Clinical Endoscopy

원저 : 식도 위장관 ; 위장관 이물질에 관한 고찰 ( Original Articles : Esophagus , Stomach & Intestine ; A Review of an Endoscopic Extraction in 19 Cases of Gaastrointestinal Foreign Bodies ): Korean J Gastrointest Endosc 1998;18(5):651-657. Published online November 30, 1997

Abstract PDF: Background
/Aims: Foreign bodies in the upper gastrointestinal (G-I) tract are produced chiefly by accidental swallowing and rarely produce symptoms. But it is recommended to remove the foreign bodies if they produce symptoms or remain in the G-I tract for a long duration. The purpose of this study was to anlyze the results of therapeutic endoscopic foreign bodies extraction and appropriate removal methods for each foreign bodies. Methods: A clinical review was performed in 19 cases involving a foreign body in the upper & lower G-I tract which underwent the endoscopic extraction of the foreign body at Samsung Medical Center from November 1995 to November 1997. (Kerean J Gastrointest Endosc 18: 651-657, 1998) (continue..)

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원저 : 식도 위장관 ; 위선종의 내시경적 점막 절제술 및 추적 관찰 ( Original Articles : Esophagus , Stomach & Intestine ; Endoscopic Mucosal Resection of Gastric Adenoma : A Follew-up Study ): Korean J Gastrointest Endosc 1998;18(5):658-664. Published online November 30, 1997

Abstract PDF: Background
/Aims: Endoscopic mucosal resection (EMR) is a useful method in both the accurate diagnosis and treatment of gastric mucosal lesions. A gastric adenoma is a neoplastic lesion which has malignant potential, and therefore it is advisable to have it removed completely when discovered. We evaluated the role of EMR in the treatment of gastric adenomas by analyzing the follow-up endoscopic results of patients treated with EMR for such lesions. Methods: We analyzed the initial endoscopic findings, EMR results, and follow-up endoscopic outcomes of 35 patients with 41 gastric adenomas, from June 1994 to January 1997 in Seoul National University Hospital. (Korean J Gastrointest Endose 18: 658-664, 1998) (continue)

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원저 : 식도 위장관 ; 십이지장 유두부 종양의 내시경적 절제술 : 장기 추적 관찰 결과 ( Original Articles : Esophagus , Stomach & Intestine ; Endoscopic Ampullectomy for Tumors of the Ampulla of Vater : Long-term Follow-up Results ): Korean J Gastrointest Endosc 1998;18(5):665-670. Published online November 30, 1997

Abstract PDF: Background
/Aims: The resectability rate and prognosis of tumors of the ampulla of Vater are significantly better than for other periampullary tumors. Treatment for ampullary tumors has traditionally been surgical resection. However, endoscopic ampullectomy has been reported in patients with benign ampullary tumors. This study is being conducted to evaluate the availability of endoscopic ampullectomy. Methods: Between 1994 and 1996, 6 cases (M: F=5: 1) with ampullary tumors were treated by endoscopic ampullectomy. Clinical presentations, complications, pathologic findings, and follow-up information were reviewed. Results: Complete resection was perfomed in 5 cases. Pancreatitis after this procedure occurred in 2 cases, but were resolved by conservative care. Pathologic findings of resected specimens were adenama in 4 cases and adenocarcinoma in 2 cases. There was no recurrence in adenoma during the follow-up period (9-37 months) except in one case, which the patient was lost after 9 months. In one case with adenocarcinoma, the patient refused the operation, and consequently had the tumor recurrence 13 months later. Conclusions: Endoscopic ampullectomy was considered safe and effective treatment for removing benign ampullary tumors as well as malignant tumors, the latter of which are not considered suitable for operation. (Korean J Gastrointest Endosc 18: 665-670, 1998)

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원저 : 담도 췌장 : 담췌관 합류부위의 형태와 담췌관 질환 ( Original Articles : Biliary Tract & Pancreas ; The Pancreaticobiliary Ductal Union System and Associated Disorders ): Korean J Gastrointest Endosc 1998;18(5):671-680. Published online November 30, 1997

Abstract PDF: Background
/Aims: The anatomy of the distal ends of the common bile duct and the main pancreatic duct has received attention becauwe of its importance in pancreaticobiliary disense. The two ducts open into the duodenum either separately or via a common channel. But basie data about the pancreaticabiliary ductal union system has not existed in Korea until now. Methods: In this study all cases performed with an ERCP were reviewed over the past 5 years (1992.1.1 1996.12.31). Among 3,234 cases, 307 were selected and analyzed because of their clear identification by the pancreaticobiliary ductal union system. (Korean J Gastrointest Endosc 18: 671-680, 1998) (continue)

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원저 : 담도 췌장 : 담도의 다발성 유두종 9예 ( Original Articles : Biliary Tract & Pancreas ; An Analysis of Nine Cases of Multiple Biliary Papillomatosis ): Korean J Gastrointest Endosc 1998;18(5):681-689. Published online November 30, 1997

Abstract PDF: Background
and Study Aims: Multiple biliary papillomatosis (MBP) is an uncommon disease. This study was undertaken to review cases with respect to describing clinical features and characteristical cholangiographic findings, and to define the role of cholangioscopy in the diagnosis and treatment of this disorder. Patients and Methods: from 1990 to 1997, nine patients (mean age; 57.3 years, 6 men and 3 women) were diagnosed as having MBP arnong 5,361 cases of endoscopic retrograde cholangiography (ERC) conducted at our center. A retrospective analyses of the cholangiographic and cholangioscopic findings as well as clinieal features were performed.(Korean J Gastrointest Endosc 18: 681-687, 1998)

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증례 : 식도 위장관 ; 식도 방추상세포암종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Spindle Cell Carcinoma of the Esophagus ): Korean J Gastrointest Endosc 1998;18(5):691-697. Published online November 30, 1997

Abstract PDF: Spindle cell carcinoma of the esophagus containing both carcinomatous and sarcomatous elements is rare, accounting for approximately 1- 2% of all esophageal neoplasms. Terms used to describe this lesion include carcinosarcoma, pseudosarcoma, polypoid carcinoma, pseudosarcomatous squamous cell carcinoma and spindle cell variant of squamous cell carcinoma. Spindle cell carcinomas were originally classified as carcinosarcomas or pseu- dosarcomas, depending on the morphology and bilologic behavior of the particular lesian. However, pseudosarcoma and carcinosarcoma appear to be the same pathologic entity with varying degrees of anaplastic spindle cell metaplasia of the carcinomatous portion of the tumor. Thus, these lesions have been clsssified together as spindle cell carcinomas. A 59 year-old man who experienced weight loss for 4 months was hospitalized as a result of suffering from dysphagia for 2 months. A diffuse bulky protruding mass with superficial ulceration and easy friability on 25 to 35 cm from the incisors, which invaded the right intermediate bronchus and involved the right paratracheal and subcarnial lymph nodes, were obsetved in esophagogram, endoscopy and chest CT. Pathologic finding, including immunoreactivity to cytokeratin and vimentin, was consistent with spindle cell carcinoma. We report a case of spindle cell carcinoma of the esophagus, (Korean J Gastrointest Endosc 18: 691-697, 1998)

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증례 : 식도 위장관 ; Boerhaave 증후군의 내시경적 소견 3예 ( Case Reports : Esophagus , Stomach & Intestine ; Endoscopic Findings in Boerhaave's Syndrome - Report of three cases - ): Korean J Gastrointest Endosc 1998;18(5):698-705. Published online November 30, 1997

Abstract PDF: Boerhaave's syndrome, which was first described by Herman Boerhave in 1724, is a spontaneous esophagcal rupture resulting from severe nausea and vomiting. It is a very rare disorder, frequently developed in the 4th to 6th decade of life, and affects males more commonly than females. A typical clinical triad of chest pain, fever, and subcutaneous emphysema was manifested in only 20-30% of cases involving an esophageal rupture and most patients complained of many nonspecific symptoms such as dyspnea and hematemesis. In cases of vomiting resulting from alcohol ingestion, gastrofiberscopy can be performed in hematemetic patients under the assumption of upper gastrointestinal bleeding in most cases of Boerhaave's syndrome. We report 3 patients of Boerhaave's syndrome who visited our hospital because of hematemesis. Their endoscopic findings were, 1) a large, deep oval-shaped laceration with a sharp margin on the distal esophagus 2) a cavitary lesion with internal multiple hematomas and/or necrotic debris, and 3) a formation of air bubbles in the hematoma relating to respiration. (Korean J Gastrointest Endosc 18: 698-703, 1998)

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증례 : 식도 위장관 ; Helicobacter pylori 감염의 박멸후 발생한 역류성 식도염 ( Case Reports : Esophagus , Stomach & Intestine ; Reflux Esophagitis after Cure of Helicobacter pylori Infection - Report of two cases - ): Korean J Gastrointest Endosc 1998;18(5):707-712. Published online November 30, 1997

Abstract PDF: Helicobacter pylori infection causes chronic gastritis and its well documented con- sequences are peptic ulcer disease and gastric neoplasia. As duodenal ulcer is often associated with gastroesophageal reflux disease and antral gastritis is a frequent finding in patients with reflux disease, H. pylori infection may be a common cause of both conditions. Recent studies reveal that H. pylori has no role in the pathogenesis of reflux esophagitis. Furthermore, there are some arguments on whether H. pylori infection may have a protective role in reflux esophagitis. We have experienced two cases of reflux esophagitis after cure of H. pylori infection. H. pylori eradication therapy was performed in two patients who have gastric and/or duodenal ulcer with omeprazole and two anti-biotics (clarithromycin and amoxicillin). After cure of H. pylori infection, reflux esophagitis was demonstrated in these patients by endoscopy. (Korean J Gastrointest Endosc 18: 707-712, 1998)

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증례 : 식도 위장관 ; 장기축회전형 만성위축염전증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of an Organoaxial Type of Chronic Gastric Volvulus ): Korean J Gastrointest Endosc 1998;18(5):713-718. Published online November 30, 1997

Abstract PDF: Gastric volvulus is a rotation of the stomach of at least 180 associated with a closed loop obstruction. Pare described the first case of gastric volvulus m 1579. Laxity of the gastric ligament, a congenital or acquired diaphragmatic defect, increased abdominal pressure, and a genetic component contributing to gastric volvulus. Gastric volvulus has been classified clinically as acute and chronic gastric volvulus, and can be classified anatomically as organoaxial, mesenteroaxial or a mixed type. Gastric volvulus occurs in children usually before 1 year of age or elderly patients. In acute gastric volvulus, and be patients complain of sudden abdominal or chest pain. The chest pain, which can radiate to the arms and neck accompanied by dyspnea, may initially lead to consideration of ischemic heart disease. Chronic gastric volvulus is difficult to diagnose because it may be associated with mild and nonspecific symptoms such as epigastric discomfort, fullness or heartburn. We experienced a case of 83 year old male with an organoaxial type of chronic gastric volvulus, iagnosed by upper gastrointestinal series, and treated with conservative rnanagement. (Korean J Gastrointest Endosc 18: 713-718, 1998)

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증례 : 식도 위장관 ; 성인에서 발견된 췌장 가성낭종 양상을 보인 위 거대 중복낭종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Large Gastric Duplication Cyst Resembling a Pancreatic Pseudocyst in an Adulf - Report of one case - ): Korean J Gastrointest Endosc 1998;18(5):719-725. Published online November 30, 1997

Abstract PDF: Duplication of the alimentary tract is an unusual congenital anomaly which may occur at any level, from the oral cavity to the rectum. Gastric duplication cyst is quite rare and most of them are presented in infancy with the sypmtoms of vomiting, abdominal pain, weight loss, gastrointestinal bleeding resulting from partial or complete obstruction. Some cases have not been diagnosed until adult when duplication cyst is not large enough to cause acute obstruction in infancy. Our case is more unusual in the aspect of its presence in adult and its nature resembles huge pancreatic pseudocyst. A 18-year man came to our hospital with complaint of epigastric pain for three days. A gastrofiberoscopy revealed a round protruding mass with smooth surface of normal mucosa at the fundus and computed tomography of the abdomen revealed the presence of 6.0 X 6.0 cm sized cystic mass between posterior wall of stomach and pancreas, and another 2.0 x 2.0 cm sized mass in ant. wall of stomach, which were regarded as mutiple pancreatic pseudocysts in perigastric region. Endoscopic retrograde cholangiopancreatography did not disclose any pancreatic ductal abnormality or communication with the cyst. Endoscopic ultrasonography showed anechoic cystic mass under 3rd layer of stomach wall, which was removed by surgical resection. Postoperative pathologic examination disclosed multiple gastric duplications. (Korean J Gastrointest Endosc 18: 719-723, 1998)

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증례 : 식도 위장관 ; Mallory - Weiss Syndrome 을 동반한 위 아니사키증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Anisakiasis Causing Mallory - Weiss Syndrome ): Korean J Gastrointest Endosc 1998;18(5):727-731. Published online November 30, 1997

Abstract PDF: Anisakiasis is an infection in humans caused by larval nematodes of the family Anisakidae and is encountered in people who eat inadequately prepared raw, salt-water fish or "sashimi". This clinical syndrome is characterized by severe cramping abdominal pain, nausea, and vomiting. Because Koreans like to eat raw fish, anisakiasis of the stomach has been reported occasionally, but the incidences of upper gastrointestinal bleeding caused by anisakiasis has been very rare. The present case is a 30 year-old male Admitted with an episode of hematemesis. A gastrofibroscopy revealed a mucosal laceration and the larva of Anisakis on the esophagogastric junction. We report one case of Mallory-Weiss Syndrome due to gastric Anisakis larva, confirmed by an endoscopy. (Korean J Gastrointest Endosc 18: 727-731, 1998)

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증례 : 식도 위장관 ; 물개회충 ( Pseudoterranova Decipiens ) 의 유충에 의한 위 아니사키스증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Human Infection of the Larvae from Pseudoterranova Decipiens ): Korean J Gastrointest Endosc 1998;18(5):732-736. Published online November 30, 1997

Abstract PDF: A case of gastric anisakiasis due to the larva of Pseudoterranova decipiences was con- firmed by a gastroendoscopic examination. A long whitish nematode larva invading the stomach wall (fundus) was discovered and was extracted using biopsy forceps after 3 days to the onset of symptoms. The worm was 42.6 X 1.1 mm size, and was identified as being a the 4th stage larva of P. decipiens, based upon its morphological characteristics, The patient, residing in Seoul, was a 51-year-old housewife, who complained of severe epi- gastric pain and recalled that she had previously eaten the raw flesh of an Astroconger myriaster in a Japanese restaurant (sushi Bar). This study probably emerges as the 7th human case of gastric anisakiasis of pseudoterranoviasis in Korea. (Korean J Gastrointest Endosc 18: 732-736, 1998)

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증례 : 식도 위장관 ; Histoacrylⓡ 을 이용한 위흉강 누공의 치료 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastropleural Fistula Treated by Endoscopic lnjection of Histoacrylⓡ ): Korean J Gastrointest Endosc 1998;18(5):737-743. Published online November 30, 1997

Abstract PDF: Gastropleural fistula is an uncommon condition which can be induced by a trauma, gastroesophagectomy, subphrenic abscess, malignancy, and or hiatal hernia. In the patient with a predisposing factor, gastropleural fistula must be considered when pneumothorax, pyothorax, hemothorax, or food materials in the chest tube is detected. Diagnosis can be confirmed by an esophagogastrogram or endoscopy. The prognosis is often very poor with conservative care needed, along with a fistulectomy reguiring repair of orifice. We experienced a case of gastropleural fistula treated by endoscopic injection of Histoacryl and report it here with a review of related literature.(Korean J Gastrointest Endosc 18: 737-741, 1998)

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증례 : 식도 위장관 ; 출혈을 동반한 위 평활근육종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Leiomyosarcoma with Bleeding ): Korean J Gastrointest Endosc 1998;18(5):745-749. Published online November 30, 1997

Abstract PDF: Leiomyosarcoma accounts for 1-3% of all the gastric malignancies. The most common clinical presentation of gastric leiomyosarcoma is gastrointestinal hemorrhage due to tumor ulceration. Surgical resection is the treatment of choice for gastrointestinal sarcomas and the appropriate surgical management requires deliberate efforts for complete excision of the tumor with an adequate margin of normal tissue. A 70-year-old woman was admitted to our hospital due to a melena persisting for 7 days. A gastrofiberscopy was performed and a large normal mucosa covered lobulated mass with deep multiple round ulcers were found in the fundus. A slightly protruding vessel was visible on the base of the posterior wall of the fundus. An abdominal CT revealed a heterogenous mass with irregular multifocal necrotic portions in the fundus. During on operation, a tumorous mass was found in the fundus. The liver was free of metastasis and lymphadenopathy was not discovered. A total gastrectomy, omentectomy, and an end to end esophagojejunostomy were performed. The pathologic diagnosis determined a high grade leiomyosarcoma. (Korean J Gastrointest Endosc 18: 745-749, 1998)

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증례 : 식도 위장관 ; 소아에서 내시경 초음파 검사로 진단된 위 점막하 종양 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Submucosal Tumors in Children Diagnosed by Endoscopic Ultrasonography ): Korean J Gastrointest Endosc 1998;18(5):750-754. Published online November 30, 1997

Abstract PDF: Benign neoplasms of the stomach are uncommon in children. They include adenomatous and hyperplastic polpys, leiomyomas, lipomas, and other lesions. Gastric leiomyoma in childhood represent only 1% of all gastrointestinal neoplasms reported, and slightly more than half of these are gastric. The tumor arises in the muscle layer of the stomach and is usually intragastric and submucosal. Barium contrast studies are useful in localizing leiomyoma with significant intramural or submucosal growth. An endoscopy can permit histologic confirmation if the tumor has eroded through the mucosa. Differentiation however, of malignant lesions from benign submucosal leiomyomas may be difficult. Using endoscopic ultrasonund imaging, highly accurate gastrointestinal tumor characterization, especially submucosal masses, and differentiation of malignant from benign lesion are now relatively possible without surgery. We experienced a case of a gastric submucosal tumor regarded as a leiomyoma, which was diagnosed using endoscopic ultrasonography, and report the findings with a review of related literatures. (Korean J Gastrnintest Endosc 18: 750-754, 1998)

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증례 : 식도 위장관 ; 폐소세포암의 위전이 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Metastatic Gastric Cancer Resulting from Small Cell Lung Cancer ): Korean J Gastrointest Endosc 1998;18(5):755-761. Published online November 30, 1997

Abstract PDF: Blood-borne metastatic cancer of the stomach is a rare occurrence according to a number of reports in the literature. Morever, it is extremely rare that gastric metastasis is man- ifested during life and most metastatic gastric tumors have been found at autopsy. The tumors most commonly reported to metastasize to the stomach include melanoma, breast carcinoma, and lung carcinoma. The frequency of metastatic gastric cancer from small cell lung cancer is 0.2-0.5% in the world literature. In Korea, there has been only one case reported on metastatic gastric cancer from small cell lung cancer. A 53-year-old man who had primary small cell lung carcinoma with brain metastasis complained of nausea, vomiting, and poor oral intake, An esophagogastroduodenoscopy revealed two submucosal tumors in the fundus and the mid body of the stomch. Pathologic examination revealed submucosal infiltration of small cell carcinoma. We report a case of metastatic gastric cancer, from small cell lung cancer that could be diaignosed during the subjectis followed by review of the life, literature. (Korean J Gastrointest Endosc 18: 755-760, 1998)

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증례 : 식도 위장관 ; Cytomegalovirus 에 의한 다발성 위장관 궤양 2예 ( Case Reports : Esophagus , Stomach & Intestine ; Two Cases of CMV Esophagitis and Proctitis ): Korean J Gastrointest Endosc 1998;18(5):763-768. Published online November 30, 1997

Abstract PDF: Gastrointestinal cytomegalovirus (CMV) disease most frequently occurs in adults with immune deficiency due to acquired immune deficiency syndrome (AIDS), organ trans- plantation, cancer chemotherapy, and steroid therapy. Because the number of patients with immune deficiency has increased in recent years in Korea and CMV is one of the most common infecting complications in these settings, the number of patients with CMV disease is also increasing. Most cases of CMV disease are due to reactivation of a latent virus. The pathogenesis of this intestinal disease is vascular endothelial involvement with subsequent ischemic mucosal injury. An endoscopy usually reveals large, well defined ulcers greater than 3 cm. Deep longitudinal serpiginous ulcers represent a coalescence of adjoining smaller ulcers. CMV infection produces a characteristic cytomegalic cell containing a intranuclear inclusion, which is sometimes surrounded by a clear halo ("owl's eye"). The presence of cytomegalic cells on mucosal biopsy specimens stained with hematoxylin and eosin has been considered the golden standard for establishing the diagnosis of CMV gastrointestinal disease. Immunohistochemistry with monoclonal antibody to CMV antigens and in situ hybridization for CMV DNA are useful in the diagnosis. We report 2 cases of CMV esophagitis and proctitis which showed characteristic endoscopic and histologic findings of the CMV infection. (Korean J Gastrointest Endosc 18: 763-768, 1998)

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증례 : 식도 위장관 ; 장간막 정맥 혈전증에 의한 십이지장 허혈성 장염 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Duodenal Ischemic Enteritis Due to Mesenteric Venous Thrombosis ): Korean J Gastrointest Endosc 1998;18(5):769-775. Published online November 30, 1997

Abstract PDF: Mesenteric vein thrombosis (MVT) is an infrequent but old form of acute mesenteric ischemia, various forms of which have been recognized through imaging techniques. Pre- viously, diagnosis was made only by a laparotomy or autopsy. MVT is an abdominal emergency that is rarely diagnosed early. Review of the literature has shown that most cases have been treated by intestinal resection, and a few by thrombectomy with or with- out resection. Most are primary thromboses, but some are related to thromboembolic dise- ases, sepsis, cirrhosis, coagulopathy, abdominal neoplasms, traurna, or use of oral contra- ceptives. We report a case of superior mesenteric vein thrombosis with acute ischemic bowel disease, diagnosed early through a duodenoscopy and definitively assessed by superior mesenteric angiography and computed tomography. The predisposing factor for this case was a pelvic abscess post placenta previa operation. The first symptoms were hematemesis and abdominal pain. An intestinal mucosal lesion and clinical symptoms were improved by only heparinization and symptomatic treatment without resection. (Korean J Gastrointest Endosc 18: 769-773, 1998)

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증례 : 식도 위장관 ; 기계적 장폐색으로 발현한 충수돌기 점액류종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Appendiceal Mucocele Presented as a Bowel Obstruction Symptom ): Korean J Gastrointest Endosc 1998;18(5):777-780. Published online November 30, 1997

Abstract PDF: Mucocele of the appendix is a rare disease entity which is infrequently diagnosed prior to a laparotomy. With progress in diagnostic procedures, such as the use of ultrasonography, computed tomography, and colonoscopy, preoperative diagnosis of the appendiceal mucocele has become possible. The case that we have experienced involves an eighty five-year old male. He was admitted with bowel obstruction symptoms such as severe abdominal pain, tenderness, and increased bowel sound sounds. He was diagnosed as having appendiceal mucocele by an abdominal CT and colonoscopy, He was operated on and the surgical specimen revealed appendicea] mucocele. (Korean J Gastrointest Endosc 18: 777-780, 1998)

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증례 : 담도 췌장 ; 유두부 괄약근 절개술로 치유한 Choledochocele ( Case Reports : Biliary Tract & Pancreas ; Treatment Using an Endoscopic Sphincterotomy for Two Patients with Choledochocele ): Korean J Gastrointest Endosc 1998;18(5):781-787. Published online November 30, 1997

Abstract PDF: A choledochocele is a cyst like herniation of the intramural segment of the distal common bile duct protruding into the duodenal lumen. It is controversial whether this disease entity represents a type III variation of a choledochal cyst or an acquired lesion due to a calculus, papillitis or sphincter of Oddi dysfunction. The choledochocele is the rarest form of choledochal cysts and represents only 1.4-5.0% of all choledochal cysts. The diagnosis of choledochocele can be confirmed with certainly using a cholangiography. During a side viewing duodenoscopy followed by retrograde cholangiopancreatography, the mucosa appears normal but the papilla may be larger than usual. When probing the choledochocele with a cannulating catheter, its surface may be appear to be soft and compressible, similar to the pillow sign. After contrast dye is instilled into the bile duct, a round, cyst-like contrast filled structure can be identified adjacent to the terminatian of the common bile duct and an air halo sign may be visible around it. The established treatment of choledochocele is surgical resection of the cyst with anastomosis of the common bile duct to the small intestine, but transduodenal sphincteroplasty or endoscopic sphincterotomy has been advocated as an alternative to excision because of the very low risk of malignant degeneration, operative complications and morbidity. The choice of therapy for the patients with symptomatic choledochchocele is to establish effective drainage of the common bile duct and pancreatic duct. The objective can be achieved using an endoscopic sphincterotomy or transduodenal sphinateroplasy. It has been determined in recent years that endoscopic sphincterotomy is v effective and often followed by a positive prognosis. We report two patients with reicurrent pancreatitis and the common bile duct dilatation secondary to a choledochoce]e, who were treated effectively by endoscopic sphincterotomy. (Korean J Gastrointest Endosc 18: 781-787, 1998)

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증례 : 담도 췌장 ; 내시경적으로 제거한 총담관 융모성 선종 2예 ( Case Reports : Biliary Tract & Pancreas ; Two Cases of Villous Adenoma of the Common Bile Duct : Endoscopic Diagnosis and Treatment ): Korean J Gastrointest Endosc 1998;18(5):788-797. Published online November 30, 1997

Abstract PDF: Villous adenomas of the common bile duct are rare and accordingly it is difficult to render a firm preoperative diagnosis. They are the unusual cause of bile duct obstruction and can mimic malignant extrahepatic biliary tumors or stones. Until recently, only a few cases had been reported in the medical literature. Although some authors advocate open surgical excision, especially with recurrence or carcinomatous change, an endoscopic resection of a distal common bile duct adenoma is a viable alternative for those patients considered poor surgical risks. We present two cases of villous adenoma of the common bile duct diagnosed by an endoscopic biopsy and endoscopically resected, with review of the relevant literature on the subject. (Korean J Gastrointest Endosc 18: 788-795, 1998)

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