Clinical Endoscopy

밀착된 예리한 식도 이물의 Ballon 이용 적출술 ( Endoscopic Removal of an Impacted Sharp Foreign Body in the Esophagus ): Korean J Gastrointest Endosc 2000;21(1):503-508. Published online November 30, 1999

Abstract PDF: Background
/Aims : Sharp impacted esophageal foreign bodies can be very difficult to manage. When attempting to remove such objects inappropriately, life threatening complications, such as perforation can occur. Terefore, surgical intervention generally affords a safer approach. The aim of this study was to evaluate the safety and efficacy of endoscopic remval of sharp impacted esophageal foreign bodies using a dilatation method with an oral side balloon. Methods : A total of 17 patients (7 Male, 10 Female)with sharp impacted esophageal foreign bodies underwent endoscopic Extraction. The following technique was successfully performed; an oral side balloon (Top Co., Japan) for esophageal variceal sclerotherapy was attached on the distal part of the endoscope. Under local anesthesia, the endoscope was inserted near the proximal part of the esophageal foreign body. Then, the oral side balloon was gradually dilated. Dilataion of the proximal part of the esophagus made it possible to release the sharp impacted foreign body from the esophageal wall. Results : The types of foreign bodies were fish bones (6 cases), press-through packages (6 ases), chichen bones (3 cases), dentures (1 case), and a watch (1case). Endoscopic removal was successful in all 17 cases without complications such as perforation. Conclusions : This method of using an oral side balloon is safe and effective in removing sharp impacted esophageal foreign bodies, preventing, surgery and possible perforation. (Korean J Gastrointest Endosc 2000; 21:503-508)

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악성 위출구 협착에서의 경구적 자가확작형 금속제 인공관 유치의 유용성 - 경내시경적 인공관을 중심으로 - ( Palliation of Unresectable Gastric Outlet Obstruction with Self-Expandable Metal Stent ): Korean J Gastrointest Endosc 2000;21(1):509-517. Published online November 30, 1999

Abstract PDF: Background
/Aims : Placement of stents in cases of inoperable malignant gastric outlet obstruction is difficult due to anatomical and technical problems. The aim of this study was to assess the feasibility, effectiveness, safety, and long-term outcome of a self-expandable metal stent (SEMS) as a means of providing palliative care for patients with an inoperable malignant gastric outlet obstruction, Methods : Fifty-one consecutive patients (53 cases of stent insertion) with onoperable gastric outlet obstruction were treated palliatively with EsophaCoil, Choo's stent, or through-the-scope (TTS) stent. Results : Technical Success was achieved in 46 cases (86.8%). Six cases of stent insertion failure were caused by acute angulation of the stenotic area and sereve distal luminal narrowing. The other failed case was due to the inappropriate location of the stent. In 41 cases, the patients (89.1%) could ingest soft or solid foods after successful insertion of the stents. All the remaining 16 cases of TTS SEMS had technical and clinical successes. During the follow-up (mean; 3.3±1.1 months, range; 1∼11 months), there was 1case of aspiration pneumonia, 1 case of bowel perforation, 2 cases of stent migration, and 2 cases of stent occlusion by tumor ingrowth. Conclusions ; Placement of a SEMS, especially TTS SEMS in patients with malignant gastric outlet obstruction is a feasible, effective, and safe palliative therapy. (Korean J Gastrointest Endosc 2000; 21:509-517)

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수면내시경 검사에서 Midazolam 전처치와 Flumazenil 길항작용에 대한 연구 ( Effectiveness of Flumazenil against Midazolam as Premedication for Upper Gastrointestinal Endoscopy ): Korean J Gastrointest Endosc 2000;21(1):518-524. Published online November 30, 1999

Abstract PDF: Background
/Aims : Midazolam is utilized as a premedication for uppoer gastrointestinal endoscopy. Midazolam has a more rapid onset of reaction than that of diazepam and its duration is shorter. But the Consciousness of premedicated patients has not been regained sooner. The Purpose of this study was to examine the effectiveness of flumazenil against midazolam as premedication for upper gastrointesinal endoscopy. Methods : Sixty patients underwent upper gastrointestinal endoscopy. These patients were divided to three groups: Group I included twenty patients without premedication; Group Ⅱ Included twenty patients with premedication of midazolam and then were not given an antisedative agent excluign of normal saline; and Group Ⅲ included the others with midazolam and flumazenil as an antisedative agent. Results : There was no change in vital signs after midazolam and flumazenil as an antisedative agent. Results : There was no change in vital signs after midazolam injection, compared with presedation value. Modified Steward Coma Scale showed a significant increase after flumazenil injection as an antagonist of midazolam. The assessment of the endoscopist and the comfort of patients were satisfactory. When the 40 patients were asked about their willingness to undergo the same procedure in the future, thirty-four patients responded favorably. Conclusion : Midazolam was safe and effective for sedation for upper gastrointestinal endoscopy. There was rapid regaining of consciousness with flumazenil indection after midazolam, so the use of flumazenil against midazolam injection also appeared to be effective. ( Korean J Gastrointest Endosc 2000;21:518-524)

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유두부암 환자에서 내시경적 담관 십이지장 누공 형성술의 임상적 유용성 ( Clinical Usefulness of Endoscopic Choledochoduochoduodenal Fistulotomy in Patients with Ampullary Cancer ): Korean J Gastrointest Endosc 2000;21(1):525-533. Published online November 30, 1999

Abstract PDF: Backgorund/Aims : Endoscopic choledochoduodenal fistulotomy(fistulotomy), using a needle-knife sphin-cterotome as an alternative to failed duct cannulation and subsequent endoscopic drainage in patients with ampullary cancer, can be performed in patients with a suprapapillary bulged or distorted papilla. The purpose of this prospective sutdy was to evaluate the safety and clinical usefulness of endoscopic fistulotomy in patients with ampullary cancer. Methods : Of the 29 patients with ampullary cancer requiring biliary drainage, 13 patients with a suprapapillary bulged papilla underwent fistulotomy either alone or followed by an upward extension of the fistulous orifice using a standard sphincterotome (fistulotomy group). Of the remaing 16 patients, transpapillary biliary stenting was successful in 13 patients (biliary stenting group). In both group, the rate of successful bile duct cannulation and effective biliary drainage were assessed and compared. Results : Bile duct cannulation was successful in 92.3% of the patients in the fistulotomy group and 81.3% of patients in the biliary stenting group, and the only complications were mild bleeding in 1 patient (7.7%) and cholangitis in 1 patient(6.3%). The success rate for initial biliary drainage with the fistulotomy or transpapillary stenting were 100% and 84.6%, respectively. Of the 12 patients in whom biliary drainage was used as the definite treatment, the symptom-free duration was 3.2 months in 6 patients of the fistulotomy group and 3.9 months in 6 patients in the biliary stenting group. Conclusions : Endoscopic fistulotomy is safe and effective for both preoperative and palliative biliary decompression in patients with ampullary cancer and it is suggested that the procedure can be applied primarily to increase the success rate of biliary access and subsequent biliary drainage especially in patients with a bulged papilla. (Korean J Gastrointest Endosc 2000;21:525-533)

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내시경적 역행성 담췌관조영술과 관련된 췌손상 예방에 대한 Gabexate Mesilate의 효과 ( Effects of Gabexate Mesilate for the Prevention of Pancreatic Damage Related to ERCP ): Korean J Gastrointest Endosc 2000;21(1):534-542. Published online November 30, 1999

Abstract PDF: Background
/Aims : Recent studies reported that 1g of gabexate mesilate (GM) was effective in preventing endoscopic retrograde cholangiopancreatography (ERCP)-related pancreatic damage. The aim of this study was to evaluate the effectiveness of low dose GM for the prevention of ERCP-related pancreatic damage. Methods : This study was performed prospectively with 102 consecutive patients (68 for the GM group, 34 for the placebo group) who were scheduled for ERCP. Infusion of GM (500 mg) was started 30 minutes before ERCP and continued for 12 hours afterward. The serum amylase and lipase were measured before ERCP and 4, 8, and 24 houps after ERCP. Results : The incidence of hyperenzymemia was 45.6% in the GM group and 55.9% in the control group (p=0.40). Acute pancreatitis was developed in only one patient who was given the placebo. Although difficult cannulation, visualization of the pancreatic duct, performance of therapeutic procedures, and longer total procedure time were associated with an increased incidence of hyperenzymemia, the incidence of pancreatic damage was not affected by the GM treatment in these conditions. Conclusions : Prophylactic treatment with 500 mg of GM has no advantage for the prevention of ERCP-related pancreatic damage. Considering the cost effectiveness, further studies are necessary to identify the patients at greatest risk fot acute pancreatitis. (Korean J Gastrointest Endosc 2000;21:534-542)

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관해를 보인 Cronkhite - Canada 증후군 2예 ( Two Cases of Cronkhite - Canada Syndrome with Remission ): Korean J Gastrointest Endosc 2000;21(1):543-548. Published online November 30, 1999

Abstract PDF: The Cronkhite-Canada Syndrome (CCS) is a monfamilial disorder of adults characterized by diffuse gastro-intestinal polyposis, ectodermal changes consisting of alopecia, dystrophy of nails and cutaneous hyper-pigmentation. The pathogenesis and the causes of CCS remain unknwon but the symptoms such as diarrhea and malnutrition are generally progressive, and the prognosis is knwon to be poor. Though the definitive treatment is not well known, it has been reported that the conservative management is the most important treatment, and that the clinical sourse can be reversible. One case was experienced involving Cronkhite-Canada Syndromen in a patient who was managed by conservative treatment and an other who was treated by corticosteroid. These two cases are reported herein with a review of corresponding literature. (Korean J Gastrointest Endosc 2000; 21:543-548)

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식도 정맥류 출혈을 동반한 원발성 골수섬유증 1예 ( A Case of Idiopathic Myelofibrosis Causing an Esophageal Variceal Hemorrhage ): Korean J Gastrointest Endosc 2000;21(1):549-553. Published online November 30, 1999

Abstract PDF: Idiopathic Myelofibrosis (IMF), a clonal disorder of a multipotent hemtopoietic progenitor cell of unknown etiology, is characterized by massive splenomegaly, leukoerythroblastic blood changes, and bone marrow fibrosis. Portal hypertension occurs in approximately 10% of patients with IMF. Alsom there mey be bleeding from esophageal varices. A 59-year-old woman was admitted with intermittent abdominal distension and melena. An esophagogastroduodenoscopy revealed extensive esophageal varices with red colored signs, and subsequently esophageal variceal ligation was performed. Marked splenomegaly and ascites was observed through abdominal US and MRI scan. Bone marrow biopsy revealed an increase in reticulin and fibrosis. Extramedullary hematopoiesis and sinusoidal change were observed in the liver biopsy specimen. This case of IMF causing an esophageal variceal hemorrhage is herein reported. (Korean J Gastrointest Endosc 2000;21:549-553)

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상부 위장관 출혈을 동반한 다발성 원발성 위장관 간질 종양 1예 ( Double Primary Gastrointestinal Stromal Tumor Associated with Upper Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 2000;21(1):554-558. Published online November 30, 1999

Abstract PDF: The terms "gastrointestinal stromal tumor" (GIST) have been applied to mesenchymal tumos that represent neither typical leiomyoma nor schwannoma. The majority of GISTs are Located in the stomach and small intestine, and only 4% of GISTs are found in duodenum. The most important characteristic is their indolent, slow-growing nature, rendering the most common definitions of malignancy invalid and inapplicable. Clinical and pathological criteria to differentiate benign from malignant GISTs are not well established. Tumor size and mitoic activity are commonly considered as important features, allowing for the prediction of biological behaviour and outcome. The case of a 87-year-old male patient who was presented with melena and acute anemia is herein reported. Esophagogastroduodenoscopy and computed tomography of the abdomen revealed two submucosal tumors in the stomach and duodenum. Histological and immunohistochemical studies on the surgical resection specimen revealed a gastrointestinal stromal tumor of an uncommiteed type, with no evidence of increased mitotic activity. The patient was treated with local excision of the tumors and is now in a favorable state. (Korean J Gastrointest Endosc 2000;21:554-558)

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위에 발생한 사구종야 1예 ( A Case of Glomus Tumor Arising in the Stomach ): Korean J Gastrointest Endosc 2000;21(1):559-562. Published online November 30, 1999

Abstract PDF: It is very important to be aware of occurrence and distinctive histologic features of gastric glomus tumor because its clinical presentation and endoscopic ficdings are indistinguishable from other gastric tumors. A 58-year-old man was admitted because of intermittent epigastric pain and indigestion for 2 months. Physical examination and laboratory findings revealed within normal limits. Upper gastroendoscopy demonstrated a submucosal mass near the antrum with central mucosal depressionand peripheral multiple erosions. Endoscopic ultrasonography revealed a circumscribed mass that continued to the third and fourth layers which demonstrated a heterogeneous low echo pattern mixed with internal high echo spots. Histologically, the tumor cells have uniform small nuclei with inconspicuous nucleoli. Immunochemical analysis on the tumor cells expressed alpha 1 smooth muscle actin and the tumor cells are enveloped by reticulin fiber, individually or grouped. A case of glomus tumor of the stomach is herein reported with a review of literature. (Korean J Gastrointest Endosc 2000;21:559-562)

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대장내시경 및 CT 검사에서 종양으로 오진도니 맹장 게실염 1예 ( A Case of Solitary Cecal Diverticulitis Misdiagnosed as a Cecal Tumor ): Korean J Gastrointest Endosc 2000;21(1):563-567. Published online November 30, 1999

Abstract PDF: Cecal diverticulitis is a rare entity and remains a difficult diagnostic problem. Most patients are presented with an acute pain in the abdomen, which is nearly indistinguishable from that of appendicitis. Preoperative diagnostic studies are not helpful. Even with an operation, the correct diagnosis may be difficult to predict with certainty. The differential diagnosis between a cecal malignant tumor and a mass caused by inflammation due to cecal diverticulitis is difficult. Suspicion of a neoplastic process continues to prompt colectomy in an emergency setting. If diagnosed preoperatively, it can be treated effectively with a broad spectruum of antibiotics without surgical intervention. The physician must be aware this condition and be prepared to choose the most apropriate treatmetn. A case was experienced involving of solitary cecal diverticulitis misdiagnosed as a cecal tumor in a 61-year-o0ld female. This unique form of diverticulitis is herein reported with literature review. (Korean J Gastrointest Endosc 2000; 21:563-567)

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호중구성 복수를 동반한 위막성 대장염 1예 ( A Case of Pseudomembranous Colitis Associated with Neutrocytic Ascites ): Korean J Gastrointest Endosc 2000;21(1):568-571. Published online November 30, 1999

Abstract PDF: Antibiotic associated colitis due to Clostridium difficile is a common infection associated with significant morbidity. In severe cases, Pseudomembranous colitis (PMC) may be associated with intraperitoneal fluid accumulation. Howwver, the characteristics of the liquid are seldom described. This case report describes PMC patients who were presented with low serum-ascites albumin gradients (SAAG)and neutrocytic ascites, without evidence of infectious, malignant, or inflammatory peritoneal disease. The characteristics of their fluid specimens and the possible pathogenic mechanisms are discussed. These findings suggest that PMC without bowel perforation or spontaneous bacterial peritonitis. ( Korean J Gastrointest Endosc; 21: 568-571)

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대장 림프관종의 내시경적 상개절제술 2예 ( Endoscopic Unroofing Therapy for Colonic Lymphangioma - A report of two cases - ): Korean J Gastrointest Endosc 2000;21(1):572-576. Published online November 30, 1999

Abstract PDF: A lymphangionma is a rare benign tumor occuring in the gastrointestinal tract, which is composed of lymphatic vessels of various size. A sharply demarcated smooth, soft, cystic submucosal tumor which is easily compressible and covered with normal mucosa is a characteristic ally an endoscopic feature. This lesion is considered to be a benign lesion, which does not need to be treated, but in cases that involve risk of any complications or symptoms, the lesion needs to be removed. Servral endoscopic treatment methods for a symptomatic lymphangioma have been introduced, but accompanying risk of complications, such as bleeding or perforation were reported. As complete removal of a lymphangioma is impossible due to its broad base, a newly developed unroofing method is presented to be effective and safe for resection of a large lymphan-gioma. Recently, 2 cases were experienced involving a lymphangioma in the large intestine, which was removed successfully by colonscopic unroofing therapy. (Korean J Gastrointest Endosc 2000; 21:572-576)

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직장 Dieulafoy양 병변 출혈의 내시경적 치료 1예 ( A Case of Bleeding from Rectal Dieulafoy-like Lesion Treated by Endoscopy ): Korean J Gastrointest Endosc 2000;21(1):577-580. Published online November 30, 1999

Abstract PDF: Dieulafoy-like lesion is a relatively uncommon disease which is a potential source of life-threatening gastrointestinal bleeding. The lesion comprises mainly of an abnormally large submucosal artery that protrudes through a small mucosal defect. The lesion is frequently found at distal portion of gastroesophageal junction but may occur anywhere in gastrointestinal tract including small bowel, colon and rectum. Moreover bleeding from dieulafoy-like lesion of rectum is very reae. It has been reported that rectal Dieulafoy-like lesion is very rare source of lower gastrointestinal bleeding and its pathogenesis may be associated with constipation. Recently, endoscopy has an important role in the diagnosis and treatment (including injection and coagulation therapy) of bleeding from Dieulafoy-like lesion. We herein report a case of a patient who presented wih massive hemorrhage from a small rectal ulcer with adherent blood clots. Bleeding was controlled with endoscopic treatment by utilizing bipolar electrocoagulation without complication and recurrence.(Korean J Gastrointest Endosc 2000;21:577-580)

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체외충격파 쇄석술이 유효했던 췌관결석과 췌관협착을 동반한 분할 췌 1예 ( A Case of Pancreas Divisum Associated with a Pancreatic Duct Stone and Stricture for which Extracorporeal Shock Wave Lithotripsy was Effective ): Korean J Gastrointest Endosc 2000;21(1):581-585. Published online November 30, 1999

Abstract PDF: A 40-year-old man was presented with recurrent abdominal pain. An ERCP (Endoscopic RETROGRADE Cho-langiopancreatography) revealed complete pancreas divisum and pancreatic duct stricture with a stone. Initially, endoscopic stone removal through the minor papilla origice was unsuccessful due to an impacted pancreatic stone associated with a dominant stricture at the dorsal pancreatic duct. Extracorporeal shock wave lithotripsy (ESWL) was performed twice and the impacted pancreatic stone was fragmented. After ESWL, endoscopic stone removal became possible and pancreatic stenting was performed for the correction of the dorsal duct stricture. This case in herein reported in which ESWL was successful in treating an impacted dorsal pancreatic duct stone associated with pancreas divisum. (Korean J Gastrointest Endosc 2000;21:581-585)

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복강경적 담낭 절제술 후 부담관에서 발생한 담즙 유출 1예 ( A Case of Bile Leak from the Accessory Bile Duct after Laparoscopic Cholecystectomy ): Korean J Gastrointest Endosc 2000;21(1):586-589. Published online November 30, 1999

Abstract PDF: Bile leak is one of the complications of both open and laparoscopic cholecystectomy. The majority of postcholecystectomy leaks occur from the cystic duct stump. Due to their location and small size, accessory ducts are vulnerable to injury during cholecystectomy. A clinical significant leak from the injured accessory bile duct is rare and has rarely been reported in Korea. Endoscopic retrograde cholangiopancreatography (ERCP) has a major role both in detecting such a leak, determining its site, and in managing it. A case was experienced involving a significant bile leak after laparoscopic cholecystectomy from the accessory bile duct in a 49 year-old man. The site of the leak was diagnosed by ERCP and the leak was successfully treated endoscopically by using biliary stenting. However, the diagnosis of the accessory bile duct was established only by a follow-up ERCP done after the healing of the bile leak. This case in herein reported with a review of the related literature. (Korean J Gastrointest Endosc 2000;21:586-589)

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단신 : 대장종양 환자에서 상부위장관 병변과 Helicobacter pylori 감염빈도는 연관성이 있는지?: Korean J Gastrointest Endosc 2000;21(1):590-591. Published online November 30, 1999

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단신 : (답변) 대장종양 환자에서 상부위장관 병변과 Helicobacter pylori 감염빈도는 연관성이 있는지?: Korean J Gastrointest Endosc 2000;21(1):592-593. Published online November 30, 1999

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