Clinical Endoscopy

Genta 염색을 이용한 위점막 장상피화생 부위의 Helicobacter pylori 부착 빈도 ( Adherence of Helicobacter pylori to Areas of Gastric Intestinal Metaplasia by the Genta Stain ): Korean J Gastrointest Endosc 2000;20(1):1-5. Published online November 30, 1999

Abstract PDF: Background
/Aims: Infection with Helicobacter pylori is the most important cause of chronic active gastritis. One means of evolution of chronic active gastritis is the development of atrophic gastritis, a condition almost universally associated with extensive intestinal metaplasia. But Helicobacter pylori is not usually found in areas of intestinal metaplasia. Recently Genta RM developed a staining technique that allows simultaneous visualization of Helicobacter pylori and gastric morphology, including intestinal metaplasia. Therefore, the evaluation of the frequency of Helicobacter pylori adherence to intestinal metaplasia using the Genta stain is herein reported. Methods: The study was conducted on 69 gastric biopsy specimens with intestinal metaplasia. Slides from each specimen were stained using the Genta stain to identify the adherence of bacteria and types of intestinal metaplasia. Results: In 56 (81%) of 69 patients, incomplete intestinal metaplasia was found. In 9 (16%) of 56 patients with incomplete intestinal metaplasia, H. pylori was attached in the area of intestinal metaplasia. But in all of the intestinal metaplasia, H. pylori was not attached in the area of the intestinal metaplasia Conclusions: The common subtype of intestinal metaplasia was incomplete metaplasia. Although in small cases, H. pylori was attached only to the area of the incomplete type of intestinal metaplasia. (Korean J Gastrointest Endosc 2000;20:1~ 5)

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소아 상부 위장관 이물의 내시경적 적출술 - 대구, 경북지역 소아 78예에 대한 고찰 - ( Endoscopic Removal of Foreign Bodies from the Upper Gastrointestinal Tract in Children: Management of 78 Cases in Taegu, Korea ): Korean J Gastrointest Endosc 2000;20(1):6-13. Published online November 30, 1999

Abstract PDF: Background
/Aims: Foreign body (FB) removal is a common indication of therapeutic endoscopy in children. The trend is becoming wider and more rational in application. The spectrum of upper gastrointestinal FB's in children during a recent 2 year period was reviewed in Taegu, Kyungbook Province in order to obtain a the consensus of recent trend of indications and techniques of endoscopic FB removal in children. Methods: Esophagogastroscopy was performed on 78 children who had been referred to 3 University Hospitals in Taegu for FB ingestion from Oct. 1996 to Sep. 1998. Results: Age between 1∼2 year was the peak age group; 22 cases (28%). Male to female ratio was 1.9：1. Thirty four cases (44%) were in the esophagus, 44 cases (56%) in the stomach. The majority (49%) of the FB's were coins, 26 of 34 esophageal FB's and 12 of 44 gastric FB's. Others were 14 sharp/pointed objects, 12 big/long objects, 7 toxic objects, etc. In 67 children (86%) the FB was successfully removed and spontaneous passage through the pylorus was observed in 9 children. Conclusions: Endoscopic FB removal can be performed safely and effectively in children with minimal or no complications by an experienced endoscopist. Proper arrangement should be conducted with consideration to the property of FB's, expected complication, and the possibility of an emergency situation. (Korean J Gastrointest Endosc 2000;20:6~13)

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내시경적 역행성 담췌관 조영술상 췌관의 형태와 질환과의 관계 ( Anatomical Variations and Morphological Diversities of the Pancreatic Ductal System - Clinical and ERCP evaluation - ): Korean J Gastrointest Endosc 2000;20(1):14-20. Published online November 30, 1999

Abstract PDF: Background
/Aims: The advent of endoscopic retrograde cholangiopancreaticography (ERCP) has made it possible to identify the pancreatic ductal (PD) system. There is no established relationship between the PD system and various pancreaticobiliary diseases. The purpose of this study was to identify the morphological diversities and anatomical variations of PD and to define the relationship between PD types and pancreaticobiliary diseases. Methods: Five hundred and eighty-two consecutive patients, in whom both PD and common bile duct (CBD) were clearly visualized by ERCP, were included. PD types were categorized according to the relationship between CBD and PD. The anatomical variations were classified into migration, fusion, and duplication anomalies. Results: The PD types were classified into type A 84.4%, type B 9.6%, type C 3.4%, and type D 2.6%. The PD anomalies were noted in 51 patients, which were comprised of 19 (3.3%) fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum) and 32 (5.5%) duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. Hyperamylasemia was more frequently complicated in type C (41.7%) and D (50%) than in type A and B after ERCP. Conclusions: Though a close relationship was not found between various PD types and pancreaticobiliary diseases, being familiar with the morphology and anatomical variation is worth it, for more accurate interpretation and for prediction of a complication such as pancreatitis. (Korean J Gastrointest Endosc 2000;20:14~20)

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담낭이 있는 총담관 담석 환자의 내시경 치료에 대한 연구 ( Endoscopic Treatment of Bile Duct Calculi in Patients with Gallbladder in Situ ): Korean J Gastrointest Endosc 2000;20(1):21-25. Published online November 30, 1999

Abstract PDF: Background
/Aims: Endoscopic sphincterotomy (EST) is a safe and effective method of managing CBD calculi. But whether EST of CBD calculi in patients with gallbladder in situ should be followed by routine post-EST cholecystectomy, is still a subject of controversy. The aims of this study was to identify the recurrence rate and predictive factors of biliary symptoms after EST of CBD calculi in patients with gallbladder in situ. Methods: 90 patients of CBD calculi with intact gallbladder treated with endoscopic sphincterotomy from 1992 to 1998 were reviewed. Follow up on the patients consisted of phone calls or personal interviews and the length of the follow up ranged from 6 to 77 months. Results: Cholecystectomy was required in 12 patients (13.3%) due to recurrent biliary symptoms and the remaining 78 patients (86.6%) were symptom free. Of the recurrence, 67.7% occurred within 12 months after EST and only one occurred after 5 years of follow-up. The risk of recurrence was higher in those patients with periampullary diverticulum in ERCP. Conclusions: The low recurrence rate of 13.3% after EST of CBD stones in patients with gallbladder in situ hardly justifies routine post-EST cholecystectomy and rather suggests selective post-EST cholecystectomy especially in high operative risk patients. (Korean J Gastrointest Endosc 2000;20:21~25)

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담도 배액관 유도 유두부 절개술 - 난해한 유두부주위 게실 및 위 부분절제술 환자에서 - ( A Stent-Guided Sphincterotomy in Patients with a Difficult Periampullary Diverticulum or with a Billroth-II Gastrectomy ): Korean J Gastrointest Endosc 2000;20(1):26-32. Published online November 30, 1999

Abstract PDF: Background
/Aims: Patients with a congenitally or surgically altered anatomy such as a large diverticulum in which an ampullary orifice exists or a Billroth-II gastrectomy, have an increased complication rate after endoscopic sphincterotomy (EST) compared to normal anatomies. An experience involving a stent-guided sphincterotomy using an endoprosthesis is herein reported. Methods: 10 patients with a Billroth-II gastrectomy and 9 patients with a large diverticulum received a stent-guided EST. In the diverticula cases, all the ampullary orifices were located either inside the diverticulum or in an unusual position. All patients had common bile duct stones and symptoms of cholangitis. After a 0.035 inch guide wire was inserted through the side-viewing duodenoscope, a 10 Fr. endoprosthesis (MTW, Germany) was inserted and a needle-knife sphincterotome was introduced. In patients with a Billroth-II anatomy, the incision was made from the papillary orifice of the 12 o'clock position toward 6 o'clock. In patients with periampullary diverticula, the incision was made with sweeps of the needle-knife in a 6 to 12 o'clock direction. The cautery current was applied to the mucosa along the stent and the stent was retrieved by a polypectomy snare through the biopsy channel without removal of an endoscope. Results: Among the 19 patients, the guide wire and stent insertion were possible in all except one patient due to the inability of selective cannulation. An EST was performed in all patients after stent insertion. There were no serious complications during and after the stent-guided EST except for two minor bleedings which were treated with a coagulation current using the needle-knife. Consequently, complete endoscopic stone removal was achieved in all patients including three patients in whom a mechanical lithotriptor was needed. Conclusions: In stent-guided EST, the stent not only guides the adequate direction of the incision but also allows a controlled incision under a favorable visual field. Therefore, blind cutting and exploration during EST can be avoided and successful EST is possible even in difficult situations such as that created by an altered anatomy. (Korean J Gastrointest Endosc 2000;20:26~32)

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췌장의 점액 생산성 종양과 유사한 점액 생산성 담도암 8예 ( Eight Cases of Mucin-hypersecreting Cholangiocarcinoma Similar to Intraductal Papillary Mucinous Tumor of the Pancreas ): Korean J Gastrointest Endosc 2000;20(1):33-40. Published online November 30, 1999

Abstract PDF: Background
/Aims: Mucin-hypersecreting cholangiocarcinoma is very similar to intraductal papillary mucinous tumor (IPMT) of the pancreas. But this disease is rare and its clinicopathologic features are not well known. The purposes of this study are to report our experience of eight patients with the tumor and to analyze the characteristics of its clinical, radiological and pathological finding. Methods: Eight patients (3 men and 5 women, mean age 52 years) were diagnosed as having a mucin-hypersecreting cholangiocarcinoma among 4,570 cases of ERCP from 1995 to 1998. Results: Recent or previous attacks of biliary pain or acute cholangitis were elicited in most of the patients. CT showed diffuse intra- and extra-hepatic duct dilatation in all patients and suspicious ill-defined mass shadow in 2 out of 8 patients. On cholangioscopic examination, a papillary mass or minute mucosal lesion was found in the dilated bile duct containing thick viscid mucin. Eight patients were recommended an operation and curative resection was performed in seven patients. Histologically, well-differentiated adenocarcinoma in the background of benign hyperplasia and adenoma was documented in all patients. Conclusions: Mucin- hypersecreting cholangiocarcinoma may be characterized by exceedingly similarity to IMPT of the pancreas in clinical, radiological and pathological features. Further investigation is needed for detailed information such as natural history and outcome. (Korean J Gastrointest Endosc 2000;20:33~40)

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대량의 위출혈을 보인 위 칸디다증 1예 ( A Case of Gastric Candidiasis Presented with Massive Gastric Bleeding ): Korean J Gastrointest Endosc 2000;20(1):41-45. Published online November 30, 1999

Abstract PDF: Candida albicans is a saprophytic organism that frequently resides in the mouth, skin, gastrointestinal and vaginal mucosa. It is also an opportunistic pathogen in immune compromised individuals, alcoholics, and debilitated subjects treated with antibiotics, steroids, or antineoplastic drugs. Although the most common site of gastrointestinal involvement is the esophagus, gastric candidiasis may occur in immune suppressed patients and is rarely apparent in healthy individuals. Symptoms are nonspecific; indigestion, abdominal pain, fever and weight loss have been described. The diagnosis can usually be established by visualizing yeast and/or mycelial forms in endoscopic biopsy or in mucosal brushings of the lesions. A case of gastric candidiasis presented with bleeding was experienced in a 69-year-old female with chronic renal failure due to diabetic nephropathy. She underwent orthopedic surgery because of intertrochanteric fracture of her femur. On the 6th day of the postoperative period, the patient began suffering from a large amount of melena. Endoscopic findings revealed multiple whitish or central necrotic plaques in the body and antrum of the stomach. Endoscopic biopsy revealed budding yeast and pseudohyphae infiltrating through the ulcerated stomach wall. After the patient was treated with mycostatin for 7 days, endoscopic and pathologic findings did not show any evidence of the candidiasis. The case is herein reported of gastric candidiasis presented with gastric bleeding, along with a review of corresponding literature. (Korean J Gastrointest Endosc 2000;20:41~45)

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외상성 횡격막허니아의 지연 병발 1예 ( A Case of Delayed Presentation of a Traumatic Diaphragmatic Hernia ): Korean J Gastrointest Endosc 2000;20(1):46-48. Published online November 30, 1999

Abstract PDF: The majority of undiagnosed diaphragmatic ruptures are associated with a high mortality rate if not treated immediately. A high index of suspicion for diaphragmatic injury during initial evaluation is the most important factor. A case was experienced involving delayed presentation of a traumatic diaphragmatic hernia, in a 49 year old female injured in a road traffic accident a year prior to admission. She was admitted with complaints of left side chest pain, nausea, and vomiting for 7 days. She was diagnosed as a diaphragmatic hernia on her left side by several diagnostic tests including a gastroscopy and CT scan. Her medical history was carefully examined as well. Surgical repair was performed. (Korean J Gastrointest Endosc 2000;20:46~48)

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거대 위궤양에서 발견된 집락형성형 모균증(Mucormycosis) 1예 ( A Case of Gastric Mucormycosis Colonization Associated with Giant Gastric Ulcer ): Korean J Gastrointest Endosc 2000;20(1):49-52. Published online November 30, 1999

Abstract PDF: Mucormycosis is an uncommon, frequently fatal opportunistic infection. Mucormycosis of the gastrointestinal tract is usually found in patients suffering from chronic illness and is thought to arise from fungi entering the body through food. When gastric mucormycosis is presented as an invasive fungal infection, the prognosis is extremely poor. But when the fungus colonizes on the gastric mucosa or on necrotic debris without invasion of the blood vessels, the prognosis is good. A case is herein reported of a colonization type of gastric mucormycosis in a 46 year old male alcoholic. On histologic examination, characteristic findings of nonseptate hyphae with right angle branchings were observed in the ulcer debris without tissue or vessel invasion. Also, the broad and ribbon-like aseptate hyphae was noted on the fungus culture. The patient was treated with nystatin syrup and a proton pump inhibitor without systemic antifungal therapy. (Korean J Gastrointest Endosc 2000;20:49~52)

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경피골막증과 동반된 비후성 위염 및 조기 위암 1예 ( A Case of Hypertrophic Gastropathy and Early Gastric Cancer Associated with Pachydermoperiostosis ): Korean J Gastrointest Endosc 2000;20(1):53-57. Published online November 30, 1999

Abstract PDF: Pachydermoperiostosis is a rare hereditary syndrome characterized by finger clubbing, periosteal new bone formation of tubular bones, and hypertrophic skin changes (pachydermia). This syndrome is known to be associated with a variety of diseases such as cranial suture defect, female escuchen, bone marrow failure and autonomic nervous system symptoms such as facial flushing and hyperhidrosis. There are just a few reports documenting gastric ulcer, hypertrophic gastropathy and Crohn's disease as associated diseases. A case is herein reported of pachydermoperiostosis accompanied by hypertrophic gastropathy and early gastric cancer. (Korean J Gastrointest Endosc 2000;20:53 57)

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십이지장벽 내에 발생한 췌장 가성낭종 1예 ( A Case of Intramural Pancreatic Pseudocyst of the Duodenum ): Korean J Gastrointest Endosc 2000;20(1):58-62. Published online November 30, 1999

Abstract PDF: Pancreatic pseudocysts are a well-recognized complication of pancreatitis. Most occur in or adjacent to the pancreas. Occasionally, duodenal involvement may occur due to the nonperitonealized posterior surface of the duodenum is in direct contact with the head of the pancreas. But there is little awareness of the intramural and major extrinsic involvement of the duodenum with also occurs. A case was recently experienced involving an intramural pancreatic pseudocyst of the duodenum. (Korean J Gastrointest Endosc 2000;20:58 62)

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위장과 대장에 발생한 과형성 용종증 1예 ( A Case of Multiple Hyperplastic Polyps in the Stomach and Colorectum ): Korean J Gastrointest Endosc 2000;20(1):63-67. Published online November 30, 1999

Abstract PDF: Hyperplastic polyps are a benign epithelial proliferation and a common type of colorectal and gastric polyps. Malignant change of hyperplatic polyps is rare. Patients with multiple lesions however, tend to have a high frequency of malignancy. Colorectal polyposis syndromes with gastric polyps include familial adenomatous polyposis, Gardners syndrome, Peutz-Jeghers syndrome, juvenile polyposis and others. But the case of colorectal hyperplastic polyposis with multiple gastric hyperplastic polyps has not been reported until now. A case was recently experienced involving a 32 year old women with both colorectal and gastric hyperplastic polyposis. Multiple hyperplastic polyps were found in the lower part of the body and the antrum of the stomach, rectosigmoid, transverse and ascending colon. (Korean J Gastrointest Endosc 2000;20:63~67)

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위 전정부 및 십이지장에 비용종성 선종을 동반한 가족성 선종성 용종증 1예 ( A Case of Antral and Duodenal Nonpolypoid Adenomas in a Patient with Familial Adenomatous Polyposis ): Korean J Gastrointest Endosc 2000;20(1):68-72. Published online November 30, 1999

Abstract PDF: Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited colon cancer-predisposing disorder, characterized by the development of innumerable adenomas in the large intestine. Polyps are present in the upper gastrointestinal tract in almost all FAP patients and there is a peculiar predilection for adenomatous change in the duodenum. Colonic adenomas in FAP are commonly observed as polyps but nonpolypoid adenomas can also be seen in the upper gastrointestinal tract. Careful endoscopic examination is needed for detecting such nonpolypoid lesions. At present, the adenoma-carcinoma sequence is thought to exist also in the duodenum, and malignancy of the duodenum represents one of the most common causes of mortality among patients with FAP. Therefore, careful periodic follow-up of upper intestinal endoscopies are recommended in patients with this disease, in consideration to the possible development of duodenal nonpolypoid adenomatous lesions. A case involving an experience of antral and duodenal nonpolypoid adenomas in a patient with FAP is herein reported. (Korean J Gastrointest Endosc 2000;20:68 72)

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Peutz-Jeghers 증후군 환자에서 발생한 장중첩증 1예 ( A Case of Peutz-Jeghers Syndrome with Intussusception ): Korean J Gastrointest Endosc 2000;20(1):73-76. Published online November 30, 1999

Abstract PDF: Peutz-Jeghers syndrome is a rare autosomal dominant disorder defined by hamartomatous polyps of gastrointestinal tracts and the occurrence of melanin spots on the mucocutaneous surface. This syndrome has important complications such as malignant transformation, gastrointestinal bleeding, and intussusception. About 50% of patients with Peutz-Jeghers syndrome involved Intussusception. A case of Peutz-Jeghers syndrome with intussusception was recently experienced and herein reported. (Korean J Gastrointest Endosc 2000;20:73~76)

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인터페론에 의한 급성췌장염에 합병된 다발성 췌장농양 1예 ( A Case of Pancreatic Abscesses Complicating Acute Pancreatitis Associated with Interferon Therapy ): Korean J Gastrointest Endosc 2000;20(1):77-82. Published online November 30, 1999

Abstract PDF: A patient experienced a silent gallstone accompanied by acute severe pancreatitis during interferon theraphy for renal cell carcinoma. Although the gallstone was highly suspected to be the cause of the pancreatits, there were no duodenoscopic or endoscopic retrograde cholangiopancreatographic findings suggesting gallstone pancreatitis such as papillitis, impacted papillary and common bile duct stones, and/or a wider cystic or pancreatic duct, respectively. It is believed that the acute pancreatitis in the presenting case was probably caused by interferon because 1) sludge nor biliary crystal was not detected by light microscopic examination, 2) no tumors, anomalies, nor any obstructing ductal lesions in the pancreas were found, 3) this patient had no other potential causes of acute pancreatitis, and 4) there was no use of potential drugs which could be responsible for the acute pancreatitis other than interferon. In addition, trials of endoscopic drainage of complicated pancreatic abscesses were discussed. (Korean J Gastrointest Endosc 2000;20:77~82)

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