Clinical Endoscopy

Glutaraldehyde 와 자동 세척기를 이용한 내시경 소독방법의 임상에서의 유용성 ( Disinfection Efficacy of Glutaraldehyde and an Automated Endoscope Reprocessor : an In - Use Evaluation ): Korean J Gastrointest Endosc 2001;22(6):393-398. Published online November 30, 2000

Abstract PDF: Background
/Aims: Safety of endoscopic procedures has been a major issue over the last 10 years. Most endoscopy units use 2% glutaraldehyde and automated endoscope reprocessors (AERs) for disinfecting gastrointestinal endoscopes. We attempted an in-use evaluation of the current reprocessing procedures. Methods: Thirty flexible endoscopes were randomly collected just after upper endoscopic examinations and were disinfected using 2% glutaraldehyde in an AER. Cultures were taken from biopsy channels (S-l), tip of the insertion tubes (S-2), umbilical cords (S-3), and angulation knobs (S-4). Results: In 63,3% (19/30) of endoscopes, there was no microbial contamination after disinfection procedures. The culture positive rates of S-l, S-2, S-3, and S-4 samples were 20,0%, 0.0%, 3.3%, and 20.0%, respectively. Microorganisms of 13 species were identified, but there was no pathogen related with reported infectious complications after endoscopic procedures. Conclusions: Current disinfection procedure using 2% glutaraldehyde and an AER appears to be very effective in decontaminating patient-used endoscopes. Low level microbial contamination of endoscopes after conventional reprocessing methods may not impose great risk on patients. (Korean J Gastrointest Endosc 2001;22:393-398)

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Propofol 과 Fentanyl 로 상부 위장관 내시경시 산소 공급에 따른 산소 포화도에 관한 연구 ( Study on the Degree of Oxygen Saturation during Upper Gastrointestinal Endoscopy Using Propofol / Fentanyl With Oxygenation ): Korean J Gastrointest Endosc 2001;22(6):399-405. Published online November 30, 2000

Abstract PDF: Background
/Aims: Propofol is usually used for anesthesia in the case of day surgery. We studied the effects of propofol plus fentanyl for sedation and the effect of oxygenation during gastroscopy, Methods: 154 patients who asked conscious sedation during gastroscopy were randomly divided into three groups. The first group (PF-0 group, 50 patients) and the second group (PF group, 48 patients) were received an initial bolus dose of propofol (40 mg) plus fentanyl (50 ㎍) intravenously, followed by additional doses of propofol at one minute interval until conscious sedation. PF-0 group was received preoxygenation (3 L/min) via nasal canula, and PF group was not, The third group (56 patients) received an initial bolus dose of midazolam (3 mg) intravenously, followed by additional doses of midazolam at two minutes interval (M group). Results: In PF-0 group, time to achieve sedation, regain orientation, and recover walking ability were 118.0±85.2 sec, 67.5±91.2 sec and 11.1±5.3 min. Gag reflex during the procedure was absent or nearly absent in 96% of patients. Despite the changes of blood pressure and heart rate compared to the values taken prior to the procedures were observed, all values were not clinically significant, In PF-0 group, transient oxygen desaturation (SaO2<90%) was observed in four (8.0%) patients. Conclusions: Propofol plus fentanyl with oxygenation seems to be more acceptable and suitable method for sedation during outpatient gastroscopic examination. (Korean J Gastrointest Endosc 2001;22:399-405)

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활동성 크론병에서 초기 스테로이드 치료 반응에 따른 임상적 , 생화학적 , 병리학적 인자들에 관한 연구 ( Analysis of Clinical , Biochemical and Pathologic Factors According to the Response to Initial steroid Therapy in Active Crohn`s Disease ): Korean J Gastrointest Endosc 2001;22(6):406-410. Published online November 30, 2000

Abstract PDF: Background
/Aims: The predictory factors of the response to initial steroid therapy in active Crohn's disease has been controversial in numerous literature reviews. We evaluated any predictory faetor of the response to initial steroid therapy in active Crohn`s disease patients, Methods: The medical records of 32 patients with active Crohn`s disease who clinically responded to oral steroid therapy were retrospectively reviewed. The steroid responsive group was defined as the one showing maintenance of response for more than one month from steroid withdrawal and the steroid dependent group as the one showing relapse or exacerbation during steroid tapering or within 30 days from steroid withdrawal. The clinical, biochemical, and pathologic factors were evaluated. Results: There were 22 male and 10 female patients. The mean age was 28.9 years. The number of steroid responsive and dependent group was 22 (68,8%) and 10 (31.2%), respectively. There were no significant differences between these two groups in age, sex, time to diagnosis, perianal lesion, extent of disease, extraintestinal manifestations, presence of granuloma, presenting features, hemoglobin, ESR, and CRP, except serum albumin level. Conclusions: Serum albumin level was significantly lower in steroid dependent group than steroid responsive group, reflecting severe inflammation in steroid dependent group, (Korean J Gastrointest Endosc 2001;22:406-410)

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대장 점막하 침윤암의 림프절 전이의 위험인자 : 심달도 분류를 중심으로 ( Risk Factors of Lymph Node Metastasis in Submucosally Invasive Colorectal Carcinoma : with Special Reference to the Depth of Invasion ): Korean J Gastrointest Endosc 2001;22(6):411-418. Published online November 30, 2000

Abstract PDF: Background
/Aims: It has been reported that lymph node (LN) metastasis occurs in approximately 10 percent of patients with submucosally invasive colorectal carcinoma. The present study was performed to determine the clinical significance of absolute and relative depth of submucosal invasion and to find the associated pathological risk factors of LN metastasis in submucosally invasive colorectal carcinoma. Methods: From June, 1989 to May, 1999, 2,580 patients were pathologically confirmed as having colorectal carcinoma, Of these patients, a total of 61 subjects with submucosally invasive carcinoma could be reviewed pathologically and were included in this retrospective analysis. The relative depth of submucosal invasion was evaluated by Kudo (sm1, 2, 3) and modified Haggitt (L1, 2, 3) classifications, and the absolute depth was measured, Results: The absolute depth of submucosal invasion was significantly correlated with the relative depth evaluated by both Kudo and modified Haggitt classifications (p<0.01). Of 51 patients in whom the status of LN metastasis could be evaluated, six (11.8%) showed LN metastasis, Among the patients with LN metastasis, there was no one with sm1or L1in the relative depth and 500 ㎛or less in the absolute depth. The risk of LN metastasis was related to the gross type, and lymphatic or vessel invasion (p <0.05). Conclusions: The risk factors for LN metastasis in submucosally invasive colorectal carcinoma were the gross type and lymphatic or vessel invasion, The results also suggest that the absolute depth of submucosal invasion might be a useful parameter to select the patients for the endoscopic treatment, (Korean J Gastrointest Endosc 2001;22:411- 418)

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거대 용종형 조기우암 1 예 ( A Case of Huge Polypoid Early Gastric Cancer ): Korean J Gastrointest Endosc 2001;22(6):419-422. Published online November 30, 2000

Abstract PDF: The survival rate of gastric cancer is mainly affected by lymph node metastasis and depth of invasion. It is now recognized that in early gastric cancer submucosal invasion and lymph node metastasis depend on the size of tumor, A 71-year-old man with epigastric discomfort for 1 month was admitted. Endoscopy showed a huge polypoid tumor with friable and nodular surface occupying the whole lumen of stomach. We suspected a Borrmann type 1 advanced gastric cancer, but we confirmed the gastric cancer confined to only mucosa without lymph node metastasis after operation. So we report a case of huge polypoid early gastric cancer mimicking advanced gastric cancer with a review of relevant literatures, (Korean J Gastrointest Endosc 2001;22:419-422)

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짧은 추적기간 중 형태학적 변화를 보인 과형성 위용종증 1 예 ( A Case of Hyperplastic Gastric Polyposis with Morphological Changes during Short Follow - up Period ): Korean J Gastrointest Endosc 2001;22(6):423-427. Published online November 30, 2000

Abstract PDF: Hyperplastic polyps are often multiple and by far the most frequent lesions among gastric polyps, contributing for about 90% of the polypoid lesions observed in the stomach. However, hyperplastic gastric polyposis is rare and was not exactly evaluated for natural course. These lesions are considered reactive and not genetically determined conditions. So it has been claimed that the hyperplastic polyps and hyperplastic polyposis are non-neoplastic lesions that result from regenerative hyperplastic reaction to inflammation and erosion. Recently we experienced a hyperplastic gastric polyposis with morphological changes during short follow-up period and reported herein. (Korean J Gastrointest Endosc 2001;22:423-427)

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거대 점막주름을 동반한 위 랑게르한스세포 조직구증 1 예 ( A Case of Gastric Langerhans Cell Histiocytosis Showing Hypertrophic Folds ): Korean J Gastrointest Endosc 2001;22(6):428-430. Published online November 30, 2000

Abstract PDF: Langerhans cell histiocytosis is a rare disease entity in which various tissue are infiltrated by proliferating histiocytes. Involvement of alimentary tract is rare (<5%), especially in the stomach, Only seven cases of gastric Langerhans cell histiocytosis have been reported in Enlglish literature. Diabetes insipidus is the most common endocrinologic complication. We report a case of Langerhans cell histiocytosis involving stomach and pituitary stalk. The diagnosis of gastric Langerhans cell histiocytosis and diabetes insipidus was based on gastric mucosal biopsy specimen from a Korean man with suspicious hypertrophic gastric folds of gastric body, water deprivation test and sella MRI. (Korean J Gastrointest Kndosc 2001;22:428-430)

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Alto ShooterTM 로 조절된 말기 신부전증 환자에서의 다발성 표재성 위전정부 출혈 ( Successful Treatment of Multiple Superficial Gastric Antral Bleeding with Alto ShooterTM in a Patient with End Stage Renal Disease ): Korean J Gastrointest Endosc 2001;22(6):431-434. Published online November 30, 2000

Abstract PDF: Diffuse or multifocal superficial gastrointestinal bleeding can be treated by endoscopic laser, argon plasma coagulation, heater probe, or electrocoagulation. However, these methods need relatively expensive equipments and clinical experience. Recently, Alto Shooter (Kaigen Co, Ltd, Osaka, Japan) which can spray 100% sodium alginate was developed to control gastrointestinal bleeding as a topical therapy. We herein present a 47-year-old man with end stage renal disease in whom multiple superficial gastric antral bleeding was successfully managed by the use of Alto Shooter. This method is easy and relatively cheap to use and seems to control superficial bleeding effectively from vascular lesions or after endoscopic biopsy. (Korean J Gastrointest Endosc 2001;22:431-434)

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성인에서 발생한 소장의 Burkitt 림프종 1 예 ( A Case of Small Intestinal Burkitt`s Lymphoma in an Adult ): Korean J Gastrointest Endosc 2001;22(6):435-439. Published online November 30, 2000

Abstract PDF: Burkitt`s lymphoma is a rare disease that belongs to the aggressive non-Hodgkin`s lymphomas. Burkitt`s lymphoma usually occurs in children or younger persons. There is a strong association between endemic Burkitt's lymphoma and Epstein-Barr virus, whereas the association is weaker in the sporadic form occurring in Western countries. Burkitt`s lymphoma of the gastrointestinal tract occurring in adults has not been reported in Korea. We herein report an unusual case of Burkitt's lymphoma presenting with a palpable abdominal mass in a 52-year-old man infected with Epstein-Barr virus. A computed tomographic scan showed marked low density wall thickening of the terminal ileum. An endoscopy revealed a narrow lumen, shallow ulcerations, and irregular nodularity of the terminal ileum. Small bowel resection and hemicolectomy were performed and a histologic examination of the resected specimen confirmed the diagnosis. Six cycles of adjuvant chemotherapy were given and the patient has been doing well without evidence of recurrence. (Korean J Gastrointest Endosc 2001;22:435-439)

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응급대장내시경술로 치료한 S 상결장염전증 1 예 ( A Case of Emergency Endoscopic Treatment of Sigmoid Volvulus ): Korean J Gastrointest Endosc 2001;22(6):440-443. Published online November 30, 2000

Abstract PDF: Sigmoid volvulus is a unfrequent cause of colon obstruction in Korea. Colonoscopic reduction and decompression is the preferred initial treatment of patients with sigmoid volvulus who do not have signs of bowel strangulation because of the high mortality associated with emergency surgery. We experienced a case of sigmoid volvulus in a 60-year-old male who presented with constipation, abdominal distension and abdominal pain. Sigmoid volvulus was diagnosed by simple abdominal film and he had taken successful emergency colonoscopic reduction of sigmoid volvulus, We report our experience & reviews the literature on the use of the colonoscope to treat sigmoid volvulus. (Korean J Gastrointest Kndosc 2001;22:440-443)

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대장선종에서 진행한 대장암 2 예 ( Two Cases of Colon Adenocarcinoma Transformed from Colonic Adenoma ): Korean J Gastrointest Endosc 2001;22(6):444-448. Published online November 30, 2000

Abstract PDF: Sigmoid volvulus is a unfrequent cause of colon obstruction in Korea. Colonoscopic reduction and decompression is the preferred initial treatment of patients with sigmoid volvulus who do not have signs of bowel strangulation because of the high mortality associated with emergency surgery. We experienced a case of sigmoid volvulus in a 60-year-old male who presented with constipation, abdominal distension and abdominal pain. Sigmoid volvulus was diagnosed by simple abdominal film and he had taken successful emergency colonoscopic reduction of sigmoid volvulus, We report our experience & reviews the literature on the use of the colonoscope to treat sigmoid volvulus. (Korean J Gastrointest Kndosc 2001;22:440-443)

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종양과의 감별이 어려웠던 원위부 총담관의 감돈 결석 ( An Impacted Distal Common Bile Duct Stone Mimicking a Tumor : An Unusual Manifestation of Gallstone Disease ): Korean J Gastrointest Endosc 2001;22(6):449-453. Published online November 30, 2000

Abstract PDF: Patients with bile duct stones usually present with biliary pain, obstructive jaundice, ascending cholangitis, or pancreatitis, When endoscopic retrograde cholangiopancreatography (ERCP) is performed, bile duct stones are usually movable and thus easily detected. If a stone in the bile duct presents unusually, it may pose some diagnostic challenges. Recently, we experienced a case of an impacted distal common bile duct (CBD) stone mimicking a tumor which resulted in performing a pylorus-preserving pancreaticoduodenectomy in an asymptomatic 56-year-old man. On ERCP, an obstructing distal CBD lesion did not move even by doing brush cytology. Moreover, the result of brush cytology was positive for atypical cells. A major resective surgery performed after recovery from severe post-ERCP pancreatitis confirmed the diagnosis. Interestingly, this stone caused erosion with acute and chronic inflammation and fibrosis containing foci of mild epithelial dysplasia. We herein report an unusual manifestation of gallstone disease with a review of the literature. (Korean J Gastrointest Endosc 2001;22:449-453)

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