Clinical Endoscopy

조기 위암의 조직 분화도에 따른 내시경적 육안 소견 ( Correspondence of Endoscopic Findings with Histologic Differentiation in Early Gastric Cancer ): Korean J Gastrointest Endosc 2000;20(2):83-90. Published online November 30, 1999

Abstract PDF: Background
/Aims : The aim of this study was to investigate the endoscopic findings of early gastric cancer according to histological differentiation. Methods : One hundred eight cases of early gastric cancer (EGC) which had been confirmed surgically over a 1 year and 7 month period, were studied to assess the relationship between histological differentiation and endoscopic findings. Results : All elevated types of EGC (41 cases) were found to be differentiated carcinoma. 48.2% (30/67 cases) of the depressed type EGC was determined to be differentiated carcinoma, while the others (51.8%) were undifferentiated carcinoma. Twenty-four of thirty cases with differentiated depressed type EGC showed a reddish discolored surface (80%), and the others manifested a whitish or mixed colored surface of red and white. In the undifferentiated depressed type EGC, 73% (27/37 cases) revealed a whitish or mixed colored surface, while the others (27%) showed a reddish discoloration. In the differentiated depressed type EGC, the character of the depressed surface was mainly regular and soft or fine granular (77%), while that of the undifferentiated cases appeared as uneven large granules (43.2%) or fine granules (43.2%), sclerotic (2.8%) and/or elevated (10.8%). The margin of the depressed type EGC with differentiated carcinoma was mainly of a shoaling beach type (83.3%), and that of the undifferentiated carcinoma was not uniform and existed as a cliff type (60%), Riasis coast type (11.4%) and shoaling beach type (28.6%). Conclusions : All elevated types of EGC showed differentiated types, and histological differentiation of depressed type EGC was macroscopically determined by the size of lesions, color, and character of the depressed surface and margin of the depression. (Korean J Gastrointest Endosc 2000;20:83 90)

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대장용종 및 대장암 환자에서 상부 위장관 병변과 Helicobacter pylori 감염 빈도 ( Upper Gastrointestinal Lesions and Helicobacter pylori Infection in Patients with Colorectal Neoplasia ): Korean J Gastrointest Endosc 2000;20(2):91-96. Published online November 30, 1999

Abstract PDF: Background
/Aims : There are some reports which show higher Helicobacter pylori (H. pylori) seroprevalence in patients with colonic adenoma and carcinomas, than in control subjects. The H. pylori infection rate and simultaneous gastroduodenal lesions were evaluated to document the relationship between colonic lesions and H. pylori infection. Methods : Patients with colonic polyps or cancers who were confirmed by colonoscopic polypectomy or biopsy were studied. H. pylori infections were evaluated serologically and/or with CLO testing. Gastroduodenoscopy was performed. Results : Twenty six subjects were involved. The numbers of the patients with hyperplastic polyps, tubular adenomas and carcinomas were 7, 6 and 13, respectively. The H. pylori infection rate was 65.4%. Simultaneous gastroduodenal lesions were observed in 11 patients (42.3%) and H. pylori infections were found in 9 (81.8%). Among the 17 subjects with H. pylori infections, 9 subjects (52.9%) had simultaneous gastroduodenal lesions. In contrast, 2 subjects (22.2%) had upper gastrointestinal lesions among 9 subjects without H. pylori infections. Conclusions : Patients with colorectal neoplasia can experience, simultaneous gastroduodenal lesions, especially in the cases involving H. pylori infection. (Korean J Gastrointest Endosc 2000;20:91 96)

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말기 신부전 환자에서 Helicobacter pylori 유병률 ( Prevalence of Helicobacter pylori in Patients with End Stage Renal Disease ): Korean J Gastrointest Endosc 2000;20(2):97-102. Published online November 30, 1999

Abstract PDF: Background
/Aims : It has been reported that patients with chronic renal failure have a tendency foward increased incidences of peptic ulcer diseases. However, it is yet unclear whether the increased incidence is due to altered gastric acidity, hypersecretin of gastrin, or increased colonization of Helicobacter pylori (H. pylori). This study was conducted to investigate the role of H. pylori in the development of peptic ulcer diseases in patients with chronic renal failure. Methods : Forty nine patients with end stage renal disease (ESRD) and 41 age-matched controls with normal renal function, were examined for H. pylori infection using a rapid urease test, histological examination with Hematoxylin, Eosin, Warthin-Starry silver stain, and culture. The presence of H. pylori was defined either as the positive culture or as positive for both CLO and histological examination. Results : Ninteen (38.8%) out of 49 ESRD patients were positive for H. pylori, which was lower than 70.7% of the controls (p＜0.01). Endoscopic examination revealed that 6 ESRD patients (12.2%) had peptic ulcers, while 2.4% of the controls did, which was not statistically significant. The ESRD patients were divided into two groups by therapeutic modality: group 1 included 31 patients under dialysis, and group 2, 18 patients with maintenance therapy. The incidence of H. pylori infection in group 1 was 51.6%, which was significantly higher than the 16.7% in group 2 (p＜0.05). Conclusions : The results of this study suggest that the increased incidence of peptic ulcers in ESRD patients cannot be explained by H. pylori colonization, and that there may be other factors such as a high concentration of urea in the stomach of patients with ESRD, which can suppress the colonization of H. pylori. (Korean J Gastrointest Endosc 2000;20:97 102)

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초음파 내시경을 이용한 담낭용종의 진단적 접근 ( A New Strategy to Predict the Neoplastic Polyps of the Gallbladder Based on a Scoring System Using Endoscopic Ultrasonography ): Korean J Gastrointest Endosc 2000;20(2):103-112. Published online November 30, 1999

Abstract PDF: 목적/배경 : 초음파 내시경의 소견을 기초로 하여 담낭용종의 감별진단을 위한 새로운 지침을 제안하였다. 방법 : 92년부터 95년 사이에 초음파 내시경과 담낭절제술을 받은 79예를 대상으로 종양성(선종, 악성종양)과 비종양성 용종으로 나누었다. 용종은 크기에 따라 4그룹(≤5, 5∼10, 10∼15, 그리고 ≥15 mm)으로 나누어 분석하였고, 용종의 크기가 5∼15 mm인 환자에서 5개의 초음파 내시경적 변수들의 점수의 크기는 판별분석과 대응위험도를 이용하여 계산하였다. 그리고 나서 5가지 변수들의 합계 점수를 96년부터 98년까지 입원한 26예에 적용하였다. 결과 : 92년부터 95년까지의 79예에서 다변량 변량분석을 시행하였을 때 용종의 크기는 가장 의미있는 종양성 용종의 예측인자였으며(p＜0.01), 용종의 크기가 5 mm 이하인 모든 용종은 비종양성이었고, 15 mm 이상인 경우 94%가 종양성 용종이었다. 그러나, 용종의 크기가 5∼10 mm 군과 10∼15 mm 군에서의 종양성 용종의 위험도는 통계학적으로 의미있는 차이는 없었으며(p=0.128), 15 mm를 초과할 경우 5∼10 mm 군과 10∼15 mm 군과 비교하여 의미있게 종양성 용종의 위험도가 증가하였다. 96년부터 98년까지 입원한 환자에서 용종의 크기가 5∼15 mm일 때, 5개 변수들의 합계 점수가 6 이상인 경우 종양성 용종의 위험도는 5 이하와 비교하여 의미있게 증가하였다. 결론 : 5 mm 이하의 용종은 추적관찰, 15 mm 이상의 용종은 수술적 치료를 시행하고, 5∼15 mm 크기의 경우 초음파 내시경 소견을 바탕으로 수술 여부를 결정하는 것이 치료방침에 유용할 것으로 볼 수 있겠다. (Korean J Gastrointest Endosc 2000; 20:103 112)

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화농성 간농양 환자에서 내시경적 역행성 담도 조영술의 유용성에 관한 연구 ( A Study on the Usefulness of ERCP in Patients with Pyogenic Liver Abscess ): Korean J Gastrointest Endosc 2000;20(2):113-118. Published online November 30, 1999

Abstract PDF: Background
/Aims : This study was undertaken to evaluate the usefulness of ERCP in patients with pyogenic liver abscess. Methods: An endoscopic retrograde cholangiographic study of 70 consecutive cases of pyogenic liver abscess was conducted during the period from January, 1993 to December, 1997. Among 70 cases of pyogenic liver abscess, the male to female ratio was 1.69：1, and the peak incidence was in the sixth decade. Results : The common associated diseases were liver cirrhosis (11.4%), diabetes mellitus (8.5%), and malignancy (5.7%). The most common origins of the abscess in decreasing order of frequency were, transbiliary infection (51%), hematogenous spread, and trauma-associated causes. The ascending infection through the biliary tract as the etiology of liver abscess, has been common since the 1970's. The positive rate of abdominal US, CT, and ERCP in the diagnosis of the etiology of the liver abscess was 68, 82, 84% respectively. The treatments of the pyogenic liver abscess were, surgical drainage in 15 cases (21%) and percutaneous drainage in 51 cases (73%). Among 70 patients treated for pyogenic liver abscess, 12 patients had CBD stones and 11 patients were cured by EST. Conclusions : The most common origin of liver abscess is ascending infection through the biliary tract and ERCP may be a effective tool in the assessment and management of the etiology of pyogenic liver abscess. (Korean J Gastrointest Endosc 2000;20:113-118)

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궤양을 동반한 급성 봉소염성 식도염 1예 ( A Case of Acute Phlegmonous Esophagitis ): Korean J Gastrointest Endosc 2000;20(2):119-123. Published online November 30, 1999

Abstract PDF: Phlegmonous esophagitis is an uncommon disease characterized by purulent infection of the esophageal wall, sparing the mucosa. Bacterial infection of the eosphagus is usually presented as a superimposed infection upon a preexisting viral or fungal esophagitis and most victims are immunocompromised hosts. A case was experienced involving an acute phlegmonous esophagitis in an 21-year-old man who was immunologically normal and whose main symptoms were epigastric pain and fever for one day. Esophagographic examination revealed a large ulceration of the eosphagus with exudation, and submucosal lesions. Due to its rarity, this case is herein reported with a review of the corresponding literature. (Korean J Gastrointest Endosc 2000;20:119-122)

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상부 위장관 출혈을 동반한 위 사구종양 1예 ( A Case of Gastric Glomus Tumor with Bleeing ): Korean J Gastrointest Endosc 2000;20(2):123-126. Published online November 30, 1999

Abstract PDF: A glomus tumor is a benign neoplasm arising from the neuromyoarterial glomus body, a specialized arteriovenous communication. It functions as a temperature regulator, predominantly in the skin. The glomus tumor occurs rarely in the stomach. The common presenting symptoms are upper gastrointestinal bleeding, epigastric discomfort, nausea, and vomiting. This benign tumor is seen as an intramural mass and is most frequently located in the gastric antrum. Because of its highly cellular nature, the frozen section is often misinterpreted as malignant, and an unduly extensive resection is sometimes performed. A 57-year-old woman was recently admitted due to hematemesis and melena for one day. A gastrofibroscopy was performed and a 3 4 cm sized submucosal mass with central ulceration was found on the anterior wall of the antrum. Fresh blood clots were noted on the ulcer base. Due to recurrent bleeding, a hemigastrectomy was performed. Pathologic findings, including immunoreactivity to α-smooth muscle actin and vimentin, was consistent with a glomus tumor of the stomach. (Korean J Gastrointest Endosc 2000;20:123-126)

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위와 피하 연부 조직에 동반된 해면 혈관종 1예 ( A Case of Cutaneous and Gastric Cavernous Hemangiomas ): Korean J Gastrointest Endosc 2000;20(2):127-131. Published online November 30, 1999

Abstract PDF: A hemangioma is a common soft tissue tumor, usually affecting the cutaneous regions of the head and neck in infancy and childhood. A hemangioma in the gastrointestinal tract is rare occurrence which is usually found in the submucosa of the small and large intestine, but rarely in the stomach. Infrequently, multiple cavernous hemangiomas have been reported on skin and in the intestines. A 23-year-old man was admitted with hematemesis. An upper endoscopy revealed a purple colored sessile lesion at the posterior wall side of the fundus which had surface erosion and erythema. This lesion was easy to bleed when the patient retched. Another sessile lesion was detected at the greater curvature side of the upper body. The patient had two intradermal soft masses at the back and left forearm. An X-ray revealed a phebolith that suggested a cavernous hemangioma. An abdomen CT and angiography revealed that these lesions were highly suggestive of hemangioma. Gastric wedge resection was performed and the histological diagnosis was gastric cavernous hemangiomas. (Korean J Gastrointest Endosc 2000;20:127 131)

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이소성 점막을 동반하지 않은 Meckel 게실 환자에서 발현된 대량 하부 장관 출혈 1예 ( A Case of Massive Hematochezia from a Meckel's Diverticulum without Ectopic Mucosa ): Korean J Gastrointest Endosc 2000;20(2):132-136. Published online November 30, 1999

Abstract PDF: Meckel's diverticulum, which is a persistence of a remnant of the omphalomesenteric duct, is the most common developmental anomaly of the gastrointestinal tract, with an incidence of about 2% in the general population. Typically, Meckel's diverticulum is a true diverticulum because it arises from the antimesenteric border of the small bowel and all layers of the intestinal wall are present. Complications of Meckel's diverticulum include bleeding, perforation, diverticulitis, intestinal obstruction, stones, intussusception, hernia, and neoplasm. Bleeding in particular is a common complication and has always been caused by an ulceration of the ileal mucosa adjacent to the acid-producing ectopic gastric mucosa in a Meckel's diverticulum. A case was recently experienced involving massive hematochezia from Meckel's diverticulum without ectopic gastric mucosa in a 27 year-old woman, and in herein reported. (Korean J Gastrointest Endosc 2000;20:132-136)

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췌담관 합류 이상과 담관 낭종이 동반된 담낭암 1예 ( Gallbladder Cancer Associated with an Anomalous Union of the Pancreaticobiliary Duct and a Choledochal Cyst ): Korean J Gastrointest Endosc 2000;20(2):137-140. Published online November 30, 1999

Abstract PDF: An anomalous pancreaticobiliary ductal union is a rare anomaly occurring in the biliary tract. This anomaly has been implicated as a cause of choledochal cysts, bile duct and gallbladder carcinoma, and recurrent pancreatitis. A case is herein reported of a 63 year-old woman who suffered from gallbladder cancer associated with a choledochal cyst and an anomalous pancreaticobiliary union. (Korean J Gastrointest Endosc 2000;20:137 140)

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분할 췌와 동반된 췌담관 합류 이상 1예 ( A Case of an Anomalous Union of the Pancreatobiliary Duct Associated with Pancreas Divisum ): Korean J Gastrointest Endosc 2000;20(2):141-144. Published online November 30, 1999

Abstract PDF: An anomalous union of the pancreatobiliary ductal system is defined as the junction between the common bile duct and the pancreatic duct outside the duodenal wall and beyond the influence of the sphincter of Oddi. This anomaly may relate to some pancreatobiliary lesions such as choledochal cysts, biliary tract carcinomas, or pancreatitis. Pancreas divisum is the most common congenital variant of the pancreatic ductal anatomy, and when it occurs, the ductal system of the dorsal and ventral pancreatic bud, fail to fuse during the second month of gestation. There have only been four cases of the coexistence of an anomalous union of the pancreatobiliary duct and pancreas divisum, reported until now. The case of a 29 year old man with epigastric pain and fever was recently experienced. An ERCP revealed an anomalous union of the pancreatobiliary duct, complete pancreas divisum and common bile duct stone. The case is herein reported. (Korean J Gastrointest Endosc 2000;20:141 144)

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특이한 합류 형태를 보인 담췌관 합류 이상 ( A Peculiar Type of Anomalous Pancreaticobiliary Ductal Union ): Korean J Gastrointest Endosc 2000;20(2):145-148. Published online November 30, 1999

Abstract PDF: Anomalous pancreaticobiliary ductal union (APBDU) is an uncommon anomaly, defined as the junction between the common bile duct and the pancreatic duct outside the duodenal wall and beyond the influence of the sphincter of Oddi. This anomaly, which has been recognized frequently since the introduction of ERCP, is believed to be associated with biliary tract lesions such as congenital biliary dilatation, biliary tract carcinoma, and pancreatic lesions such as pancreatitis new paragraph. A 28-year-old male was admitted due to sudden abdominal pain and vomiting. An ERCP revealed a peculiar type of APBDU; the duct of Wirsung and CBD fused and formed a long common channel before entering the major papilla, and the duct of Santorini connected to the duct of Wirsung is patent. So, when contrast dye was inserted into the minor papilla, both the CBD and the duct of Wirsung were made visible. This case of the peculiar type of APBDU which showed characteristic ERCP findings are herein reported. (Korean J Gastrointest Endosc 2000;20:145-148)

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간세포암을 동반한 담관 낭종 1예 ( A Case of a Choledochal Cyst Combined with a Hepatocellular Carcinoma ): Korean J Gastrointest Endosc 2000;20(2):149-153. Published online November 30, 1999

Abstract PDF: A choledochal cyst is relatively rare lesion in the biliary system, and a carcinoma arising from such a cyst is rarely reported. Until now, a case of a hepatocellular carcinoma combined with a choledochal cyst had not been reported. A 45-year-old woman was recently admitted due to abdominal pain. An abdominal computed tomography revealed a 5 cm-sized low attenuative mass involving the right anterior and left medial segment of the liver and gallbladder fossa. An endoscopic retrograde cholangiopancreatogram showed fusiform dilatation of the common bile duct, but anomalous union of pancreaticobiliary duct was not observed. Fine-needle aspiration of the liver was conducted and yielded a hepatocellular carcinoma. On celiac arteriography, a hypervascular hepatic mass was also found. Transarterial chemoembolization was performed. It is believed this may be the first case of a choledochal cyst combined with a hepatocellular carcinoma in the literature. Hence, this case is herein reported with a review of related literatures.

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악성 완전 담도협착에서의 경피적 세침천자술에 의한 경피적 내시경적 담도배액술 ( Percutaneous Endoscopic Biliary Stenting (PEBS) Using the Percutaneous Fine Needle Puncture Method in Malignant Complete Biliary Obstruction ): Korean J Gastrointest Endosc 2000;20(2):154-157. Published online November 30, 1999

Abstract PDF: Nonsurgical drainage of malignant obstructive jaundice is an interesting alternative to surgical drainage in the palliative treatment of pancreaticobiliary neoplasms. Biliary drainage by endoprosthesis is as effective and better supported than percutaneous external drainage, but more difficult to control. Endoscopic retograde biliary drainage (ERBD) is a safe and effective biliary drainage procedure, and is indicated with malignant obstructive jaundice in patients on whom endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) can be performed. A nonoperative method of palliation was used in patients with malignant obstructive jaundice, in whom a biliary endoprosthesis could not be placed endoscopically due to complete obstruction of the bile duct. A guide wire was manipulated through the lesion by a percutaneous transhepatic route, after puncturing the tumor by a fine needle, and retrieved from the duodenum through an endoscope. A stent was then passed through the endoscope over the guide wire across the stricture.

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만성 췌장염에 합병된 하대정맥 및 슬와정맥 혈전증 1예 ( A Case of Thrombosis of the Inferior Vena Cava and Right Iliac Vein Complicated by Chronic Pancreatitis ): Korean J Gastrointest Endosc 2000;20(2):158-162. Published online November 30, 1999

Abstract PDF: Vascular thrombosis and systemic hypercoagulable states are known complications of pancreatitits. The incidence of vascular obstruction associated with pancreatitis has been reported at 0.9%. They are thought to be secondary to release of proteolytic enzymes of the pancreas and direct vasculitis. Vessels near the head of the pancreas are more frequently involved, and arterial vessels are most commonly affected. Inferior vena cava (IVC) thrombosis however, is a very rare presentation of acute and chronic pancreatitis. Dignosis of IVC thrombosis may be far from easy; the presence of a leg edema, superficial thrombophlebitis or thromboembolic events may arouse clinical suspicion. Therefore, a high degree of suspicion for this complication is necessary in order to render a diagnosis. A case of a 24-year old man with chronic pancreatitis, who was found to have IVC and right iliac vein thrombosis, is herein report with a review of the relevant literature.

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단신 ( 제20권 제2호 ) : 소아에서 발생한 베체트 장염의 치료와 임상경과는?: Korean J Gastrointest Endosc 2000;20(2):163-163. Published online November 30, 1999

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단신 ( 제20권 제2호 ) : "소아에서 발생한 베체트 장염의 치료와 임상 경과는?"에 대한 답변: Korean J Gastrointest Endosc 2000;20(2):164-164. Published online November 30, 1999

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