Clinical Endoscopy

경미한 미란성 식도염에서 식도 운동 및 위산 역류의 양상 ( Patterns of Gastroesophageal Reflux and Esophageal Motility in Patients with Mild Reflux Esophagitis ): Korean J Gastrointest Endosc 1999;19(5):693-699. Published online November 30, 1998

Abstract PDF: Background
/Aims: The major complications of reflux esophagitis are stricture formation and Barrett's esophagus. In Korea, the incidence of these complications is low and most patients with reflux esophagitis undergo a mild clinical course. The purpose of this study was to investigate patterns of acid reflux and esophageal motility in mild reflux esophagitis in Korea. Methods: Using conventional manometry and 24-hour ambulatory pH monitoring, we were investigated esophageal motility and patterns of gastroesophageal reflux in 41 patients with reflux esophagitis Savary-Miller (S-M) Ib using on endoscopy. The total supine, and upright reflux periods, as well as frequency and duration of reflux episodes were determined from the 24-hour pH monitoring record using standard software. Pathologic reflux was defined when the percentage of the total time with pH less than 4 (acid exposure time) exceeded 4%. Results: Pathologic reflux was observed in 17 patients (41.5%), who were categorized into upright refluxers (70.6%), supine refluxers (11.8%), and combined refluxers (17.6%). Patients with reflux esophagitis did not differ in lower esophageal sphincter pressure from the normal subjects. There were two patients (4.9%) with a lower esophageal pressure ≤ 10 mmHg and four patients (9.8%) with hiatal hernia. Failed peristalsis was seen in 4 patients (9.8%). Conclusions: A high proportion of upright reflux and low incidence of esophageal peristaltic dysfunction may contribute to the low incidence of stricture formation and Barrett's esophagus in patients with mild reflux esophagitis in Korea. (Korean J Gastrointest Endosc 19: 693∼699, 1999)

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인공식도관 일탈 방지를 위해 새로 고안한 막 부착형 금속형 인공식도관의 유용성 ( A Prospective Clinical Trial of the Newly Designed Esophageal Covered Metal Stent for Prevention of Stent Migration ): Korean J Gastrointest Endosc 1999;19(5):700-705. Published online November 30, 1998

Abstract PDF: Background
/Aims: Palliation of malignant esophageal obstructions consists mainly of symptomatic treatment of dysphagia. For this purpose, variable self expandable esophageal stents have recently been used. Of these stents, membrane covered self expandable metal stents (SEMS) are effective to prevent tumor ingrowth and stent obstruction. But migration is the main problem of covered SEMS. So we made a newly designed covered SEMS for the prevention of stent migration and studied prospectively to define its palliative ability and whether this stent is effective for prevention of migration problems. Methods: From January to December 1998, 27 patients [23 men, 4 women; mean age 60 years, range 20 to 80] were inserted with newly designed esophageal stents and studied. Data analysis included the location and length of malignant strictures, the length of the inserted esophageal stents, the time for fixation of the stents after insertion, complications related to stent insertion, and the effectiveness of the newly designed stent for prevention of the stent migration. Results: 1) The location of esophageal strictures were 4 in the mid- esophagus (three tracheo-esophageal fistula due to two lung and one esophageal cancer, one esophageal cancer), 7 in the distal esophagus (all esophageal cancer), and 16 in the esophagogastric junction (6 cases of esophageal cancer, 9 with gastric cardiac cancer, and 1 with gastric lymphoma). 2) The mean length of the strictures was 5.2 (3 to 12) cm. 3) The mean length of the stents was 11 (8 to 16) cm. 4) Time for fixation of the stents was 7.2 (5 to 13) days after the stent insertion. 5) Stent placement was successful in all patients without any serious stent-related complications such as esophageal perforation or hemorrhage. During the mean follow-up period of 6 (1 to 12) months, there was no stent migration. Conclusions: The newly designed covered SEMS was very effective in preventing stent migration without any serious stent-related complications, especially in malignant strictures of the esophagogastric junction, short segment strictures, and T-E fistulas without tumor shoulder. (Korean J Gastrointest Endosc 19: 700∼705, 1999)

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Propofol 지속정주를 이용한 상부소화관 내시경 ( Gastrointestinal Endoscopy under Sedation with a Continuous Infusion of Propofol ): Korean J Gastrointest Endosc 1999;19(5):706-715. Published online November 30, 1998

Abstract PDF: Background
/Aims: Propofol is a short-acting intravenous sedative-hypnotic agent that can be used as a hypnotics for upper gastrointestinal endoscopy. A study was conducted to evaluate the effectiveness and safety of propofol as a hypnotic agent for upper gastrointestinal endoscopy. Methods: From June to October 1998, twenty eight patients undergoing upper gastrointestinal endoscopy were to receive propofol. Vital signs and peripheral oxygen saturation (SpO2) were monitored by pulse oximetry during continuous infusion of propofol. Propofol (1% solution) was initially infused by 26.7 mg/kg/hr until loss of eyelash reflex and then titrated to 6∼10 mg/kg/hr according to the patient's response and vital sign. Propofol infusion was discontinued while the endoscopic fiber was removed. Recovery time was defined from discontinuation of infusion to positive Romberg test. Evaluation was made from the endoscopists' assessment, patients' satisfaction, patients' recall of the procedure, and consciousness of the patients. Results: It was discovered that systolic, diastolic pressure and heart rate were significantly decreased, compared to control group. But clinically significant changes were not found. Apnea did not exist. And the respiration rate was significantly increased during propofol infusion. Peripheral oxygen saturation (SpO2) was transiently decreased during endoscopy. 14 patients (50%) complained of transient dizziness. Pain and redness over the infusion site was not found. The mean total dose of propofol was 133.6 mg. The mean infusion time of propofol was 6.2 minutes. Mean response and recovery time was 3.7 2.1, 20.9 5.4 minutes. Endoscopists' assessment and patients' comfort for endoscopy were satisfactory. When we asked 28 patients about willingness to undergo the same procedure in the future, 27 patients (96.4%) agreed. Degree of amnesia after examination revealed total amnesia in 27 patients (96.4%), partial amnesia in 1 patients (3.6%), and recall was not. Conclusions: Propofol has beneficial effects as hypnotic for upper gastrointestinal endoscopy without significant alteration in cardiopulmonary parameters. Patients' and endoscopists' assessment is good. This suggest that propofol may be used more frequently as a kind of premedication, especially in the cases of repeated endoscopy. (Korean J Gastrointest Endosc 19: 706∼715, 1999)

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상부 위장관 내시경의 전처치로서 Propofol의 효과 ( The Effect of Propofol for Sedation during Upper Gastrointestinal Endoscopy ): Korean J Gastrointest Endosc 1999;19(5):716-720. Published online November 30, 1998

Abstract PDF: Background
/Aims: This research was conducted in order to study the clinical usefulness and stability of the propofol used for sedation during upper gastrointestinal endoscopy. Methods: The objective of this research was to study one hundred patients, who were chosen based upon their preference to be examined through diagnostic upper gastrointestinal endoscopy accompanied with propofol from July 1998 to August 1998, and who showed normality in the pulmonary function test and ECG. The elements observed were hemodynamic variations, injection dosage, injection time, recovery time and side effects. Results: All patatints had no recollection of the procedure during gastrointestinal endoscopy. It was found that the older the patients were, the less amount of propofol sleep was indued. Systolic blood pressure, diastolic blood pressure and the mean arterial blood pressure were lowered noticeably after sleep, compared with those before the injection of propofol, while the heart rate hardly changed. Conclusions: Profopol is believed to be a useful sedative for upper gastrointestinal endoscopy. As blood pressre can be lowered however, a cautious attitude should be considered when injecting propofol in the elderly or in patients who have cardiovascular disease. (Korean J Gastrointest Endosc 19: 716∼720, 1999)

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위암의 병기 결정에 있어서 내시경초음파검사와 위에 물을 채우고 시행하는 복부초음파검사의 비교 ( A Comparison of Endoscopic Ultrasonography with Transabdominal Ultrasonography of Water-Filled Stomach in the Accuracy of Staging of Gastric Cancer ): Korean J Gastrointest Endosc 1999;19(5):721-729. Published online November 30, 1998

Abstract PDF: Background
/Aims: There was no single method satisfying accuracy, patient compliance and cost in preoperative staging of gastric cancer. A transabdominal ultrasonography of water-filled stomach (TUS) was compared with endoscopic ultrasonography (EUS) for TN staging in operated gastric cancer. Methods: We performed EUS conventionally and TUS immediately after 600 mL deaerated water ingested in 40 patients with gastric cancer prior to operation. All the cases were operated and the histological findings were compared with the results of preoperative TN staging. Results: The overall T-staging accuracy rate of TUS was 62.5% and 55.0% for EUS. Both TUS and EUS could differentiate EGC from AGC in 85.0%. There was no statistical difference in the accuracy for the depth of cancer invasion between EUS and TUS. Differentiation of the cancer defined within the gastric wall (T3) from the cancer invading adjacent organs (T4) was possible in 92.5% for TUS and 87.5% for EUS. The accuracy of determining the depth of invasion was tent to be lower in fundus than in antrum and body. Lymph node metastasis was correctly diagnosed in 67.5% for TUS and in 70.0% for EUS. Conclusions: TUS may be a considered to be a relatively accurate and simple method for preoperative staging of gastric cancer in the absence of available EUS. (Korean J Gastrointest Endosc 19: 721∼729, 1999)

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수술이 불가능한 위암 환자에 있어서 악성 위유문부 협착에 대한 코일형 인공관 삽관술 ( Peroral Intubation of a Self-expanding Coil Stent for Palliation of Unresectable Gastric Cancer with Antral Obstruction ): Korean J Gastrointest Endosc 1999;19(5):730-736. Published online November 30, 1998

Abstract PDF: Background
Peroral intubation of a self-expanding metal stent is usually difficult in malignant antral obstruction in patients with unresectable gastric cancer, due to the curved gastroduodenal structure. Methods: The delivery catheter of a self-expanding nickel-titanium coil stent was modified, which was originally used in obstructive esophagocardial cancer. Peroral intubation of the coil stent was attempted in patients suffering from intractable vomiting due to unresectable gastric cancer with antral obstruction. Results: Fifteen of 18 patients (83.3%) were successfully managed without immediate complications such as stent migration, serious bleeding, bowel perforation, and procedure- related mortality. One patient, who failed the peroral intubation, was managed by percutaneous intubation of the coil stent via the route of percutaneous endoscopic gastrostomy. After insertion of the coil stent, food ingestion and symptomatic improvement of vomiting was achieved in 15 (93.8%) of 16 patients. The mean survival time was 3.7 months (range, 1∼10 months). No delayed stent migration and occlusion by tumor overgrowth occurred. Stent occlusion by food materials occurred in one patient during the follow-up period, which was corrected by endoscopic flushing. Conclusion: These results suggest that peroral intubation of a self-expanding coil stent is a safe and effective palliation for unresectable gastric cancer with antral obstruction. (Korean J Gastrointest Endosc 19: 730∼736, 1999)

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내장역위증에서 발견된 위암과 식도암이 병발된 중복암 1예 ( A Case of Double Cancer of the Esophagus and Stomach in Situs Inversus Totalis ): Korean J Gastrointest Endosc 1999;19(5):733-767. Published online November 30, 1998

Abstract PDF: Left-to-right transposition of the normally asymmetrical organs of the body is termed situs inversus. Situs inversus is a rare congenital anomaly; according to Varano and Merklin, the reported incidence is estimated at 1：5,000 to 10,000 in adults. Its etiology is obscure but it apparently does not influence normal health or life expectancy. Many cases of malignant neoplasms with situs inversus have been found in corresponding English literature, but there was no documentation of double cancer of the esophagus and stomach associated with situs inversus totalis. We present a case of double cancer of the esophagus and stomach in a 49-year-old male with situs inversus totalis. Chest X-rays and an abdominal CT scan revealed situs inversus totalis. A chest and abdominal CT scan, and gastroscopy with tissue biopsy determined esophageal and gastric cancer. (Korean J Gastrointest Endosc 19: 763∼767, 1999)

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위 이소성 췌장의 내시경적 소견 ( Endoscopic Findings of Ectopic Pancreas in the Stomach ): Korean J Gastrointest Endosc 1999;19(5):739-746. Published online November 30, 1998

Abstract PDF: Backgound/Aims: Ectopic pancreas in the stomach is a relatively uncommon abnormality. Although its typical finding on endoscopy was described as a submucosal nodule with central umbilication, it is still difficult to differenciate ectopic pancreas from other pathologies. So we investigated the endoscopic findings of ectopic pancreas in the stomach. Methods: Between Jan. 1987 and Aug. 1998, nineteen patients who underwent gastroendoscopy and were histologically diagnosed as ectopic pancreas by various methods, were encountered at the Department of Internal Medicine, Severance Hospital, Yonsei University. The clinicopathologic records of all the patients were reviewed. Results: The mean age of the patients was 39.3 years old with a male to female ratio of 1：2.8. Endoscopically, seventeen cases (89.5%) were suggestive of submucosal tumors. Submucosal tumors combined with umbilication were in 4 cases (21.1%), with ulceration in 2 cases (10.5%), erosion in 5 cases (26.3%), ulceration and erosion in 1 case (5.3%), and normal mucosa in 5 cases (26.3%) respectively. The size of ectopic pancreas was in the range of 0.8∼3.0 cm, except in one case which measured 6.0 cm. The location of ectopic pancreas was in the antrum in 18 cases (94.7%), and in the angle in 1 case (5.3%). The endoscopic diagnoses were ectopic pancreas in 5 cases (26.3%), submucosal tumor in 12 cases (63.1%), gastric polyp in 2 cases (10.5%). The methods of histologic diagnosis of ectopic pancreas in 3 cases (15.8%) was by endoscopic biopsy, by endoscopic submucosal resection in 10 cases (52.6%), and by operation in 6 cases (31.6%). Conclusions: Ectopic pancreas in the stomach is found in various morphology, presented as submucosal tumors in the antrum. Because histological diagnosis by endoscopic forcep biopsy is difficult in many cases, endoscopic submucosal resection or operation should be considered. (Korean J Gastrointest Endosc 19: 739∼746, 1999)

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담낭관 저위합류의 임상적 의의 ( Clinical Significance of Low Junction of the Cystic Duct ): Korean J Gastrointest Endosc 1999;19(5):747-755. Published online November 30, 1998

Abstract PDF: Background
/Aims: Recently, similar to the anomalous union of the pancreatobiliary duct (AUPBD), a low junction of the cystic duct (LJCD) was reported to be associated with the carcinogenesis of the gall bladder (GB) and other pancreatobiliary diseases. This study was designed to evaluate the clinical significance of the LJCD. Methods: In this study all cases were performed ERCP. Three hundred and twenty two cases were selected due to their clear identification of the union area between the bile duct and the pancreatic duct, inserted area of the cystic duct, and the duodenal opening of the bile duct. The LJCD was defined that the cystic duct joins the distal bile duct between the upper margin of the pancreas and the duodenal opening of the bile duct. AUPBD was defined as a common channel greater than 15 mm in length. The clinical data was divided into four groups-normal biliary anatomy (Group 1), AUPBD (Group 2), LJCD (Group 3), and combined with AUPBD and LJCD (Group 4), and then analyzed. Results: The mean age of the subjects was 56.6 with 183 male and 139 female cases. Among 322 cases, there were 7.1% (23 of 322) of AUPBD, 11.2% (36 of 322) of LJCD and 0.6% (2 of 322) of combined with AUPBD and LJCD. The clinical symptoms and the laboratory findings of the subjects were no statistical significance among the groups. The incidence of CBD stones was 27.3% (88 of 322) of the patients; 25.3% (66 of 261) of Group 1, 21.7% (5 of 23) of Group 2, 47.2% (17 of 36) of Group 3, and were significantly higher in Group 3 than Group 1 & Group 3 (p=0.038). However, the incidence of GB stones and cystic duct stones was no statistical significance among the groups. Malignant diseases of the biliary trees were 9.65% (31 of 322) of the patients; 6.8% (18 of 261) of Group 1, 26% (6 of 23) of Group 2, 13.8% (5 of 36) of Group 3, and were closely correlated with AUPBD (p＜0.001) and LJCD (p=0.017). Conclusions: LJCD is relatively common in patients undergoing ERCP and closely correlated with the CBD stones and the malignacies of the biliary system. However its role in these condition is uncertain and needs to be further investigated. (Korean J Gastrointest Endosc 19: 747∼755, 1999)

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정상 간기능에서 복부초음파상 간외 담관의 단순 확장은 담관 병변에 대한 정밀 검사가 필요한가? ( Is It Necessary to Examine Precisely about Extrahepatic Duct in Patients with Normal Liver Function Showing EHD Dilatation Alone on Abdominal Ultrasonography? ): Korean J Gastrointest Endosc 1999;19(5):756-762. Published online November 30, 1998

Abstract PDF: Background
/Aims: It is necessary to study about extrahepatic bile duct (EHD) lesions in cases with abnormal liver function test (LFT) and clinical symptoms, even though abdominal ultrasonography could not find out the bile duct lesions. It is unclear however, whether the precise examination of EHD lesions are necessary in asymptomatic patients with normal liver function showing EHD dilatation without any lesions on abdominal ultrasonography (US). Methods: We examined prospectively about EHD using endoscopic ultrasonography (EUS), followed by endoscopic retrograde cholangiopancreatography (ERCP) in fifty-three patients with normal LFT showing only EHD dilatation on US. The mean EHD diameter on US was 9.1 1.4 mm. Results: The EHD dilatations alone on EUS were 41.5% and the EHD dilatations with lesions were 58.5%. The observed lesions of EHD by EUS were bile duct stones in 32.1%, thickening or stricture of distal bile duct in 17.0%, ampullary mass in 5.7% and CBD polyps in 3.8%. Three cases of ampullary mass were confirmed as 2 cases of T1 ampullary cancer and 1 case of papillitis. Examination by ERCP revealed EHD dilatation alone in 49.1% and bile duct lesions in 50.9%. ERCP could not detect the 2 cases of CBD polyp and 2 cases of distal bile duct thickening. Conclusions: In patients with normal LFT showing only EHD dilatation on abdominal US, EHD lesions can be detected in high frequency. Therefore, further examination about dilatated EHD should be conducted and for this purpose, EUS is be recommended as a useful tool. (Korean J Gastrointest Endosc 19: 756∼762, 1999)

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위에 발생한 원발성 편평상피암종 1예와 선 편평상피암종 1예 ( One Case of Gastric Squamous Cell Carcinoma and Another Case of Gastric Adenosquamous Cell Carcinoma ): Korean J Gastrointest Endosc 1999;19(5):771-775. Published online November 30, 1998

Abstract PDF: Gastric squamous cell carcinoma is very rare and is termed both pure squamous cell carcinoma and adenosquamous cell carcinoma. The pathogenesis of this neoplasm remains obscure and theories vary widely. It tends to occur in the distal half of the stomach, frequently along the lesser curvature, and affects a slightly younger age group with a greater male preponderance compared to adenocarcinoma. One case of gastric squamous cell carcinoma and another case of gastric adenosquamous cell carcinoma is herein reported. In the first case, a 70-year old male was admitted as a result of epigastric pain. On endoscopy, abdominal CT and UGI, a huge fungating mass in the posterior wall of the antrum of the stomach was revealed. A subtotal gastrectomy with Billroth II anastomosis was performed. Unlike the endoscopic biopsy finding however, the histopathologic diagnosis determined a squamous cell carcinoma of the stomach. In the other case, a 64-year old male was admitted due to epigastric pain. Upon examination, a huge Borrmann type III tumor mass in the lower body and antrum of the stomach along the lesser curvature was seen. Endoscopic biopsy finding revealed a suspicious adenocarcinoma, and an operation was performed. Unlike the endoscopic biopsy finding however, the histopathologic diagnosis revealed a adenosquamous cell carcinoma of the stomach. (Korean J Gastrointest Endosc 19: 771∼775, 1999)

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위장관에 발생한 유암종(Carcinoid tumor) 3예 ( Three Cases of Gastrointestinal Carcinoid Tumors ): Korean J Gastrointest Endosc 1999;19(5):776-782. Published online November 30, 1998

Abstract PDF: Carcinoid tumors arise from enterochromaffin cells that are located predominantly in the gastrointestinal mucosa. Gastrointestinal carcinoids appear with equal frequency among men and women, most often during the fifth and sixth decades. A primary duodenal carcinoid is rare. Most carcinoid tumors of the appendix are incidentally discovered during other surgical procedures. Its natural course is usually benign and the size of the tumor is closely related with the liability of regional or distant metastasis. The vast majority of rectal carcinoid tumors are benign and can be safely treated by a local excision. Lesions larger than 2 cm that invade the muscular wall of the rectum should be considered as malignant and treated by a more radical procedure such as an abdominoperineal resection. Three cases are here in reported of gastrointestinal carcinoid tumors that were treated at presbyterian medical center. (Korean J Gastrointest Endosc 19: 776∼782, 1999)

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위내시경 검사상 점막하 종양으로 표현되었던 스파르가눔양 병변 1예 ( A Case of Intraabdominal Sparganosis Presenting as Submucosal Tumor on Gastroscopy ): Korean J Gastrointest Endosc 1999;19(5):783-788. Published online November 30, 1998

Abstract PDF: Sparganosis in humans is caused by migrating larvae of the cestode Spirometra. Humans are considered the second intermediate host that are incidentally infected. Sparganosis usually infestates the subcutaneous tissues and visceral organs have rarely been reported to be involved. A case is herein reported however, a 67-year old female patient with sparganosis in the gastric wall and perigastric region, presented as a submucosal tumor upon gastrofiberscopy. The diagnosis was made after surgery by the pathologic findings determining a characteristic degenerated Sparganum and multiple tunnel-shape cavities surrounded by many inflammatory cells and necrotic materials. (Korean J Gastrointest Endosc 19: 783∼788, 1999)

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위에서 발생한 과립세포종 1예 ( A Case of a Granular Cell Tumor of the Stomach ): Korean J Gastrointest Endosc 1999;19(5):791-795. Published online November 30, 1998

Abstract PDF: Granular cell tumors of the gastrointestinal tract are uncommon, and the esophagus is the gastrointestinal site most frequently affected. Such tumors are rarely seen in the stomach, colon, or rectum. Azzopardi first described a granular cell tumor of the stomach in 1956. Since then a few gastric granular cell tumors have been reported in corresponding literature. It is believed that there have been no reported case of a granular cell tumor of the stomach in Korea. Subsequently one case of a granular cell tumor of the stomach in 38 year-old female who complained epigastric soreness is herein reported, and was successfully managed by endoscopic resection. (Korean J Gastrointest Endosc 19: 791∼795, 1999)

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상부 위장관 출혈로 내원한 십이지장의 단발성 Peutz-Jeghers형 과오종성 용종 1예 ( A Case of a Solitary Peutz-Jeghers Type Hamartomatous Polyp in the Duodenum with Upper Gastrointestinal Bleeding as the Initial Diagnosis ): Korean J Gastrointest Endosc 1999;19(5):796-800. Published online November 30, 1998

Abstract PDF: Peutz-Jeghers syndrome is a genetic disorder consisting of mucocutaneous pigmentation and gastrointestinal polyposis. Although the polyp may be found in a solitary fashion in this syndrome, such a case is exceedingly rare and would result in a case report even in other countries. A solitary Peutz-Jeghers polyp had not been reported domestically until now, and thereby, the authors here present a case of a clinical experience of Peutz-Jeghers syndrome with a solitary hamartomatous polyp in the duodenum. (Korean J Gastrointest Endosc 19: 796∼800, 1999)

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위장관 출혈이 합병된 Henoch-Sch nlein 자반증 2예 ( Two Cases of Henoch-Sch nlein Purpura Complicated by Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1999;19(5):803-807. Published online November 30, 1998

Abstract PDF: In the course of Henoch-Sch nlein purpura, diverse gastrointestinal manifestations are common. Two cases of Henoch-Sch nlein purpura complicated by upper and lower gastrointestinal bleeding is herein reported. For both patients, peculiar endoscopic pictures revealed, severe ulcerations and frank bleeding. A biopsy showed typical leukocytoclastic vasculitis which were the same as with the skin biopsy. The endoscopic finding was determined not to be pathognomonic, but instead characteristic of Henoch-Sch nlein purpura. Therefore, an endoscopy can be useful in the diagnosis of Henoch-Sch nlein purpura, especially for those patients without a typical skin rash. (Korean J Gastrointest Endosc 19: 803∼807, 1999)

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조기 위암에 동반된 간내 다발성 과호산구성 농양 1예 ( A Case of Early Gastric Carcinoma Combined with Hypereosinophilic Multiple Liver Abscesses ): Korean J Gastrointest Endosc 1999;19(5):808-813. Published online November 30, 1998

Abstract PDF: Eosinophilia is defined as the presence of more than 500 eosinophil/mL of blood and is common in the clinical condition such as parasite infestation, drug, allergy, hypereosinophilic syndrome, and malignant diseases. Determining the cause of eosinophilia may be one of the most frustrating endeavors in clinical medicine. Hepatic infiltration of eosinophils and microabscess formation are observed in many disorders. Gastric cancer and intestinal malignancies show frequent liver metastasis and blood eosinophilia. Several cases of an early gastric carcinoma (EGC) with metastasis of the liver have been reported. When multiple intrahepatic lesions of suspicious malignancy appear in radiologic study, clinicians must differentiate malignancy from benign diseases. A case is herein reported of a 56- year-old male patient with synchronously developed, multiple low density hepatic lesions with early gastric carcinoma. He was managed with systemic chemotherapy at another hospital, because he was diagnosed with distant metastasis of early gastric carcinoma. Upon operating these lesions were proved to be EGC combined with hypereosinophilic multiple liver abscesses. This case is herein reported with a review of relevant literatures. (Korean J Gastrointest Endosc 19: 808∼813, 1999)

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위암으로 오인된 위십이지장 크론병 1예 ( A Case of Gastroduodenal Crohn's Disease Mistaken for a Gastric Malignancy ): Korean J Gastrointest Endosc 1999;19(5):817-822. Published online November 30, 1998

Abstract PDF: Gastroduodenal Crohn's Disease (CD), which is uncommon in adults, involves the gastric antrum and proximal duodenum in most cases, and results in epigastric pain, weight loss, and gastric outlet obstruction, raising initial suspicion that it may be peptic ulcer disease or a malignancy. On upper endoscopy, aphthous ulcers are typical in the early stages but linear or stellate ulcers with a cobblestone appearance and luminal narrowing can be found in advanced diseases. Multiple mucosal biopsies are helpful for diagnosis despite the fact that granulomas are seen in less than one third of all cases. Gastroduodenal CD requires oral sulfasalazine therapy or systemic corticosteroid therapy in advanced cases. A case of gastroduodenal CD in a 37-year-old man admitted with epigastric pain, anorexia, vomiting and weight loss is herein reported. Malignancy was suspected as a result of the patient's clinical manifestations and endoscopic findings. An endoscopic biopsy revealed an active inflammation in the mucosa and lamina propria. The patient's condition improved with oral sulfasalazine and prednisolone therapy. (Korean J Gastrointest Endosc 19: 817∼822, 1999)

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상장간막 동맥증후군 2예 ( Two Cases of Superior Mesenteric Artery Syndrome ): Korean J Gastrointest Endosc 1999;19(5):823-828. Published online November 30, 1998

Abstract PDF: Superior mesenteric artery (SMA) syndrome results from compression of the third portion of the duodenum by the superior mesenteric artery or one of its branches where this vessel crosses over the duodenum as it descends from the aorta. Recently 2 cases of SMA syndrome were experienced. A 43-year-old female and a 41-year-old male were admitted due to complaints of frequent postprandial abdominal distension and vomiting for 4 months. An UGI series and abdominal CT scan revealed distension of stomach and duodenum with a cut-off in the duodenal third portion. Both patients underwent duodenojejunostomy with successful symptom relief. (Korean J Gastrointest Endosc 19: 823∼828, 1999)

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대장의 점막하 혈종과 출혈을 동반한 전신성 유전분증 1예 ( A Case of Primary Systemic Amyloidosis Presenting Submucosal Hematoma and Bleeding in the Lower Gastrointestinal Tract ): Korean J Gastrointest Endosc 1999;19(5):829-833. Published online November 30, 1998

Abstract PDF: A case of systemic amyloidosis involving the upper and lower gastrointestinal tract is presented. The initial manifestation of this case was bloody diarrhea. On colonoscopy, multiple submucosal hematomas and irregular ulcerations of the sigmoid and descending colon were found. The pathologic diagnosis was confirmed by an endoscopic mucosal biopsy of the gastrointestinal tract and the specimen revealed massive amyloid deposits in the wall of the upper and lower intestinal tract. With intensive medical treatment, the submucosal hematoma disappeared and the ulcerations decreased in size. However, on the 29th day, the patient was expired due to unexpected sepsis. (Korean J Gastrointest Endosc 19: 829∼833, 1999)

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경피경간 담도배액관을 따라 피부로 전이된 담도암 1예 ( Subcutaneous Implantation Metastasis of a Cholangiocarcinoma of the Bile Duct after Percutaneous Transhepatic Biliary Drainage (PTBD) ): Korean J Gastrointest Endosc 1999;19(5):837-842. Published online November 30, 1998

Abstract PDF: Percutaneous transhepatic biliary catheterization (PTC) has not only been increasingly used in the localization of benign and malignant lesions, but it is also considered rapid, safe and effective method to establish internal and external drainage for decompression of biliary obstructions. Infections and granulomas at the catheter entry site can occasionally develop, but are easily managed. However, such technique, when used both for obtaining malignant cells for diagnosis and for percutaneous decompression of the biliary tract can exposure the patient at risk for dissemination of the tumor along the catheter tract. This rare complication has been observed in a patient who underwent percutaneous transhepatic biliary drainage (PTBD) for malignant biliary tract obstruction. Although tumor cell seeding along the catheter tract is a very rare complication, we think that PTBD should be avoided when curative resection is planned. (Korean J Gastrointest Endosc 19: 837∼842, 1999)

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정상 십이지장경 소견을 보인 췌장의 Mucinous Ductal Ectasia 2예 ( Two Cases of Mucinous Ductal Ectasia of Pancreas with Normal Duodenoscopic Findings ): Korean J Gastrointest Endosc 1999;19(5):843-847. Published online November 30, 1998

Abstract PDF: Fairly specific and important duodenoscopic findings for diagnosing mucinous ductal ectasia (MDE) of pancreas include a prominant ampulla, patulous ampullary orifice and extrusion of mucin through the ampulla. However, we have experienced two cases of mucinous ductal ectasia without these pathognomonic appearance of ampulla. Initially, two cases were admitted for evaluation of pancreatic multicystic lesions, and MDE was incidentally found. Their pancreatographic findings showed normal main duct and cystic dilatation confined to the branch ducts. On gross findings of surgical specimens, a duct dilatation with gelatinous mucin was localized at the uncinate process of the pancreas. Microscopically, the ductal epithelia containing mucin were lined with well-differentiated tall columnar cells showing focal hyperplastic change. We report these unusual cases of MDE with review of the literatures. (Korean J Gastrointest Endosc 19: 843∼847, 1999)

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다낭성 신질환을 동반한 선천성 간 섬유화증 1예 ( A Case of Congenital Hepatic Fibrosis Associated with Polycystic Kidney Disease ): Korean J Gastrointest Endosc 1999;19(5):848-852. Published online November 30, 1998

Abstract PDF: Congenital hepatic fibrosis is a developmental abnormality that may appear either sporadically or in a familial form. It is an inherited disease defined pathologically by bands of fibrous tissue within the liver, and is occasionally associated with cystic kidney disease. A 21-year-old woman was admitted to our hospital for evaluation of pancytopenia. She showed esophageal varices, hepatomegaly and splenomegaly, but had normal results on her liver function test. Peripheral stigmata of chronic liver disease such as palmar erythema or spider angioma was not found. Hepatosplenomegaly, polycystic kidney and psoas muscle cyst were detected through an abdominal CT and MRI. The patient is diagnosis was confirmed as congenital hepatic fibrosis using laparoscopic liver biopsy. The first case of congenital hepatic fibrosis associated with polycystic kidney disease in Korea is herein reported. (Korean J Gastrointest Endosc 19: 848∼852, 1999)

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