Clinical Endoscopy

혈관 확장증에 의한 상부위장관 출혈의 내시경적 치료 ( Endoscopic Treatment of Bleeding Angioectasia of the Upper Gastrointestinal Tract ): Korean J Gastrointest Endosc 2000;21(3):683-689. Published online November 30, 1999

Abstract PDF: Background
/Aims: Angioectasia of the gastrointestinal tract have been recognized with increasing frequency as an important cause of acute and chronic gastrointestinal bleeding. The purpose of this study is to define the response of endoscopic treatment for bleeding angioectasia of upper gastrointestinal tract and to evaluate long term efficacy of endoscopic treatment. Methods: A clinical study was done on 18 patients (20 cases) of angioectasia bleeding of upper gastrointestinal tract who admitted to Yeungnam University hospital from January 1989 to October 1998. Endoscopic therapy was done by electrocauterizaton, laser therapy, O-band ligation. In cases of failure to achieve hemostasis after endoscopic retreatment, we have done operation or used antifibrinolytic agent. Results: The mean age was 60.6±11.2 years (range 31-77 years). Bleeding control was succeeded in 19 cases and one case was failed by endoscopic therapy. This patient was operated. Recurred bleeding was observed in 4 patients during long term follow-up period. Bleeding was controlled after endoscopic re-treatment in two of four patients. The other patients (Osler-Weber-Lendu syndrome 2 patients) were periodically required of transfusion after endoscopic therapy. Tranexamic acid was given to these patients) Conclusions: Endoscopic therapy for bleeding angioectasia could reduce bleeding or make it stop, but repeated treatment was often necessary for multiple angioectasia. Tranexandc acid may be a useful treatment for refractory bleeding due to multiple angioectasia, such as Osler-Weber-Lendu syndrome.

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위선종과 조기위암에서 투명캡을 이용한 흡인점막절제술의 임상적 유용성 평가 ( Endoscopic Aspiration Mucosectomy of Gastric Adenoma and Early Gastric Cancer : Two Year Experience with Assessment of Results ): Korean J Gastrointest Endosc 2000;21(3):690-695. Published online November 30, 1999

Abstract PDF: Background
/Aims: Endoscopic aspiration mucosectomy (EAM) can always lift up the lesion by suction regardless of its location and does not injure the mucosal surface. The clinical usefulness of this method was evaluated as follows. Methods: Thirty two patients with gastric adenoma (35 lesions) and 6 patients with early gastric carcinoma were treated by EAM from March 1997 to February 1999. Their characteristics (diameter, macroscopic appearance, and histologic diagnosis) were verified at endoscopy with a biopsy specimen. The complete resection was defined as the presence of normal mucosa at the resected margin. Results: The average size of the resected specimens was 17.8 mm in antrum and 16.5 mm in body. The ratio of complete resection by location was 67% in anterior wall, 88% in posterior wall, 86% in lesser curvature and 92% in greater curvature. The complete resection rate for smaller lesions (≤15 mm) was highly distinguished from that cf larger lesions (>15 mm). No serious complication was encountered. Conclusions: EAM is suitable for the treatment of gastric tumors. Lesions 15 mm or less in diameter can be resected easily by single procedure regardless of its location.

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젊은 소화불량증 환자에서 비궤양성 소화불량증의 선별 검사로서 Helicobacter pylori 혈청학 검사가 유용한가? ( Can Helicobacter pylori Serology Predict Non-Ulcer Dyspepsia in Young Dyspeptic Patients? ): Korean J Gastrointest Endosc 2000;21(3):696-703. Published online November 30, 1999

Abstract PDF: Background
/Aims: In western courtry, Helicobacter pylori (H. pylori) serology is a screening test for non-ulcer dyspepsia (NUD) before endoscopy in dyspeptic patients under 45 years old without alarm symptoms The aim of this study was to determine the usefulness of H. pylori serology before endoscopy in Korea Methods: Six hundred and fifteen outpatients (M: F=339: 276, mean age 43.6±13.8, range 15-81) with dyspepsia performed anti-H. pylori IgG (GAP or HM-CAP) and upper gastrointestinal endoscopy with biopsy. Exclusion criteria were alarm symptoms, history of gastrectomy, NSAID use and previous anti-H. pylori treatment. Results: The prevalence of anti-H. pylori IgG was 61.0% in patients under and 40 years old and 63.8% in patients over 40 years old. There was no significant difference between age groups. For patients under and 40 years old, serology predicted all pathology except 5 gastric ulcer, 8 duodenal ulcer, 2 reflux esophagitis and 2 gastric submucosal tumor. The sensitivity and negative predictive value (76.7, 85.8%) in patients under and 40 years old were higher than that (61.9, 64.0%) in patients over 40 years old (p=0.037, p=0.001), Conclusions: H. pylori serology seems to be an acceptable screening test for NUD in dyspeptic patients under and 40 years old without alarm symptoms.

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우측 대장 게실염의 내시경적 진단 ( Endoscopic Diagnosis of Right-Sided Colonic Diverticulitis ): Korean J Gastrointest Endosc 2000;21(3):704-709. Published online November 30, 1999

Abstract PDF: Background
/Aims: Recently, it has been well known that the incidence of colonic diverticulosis is increasing in Korea. However, cases of right-sided colonic diverticulitis are rare although diverticula are located in right-sided colon more than left-side. The major clinical symptom of right-sided colonic diverticulitis is acute right lower quadrant pain which may mimic acute appendicitis. Therefore, we evaluated the clinical characteristics of the patients with right-sided colonic diverticulitis and safety of the colonoscopic examinations in these patients. Methods: The evidence of diverticulitis was confirmed by the presence of pus at the diverticular lesions on colonoscopy. We retrospectively analyzed clinical menifestations, laboratory findings, colonoscopic findings and the presence of complications after colonoscopy, and radiologic findings of the patients with right-sided colonic diverticulitis. Results: All the patients with right-sided colonic diverticulitis had abdominal pain. Physical examinations showed abdominal tenderness in all patients and leukocytosis was noticed in 8 out of 12 patients (66%), There was no complication during and after colonoscopy. All the patients were managed with conservative treatment including broad-spectrum antibiotics and improved without clinical aggravation. Conclusions: The colonoscopic examination may be helpful to diagnose right-sided colonic diverticulitis.

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원위부 대장 선종의 특성에 따른 근위부 대장 선종 빈도에 대한 연구 ( Incidence of Proximal Colon Adenoma According to Distal Colon Adenoma Characteristics ): Korean J Gastrointest Endosc 2000;21(3):710-716. Published online November 30, 1999

Abstract PDF: Background
/Aims: The aim of this study was to examine the incidence of proximal colon adenoma according to characteristics of distal colon adenoma. Methods: Ninety-two colon adenoma patients who underwent total colonoscopy and endoscopic polypectomy were analyzed retrospectively. Adenoma was classified as proximal when located in proximal to splenic flexure. The advanced adenoma was defined as an adenoma larger than 10 mm or any size with a villous component or severe dysplasia. Results: The incidence of proximal adenoma was increased significantly in those with old age (odds ratio (OR)=3.3), villous (OR=5.3) or dysplastic histology (OR=8.1) or the presence of advanced distal adenoma (OR=3.4). However, the incidence of advanced proximal adenoma was increased only in those with old age (OR=11.2). Nineteen in thirty-nine (48.7%) patients with proximal colon adenoma did not have distal colon adenoma, Conclusions: Various characteristics of distal colon adenoma couldn't exactly predict the presence of synchronous proximal adenoma and a greater percentage of subjects with proximal adenoma didn't have distal adenoma. So, colonoscopy could be a standard method for colon cancer screening in Korea.

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대장암 및 충수돌기 주위 농양으로 오인된 복부 방선균증 ( Abdominal Actinomycosis Initially Diagnosed As a Colorectal Cancer or Periappendiceal Abscess ): Korean J Gastrointest Endosc 2000;21(3):717-722. Published online November 30, 1999

Abstract PDF: Background
/Aims: Colonic actinomycosis is a rare disease with clinical and radiographic findings that overlap those of other inflammatory and neoplastic conditions. We performed this study to analyze clinical manifestation, characteristic radiologic findings of 5 cases of abdominal actinomycosis, which was initially diagnosed as a colorectal cancer or periappendiceal abscess. Methods: We analyzed chief complaint, predisposing factor, presence of leukocytosis and sulfur granule, involved site, presence of LN involvement and abdominal CT findings, retrospectively. Results: The most common clinical manifestation was abdominal pain. In 3 cases, predisposing factors were identifiable, which were intrauterine contraceptive device (IUD), previous appendectomy, and diabetes mellitus (DM) respectively. Leukocytosis was noted in 4 cases (80%) and sulfur granule in all 5 cases. Sigmoid colon was the most common involved site (4 cases) followed by appendix and rectum. On computed tomography, inhomogeneous mass or severe inflammation along the bowel wall or serosa was noted. Explorations were performed in 4 cases. Preoperative diagnosis was a colorectal cancer in 3 cases and periappendiceal abscess in 1 case. Conclusions: Actinomycosis should be born in mind in the differential diagnosis of patients with IUD, previous appendectomy and DM, presenting leukocytosis and CT finding of inhomogeneous mass and relatively uncommon LN involvement to eliminate unnecessary exnlorations.

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췌장 외분비 기능검사로서 내시경적 췌관 내 세프레틴 검사 ( Intraductal Secretin Test )의 유용성 ( Usefulness of Intraductal Secretin Test in Assessing Exocrine Pancreatic Function in Patients with Chronic Pancreatitis ): Korean J Gastrointest Endosc 2000;21(3):723-729. Published online November 30, 1999

Abstract PDF: Background
/Aims: The duodenal intubation test (duodenal secretin test; DST) is now considered the 'gold standard' test of exocrine pancreatic function in detecting exocrine pancreatic dysfunction in patients witd chronic pancreatitis. However, the DST has not been widely used, because it is time-consuming, invasive, and labor-intensive. On the other hand, intraductal secretin test (IDST) with endoscopic retrograde cannulation cf the main pancreatic duct has been showed similar diagnostic efficiency compared with DST. We assessed the clinical usefulness of IDST and investigated parameters for assessing impaired pancreatic function of IDST. Methods: Pure pancreatic juices were collected from 12 patients with chronic pancreatitis by endoscopic cannulation after a bolus intravenous injection of secretin 100 U, for 15min in three 5-min intervals. Five parameters of IDST were measured, and the sensitivity, specificity, and accuracy of IDST evaluated compared with ERP. Results: When we regarded mean-l.5 SD as the lower limits of IDST, the diagnostic sensitivity, specificity, and accuracy of five parameters to detect chronic pancreatitis were 91.7-100%, 75-87.5%, and 85-90%, respectively. Among five parameters, pancreatic juice secretory volume, bicarbonate concentration, and amylase output showed the highest diagnostic accuracy, followed by lipase output and bicarbonate output. A 10-min collection showed as much information as a 15-min collection. Conclusions: 10-min intraductal secretin test is useful as the conventional exocrine pancreatic function test in detecting exocrine pancreatic dysfunction in patients with chronic pancreatitis and the most discriminatory parameters are pancreatic juice secretory volume, bicarbonate concentration, and amylase output.

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내시경적 역행성 담췌관 조영술의 췌장 합병증 예방에 대한 Gabexate Mesilate의 유용성 ( Gabexate of the Prevention of Pancreatic Complication Follwing Endoscopic Retrograde Cholangiopancreatography ): Korean J Gastrointest Endosc 2000;21(3):730-734. Published online November 30, 1999

Abstract PDF: Background
/Aims: Gabexate, a protease inhibitor, has been known to prevent pancreatic damage following ERCP. We conducted a prospective and randomized study to assess the preventive effect of gabexate. Methods: Of the 96 patients enrolled, 46 were treated with gabexate and 50 with placebo. The groups were similar with regard to sex, age, body-mass index, and the final diagnosis of ERCP. Results: 24 patients (25.0%) had elevated pancreatic-enzyme levels; the frequency was similar in the two groups (P=0.48). Mean serum amylase value at 4 hours after ERCP was similar in patients with elevated basal level (220.5±43.2 U/L) and those with normal basal level (170.4±31.2 U/L). After the procedures, serum amylase values were lower in the gabexate group (137.1±19.8 U/L) than in the placebo group (212.0±50.4 U/L). The differences were not significant in the mean levels of amylase between the groups for any of imaging of the pancreatic ducts (pancreatic-duct imaging, 201.5±49.4 U/L, bile-duct imaging, 153.7±30.0 U/L). But in the patients with pancreatic duct imaging, serum amylase values were significantly higher in the placebo group (295.0±97.6 U/L) than in the gabexate group (112.0±10.6 U/L)(p<0.05). Conclusions: Prophylactic treatment witd gabexate does not reduce pancreatic damage related to ERCP, but only in the patients with pancreatic duct imaging there were the significant differences between in the gabexate group and in the placebo group.

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성인에서의 혈관윤에 의한 연하곤란 3 예 ( Three Cases of Dysphagia Due to Vascular Ring in Adults ): Korean J Gastrointest Endosc 2000;21(3):735-740. Published online November 30, 1999

Abstract PDF: Vascular rings resulting from abnormalities of the aortic arch can cause symptoms of esophageal or tracheal compression early in life. Right aortic arch with aberrant left subclavian artery is the most common type of aortic arch abnormalities, followed by double aortic arch, and then left arch with aberrant right subclavian artery. These anomalous vessels usually do not produce symptoms, but occasionally symptomatic patients require surgical intervention. Development of symptoms later in life is due to atherosclerotic enlargement of the arch (Kommerell's diverticulum). We experienced three adults who had anomalous vessels with dysphagia. Diagnosis was made by esophagography and chest CT. Of these three patients, one patient had Kommerell's diverticulum and underwent surgical repair to prevent rupture of an enlarged diverticulum as well as to relieve dysphagia. We consider that diagnosis of dysphagia caused by anomalous vessel is made by noninvasive chest CT and that the patients who have enlarged diverticulum should undergo surgical repair even with mild symptoms to prevent vascular rupture.

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내시경 결찰술을 이용하여 치료한 위 동정맥 기형 1 예 ( A Case of Endoscopic Band Ligation Therapy in Gastric Arteriovenous Malformation ): Korean J Gastrointest Endosc 2000;21(3):741-745. Published online November 30, 1999

Abstract PDF: Although various endoscopic treatments, such as laser photocoagulation, electrocoagulation, heater probe, injection have been used for treatment of arteriovenous malformation (AVM), associated complications also have been reported. In order to avoid the complications, elastic band ligation has recently been used as an alternative method for endoscopic treatment of gastric AVM. A 58-year-old man was admitted due to hematemesis and melena. A gastroscopy revealed AVM with vessel exposure and active bleeding at the greater curvature of fundus, and we performed arteriography for emergency embolization, but, we do not find the bleeding vessel. Endoscopic band ligation therapy was performed as an alternative method for control of bleeding. 2 months later, follow-up endoscopy showed disappearance of AVM and no evidence of hemorrhage.

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대량의 상부 위장관 출혈을 유발한 십이지장게실 1 예 ( A Case of Massive Upper Gastrointestinal Bleeding from a Duodenal Diverticulum ): Korean J Gastrointest Endosc 2000;21(3):746-749. Published online November 30, 1999

Abstract PDF: Duodenal diverticulum is well-known pathologic entity. The incidence of duodenal diverticulum varies from 5% to 23% in the general population. Most of diverticula are asymptomatic and have been incidentally observed in upper gastrointestinal series or upper gastrointestinal endoscopy. It usually occurs in the second portion and the medial side of duodenum. The complications of duodenal diverticulum are rare but often result in significant morbidity. They include obstruction, cholelithiasis, ascending cholangitis, ulcers, hemorrhage and perforation. Major gastrointestinal hemorrhage resulting from an inflamed or ulcerated duodenal diverticulum is an uncommon event and it can be treated endoscopically. We report a case of massive upper gastrointestinal bleeding from a duodenal diverticulum which was treated endoscopically.

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고립성 직장 궤양 증후군 1 예 ( A Case of Solitary Rectal Ulcer Syndrome ): Korean J Gastrointest Endosc 2000;21(3):750-755. Published online November 30, 1999

Abstract PDF: Although solitary rectal ulcer syndrome (SRUS) has a characteristic pathologic findings on biopsy specimen, the diagnosis of which often is delayed because this syndrome is easily mistaken for rectal cancer, inflammatory bowel diseases or other forms of proctitis. The mucosal prolapse syndrome has been widely accepted because presence of rectal ulcer is multiple or absent, and this syndrome include related disorder like as colitis cystica profunda. Proctosigmoidoscopy can show variable lesion to differentiate SRUS, which has abnormal gross findings from ulcerative lesions to polypoid lesion, mild proctitis, thickened nodular folds. Endoscopic transrectal ultrasonography (ETUS) has been known to useful procedure to staging and follow up of anorectal carcinoma. ETUS could clearly delineate the rectal wall and its separate layers, and mucosal ulcers or changes in the rectal wall architecture. A 49-year-old female complained of rectal bleeding, mucoid stool and excessive straining with rectal pain. Proctosigmoidoscopic finding revealed irregular rectal ulcers mimicking malignancy. SRUS was diagnosed based on clinical symptom, rectal biopsy and ETUS.

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담관낭선종에 의한 총간담관 압박으로 폐쇄성 황달이 발생한 1 예 ( A Case of Obstructive Jaundice Caused by Extrinsic Compresson of Biliary Cystadenoma of the Common Hepatic Duct ): Korean J Gastrointest Endosc 2000;21(3):756-759. Published online November 30, 1999

Abstract PDF: Biliary cystadenoma is a rare tumor that arises in the liver or, less frequently, in the extrahepatic ducts. Jaundice in patients with biliary cyst adenoma is not uncomon, but it is very rare that the jaundice is caused by tumor compression of the bile duct. A 43-year-old woman who had a huge biliary cystadenom.a occupying the left liver developed deep jaundice. Endoscopic retrograde cholangiopancreatograpy demontrated that this tumor compressed the common hepatic ducts extrinsically which caused the deep jaundice.

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단신 : 내시경적 담관 결석 제거술 후 담낭의 운명은?: Korean J Gastrointest Endosc 2000;21(3):760-761. Published online November 30, 1999

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단신 : (답변) 내시경적 담관 결석 제거술 후 담낭의 운명은?: Korean J Gastrointest Endosc 2000;21(3):761-762. Published online November 30, 1999

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