Clinical Endoscopy

원저 / 양성 식도문합부 협착의 치료로서 침형절개도를 이용한 전기소작 확장술과 스테로이드 국소주사 병합요법의 유용성 ( Clinical Usefulness of Combination Therapy with Endoscopic Incision Using Needle - Knife Papillotome and Local Injection of Steroid for the Treatment of Benign Esophageal Anastomotic Stricture ): Korean J Gastrointest Endosc 2001;22(3):131-138. Published online November 30, 2000

Abstract PDF: Background
/Aims: The endoscopic incision for the treatment of benign esophageal anastomotic stricture (BEAS) was uncommonly reported because of the frequent recurrence of stricture. Intralesional steroid injection has been shown to be effective in prevention of recurrence, so we have performed the combination therapy with endoscopic incision and intralesional steroid injection. Methods: Fourteen patients with BEAS were treated with endoscopic radial cuts using needle - knife papillotome together with intralesional injection of triamcinolone. The mean age of the 14 patients was 58.1 and mean follow - up days was 205.8 (65 ~ 439). Results: The onset of BEAS were 135.6±73.0 days and significantly early in patients with distorted stapling (p=0.012). After treatment the diameter of stricture was successfully done in one session and there was 10 cases of mild bleeding. The stricture recurrence was developed in 4 cases (30.7%), which showed tendency in ling length of stricture (p=0.12) and significance on distorted stapling (p=0.007). Conclusions: The combination therapy with endoscopic incision and steroid injection may be useful method for the treatment of BEAS, but further long-term follow-up and comparative study were needed. (Korean J Gastrointest Endosc 2001;22:131 - 138 )

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원저 / 비후성 위벽에 대한 내시경적 초음파단층촬영술의 의의 ( The Usefulness of the Endoscopic Ultrasonography in the Evaluation of the Thickened Gastric Wall ): Korean J Gastrointest Endosc 2001;22(3):139-145. Published online November 30, 2000

Abstract PDF: Background
/Aims: The thickened gastric wall are seen in a great number of benign and malignant conditions. Sometimes the differential diagnosis with either upper gastrointestinal X-ray or endoscopy of those lesions is difficult. We evaluated the usefulness of the endoscopic ultrasonogrphy (EUS) in the differential diagnosis for the thickened gastric wall of benign and malignant lesions. Methods: Fifty Borrmann type 4 advanced gastric cancers, 7 gastric lymphomas, 4 hypertrophic gastropathies, 3 acute gastric mucosal lesions, and one anisakiasis were included. We measured the full thickness of the gastric wall, the thickness of each layer and the preservation of the five-layered structure of the gastric wall, and then compared them with the endosonographic findings of 11 healthy controls. Results: Endosonographic findings of Borrmann type 4 advanced gastric cancers showed a diffuse thickening of all five layers, especially the third and fourth layers. Endosonographic findings of gastric lymphomas showed enlargement of the second, third, and fourth layers in 4 patients, the second and third layers in 1 patient, and only the second layer in 2 patients. The second layer was thickened in hypertrophic gastropathies, the second and third layers were thickened in acute gastric mucosal lesions, and the third layer was thickened in anisakiasis. The fourth ultrasound layer corresponding to the muscularis propria was significantly thickened only in malignant lesions. Conclusions: EUS can clearly visualize the wall architecture of the thickened gastric wall. EUS may be useful for the differential diagnosis of the thickened gastric wall and the differentiation of benign from malignant gastric lesions, (Korean J Gastrointest Endosc 2001;22:139 - 145)

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원저 / 담도암 환자에서 담도경적 조직 검사 결과에 영향을 미치는 인자 ( Factors Affecting the Yield of Cholangioscopic Biopsy in the Patients with Bile Duct Cancer ): Korean J Gastrointest Endosc 2001;22(3):146-151. Published online November 30, 2000

Abstract PDF: Background
/Aims: This study analyzed the factors associated with the yield of percutaneous transhepatic cholangioscopic biopsies in patients with bile duct cancer. Methods: One hundred and sixteen patients who had received percutaneous transhepatic cholangioscopy and who had been confirmed as having bile duct cancer were enrolled in this study. Results: When the location of the tumor was divided into intrahepatic (IHD), hilar and common bile duct, the biopsy yield was significantly higher in IHD cancer (93.7%) than in cases of hilar cancer (69.6%) (p<0,05). After a bile duct cancer had been classified as a nodular (n=31), papillary (n=27) or infiltrative type (n=58) upon cholangioscopic findings, the biopsy yields from nodular (96.8%) or papillary types (96,3%) were significantly higher than from infiltrative types (58.6%; p<0.01). However, cholangioscopic classification of bile duct cancer was the only independent factor affecting biopsy yield by multiple logistic regression analysis (p=0,001). The sensitivity of the combination of cholangioscopic biopsy and tumor vessel in overall bile duct cancer, especially in the infiltrative type, was significantly increased when it was compared with that for cholangioscopic biopsies (p<0.01) or for tumor vessels alone (p<0,01). Conclusions: The cholangioscopic classification of bile duct tumors might provide important clues to predict biopsy yield. (Korean J Gastrointest Endosc 2001;22:146 - 151)

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원저 / 담도 질환에서 자기공명영상 담도췌관조영술과 내시경적 역행성 담도췌관조영술의 비교 ( Comparison of Magnetic Resonance Cholangiopancreatography with Endoscopic Retrograde Cholangiopancreatography in the Evaluation of the Biliary Tract Diseases ): Korean J Gastrointest Endosc 2001;22(3):152-158. Published online November 30, 2000

Abstract PDF: Background
/Aims: This study was performed to evaluate the diagnostic accuracy and clinical applications of magnetic resonance cholangiopancreatography (MRCP) compared with endoscopic retrograde cholangiopan - creatography (ERCP). Methods: Prior to carrying out ERCP, MRCP was performed on 71 patients and the two examinations were compared using a double blank test, Results: The results revealed that 15 patients had choledocholithiasis, 4 gall bladder stones, 28 cholangiocarcinomas, 12 pancreatic head cancers, 2 ampulla of Vater cancers, 1 gall bladder cancer with ductal invasion, 4 other benign diseases and 5 normal conditions. For the patients with choledocholithiasis, the values of MRCP's sensitivity, specificity and accuracy were 100%, 9S.2% and 98.6%, respectively, and those of ERCP's were all 100%, For the patients with malignant obstructions, the values of MRCP's sensitivity, specificity and accuracy were 90.7%, 100% and 94.4%, respectively, and the values of ERCP's were 95.3%, 92.9% and 94.4%. Conclusions: These data show that MRCP has a rather high sensitivity, specificity and accuracy in the diagnosis of the biliary tract system, and therefore MRCP can be substituted for ERCP in the aspect of diagnosis (Korean J Gastrointest Endosc 2001;22:152 - 158)

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증례 / 전 위장관을 침범하고 호산구성 복수를 동반한 호산구성 위장관염 ( Eosinophilic Gastroenteritis Involving Entire Gastrointestinal Tract with Eosinophilic Ascites ): Korean J Gastrointest Endosc 2001;22(3):159-163. Published online November 30, 2000

Abstract PDF: Eosinophilic gastroenteritis is a rare disease of unknown cause characterized by eosinophilic infiltration in various areas of gastrointestinal tract with gastrointestinal symptoms such as abdominal pain, vomiting, diarrhea and rarely ascites. Its clinical feature depends on the type of layer and location involved. Serosal eosinophilic infiltration, the rarest form of presentation, may result in development of eosinophilic ascites. We experienced a case of eosinophilic gastroenteritis involving entire gastrointestinal tract with eosinophilic peritoneal fluid in a 38-year-old female with abdominal distension and abdominal pain, Upper gastrointestinal endoscopy, colonoscopy, small bowel series, abdominal CT showed diffuse wall thickening from esophagus to rectum. The eosinophilic peritoneal fluid and peripheral eosinophilia were confirmed by multiple biopsies of the gastrointestinal tract, She was treated with corticosteroid and responded dramatically. We report this case with a brief review of the literatures. (Korean J Gastrointest Endosc 2001;22:159 - 163)

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증례 / Menetrier씨병 1예 ( A Case of Menetrier's Disease ): Korean J Gastrointest Endosc 2001;22(3):164-168. Published online November 30, 2000

Abstract PDF: Menetrier's disease is a form of hypertrophic gastropathy occurring primarily in middle-aged males, Patients generally present clinically with dyspepsia and, on occasion, with hypoproteinemic edema and anemia. The latter feature, when combined with the radiographic appearance of the stomach in Menetrier's disease, can lend to confusion with carcinoma and malignant lymphoma. A 45-year-old male was admitted with chief complaint of epigastric dscomfort. Endoscopic examination revealed the appearance of enlarged gastric folds involving the body and fundus of the stomach with relative sparing of the antrum and endoscopic ultrasonography (EUS) reveals characteristic thickening with enhanced echogenicity of the second layer. Biopsies revealed foveolar hyperplasia with cystic dilatation of the glands, compatible with Menetrier's disease. We report a case of Menetrier's disease with brief review of literatures. (Korean J Gastrointest Endose 2001;22:164 - 168)

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증례 / 점막하 종양양상의 위 과오종 1예 ( A Case of Gastric Hamartoma Presenting as a Submucosal Tumor ): Korean J Gastrointest Endosc 2001;22(3):169-173. Published online November 30, 2000

Abstract PDF: Hamartomatous polyps in the stomach have been described as gastric lesions of familial polyposis coli or not associated with polyposis coli. However, submucosal tumor-like lesion of the gastric hamartoma is very rare. We have experienced an unusual hamartoma in the stomach in a 69-year-old man. He was hospitalized with epigastric discomfort. Endoscopy revealed a submucosal mass at the greater curvature of the high body of the stomach. The resected mass measured 3 X 2 X 1.5 cm and was characterized by cystic dilation of glandular structures, The glandular structures consisted of various types of lining cells, including surface foveolar cell types, pyloric cell types and parietal-like cells, and irregularly arranged smooth muscle bundles and collagen fibers were noted. We report this unusual gastric hamartoma presenting as a submucosal tumor with a review of literatures. (Korean J Gastrointest Endosc 2001;22:169 - 173)

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증례 / 내시경적 방법으로 교체된 Buried Bumper Syndrome 1예 ( A Case of Buried Bumper Syndrome Replaced by Endoscopic Management ): Korean J Gastrointest Endosc 2001;22(3):174-177. Published online November 30, 2000

Abstract PDF: Percutaneous endoscopic gastrostomy (PEG) is used for nutritional support to the patients who cannot maintain the adequate oral intake. Compared with operative gastrostomy, PEG is a safe, rapid, and less expensive technique. Among several complications, buried bumper syndrome is a late complication in which internal bumper erodes into the gastric wall or migrates into the abdominal wall due to improper compression to the gastric wall. We here report a patient with peritubular leakage, resistance of tube feeding, and abdominal pain which were developed 13 months after percutaneous endoscopic gastrostomy. On endoscopic examination, the gastrostomy lumen could not be found. The gastrostomy tube was replaced successfully to new one with single procedure endoscopic technique. No complication was occurred and the function of tube has been well preserved. (Korean J Gastrointest Endosc 2001;22:174 - 177)

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증례 / 생선회를 먹은후 십이지장 벽에 박힌 쇠바늘의 내시경적 제거 ( Endoscopic Removal of a Metal Thread in the Duodenal Wall after Eating Raw Fish - A case report - ): Korean J Gastrointest Endosc 2001;22(3):178-181. Published online November 30, 2000

Abstract PDF: Foreign bodies in the stomach and duodenum are usually accidentally swallowed by children, mentally ill patients, alcoholics, or persons with dentures. Swallowed foreign bodies are usually asymptomatic, and moved down the alimentary tract to be passed spontaneously without discomfort. There had been reported many kinds of foreign bodies, for example, metal fragments, fish bones and so on. A metal thread, which looks like a fishing hook in gastrointestinal tract as a foreign body, has never been reported in humans. A 62-year-old male patient was admitted due to abdominal discomfort for five days after eating raw fish. We performed gastroduodenoscopy and could find a thread penetrating to the anterior wall of duodenal bulb. It was removed by biopsy forcep. Herein, we report a case of a metal thread in duodenal bulb, which looked like a fishing hook. (Korean J Gastrointest Endosc 2001;22:178 - 181)

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증례 / 소장폐색을 일으킨 Phytobezoar 2예 ( Small Intestinal Obstruction due to Phytobezoars - Case reports - ): Korean J Gastrointest Endosc 2001;22(3):182-186. Published online November 30, 2000

Abstract PDF: Phytobezoars are the most common type of bezoars composed of nondigestible food material. They are usually formed in stomach and do not migrate to the other intestinal tract. Recently, we experienced two cases of small bowel phytobezoars resulting in obstruction. The first case is a 72-year-old male patient who had no previous history of surgery. He had poor dentition, and the history of eating dry persimmons 20 days before the onset of symptoms. The phytobezoar (4x3cm) obstructed the terminal ileum. Colonoscopic removal was performed successfully. The second case is a 45-year-old male patient undergone previous vagotomy and pyloroplasty for duodenal ulcer perforation. He had a huge phytobezoar (10 X 6 cm) in stornach, which was treated by endoscopic removal. After incomplete endoscopic treatment, it moved into the proximal jejunum and obstructed the lumen. It was removed by operation, (Korean J Gastrointest Endosc 2001;22:182 - 186)

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증례 / 담도경을 통한 알코올 주입술이 유용했던 활달형 간세포암 ( Icteric Type Hepatocelluar Carcinoma for Which Cholangioscopic Ethanol Injection Was Effective ): Korean J Gastrointest Endosc 2001;22(3):187-191. Published online November 30, 2000

Abstract PDF: Hepatocellular carcinoma often invades the portal or hepatic veins, but rarely proliferates in the bile duct. Since curative resection is rarely possible in these cases, conservative therapy has been the sole modality. Herein, we report a case of icteric type hepatocellular carcinoma for which cholangioscopic ethanol injection was effective. By only transcatheter arterial chemoembolization in this patient, obstructive jaundice and intermittent cholangitis were not relieved. Therefore, we performed ethanol injection into the intraductal hepatoma mass under percutaneous transhepatic cholangioscopic guidance. As a result of therapy, he had been well without jaundice and cholangitis for 9 months until die. (Korean J Gastrointest Endosc 2001;22:187 - 191)

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단신 / 확대 대장내시경의 유용성과 문제점은?: Korean J Gastrointest Endosc 2001;22(3):192-193. Published online November 30, 2000

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