Clinical Endoscopy

자가팽창성 식도 금속스텐트의 역학적 특성 분석 ( Mechanical Characterization of self - Expandable Esophageal Metal Stents ): Korean J Gastrointest Endosc 2001;23(2):61-68. Published online November 30, 2000

Abstract PDF: Backgound/Aims: One of the most important mechan- ical properties to consider in selecting clinically optimal stents would be expansile pressure. However, there were scanty data about the expansile pressure of stents. Furthermore, the data were improper for the clinical selection of stents. In this study, the authors tried to develop a precise and reproducible expansile pressure measurement method and to measure the expansile pressure of a variety of stent types. Methods: We developed a new method of expansile force measurement using a cylindrical measurement device under a quasi-static equilibrium state and measured the expansile forces of six different stents made by various manufacturers; covered and uncovered Y2P SR, covered Y3E SR (Stentech, Korea), covered and uncovered Ultraflex and uncovered Wallstent (Boston Scientific, USA) Results: Three important points critical in explaining and predicting the expansion characteristics of stents were found. Firstly, the radial expansion force varies greatly among the types of stents. Secondly, stents could be categorized to 'soft stent" and "stiff stent based upon the slope of expansion force change. Lastly, the initial force needed to compress the fully expanded stents is far greater in stents covered with membrane compared with the stents without membrane. Conclusions: The newly developed method of measurement helped the authors to get more realistic data of expansion force and pressure, which are thought to be helpful in clinical selection of stent type. (Korean J Gastrointest Endosc 2001;23:61-68)

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위정맥류 출혈에 대한 N-butyl 2-Cyanoacrylate 주사요법의 치료 효과 ( Efficacy of N-Butyl 2-Cyanoacrylate Injection Therapy for Gastric Variceal Bleeding ): Korean J Gastrointest Endosc 2001;23(2):69-75. Published online November 30, 2000

Abstract PDF: Background
/Aims: The aim of the study was to evaluate the efficacy of n-butyl 2-cyanoacrylate injection therapy for gastric variceal bleeding and to find out the factors related to clinical outcome, Methods: Sixty-seven patients treated with n-butyl 2-cyanoacrylate injection therapy for gastric variceal bleeding were retrospectively reviewed. Results: Initial hemostasis was achieved in all 12 patients, Success of therapy was achieved in 88% of the patients. A stepwise logistic regression analysis including age, sex, cause of cirrhosis, Child-Pugh class, variceal form, bleeding site, initial hemoglobin, and presence of hepatocellular carcinoma as variables indicated that only the Child-Pugh class was an independent predictive factor of treatment failure. Rebleeding occurred in 19% of the patients during the 4 weeks after therapy, The cumulative probability of 4-week remaining free of rebleeding was significantly higher in Child-Pugh A and B than in Child- Pugh C. Mortality at 4 weeks was 15%. The Child-Pugh class and the presence of hepatocellular carcinoma were the independent predictive factors of mortality at 4 weeks, Conclusions: N-butyl 2-cyanoacrylate injection therapy is highly effective in the management of bleeding from gastric varices, Child-Pugh class is an important predictive factor of treatment failure, rebleeding, and survival after the therapy. (Korean J Gastrointest Endosc 2001;23:69-75)

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비정맥류 , 비궤양성 장관 내 출혈 및 용종 제거술 후 내시경적 밴드 결찰술 ( Endoscopic Band Ligation for Non - variceal , Non - ulcer Gastrointestinal Hemorrhage and Post - polypectomy Hemorrhage ): Korean J Gastrointest Endosc 2001;23(2):76-81. Published online November 30, 2000

Abstract PDF: Background
/Aims: There is no consensus as to the best treatment for non-variceal, non-ulcer gastrointestinal hemorrhage. Endoscopic band ligation is an inexpensive, readily available, and easily learned technique in contrast to conventional thermal methods of endoscopic hemostasis. The purpose of this study is to define the effectiveness of endoscopic band ligation for non-variceal, non-ulcer gas- trointestinal hemorrhage and post-polypectomy hemorrhage. Methods: Twenty eight patients were treated by band ligation between July 1996 and October 2000. The lesions treated were; Dieulafoy’s lesion in 13, Mallory-Weiss tear in 7, angiodysplasia in 1, post-polypectomy bleeding in 4, post-endoscopic mucosal resection bleeding in 2, post- endoscopic biopsy bleeding in I. Results: Endoscopic band ligation was successful in 25 of 28 cases. Additional sclerotherapy was necessary in two cases of Dieulafoy’s lesion. The remaining case was early band detachment. Conclusions: Endoscopic band ligation is effective for non-variceal, non-ulcer bleeding. It has the advantage of ease of use and is relatively inexpensive. (Korean J Gastrointest Endosc 2001;23:76-81)

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부식제에 의한 상부 위장관 손상의 임상적 고찰 ( A Clinical Study on the Upper Gastrointestinal tract Injury Caused by Corrosive Agent ): Korean J Gastrointest Endosc 2001;23(2):82-87. Published online November 30, 2000

Abstract PDF: Background
/Aims: The incidence of corrosive injury has been decreased, compared with past years. However, the ingestion of corrosive agent for suicidal attempt is on an increasing trend. Though corrosive injury on gastrointestinal tract is very common, there are few clinical studies on this field. Methods: Retrospective study was performed on 48 patients who ingested corrosive agent from 1992 to 1998. The kinds of corrosive agent, cause of ingestion, symptoms, gastroscopic findings, treatment and compli- cations were analyzed. Results: The most common agent of ingestion was acetic acid (47.9%), followed by hydrocholoric acid (18.8%), cresol (10.4%), lye (10.4%), sulfuric acid (4.2%). Ingestion for suicidal attempt (60.4%) was more frequent than accidental ingestion (39.6%). The frequent symptoms were sore throat (31.3%), dysphagia (27.1%), epigastric pain (22.9%), vomiting (18,8%), chest pain (18.8%), GI bleeding (12.5%), dyspnea (12.5%) and hematuria (8.3%). The esophagus was the most common site of corrosive injury and Grade Iia injury was the most frequent finding on gastroscopy. In most cases, pro- phylactic antibiotics with or without steroid was administered for conservative treatment. For long-term sequelae, there were 7 cases (14.6%) of esophageal stricture, and 2 cases (4.2%) of gastric outlet obstruction. Conclusions: Corrosive injury on gastrointestinal tract is frequently observed on early gastroscopy and can cause significant late sequelae, such as stricture. Therefore, it is necessary to evaluate regular follow up gastroscopy for the management of late sequelae. (Korean J Gastrointest Endosc 2001;23:82-87)

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대장내시경 전처치제로서 Sodium Phosphate 투여에 따른 배변활동시간 분석 ( Bowel Cleansing Method of Sodium Phosphate : Onset and Duration of Bowel Activity ): Korean J Gastrointest Endosc 2001;23(2):88-92. Published online November 30, 2000

Abstract PDF: Background
/Aims: Divided-dose oral sodium phosphate laxative is recommended for bowel cleansing before colonoscopy. Patients need information about the onset and duration of activity of the preparation. This study was designed to develop practical prescribing information for the patients to reduce anxiety and insomnia concerning bowel movement, Methods: one hundred ninety patients were requested to take 45 mL sodium phosphate in the previous evening and the morning of the procedure, and to complete a questionnaire. The overall quality of bowel cleansing were assessed by endoscopists. Results: Bowel activity began 2,25 (90 percentile: 3.58) hours after the first dose and continued for 6.55 (90 percentile: 8.5) hours. For the second dose the time of onset was 0.85 (90 percentile: 1,67) hours, and bowel activity continued for 3,6 (90 percentile: 5.17) hours. Conclusions: The onset of bowel activity from the first dose of sodium phosphate starts within 4 hours and it is completed within 8,5 hours for most. We can recommend the patients to take the first dose of NaP solution at 4 p.m. of the previous day of the exam and second dose more than 5 hours earlier before the colonoscopy in the care that the onset of the bowel activity after the first dose take longer than 4 hours. (Korean J Gastrointest Endosc 2001;23:88-92)

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악성 담관협착에서 Niti - S 스텐트 및 Wallstent 의 비교 ( A New Covered Biliary Metal Stent versus Uncovered Wallstent for Malignant Biliary Obstruction ): Korean J Gastrointest Endosc 2001;23(2):93-99. Published online November 30, 2000

Abstract PDF: Background
/Aims: In order to provide a complete ob- stacle to tumoral growth, we designed a new self- expandible metal stent fully covered with polyurethane membrane. The purpose cf the study was to compare the safety and effectiveness of a new membrane-covered Niti-S stent versus conventional uncovered Wallstent. Methods: In a prospective trial, 59 patients with malignant extrahepatic biliary obstruction received either a newly developed covered metal stent (Niti-S stent, 30 cases) or an uncovered metal stent (Wallstent, 29 cases) by the endoscopic trans-papillary route. Results: Effective biliary decompression was achieved in all patients initially, and short-term results were similar in both groups. Stent failure was observed in 4 of the 30 patients (13%) after a median period of 165 days in the Niti-S group and in 8 of the 29 patients (28%) after a median period of 152 days in the Wallstent group. The reasons of stent failure were occlusion (n=3) and migration (n=l) in the covered Niti-S stent group and occlusion (n=8) in uncovered Wallstent group. According to the Kaplan-Meier life table analysis, the patency rates after 90, 180, and 360 days were 100%, 90%, and 74% in covered Niti-S stent group and 100%, 73%, and 61% in uncovered Wallstent group respectively. The occluded membrane-covered Niti-S stent was easily removed endoscopically and a new Niti-S stent was reinserted in one patient. Conclusions: The new, membrane-covered Niti-S stent has a lower stent failure rate and a tendency toward long-term patency rate compared to uncovered Wallstent. The covering may effectively prevent tumor ingrowth and it is sometimes possible to remove an occluded Niti-S stent. (Korean J Gastrointest Endosc 2001;23:93-99)

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금속제 스텐트의 개통성에 영향을 미치는 악성 담도 폐쇄의 특징 ( Features of Malignant Biliary Obstruction Affecting the Patency of Metallic Stents : A Multicenter Study ): Korean J Gastrointest Endosc 2001;23(2):100-108. Published online November 30, 2000

Abstract PDF: Background
/Aims: Although metalic stents are established therapeutic options for the palliation of malignant biliary obstruction, it remains unclear which stricture or stent related factors affect the stent patency. Methods: Metallic Wallstents (Microvasive, Boston-Scientific, MA, U.S.A.) were inserted endoscopically in 68 patients (mean age; 70.2+8.5, M: F=38: 30) with malignant biliary obstruction. Patency rates were prospectively analyzed ac- cording to the characteristics of malignant strictures in cluding length, morphologic type and degree of stricture. Furthermore, patient age, initial serum bilirubin level, the length of stent, the adequate expansion time, and the location of the distal stent end were evaluated as possible factors affecting the stent patency. Stent patency was assessed using the survival analysis of the Kaplan-Meier estimation and Cox regression analysis. Results: Median overall stent patency was 231 days and overall rate of stent occlusion was 41,2% (28/68). The causes of stent blockage were tumoral ingrowth in 23 patients (33.8%), distal overgrowth of the cancer in 3 (4.4%), proximal overgrowth in 1 (1.5%) and sludge incrustation in 1 patient (1,5%). No significant differences in metallic stent patency rates according to primary tumor type, length and morphologic type of stricture, and length and location of distal end of the stent were found. Log-rank test and multivariate regression analysis, however, demonstrated that the degree of stricture assessed by cannula or guidewire passage and the adequate expansion time of the stent are independent factors associated with long-term metallic stent patency. Conclusions: Our study showed that early expansibility of the stent and easy passage of larger-caliber instruments over the stricture were favorable factors for long-term patency of the metallic stent. (Korean J Gastrointest Endosc 2001;23:100-108)

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비스테로이드성 소염진통제의 장기 사용으로 유발된 하행십이지장 협착 1 예 ( A Case of Stricture of Second Portion of Duodemum Induced by Chronic Use of Nonsteroidal Anti - inflammatory Drug in Patient with Ankylosing Spondylitis and Rheumathoid Arthritis ): Korean J Gastrointest Endosc 2001;23(2):109-112. Published online November 30, 2000

Abstract PDF: In endoscopic clinical research studies of patients who take NSAIDs, 10% to 20% of patients develop gastric ulcers and 4% to 10% develop duodenal ulcers. Ulcers associated with chronic NSAIDs use are typically painless and are located in the prepyloric region of the stomach. These characteristics make NSAIDs potential causes of gastric outlet obstruction. There were multiple cases of single or multiple strictures that were found in the esophagus, small bowel and colon. Most of duodenal strictures were confined to bulbar area. Only one case of duodenal second portion diaphragmlike stricture was reported in association with acetylsalicylic acid. We experienced one case of chronic NSAIDs induced duodenal 2nd portion stricture in ankylosing spondylitis and rhemathoid arthritis patient and reported with a review of literature. (Korean J Gastrointest Endosc 2001;23:109-112)

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스테로이드 치료에 관해를 보인 Cronkhite - Canada 증후군 1 예 ( A Case of Cronkhite - Canada Syndrome with a Remission to Steroid Therapy ): Korean J Gastrointest Endosc 2001;23(2):113-117. Published online November 30, 2000

Abstract PDF: Cronkhite-Canada syndrome is characterized by generalized gastrointestinal polyposis, ectodermal changes, and the eventual development of diarrhea and weight loss. The pathogenesis of the disease is unknown, and there is no established therapy. The disease has a poor prognosis because of malnutrition resulting from altered absorption in the gastrointestinal tract. We experienced a case of a 56-year-old female with Cronkhite-Canada syndrome. After enteral nutrition and administration of prednisolone for 3 months, clinical improvement was noted with cessation of diarrhea, increased serum protein, disappearance of pigmentation, and regrowth of the scalp hair, finger- and toenails, Endoscopy showed resolution of the gastrointestinal polyposis. So we report here a case of diffuse gastrointestinal polyposis which has been in remission with steroid therapy, (Korean J Gastrointest Endosc 2001;23:113-117)

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대장 내시경을 위한 장 세척 과정 중 발생한 Mallory - Weiss 증후군 2 예 ( Two Cases of Mallory - Weiss Syndrome During Bowel Preparation for Colonoscopy ): Korean J Gastrointest Endosc 2001;23(2):118-121. Published online November 30, 2000

Abstract PDF: Polyethylene glycol solutions have been usually available for clinical use since 1980 and been considered a standard method of bowel preparations for colonoscopy. There have been many reports about minor complications such as nausea and bloating associated with their use, which are frequently occurred. After ingestion of polyethylene glycol, vomiting occurrs less frequently but it can make major complication such as Mallory-Weiss syndrome and aspiration pneumonia. We have reported here two cases of Mallory-Weiss syndrome, which were occurred after ingestion of polyethylene glycol solution for colonoscopy. (Korean J Gastrointest Endosc 2001;23:118-121)

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다발성 용종으로 발현된 대장의 MALT 림프종 1 예 ( A Case of Mucosa - Associated Lymphoid Tissue Lymphoma of Colon as Multiple Large Polypoid Lesions ): Korean J Gastrointest Endosc 2001;23(2):122-126. Published online November 30, 2000

Abstract PDF: Mucosa-associated lymphoid tissue (MALT) lymphoma of colon usually presents with a solitary lesion of polypoid appearance but may rarely present with multiple polypoid lesions. MALT lymphoma of colon presented as multiple polypoid lesions are not easy to differentiate from multiple lymphomatous polyposis. We experienced a case of MALT lymphoma of colon with a large mass in proximal ascending colon involving ileocecal valve and multiple polypoid lesions in entire colon, (Korean J Gastrointest Endosc 2001;23:122-126)

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간암 절제술 후 후기 합병증으로 발생한 기관지담관루의 치료 1 예 ( Bronchobiliary Fistula as a Late Complication of Hepatic Resection ): Korean J Gastrointest Endosc 2001;23(2):127-131. Published online November 30, 2000

Abstract PDF: A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hemihe-patectomy, trauma, hydatid disease, choledocholithiasis, and other causes of biliary obstruction, BBF are rare complication of hepatic resection that can present from days to years after operation. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous trans-hepatic cholangiography (PTC) are the diagnostic studies of choice and offer the possibility of therapeutic intervention. Although large series in the literature emphasize the surgical management of BBF, the reoperative procedures tend to be complicated, with a significant morbidity and mortality. Nonsurgical intervention via ERCP or PTC are more recently notably successful when resolution of a distal biliary obstruction is accomplished. Only after aggressive attempts at nonoperative, interventional techniques have failed should operative approaches be entertained. We are reporting a case of BBF secondary to hepatic resection of hepatocellular carcinoma which was managed by surgical operation, (Korean J Gastrointest Endosc 2001;23:127-131)

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