Clinical Endoscopy

원저 : 식도 위장관 ; 칸디다 식도염에 대한 임상적 고찰 - 내시경 소견을 중심으로 - ( Original Articles : Esophagus , Stomach & Intestine ; Candida Esophagitis - A retrospective study , with emphasis on endoscopic findings - ): Korean J Gastrointest Endosc 1998;18(2):145-151. Published online November 30, 1997

Abstract PDF: Background
/Airns: Generally, candida esophagitis has a low incidence of occurrence, but the prevalence of candida esophagitis was found to be higher in cases involving patients with impaired immunity due to an underlying disease and thereby using immunosupressive drugs. This study was designed to evaluate the relation of symptoms, endoscopic findings, and pathologic findings of each patient. Methods: Between January 1993 and August 1996, 14,090 upper digestive tract endoscopies were done in Inha hospital. Among those patients, 20 cases of candida esophagitis (0.14%) were confirmed by an endoscopic biopsy. During these same endoscopic sessions, retrospectively reviews were conducted. (Korean J Gastrointest Endosc 18: 145-151, 1998) (continue)

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원저 : 식도 위장관 ; O형 고무 밴드 결찰법을 이용한 Mallory - Weiss 증후군의 치료 ( Original Articles : Esophagus , Stomach & Intestine ; Management of Mallory - Weiss Syndrome by 0-ring Band Ligation ): Korean J Gastrointest Endosc 1998;18(2):152-160. Published online November 30, 1997

Abstract PDF: Background
/Aims: Mallory-Weiss syndrome refers to a laceration or lacerations in the region of the gastroesophageal junction due to vomiting, retching, or coughing induced by several causes, and preceding hematemesis. In the last several years, endoscopic therapies have dramatically changed the need for emergency surgery in patients with upper gastrointestinal bleeding. There is only little information however, regarding the indication criteria and the efficacy of endoscopic therapies in severe upper gastrointestinal bleeding, due to Mallory-Weiss syndrome. This study was designed to assess the usefulness and the indications of endoscopic O-ring band ligation. Methods: Thirty patients with Mallory- Weiss syndrome who were experiencing a related hemorrhage were studied. Among these, 5 patients with active bleeding or a visible vessel revealed during an endoscopic examination were treated with O-ring band ligation. Patients with blood clots or linear tears received only conservative treatment. (Korean J Gastrointest Endosc 18: 152-160, 1998) (continue)

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원저 : 식도 위장관 ; 건강검진 수진자 9,137 명에 대한 위내시경적 집단 검진 소견 ( Original Articles : Esophagus , Stomach & Intestine ; Esophgogastroduodenoscopic Findings in 9,137 Healthy Subjects Examined for the Secondary Prevention ): Korean J Gastrointest Endosc 1998;18(2):161-168. Published online November 30, 1997

Abstract PDF: Background
A esophagogastroduodenoscopy is now considered to be one of the essential rnethods for diagnosis of upper gastrointestinal disease. Furthermore early detection of stomach cancer by such a mass screening techique is very important to increase the survival rate. Methods: A clinical analysis was conducted on 9,137 healthy subjects who had undergone a gastrofiberscopic examination for the secondary prevention, from January 1995 to December 1996, in Kangbuk Samsung hospital. Results: 1) Number of cases with normal finding was 764 (8.4%). 2) The most prevalent disease found was chronic gastritis (82%). The number of cases with superficial gastritis was 64.7%, erosive gastritis 9.0%, atrophic gastritis 6.4% and metaplastic gastritis 1.6%. Atrophic and metaplastic gastritis were more frequent in the older age group. 3) The prevalence of peptic ulcer was 13.9% and duodenal ulcers (8.1%) was more common than gastric ulcers (5.8%, p<0.05) with a male to female ratio of 3.7: 1, and 2.1: 1 respectively. 4) Of the 10 cases with stomach cancer (0.11%), 5 cases (0.055%) were found to be advanced stomach cancer and the other 5 cases (0.055%) were early gastric cancer. The macroscopic type of early gastric cancer was type IIc in 4 cases and type IIb in another case, and 4 cases were limited in mucosa but another was in submucosa. The size of 4 cases were below 1 cm and there was no lymph node metastasis. Conclusion: Medically screened subjects were found to have many abnormalities, and therefore, it is recommanded that regular check ups using an endoscopy would be needed for early detection of early gastric cancer regardless of clinical symptoms. (Korean J Gastrointest Endosc 18: 161-168, 1998)

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원저 : 식도 위장관 ; 소화성 궤양을 갖는 간경변증 환자에서 H. pylori 의 역할에 관한 연구 ( Original Articles : Esophagus , Stomach & Intestine ; Helicobacter pylori in Cirrhotic Patients with Peptic Ulcer Disease : a Prospective , Controlled Case Study ): Korean J Gastrointest Endosc 1998;18(2):169-175. Published online November 30, 1997

Abstract PDF: Rackground: There is an increased prevalence of peptic ulcer disease in patients with liver cirrhosis, but the role of Helicobacter pylori is unclear. Method: IgG antibodies against H. pylori were measured in 30 patients with compensated liver cirrhosis, in 30 sex- and age-matched patients with decompensated liver cirrhosis, and 30 normal controls. All patients underwent a panendosocpic examination in order to search for the evidence of esophageal varices, congestive gastropathy, and peptic ulcers. Results: Duodenal ulcers were more common in compensated and decompensated cirrhotic patients (13.3% and 13.3%, respectively) than in the normal controlled group (6.7%, p <0.05). The prevalence of H. pylori was not statistically different among the three groups (normal 63.3%, compenstated 63.3%, and decompensated, 70.0%; p > 0,05). The prevalence of H. pylori also showed no statistical differences in respect to duodenal ulcers (100%, 75%, and 75%, repectively, p>0.05) or gastric ulcers (100%, 100%, and 60%, respectively, p >0.05). The prevalence of an H. pylori infection did not differ significantly in relation to the presence or absence of esophageal varices or of congestive gastropathy. In cirrhotic patients with peptic ulcers, the prevalence of H. pylori was lower in the presence of esopahgeal varices (60.0% vs 100% if without varices, p=0.04) and in the presence of congestive gastropathy (50.0% vs 88.9% p=0.03). Conclusions: The prevalence of peptic ulcer was increased in cirrhotic patients, but the prevalence of H. pylori was similar in compensated cirrhotic patients, decompensated cirrhotic patinets, and in the normal controlled group. The frequency of non-H. pylori associated with peptic ulccrs in cirrhotic patients was increased in the presence of an esophageal varix or a congestive gastropathy. (Korean J Gastrointest Endosc 18: 169-175, 1998)

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원저 : 담도 췌장 ; 담도계 질환에 있어서 경구적 담도내시경검사의 유용성 ( Case Reports : Biliary Tract & Pancreas ; Clinical Application of Peroral Cholangioscopy in Biliary Diseases ): Korean J Gastrointest Endosc 1998;18(2):176-182. Published online November 30, 1997

Abstract PDF: Background
Peroral cholangioscopy (PCS) was usually conducted for a differential diagnosis in cases which were difficult to diagnose on a routine endoscopic retrograde cholangiogram (ERC) or during fragmentation of a large bile duct stone with electrohydraulic lithotripsy. This study was conducted to evaluate the clinical utility of a PCS in biliary diseases. Method: We retrospectively reviewed the clinical records of 31 patients in whom a PCS was performed to evaluate various biliary diseases from July 1991 to Aug. 1996. Result: A peroral cholangioscope was successfully inserted into the bile duct in 90.3% (28/31) of the patients. The underlying diseases included bile duct stones (11 cases), bile duct cancer (9 cases), benign bile duct strictures (2 cases), benign bile duct turnors (2 cases), biliary cystadenocarcinoma (2 cases), emboli of the HCC in the bile duct(1 case), and common bile duct polyposis (1 case). Most PCSs were performed for the differential diagnosis between benign and malignant bile duct strictures or obstructions (14 cases) and fragmentation of large bile duct stone with electrohydraulic lithotripsy (10 cases). Overall, the success rate was 78.6% (22/28) in achieving the purpose 88.9% (16/18) in diagnostic aim and 60.0% (6/10) in therapeutic aim. Complications from the PCS occurred in 4 cases (14.3%). Cholangitis and acute pancreatitis was found in 1 case and asymptomatic hyperamylasemia were discovered in 2 cases. Conclusion: PCS plays a major role in confirming difficult cases to diagnose using on ERC and fragment to remove large cornmon bile duct stones. (Korean J Gastrointest Endosc 18: 176-182, 1998)

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원저 : 담도 췌장 ; 침형 유두절개술시 체관내인공관의 임상적 유용성 ( Case Reports : Biliary Tract & Pancreas ; The Needle - Knife Sphincterotomy over Pancreatic Stent : A Safe and Effective Technique? ): Korean J Gastrointest Endosc 1998;18(2):183-195. Published online November 30, 1997

Abstract PDF: Background
/Aims: Needle-knife sphincterotomy (NKS) is an alternative technique to EST when selective bile duct cannulation can not be achieved with a variety of techniques or accessories. The risk of post-procedure pancreatitis is high, however, when papillary edema, sphincter of Oddi spasm, and the resulting restriction of pancreatic juice flow are induced by both mechanical injury associated with repeated cannulation attempts and possible burn injury due to NKS itself. Recently, nasopancreatic drainage and pancreatic stenting were suggested to be effective in preventing pancreatitis in patients with high risk of postprocedure pancreatitis and in patients who underwent NKS, respectively. The purpose of this study is to evaluate the role of pancreatic stenting on the clinical outcomes in patients with high risks of postprocedure pancreatitis who undergo NKS. Methods: Of the 119 patients who had undergone NKS, pancreatic stenting with 2-4 cm, 7Fr polyethylene biliary stent was performed prior to NKS in 13 patients (pancreatic stent group), and an incision was begun without pancreatic stenting at the papillary roop avoiding trauma of the papillary orifice and thus, reducing the risks of pancreatitis in 15 patients (control group). Both groups were at high risks of pancreatitis associated with repeated, unsuccessful bile duct cannulation attempts. In the two groups, the success rate of bile duct cannulation and the incidence of pancreatitis were analyzed and compared. (Korean J Gastroint,est Endosc 18: 183-193, 1998) (continue)

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증례 : 식도 위장관 ; 식도 궤양을 동반한 Behcet 병 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case Report of Esophageal Involvement in Behcets Disease ): Korean J Gastrointest Endosc 1998;18(2):197-201. Published online November 30, 1997

Abstract PDF: Behcet's disease is a recurrent and multisystemic disorder which usually persists over many years and is classified under vasculitic syndrome. A classic triad in this disorder is composed of a recurrent oral ulcer, genital ulceration and uveitis. While intestinal Behcet's disease most commonly affects the ileoecal region, dysphagia associated with esophageal ulceration is very uncommon. A 34-year-old-female patient visited our hospital because of dysphagia, epigastric pain and fever. The patient had ulcers on the oral mucosa, soft palate and extemal genitalia. Multiple irregularly marginated ulcers surrounded with hyperemic edematous mucosa were found on the middle and distal esophagus and lesser curvature of the stomach by an esophagogastroduodenoscopic examination. The pathologic findings were non-specific ulcers with necrotizing vasculitis in the vulva and with suspicious vasculitis in the esophagus. So she was diagnosed to have a Behcets disease and was treated with steroid and sulfasalazine. In this study we report a case of esophageal involvement of Behcet's disease with a review of the literature. (Korean J Gastrointest Endosc 18: 197- 201, 1998)

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증례 : 식도 위장관 ; 자발성 점막하 식도 박리 1예 ( Case Reports : Esophagus , Stomach & Intestine ; Spontaneous Submucosal Dissection of the Esophagus - A case report - ): Korean J Gastrointest Endosc 1998;18(2):202-210. Published online November 30, 1997

Abstract PDF: A 55-year-old male was admitted to our hospital complaining of chest discomfort, dysphagia and severe pain on swallowing. Esophageal manometry identified the lower esophageal sphincter as having no response to swallow. Barium swallow showed typical esophagograms of double barrelled esophagus or mucosal stripe. An endoscopic examination revealed an appearance as if an esophago-tracheal fistula had been made at the level of the upper thoracic esophagus. Also, two slitlike mucosal tears were seen on the lower esophagus. Subsequent fasting and total parenteral nutrition for several weeks failed to bring about any improvement in his symptoms. So, as a treatment, primary closure of the upper opening of the false channel was performed under general anesthesia. Soon after the surgical procedure, the patients symptoms disappeared except for mild dysphagia. He was discharged after oral intake had been judiciously commenced with fluids and soft diets. During his follow-up in the out-patient department, he was examined and found to have no specific symptoms including fever or dysphagia. Moreover, there was great improvement from the massive dissection of the esophagus on esophagogram. (Korean J Gastrointest Endosc 18: 202-210, 1998)

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증례 : 식도 위장관 ; 점막하종양으로 오인된 호산구성 위염 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Eosinophilic Gastritis Mimicking Gastric Submucosal Tumor ): Korean J Gastrointest Endosc 1998;18(2):211-217. Published online November 30, 1997

Abstract PDF: Eosinophilic gastroenteritis is an uncommon disorder characterized by eosinophilic infiltration of the bowel wall, usually associated with peripheral blood eosionphilia. It usually involves the stomach and small intestine simultaneously. If the stomach alone is involved, the lesion can sornetimes be misdiagnosed as a primary gastric neoplasm. We experienced a case of eosionphilic gastritis mistaken for gastric submucosal tumor. A 37-year-old man presented to our hospital with acute epigastric pain. Endoscopy showed gastric submucosal tumor in the antrum of the stomach. Endoscopic ultrasonography(EUS) revealed diffuse thickening of the 3rd and 4th layer of the stomach. The patient underwent gastric surgery under the impression that he had a gastic neoplasm. (Korean J Gastrointest Endosc 18: 211-215, 1998)

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증례 : 식도 위장관 ; 위에 발생한 악성 섬유성 조직구증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; Malignant Fibrous Histiocytoma of the Stomach - A case repot - ): Korean J Gastrointest Endosc 1998;18(2):219-224. Published online November 30, 1997

Abstract PDF: Malignant fibrous histiocytoma is a pleomorphic sarcoma in adults, which occurs principally as a mass on an extremity or in the abdominal cavity or retroperitoneum. It typically involved deep fascia or skeletal muscle and only rarely was confined to the subcutis without fascial involvement. Malignant fibrous histiocytomas developed in the intraabdominal organs are very rare and only few cases have been reported until now. Here, we report a case of malignant fibrous histiocytomar developed in the stomach of a 46-year old male who showed clinical and histologic features of malignant fibrous histiocytoma without any identified etiologic factors. The patient was treated successfully with surgery, and has had no recurrence since, during the ensuring one and a half yars. (Korean J Gastrointest Endosc 18: 219-224, 1998)

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증례 : 식도 위장관 ; 내시경적 결찰요법으로 치유한 Dieulafoy 궤양 2예 ( Case Reports : Esophagus , Stomach & Intestine ; 2 Cases of Endoscopic Ligation Therapy of a Dieulafoy Ulcer ): Korean J Gastrointest Endosc 1998;18(2):225-229. Published online November 30, 1997

Abstract PDF: A dieulafoy ulcer is rarely recognized but is not an uncommon cause of massive, recurrent and frequently fatal gastrointestinal bleeding resulting from the erosion of an unusually large submucosal artery. Although the lesion has been predominantly found in the proximal stomach, it has also been detected throughout the gastrointestinal tract. Diagnosis can be made by observation of protruding and eroded arteries with pulsatile bleeding, or through detection of an adherent thrombus using an endoscopy. In the past, surgical intervention was believed to be the best treatment, but currently, therapeutic endoscopy is more favored, due to its recent success in achieving permanent hemostasis. We experienced 2 cases of Dieulafoy's ulcer of the stomach. Endoscopic ligations using an O ring were performed successfully. (Korean J Gastrointest Endosc 18: 225-229, 1998)

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증례 : 식도 위장관 ; 신이식에 합병된 위모균증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; Gastric Mucormycosis in a Renal Transplant Recipient ): Korean J Gastrointest Endosc 1998;18(2):230-237. Published online November 30, 1997

Abstract PDF: Mucormycosis is a rare opportunistic infection caused by fungi of the nrder Mucorales. It occurs almost exclusively in immunocompromised patients, and the prognosis is grave. Rhinocerebral and pulmonary diseases are the most comrnon forms. Gastric mucormycosis is very rare and the manifestations range from colonization of peptic ulcers to infiltrative disease with vascular invasion and dissemination. Only one case of gastric mucormycosis was reported in Korean literature. We recently experienced a case of gastric mucormycosis in a renal transplant recipient. The 29-year-old male patient received a renal transplant from his rnother seven years ago, and had been on immunosuppressive therapy. He experienced intermittent epigastric pain for one week, and a gastroscopy revealed a huge gastric ulcer covered with black necrotic material. The diagnosis of gastric mucormycosis was confirmed on a histologic examination, and amphctericin B was administered. Despite two weeks of intensive medical therapy he expired due to shock and multiorgan failure. This is the first case of gastric mucormycosis in an organ transplant recipient in Koren. (Korean J Gastrointest Endosc 18: 230-235, 1998)

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증례 : 식도 위장관 ; 거대 십이지장 브루너선종의 Detachable Snare 를 이용한 제거 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Endoscopic Polypectomy with a Detachable Snare in a Huge Duodenal Brunner's Gland Adenoma ): Korean J Gastrointest Endosc 1998;18(2):239-243. Published online November 30, 1997

Abstract PDF: Duodenal Brunner's gland adenoma is characterized by hyperplasia of the Brunner's gland, which is usually found in a duodenal bulb as a pedunculated polypoid mass. Conservative management is advocated for asymptomatic small lesions, but in larger lesions causing obstructive symptoms or bleeding, either endoscopic or surgical removal of the mass should be performed. But an endoscopic polypectomy for a huge mass lesion, especially one having a broad base, runs the risk of bleeding, so to minimize this complication, detachable snare is used before the polypectomy. We have experienced a case of huge duodenal Brunner's gland adenoma was successfully removed by an endoscopic polypectomy with a detachable snare, in a patient with recurrent upper gastrointestinal bleeding. (Korean J Gastrointest Endosc 18: 239-243, 1998)

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증례 : 식도 위장관 ; 특발성 문맥압 항진증에 동반된 십이지장 정맥류 출혈 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Bleeding Duodenal Varices in a Patient with Idiopathic Portal Hypertension ): Korean J Gastrointest Endosc 1998;18(2):244-248. Published online November 30, 1997

Abstract PDF: Bleeding duodenal varices are a rare complication in patients with portal hypertension. Cirrhosis followed by portal vein obstruction and splenic vein obstruction are the most common causes. Although the prognosis of bleeding duodenal varices is usually poor, an awareness of its characteristic presentation may enable diagnostic and therapeutic proce- dures to be performed rapidly with an increased likelihood of a reaching successful out- come. In this study, we report a case of bleeding duodenal varices in a 23-year-old woman with idiopathic portal hypertension who was also suffering with recurrent melena. Panendoscopy identified prominant tortuous varices with central erosion in the 3rd portion of the duodenum and no esophageal and gastric varices. The varices were successfully treated by distal splenorenal shunt. (Korean J Gastrointest Endosc 18: 244-248, 1998)

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증례 : 식도 위장관 ; 내시경적 경화요법에 의한 십이지장 정맥류출혈의 치유 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Successful Endoscopic Injection Sclerotherapy of a Bleeding Duodenal Varix ): Korean J Gastrointest Endosc 1998;18(2):249-255. Published online November 30, 1997

Abstract PDF: Bleeding frorn the duodenal varix is an unusual event. Upper gastrointestinal endoscopy is the diagnostic procedure of choice in diagnosing duodenal varices. If performed during active bleeding, it can differentiate between esophageal and duodenal varices as the source, which has important therapeutic implications. A thorough examination of the duodenum for varices is important in an upper gastrointestinal hemorrhage. Treatment modalites for bleeding duodenal varices are sclerotherapy, varix suture ligation, portocaval shunt, and duodenal resection. Although endoscopic sclerotherapy has lirnited success in controlling active duodenal varix as initial treatment, endoscopic injection sclerotherapy is a useful first-line therapeutic measure in the treatment of bleeding duodenal varices. In this study we present a case of a ruptured duodenal varix, which was defected by an endoscopy, in a 61-year-old male. An endoscopic examination showed small and nonbleeding esophageal varices and a prominant ulcerated varix was identified in the 2nd portion of the duodenum. Endoscopic sclerotherapy was performed by injecting ethanolamine oleate into the varix. Our report demonstrate that endoscopic sclerotherapy can be efficient even in the presence of acute bleeding and that it can provide a definitive method of curing of a bleeding duodenal varix. (Korean J Gastrointest Endosc 18: 249-253, 1998)

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증례 : 식도 위장관 ; 십이지장 결핵 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Tuberculosis of the Duodenum ): Korean J Gastrointest Endosc 1998;18(2):257-261. Published online November 30, 1997

Abstract PDF: The rate of tuberculosis has been significantly decreased due to development of effective antituberculosis chemotherapy. Tuberculosis of the duodenum is very rare and diagnosis is very difficult because of nonspecific symptoms and nonspecific duodenal lesions. A case of duodenal tuberculosis which was clinically diagnosed as malignancy of the duodenum was discovered. The diagnosis was confirmed by a subsequent operation and administration of antituberculous chemotherapy resulted in a positive response. Consequently, the following is a report on this case, review of related literature. (Korean J Gastrointest Endosc 18: 257-261, 1998)

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증례 : 식도 위장관 ; Clostridium Perfringens 에 의한 위막성 대장염 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Pseudomembraneous Colitis by Clostridium Perfringens ): Korean J Gastrointest Endosc 1998;18(2):262-269. Published online November 30, 1997

Abstract PDF: A 62-year-old female was adrnitted to the Catholic University Hospital of Taegu-Hyosung with an intracerebral hemorrhage. She was operated on successfully, but developed bacterial pneumonia. She was then treated with sulperazone, tobramycin, and metronidazole for 1 month. After the antibiotic treatment, she suffered from a fever and bloody, mucoid diarrhea for 3 days, and was examined with a sigmoidoscope. The sigmoidoscopic examination revealed yellow patches of ulcerations and swelling covered with thick sero- sanguinous exudate in the distal transverse colon and sigmoid colon. A latex agglutination test for C. was performed on her stool, whereby difficile cytotoxin was negative, however, metronidazole resistant C. perfringens was isolated from anaerobic culture of the biopsied colon tissue. She recovered with 15 days using oral vancomycin treatment. The possibility of C. perfringens as a causative organism of pseuclomernbraneous colitis was discussed. (Korean J Gastrointest Endosc 18: 262-267, 1998)

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증례 : 식도 위장관 ; 혈압이 떨어질 정도의 심한 장출혈을 보인 크론병 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Crohn's Disease with Blood Pressure Falling Intestinal Bleeding ): Korean J Gastrointest Endosc 1998;18(2):271-275. Published online November 30, 1997

Abstract PDF: Life-threatening gastrointestinal hemorrhage is a rare complication in Crohn's disease. The authors experienced a case of Crohn's disease manifested with massive lower intestinal bleeding. A 22-year-old woman, who had underwent small bowel resection for bowel perforation and intestinal fistula, was admitted with lower abdominal pain and massive hernatochezia. A radioisotope bleeding scan and mesenteric angiography revealed suspi- cious intestinal bleeding in the small bowel area. The colonoscopy showed multiple shallow ulcers at the terminal ileum and scars on the cecum. In spite of medical management with the diagnosis of Crohn's disease, she continuecl to rebleed and required fistuloplasty and ileal resection. In the surgical specimen was discovered multiple exposed small vessels and diffuse blood oozing at terminal ileum. After surgery, there were no more bleeding episodes and she recovered with the aid treatment of sulfasalazine and prednisolone. (Korean J Gastrointest Endosc 18: 271-275, 1998)

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증례 : 담도 췌장 ; 만성췌장염에 동반된 가성동맥류 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of a Pseudoaneurysm in Chronic Pancreatitis ): Korean J Gastrointest Endosc 1998;18(2):276-280. Published online November 30, 1997

Abstract PDF: The bleeding pseudoaneurysm is a rare condition but one of the lethal complications in patients with chronic pancreatitis. Early diagnosis and emergent intervention can reduce mortality and promise better outcomes. We experienced a case of a bleeding pseudo- aneurysm in a chronic pancreatitis patient. The 44-year-old male was suffering from con- tinuous, vague epigastric pain and black tarry stool. An abdominal CT scan revealed a homogeneously enhancing round mass in the pancreatic pseudocyst, and celiac angi- ography found that a pseudoaneurysm had originated from the pancreaticoduodenal artery. The patient was treated with Whipple's operation and was later discharged, having improved in his condition. (Korean J Gastrointesl Endosc 18: 276-280, 1998)

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증례 : 담도 췌장 ; 췌장의 Mucinous Ductal Ectasia - 증례보고 및 국내 문헌 고찰을 중심으로 - ( Case Reports : Biliary Tract & Pancreas ; Twenty-Six Cases of Mucinous Ductal Ectasia of the Pancreas Including Six New Cases ): Korean J Gastrointest Endosc 1998;18(2):281-289. Published online November 30, 1997

Abstract PDF: We have experienced six new cases of mucinous ductal ectasia of the pancreas. Muci- nous ductal ectasia is characterized by mucin secretion and dilatation of the main pancreatic duct. These tuinors have been reported with increasing frequency, especially in Japan, where in 1982, it was advocated that they represent a new clinical entity. ERCP revealed a dilated pancreatic duct in the absence of obstructing ductal strictures and amorphous filling defects in the main pancreatic duct. Endoscopic findings included a patulous ampullary orifice, bulging ampulla of the Vater and mucin secretion from an orifice. We reviewed a total of twenty six cases including our six, of mucinous ductal ectasia, which were reported in various Korean literature. Clinical and radiologic studies of the twenty six cases were performed. They included nineteen men and seven women, 40-79 years of age. Twelve patients had symptoms of epigastric pain. From endoscopic retrograde pancreatography, twenty four patients showed mucin secretion from an orifice, twenty three patients showed a patulous arnpullary orifice, and twenty four patients showed dilatation of the main pancreatic duct. Pathological examination showed fifteen intraductal papillary mucinous hyperplasias, seven adenocarcinom-as, and four adenomas. (Korean J Gastrointest Endosc 18: 281-288, 1998)

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