Clinical Endoscopy

최근 역류성 식도염의 유병률 변화 - 건강 검진자군과 소화기 증상군을 대상으로 - ( Prevalence Alteration of Reflux Esophagitis in Recent Years ): Korean J Gastrointest Endosc 2001;23(3):144-148. Published online November 30, 2000

Abstract PDF: Background
/Aims: Reflux esophagitis is pertained to gastroesophageal refux disease. On recent studies, western GERD patients shows reflux esophagitis over than 50% on gastroscopy. We expect lower incidence of reflux esophagitis in Korea, but few epidemiological data are available for korean patients. We intended to investigate the alteration of incidence of reflux esophagitis by gastroscopy result for patients who visited general health screening center and department of gastroenterology with chief complaint of gastrointestinal symptoms. Methods: The 31,439 people of general health screening center visitors, 28,037 patients who visited department of gastroenterology due to gastrointestinal symptoms from March, 1996 to August, 1999 were underwent gastroscopy. And 24,952 patients who showed gastrointestinal symptoms and general health screening center visitors from March, 1993 to Feburary, 1996 were also underwent gastroscopy. The grading of esophagitis was based on the Savary-Miller classification and prevalence alteration of reflux esophagitis was investigated by retrospecive manner. Results: 1) Overall prevalence of general health screening people group and patients with gastrointestinal symptoms from March, 1993 to Feburary, 1996 was 2.08%. 2) Overall prevalence of general health sceening group from March, 1996 to August, 1999 was 2.37%. During the same period, Overall prevalence of patients with gastrointestinal symptoms was 3.69%. Overall prevalence was 2.96% and it was higher than that of 3 years ago (2.02%). Conclusions: On recent gastrofiberscopy studies, prevalence of reflux esophagitis is increasing. So further investigation is needed on the prevalence of reflux esophagitis over the whole country by prospective manner. (Korean J Gastrointest Endosc 2001;23:144-148)

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위절제 후의 역류성 위염에서 helicobacter pylori 감염의 영향 ( Effect of Helicobacter pylori Infection on Reflux Gastritis after Gastrectomy ): Korean J Gastrointest Endosc 2001;23(3):149-154. Published online November 30, 2000

Abstract PDF: Background
/Aims: Reflux gastritis after gastrectomy is believed to be due to reflux of bile into residual stomach. However the substances that cause gastritis have not yet been precisely defined. Helicobacter pylori (H. pylori) infection is considered one of the most important pathogenetic factors in gastritis. The prevalence of H. pylori infection and the role of its infection on reflux gastritis after gastrectomy were investigated. Methods: Eighty-one patients who had undergone subtotal gastrectomy were enrolled. Rapid urease test and histologic examinatin for H. pylori infection were perrormed during gastrofiberacopy. An eradication of H. pylori was attempted in fifteen H. pyori-positive patients who suffered from gastritis symptoms after gastrectomy. Follow-up endoscopy was performed more than 4 weeks afrtr the end of eradication treatment. Results: Forty-nine patients (60.5%) demonstrated H. pylori infection in their residual stomach. The histological gastritis score in patients with H. pylori infection was significantly higher than that without infection. Ten of the 15 patients (66.7%) with H. pylori infection had their infection successfully eradicated. And also their symptoms and histological gastritis score were significantly improved. Conclusions: H. pylori infection does play an important role on reflux gastritis after subtotal gastrectomy. (Korean J Gastrointest Endosc 2001;23:149-154)

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상부 및 하부 위장관 출혈의 감별에서 Blood Urea Nitrogen / Creatinine 비의 유용성 ( Efficacy of Blood Urea Nitrogen / Creatinine Ratio in Distinguishing Upper from Lower Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 2001;23(3):155-158. Published online November 30, 2000

Abstract PDF: Background
/Aims: When stools containing altered blood are the sole evidence for acute gastrointestinal bleeding, the bleeding source is uncertain. Because the absorption of blood products via the small intestine is responsible for azotemia after gastrointestinal bleeding, patients with colorectal bleeding rarely become azotemic. Therefore the blood urea nitrogen to creatinine ratio (BUN/Cr ratio) is believed to reliably discriminate upper gastrointestinal bleeding (UGIB) from lower gastrointestinal bleeding (LGIB). This study was conducted to evaluate the BUN/Cr ratio for distinguishing an upper versus lower source of gastrointestinal bleeding. Methods: Charts of patients who were admitted to Maryknoll hospital with the diagnosis of gastrointestinal bleeding from August 1994 to August 2000, were retrospectively reviewed for source of bleeding, initial blood urea nitrogen (BUN), creatinine (Cr), BUN/Cr ratio, hemoglobin, and hematocrit. Results: A total of 298 patients were eligible for inclusion, 210(70%) of whom were male. A total of 168 (56%) patients had and UGIB. Gastric ulcer disease (42%) and esophagenal varices (27%) were the most common causes of UGIB, whereas malignant neoplasm was etiologic in 29% of LGIB episodes. The mean±standard deviation BUN/Cr ratio was significantly higher in UGIB than LGIB (34.1±12.9 vs. 12.2±3.8; p<0.0001). Conclusions: The BUN/Cr ratio may be a useful tool in distinguishing upper from lower sources of gastrointestinal bleeding, especially in patients with an uncertain source that could be upper or lower in origin. (Korean J Gastrointest Endosc 2001;23:155-158)

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악성 담도협착증에서 내시경적 쇄자세포진 검사의 진단적 유용성 ( Usefulness of Endoscopic Brush Cytology from malignant Biliary Obstruction ): Korean J Gastrointest Endosc 2001;23(3):159-163. Published online November 30, 2000

Abstract PDF: Background
s/Aims: In patients with obstructive jaundice due to malignant biliary tract stricture, a tissue diagnosis is essential because the various treatment options are available. The tissue biopsy form the biliary tree is difficult because of the focal, sclerotic, small annular nature and lower celluarity. Brush cytology is and effective method for obtaining a tissue from bile duct stricture, and the diagnostic sensitivity of endoscopic brush cytology is reported as between 40% and 70% form malignant bile duct strictures. In this study, we analyzed the diagnostic value of endoscopic brush cytology in patient with extrahepatic bile duct strictures. Methods: The eight patients with extrahepatic bile duct strictures diagnosed with endoscopic retrograde cholangiopancretography underwent endoscopic brush cytology and aspiration bile cytology. Brushing were taken using a Greenen cytology brush passed with a guide wire through the stricture. Results: The final diagnoses were made by surgical pathology and clinical follow-up. The sensitivity of brush cytology (62.5%, 5/8) was significantly higher than the sensitivity of bile cytology (0%; 0/8). No procedure related complication occurred. Conclusions: Endoscopic brush cytology would be an effective and a relatively safe method for tissue diagnosis in patients with malignant biliary obstruction.

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식도암으로 오인된 원발성 식도 결핵 1 예 ( A Case of Primary Esophageal Tuberculosis Confused as Esophageal Cancer ): Korean J Gastrointest Endosc 2001;23(3):164-168. Published online November 30, 2000

Abstract PDF: Tuberculous involvement of the esophagus is very rare even in the presence of extensive pulmonary tuberculosis or in the endemic area. This is resulted from local extension to the esophagus from contiguous tuberculosis organs or miliary spread. Such secondary involvement is more common than primary tuberculosis, in which there is no evidence of tuberculosis elsewhere. The diagnosis of esophageal tuberculosis may be difficult. So the radioogic, endoscopic, histologic findings and clinical feature including the response to chemotherapy may be needed to avoid misdiagnosis. Most cases can be treated sucdessfrlly with antituberculosis medication. A 67-year-old man was admitted to our hospital complaining of swallowing difficulty for 2 months. On the gastrofibroscopic examination, 22 츠 sized protruding mass with central deep ulceration was discovered at the mid-esophagus. The biopsy showed the ulcer with chronic granulomatous inflammation and multinucleated giant cells consistent with tuberculosis. After antituberuculosis medication, the lesion of esophageal thberculosis was healed completely remaining minimal ulcer scar. (Korean J Gastrointest Endosc 2001;23:164-168)

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식도 궤양과 회맹장부 궤양을 동반한 베체트병 1 예 ( A Case Report of Esophageal and Ileocecal Valve Involvement in Behcet`s Disease ): Korean J Gastrointest Endosc 2001;23(3):169-173. Published online November 30, 2000

Abstract PDF: Behcet`s disease characterized by recurrent oral and genital ulceration and ocular inflammation has been recognized as a multi-system disorder with numerous manifestitions including gastrointestinal tract. Therminal ileum and cecum are the most frequently involved portions of the gastrointestinal tract in Behcet`s disease and esophageal involvement is very uncommon. We experienced a case of Behcet`s disease involved esophagenal and ileocecal region which had been diagnosed by endoscopy. A 20-year-old male was admitted by dysphagia and substernal discomfort. There was a history of recurrent aphthous stomatitis and genital ulcers. The large geographic ulcers surrounded with edematous mucosa were forund at mid esophagus and the huge ulcer with exudate was noted on ileocecal valve area in endoscopic examination. The microscopic finding of endoscopic biopsy showed chronic nonspecific inflammation with necrotic inflammatory exudate. Pathergy test was positive. So he was diagnosed as Behcet`s disease, and his symptoms and signs were resolved after steroid treatment. (Korean J Gastrointest Endosc 2001;23:169-173)

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위 천공과 거대점막주름을 동반한 Gastritis Cystica Profunda 1 예 ( A Case of Gastritis Cystica Profunda Associated with Gastric Perforation and Hypertrophic Gastric Folds ): Korean J Gastrointest Endosc 2001;23(3):174-178. Published online November 30, 2000

Abstract PDF: Gastritis cystica profunda (GCP) is a rare disease in which cystically dilated gastric foveolae or glands extend into the muscularis mucosae or below. The pathogenesis of GCP has been described as an interruption of the muscularis mucosae and migration of epithelial elements to submucosa caused by presence of suture materials after surgery or erosion of the gastric mucosa in chronic gastritis and ischemia. Macroscopically, GCP may present not only as a giant gastric mucosal folds but also as a submucosal tumor or as solitary or diffuse polyps. An endoscopic ultrasonographic (EUS) findings clearly differ from findings in the other disordes. The combination of EUS and mucosectomy appears to be very useful for the diagnosis of GCP. Therefore, all unnecessary surgical procedures should be avoided in cases of GCP. We report a case of GCP associated with gastric perforation which presented as diffuse giant gastric folds and clinically advanced gastric cancer was suspected. (Korean J Gastrointest Endosc 2001;23:174-178)

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간헐적 위출구 폐쇄를 유발한 위용종 3 예 ( Three Cases of Gastric Polyps Producing Intermittent Gastric Outlet Obstruction ): Korean J Gastrointest Endosc 2001;23(3):179-183. Published online November 30, 2000

Abstract PDF: The manifestations of gastric polyps vary, including abdominal pain, nausea, and vomiting or gastrointestinal bleeding. Sometimes large polyp of the stomach causes intermittent outlet obstruction. Most of gastric polyps that prolapse through the pylorus are peduculated adenomatous polyps located in the antral and prepyloric regions. Even though the polyps has no evidence of malignancy, the polyps producing pyloric obstruction should be removed by polypectomy or surgery. Herein we describe 3 cases of a large, benign, and pedunculated gastric polyp that led to intermittent gastric outlet obstruction with review of literatures. (Korean J Gastroites Endosc 2001;23:179-183)

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위를 침범한 베체트병 1 예 ( A Case of Behcet`s Disease with Gastric Involvement ): Korean J Gastrointest Endosc 2001;23(3):184-187. Published online November 30, 2000

Abstract PDF: Behcet's disease is characterized by mucocutaneousocular symptoms, namely recurrent stomatitis aphthosis, genital ulcer and ocular symptoms. Gastrointestinal tract involvement is common in Behcet's disease. In Korea, incidence of gastrointestinal tract involvement is 4.0~7.3% and the most common manifestation is ulceration of the bowel, localized to the terminal ileum, ileocecal vlave, and cecum, but gastric involvement is very rare. We experienced a case of Behcet's disease with gastric ulcer perforation and recurrent gastric ulcer after primary suture, selective vagotomy and pyloroplasty. We failed to improve the recurrent active gastric ulcers with Helicobacter pylori eradication and antiulcer medication. So we tried steroid and azathioprine therapy for 3 months and active ulcers were healed to multiple scarring ulcers. We would like to suggest this case as a Behcet's disease with gastric involvement. (Korean J Gastrointest Endosc 2001;23:184-187)

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궤양성 대장염에서 발생산 비호치킨 림프종 1 예 ( A Case of Malignant Lymphoma in Patient with Ulcerative Colitis ): Korean J Gastrointest Endosc 2001;23(3):188-191. Published online November 30, 2000

Abstract PDF: Ulcerative colitis has been recognized as a premalignant condition because a considerable proportion of patients with colitis eventually develop colorectal carcinoma at the site of the inflammatory disease. Malignant lymphoma occurring in cases of long-standing ulcerative colitis is rare. Cancer risk is positively correlated with duration and anatomic extent of colitis, but do not appear to be increased by early age at onset of disease. Patients with chronic ulcerative colitis should have periodic rectal and colonoscopic biopsies, and those with moderate to marked dysplasia require colectomy because of the increased risk of colon carcinoma. We report a case of malignant lymphoma in patient with ulcerative colitis. (Korean J Gastrointest Endosc 2001;23:188-191)

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다발성 직장 유암종 2 예 ( Two Cases of Multiple Carcinoid Tumors of the Rectum ): Korean J Gastrointest Endosc 2001;23(3):192-196. Published online November 30, 2000

Abstract PDF: Carcinoid tumors of the rectum are relatively uncommon and comprise only about one percent of all rectal neoplasms. Typically, rectal carcinoids present as small, solitary submucosal nodules and have benign course. But, multicentricity is rare. The frequency of an associated second malignancy is about 13%. The explanation of the high frequency of other neoplasms associated with carcinoid tumors is still unclear. We have experienced two cases of multiple carcinoid tumors of the rectum, one was coexisted with adenocarcinoma of the sigmoid colon. They presented with mass on the right inguinal area and hematochezia. Carcnoids was found incidentally. Because the tumors measured 15 mm or less in diameter, did not infiltrate beyond the submucosal layer and had no histological atypia, carcinoids was treated by endoscopic polypectomy and mucosal resection. Thereafter, one underwent surgery for adenocarcinoma of the sigmoid colon. Herein we present our experience with reviewed literatures. (Korean J Gastrointest Endosc 2001;23:192-196)

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선천적 배측 췌장 부분 발육 부전증 1 예 ( A Case of partial Agenesis of Dorsal Panacreas ): Korean J Gastrointest Endosc 2001;23(3):197-200. Published online November 30, 2000

Abstract PDF: Complete or partial agenesis of dorsal pancreas has been reported in a small number of pediatric and adult patients. A case of partial agenesis of dorsal pancreas was reported. This case was not associated with diabetes mellitus and pancreatic exocrine dysfunction, or abdominal pain. A 37-year-old man with chronic hepatitis B visited to our hospital due to further examination for chronic hepatitis B. Abdominal ultrasonography showed enlarged pancreatic head. Diagnosis was made by endoscopic retrograde cholangiopancreatography and computed tomography. Explorlaparotomy was not done. (Korean J Gastrointest Endosc 2001;23:197-200)

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