Clinical Endoscopy

원저 : 식도 위장관 ; 식도에서 편평세포유두종과 인유두종바이러스와의 관계 ( Original Articles : Esophagus , Stomach $ Intestine ; Correlation between Squamous Papilloma and Human Papillomavirus in Esophagus ): Korean J Gastrointest Endosc 1998;18(6):805-810. Published online November 30, 1997

Abstract PDF: Background
/Aims: Esophageal squamous papillorma is a rare benign lesion. This lesion is generally asymptomatic and solitary. Resent studies reveal the presence of human papil- lomavirus in certain cases of esophageal squamous papilloma, and human papillomavirus appears to be pathogenetically related to the esophageal squamous papilloma. The aim of this study was to evaluate the presence of human papillomavirus in esoplmgeal spuamous papilloma. Methods: In situ hybridizations and direct in situ polymerase chain reactions for human papillomavirus type 6/11 were performed on 16 paraffin embedded tissues with esophageal squamous papilloma. Results: Human papillomavirus type 6/11 was detected in 1 of 16 esophageal squamous papillomas on direct in situ polymerase chain reaction. All lesions were solitary, and 12 of 16 cases were located in distal one-third of the esophagus. Age range was 23-71 years (mean, 41 years). Conclusion: These results indicate that causal relation between human papillomavirus type 6/11 and esophageal squamous papilloma is inconspicuous. (Korean J Gastrointest Endosc 18: 805-810, 1998)

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원저 : 식도 위장관 ; 내시경검사 전처치로서의 인두 국소마취가 연하기능에 미치는 영향 ( Original Articles : Esophagus , Stomach $ Intestine ; The Effect of Regional Anesthesia for Premedication of Esophagogastroduodenoscopy on Swallowing Motor Function ): Korean J Gastrointest Endosc 1998;18(6):811-816. Published online November 30, 1997

Abstract PDF: Regianal anesthesia applied by means of a gargle provides satisfactory analgesia for premedication of esophagogastroduodenoscopy (EGD). To access the influence of 2% lidocaine hydrochloride after regional anesthesia on oropharyngeal components of swal- lowing, we used the videofluorographic swallowing study for the evaluation of pharyngeal architecture, time of pharyngeal barium passage, and the submental surface EMG(S-EMG) for the evaluation of functional changes in skeletal muscle. Measurements were made in 10 healthy volunteers without any oropharyngeal problems. There was no liquid aspiration symptoms or signs before and after regional anesthesia application. Also, there were no structural changes in pharyngeal swallowing motion and no significant prolongation of pharyngeal barium transit time. But regional anesthesia affected the eletro-activities in swallowing skeletal muscle, i.e, the swallowing durations, peak amplitudes of peristaltic wave, and area under curves in S-EMG, which returned to pre-anesthesia levels in 60 minute's time. Therefore, it will be recommended to avoid meal within 60 minute's after regional anesthesia for EGD. (Korean J Gastrointest Endosc 18: 811-816, 1998)

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원저 : 식도 위장관 ; 소화성궤양 출혈 환자에서 다양한 내시경적 국소 주입 요법과 Hemoclip 요법의 치료효과 비교 ( Original Articles : Esophagus , Stomach $ Intestine ; Comparison of Various Endoscopic Injection Therapy and Hemoclipping for Bleeding Peptic Ulcers ): Korean J Gastrointest Endosc 1998;18(6):817-824. Published online November 30, 1997

Abstract PDF: Background
/Aims: Widely practiced endoscopic methods for hemastasis of bleeding peptic ulcer include thermal application (laser, heater probe) and local injection (epi- nephrine, fibrine-glue or various sclerosing agents). Studies evaluating these modalities have presented high success rates for achieving initial hemostasis. Recently, endoscopic hemoclipping is considered to be a safe and effective hemostatic method for upper gas- trointestinal bleeding. The aim of this study was to compare various hemostatic modalities for bleeding peptic ulcer. Methods: Over a three year period between June 1994 and October 1997, a total of 133 patients with bleeding peptic ulcer were included in this study, We have conducted clinical trials and a retrospective analysis. All of the patients we selected had either active bleeding or a nonbleeding visible vessel on endoscopy. Endoscopy was performed on an emergency basis within 12 hours of hospital arrival. (Korean J Gastrointest Endosc 18: 817-824, 1998) (continue)

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원저 : 식도 위장관 ; 상부 위장관 Stromal Tumor 의 악성 감별진단에 있어서 내시경 초음파 검사의 유용성 ( Original Articles : Esophagus , Stomach $ Intestine ; The Role of Endoscopic Ultrasonography in Differentiating Benign and Malignant Stromal Tumors of Upper Gastrointestinal Tract ): Korean J Gastrointest Endosc 1998;18(6):825-831. Published online November 30, 1997

Abstract PDF: Background
/Aims: Endoscopic ultrasonography (EUS) has been useful in evaluating submucosal lesions of the upper gastrointestinal tract as well as providing guidelines for therapeutic plans. Large proportions of submucosal tumors are diagnosed as stromal tumors. Most are benign, but a significant proportion of them could be malignant. There are a few reports concerning EUS findings as being predictive of malignancy. The aim of this study was to evaluate specific EUS features favoring malignancy in stromal tumors of the UGI tract. Methods: From January, 1992 to June, 1997, thirty-three cases appeared involving stromal tumors (18 benign, 15 malignant (including 8 STUMP)), and were either surgically (27 cases) or endoscopically (6 cases) resected. Videotapes and photographs were reviewed and EUS features that favored the malignancy were analyzed. (Korean J Gastrointest Endosc 18: 825-831, 1998) (continue)

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원저 : 식도 위장관 ; 내시경적 절제술을 시행받은 위용종 290예의 임상적 및 조직학적 검토 ( Original Articles : Esophagus , Stomach $ Intestine ; Clinicopathologic Evaluation of 290 Cases Involving Endoscopic Gastric Polypectomy ): Korean J Gastrointest Endosc 1998;18(6):832-840. Published online November 30, 1997

Abstract PDF: Background
/Aims: Gastric polyps are recommended to be removed due to their premalignant potential. Endoscopic polypectomy has long been considered a safe and effective method for removal of gastric polyps. Methods: The authors diagnosed and treated 290 gastric polyps using endoscopy on 210 patients who had been admitted to Chungnam National University Hospital from January, 1990 to August, 1996. The clinical endoscopic and pathologic findings were evaluated. (Korean J Gastrointest Endosc 18: 832-840, 1998) (continue)

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원저 : 식도 위장관 ; 복강경을 이용한 양성 위종양 절제술 ( Original Articles : Esophagus , Stomach $ Intestine ; Laparoscopic Partial Gastric Resection for Benign Gastric Tumors ): Korean J Gastrointest Endosc 1998;18(6):841-846. Published online November 30, 1997

Abstract PDF: Background
/Aims: Since the laparoscopic cholecystectomy has been introduced, minimally invasive techniques have been applied to the management of various intraabdominal lesions. Laparoscopic resection of benign gastric tumor has several advantages compared to open surgery; such as reduced postoperative discomfort, early hospital discharge and less complications. Methods: We performed laparoscopic gastric resection for 6 benign gastric leiomyomas and 3 heterotropic gastric pancreases diagnosed by gastric endoscopy and did endoscopic ultrasonography routinely to find out the exact location of mass and depth of invasion. Results: 1) Male to female ratio was 2: 7 and mean age was 48 years. 2) The masses were located at posterior wall of body in 5 cases, fundus in 2 cases, anterior wall of antrum in 1 case, and enterior wall of body, lesser curvature in 1 case. 3) Resection of benign gastric tumors were readily achieved laparoscopically, aided by disposable stapling instruments. 4) Mean operation time was 120 minutes and mean hospital stay was 5.1 days. Conclusions: The benign gastric tumors can be managed laparoscopically with good results and this procedure provides another choice for the resection of them. (Korean J Gastrointest Endosc 18: 841-846, 1998)

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원저 : 식도 위장관 ; Helicobacter pylori 균주의 Metronidazole 내성이 균 박멸에 미치는 영향 ( Original Articles : Esophagus , Stomach $ Intestine ; Metronidazole Resistance and the Eradication of Helicobacter pylori ): Korean J Gastrointest Endosc 1998;18(6):847-852. Published online November 30, 1997

Abstract PDF: Background
/Aims: The success of Helicobacter pylori eradication is limited by antibiotic resistances, and the primary resistance to metranidazole seems to be high. In this study, the frequency af metronidazole resistance and the eradication rate in metronidazole-resistant H. pylori strain was evaluated. Methods: Sixty-eight patients were tested for metronidazole resistance using microdilution broth, the E test and disk diffusion method. Twenty-two patients were treated for 14 days with amoxicilline 2000 mg, metronidazole 750 mg, and tripotassium dicitrate bismuth 1200 mg. Results: Metronida-zole resistance was 46% (31/68). The eradication rates for H. pylori was 91.7% in patients with metronidazole-sensistive strains and 70% in patients with metronidazole-resistant strains. Conclusions: Metronidazole resistance was high (46%) in Korea, however, triple therapy was an efficient method of eradicating H. pylori in both metronidazole sensitive and resistant strains. (Korean J Gastrointest Endosc 18: 847-852, 1998)

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원저 : 식도 위장관 ; 혈변 환자의 임상적 고찰 ( Original Articles : Esophagus , Stomach $ Intestine ; Clinical Observation on Patients with Hematochezia ): Korean J Gastrointest Endosc 1998;18(6):853-862. Published online November 30, 1997

Abstract PDF: Backgroud/Aims: The purpose of this study was to examine the clinical observations of patients with hematochezia in attempt to determine the appropriate evaluation and treatment of this group of patients. Methods: Seventy patients with hematochezia were admitted to Intemal medicine (IM) Department of Chungnam National University Hospital from January 1990 to August 1997. The clinical observations of patients with hematochezia were reviewed and the results are as follows. Results: 1) The causes of the hematochezia were ischemic colitis (18.6%), hemorrhoids (15.7%), ulcerative colitis (14.3%), unknown (12.8%), rectal cancer (7.1%), nonspecific ulcers (rectum; 4.3%, colon; 1.4%), diverticulosis (5.7% ), colon cancer (4.3%.), mdiation colitis (2.9%), angiodysplasia (2.9%), polyps (2.9%), Samonella colitis (2.9%), rectal varix (1.4%), ileitis(1.4%) and ileal ulceration (1.4%). 2) The average hemoglobin of the patients with hematochezia was 9.6 g/dl. Forty percent of the patients with hematochezia required a transfusion and the average transfusion amount was 4.4 packs (Pack Red Cell). Patients with nonspecific ulcers (recutum, colon), angiodysplasia, colon cancer, ilieal lesion and rectal varix required more transfusions (average transfusion amount, 5.7 packs). 3) Patients who improved with eonservative treatment only were 85.7%, and 11.4% required surgical intervention. Also 2.9% required endoscopic intervention. 4) Confirmative modalities of hematochezia included colonoscopy (80%), and others (angiography, barium enema, and operation etc.). Conclusions: In patients with hematochezia admitted to the IM Department, the cause of hematochezia was confirmed by colonoscopy and patients with hematochezia were mainly managed using conservative treatment. (Korean J Gastrointest Endosc 18: 853-862, 1998)

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원저 : 담도 췌장 ; 담낭관결석의 내시경적 치료 ( Original Articles : Biliary Tract & Pancreas ; Endoscopic Treatment with ESWL of Impacted Cystic Duct Stones ): Korean J Gastrointest Endosc 1998;18(6):863-871. Published online November 30, 1997

Abstract PDF: Background
/Aims: The established treatment for cystic duct stones is surgery, but nonoperative removal of gallstones through percutaneous cholecystostomy can also be a useful procedure in patients at high risk for surgery. Conventional methods using endoscopic or percutaneous stone extraction usually fail due to the inability to access or capture the cystic duct stones in the narrow, long, spiral portion of the cystic duct, especially in impacted cases. As a result stone fragmentation is required during endoscopic stone removal. It is impossible for an electrohydraulic lithotripsy (EHL) to gain access to the stones, due to the rigid distal metal tip of the lithotripter and the narrowness of the long, spiral cystic duct. Using extracorporeal shockwave lithotripsy (ESWL) to disintegrate gallstones is a more effective method for removal of cystic duct stones. Experiences of endoscopic treatment for cystic duct stones of patients with high risk for surgery were reviewed, and conclusions are included in this study. Methods: Patient records of endoscopic management of cystic duct stones between January, 1994 and December, 1997, were reviewed for methods and results of treatment. Most of the patients had undergone lithotripsy followed by percutaneous transhepatic cholecystostomy. (Korean J Gastrointest Endosc 18: 863-871, 1998) (continue)

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증례 : 식도 위장관 ; 자발성 벽내성 식도 혈종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; Spontaneous Intramural Hematoma of the Esophagus ): Korean J Gastrointest Endosc 1998;18(6):872-877. Published online November 30, 1997

Abstract PDF: Spontaneous intramural hematoma of the esophagus is a rare condition in which an intramural hemorrhage leads to a varying degree of submucosal dissection of the esophageal wall. This disorder has been seen predominantly in women in the sixth or seventh decade and has occured with variable etiology. The pathogenesis of this disorder has yet to be clarified. The triad of symptoms of this disorder includes retrostemal pain, mild hematemesis and odynophagia. The diagnosis is usually made by endoscnpy or with an esophagogram, It is important to differentiate esophageal submucosal dissection from other disorders of similar appearance, such as Mallory-Weiss syndrome, esophageal perforation, or dissecting aneurysm, all of which require surgical treatment. The prognosis of spontaneous intramural hematoma of the esophagus (SIHE) is excellent with conservative therapy, but close follow-up care is necessary. A 62-year-old female was admitted to our hospital complaining of chest pain and hematemesis. Endoscopic features showed a large bluish hematoma which obliterated esophageal lumen from the proximal esophagus. We report a case of spontaneous intramural hematoma of the esophagus showing typical endoscopic findings with spontaneous improvement with a review of the literature, (Korean J Gastrointest Endosc 18: 872- 876, 1998)

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증례 : 식도 위장관 ; 양측 폐농양을 동반한 Boerhaave Syndrome 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Boerhaave Syndrome with Empyema in both Lungs in Alcoholic Liver Cirrhosis ): Korean J Gastrointest Endosc 1998;18(6):879-883. Published online November 30, 1997

Abstract PDF: Spontaneous esophageal perforation (Boerhaave Syndrome) is an unusual condition that frequently leads to fatal complications. It typically occurs with rigorous emesis after an unduly large meal or heavy drinking. Its diagnosis is often delayed in almost all cases due to nonspecific symptoms and signs, resulting in increased morbidity and mortality. Therefore early diagnosis and appropriate treatment are very important. Recently we experienced a case of esophagogastric junctional perforation accompanied by bilateral empyema and mediastinitis after heavy alcohol drinking in a 56-year-old male patient. He was presented with hematemesis and abdominal pain. We diagnosed him using esophagography and chest CT. Thus, we report a case with a brief review of related literatures. (Korean J Gastrointest Endosc 18: 879-883, 1998)

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증례 : 식도 위장관 ; 식도 및 위십이지장 칸디다증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Esophageal and Gastroduodenal Candidiasis ): Korean J Gastrointest Endosc 1998;18(6):884-888. Published online November 30, 1997

Abstract PDF: Candidiasis of the gastrointestinal tract typically occurs in a setting of decreased re- sistance to opportunistic infection, but also occurs in apparently normal individuals. Mucosal lesions in the gastrointestinal tract predominantly involve the esophagus, and gastroduodenal and enteric candidial lesions, which are less frequent, have only infrequently been detected antemortem. A case was experienced involving esophageal and gastroduodenal candidiasis in the patient of hepatocellular carcinoma and spinal metastasis treated with emergent radiotherapy and corticosteroid. He complained of anorexia and dyaphagia in the 4th day of radiotherapy. Endoscopy revealed multiple, large raised, white plaques and patches covering the mid- and distal esophageal mucosa, and several superficial aphthous ulcerations covered with white plaques in the entire stomach, and two deep excavating ulcers at the angle and antrum. The duodenal mucosa was covered with multiple small, white plaques, and a huge penetraing ulcer was seen in the duodenal bulb. Endoscopic biopsy showed budding yeast and pseudohyphae infiltrating through the ulcerated mucosa. Cultures of the same material canfirmed the organism to be Candida albicans. The patient was treated with fluconazole for 2 weeks. The case of esophgeal and gastroduodenal candidiasis is reported with reviiew of relevant literature. (Korean J Gastrointest Endosc 18: 884-888, 1998)

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증례 : 식도 위장관 ; 상부 위장관 내시경으로 증명된 속발성 혈색소증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Secondary Hemochromatosis Revealed in Gastrofiberscopy ): Korean J Gastrointest Endosc 1998;18(6):889-893. Published online November 30, 1997

Abstract PDF: A patient who underwent a transfusion due to an aplastic anemia subsequently experienced secondary hemochromatosis, which is very rare in Korea. The 56 year old female was admitted to our hospital with complaints of general weakness, fatigue, a brown-colored facial complexion, dyspnea upon exertion, and abdominal distension. Laboratory examination disclosed functional impairment of the liver and echocardiography revealed a congestive heart failure pattern. Gastrofiberscopy revealed brown colored gastric mucosa, and a fundal mucosa biopsy revealed a hemosidt pigment in iron stain. (Koreaa J Gastrointest Endosc 18: 889-892, 1998)

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증례 : 식도 위장관 ; Menetrier's Disease 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Menetrier's Disease ): Korean J Gastrointest Endosc 1998;18(6):895-899. Published online November 30, 1997

Abstract PDF: Menetrier's disease is a rare, characterized by the presence of large rugal folds involving part or all of the stomach. Patients with hypertrophic gastropathy often have distressing abdominal symptoms, weight loss, and edema due to gastric protem loss. A 64 year old male patient was admitted with the chief complaint of epigastric discomfort. Endoscopic, radiologic and histologic examination, revealed characteristic findings of Menetrier's disease. A case of Menetrier's disease is reported with a brief review of literature. (Korean J Gastrointest Endosc 18: 895-899, 1998)

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증례 : 식도 위장관 ; 폐암의 위전이 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Squamous Cell Lung Cancer with Metastasis of the Stomach ): Korean J Gastrointest Endosc 1998;18(6):900-907. Published online November 30, 1997

Abstract PDF: Blood-borne metastatic involvement of the gastric mucosa as a result of cancer is a rare occurrence. The tumors which were most commonly reported to metastasize to the stomach include melanoma, breast carcinoma, and lung carcinoma. Some reports document that large cell carcinoma and squamous cell carcinoma of the lungs have a higher pre- dilection for gastrointestinal tract metastases. Upper gastrointestinal endoscopic findings of metastatic lesions may vary but often produce a characteristic single or multiple bulls eye or target lesion. Therefore, whenever single or multiple target lesions are seen in the stomach on upper gastrointestinal endoscopy or barium study, the examination should include careful radiographic evaluation of the chest. Moreover, when the patient is known to have lung cancer, metastatic disease should be suspected. With a correct diagnosis and proper treatment, relief of symptoms and prolongation of life can sometimes be achieved, A case in reported involving squamous cell lung cancer with stomach metastasis in a 73 year-old woman. The patient was diagnosed by bronchoscopy, upper gastrointestinal endoscopy, chest CT, and abdominal CT. The chest and abdominal CT revealed a poorly marginated, lobulated, and 4 x 3 cm sized mass lesion in the right lower lobe causing obstruction of right lower lobe bronchus with invasion to the left atrium. right inferior pulmonary vein, and superior vena cava. Mediastimal lymph node enlargement and liver metastasis was also detected. Upper gastrointestinal endoscopy showed two "bulls eye" lesions with different sizes and two nodules without tip ulceration. (Korean J Gastrointest Endosc 18: 900-907, 1998)

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증례 : 식도 위장관 ; 위 점막하 종양으로 나타난 신경초종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastric Schwannoma Presenting with Submucosal Tumor ): Korean J Gastrointest Endosc 1998;18(6):908-915. Published online November 30, 1997

Abstract PDF: Most submucosal tumors of the stomach are of mesenchymal origin. According to the advances of immunohistochemical staining and electron microscopy, spindle cell tumors which were considered as leiomyoma or leiomyosarcoma appeared to be heterogeneous group; from smooth muscle cell, neural, bidirectionally differentiated cells of smooth muscle cell and neural cell, or immature mesenchymal cell. Therefore, the gastrointestinal mesenchymal tumors are referred to as gastrointestinal stromal tumors. The biologic behavior of gastrointestinal stromal tumors is difficult to predict, except benign leiomyoma and schwannoma. Recently, we experienced a case of 5 cm-diameter submucosal tumor with a central ulcer on body of the stomach, endoscopically. The tumor was a well cir- cumscribed submucosal mass located in the midbody along greater curvature. Micros- copically, the tumor was composed of fasciculating bundles of spindle cells with benign nuclear atypia and peripheral lymphoid cell cuffing. The tumor cells revealed a diffuse strong immunoreactivity to S-100 protein and vimentin, but were negative to desmin and smooth muscle actin. Ultrastructurally, many tumor cells showed a number of thin elon-gated and interdigitating dendritic-like cell processes, distinct uniform basal laminae, frequent cellular attachments and microfilaments. The findings supported the schwannian nature of the tumor. (Korean J Gastrointest Endosc 18: 908-913, 1998)

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증례 : 식도 위장관 ; 위 , 십이지장 , 공장에 발생한 MALToma 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of MALToma Involving Stomach and Small Intestine ): Korean J Gastrointest Endosc 1998;18(6):917-921. Published online November 30, 1997

Abstract PDF: A 74- year old male was admitted to St. Mary's Hospital due to symptoms of diarrhea and fever. He was diagnosed with MALToma in the jejunum 6 months previously, but had refused any treatment. This time, an endoscopy revealed multiple erosions and nodular mucosa in the body, fundus of the stomach and 3rd portion of duodenum. Abdominal computed tomography showed wall thickening in 3rd portion of the duodenum and upper jejunum with multiple lymph nodes enlargement. Additionally, an endoscopic biopsy revealed MALToma in the stomach and duodenum. Salmonella group B grew in a blood culture and a chest PA determined pneumonic infiltration in the left lower lobe. He received sulperazone for 7 days, but again refused any further treatment and was thereby discharged after had improved condition. (Korean J Gastrointest Endosc 18: 917-921, 1998)

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증례 : 식도 위장관 ; 위와 회장말단부에 발생한 Hodgkin 씨병 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Hodgkin's Disease Involved in the Stomach and Terminal Ileum ): Korean J Gastrointest Endosc 1998;18(6):922-929. Published online November 30, 1997

Abstract PDF: Cases with extranodal Hodgkin's disease located in sites outside those defined as lymphatic structure are quite rare. The exact incidence of this localized form of Hodgkin's disease is unknown, but it is estimated to be only 0.25% for overall incidence of Hodgkin's disease. Localized primary extranodal Hodgkin's disease seems to have an excellent prognosis in some cases including skin, tongue, lung, stomach, small bowel, and thyroid. We report a case of primary gastrointestinal Hodgkin's disease involved in the stomach and terminal ileum in 48-year-old man with 7 kg of weight loss for 3 months, fever with chills for 1 week, and intermittent epigastric pain for 1 year. The histologic type of this case was lymphocyte predominance, which was diagnosed by biopsy of the stomach and terminal ileum with immnophenotyping study. And the stage of this case was IIE. We tried combination chemotherapy with adriamycin, bleomycin, vinblastin, and dacabazine with excellent response. For its rarity, we report this case with review of literatures. (Korean J Gastrointest Endosc 18: 922-927, 1998)

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증례 : 식도 위장관 ; 후천성 면역 부전 환자에서 거대세포바이러스 감염과 관련된 회장 천공 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Ileal Perforation Associated with Cytomegaloviral Enteritis in a Patient with Acquired Immune Deficiency Syndrome ): Korean J Gastrointest Endosc 1998;18(6):931-936. Published online November 30, 1997

Abstract PDF: We report a case of ileal perforation associated with Cytomegaloviral enteritis in a 62 years old man who was diagnosed as AIDS lately. The perforated lesian was located at distal ileum approximately 50 cm above ileo-cecal valve. The lesion was simply closed by surgery. There were numerous erythematous patches on the serosal surface of jejunoileum. His gastrofiberscopic examination revealed multiple shallow ulcers in distal esophagus and stomach. Mieroscopic findings of both surgical and endoscopic specimens showed characteristic cytonegalic cells with inclusion bodies. There were numerous cytomegalic endothelial cells found in the ileal specimen without direct evidence of vasculitis. The diagnosis was confirmed by colorimetric detection of cytomegalovirus DNA using in situ hybridization. (Korean J Gastrointest Endosc 18: 931- 936, 1998)

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증례 : 식도 위장관 ; 교원질성 대장염 2예 ( Case Reports : Esophagus , Stomach & Intestine ; Two Cases of Collagenous Colitis ): Korean J Gastrointest Endosc 1998;18(6):937-943. Published online November 30, 1997

Abstract PDF: Collagenous colitis was first described by Lindstrom in 1976. Now this disorder is recognized as one of the more common causes of chronic diarrhea of obscure origin. This disorder is described as a disease of colon associated with chronic watery diarrhea and the typical histologic findings of a thickened subepithelial collagenous band. But in korea a few cases have been reported. We had observed a 52-year-old businessman with chronic watery diarrhea without abdominal pain in the past. And then we had reported previously that case. We also recently observed a 42-year-old housewife with chronic watery diarrhea with lower abdominal discomfort for 10 years. Colonoscopy disclosed no gross abnormalities through the entire colon ineluding the terminal ileum but we could find the pronounced thickening of subepithelial collageous band and chronic inflammation in the lamina propria in the histologic examination. We summarized the above two cases of collagenous colitis with a review of literatures. (Korean J Gastrointest Endosc 18: 937-942, 1998)

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증례 : 식도 위장관 ; 결핵성 장염으로 오진된 Crohn 병 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Crohns Disease Misdiagnosed as Intestinal Tuberculosis ): Korean J Gastrointest Endosc 1998;18(6):945-950. Published online November 30, 1997

Abstract PDF: Crohn's disease is a rare inflammatory bowel disease requiring a differential diagnosis with intestinal tuberculosis in Korea. There have been several problems in the diagnosis of Crohn's disease due to the much higher incidcnce of intestinal tuberculosis and the clinical similarities between the two diseases. Therefore, in many cases, treatment involveed anti-Tb drugs based upon empirical diagnosis, This study presents a case of Crohn's disease treated with anti-Tb drugs for about 9 months after intestinal tuberculosis was misdiagnosed. (Korean J Gastrointest Endosc 18, 945-950, 1998)

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증례 : 식도 위장관 ; 내시경적 낭종배액술로 치료한 췌장 가성낭종 2예 ( Case Reports : Esophagus , Stomach & Intestine ; Two Cases of Pancreatic Pseudocyst Treated with Endoscopic Cystogastrostomy throughout Stent and ENPD Catheter ): Korean J Gastrointest Endosc 1998;18(6):951-956. Published online November 30, 1997

Abstract PDF: Pancreatic pseudocysts were complicated in 10-27% of acute pancreatitis and 11-41% of chronic pancreatitis. Asymptomatic pseudocysts require no treatment, but symptomatic pseudocysts should be decompressed. Surgical management had been the traditional approach to treating pancreatic pseudocysts. Endoscopic transpapillary or transduodenal cystoenterostomy were recently suggested as an alternative to surgery in order to avoid surgical complications. The success rates of endoscopic treatment was 65-94%, procedure related morbidity was 6-21% and mortality was 0-5%. We reported two cases of patients with pancreatic pseudocysts which were treated with endoscopic cystogastrostomy and proceeded to drain through stent and ENPD catheter. (Korean J Gastrointest Endosc 18: 951-956, 1998)

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증례 : 식도 위장관 ; 반복적인 담관염으로 나타난 점액 생성 담관암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Mucin - producing Cholangiocarcinoma in the Patient with Recurrent Cholangitis ): Korean J Gastrointest Endosc 1998;18(6):957-962. Published online November 30, 1997

Abstract PDF: Free-floating tumor debris or mucobilia as a cauae of intermittent obstruction has been described infrequently. A middle aged woman with intermittent jaundice caused by abundant mucus from an intrahepatic mucinous cholangiocarcinoma is presented. Symptoms of juandice, midepigastric pain and fever developed despited an intitial cholecystectomy and common bile duct stone extraction using endoscopic retrograde cholangography (ERCP). Intraductal mucin was diagnosed through on ERCP and confirmed intraoperatively and pathologically as the cause of the obstructive juandice. The patient remained asymptomatic and without evidence of disease for more than 2 years postoperatively. Description is presented of the patient who was admitted presented with recurrent cholangitis caused by profuse secretion of mucus by mucin-producing cholangiocaricnoma, with a review of relevant literature. (Korean J Gastrointest Endosc 18: 957-962, 1998)

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증례 : 식도 위장관 ; 췌장염에 동반된 가성 낭종으로 오인했던 췌장의 점액성 낭성 종양 1예 ( Case Reports : Esophagus , Stomach & Intestine ; Pancreatic Mucinous Cystic Neoplasm Presented as Recurrent Pancreatitis with Masquerading a Pseudocyst ): Korean J Gastrointest Endosc 1998;18(6):963-967. Published online November 30, 1997

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증례 : 식도 위장관 ; 간내 담석이 위치한 부위와 다른 부위에 병발된 간내 담관암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Intrahepatic Cholangiocarcinoma Developed in a Remote Region from the Site of Hepatolithiasis ): Korean J Gastrointest Endosc 1998;18(6):968-975. Published online November 30, 1997

Abstract PDF: An association of hepatolithiasis and cholangiocarcinoma is thought to be rare, with a rate reported to be 2.36%-10%. Most of the cholangiocarcinomas concurrent with intrahepatic stones are found in the vicinity of the hepatolithiasis, and the diagnosis of intrahepatic cholangiocarcinoma in cases with hepatolithiasis is very difficult to detect preoperatively in spite of recent developments in techniques of imaging studies. Recently, the development of cholangiocarcinoma was reportd even after the complete removal of the hepatic stones. Thus, bile stasis and bacterial infecton appear to be important causative factors causing cholangiocarcinoma rather than the stone itself. A rare case is reported on intrahepatic cholangiocarcinoma developed in a remote region from the site of the hepatolithiasis. Therefore, the possible presence of cholangiocarcinoma should always be considered and sought during the diagnosis and treatment of hepatolithiasis. (Korean J Gastrointest Endosc 18: 968-973, 1998)

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