Clinical Endoscopy

Helicobacter Pylori 에 대한 혈청 lgG 항체가와 내시경 및 조직병리소견과의 연관성 ( Correlation of Helicobacter pylori Serology titer with Endoscopic and Histologic Findings ): Korean J Gastrointest Endosc 2001;23(1):1-6. Published online November 30, 2000

Abstract PDF: Baekgronnd/Alms: dinical practlce, among the technique tg defe4ed Heticobacter pylori (H. pylori) infaction IgG serological test is noninvasive, safe, quick, widely available, and inexpensive. We studied that whether the titers of anti-g. pylori IgG antibody were correla0d with endoscopic finding, and the degree of microscopic gastric damage and H. pylori density in dyspeptic patients. Methods: Gastric biopsy specimens were obtained in IGP patiens with H. pylori infec5on undergoing upper gastric endoscopy. The titers of serum IgG antibodies to H pylori were measured by enzyme immumoassay. Macrpscopic gastric damages and. Histologic pylori were scored by the Sydney system. Resnlts: Bndoscopic findings showed no significant association with H. pylori antibody titers (p=0.111). There was significant correlation between H pylori antibody titers and lymphocyte infiltration (p 0.002), neutrophil infiltration (p=0.002), H, pylori density (p=0.000I), respectively. There was no significant correlation between 8 py4ri antibody titers and atropy (p=0. 142), irrtestinal metaplasia (p=0.368), respectivelp. Conclnsions: H. pylori antibody titer has signi6cant association with the H. pylori density, neutrophil and 1ymphocyfe infiltration. The serological test using BIA method is a use5G in detecting H, pylori infection and it may be used as a predictor for the H. pylori density and degree of inflammation. (Korean J Gastrointest Eadose 2001;23:1-6)

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만성 신부전 환자에서 Helicobabter Pylori 감염률과 위장관 증상과의 연관성 ( The Infection Rate of Helicobacter Pylori and Its Relation to Gastrointestinal Symptoms in Patients with Chronic Renal Failure ): Korean J Gastrointest Endosc 2001;23(1):7-13. Published online November 30, 2000

Abstract PDF: Background
/Aims: Helicobacter pylori (H. pylori) can survive in the add milieu of stomach by producing urease, which generates acid neutralizing ammonia by splitting gastric urea and creates a satisfactory environment for H. pylori. Thus the patients with chronic renal failure (CRF) with increased diffusion of blood urea to gastric lumen may be theoretically more susceptible to colonization with If pylori. To investigate the infection rate of H, pylori in CRF and ifs relation to gastrointestinal symptoms, we performed prospective controlled study. Methods: We performed gastroscopy in forty-two patients with CRF. Rapid urease test and histologic examination for H. pylori infection were performed, Histological gastritis was graded by updated Sydney classiflcation. Gasboinfes5nal symptoms were assessed in all CRF patients and serum blood urea nitrogen and creatinine levels were also measured. Results: Twenty-one (50.0%) demonstrated H, pylori infection in patients with CRF. H. pylori infection and major endoscopic findings were not related to the gastrointestinal symptoms in patients with CRF. In H, pyloripositive CRF patients, density of H. pylori and grade of histological gastritis were not related to the severity of gastrointestinal symptoms. Conclnsions: The infection rate of H, pylori was 50% in patients with CRF. Gastrointestinal symptoms in CRF were related to factors other than H. pylori infection. (Korean J Gastmiatest Endoec 2001;23:7-13)

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대장 선종과 Apolipoprotein E 유전형과의 관계 ( An Association between Apolipoprotein E Genotype and Colonic Adenomas in Korean ): Korean J Gastrointest Endosc 2001;23(1):14-20. Published online November 30, 2000

Abstract PDF: Background
/Aims: Apolipoprotein B polymorphism plays an important role in the metabolism of cholesterol. And bile acids, which may be related to the development of colorectal adenomas, An association between apolipoprotein B genotype and colonic adenomas bas been reparted in a western country. This study was designed to determine whether the apolipopratein S was genotype would be associated with proximal or distal colonic adenomas in Koreans. Methods: On the colonoscopy, colonic adenomas were found in 132 patients. Proxima1 colonic adenoma was found in 35 patients and distal colonic adenoma was found in 97 patients. Serum leveis of total cholesterol, LDL-cholesterol, HDL-cholesterol and trlglyceride were measured. Apolipoprotein E genotype was determined by PCR and allele specific oligonucleotide hybridization. 279 contro1 subjects without an adenoma on the screening sigmoidoscopy were se1ecfed randomly. Results: The serum levels of total choles0'rol, LDL-cholesterol, HDL-cholesterol and triglyceride did not significantiy differ between each adenoma group and control group. The individual frequencies of ε2, ε3 and ε4 alleles in patients with colonic adenomas did not differ from those in control subjects. The frequency of either heterozygote or homozygote for g 4 allele in patients with proximal adenoma was lower than that in control subjects (0.029 vs O.I68, p < 0.05). Conclnsions: The data suggest that g 4 allele may be associated with a lower risk for the development of proximal colonic adenoma in Korean men. (Korean J Gastroiuteat Endosc 2001;23:14-20)

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대장내시경으로 확인된 악성 림프종의 내시경적 분류와 임상병리학적 고찰 ( Clinicopathological Features of Malignant Lymphoma Detected by Colonoscopy : An Analysis According to the Endoscopic Classification ): Korean J Gastrointest Endosc 2001;23(1):21-27. Published online November 30, 2000

Abstract PDF: Background
/Alms: There have been only a few endoscopic s0dies of lower intestinal lesions of malignsnt lymphoma. The aims of this study were to classify the ileocolonic 1ymphomas according to the colonoscopic fhgdings and to reveal the dinicopathological relationship according to the classes. Methods: Subjects were 24 cases of ileocolonic lymphomas. We evaluated the clinicopathological features according to their endoscopic fmdings. Results: The chief complaints were abdominal pain, bleeding, and abdomina1 mess, Twenty-six lesions from 22 patients, excluding 2 multiple lymphomatous polyposis, were endoscopically classfled as follows. Fungating (10 lemons), ulcerofungating (7 lesions), inflltrative (5 lesions), ulceroinfiltrative (3 lesions), and ulcerative (1 lesion). The 1ocafim of the lesions was the terminal ileum in 11 lesions, the colon in 10 lesions, and both regions in 5 lesions. Within the 1arge bowel, the cecum was involved most frequently, followed by the ascending colon and the remainder. Most of pathological types were the diffuse large cell and the large cell immunoblastic. There was no relationship between the endoscopic findings and the histologic types. Eight eases were manifested as intussusceptlon. Conclasions: Ileocolonic lymphomas can be classified endoscopically into five types. Among the types, fungating and ulcerofungating types axe the most frequent. (Korean J Gastrointest Eadosc 2001;23:21-27)

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수술 전 진단이 가능하였던 사중 조기위암 1 예 ( A Case of Synchronous Quadruple Early Gastric Cancer which was Detected Preoperatively ): Korean J Gastrointest Endosc 2001;23(1):28-31. Published online November 30, 2000

Abstract PDF: Early diagnosis of gastric cancer is very important since gastric cancer is one of the leading causes of cancer-modality in Korea. The incidence of early gastric cancer has increased reoentiy with much advances in diagnostir modalities and increasing concerns about individual health status. The incidence of multiple gastric cancer is also increasing. The number of lesions in cases with multiple gastric cancer is usually 2 or 3, and 1esians over 4 sites are rare. The problem in the diagnosis of multiple gastric cancer is the 1ow preoperative defection rate in spite of the recent. Advances of diagnostic techniques, especially in cases with sma11 flat or elevated lesions. We report a case of a synchronous quadruple early gastric cancer which was preoperatively diagnosed with endoscopy. Of the four lesions, one was depressed (Iic) and the other three were superficial elevated (Iia). A11 four 1esions were well differentiated adenocarcinomas confined to the mucosa. (Korean J Gastrointest Eadosc 2001;23:2S-31)

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가족성 선종성 용종증 수술 후 발생한 유건종과 십이지장 선종 1 예 ( Desmoid Tumor and Duodenal Adenoma in a Patient with Familial Adenomatous Polyposis : A Case Report ): Korean J Gastrointest Endosc 2001;23(1):32-35. Published online November 30, 2000

Abstract PDF: Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited disorder due to germline mutation of the tumor suppressor adenomatous polyposis coli (APC) gene, Multiple large bowel polyps usually develop in adolescenoe or early adulthood with inevitable progression to colorectal carcinoma. It is well known that patients with FAP are at considerable risk of developing extracolonic manisfestations of the disease. Particularly, desmoid tunors of the abdominal cavity, and duodenal adenomas and carcinomas are the most serious ones. Desmoid tumors and duodenal carcinomas are major muses of death in those patients in whom a prophylactic (procto) colectomy has been performed. We report the case of a 38-yeaz-old man with desmoid tumor and duodenal adenoma developing after total colectomy with ileostomy due fo FAP, and 1iferafures were reviewed. (Korean J Gastroietest Endosc 2001;23:32-35)

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십이지장암으로 오인된 비후형 십이지장 결핵 1 예 ( A Case of Hypertrophic Form of Duodenal Tuberculosis Mimiking Duodenal Cancer ): Korean J Gastrointest Endosc 2001;23(1):36-40. Published online November 30, 2000

Abstract PDF: The prevalence of intestinal tuberculosis has been markedly decreased with the development of antituberculoug chemotherapy, improved economic conditions, preventive medicine and early detection and treatment of pulmonary tuberculosis. An even more impressive resurgence of pulmonary and extrapulmonary tuber culosis has been seen in recent years among persons infected with the human immunodeficiency virus. The most common signs of infeshna1 tuberculosis is the ileocecal region, and duodenum is a rare site. Symptoms and signs of duodenal tuberculosis are nonspecific. The gross pathologic appearance of the duodeznal tuberculous lesions has to its traditional categoriration into three farms. 1) ulcerative, 2) hypertrophic, and 3) ulcerohypertrophic (mixed). Hypertrophic lesions of the duodenal tuberculosis should be differentiated from duodenal adenocarcinoma and lymphoma. We herein report a case of duodenal tuberculosis presenting as intraluminal protruding mass in gastroduodenoscopy and multiple intraabdomina1 lymphadenopathy on abdominal CT. We have confirmed the duodena1 tuberculosis by endoscopic biopsy, and review the current literatures. (Korean J Gastroluetest Endosc 2001;23:30-40)

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Dieulafoy 양 병변에 의한 십이지장게실 출혈 1 예 ( A Case of a Bleeding Duodenal Diverticulum by a Dieulafoy - like Lesion ): Korean J Gastrointest Endosc 2001;23(1):41-44. Published online November 30, 2000

Abstract PDF: Duodenal diverticula are first reported by Chomel in 1710. Duodenal diverticula are relatively common in adults with a prevalence of 23% in SRCP. The most duodenal diverticulum is asymptomatic. Complications such as obstruction, cholangitis, blliary stones, ulceration, perforation and hemorrhage can occur in approximately 10%. However, relatively few cases of bleeding from a duodenal diverticulum have been reported. The cause of bleeding from a duodenal diverticulum is uncertain and various suspected etiologies were suggested, such as ectopic gastric mucosa, stasis-induced ulceration, erosion into major vessels, aortoenteric fistuias, intradiverticujar polyp, aspirin-induced erosion. We report a case of a bleeding duodenal diverticulum by a Dieulafoy-like lesion and suggest this 1esion as one of posslble causes of blee4ng in duodenal diverticulum. (Korean J Gastroiatest Endosc 2001;23:41-44)

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내시경적 점막절제술로 확진한 직장 바리움 육아종 1 예 ( A Barium Granuloma of the Rectum which was Diagnosed by Endoscopic Mucosal Resection ): Korean J Gastrointest Endosc 2001;23(1):45-48. Published online November 30, 2000

Abstract PDF: A barium granuloma of the colon and rectum is a rare complication of radiologic examination of the digestive tract using barium. This complication is exceptional. During the enema, the ungula may ulcerate the mucosa which is blown up secondarlly by the barium, Clinically, the granuloma presets as a hard polyp like a malignant tumur. So, the recognition of this entity is important because it can mimic other lesions induding a neoplastic process endoscopically. Moreover, hisologiaa1 findings, though they may be characterlstic, often go unnoticed with routine techniques only. The authors report a barium granuloma of the rectum which was djagmosed by endoscopic mucosal resection and radiographic study of the paraffin block, (Korean J Gastrointest Endose 2001;23:45-48)

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직장 출혈을 보인 생선뼈 이물의 내시경적 제거 1 예 ( Endoscopic Removal of fish Bones Impacted in the Rectosigmid Colon ): Korean J Gastrointest Endosc 2001;23(1):49-52. Published online November 30, 2000

Abstract PDF: Impaction of an ingesfed foreigm body in the colon is uncommon but surgical or endoscopic intervention is occasionally needed when serious complicafions such as perforation, obstruction or hemorrhage occur. Several factors may predispose a patient to ingestion and subsequent impaction of lower intestinal foreign body. It is more common in the elderly who wear dentures, in the mentally infirm, in chronic alcoholics or rapid eating. The majority of impaction occurs at narrowing and angulation such as ileocecal valve or rectosigmoid junction. The diagnosis of lower intestinal foreign body should be considered, among more common conditions, in the differential diagnosis of elderly patients who present with altered bowel habits. We report the case with a literature review that successfully endoscopically removed the fish bones impacted in the rectosigmoid colon complicated by rectal bleeding. (Korean J Gastrointest Endosc 2001;23;49-52)

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게실 내 유두에서 두 개의 카테타를 이용한 췌담관 삽관술 ( A Novel Approach for Cannulation of the Ampulla within a Diverticulum : A Two - Catheter Method ): Korean J Gastrointest Endosc 2001;23(1):53-55. Published online November 30, 2000

Abstract PDF: cAn ampulla within a diverticulum is not rare especially in elderly patients with duct stones, but may pose a problem in identifying the papilla and properly orienting this structure for cannulation during endoscopic retrograde cholangiopancreatography. We therefore have used a new technique using the application of an additional catheter to keep the ampulla outside the diverticulum. When we pushed the duodenal fold downward and laterally with the first catheter, the ampulla was everted from the diverticulum and the hidden papilla was brought into view. Once the papilla was visible, the second catheter which was identical to the first, was advanced alongside it and inserted into the papillary orifice without difficulty. Bventually a successful Cholangiogram was obtained. With the insertion of a guidewire through the second catheter, sphincterotomy and insertion of endoscopic nasobiliary drainage tube were also performed successfully. (Korean J Gastrointest Endosc 2001;23;53-55)

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내시경적 역행성 담관조영술 후 발행한 담즙증 1 예 ( A Case of Hepatic Biloma Following Endoscopic Retrograde Cholangiography ): Korean J Gastrointest Endosc 2001;23(1):56-59. Published online November 30, 2000

Abstract PDF: Endoscopic retrograde cholangiography has now evolved into a highly sophisticated diagnostic and therapeutic tool in patients with hepatobiliary-pancreatic disorders. However, this procedure is associated with risks of significant complications such as cholangitis, pancreatitis, hemorrhage, and perforation which have been widely recognized. Hepatic subcapsular biloma is a very rare and less recognized complication of this procedure. Recently, we experienced a case of hepatic subcapsular biloma, developed after endoscopic removal of choledocholithiasis, managed with percutaneous drainage procedure and endoscopic stenting, and report with a review of literature. (Korean J Gastroitest Endosc 2001;23:56-59)

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