Clinical Endoscopy

Corelation between the Finding of Magnifying Endoscopy and Histologic Finding in the Helicobactor Pylori Induced Gastritis: Jae Young Jang, M.D., Jun Sung Jung, M.D., Gab Jin Cheon, M.D., Kwon Ho Ryu, M.D.,Bo Young Lee, M.D., In Seop Jung, M.D., Chang Beom Ryu, M.D., Jin Oh Kim, M.D.,Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D.,Chan Sup Shim, M.D., Boo Sung K; Korean J Gastrointest Endosc 2002;25(6):431-437. Published online December 30, 2002

Abstract PDF: Background
/Aims: This is the study to find diagnostic possibility of the H. pylori induced gastritis by using the magnifying endoscope. Methods: The objectives were 144 pathologies from 48 patients with gastritis. The three sites of gastric mucosa have been magnified up to 80 times by using the magnifying endoscope. According to the patterns of the collecting venule, they have been classified into 3 patterns; regular (R), irregular (I) and disappearance (D) pattern and biopsy of each part has been performed. Each tissue has been evaluated into five kinds of morphological index (point: 0∼3) by using an updated Sydney system. Results: In 144 collecting venule, R, I and D-pattern was 19, 67, 58, respectively. Regarding the total score of morphologic points, the point of R-pattern was less than that of D-pattern (p＜0.05). Regarding the infection of H. pyrori, the infection rate was 0%, 53.7%, and 60.3% in each pattern, and infection rate of R-pattern was less than other two patterns (p＜0.05). Regarding the activity of neutrophile, R-pattern was less than those of I and D-pattern (p＜0.05). Conclusions: Observance of the collecting venule of the gastric mucosa by magnifying endoscopy is considered to be useful when estimating the inflammation degree and H. pylori infection. (Korean J Gastrointest Endosc 2002;25:431⁣437)

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Comparison of Clinicopathologic Findings between Colorectal Adenoma with High Grade Dysplasia and Colorectal Carcinoma with Mucosal Invasion: Myoung Joo Ki, M.D., Hyun Duk Shin, M.D., Jae Duk Kim, M.D.,Jeong Eun Shin, M.D. and Chang Young Lim, M.D.; Korean J Gastrointest Endosc 2002;25(6):438-442. Published online December 30, 2002

Abstract PDF: Background
/Aims: The precancerous lesion of colorectal cancer is adenoma. Adenoma with high grade dysplasia has been known as the lesion having high malignant potentials. The cancer with invasion to mucosa is limted to the mucosa, and it is difficult to pathologically differentiate the adenoma with high grade dysplasia. Methods: Fifty three adenomas with high grade dysplasia (type I group) and 40 cancers with invasion to mucosa (type II group) for 4 years, were analyzed for the colonoscopic findings and pathological findings before and after EMR. Results: Mean ages were 57.0 years old for type I group and 60.4 for type II group. Chief complaint for colonoscopy was rectal bleeding (21.0%) for type I group, and rectal bleeding (35.0%) for type II group. Mean sizes of the lesions were 1.18 cm for type I group, and 1.71 cm for type II group. Locations of the lesion were rectum 43.4%, sigmoid colon 32.1%, proximal colon 24.5% for type I group, and rectum 45.7%, sigmoid colon 42.9%, proximal colon 11.4% for type II group. Shapes of the lesions were Is 46.9%, Ip 30.6%, Isp 18.4%, LST 4.1% for type I group, and Isp 34.2%, Ip 31.6%, Is 18.4%, LST 5%, IIa⁢depression 5%, Is⁢IIc 5% for type II group. Methods for therapy were EMR 60.4%, operation 1.9%, electrocoagulation 11.3%, observation 26.4% for type I group, and EMR 85.0%, operation 15.0% for type II group. Pathological agreement before and after EMR was 57.1% for type I group and 31.3% for type II group. Conclusions: Type II group had more rectal bleeding, larger, more Isp type, more EMR therapy, more pathological disagreement ratio before and after EMR, than type I group. (Korean J Gastrointest Endosc 2002;25:438⁣442)

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Efficacy of Percutaneous Treatment of CBD Stones Which Could: Jung In Seo, M.D., Dong Ki Lee, M.D., Yeun Jong Choi, M.D., Phil Ho Jeong, M.D.,Moon Young Kim, M.D., Dong Hoon Park, M.D., Hyun Soo Kim, M.D.,Soon Koo Baik, M.D. and Sang Ok Kwon, M.D.; Korean J Gastrointest Endosc 2002;25(6):443-448. Published online December 30, 2002

Abstract PDF: Background
/Aims: Common bile duct (CBD) stones can be removed by endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) in most cases. In addition, surgery or stenting as well as percutaneous transhepatic cholangioscopy (PTCS) with lithotripsy can be used to remove CBD stones also. In this study we evaluated the efficacy of percutaneous removal of CBD stones which could not be removed by per-oral endoscopic method. Methods: From Jan. 1998 to Sep. 2001, ERCP were tried to remove CBD stones in 395 patients. We reviewed causes of treatment failure through the peroral method and PTCS-results by the medical records and cholangiograms in 15 patients. Results: We successfully removed stones with PTCS in all 15 patients. The reasons for percutaneous approach were previous operation history in 8 (53.3%) and old age in 10 (66.7%). Mean number and size of stone were 4.4 and 17.4⁓13.1 mm, respectively. Complete fragmentation and removal of stones were achieved in a single session in 40%. Mean time to complete removal was 19 days. In 1 patient, bile peritonitis was developed but cured by conservative management alone. Conclusions: PTCS with or without lithoptripsy is an effective and safe method for the treatment of CBD stones which can not be removed by peroral endoscopic approach. (Korean J Gastrointest Endosc 2002;25:443⁣448)

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Neurofibroma of the Esophagus: Yong Dae Kwon, M.D., Hong Sik Lee, M.D., Won Seok Jeong, M.D., Du Rang Kim, M.D.,Yun Jung Chang, M.D., Young Hee Rho, M.D., Chul Hee Park, M.D., Yoon Tae Jeen, M.D.,Hoon Jai Chun, M.D., Soon Ho Um, M.D., Sang Woo Lee, M.D., Jai Hyun Choi, M.D.,Chang Duck; Korean J Gastrointest Endosc 2002;25(6):449-452. Published online December 30, 2002

Abstract PDF: Neurofibroma in gastrointestinal tract are presented as localized forms or in associated with neurofibromatosis. Previous reported cases were presented as relatively large sized esophageal mass and treated by surgical resection. However, a neurofibroma was found incidentally during endoscopy in this case. It was presented as palisade like solitary nodules with or without connecting mucosal bridges in lower esophagus. It was treated by mucosectomy and followed up without recurrence. (Korean J Gastrointest Endosc 2002;25: 449⁣452)

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A Case of Abdominal Actinomycosis Developed in Upper Gastrointestinal Tract: Jong Tae Baek, M.D., Dong Su Lee, M.D., Byoung Min Ahn, M.D., Kang Mun Lee, M.D.,Seong Hee Jang, M.D., Jin A Park, M.D., Yung Yi Chang, M.D., Sun Jong Jeong, M.D.,Jun Seok Kim, M.D., In Sik Chung, M.D., Doo Ho Park, M.D. and Hye Kyoung Lee, M.D.*; Korean J Gastrointest Endosc 2002;25(6):453-456. Published online December 30, 2002

Abstract PDF: Actinomycosis is a rare chronic suppurative disease caused by actinomyces species, which are normal flora in the oral cavity and gastrointestinal tract, and characterized by formation of sulfur granule. Actinomyces can affect cervicofacial, pulmonary, abdominal and pelvic area. However, abdominal and pelvic inflammations are less frequently observed. Most of abdominal actinomycosis develop after abdominal operation, trauma, inflammatory bowel disease or use of intrauterine devices. The definitive diagnosis was made after histopathological study of the tissues. Treatment is long-term antibiotic therapy. Herein, we report a case of a 69-year-old woman with an unusual form of abdominal actinomycosis after total gastrectomy. (Korean J Gastrointest Endosc 2002;25:453⁣456)

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A Case of Anisakiasis Diagnosed after Partial Resection of Ileum Due to Eosinophilic Ascites and Ileal Abscess: Moon Young Kim, M.D., Hyun Soo Kim, M.D., Dong Hoon Park, M.D., Yeun Jong Choi, M.D.,Soon Koo Baik, M.D., Dong Ki Lee, M.D. and Sang Ok Kwon, M.D.; Korean J Gastrointest Endosc 2002;25(6):457-460. Published online December 30, 2002

Abstract PDF: Eosinophilic enteritis is characterized by massive infiltration of eosinophil throughout the entire or each layer of intestinal wall with marked submucosal edema. The etiology of this disease is not clear until now, and parasite infestation should be considered as a cause of eosinophilic enteritis like this case. We experienced a case of eosinophilic enteritis manifested by intermittent periumbilical pain and bloody ascites. After partial resection of ileum, we confirmed the eosinophilic abscess from Anisakis infestation and successfully treated this patient without sequalae and report it with literatures review. (Korean J Gastrointest Endosc 2002; 25:457⁣460)

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A Case of Abdominal Actinomycosis Confirmed by Colonoscopic Biopsy: Dong Uk Kim, M.D., Dong Soo Han, M.D., Hang Lak Lee, M.D., Jin Bae Kim, M.D., Joon Yong Park, M.D., Oh Young Lee, M.D., Yong Cheol Jeon, M.D., Joo Hyun Sohn, M.D., Byung Cheol Yoon, M.D., Ho Soon Choi, M.D. and Joon Soo Hahm, M.D.; Korean J Gastrointest Endosc 2002;25(6):461-465. Published online December 30, 2002

Abstract PDF: Actinomycosis is a chronic pyogenic granulomatous disease, defined as infection caused by gram-positive anaerobic Actinomyces, mainly Actinomyces Israelii. It colonize in human oral cavity, gastrointestinal tract, or genital tract of female, and characterized by lesion that secretes sulfur granules. Generally, abdominal actinomycosis shows chronic disease progression without any typical clinical symptoms, sometimes forming an inflammatory mass within the abdominal cavity. Due to this fact, it is frequently mistaken as malignant neoplasm, diagnosed only after operation. We report this case after diagnosing abdominal actinomycosis without an open abdominal surgery ; colonoscopy and biopsy was carried out in a patient with mucosal changes and luminal narrowing of transverse colon on colon study, ultimately diagnosing abdominal actinomycosis without an open abdominal surgery. (Korean J Gastrointest Endosc 2002;25:461⁣465)

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A Case of Pseudomembraneous Colitis Associated with Ascites: Cheon Il Kang, M.D., Hyun Jeong Lee, M.D., Young Tak Kim, M.D., Young Hak Lee, M.D.,Seung Yeob Lee, M.D., Chang Min Cho, M.D., Won Young Tak, M.D., Young Oh Kweon, M.D., Sung Kook Kim, M.D., Yong Hwan Choi, M.D., Joon Mo Chung, M.D., Soo Kyung Lee, M.D.*; Korean J Gastrointest Endosc 2002;25(6):466-469. Published online December 30, 2002

Abstract PDF: Antibiotics associated colitis due to Clostridium difficile is a common nosocomial infection associated with significant morbidity. In severe cases, pseudomembraneous colitis may be associated with intraperitoneal fluid accumulation. However, the characteristics of the fluid are seldom described. This case report describes pseudomembraneous colitis patient who was presented with low serum-ascites albumin gradients and lymphocytic ascites, without the evidence of infection, malignancy, or inflammatory peritoneal disease. (Korean J Gastrointest Endosc 2002;25:466⁣469)

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Pyoderma Gangrenosum on the Sternal Area in Ulcerative Colitis: Chul Hee Park, M.D., Hoon Jai Chun, M.D., Yoon Tae Jeen, M.D., Rok Sun Jeong, M.D.,Kyung Oh Kim, M.D., Yong Sik Kim, M.D., Young Sun Kim, M.D., Hong Sik Lee, M.D.,Soon Ho Um, M.D., Sang Woo Lee, M.D., Jai Hyun Choi, M.D., Chang Duck Kim, M.D.,Ho Sang Ryu,; Korean J Gastrointest Endosc 2002;25(6):470-474. Published online December 30, 2002

Abstract PDF: Pyoderma gangrenosum is a painful, chronic, ulcerative skin disease of unknown cause. It commences as an erythematous papulopustule and rapidly evolves to form an area of frank ulceration with undermined, violaceous edges and a bright outer halo of erythema. An underlying systemic illness is present in more than 75 per cent of patients. Inflammatory bowel disease, either ulcerative colitis or Crohn's disease, is the most frequent. Pyoderma gangrenosum generally appears during the course of active bowel disease and frequently concur with exacerbations of colitis. However, they also occur in inactive colitis. Nor is there general agreement regarding the relationship between the duration, activity, and extent of bowel disease and the incidence and severity of the skin lesions. We experienced a case of pyoderma gangrenosum developed on the sternum with inactive ulcerative colitis and improved with corticosteroid, antimicrobial agents and topical dressing but recurred another site with active colitis. (Korean J Gastrointest Endosc 2002;25:470⁣474)

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Three Cases of Appendiceal Mucocele Diagnosed by Colonoscopic Examination: Moo Hyun Lee, M.D., Min Seok Choi, M.D., Hiun Suk Chae, M.D., Bo In Lee, M.D.,Young Seok Cho, M.D., Sung Soo Kim, M.D., Hwang Choi, M.D., Sok Won Han, M.D.,Chang Don Lee, M.D., Kyu Yong Choi, M.D., In Sik Chung, M.D., Hee Sik Sun, M.D.,Chang Hyuk Ahn, M.D; Korean J Gastrointest Endosc 2002;25(6):475-479. Published online December 30, 2002

Abstract PDF: Mucocele is a cystic dilatation of the vermiform appendix that contains mucous material. The symptoms are non- specific and the diagnosis is seldom made prior to surgery. The reported prevalence in appendectomy specimens at surgery is 0.2∼0.3%. We have recently experienced three cases of appendiceal mucocele by colonoscopic examination. Two cases showed "volcano sign" which is typical colonoscopic feature of a smooth mound with normal overlying mucosa surrounding the appenciceal orifice. The first case was a 67-year-old male who presented for diagnostic work-up of stomach cancer. Abdomen CT suggested appendiceal mucocele, and colonoscopy showed volcano sign of mucocele. The second case was a 56-year-old female patient who had a RLQ pain of 2 months duration. The presumptive diagnosis of appendiceal mucocele was made, and we performed appendectomy. The pathologic finding was a hyperplastic mucocele. The third case was a 48- year-old male who had one month history of RLQ pain. Colonoscopy showed markedly protruding mass in the lumen with hyperemic surface, and appendectomy was performed. The pathologic finding was a hyperplastic mucocele. (Korean J Gastrointest Endosc 2002;25:475⁣479)

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A Case of Ischemic Colitis with Massive Bleeding: Si Min Kim, M.D., Young Sook Park, M.D., In Su Jung, M.D., Jin Su Yang, M.D.,Yu Seoung Seo, M.D., Yeon Ho Joo, M.D., Tae Hun Kim, M.D., Yun Ju Cho, M.D.,Joon Kil Han, M.D.* and Jong Eun Joo, M.D.^†; Korean J Gastrointest Endosc 2002;25(6):480-483. Published online December 30, 2002

Abstract PDF: Ischemic colitis generally develops in the elderly patients with concomitant cardiovascular condition, diabetes mellitus, and renal insufficiency. This disease predominently occurs in the left colon, particularly splenic flexure and sigmoid colon. The most frequent symptoms include abdominal pain, diarrhea, alteration in bowel functions and hematochezia. Blood loss is usually minimal in most patients. Herein, we report a case of ischemic colitis which developed on ascending colon with massive bleeding. A 48-year-old man was admitted because of massive lower gastrointestinal bleeding for 7 days. He has underwent hemodialysis for thirteen years. Colonoscopy showed a circular ulcer on the ascending colon with partial stenosis and mass-like oozing lesion distal to the stenotic area. We performed right hemi-colectomy. Grossly, colon showed shallow ulceration and congested ileocecal valve coated with hemorrhage. Microscopically, ulcer bed showed thickened and fibrotic submucosa which had nearly obliterated atherosclerotic vessels. (Korean J Gastrointest Endosc 2002;25:480⁣483)

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A Case of Giant Cavernous Hemangioma of Transverse Colon Associated with Hematochezia: Yong Ho Choi, M.D., Young Hun Kim, M.D., Ji Wook Kim, M.D., Hwan Yeol Kim, M.D.,Sun Hae Lee, M.D., Bo Young Lee, M.D., Youn Suk Seo, M.D., Jeong Ho Ham, M.D.,Il Kwun Chung, M.D., Hong Soo Kim, M.D., Moon Ho Lee, M.D., Sun Joo Kim, M.D.and Hyun Deuk Cho, M; Korean J Gastrointest Endosc 2002;25(6):484-488. Published online December 30, 2002

Abstract PDF: Gastrointestinal hemangiomas are not common and congenital lesion. Intestinal bleeding is the most common symptom of it. Hemangiomas were classified with capillary, cavernous and mixed type. Cavernous hemangioma is most common. Colonic cavernous hemangioma is rare and are usually arising in the sigmoid colon or/and rectum. Transverse colonic cavernous hemangioma are very rare. Gastrointestinal hemangioma is commonly developed in childhood and in young adults. Fifty eight-year-old man who complained of hematochezia was admitted. Physical examination was unremarkable. Stool occult blood was positive. Abdominal computerized tomography show normal finding. Colonoscopic examination showed giant and bluish-purple colored vascular malformation, 15 cm in length with tough bleeding, on the transverse colon. The patient underwent segmental resection of transverse colon for confirmatory diagnosis and treatment. The final pathologic diagnosis of the resection lesion was cavernous hemangioma of the transverse colon. We report a case of giant hemangioma of the transverse colon associated with hematochezia, with review of relevant literature. (Korean J Gastrointest Endosc 2002;25:484⁣488)

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