Clinical Endoscopy

원저 : 성인 위 배출구 폐쇄의 임상 양상의 변화 및 내시경술의 의의 ( Change of Clinical Patterns and Significance of Endoscopy in Gastric Outlet Obstruction ): Korean J Gastrointest Endosc 2001;22(2):65-69. Published online November 30, 2000

Abstract PDF: Background
/Aims: The causes of gastric outlet obstruction (GOO) have changed from peptic ulcer disease (PUD) to malignant diseases in recent years. The aims of this study are to determine the relative incidence of malignany and other causative diseases, and to consider therapeutic and diagnostic usefulness of endoscopy. Methods: 95 patients with GOO who diagnosed by radiologic and endoscopic examination or surgery were reviewed by causative diseases, clinical features, endoscopic findings and outcome of treatment. Results: 1) The mean age was 57.5 years (M: F=2.4: 1). 2) The causative diseases were gastric or duodenal malignancy (56.8%), complication of PUD (39.2%), and biliary and pancreatic disease (4,2%). 3) Malignancy was diagnosed by upper gastrointestinal (UGI) endoscopy in 95.8%; obstruction by complication of PUD was detected by endoscopy in 100%. 4) The most common endoscopic type of malignancy was Borrman type 3 (84.8%) and the most common benign lesions were duodenal or pyloric ulcer (94.5o). 5) The managements of malignancy were operation (53.5%), endoscopic stenting (18.5%), and conservative treatment (38.8%). The complications of PUD were treated by anti-ulcer medication (S5.3%), endoscopic dilatation (4.8%) and operation (13.6%). Conclusions: The main causes of GOO are changed to malignancy in recent 5 years. Endoscopy is useful to detect the various causes of GOO, and necessary procedure to decide the method of their management. (Korean J Gastrointest Endosc 2001;22:65 - 69)

1,295 View
6 Download

원저 : Pronto Dry 검사에 의한 Helicobacter pylori 감염진단 ( Diagnosis of Helicobacter pylori Infection by Pronto Dry Test ): Korean J Gastrointest Endosc 2001;22(2):70-75. Published online November 30, 2000

Abstract PDF: Background
/Aims: Pronto Dry test, a new rapid urease test, is consisted of a dry filter paper containing urea and has been reported to have a more rapid reaction time than others. We performed this study to compare the accuracy of Pronto Dry test with the other conventional tests for detection of H. pylori. Methods: One hundred patients underwent gastroscopy in our hospital for gastrointestinal symptoms. Biopsy specimens were taken for Pronto Dry test, polymerase chain reaction, culture, and histologic examination (Warthin-Starry stain). 13C-urea breath test was also performed. The results of Pronto Dry test were read after 1 hour. Results: The sensitivity, specificity, positive and negative predictive value of Pronto Dry test to diagnose H. pylori infection were 90.0%, 100%, 100%, and 90.9%, respectively. The kappa statistic between H. pylori status and Pronto Dry test was 0.90, demonstrating an acceptable level of reliability. Conclusions: Pronto Dry test has a high sensitivity and specificity, and can be used as a rapid test to diagnose H. pylori infection. (Korean J Gastrointest Endosc 2001;22:70 - 75)

1,541 View
8 Download

원저 : 허혈성 대장염의 임상 양상과 예후 인자 ( Clinical Patterns and Prognostic Factors of Ischemic Colitis ): Korean J Gastrointest Endosc 2001;22(2):76-82. Published online November 30, 2000

Abstract PDF: Background
/Aims: Colonic ischemia is recognized as the most common vascular disorder of the intestines in the elderly. The severity of the disease may vary considerably with the prevalent benign transient forms, being amenable to conservative treatments and the severe gangrenous forms, requiring surgery. Correct diagnosis is usually made after the ischemic episode is over and colonic ischemia is frequently misdiagnosed. The aim of this study is to identify the clinical patterns and prognostic factors of ischemic colitis. Methods: We found 60 patients with nonoccusive ischemia of the large intestine, We analyzed age, sex, symptoms, signs, associated disease, location, endoscopy, hematologic, histologic, radiologic finding and treatment, retrospectively. Results: The mean age was 60.2±6.3 years. The most common symtoms were abdominal pain or bloody diarrhea. The most common sign was diffuse abdominal tenderness. The most common hematologic findings were anemia and leukocytosis. Associated medical illnesses were diabetes, rhematoid arthritis and cerebrovascular accident, et al. Both computed tomography (CT) and endoscopy were useful diagnostic tools. The most common involved site was sigmoid colon. 46 patients were treated conservatively and 14 patients were managed surgically. Conclusions: Male gender, those with rebound tenderness, severe anemia, right or total colon involvement as well as rheumatoid arthritis had a poor prognosis. Both CT and endoscopy were useful in predicting prognosis. (Korean J Gastrointest Endosc 2001;22:76 - 82)

1,777 View
17 Download

원저 : 전 대장내시경 검사로 관찰한 살모넬라 대장염의 임상적 고찰 ( Clinical Presentations of Salmonella Colitis on Total Colonoscopy ): Korean J Gastrointest Endosc 2001;22(2):83-87. Published online November 30, 2000

Abstract PDF: Background
/Aim: Salmonella can cause an asymptomatic intestinal carrier state or clinical disease. The most common clinical manifestation is enterocolitis. In diagnosis of salmonellosis, total colonoscopy is not perfomed routinely, but to diagnose and treat the some of salmonellosis presented with acute massive rectal bleeding, fever, diarrhea, or abdominal pain resulted from vague cause. We evaluated colonoscopic findings of salmonella colitis, and the efficacy of the colonoscopic biopsy and tissue culture compared with conventional culture of blood, urine, and stool, retrospectively. Methods: Six cases were performed total colonoscopy. We analyzed the correlation between clinical onset and colonoscopic findings and compared the efficacy of conventional culture methods. Results: Colonoscopic findings were summarized as; 1. Major involved sites were terminal ileum, cecum, and ascending colon, but in some cases, entire colon was involved. 2. Mucosal changes were nonspecific. Of variable culture methods, colonoscopic tissue culture was the most sensitive for identification of causative organisms. Conclusions: Colonoscopic features are not useful to diagnose salmonella colitis, because the findings are similar to those in inflammatory bowel disease, and there was no correlations between colonoscopic findings and symptom onset and severity. But, it is safe and useful method to isolate the causative organism of acute infectious colitis. (Korean J Gastrointest Endosc 2001;22:83 - 87)

1,258 View
9 Download

원저 : 외상성 췌관 손상에서 내시경적 역행성 췌관조영술의 역할 ( The Role of Endoscopic Retrograde Pancreatography for Traumatic Pancreatic Duct Injury ): Korean J Gastrointest Endosc 2001;22(2):88-95. Published online November 30, 2000

Abstract PDF: Background
/Aims: Because the status of the main pancreatic duct (MPD) is the most important determinant for pancreatic trauma associated morbidity and mortality, early diagnosis and optimal treatment are critical, especially in MPD injury. Methods: Twenty-three pancreatic trauma patients were divided into two groups according to the interval between trauma and endoscopic retrograde pancreatography (ERP). The clinical and laboratory findings, CT and ERP results were described. The treatment modality and its clinical outcome were assessed according to ERP findings. Results: The pancreatic duct was injured in 14 of the 23 trauma patients: 11 MPD injuries and 3 branching duct injuries. CT scan correctly predicted the MPD injury in only 6 (54.5%) of the 11 patients, whereas ERP correctly demonstrated the origin and the degree of pancreatic duct injury in all patients. Through contrast leakage from the MPD into peritoneal cavity, ERP confirmed an MPD injury in 8 patients and they underwent surgical exploration, Three patients who showed parenchymal leakage from branching duct recovered with conservative treatment. Transpapillary pancreatic stents were successfully inserted into the distrupted MPD in 3 patients who showed that the contrast leakage was confined to the pancreatic parenchyme and they achieved complete resolution of the pancreatic leaks after a 3-month follow-up period. The late ERP group 72 hours after trauma) had a significantly higher pancreas associated complication rate and a tendency to a longer hospital stay than the early ERP group. Conclusions: Early ERP is the most useful tool for demonstrating the presence of MPD injury as well as planning the optimal treatment modality according to the degree of pancreatic duct injury. (Korean J Gastrointest Endosc 2001;22:88 - 5)

1,274 View
3 Download

증례 : Alport 증후군의 미만성 식도 평활근종증에 의하여 병발된 이차성 Achalasia 1예 ( A Case of Secondary Achalasia Presented by Diffuse Leiomyomatosis of Alport Syndrome ): Korean J Gastrointest Endosc 2001;22(2):96-100. Published online November 30, 2000

Abstract PDF: Alport syndrome (AS) is one of the most common familial nephropathy characterized by microscopic hematuria with or without proteinuria, irregular thickening or thinning of the glomerular basement membrane, progressive bilateral sensorineural hearing loss and ocular changes including anterior lenticonus and retinal flecks. AS with diffuse leiomyomatosis (ASDL) is defined by the association of AS with esophageal, tracheobronchial, and genital leiomyomatosis. Since the first case of ASDL was reported in 1983, a number of cases have been reported in the western countries. ASDL has a X-linked dominant trait with different penetrance and expressivity between female and male. We experienced an ASDL who is the first case in Korea. A 13-year-old boy was diagnosed as AS by microscopic hematuria, sensorineural hearing loss and congenital cataract. And also he had suffered from achalasia symptoms such as severe dysphagia and frequent vomiting due to diffuse esophageal leiomyomatosis. The lesion was confirmed by total esophagectomy and pathologic findings, (Korean J Gastrointest Endosc 2001;22:96 - 100)

1,357 View
6 Download

증례 : 직시 위내시경으로 발견된 조기 십이지장 유두부암 1예 ( Early Carcinoma of the Ampulla of Vater Detected by Gastroscopy ): Korean J Gastrointest Endosc 2001;22(2):101-104. Published online November 30, 2000

Abstract PDF: With progress in diagnostic procedures such as duodenoscopy and endoscopic retrograde cholangiopancre - aticography, early diagnosis of carcinoma of ampulla of Vater has become possible. Early carcinoma of the ampulla of Vater, not infiltrated beyond Oddi's muscle shows excellent postoperative outcome of high curability. A 57 year old female was visited our hospital because of intermittent upper abdominal discomfort. During gastroscopy, shallow ulcerative mucosal lesion of ampulla of Vater was dicovered, and then biopsy was done via duodenoscopy. The biopsy specimen shows adenocarcinoma and successful operation was done. Cancer cells were not infiltrated beyond Oddi's muscle. (Korean J Gastrointest Endosc 2001;22:101 - 104)

1,427 View
7 Download

증례 : 대장의 원발성 CD56+ T/NK 세포 림프종 ( A Case of Primary CD56+ T/NK Cell Lymphoma of the Colon ): Korean J Gastrointest Endosc 2001;22(2):105-110. Published online November 30, 2000

Abstract PDF: Primary T/natural killer (NK) cell lymphoma of the colon is extremely rare. Although this tumor is well known to arise in the nasal cavity and upper aerodigestive tract, only a few cases have been reported in the colon as an extranodal disease, which were mainly reported in East Asia. Recently, several authors have described the clinicopathologic, immunophenotypic, and genotypic features of CD56-positive tumor as a distinct subgroup due to its aggressive clinical behavior and poor prognosis, However, primary T/NK cell lymphoma of the colon may present a difficult diagnostic challenge to physicians because the symptoms and colonoscopic findings are non-specific and available data in the literature are very limited. We herein describe a case of primary T/NK cell lymphoma of the colon presenting as ulcerative lesions similar to Crohn's colitis and complicated by cecal bleeding/perforation. (Korean J Gastrointest Endosc 2001;22:105 - 110)

1,355 View
5 Download

증례 : 전 대장절제술 후 재발한 회장 크론병 환자에서 발생한 폐동맥 색전증 1예 ( A Case of Pulmonary Embolism in Recurrent Ileal Crohns Disease after Total Colectomy ): Korean J Gastrointest Endosc 2001;22(2):111-115. Published online November 30, 2000

Abstract PDF: Thromboembolic complications such as deep vein thrombosis, portal and mesenteric vein thrombosis, and pulmonary emboli are rare extraintestinal manifestations of inflammatory bowel disease but are associated with a high morbidity and mortality. The cause of thrombotic complications in inflammatory bowel disease is generally considered to be hypercoagulability. We experienced a case of pulmonary embolism complicated in recurrent ileal Crohn's disease in a 36-year-old female who presented with a sudden onset of dyspnea and hemoptysis. She had taken total colectomy 2 years before due to colonic stricture complicating Crohns disease. An anti-coagulation therapy was successful in managing this rare complication of Crohn's disease. (Korean J Gastrointest Endosc 2001;22:111 - 115)

1,378 View
1 Download

증례 : Cyclosporine과 Azathioprine으로 관해된 스테로이드 저항성 궤양성 대장염 1예 (Steroid-resistant Ulcerative Colitis in Acute Exacervation Phase Remitted by Cyclosporine and Azathioprine - A case report - ): Korean J Gastrointest Endosc 2001;22(2):116-120. Published online November 30, 2000

Abstract PDF: Ulcerative colitis is chronic inflammatory disease of bowel without definite cause. Standard therapy of ulcerative colitis consists of aminosalicylates and glucocorticoid. In recent years, the effectiveness of cyclosporine in inflammatory bowel disease has been reported. Cyclosporine is useful in inducing remission in patients with acute exacervation phase who do not achieve remission with an intensive intravenous steroid therapy. We report a case of steroid-resistnat ulcerative colitis, treated with cyclosporine in 45-year-old man. Remission was not achieved with treatment of sulfasalazine and intensive intravenous glucocorticoid therapy for 10 days. We administered cyclosporine parenterally in dose of 4 mg/kg/day for 10 days. He improved dramatically without significant side effects of drug and avoided colectomy. He was discharged with oral cyclosporine and azathioprine and has been followed up outpatients department remained in clinically remission. Cyclosporine seems to be an effective treatment for patients with steroid-resistnat severe ulcerative colitis in whom colectomy seems inevitable. (Korean J Gastrointest Endosc 2001;22:116 - 120)

1,345 View
3 Download

증례 : 부췌관에서 발생한 Intraductal Papillary Mucinous Tumor ( IPMT ) 1예 ( A Case of Intraductal Papillary Mucinous Tumor Arising from the Accessory Pancreatic Duct ): Korean J Gastrointest Endosc 2001;22(2):121-125. Published online November 30, 2000

Abstract PDF: Mucin-producing tumors of the pancreas were first reported by Ohhashi and Takagi in 1980. Since then, many cases of intraductal papillary mucinous tumor (IPMT) of the pancreas, which is almost homonymous to mucin-producing tumors of the pancreas, have been reported. IPMTs are generally regarded as tumors with a favorable prognosis. Some IPMTs have invasiveness and this is always associated with a poor prognosis. Most IPMTs arise from the main pancreatic duct and IPMTs arising from the accessory pancreatic duct are relatively rare, Only 6 cases have been reported in the literature so far. Our patient was a 43-year old man who was admitted to the hospital due to recurrent pancreatitis. An endoscopic retrograde pancreatography revealed a patulous minor papilla orifice extruding mucin and a cystic lesion in a branch of the accessory duct. A pancreaticoduodenectomy was performed and a pathologic examination of the resected specimen showed intraductal papaillary mucinous neoplasm, low grade malignancy, in the accessory pancreatic duct and its branch. We herein report this interesting case with a review of the literature. (Korean J Gastrointest Endosc 2001;22:121 - 125)

1,477 View
4 Download

증례 : 대량 우측 흉막 삼출로 발현한 알코올성 만성 췌장염 1예 ( Massive Right Pleural Effusion as the First Manifestation of Chronic Alcoholic Pancreatitis - A case report - ): Korean J Gastrointest Endosc 2001;22(2):126-130. Published online November 30, 2000

Abstract PDF: Patients with chronic pancreatitis develop massive pleural effusion in less than 1% and its frequency as the first clinical manifestation of the disease is unknown. Moreover, pleural effusions associated with pancreatitis are usually left-sided because the pancreas is more intimately related to the left hemidiaphragm than to the right. Recently, we experienced a case of massive right pleural effusion as the first manifestation of chonic alcoholic pancreatitis in a 39 year-old man. Pancreatic pleural effusion was diagnosed by combination of high pancreatic enzyme levels in the pleural fluid and imaging findings. A conservative management including fasting, total parenterl nutrition, and octreotide administration subcutaneously (100μg, t.i.d.) resulted in a complete recovery of the patient, We herein report this unusual manifestation of chronic alcoholic pancreatitis and discuss the therapeutic issues related to pancreatic fistulas, (Korean J Gastrointest Endosc 2001;22:126 - 130)

1,246 View
3 Download

Previous issues