Clinical Endoscopy

소화성 궤양 출혈에 대한 내시경적 순수에탄올 국소주사요법의 치료 효과 및 예후 ( The Hemostatic Effect and Prognosis of Endoscopic Ethanol Injection in Bleeding Peptic Ulcer ): Korean J Gastrointest Endosc 1999;19(3):337-346. Published online November 30, 1998

Abstract PDF: Background
/Aims: Endoscopic injection therapy improves the outcome in bleeding peptic ulcer, but the optimum regimen is unknown. Although endoscopic injection therapy is effective in controlling initial hemorrhage from a peptic ulcer, between 10% to 30% of patients suffer rebleeding. The aim of this study was to evaluate the initial and ultimate success rate of hemostasis, the rebleeding rate, hospital stay (days), and the emergency operation rate in patients who had undergone endoscopic ethanol injection for bleeding peptic ulcer. Methods: Thirty nine patients presented with active bleeding (spurting), visible vessels, or blood clots on endoscopic findings were given an endoscopic ethanol injection with a total of 1.0∼3.0 ml of ethanol. The initial and ultimate success rate of hemostasis, rebleeding rate, and emergency operation rate after the endoscopic injection was evaluated. Results: 1) The initial success of hemostasis was 38/39 (97.4%). 2) The rebleeding rate after ethanol injection was 8/39 (20.5%). 3) The success rate of the second trial of ethanol injection was 3/8 (37.8%). 4) Emergency operations were conducted in5/39 (12.8%). 5) The ultimate success rate of hemostasis was 34/39 (87.2%). 6) There were no mortalities [0/39 (0%)] related to the ethanol injections and bleeding peptic ulcers. 7) There were no complications [0/39 (0%)] related to the ethanol injections. 8) The mean duration of hospitalization was 9.5 4.5 days. Conclusions: Endoscopic ethanol injection in the treatment of bleeding peptic ulcers was as effective and safe as any other injection or mechanical hemostatic method. Further prospective studies or endoscopic trials for hemostasis are needed to reduce the rebleeding rate and emergency operation rate of bleeding peptic ulcer. (Korean J Gastrointest Endosc 19: 337∼346, 1999)

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대장내시경 전처치제로서 Sodium Phosphate 와 Polyethylene Glycol 용액의 전향적 비교 분석 ( A Prospective Endoscopic Blind Trial Comparing Precolonoscopy Bowel Cleansing Methods ): Korean J Gastrointest Endosc 1999;19(3):347-353. Published online November 30, 1998

Abstract PDF: Background
/Aims: Although some authors have suggested that sodium phosphate (NaP) is more effective than polyethylene glycol (PEG) in bowel cleansing, there has been no crossover study proving the superiority of NaP over PEG in bowel cleansing and patients' compliance. The aim of this study was to compare the two solutions for colonoscopy, PEG and NaP, through crossover design with regard to patients' compliance, cleansing ability and side effects. Methods: Thirty patients underwent two separate colonoscopies for colonic polyp(s) with PEG and NaP, respectively. Before and after bowel preparation, blood pressure, body weight, and serum biochemical parameters were measured in all patients. In addition, a detailed questionnaire was used to assess side effects and the patients' preference. The presence of bubbles, types of residual stool, and overall quality of colon cleansing were assessed by one endoscopist blinded to the type of preparation used. In each colonoscopy, two biopsy specimens were taken at rectum. Results: In the NaP group, but not in the PEG group, there were significant changes in several biochemical parameters including sodium ( +3.0 +- 3.0 mEq/L), potassium ( -0.3 +- 0.3mEq/L), calcium ( -0.5 +- 0.5 mg/dL), phosphorus ( +3.9 +- 2.2 mg/dL) and osmolarity ( +10.1 +- 9.3 mOsm/kg) after bowel preparation. In addition, the degree of body weight change was greater with NaP ( -2.2 +- 2.3 kg) than with PEG ( -1.2 +- 2.0 kg) (p=0.06) and the formation of bubbles that disturb luminal observation was more frequently found in the NaP group (p<0.01). There was no difference, however, in the type of residual stool and the overall quality of bowel preparation between the two groups and no significant mucosal change was noted after bowel preparation in both groups. Moreover, PEG was found to be more difficult to take than NaP (p<0.05) and among the 30 patients, 26 (87%) preferred NaP, while only two favored PEG (p<0.01). Conclusions: We conclude that NaP can replace PEG at least in patients with good general condition. Further studies to decrease the incidence of bubbles and to establish subgroups suitable for NaP are needed. (Korean J Gastrointest Endosc 19: 347∼353, 1999)

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내시경적 용종절제술 예에서 대장용종의 고찰 ( Clinical Observation in Endoscopic Treatment of Colonic Polyps ): Korean J Gastrointest Endosc 1999;19(3):354-360. Published online November 30, 1998

Abstract PDF: Background
/Aims: Colonic polyps are premalignant lesion, whose removal is important for the prevention of colon cancer. Methods: A series of 116 patients (195 polyps) who undergone colonoscopic polypectomy at Chung Nam National University Hospital from March 1994 to Feb.1997 were analyzed. Results: 1) The ratio of males and females was 81：35, with the average age being in the 60's. 2) Colorectal polyps were found at the rectum (39.5%), sigmoid colon (35.9%). The size of the polyps was less than 0.6 cm in diameter (44.6%), between 0.6 and 1.0 cm (27.7%), between 1.1 and 2.0 cm (22.6%). The number of polyp was single polyp (59.5%). According to the Yamada classification, type III was the most common (43.1%). 3) Histopathologic findings were as follows. Tubular adenomas (58.6%), LSPs was in 3 cases, and malignant changed polyps in 14 case. 4) The malignantly changed polyps peaked in those in their 70's, had sizes ranging between 1.1 and 2.0 cm. Histopathologic finding were villous adenomas (50.0%), tubular adenomas (13.2%), LSPs (33.3%) in orders. Conclusion: Although the prevalence of cancer of villous adenomas and LSP was higher than other polyps, the size of the adenomas, their numbers do not seem to influence the malignancy rate in this report. (Korean J Gastrointest Endosc 19: 354∼360, 1999)

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N함몰형 대장 종양에 대한 인식과 대책 ( Depressed-Type Early Colorectal Cancer ): Korean J Gastrointest Endosc 1999;19(3):361-367. Published online November 30, 1998

Abstract PDF: Background
/Aim: While detection and removal of polyps on the basis of the adenoma- carcinoma sequence has been a principal procedure for endoscopists, a new type of early colorectal cancer has been recognized and has become a hot issue. This new ailment is a depressed-type early colorectal cancer, which has the characteristics of rapid growth and early invasion of the submucosa. Though once considered to be mere conjecture, many researchers claim that this cancer is a de novo carcinoma despite of its rare occurrence. Recently, 4 depressed-type neoplastic lesions were presented, which signifies the importance of recognizing that this type of cancer exists and is characterized by rapid growth and early invasion of the submucosa. Methods: The 4 recently experienced depressed neoplastic lesions were reviewed and analyzed with respect to their endoscopic and clinicopathologic characteristics. The sizes of the lesions were measured in the fully inflated state of the bowel by using an endoscopic ruler. Results: The sites of predilection were the descending and sigmoid colon. All of the lesions were under 10 mm, with 75% being below 5 mm. The largest lesion was an 8-mm, well-differentiated mucosal carcinoma. The overall malignancy rate was 25%. Light redness was observed in all patients. Distortion with air transformation of the mucosal fold was also recognized in all the patients. The main treatment was endoscopic mucosal resection, which amounted to 50%. Conclusions: Depressed colorectal neoplasms are real. They can be determined by their characteristic endoscopic features, such as light redness and distortion with air transformation of the mucosal fold. Because of their characteristics of rapid growth and early invasion of the submucosa, it is important to detect and manage them in an early stage, when their sizes are below 10 mm. (Korean J Gastrointest Endosc 19: 361∼367, 1999)

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대장 점막하 침습암에 대한 검토 - 내시경적 특징과 내시경 치료의 한계 - ( Submucosal Invasive Cancer in the Colon ): Korean J Gastrointest Endosc 1999;19(3):368-378. Published online November 30, 1998

Abstract PDF: Background
/Aims: A superficially invasive cancer in the colon is considered a candidate for an endoscopic resection. Therefore, detecting a superficially invasive cancer and differentiating it from a massively invasive cancer is an important key in selecting proper treatment. In order to accomplish this purpose, exact knowledge of the characteristics of submucosal invasive cancers is required. In this study, attempts to define those endoscopic features and draw guidelines for treatment were made. Methods: Recently, 23 submucosal invasive cancers were experienced. All of them were detected by an endoscopic examination, and were treated by endoscopic therapy and/or surgical resection. These cancers were reviewed and analyzed with emphasis on size, configuration, differentiation, and treatment. Results: The most common sizes ranged from 10 mm to 19 mm (47.8%). There were two minute lesions below 5 mm. The most common type of lesions was sessile (43.5%). Most lesions showed redness and 60.9% showed hardness. Many cases had characteristic features such as nodules (47.8%), bleeding easily upon touch (39.1%), erosion (39.1%), and white spots (34.8%). Other characteristic features were expanded figures, depressions, and mucosal convergence. Moderately-differentiated adenocarcinomas were predominant (8/15, 53.3%), and there were four polypoid cancers (4/17, 23.5%). In 43.5% of the lesions, only endoscopic treatment was enough. Forty-four percent of all patients treated endoscopically needed additional surgical resections because of uncertainty with respect to complete excision of the cancer and/or a poorly-differentiated adenocarcinoma with lymphatic invasion. There was no lymph node metastasis in any of the patients who underwent surgical resections, and three of them had no residual tumors, as the endoscopic treatment had completely excised the cancer. Conclusions: Accurate information on submucosal invasive cancers and recognition of the endoscopic characteristics of submucosal invasive cancers are necessary for their detection and management in an early stage. Moreover, it is possible to differentiate superficially invasive cancers from massively invasive ones by their characteristic features. Therefore, in selected patients with superficially invasive cancers, surgical resections can be avoided. (Korean J Gastrointest Endosc 19: 368∼378, 1999)

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체외충격파쇄석술을 병행한 담관결석의 내시경적 치료 ( Endoscopic Removal of Difficult Bile Duct Stones Combined with Extracorporeal Shock Wave Lithotripsy ): Korean J Gastrointest Endosc 1999;19(3):379-385. Published online November 30, 1998

Abstract PDF: Background
/Aims: Nowadays, common bile duct stones are predominantly extracted endoscopically, after endoscopic papillotomy. Nearly 90% of stones can be removed with a Dormia basket or mechanical lithotripter. In the remaining patients several nonoperative procedures serve as alternatives to surgery. Once extracorporeal lithotripsy had been successfully used for gallbladder stones, this technique was extended to bile duct stones. An experience of endoscopic removal of difficult bile duct stones combined with extracorporeal shock wave lithotripsy (ESWL) is reported. Methods: 82 patients were selected for this treatment because conventional stone extraction had failed. The Biolithos Mark III was used for extracorporeal spark-gap lithotripsy and the shock wave number was 2,000 waves (average) at one session. The stones were detected through a fluoroscopy with dye injection through an endoscopic naso-biliary drainage tube. After the fragmentation of bile duct stones, endoscopic removal of stones was performed for the facilitation of the complete removal of the stones, and to decrease the discomfort of the patients for the duration of their stay. Results: Visualization of the stones using a fluoroscopy with dye injection was possible in all patients. On average, these patients had 3.1 (1∼7) sessions of treatment with ESWL. Fragmentation was achieved in 74 (90.2%) patients and complete stone removal occurred in 71 (86.5%) patients. Complete stone clearance was achieved without further intervention in 8 (11.3%) patients, and in 63 (88.7%) patients after endoscopic extraction of the fragments. Thirty-seven (58.7%) patients underwent one endoscopic intervention to extract the remaining fragments. In 54 (81.8%) patients, a balloon catheter or Dormia basket was sufficient to extract the remaining fragments and an additional mechanical lithotripsy was necessary to break down larger fragments in 12 (18.2%) patients. There were no serious adverse effects from ESWL. Conclusions: Endoscopic removal combined with ESWL is also a useful method for the treatment of difficult bile duct stones to facilitate the complete removal of the stones and to decrease the discomfort of the patients, as well as the duration of their hospitalization. (Korean J Gastrointest Endosc 19: 379∼385, 1999)

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N내시경적 유두부 풍선확장술 후 잔류결석의 진단 및 담관 내 공기음영과의 감별에 있어서 관강 내 세경초음파검사술의 역할 ( The Role of Intraductal Ultrasonography on the Detection of Small Remnant Stones and Their Differentiation from Air-Bubbles, after Endoscopic Papillary Balloon Dilatation ): Korean J Gastrointest Endosc 1999;19(3):386-393. Published online November 30, 1998

Abstract PDF: Background
/Aims: A cholangiogram, immediately taken after bile duct stone removal, does not always provide adequate information about the presence of fragmented small stones in the bile duct, due to a large amount of bowel gas around the commom bile duct (CBD) or air-bubbles in the bile duct. We performed this study to evaluate the clinical usefulness of intraductal ultrasonography (IDUS) on the detection of small remnant stones after endoscopic papillary balloon dilatation (EPBD). Methods: Among the 42 patients treated with EPBD for the removal of CBD stones, 19 patients who had undergone ESWL or mechanical lithotripsy with basket, were evaluated by IDUS for the detection of remnant bile duct stones. Results: 17 out of 19 (89.5%) patients were successfully performed IDUS. Among the 17 patients, 13 showed no definite stones on cholangiogram, but CBD stones were detected using IDUS in 4 patients (30.7%). Among the 4 whose cases were difficult to differentiate air-bubbles from stones on a cholangiogram, 3 patients were diagnosed as having air-bubbles and 1 patient was diagnosed as having stones, through IDUS. During the process of conducting IDUS 19 times, one ultrasonic miniature probe was damaged. Conclusions: IDUS is very effective in detecting remnant small bile duct stones that are occasionally undetected on cholangiogram, and in differentiating stones from air-bubbles just after the removal of stones using EPBD. More efforts, however, are needed to improve the durability of the ultrasonic miniature probe. (Korean J Gastrointest Endosc 19: 386∼393, 1999)

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내시경적 역행성 담췌관 조영술로 진단에 실패한 총담관결석에 대한 초음파내시경의 유용성 ( Diagnostic Utility of Endoscopic Ultrasonograpy (EUS) for Common Bile Duct (CBD) Stones not Confirmed by Endoscopic Retrograde Cholangiopancreatography (ERCP) ): Korean J Gastrointest Endosc 1999;19(3):394-401. Published online November 30, 1998

Abstract PDF: Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the best imaging procedure for the diagnosis of common bile duct (CBD) stones. But the difficulties of diagnosis are mostly due to problems involving cannulation, microlithiasis and pancreatitis etc. The diagnostic utility of endoscopic ultrasonography (EUS) for the diagnosis of CBD stones not detected by ERCP was retrogradely assessed in 8 patients. Methods: All the patients (N=98) underwent ERCP, and in the case where CBD stones were not confirmed by ERCP, EUS was performed. Final diagnosis was determined by ERCP with an endoscopic sphincterotomy (EST) or operative exploration. Results: 98 patients with CBD stones were studied. The first ERCP successfully imaged CBD stones in 90 patients and an EST was performed in 84 patients. In 6 patients, stones were removed through operative exploration. ERCP images were incomplete or of poor quality in 8 patients. EUS images were excellent or good in all 8 cases, where ERCP was ineffective. Factors associated with incomplete results for CBD stones included; inability to cannulate the ampulla of Vater (N=1), nonvisualized CBD (N=4), microlithiasis (N=2), and association with the periampullary fistula (N=1). The second ERCP and EST successfully confirmed the diagnosis of CBD stones in 6 patients. In 2 patients, operative exploration was needed to confirm the diagnosis of CBD stones. Conclusions: An EUS appears to be an accurate and useful diagnostic tool for assessing CBD stones in cases where an ERCP was ineffective. (Korean J Gastrointest Endosc 19: 394∼401, 1999)

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내시경적 경유두 조직생검의 진단적 의의 ( Endoscopic Transpapillary Biopsy for the Diagnosis of Patients with Pancreaticobiliary Ductal Strictures ): Korean J Gastrointest Endosc 1999;19(3):405-413. Published online November 30, 1998

Abstract PDF: Background
/Aims: Many diseases and conditions are responsible for pancreaticobiliary ductal strictures. In such patients, histologic diagnosis is crucial to determine therapeutic modalities and to predict their outcomes, as well as to avoid unnecessary operations for tissue diagnosis. To evaluate the diagnostic role of endoscopic transpapillary biopsys (ETPB), this technique was performed in patients with pancreaticobiliary ductal strictures suggestive of malignancy. Methods: After visualization of the pancreaticobiliary tree and the lesion by endoscopic retrograde cholangiopancreatography (ERCP), an ETPB of the lesion was conducted with or without an endoscopic sphincterotomy (EST) in sixty-four patients with pancreaticobiliary ductal strictures. The biopsy results were analysed according to the morphology of the lesion, site of the stricture, number of biopsys and whether or not an EST was done. Results: The final diagnoses of the sixty-four patients included forty bile duct cancers (62.5%), nine pancreatic cancers (14.1%), four metastatic cancers (6.3%), and eleven benign ductal strictures (17.2%) such as biliary stones, cholangitis, etc. The sites of the strictures were located in the upper bile duct in thirty-two patients (50.0%), the middle bile duct in twenty-two (34.4%), the lower bile duct in three (4.7%), the pancreatic head in four (6.3%), and the pancreatic body in three (4.7%). Adequate tissue specimens for pathologic examination were obtained in fifty-four cases (84.4%). An ETPB was possible without an EST in nineteen cases (29.7%). The ETPB results revealed sensitivity of 60.4% (32/53), specificity of 100% (6/6), positive predictive value of 100% (32/32), and negative predictive value of 34.4% (11/32). The sensitivity of the ETPB was higher in the EST group than in group without an EST. There was no statistical significance however, according to tumor morphology, site, or number of biopsys. Conclusions: It is recommended that an ETPB, being a safe and effective method, should be performed as a diagnostic procedure during an ERCP for patients with pancreaticobiliary ductal strictures of unknown causes. (Korean J Gastrointest Endosc 19: 405∼413, 1999)

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경비위관이 파열부를 관통한 Boerhaave 증후군 1 예 - 응급수술 없이 생존한 증례 - ( A Case of Boerhaave's Syndrome Involving Nasogastric Tube Penetration into the Pleural Cavity ): Korean J Gastrointest Endosc 1999;19(3):414-420. Published online November 30, 1998

Abstract PDF: Boerhaave's syndrome, spontaneous esophageal rupture, is lethal and associated with a 70% survival rate despite emergent surgical management in recent reports. Early diagnosis and management is critical for more favorable outcome. But, it is difficult to diagnose early because of the low incidence and lack of specific symptoms and signs. We experienced 37 year-old male patient with Boerhaave's syndrome who was heavy drinker, and suffered from chronic renal failure. He visited a hospital because of hematemesis and severe back pain. He was transferred to our hospital with a nasogastric tube insertion, which was penetrating the distal esophagus. A radiologic examination revealed that the distal tip was located in the left pleural cavity. It was assumed that the tube had passed through the preexisting perforation site. Operation was not performed emergently due to delay in diagnosis and severe hyperkalemia. The patient was in a septic condition, but had recovered slowly after systemic broad spectrum antibiotic therapy, pleural drainage and intrapleural antibiotic injections. An esophagography revealed no leakage of gastro-grafin on the 14th hospital day, and he later completely recovered from sepsis. (Korean J Gastrointest Endosc 19: 414∼420, 1999)

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연하곤란을 동반한 하부식도 Ring 1 예 ( A Case of Lower Esophageal Ring with Dysphagia ): Korean J Gastrointest Endosc 1999;19(3):421-424. Published online November 30, 1998

Abstract PDF: Lower esophageal ring are uncommon. We experienced a case of lower esophageal ring in a 51-year-old man who had intermittent swallowing difficulty for 2 years. Endoscopy revealed a circumferential narrowing at 34 cm from the incisors and congested and eroded mucosa was noted proximal to the ring. Esophagography revealed an elevation of G-E junction above the diaphragm and a reflux of dye from the stomach into the esophagus with thickened and irregular esophageal wall. (Korean J Gastrointest Endosc 19: 421∼424, 1999)

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내시경적 결찰요법으로 치유한 위 혈관이형성증 1 예 ( Endoscopic Ligation Therapy for Gastric Angiodysplasia ): Korean J Gastrointest Endosc 1999;19(3):425-429. Published online November 30, 1998

Abstract PDF: Gastric angiodysplasia may be responsible for up to 2% to 6% of upper gastrointestinal bleeding. Moreover, gastric angiodysplasia may be particularly difficult to treat and is usually associated with a high rebleeding rate. Bleeding due to gastric angiodypsplasia is usually treated by various endoscopic approaches, including argon and Nd：YAG laser photocoagulation, monopolar or biopolar electrocoagulation, heater probe, or injection. Associated complications of these methods, however, such as perforation, acute bleeding during the procedure, or delayed massive hemorrhage have been reported. Recently a few reports have been suggested that endoscopic ligation therapy is a safe, effective treatment for gastric angiodysplasia. A 70-year-old man, who had undergone subtotal gastrectomy for perforation of a duodenal ulcer for 20 years, was admitted due to melena and dizziness persisting for 1 week. A gastroscopy revealed a single angiodysplasia with active bleeding just above the anastomotic site of the remnant stomach. Endoscopic ligation therapy was performed successfully and the bleeding stopped immediately after endoscopic ligation. Since then, no recurrence of bleeding has been reported to date. (Korean J Gastrointest Endosc 19: 425∼429, 1999)

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위에 발생한 유암종 (Carcinoid Tumor) - 1예 보고 - ( A Carcinoid Tumor of the Stomach - A case report - ): Korean J Gastrointest Endosc 1999;19(3):433-437. Published online November 30, 1998

Abstract PDF: A carcinoid tumor of the stomach is uncommon, has no clinical symptoms, and is regarded as a benign. It is also incidentally found in most cases. 48-year-old woman with gastric carcinoid tumor was admitted. She had suffered from a anorexia and a dry mouth for 4-months. A gastroscopy revealed a polypoid mass on the greater curvature of the mid-body of the stomach which was subsequently thought to be an adenocarcinoma. An endoscopic mucosectomy revealed however, that it was a carcinoid tumor. A case of carcinoid tumor of the stomach is here by presented with a brief literature review. (Korean J Gastrointest Endosc 19: 433∼437, 1999)

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급격한 내시경소견의 변화와 임상경과를 보인 Epstein-Barr Virus 감염과 연관된 원발성 위 T-세포 림프종 - 증례보고 - ( A Case of Epstein-Barr Virus-associated Primary Gastric T-cell Lymphoma with Rapidly Progressive Endoscopic Features and Clinical Course ): Korean J Gastrointest Endosc 1999;19(3):438-442. Published online November 30, 1998

Abstract PDF: Primary gastric T-cell lymphoma is very rare. Only a few cases have been reported in the literature. Moreover, Epstein-Barr virus-associated primary gastric T-cell lymphoma is extremely rare. We report a case of Epstein-Barr virus-associated primary gastric T-cell lymphoma, which showed rapidly progressive endoscopic features. Three esophagogastroduodenoscopic examinations in a 26-day period revealed different findings at different locations. The lymphoma cells were positive for UCHL-1, but negative for L26 and Ki-1 in immunohistochemical staining. (Korean J Gastrointest Endosc 19: 438∼442, 1999)

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대량 토혈을 초래한 급성 아니사키스증 1 예 ( A Case of Acute Gastric Anisakiasis Causing Massive Hematemesis ): Korean J Gastrointest Endosc 1999;19(3):445-448. Published online November 30, 1998

Abstract PDF: Acute gastric anisakiasis is caused by gastric mucosal penetration from an Anisakis larvae. It occurs with those who ingest raw or inadequately cooked saltwater fish or squid containing anisakis. The clinical symptoms are severe abdominal pain, nausea, vomiting, diarrhea, and so on. A case of acute gastric Anisakiasis with massive hematemesis was presented. Initial endoscopic examination revealed an edematous or raised erosive lesion with a small blood clot-covered vessel in the fundus which was thought to be a stigmata of recent bleeding. The lesion was treated with an epinephrine-hypertonic saline injection, electrocoagulation, and an ethanol injection. A follow-up gastroscopy revealed an artificial coagulation-induced ulcer at the previous bleeding site. At the ulcer margin, a whitish linear worm was found with half of its body penetrating the gastric mucosa. The worm was removed using biopsy forceps and the patient was subsequently placed on a soft diet. The next day however, hematemesis recurred. Gastroscopic band ligation of the vessel was performed with a cessation of bleeding. Three weeks later, a gastroscopy determined that the ulcer had completely healed. (Korean J Gastrointest Endosc 19: 445∼448, 1999)

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점막하 종양으로 생각된 위 아니사키스증 1 예 ( A Case with Gastric Anisakiasis Presented with a Submucosal Tumor: Korean J Gastrointest Endosc 1999;19(3):449-453. Published online November 30, 1998

Abstract PDF: Anisakiasis is a parasitic infestation caused by nematode larvae belonging to the subfamily Anisakinae when a raw or inadequately cooked fish is ingested. The clinical symtoms are severe cramping abdominal pain, nausea, vomiting, epigastric fulling sensation, but hematemesis or melena is very rare. We report a case of a 60-year-old male patient who developed melena one day after eating raw sea-fish. An esophagogastroduodenoscopy revealed a submucosal tumor with an ulceration located in the gastric fundus and subsequently an explolaparotomy and mass excision was performed due to massive bleeding. An anisakis larva was found in the resected mass, which was thought to be gastric anisakiasis. (Korean J Gastrointest Endosc 19: 449∼453, 1999)

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대량 하부 위장관 출혈의 원인으로서 직장 내 Dieulafoy 양 병변 ( A Dieulafoy-like Lesion of the Rectum as a Cause of Massive Lower G-I Bleeding ): Korean J Gastrointest Endosc 1999;19(3):454-459. Published online November 30, 1998

Abstract PDF: Dieulafoy's lesion is an exposed submucosal artery associated with a minute mucosal defect in the stomach, and it is a rare cause of profuse, but intermittent gastrointestinal bleeding. Less commonly, similar lesions have been identified in the duodenum, jejunum, colon, and in rare cases, the rectum. Only four cases of rectal Dieulafoy's lesion have been reported in English Medical literature: one case involved a child, two in otherwise healthy young men, and one in on elderly man. In this report, two elderly men are described, who suffered an massive hematochezia from a small rectal mucosal defect with a visible vessel. Control of the bleeding was successfully achieved with on endoscopic sclerotherapy or hemoclipping. The fact that rectal Dieulafoy disease is one of the causes of massive hematochezia should serve as a reminder in future cases, especially involving alcoholics and elderly men. (Korean J Gastrointest Endosc 19: 454∼459, 1999)

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일과성 허혈성 대장염에서 합병증으로 대장협착을 보인 1 예 ( A Case of Transient Ischemic Colitis Complicated by Colonic Stricture ): Korean J Gastrointest Endosc 1999;19(3):463-468. Published online November 30, 1998

Abstract PDF: Transient ischemic colitis comprises a clinical triad of lower abdominal pain, diarrhea and rectal bleeding of sudden onset, with rapid clearance of symptoms on a non-specific management regimen. The peak age incidence of ischemic colitis is in the sixth and seventh decades, as would be expected due to progressive arterial occlusion and falling cardiac function with increasing age. In this report, transient ischemic colitis was diagnosed on the basis of colonoscopic and associated histopathological findings. Colonoscopy is a useful technique in establishing the diagnosis of transient ischemic colitis. Conservative management includes repeated careful assessment, pain management and fluid replacement. Complications are rare and the prognosis is excellent. Occasionally, patients have recurrences. We report a case of transient ischemic colitis complicated by stricture formation with review of literatures. (Korean J Gastrointest Endosc 19: 463∼468, 1999)

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대량 출혈을 동반한 대장 혈관 이형성증 1 예 ( A Case of Colonic Angiodysplasia in Massive Lower Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1999;19(3):469-472. Published online November 30, 1998

Abstract PDF: Colonic angiodysplasia is important because of the likelihood of lower gastrointestinal tract bleeding, either massively or chronically. A 66-year-old male patient visited our hospital because of hematochezia and lower abdominal discomfort. He underwent colonoscopy, which revealed 0.5 cm sized, cherry red colored, branching, ozzing vessel with fern-like margin on cecum. Although he received endoscopic injection therapy with hypertonic saline and oral estrogen-progesterone therapy, subsequent ileocecal resection was performed due to recurrent bleeding. Histology of the resected specimen showed irregularly dilated, distorted, thin-walled vessels in submucosa. (Korean J Gastrointest Endosc 19: 469∼472, 1999)

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소아에서 발생한 베체트 장염 1 예 ( A Case of Behcet's Colitis in Children ): Korean J Gastrointest Endosc 1999;19(3):473-477. Published online November 30, 1998

Abstract PDF: Behcet's disease consists of a triad of relapsing inflammatory disease of the eye (iridocyclitis) with painful and recurrent oral and genital ulcerations. Arthritis, thrombophlebitis, neurologic abnormalities, fever, and colitis are associated clinical manifestations. The disease affects predominantly young adults and is very rare in children, especially those under 10 years of age. The proportion of Behcet's colitis in Behcet's disease is about 12%. Ulcerations are localized or diffuse, with the majority occuring in the ileocecal region. Extension to the serosal surface may result in perforation. The frequent complaints are abdominal pain, nausea, vomiting, diarrhea, hematochezia, loss of appetite, loss of weight gain, distention and palpable abdominal mass. The disease is complicated by intestinal obstruction, perforation, fistula formation, abscess formation and hemorrhage. We experienced a case of Behcet's colitis in a 9-year-old boy showing symptoms of abdominal pain, tenderness, and diarrhea. Thus, we report a case of Behcet's colitis with brief review of related literatures. (Korean J Gastrointest Endosc 19: 473∼477, 1999)

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담낭결손을 동반한 총담관 대장루 1 예 ( A Case of Choledochocolonic Fistula Combined with Absence of Gallbladder ): Korean J Gastrointest Endosc 1999;19(3):481-485. Published online November 30, 1998

Abstract PDF: The enterobiliary fistulas are mostly spontaneous and are caused by biliary disease associated with calculi. Review of many series shows that the most common variety of enterobiliary fistulas is a cholecystoduodenal fistula followed by cholecystocolic, cholecystogastric and choledochoduodenal fistula in that order. But very few cases of choledochocolonic fistulae have been reported. We report a case of choledocholithiasis combined with the absence of gallbladder leading to a choledochocolonic fistula, which was confirmed by endoscopic retrograde cholangiography and abdominal exploration in a 63- year-old male patient with complaint of right upper abdominal pain. (Korean J Gastrointest Endosc 19: 481∼485, 1999)

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총담관의 편평상피세포암 1 예 ( A Case of Squamous Cell Carcinoma of the Common Bile Duct ): Korean J Gastrointest Endosc 1999;19(3):486-490. Published online November 30, 1998

Abstract PDF: A 57-year-old female with jaundice and right upper quadrant abdominal pain, was found on exploration to have squamous cell carcinoma of the common bile duct. Squamous cell carcinoma of the common bile duct is a very rare tumor, simulating adenocarcinoma in its clinical presentation and aggressiveness. Although no consistent causative factors for this tumor has been demonstrated, it has been theorized that the normal columnar epithelium of the bile duct under the influence of an inflammatory stimulus, can develop into squamous epithelium with the ongoing process leading to squamous metaplasia, and eventually carcinoma. Cholelithiasis has been implicated as a cause for bile duct cancer, which was manifested in this patient. The prognosis of this carcinoma was grave, despite all forms of surgical and medical management. A case of squamous cell carcinoma of the common bile duct is reported with a review of relevant literature. (Korean J Gastrointest Endosc 19: 486∼490, 1999)

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부유두 내 췌관 배액관 삽입술 및 부유두 괄약근 절개술로 호전된 만성 췌장염 1 예 ( One Case of Endoscopic Stenting with Minor Papilla Sphincterotomy in a Patient with Chronic Pancreatitis ): Korean J Gastrointest Endosc 1999;19(3):491-496. Published online November 30, 1998

Abstract PDF: The anatomy of the pancreatic ducts and their variations are best defined through a pancreatography, which is especially useful for determining the appropriate endoscopic management. Pressure in the pancreatic ductal system has been shown to be significantly higher in patients with painful chronic pancreatitis and dilated ducts when compared with pressure in controls. The aim of pancreatic drainage procedures is to improve the outflow of pancreatic juice, thereby lowering intraductal pressure and affording relief of pain. It is necessory for both endoscopic pancreatic sphincterotomy (EPS) and stenting have to be performed at the papilla of the dominant duct, which is the Wirsung duct (embryologic "ventral" duct), in the majority such of cases. An EPS of the minor papilla should be considered when the duct of Santorini (embryologic "dorsal" duct) predominates, as in patients with complete or incomplete divided ducts or with a distorted connection between the ventral and the dorsal duct. In these patients, access to the main pancreatic duct (MPD) is easier through the duct of Santorini. A 42 year-old man was admitted with chronic recurrent pancreatitis. Minor papilla sphincterotomy and endoscopic stent placement were performed for the drainage of the dorsal pancreatic duct. After stenting of the minor papilla, abdominal pain disappeared and pancreatitis did not develop after a 7 month follow-up, the stent was changed. (Korean J Gastrointest Endosc 19: 491∼496, 1999)

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