therapeutic method for primary achalasia, even though further evaluatian should be performed in the much more cases and the results of long term follow-up, and cost-effectiveness of this method. (Korean J Gastrointest Endosc 17: 750-759, 1997)

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원저 : 식도 위장관 ; 소아 장림프관확장증의 진단에서 내시경적 소장생검의 의의 ( Original Articles : Esophagus , Stomach & Intestine ; Significance of Endoscopic Small Bowel Biopsy in the Diagnosis of Intestinal Lymphangiectasia in Children ): Korean J Gastrointest Endosc 1997;17(6):760-769. Published online November 30, 1996

Abstract PDF: Background
/Aims: Intestinal lymphangiectasia is a disease characterized by dilated lymphatics of the intestinal mucosa and excessive enteric loss of plasma proteins. Instead of multiple blind peroral jejunal biopsy, duodenal endoscopy and endoscopic small bowel biopsy were performed. We evaluated the significance of endoscopic small bowel biopsy and the usefulness of the other diagnostic methods in the diagnosis of intestinal lym- phangiectasia in children. Methods: Fourteen children seen between August 1989 and August 1997 with clinically suggestive intestinal lymphangiectasia were analysed. The median age at onset of symptoms was 4 years. Primary intestinal lymphangiectasia occurred in 10 children and secondary intestinal lymphangiectasia occurred in 4 children, of whom two had Fontan operation, one had constrictive pericarditis, and one had Crohn's disease. Low fat, high protein diet with medium chain triglycerides was the mainstay of treatment. (Korean J Gastrointest Endosc 17: 760-767, 1997) (continue)

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원저 : 식도 위장관 ; 연령과 성별에 따른 대장 및 직장암의 분포 변화에 대한 관찰 ( Original Articles : Esophagus , Stomach & Intestine ; A Study for The Changing Subsite Distribution of Colorectal Cancer with Age and Sex ): Korean J Gastrointest Endosc 1997;17(6):771-777. Published online November 30, 1996

Abstract PDF: Background
/Aims: Changes in subsite distribution of colorectal cancer have been shown in recent years. The carcinoma tend to shift to more proximal colon and this proximal shift is influenced by age and sex. This study was designed to delineate the relationship of age to subsite incidence of colorectal cancer and to define the role of gender in this difference. Method: We have analyzed the data by patients with colorectal cancer from 1985 to 1995 for elucidate the relationships between age, sex and prinmry location of colorectal cancer. 749 patients(male 454, female 295) were diagnosed of colorectal cancer performed by colonoscopy and/or sigmoidoeopy were divided into three groups by their location of cancer (Right colon: appendix, ascending colon, hepatic flexure, T-colon proximal 2/3 Left colon: T-colon distal 1/3, splenic flexure, descending colon, sigmoid colon Rectum: rectum). (Korean J Gastrointest Endosc 17: 771-777, 1997) (continue)

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원저 : 담도 췌장 ; 십이지장 유두주위 게실 162예의 임상적 연구 ( Original Articles : Biliary Tract & Pancreas ; A Study of 162 Cases of Peri - Ampullary Diverticulum ): Korean J Gastrointest Endosc 1997;17(6):778-788. Published online November 30, 1996

Abstract PDF: Background
Periampullary diverticulum has been commonly discovered during endoscopic retrograde cholangiopancreatography(ERCP) in patients with various pancreaticobiliary diseases such as cholelithiasis and its clinical significance has been noted. Recently, periampullary diverticulum is known to be associated with choledocholithiasis, various pancreatobiliary diseases and intestinal symptoms. Our aims of study was to investigate characteristics of periampullary diverticulum and to determinate the positive relationship between periampullary diverticulum and choledocholithiasis, and to determinate whether periampullary diverticulum influences on the cannulation rate and complication performing ERCP and endoscopic sphincterotomy(EST). Methods: We reviewed 162 of 594 cases, which had periampullary diverticulums on ERCP during the past 6 years, and investigated size, location and number of periampullary diverticulums with special reference to the location of cholelithiasis. We also compared success rate and complication rate of ERCP and EST in cases with or without periamullary diverticulum. (Korean J Gastrointest Endosc 17: 778-788, 1997)

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원저 : 담도 췌장 ; 총담관결석에 의한 급성화농성담관염 환자에서 내시경적 역행성 담관배액술의 치료효과 ( Original Articles : Biliary Tract & Pancreas ; Biliary Stenting as an Altermative to Endoscopic Nasobiliary Drainage in Patients with Acute Calculous Suppurative Cholangitis ): Korean J Gastrointest Endosc 1997;17(6):789-800. Published online November 30, 1996

Abstract PDF: Background
/Aims: Acute calculous suppurative cholangitis(ACSC) is the most severe complication of bile duct stone(s) and carries 100% mortality if left untreated, and emergent decompression is a life-saving procedure. Endoscopic therapy such as endoscopic sphincterotomy(EST) or endoscopic nasobiliary drainage(ENBD) are well-mtablished treat- ment of choice instead of emergent surgieal or percutaneous drainages which have a high mortality or morbity, respectively. However, EST and subsequent stone removal is operator-dependent, time consuming, associated with complication rate of 6-12%, and may be inadequeate in many critically ill patients. Recently, endoscopic retrograde biliary drainage(ERBD) is suggested to be as effective in temporary biliary drainage for retained common duct stone and acute cholangitis as ENBD is, and preferred to ENBD in some reports, because ENBD can be pulled out occasionally by confused patient, more time consuming, unpleasant, a hindrance for the patient, and does not seem to be any more effective than ERBD. So, we performed this study to evaluate the role of ERBD in patient with ACSC. (Korean J Gastrointest Endosc 17: 789-800, 1997) (continue)

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증례 : 식도위장관 ; 철분제 과다복용 환아에서 위내시경을 이용한 구명치료 ( Case Reports : Esophagus , Stomach & Intestine ; Rescue of Child with Accidental Overingestion of Iron Tablets by Gastroscope ): Korean J Gastrointest Endosc 1997;17(6):801-805. Published online November 30, 1996

Abstract PDF: Iron overdose is one of the most common, potentially fatal intoxication in children. We rescued a 3-year-old girl who ingested about 20 iron tablets(110 mg/kg of elemental iron) with early endoscopic intervention. The stomach showed diffusc hemorrhagic gastritis with large amount of retained corrosive iron material. Removal of iron tablets was performed successfully by gastroscope with condom attached on its tip and she recovered completely without any sequelae. The severity of the endoscopic findings even in the early stage and the uneventful clinical recovery in our patient strongly support that this approach could be tried before traditional methods. We think that gastroscopy can be both diagnostic and therapeutic tool in acute drug intoxication in children, because of its safety and easy, rapid availability. (Korean J Gastrointest Endosc 17: 801-805, 1997)

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증례 : 식도위장관 ; 다발성으로 발생한 위평활근아세포종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Multiple Leiomyoblastoma of the Stomach ): Korean J Gastrointest Endosc 1997;17(6):806-813. Published online November 30, 1996

Abstract PDF: Gastric leiomyoblastoma is an uncommon intramural tumor, Its been regarded as a tumor of smooth muscle origin by its histological and electronmicroscopic characteristics. However, recent immunohistochemical staining techniques have shown that tumors diagnosed as leiomyoblastoma may have different tumor origins. We report a case of multiple leiomyoblastoma of the stomach thought to be of unknown derivation by Immunohistochemical study. (Korean J Gastrointest Endosc 17: 806-811, 1997)

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증례 : 식도위장관 ; 위암과 십이지장암이 병발한 원발성 중복암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Multiple Primary Cancer in Stomach and Duodenum ): Korean J Gastrointest Endosc 1997;17(6):815-820. Published online November 30, 1996

Abstract PDF: Double primary cancer is defined as the case of primary malignant tumors of different site origins, which are different histologically in each other. The number of reported cases of multiple primary malignant tumors has increased in recent years, of more developed diagnostic procedure and long survival of cancer patients. Malignant tumors of the small bowel are reported to account for about 1% of all gastrointestinal carcinomas. We have experienced a case with double primary malignant tumors of gastric adenocarcinoma and duodenal adenocarcinoma. For its great rarity, we report this case with review of literatures. (Korean J Gastrointest Endosc 17: 815-820, l997)

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증례 : 식도위장관 ; 십이지장 림프종과 감별이 곤란하였던 십이지장 결핵 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Duodenal Tuberculosis Which is Hardly Differentiated from Duodenal Lymphoma ): Korean J Gastrointest Endosc 1997;17(6):821-826. Published online November 30, 1996

Abstract PDF: Primary duodenal tuberculosis, duodenal Crohn's disease, duodenal lymphoma, duodenal cancer is extremely rare event. Vague upper abdominal pain, weight loss(10 Kg) had been present for several months in a 52-yeer-old woman. Endoscopy revealed an irregular ulcer in the second part of the duodenum. CT of the abdomen revealed pooly defined hypodense and centrally low density masses along the hepatoduodenal ligament, with poor separation from the head of pancreas. Hypotonic duodenogram showed spiculation and smooth indentation of mucosal fold at medical aspect of sup. portion m descending duodenum. ERCP showed medially displaced distal CBD and main pancreaticduct. At first, lymphoma, cancer, Crohn's disease, duodenal tuberculosis were considered in the differential diagnosis. Endoscopic biopsy sepecimen of duodenal lesion showed atypical lymphocytes. We excluded the diagnosis of the duodenal cancer. We started anti-tubercular drugs because in our country tuberculosis is endemic. After 4 weeks anti-tuberculosis therapy, follow up endoscopy and biopsy specimens showed healing stage of duodenal ulcer and chronic granulomatous inflammation with multinucleated giant cell. Thus we concluded that when duodenal lesion which could not confirmed histopathologically it was wise to start antitubercular therapy than to perform exploraparotomic dianostic procedures,(Korean J Gastrointest Endosc 17: 821-826, 1997)

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증례 : 식도위장관 ; 호산구성 소장염 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Eosinophilic Enteritis ): Korean J Gastrointest Endosc 1997;17(6):827-833. Published online November 30, 1996

Abstract PDF: Eosinophilic gastroenteritis is a rare disorder of the stomach, small intestine and colon, characterized by variable eosinophilic infiltration of the bowel wall and peripheral blood eosinophilia, abnormal gastrointestinal symptoms and signs. The pathogenesis of this dis- ease still remains unknown, but several studies support allergic or immunologic etiology. Considerable variability in clinical presentation depends on the site of the gastrointestinal tract and the depth of bowel wall involvement. Herein we experienced a case of eosinophilic gastroenteritis confined to small intestine presenting progressive weight loss, abdominal pain and diarrhea. Enteroscopic findings showed diffuse multiple nodularity of mucosal folds in small bowel, especially duodenum and proximal jejunum. Jejunal and duodenal biopsy specimen demonstrated marked eosinophilic infiltration. These symptoms and signs were improved within 3 weeks after short course of prednisone therapy. (Korean J Gastrointest Endosc 17: 827- 831, 1997)

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증례 : 식도위장관 ; Rendu - Osler - Weber Disease 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Rendu - Osler - Weber Disease ( Hereditary Hemorrhagic Telangiectasia ): Korean J Gastrointest Endosc 1997;17(6):835-840. Published online November 30, 1996

Abstract PDF: Hereditary hemorrhagic telangiectasia, also knawn as Rendu-Osler-Weber disease, is a rare autosomal dominant condition characterized by telangiectases, arteriovenous fistulas, and aneurysms involving the skin and mucosa, as well as blood vessels of the lung, liver, and central nervous system. The most common clinical manifestations are epistaxis and gastrointestinal bleeding. Arteriovenous shunting leads to hepatic congestion, and con- gestive heart failure may occur. We report a casie of Rendu-Osler-Weber disease which revealed typical clinical symptoms and radiologic findings with a review of relevant literatures. (Korean J Gastrointest Endosc 17: 835-840, 1997)

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증례 : 식도위장관 ; C형 간염 환자에서 원발성 항인지질 항체와 연관된 대장의 다발성 장간막혈전증과 문맥압 항진증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Mesenteric Thrombosis and Partal Hypertension Associated with Antiphospholipid in a Patient with Hepatitis C ): Korean J Gastrointest Endosc 1997;17(6):841-846. Published online November 30, 1996

Abstract PDF: The gastrointestinal rnanifestations associated with antiphospholipid antibodies include Budd-Chiari syndroame, hepatic infarction, portal hypertension, pancreatitis, intestinal infarc- tion, perforation, bleeding and ulceration. A 40-year old man, without prior thrombotic event, presented with severe abdominal pain for 3 days and septic shock. Multiple mesenteric venous thrombosis and colonic congestion were suggested by abdominal CT and angiography. Gastroendoscopy revealed esophageal varix and congestive gastropathy. Laboratory tests disclosed postive antiphospholipid antibodies, anti-HCV antibodies, HCV-PCR, prolonged PT, aPTT, thrombocytopenia and had no evidences of SLE and other connective tissue diseases. He was diagnosed as mutiple mesenteric thrombosis and portal hypertension associated with antiphospholipid antibodies in hepatitis C virus infection. He was improved with the antibiotics and intravenous vasopressors. He have had no other thrombotic events until one year after discharge. (Korean J Gastrointest Endosc 17: 841-846, 1997)

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증례 : 식도위장관 ; 염증성 장질환에 병발한 괴저성 농피증 2예 ( Case Reports : Esophagus , Stomach & Intestine ; Two Cases of Pyoderma Gangrenosum Associated with Inflammatory Bowel Diseases ): Korean J Gastrointest Endosc 1997;17(6):847-853. Published online November 30, 1996

Abstract PDF: Pyoderma gangrenosum is a painful, chronic, ulcerating skin disease of unknown cause. It commences as an erythematous papulopustule and rapidly evolves to form an area of frank ulceration with undermined, violaceous edges and a bright outer halo of erythema. Diagnosis is clinical, there being no accepted histological diagnostic criteria. An underlying systemic illness is present in more than 50 percent of patients. Pyoderma gangrenosum develops in 0.8-5.0 percent of patients with inflammatory bowel disease, which is the most frequent underlying disease of pyoderma gangrenosum. There is no report of pyoderma gangrenosum associated with Crohn's disease in Korea. We recently experienced two cases of pyoderma gangrenosum, a 52-year old man with Crohn's disease and a 30-year old man with ulcerative colitis. The cases are presented with the review of literature. (Korean J Gastrointest Endosc 17: 847-852, 1997)

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증례 : 식도위장관 ; 대장 지방종의 내시경적 치험 2예 ( Case Reports : Esophagus , Stomach & Intestine ; The Endoscopic Polypectomy in Two Cases of Colonic Lipoma ): Korean J Gastrointest Endosc 1997;17(6):855-859. Published online November 30, 1996

Abstract PDF: Lipomas are one of the most common benign nonepithelial tumors of the colon and which are often detected incidentally at radiologic investigation or on operation without specific symptoms, Most of them look like submucosal tumor with yellowish-white color, smooth surface and solitary lesion. Sometimes they produce symptoms with large size, bleeding, constipation, diarrhea, abdominal pain, indigestion, intestinal obstruction and intussusception. Diagnosis can be made by colonoscopy, abdominal CT, MRI, barium enema and histologic confirmation achieves by the endoscopic polypectomy. Endoscopic polypectomy or mucosectomy can make it easy to remove them, as therapeutic method. We report 2 cases of lipomas successfully removed by endoseopic polypectomy-the one with two lipomas each at right descending colon and ileocecal valve and the other with one lipoma at the ileocecal valve-with the relevant literatures. (Korean J Gastrointest Endosc 17: 855-859, 1997)

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증례 : 식도위장관 ; Takayasu 동맥염 환자에서 동반된 크론병 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Crohn's Disease Associated with Takayasu's Arteritis ): Korean J Gastrointest Endosc 1997;17(6):860-865. Published online November 30, 1996

Abstract PDF: Vascular manifestations as extraintestinal symptoms of inflammatory bowel diseases have rarely been reported, More than 10 case reports in the worldwide literature have suggested that Takayasu's arteritis be one of the rare vascular complications in inflammatory bowel diseases. We describe herein a 33-year-old woman with Takayasu's arteritis who was subsequently found to have Crohn's disease. Aortic arch angiogram showed typical findings of Takayasu's arteritis, and the diagnosis of Crohn's disease was made by colonoscopic and radiologic findings, clinical course, and the response to medical therapy. To our knowledge, this is the first case report in Korea. (Korean J Gastrointest Endosc 17: 860-864, 1997)

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증례 : 식도위장관 ; 직장으로 전이되어 직장 협착을 유발한 위암 1예 - 증례보고 - ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Cancer with Rectal Metastasis Developing Rectal Stricture ): Korean J Gastrointest Endosc 1997;17(6):867-871. Published online November 30, 1996

Abstract PDF: A 59-year old female was admitted to Yongdong Severance Hospital due to diarrhea and lower abdominal pain lasting for 2 months. She had a previous history of admission for stomach cancer on September 1995. At that time, she underwent total gastrectomy and gastroduodenostomy. The pathology of the specimen revealed a signet ring cell carcinoma of stomach. On admission, computerized tomography revealed rectal wall thickness and no evidence of lymph node enlargement in abdomen and pelvic cavity. Barium enema study showed stricture of rectum. After sigmoidoscopic biopsy, she was diagnosed as a rectal metastasis resulted in rectal stricture and underwent sigmoid loop colostomy. Hence we present a case of gastric cancer with rectal metastasis resulted in rectal stricture. (Korean J Gastrointest Endosc 17: 867-871, 1997)

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증례 : 담도 췌장 ; 담관 점막 및 점막하를 따라 담낭 및 총간관으로 전이된 총 담관암 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Common Bile Duct Cancer with Mucosal and Submucosal Spread to Gallbladder and Common Hepatic Duct ): Korean J Gastrointest Endosc 1997;17(6):872-877. Published online November 30, 1996

Abstract PDF: Cholangiocarcinoma is a form of adenocarcinoma arising from the intrahepatic or extra- hepatic biliary epithelium. Apparent predisposing factors include some chronic hepato- biliary parasitic infsttations, congenital anomalies with ectatic ducts, sclerosing cholangitis and chronic ulcerative colitis and occupational exposure to possible biliary tract carcinogens. Patients with cholangiocarcinoma usually present with biliary obstruction, painless jaundice, pruritus, weight loss and acholic stools. Because the obstructing process is gradua1, the cholangiocarcinoma is often far advanced by the time it presents clinically. The diagnosis is most frequently made by cholangiography following ultrasound demonstration of dilated intrahepatic bile ducts. We report a case of common bile duct cancer spreading to gallbladder and common hepatic duct along the biliary mucosal epitherium and submucosal tissue in 68-year-old female patient along with a review of literature. (Korean J Gastrointest Endosc 17: 872-877, 1997)

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증례 : 담도 췌장 ; 가족성 선종성 용종증에 동반된 십이지장 유두부 선종에 의한 급성췌장염 1예 ( Case Reports : Biliary Tract & Pancreas ; Acute Pancreatitis as the Presenting Manifestation of an Ampullary Adenoma in a Patient with Familial Adenomatous Polyposis ): Korean J Gastrointest Endosc 1997;17(6):878-885. Published online November 30, 1996

Abstract PDF: Adenomatous polyps of the duodenum is uncommon in general population, but duodenal adenomas are found in the majority of patients with both familial adenomatous polypasis and Gardner's syndrome. These polyps are usually small, multiple and most commonly found in the second portion of the duodenum, and may involve ampulla of Vater. They also have malignant potential so that routine surveillance of the duodenum including ampulla of Vater has been recommended in patients with adenomatous polyposis coli. The adenoma of ampulla of Vater can be found in approximately 50% of patients with familial adenomatous polyposis and usually is asymptomatic, but sometimes, especially villous adenoma, may exhibit clinical problems including partial gastric outlet obstruction, pancreatitis, bleeding, obstructive jaundice, in addition to a high incidence of malignancy. Among the non-malignant complications of the ampullary tumor, there are only a few case reports of acute pancreatitis as the presenting manifestation of an ampullary adenoma or carcinoma in patients with familial adenomatous polyposis in the English literature, but no cases have been reported in Korea. We present here a case of symptomatic adenoma of the ampulla of Vater presenting as acute pancreatitis in a patient with familial adenomatous polyposis. (Korean J Gastrointest Endosc 17: 878-884, 1997)

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