Clinical Endoscopy

내과 중환자실에서 위장관 출혈의 원인 ( Etiology of Gastrointestinal Bleeding in Intensive Care Unit ): Korean J Gastrointest Endosc 2000;21(4):763-768. Published online November 30, 1999

Abstract PDF: Backgound/Aims: Gastrointestinal (GI) bleeding remains a common medical problem, with morbidity and mortality rates of GI bleeding in intensive care unit (ICU) believed to have remained unchanged. There has been no report about the etiology and clinical manifestation of GI bleeding in ICU in Korea. Therefore, we performed this study to determine the frequency, etiology, risk factors, and outcome of clinically significant GI bleeding that occurred after admission to ICU. Methods: We reviewed medical records of 1829 patients admitted to medical ICU in Samsung Medical Center from October 1994 to May 1999, Cases were enrolled the patients who developed GI bleeding more than 24 hours after admission to the medical ICU. The cases were compared with control populations: a set of ICU patients without GI bleeding matched with cases for age, gender, and length of ICU stay to evaluate the risk factors of GI bleeding. Results: Clinically significant GI bleeding, confirmed by endoscopy, occurred in 71 patients of 1,829 patients (3.9%) after a mean ICU stay of 14±2.6 days. Gastric ulcer bleeding was the most common source of GI bleeding, accounting for 29.6% of cases overall. There were no statistical differences in underlying disease, mechanical ventilator use, heparin or steroid use, prothrombin time, prophylactic drug use such as H₂. blocker and antacid use between cases and controls. However, thrombocytopenia (<50,000/mm³) was more common in cases who had GI bleeding than controls (P<0.05). Conclusions: Gastric ulcer was the most common cause of GI bleeding in ICU and careful attention was necessary to patients with thrombocytopenia (<50,000/mm³) in ICU.

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Helicobaeter pylori 제규요법으로서 주말치료 ( Weekend Therapy )의 효과 ( Efficacy and Safety of Weekend Therapy for the Eradication of Helicobacter pylori Infection ): Korean J Gastrointest Endosc 2000;21(4):769-773. Published online November 30, 1999

Abstract PDF: Background
/Aims: Because treatment duration directly influences both patient compliance and side effects in the eradication of Helicobacter pylori (H. pylori), shortening the duration remains the main goal of therapeutic strategies. The aim of the present study was to evaluate the efficacy and safety of short-term regimen (weekend therapy) for curing the H, pylori infection. Methods: Twenty-eight patients with H. pylori-positive peptic ulcer received omeprazole 40 mg once daily for 7 days (from Monday to Sunday), bismuth 240 mg q.i.d., amoxicillin 1 g q.i.d., and metronidazole 500 mg q.i,d. for only 2 days (Saturday and Sunday). We compared the eradication rate with that of seventy-eight patients with H. pylori-positive peptic ulcer who had received either OAC (omeprazole, amoxicillin, and clarithromycin) or BMA (bismuth, metronidazole, and amoxicillin) regimens during the same period. H. pylori infection was assessed before treatment by rapid urease test or histologic examination. Four weeks after the end of treatment, the infection was also assessed by rapid urease test, histologic examination or urea breath test in weekend group and by urea breath test in control group. Results: H. pylori eradication rates were 61.1% by per-protocol analysis and 39.3% by intention-to-treatment analysis. There were no treatment associated serious side effects, and only one patient (5.6%) showed mild epigastric discomfort. All patients completed the course of treatment. Conclusions: Weekend therapy have relatively low eradication rate, however, this therapeutic approach is safe and shows good compliance for the treatment of H. pylori infection.

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직장 유암종 ( Carcinoid Tumor ) 에서 내시경 초음파의 임상적 유용성 ( The Clinical Value of Endoscopic Ultrasonography ( EUS ) in Rectal Carcinoid Tumor ): Korean J Gastrointest Endosc 2000;21(4):774-779. Published online November 30, 1999

Abstract PDF: Background
/Aims: Carcinoid tumor of the rectum is relatively uncommon lesion with malignant potential, representing 17-27% of gastrointestinal tract carcinoid. The selection of treatment in rectal carcinoid tumor is determined by the depth of invasion and the presence of metastasis. In this study, we evaluated the clinical utility of EUS in selecting the management of the rectal carcinoid tumor. Methods: Total 8 patients witd rectal carcinoid tumor diagnosed by means of colonoscopy and EUS from 1994 to 1999 were included in this study. None had specific symptoms of carcinoid syndrome. The treatment modality of all tumors were selected by EUS before resection. We examined histologic feature after resection of tumors in order to evaluate the effectiveness of EUS. Results: In total 8 patients, the image of tumors was oval to round. The internal echo was generally hypoechoic and homogenous. The margins were clearly visualized, and the contour was somewhat smooth. All tumor were resected completely. The overall accuracy of determining the depth of invasion using endoscopic ultrasonography was 87% (7 of 8 lesions). Conclusions; EUS is considered to be helpful in evaluating the malignant behavior of rectal carcinoid tumor. It is suggested that the criteria of the selection based on the EUS findings is available in the choice of treatment for rectal carcinoid tumor.

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담도 종양들의 조직학적 특성에 따른 담도경 소견 ( Cholangioscopic Findings of Various Bile Duct Tumors According to Histology ): Korean J Gastrointest Endosc 2000;21(4):780-785. Published online November 30, 1999

Abstract PDF: Background
/Aims: The technique of cholangioscopy has been used in the treatment of bile duct stones or for the diagnosis of various bile duct tumors. However, the cholangioscopic characteristics of the various types of bile duct tumors have not yet been clearly described. Therefore, we analyzed the results of our cholangioscopic examinations and classified the cholangioscopic findings according to tumor histology. Methods: The cholangioscopic finding from 111 patients who had benign or malignant bile duct tumors were reviewed. The mucosal changes, the presence of neovascularization, and the patterns of luminal narrowing were analyzed and compared with the histologic diagnosis, Results: Bile duct adenocarcinoma can be classified into three different types according to the cholangioscopic findings: nodular, papillary, and infiltrative. Bile duct adenoma, hepatocellular carcinoma and other types of bile duct cancer such as mucin-hypersecreting cholangiocarcinoma, biliary cystadenocarcinoma, squamous cell carcinoma also presented with their unique cholangioscopic characteristics. Conclusions: Bile duct tumors seem to show characteristic cholangioscopic findings according to their histology. Cholangioscopic examination seems to be a useful technique in the differential diagnosis of bile duct tumors.

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담석과 관련이 없는 간내 담도의 국소적 협착을 가진 환자들에서의 담도경의 유용성 ( Usefulness of Cholangioscopy in Patients with Focal Stricture of the Intrahepatic Duct Unrelated to Intrahepatic Stones ): Korean J Gastrointest Endosc 2000;21(4):786-792. Published online November 30, 1999

Abstract PDF: Background
/Aims: Intrahepatic duct strictures are usually caused by intrahepatic duct stones and. cholangitis, However, focal strictures of the intrahepatic duct unrelated to intrahepatic stones often pose diagnostic problems. This study was undertaken to prospectively evaluate the usefuless of percutaneous transhepatic cholangioscopy in patients with a focal intrahepatic duct stricture and no evidence of a stone. Methods: Twenty two patients with a focal stricture of the intrahepatic duct not related to intrahepatic stones were included. Percutaneous transhepatic cholangioscopic examination including procurement of a biopsy specimen was performed after percutaneous transhepatic biliary drainage. Results: A histopathologic diagnosis was obtained in all patients (10 adenocarcinoma, 1 squamous cell carcinoma, 2 hepatocellular carcinoma, 2 adenoma and 7 benign strictures). Of the 10 patients with bile duct adenocarcinoma, 9 underwent surgery and a curative resection was possible in 8 patients (89%). Six patients (67%) had early-stage bile duct cancer in which the cancer invasion was limited to the mucosa or fibromuscular layer and there was no evidence of lymph node metastasis. Conclusions: Percutaneous transhepatic cholangioscopy in patients with focal stricture of the intrahepatic duct unrelated to choledocholithiasis seems to be very useful for the differential diagnosis including the detection of early bile duct cancer.

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내시경적 'O'-형 밴드 결찰술과 용종절제술로 제거된 식도의 과립세포 종양 1 예 ( A Case of Esophageal Granular Cell Tumor Which Traeted by 'O'-Type Band Ligation and Polypectomy ): Korean J Gastrointest Endosc 2000;21(4):793-796. Published online November 30, 1999

Abstract PDF: Granular cell tumors involving the esophagus are rare tumors. Since Abrikossoff first reported five cases of granular tumor of the tongue in 1926, fewer than 200 cases of esophageal granular cell tumors have been reported in the world. The granular cell tumors usually were seen in tongue, skin & breast. it has rarely been noted in the esophagus. The treatment of this tumor was not established well. Therefore, we report a case of granular cell tumor of the low esophagus, which was resected by polypectomy following 'O'-band ligation. This 56-year-old male patient was transferred to our hospital because of abnormal endoscopic finding on the esophagus at local clinic. There was esophageal polypoid lesion on the low esophagus. After polypectomy, the lesion was revealed as granular cell tumor in histopathologic examination.

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위 , 식도 , 간에 병발한 동시성 원발성 삼중암 1 예 ( A Case of Syndronous Primary Triple Cancers Including Stomach , Esophagus and Liver ): Korean J Gastrointest Endosc 2000;21(4):797-801. Published online November 30, 1999

Abstract PDF: Multiple primary malignant cancer is a disease of more than two cancers occuring in an individual independently. The incidence of multiple primary malignant cancer is increasing gradually due to accurate cancer statistics, early diagnosis and treatment. Multiple primary malignant cancer may be divided into two groups, synchronous or metachronous depending on the interval between their diagnoses, Synchronous cancer is diagnosed simultaneously or within an interval of 6 months and metachronous cancer at interval of more than 6 months. Here, we report a case of synchronous primary triple cancers including stomach, esophagus and liver. The patient was a 63-year-old man with dysphagia. We performed endoscopy, chest and abdominal CT. We found cancers in stomach, esophagus and liver and confirmed triple primary cancer through endoscopic biopsy and sono-guided liver biopsy.

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간 전이를 일으킨 작은 직장 유암종 1 예 ( A Small Rectal Carcinoid Tumor with Liver Metastasis ): Korean J Gastrointest Endosc 2000;21(4):802-806. Published online November 30, 1999

Abstract PDF: Carcinoid tumors are originated from the enterochromaffin cells in the gastrointestinal mucosa, The incidence of rectal carcinoid tumors is more than 10 percent of gastrointestinal tract carcinoid. The tumor has naturally the benign character that does not develop symptoms and it is found incidentally. The tumor may infrequently have a malignant behavior such as invasion to muscle wall, obstruction of bowel lumen and metastasis to distant organ (especially, liver) almost when its size is larger than 2 cm. We have experienced a case of rectal carcinoid tumor smaller than 1 cm in its size with huge metastatic mass of liver.

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직장 유암종 1 예 ( A Case of Carcinoid Tumor of the Rectum ): Korean J Gastrointest Endosc 2000;21(4):807-810. Published online November 30, 1999

Abstract PDF: Carcinoid tumor primarily affects the intestinal tract, which arise from the Kulchitsky cells found at the base of the crypts of Lieberkuhn. Rectal carcinoids are relatively uncommon lesions, representing only 1.3 percent of all rectal tumors. Rectal carcinoids have benign course and are usually asymptomatic. While their prognosis is generally favorable, it is known that about 15% of these tumors metastasize. Rectal carcinoid tumors should be treated appropriately and aggressively when indicated. Present-day treatment programs call for radical cancer resection only for lesions larger than 2 cm in diameter and local resection for all others. We have experienced a case of carcinoid tumor of the rectum treated by endoscopic polypectomy.

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13세 여아에서 발생한 담관낭종 합병의 담도암 1 예 ( A Case of Bile Duct Cancer Arising in Choledochal Cyst in a 13-Year-Old Girl ): Korean J Gastrointest Endosc 2000;21(4):811-814. Published online November 30, 1999

Abstract PDF: Choledochal cyst, also referred to as cystic dilatation of the extrahepatic bile duct, is a rare malformation most frequently seen in female. Malignant changes in choledochal cyst have frequently been described, but only one case of malignant change in childhood has been reported till now. Recently, we experienced a case of bile duct cancer arising in choledochal cyst in a 13-year-old girl. She had been complaining of right upper abdominal pain for 15 days. Abdominal CT scan and ERCP showed a cylindrical dilatation of extrahepatic bile duct with irregular cystic wall mass and multiple liver metastasis which was confirmed as adenocarcinoma by ultrasono-guided needle biopsy. Anomalous pancreaticobiliary ductal union was not seen. This patient was the youngest case of bile duct carcinoma arising in choledochal cyst in Korea.

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단신 : Conscious Sedation을 위한 이상적인 내시경의 전처치 약제는?: Korean J Gastrointest Endosc 2000;21(4):815-816. Published online November 30, 1999

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단신 : (답변) Conscious Sedation을 위한 이상적인 내시경의 전처치 약제는?: Korean J Gastrointest Endosc 2000;21(4):816-817. Published online November 30, 1999

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