Clinical Endoscopy

조기위암 및 위 편평선종의 내시경적 점막 절제술 및 장기 추적 관찰에 관한 연구 ( Long-term Follow-up Results of Endoscopic Mucosal Resection for Early Gastric Cancer and Gastric Flat Adenoma ): Korean J Gastrointest Endosc 2000;21(6):891-897. Published online November 30, 1999

Abstract PDF: Background
/Aims: Endoscopic mucosal resection (EMR) of early gastric cancer (EGC) or gastric flat adenoma bas been widely accepted as a useful method due to its minima1 invasiveness and satisfactory post-procedure results in maintaining a good quality of life for patients. The purpos is to define the long-term effect and usefulness of EMR of EGC and gastric flat adenoma. Methods: We analysed, retrospectively, 101 lesions in 96 cases that could be followed-up were analyzed, Endoscopic surveillance with histological examination was carried out every three months for one year after the treatment, every six months for the second year, and annually thereafter. Results: 1) The mean follow-up period was 17.7 months (1∼78). 2) Of the 101 lesions, there were 6 recurrences (5.9%), the mean period was 17.3 months (2∼37). One of 28 EGC, five of 73 gastric flat adenoma showed recurrence. 3) The recurrence rate tended to be higher in as the size inereased (p=0.06), In the lesions which were resected by planned piecemeal, 10% of those lesions recurred (4/40), whiie 3.3% (2/61) of those lesions rccurred in which lesions were resected en bloc (p=0.21). 4) With respect to location of the primary lesions, the recurrence rate was higher in the lesions of the cardia (50%, p<0.05). Conclusions: We concluded that the size and location of the lesions were related to recurrence after EMR, but sex, pathology, and resection methods were not related.

1,429 View
5 Download

소화성궤양 출혈의 내시경적 지혈술 후의 조기 재출혈에 관한 우험 인자 분석 ( Risk Factors for Early Rebleeding after Initial Endoscopic Hemostasis in Patients with Bleeding Peptic Ulcers ): Korean J Gastrointest Endosc 2000;21(6):898-908. Published online November 30, 1999

Abstract PDF: Backgrund/Aims: Rebleeding rate after initial endoscopic hemostasis in patients with ulcer hemorrhage has been reported in 20-30%, Identification of patients who are at high risk for rebleeding would be expected to improve the outcome of endoscopic hemostasis. The purpose of this study was to evaluate risk factors for early rebleeding after initial hemostasis in the view of clinical and endoscopic characteristics. Methods: We reviewed 99 patients who presented with bleeding peptie ulcers and were treated with endoscopic hemostasis including hypertonic saline injection, electrocautery and clipping. We compared the clinical variables (age, pulse rate, hemoglobin), endoscopic characteristics of ulcer (size, number, and location of ulcer, clots on the base, bleeding stigmata, size and color of exposed vessel) between the patients who bled early (n=22) and who didnt bleed (n=77) within 5 days. Results: The statistically significant correlates with early rebleeding after hemostasis were number of comorbid illness (≥2) (p=0.031), volume of transfusion (≥5 units) (p=0.001), size of ulcer (>1 cm) (p=0.038), multiple ulcers (p=O.O2O), presence of blood clots on ulcer base (p=0.012), stigmata (active bleeding and visible vessels) (p=0.010), size of exposed vessel (>1 mm) (p<0.0001). In multivariate analysis, volume of transfusion (odds ratio[OR] 14.4), size of ulcer (OR 11.7), multiple ulcers (OR 5.5) and size of exposed vessel (OR 13.2) were significant risk factors. Conclusions: The risk factors for early rebleeding after hemostasis in bleeding peptic ulcer can be predicted by clinical variables and endoscopic findings. Early identifieation of risk factors such as transfusion over 5 units, large-sized ulcer, multiple ulcers, bleeding stigmata and size of exposed vessei over 1 mm can predict the prognosis of peptic ulcer bleeding.

1,654 View
12 Download

메네트리어병 국내 보고 16예의 임상적 고찰 ( Clinical Features of Menetrier's Disease in Korea - A report of sixteen cases - ): Korean J Gastrointest Endosc 2000;21(6):909-916. Published online November 30, 1999

Abstract PDF: Background
/Aims: Menetrier's disease is a poorly defined condition that is f unknown origin, characterized by giant folds in the stomach. The histoiogic fentures are foveolar hyperplasia and cystic dilatation of the gland. We presented the characteristic findings of Menetirer's disease in Korea with a review of literatures to understand the Menetirer's disease more precisely, Methods: The sixteen cases of Menetrier's disease was reported in Korea. We analyzed their age, sex, symptoms, signs, laboratory findings and treatments, retrospectively, Results: The average age was 46 years. There were 11 men and 4 women. The most common symptom was epigastric pain (94%). The most common sign were epigastric tenderness (69%) and pretibial pitting edema (63%). Patients were often associated with the hypoalbuminemia (73%). All patients showed hypertrophic folds on either gastrofiberscopy or upper gastrointestinal series, All patients showed foveolar hyperplasia histologically. Three patients were operated to control a massive upper gastrointesinal bleeding. Two patients were operated to control the intractable edema. Two patients were operated to exclude gastrie malignancy, Conclusions: Menetrier's disease showed broad clinical features such as epigastric pain, hypoalbuminemia, massive hematemesis and mimicking gastric malignancy. The giant gastric folds and foveolar hyperplasia were the most commom and important findings in the Menetrier's disease.

1,836 View
9 Download

대장 내시경을 이용한 용종 절제술의 합병증 ( Complicatian of Colonoscopic Polypectomy ): Korean J Gastrointest Endosc 2000;21(6):917-923. Published online November 30, 1999

Abstract PDF: Background
/Aims: Colonic adenomatous polyp is known as a premalignant lesion. Colonoscopic polypectomy, using for its removal and prevention of primary colon cancer has been considered as a effective and safe method. This study was conducted to assess its complication and safety of colonoscopic polypectomy. Methods: One thousand two hundred ninety three polypectomy were done using colonoscopic hot biopsy, snare polypectomy, endoscopic mucosal resection (EMR) and piecemeal polypectomy in 679 patients from 1983 to 1999, and postpolypectomy complications and its rate were evaluated. Results: 1) Postpolypectomy bleeding occured 18 cases of 1293 polypectomies (1.4%), including 10 cases of initial bleeding and 8 cases of delayed bleeding. In 9 cases (0.7%) of them hemostatic therapy were required. In delayed bleeding most cases (75%) of them occured within 66 hours after polypectomy. 2) Postpolypectomy bleeding occured in 10 cases of 982 polypectomies (1.0%) below 0.9 cm in polyp diameter, 5 cases of 242 polypectomies (2.1%) between 1.0 cm and 1.9 cm in polyp diameter and 3 cases of 69 polypectomies (4.3%) more than 2.0cm in polyp diameter (p<0.05). 3) There were no significant correlation between postpoiypectomy bleeding and polypectomy methods (p=0.06) and between postpolypectomy bleeding and gross type of polyps (p=0.40) statistically. 4) Postpolypectomy perforation occured in 1 case of 1293 polypectomies (0.1%). Estimated overall postpolypectomy complication rate including bleeding and perforation was 1.5%. Conclusions: Colonoscopic polypectomy is a relatively safe method in removing colonic polyp and its complication is related to size of polyp.

2,150 View
31 Download

거대 용종의 박리성 올가미 ( Detachable Snare )를 이용한 제거 ( Endoscopic Resection of Large Polyps Using a Detachable Snare ): Korean J Gastrointest Endosc 2000;21(6):924-929. Published online November 30, 1999

Abstract PDF: Background
/Aims: Endoscopic resection of large polyps, especially pedunculated polyps with heads 1 cm or greater in diameter, is difficult because of the risk of bleeding. We used a detachable snare to reduce this complication and evaluated its safety and effectiveness. Methods: Patients with polyps with heads 1 cm or greater in diameter were enrolled to endoscopic polypectomy with a detachable snare. Four patients with duodenal polyps and 8 patients with colonic polyps were enrolled. Results: No bleeding occurred during or after polypectomy with a detachable snare. Besides pedunculated polyps, succcssful polypectomy was performed on flat type polyps (Yamada type I; 1 case, Yamada type II, 1 case), Conclusions: Endoscopic polypectomy with a detachable snare may be safer and effective than conventional polypectomy and its use can be applied in various types of polyps other than pedunculated one.

1,512 View
10 Download

간 , 담도계 및 췌장 질환 환자에서 위 , 십이지장 병변과 담즙산의 관련성 ( The Correlation of Sile Acid and Gastroduodenal Lesions in Hepatobiliary , Pancreas Diseases ): Korean J Gastrointest Endosc 2000;21(6):930-933. Published online November 30, 1999

Abstract PDF: Background
/Aims: Various gastric and duodenal lesions were observed in patients with obstructivc biliary disease. Previously we knew that serum bile acid level may be correlated with gastric and duodenal lesion in obstructive biliary disense. Now we will confirm the correlation of the serum bile acid concentration and gastro-duodenal lesions, Methods: A clinical analysis of the endoscopic finding and serum bile acid concentration was carried out in 120 patients with hepatobiliary and pancreas disease from January 1999 to December 1999, in the department of Internal medicine, Chungnam National University Hospital. Results: 1) In the 120 patients, sex distribution showed predominance in the males (84/36). 2) Disease profiles were included, liver cirrhosis (66.7%), hepatocellular carcinoma (38.3%), pancreatic cancer (15.8%). 3) The gastroduodenal lesions were erosive gastritis (33.3%), gastric ulcer (20.0%), duodenal ulcer (16.7%) in orders. 3) According to serum bile acid concentration, gastroduodenal lesions were more than in elevated bile acid concentration group. Conclusions: Gastroduodenal lesions in hepatobiliary and pancreas disease patients were related with serum bile acid concentration.

1,369 View
3 Download

고도 이형성증을 동반한 식도 편평세포 유두종 1예 ( A Squamous Cell Papilloma of Esophagus Associated with Dysplasia ): Korean J Gastrointest Endosc 2000;21(6):934-937. Published online November 30, 1999

Abstract PDF: A squamous cell papilloma of esophagus is regarded as a rare tumor, and one of the distal esophagus is known to be not changed into a malignant neoplasm although squamous papilloma of the larynx, cervix and the upper esophagus may be associated with squamous cell carcinoma. We report the first case of a squamous papilloma associated with hig grade dysplasia at the lower esophagus. We think this case may have an important implication in the surveillance and management of esophageal papilloma found at endoscopy.

1,834 View
14 Download

상부 위장관 출혈을 동반한 위결핵 1예 ( A Case of Gastric Tuberculosis Presenting with Hematemesis ): Korean J Gastrointest Endosc 2000;21(6):938-942. Published online November 30, 1999

Abstract PDF: Gastric tuberculosis is quite rare and usually combined with pulmonary tuberculosis. Its diagnosis is so difficult as it is often unsuspected, We report a patient with gastric tuberculosis who presented with hematemesis in Korea, Upper endoscopy showed large, deep penetrating ulcer containing an exposed vessel and adherent clot in the body. Gastric biopsies revealed only chronic inflammation and no evidence of granuloma or malignancy. Diffuse mural thickening was noted on abdominal CT. The diagnosis was made postoperatively following gastrectomy for bleeding gastric ulcer. Microscopic examination of resected stomach showed peptic detritus and noncaseating granulomas. However, multiple caseating granulomas with Lagerhan's giant cells were found on the examination of lymph nodes. The patient was treated with antituberculous therapy for 12 months without any complications.

1,499 View
2 Download

내시경 풍선 확장술로 제거된 난이한 S상 결장 이물 ( Endoscopic Removal of Embedded Chieken Bone from Sigmoid Colon Using Balloon Dilatation ): Korean J Gastrointest Endosc 2000;21(6):943-946. Published online November 30, 1999

Abstract PDF: Ingested foreign bodies usually pass through the digestive system uneventfully. The diagaosis of inadvertently swallowed foreign bodies is usually delayed. It often induces serious complications, such as perforation, enterocolic fistula, abscess formation, or aortointestinal fistula. Therapeutic colonoscopy has replaced to a significant degree the need for traditional open surgical procedures to extract foreign bodies from the colon, Various foreign bodies may be extracted from the colon by a number of endoscopic techniques. We describe a case of a patient who presented with abdominal pain, loose stool during 3 months due to the impaction of a chicken bone in the sigmoid colon, The chicken bone was successfully removed by using balloon dilatation during colonoscopy.

1,585 View
7 Download

폐대세포암의 소장 및 대장 원격성 전이 1예 ( A Case of Sigmoid Colon and Jejunal Metastases from Large Cell Lung Cancer ): Korean J Gastrointest Endosc 2000;21(6):947-950. Published online November 30, 1999

Abstract PDF: Lung cancer begins insidiously, metastasizes early, and is frequently nonresectable at the time of diagnosis. Gastrointestinal metastases are considered the most unusual. A 60 year-old man was admitted for the evaluation of dizziness. For two weeks prior to admission, he had mild blood-tinged sputum and melena. He had right cervical lymphadenopathy, measured by 2 X 2 cm. Laboratory studies demonstrated hemoglobin of 3.7 g/dL, Posteroanterior and lateral chest radiographs revealed mass-like lesion of right upper lobe. An umblicated mass was found in the sigmoid colon by colonoscopic examination and biopsy was done. He developed abdominal pain, tenderness and rebound tenderness at admission 10 days, Abdominal CT showed that focal thickened wall and suspicious perforated lesion at the ileum. Operation was done. In recent time, we experienced a case in which perforation of gastrointestinal metastases developed with malignant tumors of the lung.

1,385 View
4 Download

코일형 금속 배액관 삽입 후 발생한 총담관십이지장루 ( Choledochoduodenal Fistula after Placement of Endocoil Spiral Stent for Pancreatic Head Cancer ): Korean J Gastrointest Endosc 2000;21(6):951-954. Published online November 30, 1999

Abstract PDF: Retrograde endoscopic or percutaneous transhepatic bile duct drainage is the treatment of choice for palliation of malignant biliary obstruction. An expanding metal stent, Endocoil spiral stent, with strong radial force was developed to solve the problems of other metal stents which include obstruction by tumor ingrowth, migration, and epithelial trauma from the distal hard edges of the stent. A choledochoduodenal fistula is occasionally found during endoscopic retrograde cholangiopancreatiography (ERCP) or barium radiography. Cholelithiasis is suspected to be the leading cause in some endemic areas like Korea but duodenal ulcer is more common in Western countries. The case reported here is of a 78-year-old woman, suffering from vomiting, epigastric pain, and abdominal distension, who had a Endocoil spiral stent in the common bile duct (CBD) for pancreatic head cancer for 8 months. During barium radiograph, a fistulous connection between the proximal second part of duodeum and the CBD was identified.

1,398 View
2 Download

Previous issues