Clinical Endoscopy

한국인 소화불량 환자 중 어느환자에서 내시경 검사를 할 것인가? ( Dyspepsia in Korean Population: Who Needs Endoscopy? ): Korean J Gastrointest Endosc 2001;22(1):1-7. Published online November 30, 2000

Abstract PDF: Background
/Aims: Dyspepsia is remarkably common in the general population. Although upper gastrointestinal endoscopy is the investigation of choice for dyspepsia, the selection of the patients who need endoscopy is very difficult. This study was aimed to investigate the usefulness of the various parameters for the selection of the patients who need endoscopy in Korean population, Methods: An analysis of the endoscopic findings was carried out in 141 patients with dyspepsia according to parameters including H. pylori IgG seropositivity, age and alarm signs, such as dysphagia, weight loss, vomiting, anemia, family history of upper gastrointestinal malignancy, hematemesis or melena, abdominal mass and anorexia. Results: The positive rates of stomach cancer and peptic ulcer in patients above 35 years of age were 3% (4/118) and 30% (35/118), respectively. The positive rates of stomach cancer and peptic ulcer in patients with alarm signs were 2% (2/94), 36% (34/94) and the rates in patients with H. pylori IgG seropositivity were 4% (3/70), 37% (26/70), respectively. However, no parameter was useful in the selection of patients with stomach cancer or peptic ulcer. In patients with alarm signs, the positive rates of peptic ulcer in patients with and without H. pylori IgG seropositivity were 46% (22/48) and 26% (12/46), respectively (p=0.04). In patients under 35 years of age, the positive rates of peptic ulcer in patients with and without H. pylori IgG seropositivity were 58% (7/12) and 18% (2/11), respectively (p=0.048). Conclusions: The overall positive rates of stomach cancer or peptic ulcer were significantly higher in patient group with both H. pylori IgG seropositivity and alarm signs, and that under 35 years of age with H. pylori IgG seropositivity. However, there were also considerable number of peptic ulcer in patients who were excluded from those groups. We recommend that those parameters should be used only as a decision aid in selecting the candidates for endoscopy. (Korean J Gastrointest Endosc 2001;22:1 - 7)

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Helicobacter pylori 감염에 대한 Hp Kit 검사의 진단적 유용성 ( Diagnostic Usefulness of Hp Kit Test for the Detection of Helicobacter pylori Infection ): Korean J Gastrointest Endosc 2001;22(1):8-13. Published online November 30, 2000

Abstract PDF: Background
/Aims: Rapid urease tests are used commonly for the detection of H. pylori. These tests are inexpensive and can be done easily and rapidly in the endoscopy room. A new rapid urease test, Hp Kit test, was developed for the first time in Korea. The test kit has two wells for two biopsies taken from each gastric antrum and corpus. We performed this study to estimate the diagnostic usefulness of Hp Kit test for the detection of H. pylori. Methods: In one hundred patients undergoing gastroscopy, biopsy specimens were taken for Hp Kit test, polymerase chain reaction, culture, and histologic examination (Warthin-Starry stain). The "C-urea breath test was also performed. The results of Hp Kit test were read after 2 hours. Results: The sensitivity, specificity, positive and negative predictive value of Hp Kit test to diagnose H. pylori infection were 90.0%, 97.5%, 98.2%, and 86,7%, respectively. The positive reactions in only one well were observed in 12.9% of true positives with Hp Kit test, The reaction times of the Hp Kit test were 35.2±21.4, 26.6±15.3, and 17.8±15.8 minutes (mean±S.D.) at grade 1, 2, and 3, respectively (r=-0.3, p<0.05), therefore the results were usually observed within 1 hour. Conclusions: Hp Kit test has a high sensitivity and specificity, and may be used as an alternative rapid urease test to diagnose K. pylori infection. (Korean J Gastrointest Endosc 2001;22:8 - 13)

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Helicobacter pylori 감염은 상부위장관 및 대장 병변을 동시에 일으킬 수 있는가? ( Can Helicobacter pylori Infection Cause Upper Gastrointestinal and Colonic Lesions Simultaneously? ): Korean J Gastrointest Endosc 2001;22(1):14-20. Published online November 30, 2000

Abstract PDF: Background
/Aims: Some studies showed the higher prevalence of K. pylori infection in the patients with colon adenoma and carcinoma than control subjects. The association between H. pylori infection and colonic diseases is controversial. We evaluated K. pylori infection rate and the related upper gastrointestinal lesions in the patients with colon polyp and cancer. Methods: Ninety-four subjects, 67 with colonic lesions and 27 without colonic lesions were enrolled. Colon polyp and cancer were confirmed by colonoscopic biopsy or polypectomy. The enrolled subjects were received gastroduodenoscopic examination. K. pylori infection was evaluated serologically and/or with rapid urease test. The fasting serum gastrin level was measured. Results: H. pylori infection rates in the patients with and without colonic lesions were 67.2% and 44.4%, respectively (p<0.05). Upper gastrointestinal lesions were observed in 27 of 67 patients (40.3%) with colonic lesions and in 11 of 27 patients (40.7%) without colonic lesions (p=l.0). Mean levels of serum gastrin with and without colonic lesions were 91.7±31.1 pg/mL and 88.1±37.7 pg/mL, respectively (p=0.15). Conclusions: Our study supports the relationship between H. pylori infection, colorectal neoplasia. Although there was no significant difference, the possibility of the simultaneous presence of upper gastrointestinal lesions in the patients with colorectal polyp and cancer was suggested. But the relationship between serum gastrin and the development of colorectal polyp and cancer was not documented. (Korean J Gastrointest Endosc 2001;22:14 - 20)

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궤양성 대장염에서 확대색소내시경술 (Magnifying Chromoscopy)의 유용성 ( Usefulness of Magnifying Chromoscopy in Ulcerative Colitis ): Korean J Gastrointest Endosc 2001;22(1):21-26. Published online November 30, 2000

Abstract PDF: Background
/Aims: Ulcerative colitis is an inflammatory bowel disease with unknown etiology, which has waxed and waned course. It is diagnosed by colon study, pathology, and especially colonoscopy. It is difficult to differentiate between ulcerative colitis and other infectious colitis, especially amebic colitis, and to confirm of remnant lesion by endoscopic findings. Methods: Magnifying colonoscopy has 100 time magnifying power compared to 30 time of conventional colonoscopy, By spraying 0,2% indigo carmine dye, we evaluated the magnifying and microscopic findings of 31 colonic mucosa of 23 patients with ulcerative colitis. Results: Initial and magnifying chromoscopic findings in ulcerative colitis were loss of cryptal opening 72% (13/18), loss of submucosal vessel 89% (16/18), mucosal denudation (or microscopic erosion) 83% (15/1S), and mucosal unevenness 94% (17/18). Recovery rate of magnifying chromoscopic findings after treatment in ulcerative colitis were in crytal opening S0% (+8/10), submucosal vascularity 60% (6/10), mucosal denudation (microscopic erosion) 30% (3/10), and in mucosal unevenness 40% (4/10). Conclusions: It is suggested that magnifying chromoscopic findings in ulcerative colitis may be useful in initial diagnosis and confirmation of remnant lesion, but, not in prediction of clinical severity. (Korean J Gastrointest Endosc 2001;22:21 - 26)

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수술 고위험군 급성 담낭염 환자에서의 경피경간적 담낭경검사의 안전성과 유용성 ( Safety and Usefulness of Percutaneous Transhepatic Cholecystoscopy (PTCCS) in High-Risk Surgical Patients Manifesting Acute Cholecystitis ): Korean J Gastrointest Endosc 2001;22(1):27-31. Published online November 30, 2000

Abstract PDF: Background
/Aims: The aim of the present study is to identify the diagnostic and therapeutic usefulness of percutaneous transhepatic cholecystoscopic examination (PTCCS) in high-risk surgical patients manifesting acute cholecystitis. Methods: Between January 1992 and June 1998, 33 consecutive patients who underwent percutaneous transhepatic cholecystostomy (PC) and subsequent PTCCS for the management of acute cholecystitis were included. Results: PC and subsequent PTCCS were successfully accomplished in all of 33 patients. During PTCCS, minor complication (2 of minor bleeding during electrohydraulic lithotripsy, 2 of tube dislodgement and 1 of bile leakage to peritoneum) occurred in five patients. PTCCS revealed 26 cases of gallstones, 3 cases of sludge ball, 3 cases of gallbladder carcinoma and 1 case of clonorchiasis related with acute cholecystitis. Three cases of the gallbladder cancers which were not predicted radiologically were incidentally found during PTCCS. For 26 patients with gallstones, PTCCS and concomitant stone removal were successfully carried out in one to four consecutive sessions (mean 2.2 sessions). Gallstones recurred in three (3/22, 14%) patients during the mean follow-up period of 27 months. All of them remain asymptomatic. Conclusions: PTCCS may be justified in the management of acute cholecystitis in selected patients with high surgical risk. (Korean J Gastrointest Endosc 2001;22:27 - 31)

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흑색변을 주소로 내원한 헤르페스 바이러스 식도염 1예 ( Herpes Simplex Esophagitis Presenting as Melena - A case report - ): Korean J Gastrointest Endosc 2001;22(1):32-35. Published online November 30, 2000

Abstract PDF: A 29-year-old man was admitted because of melena for 5 days. Two years ago, he underwent allogenic bone marrow transplantation for chronic myeloid leukemia and received immunosuppressive agents. Esophago - gastroduodenoscopy showed a picture - multiple scattered deep ulcers and friable pseudomembranes - of highly suggestive of a herpes simplex esophagitis and biopsy revealed multinucleated giant cells and pathognomonic intranuclear inclusion bodies. Esophageal lesions and melena improved after acyclovir therapy. (Korean J Gastrointest Endosc 2001;22:32 - 35)

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위의 다발성 유암종의 내시경적 치료 1예 ( A Case of Endoscopic Treatment of Multiple Carcinoid Tumors in Stomach ): Korean J Gastrointest Endosc 2001;22(1):36-40. Published online November 30, 2000

Abstract PDF: Multiple carcinoid tumors in stomach are very rare tumors and associated with pernicious anemia, chronic atrophic gastritis and Zollinger-Ellison syndrome. These are believed to be due to hypergastrinemia, resulting in chronic stimulation of enterochromaffine-like (ECL) cells, leading to hyperplasia, metaplasia and ultimately neoplasia. The carcinoid tumor is potentially malignant, even though it may grow slowly, so the treatment of choice must be endoscopic lumpectomy or surgical gastrectomy. The prognosis depends on the site of the tumor and its size. Most carcinoid tumors are less than 1 cm in size and metastasis is uncommon but metastasis in tumors with size over 2 cm is common. A case of multiple carcinoid tumors in stomach, which was successfully removed by endoscopy, is herein reported. (Korean J Gastrointest Endosc 2001;22:36 - 40)

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출혈을 동반한 위지방종 1예 ( A Case of Gastric Lipoma with Hemorrhage ): Korean J Gastrointest Endosc 2001;22(1):41-44. Published online November 30, 2000

Abstract PDF: Gastric lipoma is rare submucosal tumor, accounting for less than 3% of all be- nign gastric tumor. Most are usually asymptomatic, but on occasion, they may present with abdominal pain, obstruction, dyspepsia, intussuception and gastrointestinal bleeding. Surgical resection is definitive diagnostic and therapeutic procedure. Surgical removal of gastric lipoma should be considered in the following situations: 1) the lesion is large, 2) the lesion is difficult to differentiate from malignant tumor, 3) the patient is symptomatic or has recurrent bleeding or obstruction. We report a case of gastric lipoma with bleeding in a 67-year-old male. Gastroscopy showed active gastric ulcer with fresh blood clot. Although medical conservative treatment was done, bleeding was continued. We referred patient to general surgical department for open surgical procedure and subtotal gastrectomy was performed. Histopathological examination of surgical gastric segment showed 5 x 5.5 cm sized ulcerated mass. Microscopic finding of cross section showed uniform and mature adipose cell, finding consistent with lipoma. We confirmed it submucosal gastric lipoma with ulcer bleeding. (Korean J Gastrointest Endosc 2001;22:41 - 44)

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항생제 기인 출혈성 대장염 2예 ( Antibiotics Associated Hemorrhagic Colitis - A report of two cases - ): Korean J Gastrointest Endosc 2001;22(1):45-49. Published online November 30, 2000

Abstract PDF: Antibiotics related colitis is a well recognized disease entity which in its severest form may result in pseudomembranous colitis, whereas in another form, acute hemorrhagic colitis without pseudomembrane, related to the use of penicillin-type antibiotics is rarely reported. The clinical features of hemorrhagic colitis associated with antibiotics was characterized that the bloody diarrhea, often with abdominal cramping pain begins 2-7 days after starting the antibiotics and rapidly recovered after its withdrawal. Pathogenesis of this disease is not entirely clear. It has been believed that right-sided hemorrhagic colitis is one of the main forms of colitis associated with antibiotics, especially ampicillin derivatives or cephalosporin, but recent reports presented left-sided colitis. We experienced 2 cases of hemorrhagic colitis developed on the left colon after the introduction of quinolone. (Korean J Gastrointest Endosc 2001;22:45 - 49)

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재발성 급성출혈을 보인대장 게실 1예 ( A Case of Colonic Diverticulum Presented as Recurrent Bleeding ): Korean J Gastrointest Endosc 2001;22(1):50-52. Published online November 30, 2000

Abstract PDF: Colonic diverticulum is uncommon disease of gastrointestinal diverticulum, but as many as 20% of patients with colonic diverticula suffer at least one episode of bleeding in their lifetimes. Herein, we report a case of hemostasis by capping recurrent bleeding diverticulum of the colon with clips. A 36-year-old man presented recurrent hematochezia. Emergent colonoscopy was performed and showed bleeding diverticulum. Although hypertonic saline with epinephrine was injected, there was still oozing on diverticulum, and so hemostasis by hemoclip was performed. After that procedure, there have been no bleeding episode. Although further cases will be required to prove the usefulness of the technique, this endoscopic treatment is recommended in colonic diverticulum of a small amount of bleeding or post-treatment bleeding, (Korean J Gastrointest Endosc 2001;22:50 - 52)

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총간관에서 발생한 선암을 동반한 융모성 선종 1예 ( A Villous Adenoma with Foci of Adenocarcinoma Arising in the Common Hepatic ): Korean J Gastrointest Endosc 2001;22(1):53-56. Published online November 30, 2000

Abstract PDF: Villous adenoma of the extrahepatic duct is a rare disease, Even though it is benign, it has malignant potential and is considered a premalignant lesion. We here report one case of villous adenoma with foci of adenocarcinoma arising in the common hepatic duct. A 60-year-old male was admitted to our hospital because of epigastric pain. The cholangiogram revealed a large filling defect in the right intrahepatic and common hepatic duct with intrahepatic bile duct dilatation, The patient underwent right lobectomy. Grossly, stalked papillay tumor originated in the common hepatic duct was overriding the right intrahepatic duct. Microscopically, the tumor was composed of stratified tall columnar cells with various dysplasia and there were foci of invasive adenocarcinoma. (Korean J Gastrointest Endosc 2001;22:53 - 56)

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응급 기계적 쇄석술 실패 후 감돈된 바스켓 제거를 위한 새로운 방법 ( Retrieval of an Impacted Dormia Basket during Emergency Mechanical Lithotripsy Using a Novel Method - Retrieval of impacted basket - ): Korean J Gastrointest Endosc 2001;22(1):57-61. Published online November 30, 2000

Abstract PDF: In many cases where failure to remove the stone during mechanical lithotripsy occur, an emergency mechanical lithotriptor enabled the stone to be removed. Stones captured within an impacted basket are either crushed or the wires of the Dormia basket are broken to release the trapped basket. However, occasionally, emergent mechanical lithotripsy may be complicated by the impaction of a basket wire due to fracture of the traction wire during crushing of the stone. We report a novel method for retrieval of an entrapped Dormia basket fractured just outside the oral cavity during an attempt to use the emergent lithotriptor. This was done by introducing a second Dormia basket into the bile duct. After catching the knob of the impacted basket, the basket was then disengaged from the stone. The simplicity of this maneuver makes it a first line salvage technique to be used before subjecting the patient to more invasive techniques. (Korean J Gastrointest Endosc 2001;22:57 - 61)

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간, 담도계 및 췌장 질환 환자에서 위, 십이지장 병변은 담즙산에 의해 유발되는지?: Korean J Gastrointest Endosc 2001;22(1):62-63. Published online November 30, 2000

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