Clinical Endoscopy

상부 위장관 내시경 검사 시 전처치로서의 Propofol의 효과 ( Propofol as Premedication for Upper Gastrointestinal Endoscopy ): Korean J Gastrointest Endosc 2000;20(3):165-170. Published online November 30, 1999

Abstract PDF: Background
/Aims: Benzodiazepine is generally used when sedation is required for endoscopy, while propofol, a phenol-derived intravenous anesthetic agent, appears to have a more suitable phamacokinetic profile. The aim of this study was to evaluate the effectiveness and safety of propofol as premedication for upper gastrointestinal endoscopy. Methods: Between July 1998 and October 1998, 44 male patients and 70 female patients were involved in this study. The relative ease of upper gastrointestinal endoscopy, patient's tolerance, and amnestic effects on 64 patients with propofol was compared with 50 patients with non-sedation. Pulse rate and arterial oxygen saturation was monitored. The endoscopist and patients replied to a questionnaire. Results: Patients receiving propofol tolerated endoscopy much more than patients with non-sedation (p＜0.01). The change in pulse rate was less variable but arterial oxygen saturation showed a statistically significant decrease in patients receiving propofol (p＜0.01). Propofol induced complete amnesia in 93.7% of the patients and partial anesthesia in 4.7%. Most of the patients receiving propofol accepted the same sedative methods in their next endoscopy (p＜0.01). Conclusions: Propofol is highly effective, with a short recovery time and satisfaction of the patients, but careful monitoring is recommended because of its untoward effect of hypoxia. It is recommended that propofol be used as a premedication especially in patients who are apprehensive about a repeated endoscopy.

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대장 내시경 검사를 위한 전처치제로서의 Balanced Lavage Solution (Fortran )의 임상 성적 ( A Randomized Prospective Trial Comparing a New Polyethylene Glycol Based Lavage Solution with the Standard Polyethylene Glycol Solution in the Preparation of Patients Undergoing Colonoscopy (Clinical trial of new PEG solution in bowel preparation) ): Korean J Gastrointest Endosc 2000;20(3):171-176. Published online November 30, 1999

Abstract PDF: Background
/Aims: Adequate preparation of the bowel is essential for accurate colonoscopic examination. Standard polyethylene glycol solution had been used as a bowel cleansing premedication. But many patients dislike the taste and saltiness of the polyethylene glycol solution. Comparison has made between colonic preparation with a new polyethylene glycol based solution that reduced the salt content and added flavoring in attempt to improve the palatability and to encourage patient compliance with the standard polyethylene glycol solution. Methods: One hundred patients were randomized to receive either the new polyethylene glycol solution or the standard polyethylene glycol solution for their bowel cleansing preparation. Two gastroenterologists performing the colonoscopies were made unaware of the type of the preparation. The cleansing score and amount of residual fluids in each colonic segment was then evaluated. Results: There was no significant difference in the colonic cleansing score and amount of residual fluids between two groups. Patients' compliance was higher for the new polyethylene glycol solution group than for the standard polyethylene glycol group. There was no difference in side effects of bowel cleansing solutions. Conclusion: The new polyethylene glycol solution as a bowel cleansing method has a higher patient compliance rate and is as effective as the standard polyethylene glycol solution.

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비만곡 근위부 대장암에 동반된 대장 용종의 의의 ( The Significance of Synchronous Colorectal Polyps in Colon Cancer Proximal to the Splenic Flexure ): Korean J Gastrointest Endosc 2000;20(3):177-182. Published online November 30, 1999

Abstract PDF: Background
/Aims: The aim of this study was to evaluate the characteristics of colorectal polyps, especially distal colorectal polyps and their frequency in patients with colon cancer located proximal to the splenic flexure. Methods: Among 1,250 patients with colorectal cancer, 269 patients (21.5%) had colon cancer located proximal to the splenic flexure. Of these, 183 patients were involved in this study because complete colonoscopic evaluations to the cecum or to the level of proximal colon cancer were possible. Results: 54 patients (29.5%) had one or more distal colorectal polyps, 33 patients (18.1%) had one or more adenomatous distal polyps, and 3 patients (1.6%) had synchronous distal carcinoma. The percentage of patients without distal polyps was 70.5% of 183 patients with proximal colon cancer, and 80.3% of patients without distal neoplastic lesions. The percentage of patients with advanced lesions (villous component, high-grade dysplasia, or ≥1 cm in diameter) was 40.7% of 54 patients with distal colorectal polyps. Conclusions: Flexible sigmoidoscopy is insensitive and ineffective for the detection of proximal colon cancer. Ongoing evaluation of colonoscopy as a general screening test is appropriate.

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원발성 간암 환자에서 간동맥 색전술 시행 후 위십이지장 병변의 발생과 관련된 인자 ( Factors Associated with the Development of Gastroduodenal Lesions after Transcatheter Arterial Embolization in a Hepatocellular Carcinoma ): Korean J Gastrointest Endosc 2000;20(3):183-190. Published online November 30, 1999

Abstract PDF: Background
/Aims: Gastroduodenal lesions such as erosions and ulcers are less infrequent complications after transcatheter arterial embolization (TAE) procedures. This study was conducted to clarify the incidence and associated factors of post-TAE gastroduodenal lesions. Methods: Cases involving 142 patients with unresectable hepatocellular carcinoma (HCC) who underwent TAE during 70 months were retrospectively analyzed. Endoscopic examinations were performed before and after TAE. Patients were classified into two groups depending upon whether gastroduodenal lesions developed or not. Results: New gastroduodenal lesions developed in 32 of 142 patients (22.5%) within 3 months of TAE. Of these, 14 patients (9.9%) developed upper gastrointestinal bleeding. There were no significant differences in clinical and biochemical characteristics between the two groups (p＞0.05). There was also no significant difference in catheter selection level, tumor type, number of TAE, use of gelform between the two groups (p＞0.05). However, the cases involving large tumor size (＞8 cm) and angiographical abnormalities of hepatic arteries including atypical branching, vascular tortuosity, spasms or intimal dissection during the procedure, infusion of embolizing materials adjacent to vessels supplying the stomach or duodenum, had more post-TAE gastroduodenal lesions. These two factors were found to significantly affect the development of post-TAE gastroduodenal lesions by multivariate analysis (p＜0.05). Conclusions: The major factors associated with the development of post-TAE gastroduodenal lesions are large tumor sizes and angiographical abnormalities of hepatic arteries. Upper gastrointestinal endoscopy should be performed as follow-up examinations in these patients.

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총담관 결석의 내시경적 치료 성적 ( Results of Endoscopic Treatment in Common Bile Duct Stones ): Korean J Gastrointest Endosc 2000;20(3):191-197. Published online November 30, 1999

Abstract PDF: Background
/Aims: Common bile duct stones are the most common among bile duct diseases. In the past, common bile duct stones were considered a surgically operable disease, but is now considered a medical disease due to the advancement of endoscopy and endoscopic techniques. The aim of this study was to determine the results of endoscopic treatment of common bile duct stones. Methods: Removal of primary or secondary common bile duct stones were attempted by peroral or percutaneous endoscopy. The common bile duct stones were diagnosed by ultrasonography or cholangiography. As a primary approach route, the peroral transpapillary endoscopic approach was tried. On the other hand, percutaneous common bile duct stone removal was attempted if the patient already had a percutaneous route, peroral transpapillary approaches failed, or if conditions for endoscopy were unfavorable. Results: The study subjects consisted of 196 patients; 96 males and 100 females. The mean age was 61.8 years. A total of 272 endoscopic stone removal were attempted in 196 patients. Of the 272, peroral approaches were conducted 241 times for 183 patients, and percutaneous approaches were performed 31 times for 12 patients. The success rate of the first treatment modality to remove the common bile duct stones was 90.3% (176/195). The overall success rate of endoscopic common bile duct stones removal was 100%. Conclusions: In all patients, the common bile duct stones were removed successfully by endoscopy, and thus supporting the shift of recognizing common bile duct stones as a medical rather than surgical discase.

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Boerhaave's syndrome에서 Histoacryl 주입에 의해 치료된 식도늑막 누공 1예 ( A Case of Esophagopleural Fistula Treated by Endoscopic Injection of Histoacryl in Boerhaave's Syndrome ): Korean J Gastrointest Endosc 2000;20(3):198-202. Published online November 30, 1999

Abstract PDF: Boerhaave's syndrome is a spontaneous tear through all the layers of the left lateral wall of the esophagus just above the diaphragm, produced by a sudden increase in esophageal pressure. Boerhaave's syndrome is a rare but grave syndrome, with a mortality rate around 40%. Most affected patients are middle-aged men who experience violent vomiting after heavy eating or alcohol intake or both. Vomiting followed by the abrupt onset of pain, dyspnea, and/or shock are the major symptoms. The most important diagnostic tool may be an upright chest X-ray. However, esophagograms and/or a chest CT may be required to locate the lesion. The management of esophagopleural fistula must be individualized, and both the patient's condition and the specific characteristics of the fistula must be considered. Successful management of patients must include adequate nutritional support and effective therapy of the associated empyema. A case of esophagopleural fistula complicated by Boerhaave's syndrome, which was successfully treated by endoscopic injection of Histoacryl , in herein reported

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내시경적 지혈술로 치료된 십이지장게실 출혈 1예 ( A Case of Endoscopic Therapy of a Bleeding Duodenal Diverticulum ): Korean J Gastrointest Endosc 2000;20(3):203-206. Published online November 30, 1999

Abstract PDF: Duodenal divertula are relatively frequent findings in the adult gastrointestinal tract. The majority of them are asymptomatic, but vague gastrointestinal complaints have often been attributed to these lesions. These diverticula occasionally result in the obstruction of the biliary and pancreatic ducts, which leads to jaundice and pancreatitis. Other complications such as hemorrhage, perforation, sepsis, and death can occur. With the advent of therapeutic endoscopy, the diagnosis and primary treatment of duodenal diverticula associated with bleeding has changed dramatically since its first reported occurrence. Effectiveness of therapeutic endoscopy is very high in patients with diverticular bleeding in the medial aspect of sencond portion of the duodenum because of its high operative mortality. A cases of a patient suffering from gastrointestinal bleeding in the duodenal diverticulum who was diagnosed and managed by endoscopy alone is herein reported with review of relevant literature.

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소장 절제술과 수술 중 소장의 내시경적 용종 절제술을 병행하여 치료한 Peutz-Jeghers 증후군 1예 ( A Case of Peutz-Jeghers Syndrome Treated with Segmental Resection of Ileum and Intraoperative Enteroscopic Polypectomy ): Korean J Gastrointest Endosc 2000;20(3):207-212. Published online November 30, 1999

Abstract PDF: Peutz-Jeghers syndrome is a rare disease manifested by a combination of mucocutaneous pigmentation and gastrointestinal polyposis. The major morbidity results from intussusception, obstruction, and bleeding. Standard surgical management has been to perform enterotomies at the site of palpable polyps. A method of treating Peutz-Jeghers syndrome surgically with combined intraoperative enteroscopic polypectomy, is herein presented. The patient had multiple small bowel polyps, one of which was very large and required surgical resection. Segmental resection and multiple enterotomies were performed to remove the polyps. During the course of the operation, endoscope (CF-200I, 130 cm) was inserted per enterotomy site and multiple small bowel polyps were removed endoscopically using a snare. The combined surgical and endoscopic approach for the Peutz- Jeghers syndrome was successful. The procedure removes more accurately, the cause of the major morbidity associated with the disease, and may allow the patient a longer interval between laparotomies.

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궤양성 대장염에 병발한 비전형적 유암종 1예 ( A Case of an Atypical Carcinoid Tumor Arising in Ulcerative Colitis ): Korean J Gastrointest Endosc 2000;20(3):213-217. Published online November 30, 1999

Abstract PDF: Ulcerative colitis is a chronic inflammatory bowel disease manifested by diffuse continuous mucosal and submucosal inflammation. Adenocarcinoma of the colon may be complicated in the long-standing, extensive ulcerative colitis. But the case of an atypical carcinoid tumor arising in the chronic ulcerative colitis has been very rarely reported. A case was experienced involving a 54-year-old woman with chronic ulcerative pancolitis that was complicated by an atypical carcinoid tumor of the sigmoid colon. A small, flat, elevated lesion was found at the sigmoid colon, 8 years after the initial diagnosis of ulcerative colitis had been made. The microscopic finding of the lesion showed the nest of moderately differentiated, medium sized cells with large nuclei. The immunohistochemical stains for cytokeratin, NSE, chromogranin A, and synaptophysin were positive.The patient was treated with a total colectomy accompanied with an ileostomy, and is now in a very favor able state of recovery.

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췌장의 림프상피성 낭종 1예 ( A Case of a Lymphoepithelial Cyst of the Pancreas ): Korean J Gastrointest Endosc 2000;20(3):218-221. Published online November 30, 1999

Abstract PDF: Lymphoepithelial cysts of the pancreas are extremely rare cystic lesion characterized by the presence of a mature, squamous epithelial lining surrounded by dense lymphoid tissue. They were first described in 1985 by Lchtrath and Schriefers. A 70-year-old male was admitted with a four month history of intermittent right upper quadrant abdominal pain radiating to the right subscapular area. Physical examination and laboratory studies did not show any abnormal findings. Computed tomography of the abdomen revealed a 2.7 cm well-circumscribed, uniloculated cystic lesion on the tail of the pancreas. Endoscopic retrograde pancreatography showed no abnormalities in the duct system. A distal pancreatectomy with a splenectomy was performed, with a suspected diagnosis of cystic neoplasms of the pancreas. Histopathologic diagnosis was a lymphoepithelial cyst of the pancreas. Although the histogenesis of lymphoepithelial cysts is not fully disclosed, they are benign and can be cured by local excision. This case is reported herein with a review of relevant literature.

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Haemosuccus Pancreaticus 1예 ( A Case of Haemosuccus Pancreaticus ): Korean J Gastrointest Endosc 2000;20(3):222-226. Published online November 30, 1999

Abstract PDF: Haemosuccus pancreaticus describes the syndrome of gastrointestinal bleeding into the pancreatic duct, manifested by blood loss through the ampulla of Vater. It has been confined mainly to small series or isolated case reports in patients with chronic pancreatitis with pseudocysts. Endoscopy is useful mostly to exclude other sources of hemorrhage but visualization of bleeding from the papilla is a rare event. A case in herein reported of a patient, suffering from bleeding into the pancreatic duct, who had a history of recurrent, chronic pancreatitis with pseudocysts for 6 months. During duodenoscopic examination, bleeding from the papilla of Vater was identified, however the alternative cause was not suggestive. In alcoholic pancreatitis, recurrent eipsodes of acute pancreatitis with pancreatic ductal hemorrhage is a natural history, so resection of the affected segment of the pancreas can be the treatment of choice. A distal pancreatectomy and splenectomy was performed.

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선천적 배측 췌장 완전 발육 부전증 1예 ( A Case of Complete Agenesis of Dorsal Pancreas ): Korean J Gastrointest Endosc 2000;20(3):227-230. Published online November 30, 1999

Abstract PDF: Agenesis of dorsal pancreas is a rare congenital anomaly that arises from the failure of the dorsal pancreatic bud of endodermal cells to form the body and tail of the pancreas. It may be associated with diabetes mellitus, pancreatic exocrine dysfunction, or abdominal pain. Complete or partial agenesis of dorsal pancreas has been reported in a small number of pediatric and adult patients. A case is herein described involving a complete agenesis of dorsal pancreas and diabetes mellitus. A 38-year-old man with a 7-months history of non-insulin dependent diabetes mellitus was admitted due to weight loss and abdominal pain. Abdominal ultrasonography and computed tomography showed a normal biliary tree and enlarged head of the pancreas without visualization of the pancreatic body and tail. Endoscopic retrograde cholangiopancreatography (ERCP) revealved the short duct of Wirsung in the uncinate process and a head without opacification of any ducts in the pancreatic body or tail. The patient underwent explo-laparotomy for evaluation of the suspected pancreatic cancer. The patient was diagnosed as having complete agenesis of the dorsal pancreas by ERCP, CT, and surgery.

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췌관 결석에 동반된 췌담관 누공 1예 ( A Case of a Pancreaticobiliary Fistula Accompanied by Pancreatic Duct Stones ): Korean J Gastrointest Endosc 2000;20(3):231-234. Published online November 30, 1999

Abstract PDF: A Pancreaticobiliary fistula is a rare complication of acute necrotizing pancreatitis or pancreatic abscess. One case is herein reported of pancreaticobiliary fistula that was found following removal of pancreatic duct stones by extracorporeal shock-wave lithotripsy and endoscopic sphincterotomy. The patient was a 53-year old woman who was admitted with epigastric pain and fever. Endoscopic retrograde pancreatography revealed multiple stones in the main pancreatic duct. Pus from the pancreatic duct was drained through the major papilla during cannulation. On balloon cholangiogram obtained after removal of the stones, a direct fistulous connection between the main pancreatic duct and distal common bile duct was noted. It is speculated that pancreatic abscess or mechanical compression of pancreatic duct stones may contribute to the destruction of the intrapancreatic bile duct, which leads to the formation of a pancreaticobiliary fistula.

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유두괄약근 절개술 후에 발생된 유두부 재협착 1예 ( Post EST Papillary Restenosis: A Case Report ): Korean J Gastrointest Endosc 2000;20(3):235-238. Published online November 30, 1999

Abstract PDF: The occurrence of papillary restenosis following endoscopic sphincterotomy is uncommon and usually reported as a late complication. Its frequency varies from 0.8% to 3% and at present, only a few reports describe the late complication rate for a mean follow-up exceeding 10 years. The diameter of the sphincterotomy opening diminishes by about 30% in the first year without further narrowing, suggesting that restenosis occurs mainly during the first post-sphincterotomy year. Papillary restenosis may be promoted by insufficient cutting and may depend on the indication for EST such as common bile duct stones, papillary stenosis, duodenal diverticular, sphincter of Oddi dysfunction. A bleeding sphincterotomy requiring a sclerosing injection is considered a potential risk factor for papillary stenosis. However, stenosis may develop in the absence of specific predisposing factors. A case of papillary restenosis following endoscopic sphincterotomy for gollstone pancreatitis in a 33-year-old female patient is herein reported.

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악성 변화를 일으킨 췌장의 고형성 유두상 상피종양 치험 1예 ( A Case of a Solid and Papillary Epithelial Neoplasm of the Pancreas Associated with Malignant Change ): Korean J Gastrointest Endosc 2000;20(3):239-242. Published online November 30, 1999

Abstract PDF: The solid and papillary epithelial neoplasm of the pancreas is a relatively uncommon disease. It accounts for approximately 1 to 2 percent of all exocrine pancreatic tumors. This benign or low grade malignant tumor is reported to occur predominantly in young women and rarely in men. Recurrence and development of metastasis after resection are found only in a small fraction of the general population. A case is herein reported involving a solid and papillary epithelial neoplasm of the pancreas which extensively spread to nearby organs, in a 34 year-old man. Chief complaints were black stool. Physical examination revealed tenderness on the left upper quadrant of the abdomen. Esophagogastroduodenoscopy revealed multiple cardiac variceal bleeding. Abdominal sonography and CAT scan findings showed a huge lobulated mass on the left upper quadrant area with an internal necrotic portion. Surgical findings showed determined a splenic vein tumor thromboembolus, portal vein involvement, distal stomach involvement, and multiple colonic invasion. Therefore, distal pancreatectomy, wedge resection of the stomach, splenetomy, segmental resection of the transverse colon, and excision of the mass were all performed. Pathologic examination revealed a solid and papillary epithelial neoplasm in the pancreatic tail with a marked dilated splenic vein filled with tumor thromboembolus. The patient has been under chemotherapy since then, and is being closely observed.

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단신 ( 제20권 제3호 ) : 대장 내시경 삽입 시의 좌측 결장의 조건에 대한 고려는?: Korean J Gastrointest Endosc 2000;20(3):243-243. Published online November 30, 1999

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단신 ( 제20권 제3호 ) : '대장 내시경 삽입 시의 좌측 결장의 조건에 대한 고려는?'의 답변: Korean J Gastrointest Endosc 2000;20(3):244-244. Published online November 30, 1999

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