Clinical Endoscopy

식도정맥류에 대한 내시경적 정맥류 결찰요법 후 재출혈 및 재발과 연관된 위험인자들 ( Risk Factors Associated with Rebleeding and Recurrence Following Endoscopic Variceal Ligation ): Korean J Gastrointest Endosc 1999;19(1):1-8. Published online November 30, 1998

Abstract PDF: the first EVL was associated with rebleeding (p=0.01); whereas, age, Child class, grade and extent of varices, presence of gastric varices and/or portal hypertensive gastropathy, total number of bands and sessions for successful EVL were not (p ＞0.05). Persistence of esophageal ulcer at 2 weeks after the first EVL was associated with rebleeding also in multivariate analysis (relative risk 5.87, p=0.01). 3) In univariate analysis, grade (p=0.01) and extent (p=0.01) of varices were related to recurrence; whereas, age, Child class, presence of gastric varices and/or portal hypertensive gastropathy, total number of bands and sessions for successful EVL were not (p ＞0.05). In multivariate analysis, grade of varices was the only risk factor associated with recurrence (relative risk 3.76, p=0.01). Conclusions: 1) Persistence of esophageal ulcer at second week after the first EVL was associated with rebleeding. 2) Frequent follow-up endoscopic examinations are necessary in patients who present with high grade of varices since risk of recurrence is high even after successful EVL. (Korean J Gastrointest Endosc 19: 1 ∼8, 1999)

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전정부와 체부에서의 H. pylori 진단율과 장상피화생 ( The Detection Rate of H. pylori and Intestinal Metaplasia in the Antrum and in the Body ): Korean J Gastrointest Endosc 1999;19(1):9-17. Published online November 30, 1998

Abstract PDF: Aims: In this paper we have investigated the detection rate of each H. pylori test in the antrum and in the body for patients with nonulcer dyspepsia (NUD), duodenal ulcer (DU), benign gastric ulcer (BGU), and stomach cancer. In addition, we examined whether or not there is any relationship between the decrease of H. pylori detection rate and intestinal metaplasia in the antrum. Methods: Three different test methods for identifying H. pylori infection-CLOtest, Gram stain, H&E stain-were taken in the antrum and in the body. Results: 1) The detection rates of CLOtest, Gram stain, and H&E stain for NUD group were 88%, 75%, and 64% (mean: 76%) in the antrum, and 89%, 78%, and 67% (mean: 78%) in the body, respectively, and those of DU group were 95%, 95% and 81% (mean: 90%) in the antrum, and 97%, 87% and 64% (mean: 83%) in the body, respectively. Those of BGU group were 86%, 74%, 53% (mean: 71%) and 98%, 82%, 58% (mean: 79%), respectively, and those of stomach cancer group were 80%, 88%, 58% (mean: 75%) in the antrum, and 100%, 96%, 83% (mean: 93%) in the body, respectively. The B/A detection ratio which means the ratio of mean H. pylori detection rate of body to that of antrum was 1.03 in NUD, 0.93 in DU, 1.11 in BGU, and 1.24 in stomach cancer group. 2) The rate of intestinal metaplasia in the antrum was 12% for NUD, and 15% for DU group. Those of BGU and stomach cancer group were 47% and 72%, respectively. 3) The correlation etween B/A detection ratio and intestinal metaplasia in the antrum was good (correlation coefficient(r)=0.93). Conclusions: The result that body is more adequate for H. pylori detection in BGU and stomach cancer patients rather than antrum can be explained by the high rate of intestinal metaplasia in the antrum which is hostile surrounding for H. pylori. (Korean J Gastrointest Endosc 19: 0 ∼0, 1999)

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상부위장관 Dieulafoy 병 :임상 양상 및 내시경적 치료 (Dieulafoy's Disease of Upper Gastrointestinal Tract : Clinical Features and Endoscopic Treatment ): Korean J Gastrointest Endosc 1999;19(1):18-25. Published online November 30, 1998

Abstract PDF: Background
/Aims: Dieulafoy' s disease is an uncommon cause of recurrent massive gastrointestinal bleeding. The bleeding results from abnormally large submucosal artery , usually located on proximal stomach. Endoscopic examination reveals a small mucosal defect with an isolated protruding vessel without associated ulcer. Endoscopic treatment had recently been attempted to control the bleeding from these lesions. Methods : The clinical and endoscopic characteristics of 51 patients with gastrointestinal bleeding due to Dieulafoy' s disease were retrospectively analysed from January 1991 to July 1997 and the efficacy of endoscopic therapy of Dieulafoy' s disease was evaluated. Results : The mean age was 51.2 ±16.2 (Mean ±SD, range: 19 ∼80) years and male predominance (4.7 ：1) was observed. Symptoms included: melena (45.1%); hematochezia (31.4%); melena and hematochezia (23.5%). The mean hemoglobin value was 7.5 ±2.1 g/dL. The mean transfusion requirement was 12.4 ±13.2 blood units. The diagnosis was made at initial endoscopy in 72.5%. The lesion located in proximal stomach (49.0%), in mid/distal stomach (25.5%) and in duodenum (25.5%) in order. Endoscopic therapies included fibrin glue injection (FG) in 16 patients, hypertonic saline-epinephrine (1 ：1,000) injection (HSE) in 15 patients, HSE+FG in 14 patients and others in 6 patients. Overall, endo-scopic trreatment was successful in achieving hemostasis in 38 (74.5%) patients; FG in 14/16 (87.6%), HSE in 12/15 (80.0%), FG HSE in 9/14 (64.3%). There was no significant difference in success rate among the endoscopic treatment modalities. Nine patients had to be operated despite the endoscopic treatments, and four patients died due to the causes other than gastrointestinal bleeding. Conclusions: Endoscopic therapy of upper gastrointestinal Dieulafoy' s disease is effective and should be employed before the surgical intervention. (Korean J Gastrointest Endosc 19: 18 ∼25, 1999)

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위칸디다증의 임상적 고찰 (A Clinical Analysis of Gastric Candidiasis ): Korean J Gastrointest Endosc 1999;19(1):26-32. Published online November 30, 1998

Abstract PDF: Background
/Aims: Gastric candidiasis is an uncommon disorder. But in recent years this diagnosis has increased as a result of the greater use of broad-spectrum antibiotics, immunosuppressive and chemotherapeutic agents or of the use of drugs that reduce the gastric acid production, such as H2 receptor antagonists. Our aim of the present study was to investigate clinical characteristics of gastric candidiasis including endoscopic findings and histopathology. Methods: We reviewed 28 cases of gastric candidiasis who have under-went endoscopic biopsy at Wonkwang University Hospital from January 1995 to eptember 1996. Results: 1) The prevalence rate of gastric candidiasis was 0.8% (28/3400). 2) In benign and malignant gastric ulcer patients, occurrence of other clinical findings were cardio-vascular disease in 5 cases, diabetes mellitus in 3 cases, hepatobiliary disease in 5 cases, bronchopulmonary disease in 10 cases, renal disease in 1 case, immunosuppressive therapy in 1 case, peptic ulcer therapy in 4 cases, and nongastric neoplasm in 1 case. 3) Locations of benign and malignant gastric ulcers in patients with candidial infection were prepyloric area in 8 cases, angle in 7 cases, body in 11 cases, cardia and fundus in 2 cases. 4) Sizes of ulcer cases were almost ≥2 cm in benign ulcer (76.5%), all cases were ≥3 cm in malignant ulcer. 5) According to endoscopic criteria, thrush type were in 22 cases, ulcerated type in 6 cases and depth of candidial infection in ulcer base were suppurative type in 18 cases, fibrinoid type in 10 cases. 6) After 6 weeks of therapy, endoscopic and clinical cure occurred in 60% (3/5) of patients treated by H2 blocker, antacid, and occurred in 100% (5/5) of patients treated by H2 blocker, antacid and antifungal agent. Conclusions: These results suggest that gastric candidiasis has a large and dirty ulcer base, white or green-white membrane and spread over inflammed area. (Korean J Gastrointest Endosc 19: 26 ∼32, 1999)

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대장 내시경 검사시 전처치제로서 Midazolam 단독 사용에 관한 연구 ( Midazolam as a Premedication for Colonoscopy ): Korean J Gastrointest Endosc 1999;19(1):33-40. Published online November 30, 1998

Abstract PDF: Background
As the frequency of colonoscopic approaches increases, we need a less painful premedication for colonoscopy. We used midazolam as a premedication agent. It has more rapid onset of action than that of diazepam and its duration is shorter. The purpose of this study was to examine the clinical application of midazolam. Methods: Fifty patients underwent colonoscopies. An average dose of midazolam, 0.07 mg/kg, was given to patients intravenously as premedication. We measured systolic and diastolic blood pressures, pulse rates, respiratory rates, and oxygen saturation (SaO2) using pulse oxymetry before and after the injection. A Trieger test was accomplished before and after the procedures. We examined the levels of consciousness with verbal and physical stimulation during the colonoscopy. The examiners noted the degree of amnesia and pain after colono-scopy. We examined the patients' satisfaction and endoscopists' assessments. Results: 1) Systolic, diastolic blood pressures and respiratory rates showed no significant changes. But, pulse rates increased meaningfully at 15 minutes after the injection of midazolam (p ＜0.05). 2) The Trieger test showed meaningfully increased numbers of missed dots after the injection of midazolam. 3) The levels of consciousness during the test showed alertness in 22 patients (44%), drowsy mentality in 22 patients (44%) and stuporous mentality in 6 patient (12%). 4) The degree of amnesia after examination showed recall in 26 patients (52%), partial recall in 10 patients (20%) and total amnesia in 14 patients (28%). 5) Forty-five patients (90%) acknowledged this procedures to be more comfortable than previous procedures. Conclusions: Midazolam stabilized vital signs and oxygen saturation, therefore midazolam can be used safely as premedication for colonoscopy. Thirty-six patients (72%) recalled the procedures totally or partially. But, the relief of pain compared favorably to the degree of amnesia. We concluded that mida-zolam (0.07 mg/kg) was the safe and effective premedication for colonoscopy. (Korean J Gastrointest Endosc 18: 33 ∼40, 1999)

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대장내시경 검사 직후 복통 완화를 위한 직장관 사용의 유용성(Effectiveness of a Rectal Tube for Relief of Pain after Colonoscopy ): Korean J Gastrointest Endosc 1999;19(1):41-45. Published online November 30, 1998

Abstract PDF: Background
/Aims: Abdominal distension from the insufflation of air can create more troublesome discomfort after colonoscopy (CFS) than after upper endoscopy. Many patients report difficulty in expelling insufflated air after CFS. One previous study demonstrated that insertion of rectal tube at the conclusion of CFS significantly improves patient satisfaction with the procedure. The aim of this study was to compare the effectiveness of rectal tube placement for abdominal decompression after CFS in an effort to limit patient discomfort by carefully applying air suction during CFS. Methods: We conducted a prospective trial in 103 consecutive patients undergoing elective CFS. Patients were randomized to receive rectal tube placement at the end of the procedure or simple air suction during the procedure. Patients were evaluated by clinical symptoms and signs 10 minutes after completion of CFS. Results: All 103 patients had a complete examination of the colon to the cecum. No specific complications occurred during and a day after examination. The two groups were well matched with respect to age, sex, height, weight, chief complaints. There were no significant differences between the two groups for bowel preparation, duration of examination, abdominal pain during procedure, abdominal disten-sion 10 minutes after CFS, and abdominal pain 10 minutes after CFS (p ＞0.05). Conclusions: Meticulous air suction during CFS reduces abdominal discomfort and distension after CFS and is as effectively as the placement of a rectal tube at the con-clusion of CFS. (Korean J Gastrointest Endosc 19: 41 ∼45, 1999)

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미세 대장 용종 : 병리조직 및 분포에 대한 임상 고찰 ( Small Colonic Polyps : Histopathology and Spatial Distribution ): Korean J Gastrointest Endosc 1999;19(1):46-50. Published online November 30, 1998

Abstract PDF: Background
/Aims: Our aims in this study were to determine histopathology and distri-bution of small colonic polyps (up to 6 mm). Small polyps were found frequently in the colon and rectum at colonoscopy. The size of polyps which should be removed endo-scopically has been controversial. Methods: Medical reports of all patients undergoing total colonoscopic examination during 8-year period were reviewed. Results: Eight hun-dred thirty-three small (up to 6 mm) colorectal polyps, removed during colonoscopy, have been analyzed. Of the small polyps, 58.8% were neoplastic, 17.7% were hyperplastic, 22.7% were inflammatory; 0.1% contained atypia, 0.1% were carcinoid, 0.6% were xan-thoma, 0.1% were adenocarcinoma. In the colon except rectum, neoplastic polyps were more common than non-neoplastic polyps. The difference in distribution of the major types of polyps in the right colon and transverse colon was significant (p ＜0.0001). Conclusions: Most small polyps proximal to the rectum are neoplastic. All polyps should be removed when encountered during colonoscopy due to the high prevalence of adenoma among small polyps. (Korean J Gastrointest Endosc 19: 46 ∼50, 1999)

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총수담관 결석의 각종 내시경적 제거술의 효과 (Effects of Several Methods in Endoscopic Extraction of Common Bile Duct Stone ): Korean J Gastrointest Endosc 1999;19(1):51-58. Published online November 30, 1998

Abstract PDF: Background
/Aims: The objective of this paper is to compare the effectiveness of com-mon bile duct stone extraction by conditions and methods. Methods: Endoscopic sphinc-terotomies with stone extraction were practiced in 71 patients with common bile duct stones by basket extraction, balloon extraction and mechanical lithotripsy. Results: 1) In 71 patients with CBD stone, sex distribution showed predominence in females (56.3%) and most of the cases were over 60 years old. 2) After sphincterotomy, the overall success rate of the stone extraction was 87.3% (with balloon and basket or mechanical lithotrispy). The removal methods of the stone extractions were varied, but the most commonly used method was basket extraction (50.7%). 3) The complications of sphicterotomy were noted in 10 cases and in 8 cases minor bleeding was stopped with a hypertonic saline epinephrine injection. 4) After the stone extraction, counts and levels of leukocyte, aspartate transami-nase, alanine transaminase, alkaline phosphatase and total bilirubin were significantly improved (p ＜0.05). 5) Removal methods according to stone size did not show a signifi-cant difference, but the mean size of the stones was different. According to the several methods, the mean diameter of stones were different. The stone size was 1.1 cm in the case of spontaneous removal, 1.4 cm in balloon or basket removal, 1.9 cm in mechanical lithotripsy and 2.0 cm in surgical removal. Conclusions: Endoscopic stone extraction was effective and safe method with low rate of complications. However there were some significant difficulties in removing large or impacted stones, therefore EHL, ESWL or operation should be considered. (Korean J Gastrointest Endosc 19: 51 ∼58, 1999)

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위정맥류출혈에서 Histoacryl 주입으로유발된 폐색전증 1 예 (A Case of Pulmonary Embolism Induced by Complication of Histoacryl Injection Therapy in Gastric Varix Bleeding ): Korean J Gastrointest Endosc 1999;19(1):59-66. Published online November 30, 1998

Abstract PDF: N-Butyl-2-cyanoacrylate (Histoacryl) has been used successfully to control bleeding from esophagogastric varices since the first report in 1986 by Soehendra. Complications of Histoacryl injection include local sloughing with ulcer formation, rebleeding, sepsis, mediastinitis, esophageal strictures and fever. Systemic embolization, including pulmonary and cerebral embolization, has been reported. We describe here the presentation of an un-usual complication of Histoacryl injection. A 42-year-old woman presented with an attack of massive hematemesis. Endoscopy revealed bleeding evidence of gastric varices. Sclero-therapy was carried out using Histoacryl mixed with Lipiodol (ratio 1 ：1), with complete solidification of the varix. Next morning she complained of dyspnea and tachycardia. The chest x-ray showed multiple metallic densities, consistent with cyanoacrylate mixed with lipoidol, located at central portion. She was diagnosed as having pulmonary embolism by convential precontrast chest CT. She was treated conservatively using oxygen and analge-sics. She recovered soon and was discharged without significant problems. (Korean J Gastrointest Endosc 19: 59 ∼64, 1999)

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점막하 종양상을 보인 아니사키스증에 의한 호산구성 육아종 2 예 (2 Cases of Submucosal Tumors Caused by Gastric Anisakiasis ): Korean J Gastrointest Endosc 1999;19(1):67-73. Published online November 30, 1998

Abstract PDF: Anisakiasis is a parasitic disease caused by an infection of Anisakinae larvae. It occurs when the live larvae are introduced to the human gastrointestinal tract by eating infected raw fish. The endoscopic features of the gastric mucosa adjacent to the worms include redness, edematous, which are sometimes hemorrhagic and erosive. Gastric anisakiasis forming submucosal tumor, due to unobserved endoscopy, larva is very rare. 2 cases of submucosal tumors caused by gastric anisakiasis were found by endoscopic examination. The well demarcated mass lesion was seen in the submucosal layer of the stomach using endoscopic ultrasonography, and confirmed by laparoscopic wedge resection. (Korean J Gastrointest Endosc 19: 67 ∼72, 1999)

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급성출혈성 위염과 동반된 분선충증 1 예 (A Case of Stongyloidiasis Associated with Acute Hemorrhagic Gastritis ): Korean J Gastrointest Endosc 1999;19(1):73-80. Published online November 30, 1998

Abstract PDF: A 69-year-old male was admitted to the neurosurgery department for traumatic intracra-nial hemorrhage in both frontal lobes. After 2 months, he complained of epigastric dis-comfort, nausea, vomiting, and loose stools. The gastric endoscopic examination found acute hemorrhagic gastritis and there were rhabditoid nematode larvae in the gastric fluid and biopsy sections. The filariform larvae of Strongyloides sp. were discovered from a fecal culture. The patient was treated with albendazole (200 mg, po bid, for 4 weeks). The epigastric discomfort disappeared and endoscopic findings improved after treatment. (Korean J Gastrointest Endosc 19: 73 ∼77, 1999)

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긴 유경성의 Gastritis Cystica Profunda 1 예 ( A Case of Gastritis Cystica Profunda with Long Pendulous Pedicle ): Korean J Gastrointest Endosc 1999;19(1):81-83. Published online November 30, 1998

Abstract PDF: Gastritis cystica profunda (GCP) is a rare disease which is mainly observed at the site of gastroenterostomy. However, it may occur in the stomach without a previous history of surgery. Under histologic examination GCP shows hyperplastic and cystic dilatation of the pseudopyloric glands with submucosal invasion. GCP with sessile polypoid pro-trusion is most commonly found but, submucosal tumors, giant gastric mucosal folds and pedunculated forms are occasionally found. We present the case of GCP showing a large sized polyp (3 2.5 2.5 cm) with a long pendulous pedicle that had developed in the fundus of the stomach without previous surgical history. Endoscopic polypectomy was performed for confirmation. (Korean J Gastrointest Endosc 19: 81 ∼83, 1999)

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위의 장막하층에 발생한 비분화성 간질성 종양 1 예 (A Case of Subserosal Stromal Tumor of the Stomach ): Korean J Gastrointest Endosc 1999;19(1):84-92. Published online November 30, 1998

Abstract PDF: Gastrointestinal stromal tumor (GIST) were previously known as smooth muscle tumor like leiomyoma or leiomyosarcoma. Most of them were histologically spindle cell tumors, usually of mesenchymal origin. Stromal tumors account for about 1% to 2% of gastric malignant tumor, and the most important characteristics is their indolent, slow-growing nature, rendering most common definitions of malignancy invalid and inapplicable. The tumors are generally found deep within the stroma and submucosa, and only about half have an intragastric component, detectable by radiography, endoscopy or endoscopic ultra-sonography (EUS). Especially EUS is a valuable technique for diagnosing GIST. We experienced a 35-year-old female patient who complained right upper quadrant pain. She was diagnosed as subserosal stromal tumor by gastrofiberscopy, EUS, abdominal CT and operation. We report a case of gastric subserosal stromal tumor with a review of relevant literatures. (Korean J Gastrointest Endosc 19: 84 ∼89, 1999)

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다발성으로 발생한 십이지장 유암종 1 예 ( A Case of Multicentric Duodenal Carcinoid ): Korean J Gastrointest Endosc 1999;19(1):93-97. Published online November 30, 1998

Abstract PDF: Carcinoid tumors are the most common endocrine tumors of gastrointestinal tract. Argentaffin cells are the origin of carcinoids. These cells belong to the amino precursor uptake and decarboxylation (APUD) system. These cells give the tumor its most distinguishing feature: the ability to produce biogenic amines and polypeptide hormones that, in turn, give rise to the dramatic carcinoid syndrome. We treated a case of multi-centric carcinoid tumor of the duodenum in a 63-year-old male patient. He was admitted to the hospital because of epigastric pain. On the gastrofiberscopic examination, 1.0 ×1.5 cm and 0.7 ×0.8 cm sized two polyps (Yamada type II, I) were noticed on the duodenal bulb. The biopsy specimen showed carcinoid tumors of different histologic types. The level of 24-hour urine 5-HIAA of this case was normal. He was treated with subtotal gastrectomy with Billroth-II anastomosis. We report this case with literature review. (Korean J Gastrointest Endosc 19: 93 ∼97, 1999)

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결장으로의 전이를 보인 진행성 위암 1 예 (A Case of Advanced Gastric Cancer Showing Colon Metastasis with Peritoneal Seeding ): Korean J Gastrointest Endosc 1999;19(1):98-106. Published online November 30, 1998

Abstract PDF: The extension of infiltrating gastric cancer through the gastrocolic ligament into the transverse colon appears to be relatively common, but metastases from the ileocecal valve to the sigmoid colon are rare conditions and have been reported in only a few cases. Although direct invasion of tumor cells into the transverse colon and peritoneal dis-semination through the entire colon was a main cause of colon metastasis of gastric cancer, variable other causes were divided, by method of invasion to other organ. There are a few description for endoscopic finding of metastatic colon cancer. A 45-year-old man was admitted to our hospital because of epigastric discomfort and pain for 3 months ago. He was confirmed to have diffuse infiltrating adenocarcinoma (Borrman type IV) by gastro-duodenoscopy, endoscopic ultrasonography, and diagnosed as the colonic invasion by the colonoscopy and biopsy. We report a case of advanced gastric cancer with colon metastasis and review its pathogenetics and endoscopic characteristics from relevant literature. (Korean J Gastrointest Endosc 19: 98 ∼103, 1999)

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췌장을 침습한 위의 암육종 1 예 (A Case of Gastric Carcinosarcoma with Pancreatic ): Korean J Gastrointest Endosc 1999;19(1):107-110. Published online November 30, 1998

Abstract PDF: Carcinosarcoma of the stomach is regarded as a rare malignant neoplasm composed of both carcinomatous and sarcomatous components in a given tumor. Few cases have been reported since 1904. This is a case of carcinosarcoma of the stomach in a 61-year-old man. He suffered from indigestion, vomiting, and epigastric pain. Endoscopic finding showed a huge protruding mass with intact mucosa on the posterior wall of the antrum up to the pylorus. Surgery was performed and carcinosarcoma with pancreatic invasion was confirmed by pathology. (Korean J Gastrointest Endosc 19: 107 ∼110, 1999)

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장출혈을 초래한 유전분증 1 예 (A Case of Intestinal Hemorrhage in Patient with Primary Amyloidosis ): Korean J Gastrointest Endosc 1999;19(1):111-120. Published online November 30, 1998

Abstract PDF: Although intestinal bleeding is known to occur in amyloidosis, it is rare as a presenting symptom or sole manifestation of the disease. We experienced a case of intestinal hemor-rhage in a 64-year old female patient with primary amyloidosis, kappa type. Antral muco-sal erosions were discovered and one shallow healing ulcer at the angle. Colonoscopy revealed multiple purplish nodules in the sigmoid colon and descending colon, as well as a large shallow ulcer with blood clots in the sigmoid colon which was suspected to be the intestinal hemorrhage site. Endoscopic biopsy established amyloidosis. Polarizing microscopy after Congo red staining and immunohistochemical staining identified primary amyloid, kappa type. A case of intestinal hemorrhage in patients with primary amyloidosis is presented and the literature is reviewed. ( Korean J Gastrointest Endosc 19: 111 ∼117, 1999 )

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충수돌기 절제술후 발생한 지연성 위장관 출혈 1 예 (A Case of Appendiceal Stump Ulceration and Bleeding One Year after Appendectomy ): Korean J Gastrointest Endosc 1999;19(1):121-124. Published online November 30, 1998

Abstract PDF: Postappendectomy bleeding is a rare and occasionally catastrophic phenomenon. Bleed-ing in the gastrointestinal tract may occur early or late. The cause of late bleeding included ulceration, vascular malformation or granuloma. We experienced a case of delayed appen-diceal stump ulceration and bleeding who underwent an appendectomy 1 year ago. The patient was admitted due to melena. A colonoscopy showed a well-circumscribed deep ulcer containing of silk suture material at the base of appendiceal stump. Biopsy revealed only granulation tissue with nonspecific inflammation. The silk was removed by biopsy forcep and sulfasalazine was tried. A repeat colonoscopy showed the complete ulcer heal-ing 3 months later. We report this case with a review of literatures. (Korean J Gastrointest Endosc 19: 121 ∼124, 1999)

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건강한 20 대 여성에서 발생한 가역성 (A Case of Reversible Ischemic Colitis in a Young Woman ): Korean J Gastrointest Endosc 1999;19(1):125-129. Published online November 30, 1998

Abstract PDF: Therefore differential diagnosis from idiopathic ulcerative colitis will be needed. Recently, we have examined a 20 year-old Korean female patient who had the complaints of acute lower abdominal pain and bloody diarrhea. The diagnosis of ischemic colitis was confirmed on the basis of colonoscopic and associated histopathological findings. The patient dis-charged with good improvement on the thirteenth hospital day after medical treatment with antibiotics, fluid and electrolytes. We report a case of reversible ischemic colitis of descend-ing colon of a young woman with literature review. (Korean J Gastrointest Endosc 19: 125 ∼129, 1999)

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직장 유암종 1 예 (A Case of Rectal Carcinoid Tumor ): Korean J Gastrointest Endosc 1999;19(1):130-138. Published online November 30, 1998

Abstract PDF: Carcinoid is a tumor that primarily affects the intestinal tract, which arises from entero-chromaffin cells. Rectal carcinoid tumor is a relatively rare neoplasm originated in Kul-chitszky cell and clinicians have the difficulties in predicting their malignant potential and in proper treatment. These cells are found to increase in the distal small intestine, are common in the appendix, and then decrease within the mucosa of the colon from cecum to rectum. In the cumulative world literature, the incidence of carcinoids of rectum is slightly higher than 10 percent. All of these tumors are within reach of the rigid procto-sigmoidoscope, most being located between 4 and 13 cm from the anal verge. Eighty five percent are found on the anterior and lateral walls. The tumors are usually submucosal and light yellowish or reddish color. The vast majority of rectal carcinoid tumors are be-nign, which can be treated by local excision safely. Lesions larger than 2 cm and invading the muscular wall of the rectum should be considered malignant, which are treated by more radical surgery such as abdominoperitoneal resection. We experienced a case of rectal carcinoid tumor, which was excised by endoscopic polypectomy, so we present this case with a review of relevant literatures. (Korean J Gastrointest Endosc 19: 130 ∼136, 1999)

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복강경 담낭 절제술에 사용된 외과적 클립에서 발생한 총담관 결석 1예 ( A Case of Common Bile Duct Stone Resulting from a Migrated Surgical Clip after a Laparoscopic Cholecystectomy ): Korean J Gastrointest Endosc 1999;19(1):139-142. Published online November 30, 1998

Abstract PDF: Laparoscopic cholecystectomy has become the choice procedure for surgical removal of symptomatic gallbladder stones. However, with the introduction and use of this technique, unusual complications can be expected. Among them, the surgical clip has become a nidus for common bile duct (CBD) stone formation; it is a rare complication of laparoscopic or open cholecystectomy. We recently experienced a case of surgical clip migration into the CBD in a patient who underwent laparoscopic cholecystectomy. A 46-year-old woman was admitted due to right upper quadrant pain which had persisted for 1 week. A year earlier, she had undergone a laparoscopic cholecystectomy for acute cholecystitis due to gallbladder stones. On admission, physical examination revealed normal findings except subicteric sclera and minimal right upper quadrant tenderness. Laboratory evaluation determined abnormal liver functioning. Abdominal sonography revealed an echogenic density with acoustic shadows within a mildly dilated CBD. Endoscopic retrograde cholangiogram revealed a single CBD stone with two metallic surgical clips forming a nidus. The stone with clips was easily removed through the dilated ampulla of Vater orifice using a Dormia basket. There were no post-ERC complications and the patient was reportedly doing well. (Korean J Gastrointest Endosc 19: 139∼142, 1999)

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담도 폐쇄를 일으킨 고립성 장기결핵 1 예 - 결핵성 담도 주위 림프절염 1 예 - ( A Case of Isolated-organ Tuberculosis Causing Common Bile Duct Obstruction ―Tuberculous periductal lymphadenitis ― ): Korean J Gastrointest Endosc 1999;19(1):143-147. Published online November 30, 1998

Abstract PDF: The explanation of isolated-organ tuberculosis rests on the assumption that in the course of the lymphatic or hematogenous dissemination of bacilli, organisms may be rapidly destroyed in all other sites save for the particular tissue involved in the isolated tuberculous process. Tuberculosis can arise in all tissues having lymphatics or blood supply, but the disease causing biliary tract obstruction has been known to be rare. Recently, we experi-enced a case of isolated-organ tuberculosis causing common bile duct obstruction and periductal lymph node enlargement in a 46-year-old Korean male. An ultrasonography-guided percutaneous needle biopsy revealed a granulomatous inflammation of the lymph node. After 7 months of anti-tuberculous medication, the common bile duct obstruction and periductal lymph node enlargement disappeared completely in a follow up abdominal CT and ERCP. (Korean J Gastrointest Endosc 19: 143 ∼147, 1999)

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맥락막 흑색종에서 기원한 간의 전이 흑색종 1 예 (A Case of Metastatic Malignant Melanoma of the Liver Resulting from Choroidal Melanoma ): Korean J Gastrointest Endosc 1999;19(1):148-160. Published online November 30, 1998

Abstract PDF: If there are multiple masses in the liver and a history of melanoma removed from the skin or other sites, a possible diagnosis could be that the multiple masses in the liver are in that metastatic lesions originating from the primary site of the previously removed melanoma. Although ocular melanoma is not as common as the cutaneous melanoma, it is the most common malignant ocular neoplasm. The metastatic patterns of the two mela-nomas are different. The ocular melanoma spreads to the liver exclusively at an early stage. If laboratory results, CT, arteriography, and MRI suggest a metastatic malignant melanoma of the liver, the diagnosis can be confirmed by laparoscopy and aspiration needle biopsy. The treatment of the ocular melanoma with metastasis to liver has been local resection, hepatic artery embolization, or systemic chemotherapy. Those treatment modalities, how-ever, have failed to improve the survival rates, and the metastatic malignant melanoma remains to be an incurable disease. A case is reported of a metastatic malignant melanoma of the liver in a 57-year-old male patient, that was discovered 4 years after an enucleation of a choroidal melanoma of the right eye. (Korean J Gastrointest Endosc 19: 148 ∼153, 1999)

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