Clinical Endoscopy

원저 : 식도 위장관 ; 기능성 소화불량증 환자에서 미란성 유문전부 변화와 Helicobacter pylori 감염의 의미 ( Original Articles : Esophagus , Stomach & Intestine ; The Significance of Erosive Prepyloric Change or Helicobacter pylori Infection in Patients with Functional Dyspepsia ): Korean J Gastrointest Endosc 1998;18(4):479-484. Published online November 30, 1997

Abstract PDF: Background
/Aims: The etiology of funetional dyspepsia remains unknown, with inconclusive evidence for several factors, including abnormal gastroduodenal motility, personal traits, infection of Helicobactor pylori (H. pylori) and erosive prepyloric change (EPC). Therefore, we evaluated the relation between H. pylori or EPC and gastric emptying in patients with functional dyspepsia. Methods: We performed an ultrasonographic gastric emptying test in 18 patients with functional dyspepsia comparing 6 healthy volunteers as the control. The presence of BPC in the stomah was diagnosed by esophogogastroduodenoscopy, and the Helicobacter pylori infection was evaluated using a rapid urease test. Results: The erosive prepyloric change in the antrum was revealed in five patients with dyspepsia. Amang the EPC (+), EPC (-) with dyspepsia, and healthy volunteers, the parameters of the ultrasonographic gastric emptying test and subjective symptom scores did not reveal significant differences. Among the H. pylori (+), H. pylori (-) patients with dyspepsia and healthy volunteers, the parameters of the ultrasonographic gastric emptying test and subjective symptom scores did not reveal significant differences. Conclusions: No association was found between dyspeptic symtoms and the presence of H. pylori infection or EPC. The two factors, Helicobacter pylori infection and erosive prepyloric change, did not affect the gastric motility in functional dyspepsia. (Korean J Gastreintest Endosc 18: 479-484, 1998)

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원저 : 식도 위장관 ; 소화성 궤양의 재출혈 위험인자 및 에탄올 주입치료의 효과에 관한 연구 ( Original Articles : Esophagus , Stomach & Intestine ; The Risk Factors of Re-bleeding in Peptic Ulcer Patients and the Efficacy of Ethanol Injection Therapy ): Korean J Gastrointest Endosc 1998;18(4):485-498. Published online November 30, 1997

Abstract PDF: Background
/Aims: Acute peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, and needs urgent management in cases including large amounts of blood loss. Ernergency endoscopy was performed and evaluation was made on the risk factors of rebleeding in peptic ulcer patients and the efficacy of ethanol injection therapy. Methods: The clinical and endoscopic variables were evaluated according to the rebleeding rates and the efficacy of ethanol injection therapy for hemostasis and prevention of rebleeding in 161 cases including gastric ulcers (GU) with bleeding (M: F 134: 27, mean age 56.5 years) and 136 cases including duodenal ulcers (DU) with bleeding (M: F 111: 25, mean age 40.7 years). (Korean J Gastrointest Endosc 18: 485-498, 1998) (continue)

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원저 : 식도 위장관 ; 대장내시경 전처치로서 저 용량 Midazolam 의 유용성에 관한 연구 ( Original Articles : Esophagus , Stomach & Intestine ; Effect of Low - Dose Midazolam for Colonoscopy ): Korean J Gastrointest Endosc 1998;18(4):499-505. Published online November 30, 1997

Abstract PDF: Background
/Aims: Because colonoscopy is a painful procedure, analgesics and sedatives may be necessary as premedication. Midazolam reacts quicker, has a more excellent amnesic effect and fewer complications compared to diazepam. The effects of midazolam depend on dose, age, and rapidity of injection. According to several studies, side effects of midazolam were more common in high-dose injections (more than 5 mg) compared to low dose injections (0.03-0.05 rng/kg). Moreover, low dose injections were found to be as effective as high dose injections. However, there was no report about the effect and the side effects of midazolam in Korea. Therefore, we performed this study to determine the effect of low dose midazolam as premedication for colonoscopy, Methods: We performed colonoscopy in 99 consecutive patients who were randomly selected (midazolam group: 50, placebo group: 49) prospectively from July 1996 to September 1996. Premedication was administered through intravenous injection of midazolam or saline 0.03 mg/kg, combined with intramuscular injections of meperidine 50 mg, and intravenous injections of Buscopan 20 mg in all patients. Blood pressure, puise rate, and O2 saturation by oxymeter were checked before, during, and 30 minutes after colonoscopy. The degree of amnesia, discomfort, cooperation and acceptance of the re-examination were checked. (Korean J Gastrointest Endosc 18: 499-505, 1998) (continue)

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원저 : 식도 위장관 ; 융모성 종양의 특성과 대책 ( Original Articles : Esophagus , Stomach & Intestine ; Tubulovillous and Villous Adenomas of the Colon and Rectum - Endoscopic Characteristics and Management - ): Korean J Gastrointest Endosc 1998;18(4):506-519. Published online November 30, 1997

Abstract PDF: Background
/Aims: A villous tumor, histologically villous or tubulovillous adenoma, is a clinical challenge because of its higher potential for malignancy and higher recurrence rate. However, information and experience with these tumors in the Korean people is still lacking. For that reason, we designed this study to review and analyze the colonoscopic features, the potential for malignancy, and the treatiment with respect to the confirmation of guidelines for the accurate diagnosis and reasonable management of such tumors in the Korean population. Materials and Methods: We performed 753 polypectomies, including 4 transanal excisions and several bowel resections, from January 1996 to May 1997 at Song-Do Colorectal Hospital in Seoul, Among them, 447 cases (59.4%) were adenomas, comprising 405 (53.8%) tubular adenomas, 31 (4.1%) tubulovillous adenomas, and 11 (1.5%) villous adenomas. We analyzed the 42 (5.6%) tubulovillous and villous adenomas. (Korean J Gastraintest Endosc 18: 506-519, 1998) (continue)

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원저 : 식도 위장관 ; 복강경 충수절제술과 개복 충수절제술의 비교 ( Original Articles : Esophagus , Stomach & Intestine ; Laparoscopic Appendectomy vs Open Appendectomy ): Korean J Gastrointest Endosc 1998;18(4):520-526. Published online November 30, 1997

Abstract PDF: Background
/Aims: The rate of laparoscopic appendectomy has been gradually increasing. The following studies were conducted to compare laparoscopic appendectomy (LA) with open appendectomy (OA). Methods: We compared retrospectively 48 patients in the LA group with 135 patients in the OA group, all of whom were operated at Anam hospital, Korea University, from January 1996 to January 1997. Documentation included information such as age, sex, diagnostic method, postoperative diagnosis, misdiagnosis rate, operative time, conversion to open appendectomy, analgesics injection, hospital stay, and complicatians. Results: 1) The mean age and male to female ratio were 28.5 years and 1: 2.4 in LA group, and 34.1 years and 1: 1.1 in OA group, respectively. 2) An abdominal sonogram was perfomed in 18.8% of the LA group and 28.9% in OA group (p < 0.05). 3) The operative time was 68.4 minutes in the LA group and 53.7 minutes in the OA group (p<0.05). 4) The number of analgesic injections was 1.23 in the LA group and 2.65 in the OA group (p<0.05). 5) The postoperative hospital stay was 3.38 days in the LA group and 3.84 days in the OA group (p > 0.05). 6) The complication rate was 10.9% in the LA group and 15,5% in the OA group (p >0.05), but the wound infection rate was 2.2% in the LA group and 8.5% in the OA group (p<0.05). Conclusions: LA is a safe and effective operation for acute appendicitis, and is particularly superior to OA in regard to diagnosis, postoperative pain, wound infection, and cosmetic benefits. (Korean J Gastrointest Endosc 18: 520-526, 1998)

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원저 : 담도 췌장 ; 중심부 함몰이 없는 이소성 췌장의 내시경적 초음파단층촬영술 소견 ( Original Articles : Biliary Tract & Pancreas ; Endoscopic Ultrasonographic Features of a Gastric Aberrant Pancreas without Central Dimpling ): Korean J Gastrointest Endosc 1998;18(4):527-533. Published online November 30, 1997

Abstract PDF: Background
/Aims: A gastric aberrant pancreas can be easily diagnosed through con- ventional endoscopy and radiologic modalities due to its characteristic features such as central dimpling. However, in cases involving an aberrant pancreas without the central dimpling, the differential diagnosis has been some troublesome. As for differential diag- nosis of gastric submucosal tumors, endoscopic ultrasonography (EUS) allows us to visu- alize the structures underlying the gastrointestinal wall in a non-invasive manner, and has a great advantage over conventional modalities such as conventional endoscopy or the UGI series. Methods: We studied the EUS findings of a gastric aberrant pancreas without the central dimpling. We compared EUS features in 10 cases involving a gastric aberrant pancreas without the central dimpling to those in 16 cases with the central dimpling. (Kerean J Gastrointest Endosc 18: 527-533, 1998) (continue)

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원저 : 담도 췌장 ; 내시경적 췌관 괄약근 절개술 : 적응증 , 수기 및 안정성 ( Original Articles : Biliary Tract & Pancreas ; Endoscopic Pancreatic Duct Sphincterotomy : Indications , Technique and Safety ): Korean J Gastrointest Endosc 1998;18(4):534-541. Published online November 30, 1997

Abstract PDF: Background
s: The aim of this study was to evaluate the indications, techniqe and safety of endoscopic pancreatic duct sphincterotomy. Methods: Fifty-four patients, 41 of whom had chronic pancreatitis, underwent endoscopic pancreatic duct sphincterotomy during a 4 year period from 1993 to 1996. We retrospectively reviewed and analyzed the results of the endoscopic pancreatic duct sphincterotomy. Results: Successful endoscopic pancreatic duct sphincterotomy occurred in 52 (96%) of the cases. No mortalities resulted. Complications occurred in 4 patients (4.8%) and included pancreatitis (n=l), bleeding (n=l), cholangitis (n=1) and stenosis of the sphincterotomy site (n=1). They were successfully managed by medical or endoscopic treatment. Conclusions: Endoscopic pancreatic duct sphincterotomy was found to be a safe and feasible procedure involving a high success rate and low rates of complications. The authors conclude that endoscopic pancreatic duct sphincterotomy enlarges our endotherapeutic armamentarium and deserves additional evaluation. (Korean J Gastrointest Endosc 18: 534-539, 1998)

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증례 : 식도 위장관 ; 식도과립세포종 3예 - 내시경적 초음파단층촬영술 소견을 중심으로 - ( Case Reports : Esophagus , Stomach & Intestine ; Three Cases of Esophageal Granular Cell Tumor ): Korean J Gastrointest Endosc 1998;18(4):543-551. Published online November 30, 1997

Abstract PDF: Granular cell tumors (GCT), previously termed granular cell myoblastorna, was first described as a myoblastic myoma of the tongue in 1926 by Abrikossoff and has been reported in many different locations throughout the body. In 1931, Abrikossaff described the first granular cell tumor of the esophagus. The gastrointestinal tract is one of the more uncommon locations for granular cell tumors. Until recently, granular cell tumors had been considered rare but, the incidence of granular cell tumors has been slowly raising since endoscopy has been used more commonly as a diagnostic tool. In this study, we report three cases of esophageal granular cell tumors which were successfully diaganosed by an esophagoscopy and an endoscopic ultrasonography and confirmed using an endoscopic esophageal mucosal resection (EEMR). (Korean J Gastrointest Endosc 18: 543-549, 1998)

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증례 : 식도 위장관 ; 식도에서 발생한 Angiocentric T-Cell Lymphoma 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Angiocentric T-cell Lymphoma of the Esophagus ): Korean J Gastrointest Endosc 1998;18(4):553-559. Published online November 30, 1997

Abstract PDF: In this study we present a case of an angiocentric T-cell lymphoma (ACTL) which involve the esophagus. A 37-year-old male was admitted with dysphagia, odynophagia, and weight loss for 3 months. Two months before his admission, he had undergone on endoscopy with a biopsy. The first endoscopic findings revealed a large ulcerative lesion on the esophagus, although there had been no evidence of lymphoma upon microscopic examination. On the follow up endoscopic examination, this ulcerative lesion revealed progressive and destructive change. Histopathology of the third biopsied specimens showed large atypical lymphocyte infiltrates with angiocentric and angioinvasive features. Immunohistochemical studies revealed that the atypical (large) lymphocytes had T-cell phenotypes (CD3+, CD5+, and CD43+) and contained few reactive B-cells (CD20+), We assume that this is the first case of ACTL involving the esophagus and larynx. (Korean J Gastrointest Endosc 18: 553-558, 1998)

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증례 : 식도 위장관 ; 위내시경으로 진단된 원발성 위 유전분증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Primary Gastric Amyloidosis Diagnosed by Endoscopy ): Korean J Gastrointest Endosc 1998;18(4):561-566. Published online November 30, 1997

Abstract PDF: Amyloidosis is characterized by deposition of amyloid, which is resistant to proteolysis & phagocytosis, in intercellular spaces & vascular walls. The amyloid deposition provokes dysfunction of an accumulated organ & displays variable clinical symptoms depending upon the involved organ. A diagnosis is rendered through a biopsy of the affected organ, followed by staining using congo red which reveals an apple greenish refractile birefringence via polarizing microscopy. Using an electro-microscopy specific filaments can be found. Amyloidosis is classified into primary amyloidosis, composed of light chain filaments (AL) and secondary amyloidosis, comprised of A protain (AA). The AL type of amyloidosis shows deposition of amyloid in muscularis mucosa & muscularis externa. Priunary amyloidosis on the other hand, is relatively rare. We experienced primary stornach amyloidosis (AL), which was mistaken for stomch cancer. (Korean J Gastrointest Endosc 18: 561-566, 1998)

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증례 : 식도 위장관 ; 점막하 종양으로 표현된 원발성 위결핵 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Primary Gastric Tuberculosis Diagnosed as a Submucosal Tumor ): Korean J Gastrointest Endosc 1998;18(4):567-572. Published online November 30, 1997

Abstract PDF: Gastric tuberculosis is a rare disease and is usually secondary to pulmonary or intestinal tuberculosis. Only a few cases of gastric tuberculosis have been reported in the literature. In most cases, gastric tuberculosis exists as an ulcerating lesion, whereby the clinical symptom is non-specific and similar to that of a peptic ulcer. The diagnosis af gastric tuberculosis is based on either positive histological or bacteriological study. Submucasal tumors resembling gastric tuberculosis has been reported extremely rare in incidence. In this study we report a case of a young woman admitted with intermittent abdominal pain due to gastric tuberculosis presenting as submucosal tumor in the greater curvature of the lower body. After gastric resection, a histological examination revealed chronic granulomatous inflammation with caseation necrosis which is consistent with tuberculosis. There was no evidence of the tuberculous lesion anywhere else. The patient was put on antituberculosis medications. The patient's follow-up observation in the clinic was uneventful. (Korean J Gastrointest Endosc 18: 567-572, 1998)

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증례 : 식도 위장관 ; 선암을 동반한 Peutz - Jeghers 증후군 - 1예 보고 - ( Case Reports : Esophagus , Stomach & Intestine ; A Case Report of Peutz - Jeghers Syndrome with an Adenomatous Malignant Change in a 44 Year Old Male Patient ): Korean J Gastrointest Endosc 1998;18(4):573-579. Published online November 30, 1997

Abstract PDF: Peutz-Jeghers Syndrome, characterized by autosomal inheritance, skin pigmentation, and hamartomatous polyps, had long been considered a benign polyposis until recent studies suggested an association with increased risk of malignant neoplasia in patients who had been followed-up for long periods. The authors present a case of Peutz-Jeghers syndrome in a 44 year old man with an adenomatous malignant change in his small bowel. The patient underwent surgery following a diagnosis of intestinal intussuception. Observing the polyps resected, all the polyps had characteristics of hamartoma, excluding one which showed a malignant transformation. Although it has not been fully determined with certainty whether the adenocarcinoma developed from hamartoma, histologic examination of an excised specimen suggested, thht potency of hamartoma to undergo malignant transformation. All the members of the family were confirmed to have no evidence of Peutz-Jeghers syndrome. Our clinical experience determines the malignant potency in Peutz-Jeghers and recommends that intensive follow-up of gastrointestinal and extragastrointestinal sites is needed in patients with this syndrome. (Korean J Gastrointest Endosc 18: 573-577, 1998)

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증례 : 식도 위장관 ; 십이지장을 침범한 위선암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Carcinoma Spread to the Duodenum ): Korean J Gastrointest Endosc 1998;18(4):581-583. Published online November 30, 1997

Abstract PDF: In 1861 Rokitanski laid down the law that the pyloric ring served as a barrier to the duodenal spread of gastric cancer. Although this theory was generally accepted, direct spread of gastric carcinoma into the duodenum has been reported. We report a case of gastric cancer spreading into the duodenum that was diagnosed by endoscopic duodenal biopsy and review the literature. (Korean J Gastrointest Endosc 18: 581-583, 1998)

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증례 : 식도 위장관 ; 내시경적 용종 절제술로 치유한 십이지장 유암종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Endoscopically Removed Duodenal Carcinoid Tumor ): Korean J Gastrointest Endosc 1998;18(4):584-589. Published online November 30, 1997

Abstract PDF: Primary carcinoid tumor of duodenum are rare, Usually, small duodenal carcinoid tumors are often discovered endoscopically. Most of these tumors are asymptomatic, but in rare cases, jaundice, hemorrhage, duodenal obstruction, or carcinoid syndrome were apparent. Uaually, the recommended treatment is surgical or endoscopic excision of the tumor. We experienced a case of carcinoid tumor of duodenu in 53 year-old women. A 53-year-old female patient was admitted to our hospital because of epigastric discomfort and indigestion. On the gastrofiberscopic examination, 0.9 cm sized polypoid mass with central umblication was noted on the duodenall bulb. The biopsy specimen showed carcinoid cells. She was treated with endoscopic polypectomy. (Korean J Gastrointest Endosc 18: 584-588, 1998)

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증례 : 식도 위장관 ; 2차 항결핵약제로 치유된 결핵성 대장염 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Colonic Tuberculosis Cured by Secondary Anti - Tuberculosis Medicine ): Korean J Gastrointest Endosc 1998;18(4):591-596. Published online November 30, 1997

Abstract PDF: Tuberculosis is common disease in developing countries manifested by multi-organ involvement. Although the incidence of tuberculosis has been reducing recently due to the advancement of anti-tuberculosis chemotherapy, improvement of public health, and early diagnosis, the rate is still higher in developing countries. The diagnasis of colonic tubcrculosis is difficult due to its frequency, vague manifestation, and difficulty in confirming the disease process. Fortunately, the advent of flexible colonoscopy has provided an opportunity to confirm the diagnosis of colonic tuberculosis, however biopsy can frequently leveal false negative results. A-27-year-old man was admitted with a 2 week history of rectal bleeding. He complained of anorexia, abdominal pain, and weight loss. Routine laboratory tests and chest X-ray findings were within normal limits, with the exception of left pleural thickening. A colonoscopy showed irregular and small, multiple, and shallow polypoid mucosal lesions in the ascending colon and multiple ulcers in the transverse colon. Multiple colonic biopsies suggested tuberculosis. After three months of prirnary anti-tuberculosis medica tion, the patient showed slightly improved coiono- scopic findings. Follow-up colono- scopic findings revealed more aggrevation and chest X-ray findings showed multiple patch consolidation in the left lung field. Primary anti-tuberculosis medication was stopped and substituted for secondary anti-tuberculosis medication. When clinical and colonoscopic methods are found to be compatible with intestinal tuberculosis in countries with a high prevalence of colonic tuberculosis, a therapeutic trial with an antituberculosis agent is usually considered. In a failed therapeutic trial, considerations must be made not only to other inflammatory bowel diseases such as crohn's disease, but also to multi-drug resistance tuberculosis. (Korean J Gastrointest Endosc 18: 591-596, 1998)

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증례 : 식도 위장관 ; 비활동성 궤양성 대장염과 관련된 괴저성 농피증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Pyoderma Gangrenosum Associated with Inactive Ulcerative Colitis ): Korean J Gastrointest Endosc 1998;18(4):597-603. Published online November 30, 1997

Abstract PDF: Ulcerative colitis is assoicated with various extraintestinal manifestations. Skin lesions are occurring in 9-19% of patients with ulcerative colitis. Among these lesions erythema nodosum is the most common and pyoderma gangrenosum is the most severe. While pyoderma gangrenosum occurs more frequently in patients with ulcerative colitis, erythema nodosum occurs more frequently in patients with Crohn's disease. The overall incidence of pyoderma gangrenosum is approximately 1-5% of patients with inflammatory bowel disease (IBD). Painful lesions usually appear on the pretibial area, and develop in patients with long-standing IBD, but occasionally precede the diagnosis of IBD and may occur after colectomy. Lesions are discrete ulcers with a necrotic base and begin as small painful pustules, which coalesce into a fluctuant sterile abscess within days. Usually pyoderma gangrenosum is present for weeks to months, occasionally persisting for more than 1 year. The recurrence rate is reported in about 33% of all cases. Lesions usually appear in patients with pancolitis and respond to treatment of systemic corticosteroids, antimicrobial agents, and occasionally are treated with cyclosporine or surgery. We experienced a case of pyoderma gangrenosum developed on the left pretibial area in a patient with inactive ulcerative colitis, and completely healed with oral prednisolone, antimicrobial agents and external dressing. Subsequently, we report this case with a review of corresponding literature. (Korean J Gastrointest Endnsc 18: 597-601, 1998)

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증례 : 식도 위장관 ; 대장암 양상을 보인 만성췌장염에 의한 대장폐색 ( Case Reports : Esophagus , Stomach & Intestine ; Stenosis of the Colon Due to Chronic Pancreatitis Mimicking Colon Cancer ): Korean J Gastrointest Endosc 1998;18(4):605-610. Published online November 30, 1997

Abstract PDF: Obstruction of the gastrointestinal tract by the progressive fibrotie process of chronic pancreatitis is being recognized with increasing frequency. The structures commonly affected are parapancreatic in location and include the common bile duct in its intrapancreatic portion, the second and third portion of the duodenum and the colon, most commonly the transverse segment. Colonic involvement of varying severity is less common and not well recongnized, and stenosing lesions of the colon are a rare and confusing sequale to pancreatitis. Some cases of colonic stenosis complicated by pancreatitis cannot be differentiated radiologically from carcinoma. The clinical history, enzyme studies and location of the stenosis in the left colon may alert the clinician to this rare diagnosis. We report a patient with stenosis of the colon due to chronic pancreatitis in whom the initial presenting symptoms and radiologic finding resemble colon cancer. (Korean J Gastrointest Endosc 18: 6ll5-610, 1998)

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증례 : 식도 위장관 ; 장관 포상 기종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Pneumatosis Cystoides Intestinalis ): Korean J Gastrointest Endosc 1998;18(4):611-617. Published online November 30, 1997

Abstract PDF: Pneumatosis cystoides intestinalis (PCI) is defined as the presence of multiple gas filled cysts in the wall of gastrointestinal tract, and was first reported by Duvernoi in 1730 from the pathologic findings at autopsy. The etiology and pathogenesis of this relatively rare but distinctive disorder remain unresolved. We recently experienced a case of PCI, in a 28-year old woman with chronic constipation for about 10 years. The case is presented with review of the literature. (Korean J Gastrointest Endosc 18: 6l1-617, 1998)

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증례 : 식도 위장관 ; 수술 전 소장 내시경 ( Enteroscopy ) 으로 진단한 출혈성 공장 평활근종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Bleeding Jejunal Leiomyoma Preoperatively Diagnosed by Enteroscopy ): Korean J Gastrointest Endosc 1998;18(4):618-623. Published online November 30, 1997

Abstract PDF: Lower GI bleeding occurs less frquently than upper GI bleeding. Most of the lower GI bleeding is from the colon, with 15-20% of all episodes involving the small intestine. These episodes stop spontaneously in 80% of all cases, but bleeding is recurrent in 25% of these patients. The most common cause of small intestinal bleeding is angiodysplasia, and the next is benign tumors. More than 50% of benign lesions of the small intestine remain asymptomatic and are discovered during an autopsy. Diagnosis of small intestinal lesions is not easy because of nonspecific symptoms and anatomical specificity. For instance, a 47-year-old woman was admitted to us with a 2-day history of melena. A small bowel enema revealed a filling defect at the level of 20 cm below the ligament of the Treiz. An enteroscopy revealed an ovoid elevated lesion with a central black spot and an ulceration in the proximal jejunum. An enteroscopic biopsy revealed leiomyoma. A jejunal mass was excised through a segmental resection. Pathological diagnosis of the resected mass revealed the same leiomyoma. (Korean J Gastrointest Endosc 18: 618-622, 1998)

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증례 : 담도 췌장 ; 담관의 다발성 유두종에서 병발된 선암 ( Case Reports : Biliary Tract & Pancreas ; A Case of Multiple Biliary Papillomatosis with Focal Adenocarcinoma ): Korean J Gastrointest Endosc 1998;18(4):625-629. Published online November 30, 1997

Abstract PDF: Multiple biliary papillomatosis are extremely rare, fifty one cases have been reported in the literature. Clinical symptoms are associated with obsructive jaundice and cholangitis. Malignant transformation into adenocarcinoma had been described. We report a case of multiple papillomatosis in the entire biliary ductal system with malignant transformation, in which endoscopic retrograde cholangiopancreatography and peroral choledochoscopy showed multiple polypoid lesicons. The endoscopic sphincterotomy and the intraductal biopsy confirmed the histologic diagnosis of multiple papillomatosis and adenocarcinoma. (Korean J Gastrointest Endosc 18: 625-629, 1998)

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증례 : 담도 췌장 ; 담낭관의 하부접합과 연관된 원발성 중복종양 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Double Primary Cancer Associated with a Low Junction of the Cystic Duct ): Korean J Gastrointest Endosc 1998;18(4):630-636. Published online November 30, 1997

Abstract PDF: Recently it has been discovered that anomalous union of pancreaticobiliary duct (AUPBD) may play an important role in the pathogenesis of bile duct cancer. Similar to this fact, there were a few reports on the clinical significance of the low junction of the cystic duct (LJCD). LJCD refers to the situation whereby the cystic duct enters the common duct at a low position between the upper margin of the pancreas and the duodenal opening of the bile duct. The pathogenetic mechanism in LJCD is similar to AUPBD in that the pancreatic juice refluxes to the bile duct, mixes with biles, and then generates the mutagens, which act as inflammatory substances and carcinogens on the epithelium of the bile duct. A 51-year-old male who experienced dyspepsia was hospitalized due to his abnormally functioning liver and dilated common bile duct. We confirmed primary cholangiocarcinoma on the common hepatic duct and gallbladder carcinoma associated with LJCD by ERCP and pathologic review of surgical specimen. We report a case of synchronous type double primary cancer associated with LJCD with a brief review of the literatures. (Korean J Gastrointest Endosc 18: 630-636, 1997)

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증례 : 담도 췌장 ; 십이지장 구부로 이상개구한 췌담관 2예 ( Case Reports : Biliary Tract & Pancreas ; Two Cases of Anomalous Termination of the Common Bile Duct and the Pancreatic Duct into the Duodenal Bulb ): Korean J Gastrointest Endosc 1998;18(4):637-643. Published online November 30, 1997

Abstract PDF: Many examples of congenital anomalies of the pancreatobiliary ductal system are now being found due to the development of new diagnostic techniques. Recently, despite the improvement in diagnosis and management of pancreatobiliary lesions, a lack of knowledge and understanding of these variations is undoubtedly responsible for many problems in medical and surgical management. In particular, drainage of the common bile duct and pancreatic duct at sites other than the second portion of the duodenum is an anatomieal curiosity. We report two cases in this study, of anomalous termination of the common bile duct and the pancreatic duct into the duodenal bulb, diagnosed by an ERCP and a gastroscopy. (Korean J Gastrointest Endosc 18: 637-642, 1998)

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