Clinical Endoscopy

Palliative Self-expandable Metal Stents for Malignant Gastric Outlet Obstruction: Bo Suk Kim, M.D., Jae Hyeon Moon, M.D., Dae Sik Kwon, M.D., Jin Kwang An, M.D., Jeong Heo, M.D., Gwang Ha Kim, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Mong Cho, M.D. and Ung Suk Yang, M.D.; Korean J Gastrointest Endosc 2003;26(3):119-124. Published online March 31, 2003

Abstract PDF: Background
/Aim: Gastric outlet obstruction due to malignancy causes various symptoms and malnutrition and so decreases the quality of life and shortens the survival. The aim of this study was to assess the feasibility, effectiveness, safety, and outcome of a self-expandable metal stent as a palliative methods. Methods: From January, 2000 to August, 2002, 29 consecutive patients (36 cases of stent insertion) with inoperable gastric outlet obstruction were treated palliatively with through-the scope stents (Nitis^ⰒTaewoong, Korea, 29 uncovered, 7 covered). All patients had malignancy. We reviewed the success rate, complications and clinical outcome. Results: There were 21 cases with advanced gastric cancer, 5 with pancreatic head cancer and 2 with cholangiocarcinoma. The other one had primary duodenal carcinoma. Technical success was achieved in thirty four cases (94.4%). After successful placement, 26 patients could eat soft or solid foods with careful education about foods impaction. During the follow-up (mean: 2.6 months, range: 1∼9 months), there were no procedure related early complication. Seven stent occlusion occurred due to tumor in-growth (6 case) and over-growth (1 case). Conclusions: Endoscopic self-expandable metal stent placement in patients with inoperable gastric outlet obstruction is a highly successful, safe and effective palliative method. (Korean J Gastrointest Endosc 2003;26:119⁣124)

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A Clinical Study on the Effect of Transcatheter Arterial Embolization in the Treatment of Peptic Ulcer Bleeding: Jun Sik Cho, M.D., Jun Pyo Chung, M.D., Kwang-Hun Lee, M.D.*, Sung Woo Choi, M.D., Sang Won Ji, M.D., Jung Il Lee, M.D., Se Joon Lee, M.D., Kwan Sik Lee, M.D., Sang In Lee, M.D. and Ki Whang Kim, M.D.*; Korean J Gastrointest Endosc 2003;26(3):125-132. Published online March 31, 2003

Abstract PDF: Background
/Aims: Transcatheter arterial embolization (TAE) has been increasingly used in the treatment of patients with gastrointestinal bleeding due to improved catheter and guidewire technologies and emergence of safer embolization materials. We evaluated the clinical characteristics of patients in whom TAE was performed and the outcome of the treatment. Methods: Eleven patients (M：F=9：2, mean age=60.6 years) underwent TAE between April 2001 and August 2002. Causes of bleeding were gastric ulcer in 9 cases and duodenal ulcer in 2 cases. Seven patients had comorbid diseases, but 4 patients did not. Results: Successful TAE without rebleeding was achieved in 10 of 11 patients (90.9%). One patient failed to respond to TAE and died due to multiorgan failure. Another patient died due to other causes despite a successful TAE. There were no TAE-related complications. Conclusions: TAE is a safe and effective modality in the treatment of patients with peptic ulcer bleeding who do not respond to endoscopic hemostasis. Thus, TAE seems to be included in the treatment algorithm of peptic ulcer bleeding regardless of surgical risks of patients and be placed before surgery, but prospective randomized studies are needed. (Korean J Gastrointest Endosc 2003;26:125⁣132)

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Percutaneous Transhepatic Therapy Using Cholangioscopy in Patients with Benign Bilio-Enteric Anastomotic Strictures: Jung-Ho Kim, M.D., Sung-Koo Lee, M.D., Do Hyun Park, M.D., Hyun Kuk Kim, M.D., Sun Young Kim, M.D., Sang Soo Lee, M.D., Dong-Wan Seo, M.D., Myung-Hwan Kim, M.D. and Young-Il Min, M.D.; Korean J Gastrointest Endosc 2003;26(3):133-140. Published online March 31, 2003

Abstract PDF: Background
/Aims: Percutaneous transhepatic therapy (PTT) is a non-operative procedure for anastomotic strictures after bilio-enteric anastomosis which cannot be reached via transpapillary route. The aim of this study was to evaluate immediate and long-term results of the PTT using cholangioscopy in patients with benign bilio-enteric anastomotic strictures. Methods: We conducted a retrospective analysis on 22 patients who had undergone PTT for bilio-enteric anastomotic strictures between October 1994 and March 2001. The follow-up duration was 12 to 79 months after PTT (mean 33.0 months). Results: The initial technical success rate was 100%, and the short-term morbidity and mortality rates were 13.5% and 0%, respectively. However, 9 patients developed recurrent strictures (40.9%) with a mean duration of 16.8 months (range: 2 to 38). The success rate without recurrence was 59.1% and the overall success rate was 77.3% when the procedures were repeated. The long term morbidity rate was 36%, but most morbidities resolved with medical treatments. In 18 patients (81.8%), bile duct stones were combined and successfully treated by percutaneous transhepatic cholangioscopy (overall clearance rate: 94.4%, recurrence rate: 39.8%). Conclusions: The PTT using cholangioscopy in patients with benign bilio-enteric anastomotic strictures is a safe and effective method, and it appears a minimally invasive alternative to surgery. (Korean J Gastrointest Endosc 2003;26:133⁣140)

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A Case of Spontaneous Submucosal Dissection of the Esophagus: Dae Sik Kwon, M.D., Jae Hyeon Moon, M.D., Jin Kwang An, M.D., Bo Suk Kim, M.D., Yeong Mok Bae, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Mong Cho, M.D. and Ung Suk Yang, M.D.; Korean J Gastrointest Endosc 2003;26(3):141-145. Published online March 31, 2003

Abstract PDF: Spontaneous submucosal dissection of the esophagus is a rare esophageal disorder which reveals characteristic features on radiologic and endoscopic examinations. It usually presents with acute epigastric pain, typically accompanied by dysphagia and odynophagia. We experienced a case of a 56-year-old man complaining of chest discomfort and right upper quadrant abdominal discomfort. The findings of upper gastrointestinal endoscopy and barium esophagogram were compatible with submucosal dissection of the esophagus. Chest CT scan showed multiple ulcers that formed a longitudinal tunnel canal. The patient was managed conservatively with nothing by mouth and intravenous hydration. Forty days after the first upper gastrointestinal endoscopy, the patient's symptoms disappeared completely and the massive dissection of the esophagus was much improved except for slight depression on the upper esophagus. (Korean J Gastrointest Endosc 2003;26:141⁣145)

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A Case of Crohn's Disease Confined to the Stomach: Yun Yee Hwang, M.D., Yong Ki Jo, M.D., Jae Moon Cha, M.D., Kung Hwan Kim, M.D., Il Hwan Na, M.D., Dong Hyeon Lee, M.D., Hong Seong Ha, M.D., Sang Hyun Kim, M.D. and Chul Soo Song, M.D.; Korean J Gastrointest Endosc 2003;26(3):146-149. Published online March 31, 2003

Abstract PDF: Although Crohn's disease is usually found in the ileum and colon, it can be located in the whole gastrointestinal tract from the oral cavity to the anus. The frequency of gastroduodenal Crohn's disease is rare and is reported to range between 0.5% and 4.0% in Crohn's disease. And when Crohn's disease does involve the upper gastrointestinal tract, there is nearly always concomitant disease in the small bowel and colon. Very rarely, isolated Crohn's disease of the stomach and duodenum may occur. Definite diagnosis requires histologic confirmation, however, endoscopic biopsies often fail to reveal granuloma. Thus, if absence of definite histologic findings, combining clinical, radiologic and endoscopic findings suggest this condition. We experienced a first case of Crohn's disease confined to stomach and reported with review of the literature. (Korean J Gastrointest Endosc 2003;26:146⁣149)

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Two Cases of Gastritis Cystica Profunda Diagnosed by Endoscopic Polypectomy: IL Hwan Na, M.D., Yong Ki Cho, M.D., Jae Moon Cha, M.D., Kyung Hwan Kim, M.D., Yun Yee Hwang, M.D., Dong Hyeon Lee, M.D., Hong Seong Ha, M.D., Jae Seung Lee, M.D., Sang Hyun Kim, M.D. and Chul Soo Song, M.D.; Korean J Gastrointest Endosc 2003;26(3):150-153. Published online March 31, 2003

Abstract PDF: Gastritis cystica profunda (GCP) is a rare disease in which mature glandular epithelium extends into the muscularis mucosae or below. Mainly GCP lesions developed at gastroenterostomy stomas. We experienced two cases of GCP which were not related with any gastric surgery. The first case was 76-year-old woman who visited for epigastic pain and dyspepsia. The second case was 55-year-old woman complaining right upper quadrant pain. The polyps are found on the greater curvature of the antrum at first case, and on the lesser curvature of the antrum at second case. Each polyp was successfully removed by polypectomy. (Korean J Gastrointest Endosc 2003;26:150⁣153)

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A Case of Large Duodenal Ulcer Associated with Candida Albicans: Ji-Yoon Cho, M.D., Hye-Kyung Jung, M.D., Doe-Young Kim, M.D., Il-Hwan Moon, M.D. and Min-Sun Cho, M.D.*; Korean J Gastrointest Endosc 2003;26(3):154-157. Published online March 31, 2003

Abstract PDF: Candida can be a part of normal human flora, but can be harmful in immunocompromised patients. While oral or esophageal moniliasis can be found in healthy people or gravely ill patients, ulceration of the duodenum is far less common. Acid-reducing drugs such as H2 receptor blocker increase growth of microbes, including fungus, and candidal invasion is regarded as rare one of the factors that are associated with failure to respond to H2 receptor blocker therapy. Recently, we experienced a case of atypical duodenal ulcer which was found in a patient with iatrogenic Cushing's syndrome and diabetes mellitus and failed to respond to H2 receptor blocker therapy. Fungal spores and hyphae were histologically identified from the biopsy specimens that were obtained from the margin of the duodenal ulcer, and this fungus was confirmed as Candida albicans by blood culture. It should be considered that in immunocompromised patients, gastroduodenal ulcers can be caused by fungal infection. (Korean J Gastrointest Endosc 2003;26:154⁣157)

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A Case of Cytomegalovirus (CMV) Colitis in a Patient after Splenectomy: Sang Yol Chon, M.D., Yun Jeong Lim, M.D., Mi Young Kim, M.D*., Jung Rye Kim, M.D^†., Dong Hyun Lee, M.D., Ju Rak Ma, M.D., Ga Young Lee, M.D., Choon Kwan Kim, M.D., Su Hyun Yang, M.D., and Jong Hun Byun, M.D.; Korean J Gastrointest Endosc 2003;26(3):158-162. Published online March 31, 2003

Abstract PDF: Cytomegalovirus (CMV) is the most common cause of life-threatening opportunistic viral infection in patients with acquired immunodeficiency syndrome (AIDS). However, CMV infection may occur in the immunocompetent individuals. CMV colitis has not been reported in a patient with splenectomy in Korea. Recently, we experienced a case of fatal CMV colitis in a patient with splenectomy. A 69-year-old man complained of bloody mucoid diarrhea and abdominal pain for 2 months. He had the splenectomy 6 months ago. CMV colitis was diagnosed by colonoscopy and pathologic examination. He died of sepsis in spite of antiviral ganciclovir therapy. (Korean J Gastrointest Endosc 2003;26:158⁣162)

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A Case of Stercoral Ulcer in the Proximal Colon: Seong-Eun Kim, M.D., Sung-Ae Jung, M.D., Ki-Nam Shim, M.D., Jung Mi Kwon, M.D., Ji Young Park, M.D., Chang Yoon Ha, M.D., Soo Hyun Park, M.D., Kwon Yoo, M.D. and Il-Hwan Moon, M.D.; Korean J Gastrointest Endosc 2003;26(3):163-166. Published online March 31, 2003

Abstract PDF: Stercoral ulcer is the ulcerated colonic mucosa due to the pressure effects of hard, scybalous feces. It is a rare clinical entity that usually occurs in the elderly, or the bedridden patients with chronic constipation, and usually located in the rectosigmoid area. If stercoral ulcer is presented with fatal complications such as massive hemorrhage or perforation, emergent operation is needed. There has been very few reports of stercoral ulcer found in the proximal colon. We experienced an unusual case of stercoral ulcer in the proximal colon in a middle-aged woman who had not suffered any organic disease, and she recovered completely after medical conservative treatment only, so we report this case with a review of the literature. (Korean J Gastrointest Endosc 2003;26:163⁣166)

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A Case of Mucin-hypersecreting Biliary Papillomatosis ⁣Including Review of Korean Literatures⁣: Dae Kyoum Kim, M.D., Myung Hwan Kim, M.D., Kyoung Min Park, M.D., Yoon Seon Lee, M.D., Kwi Sook Choi, M.D., Hyun Soon Song, M.D., Jong Seok Bae, M.D., Hyun Jun Kim, M.D., Sang Soo Lee, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D., Young Il Min, M.D., Youn; Korean J Gastrointest Endosc 2003;26(3):167-171. Published online March 31, 2003

Abstract PDF: The mucin-hypersecreting bile duct tumor is rare and its clinical, radiologic, and pathologic features are not well known. We report the case of mucin-hypersecreting biliary papillomatosis with malignant transformation including review of 11 korean literatures. A 65-year-old female was admitted to our hospital with fever, chills, and right upper quadrant pain. A CT scan showed marked dilatation of left intrahepatic duct with intraductal filling defects. During endoscopic retrograde cholangiograpy, mucin from the ampulla was observed and dilated common bile duct with multiple amorphous filling defects was noted. Cholangioscopy revealed muliple coral-like mucosal papillary projections with large amount of mucin in the left intrahepatic ducts. The patient underwent left lobectomy, and the biopsy revealed intraductal papillary adenocarcinoma in the background of papillary adenoma. (Korean J Gastrointest Endosc 2003;26:167⁣171)

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Intraductal Papillary Mucinous Tumor of the Pancreas Still Resectable 5 Years after Diagnosis: Kwi Sook Choi, M.D., Myung Hwan Kim, M.D., Yoon Seon Lee, M.D., Jin Young Kim, M.D., Dae Kyoum Kim, M.D., Hyun Soon Song, M.D., Jong Seok Bae, M.D., Hyun Jun Kim, M.D., Sang Soo Lee, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D., Young Il Min, M.D., Jung S; Korean J Gastrointest Endosc 2003;26(3):172-176. Published online March 31, 2003

Abstract PDF: Intraductal papillary mucinous tumor (IPMT) of the pancreas is a spectrum of conditions ranging from benign to malignant. It is known that the biologic behavior of IPMT is slower and less aggressive than that of pancreatic ductal carcinoma. We report a case of IPMT of pancreas resected 5 years after diagnosis. The carcinoma remained localized without evident stromal invasion or lymph node metastasis with the background of adenoma, suggesting a adenomacarcinoma sequence. This is a case report that may be helpful to study the natural history of IPMT, particularly slow progression of IPMT. (Korean J Gastrointest Endosc 2003;26:172⁣176)

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A Case of Idiopathic Granulomatous Pancreatitis: Jae Ho Lee, M.D., Eun Taek Park, M.D., Young Min Lee, M.D., Jae Kyung Lee, M.D., Min Ki Kim, M.D., Sung Youn Yang, M.D., Bong Ki Choi, M.D., Yun Sik Jang, M.D., Sang Hyuk Lee, M.D., Sang Young Seol, M.D., Jung Myung Chung, M.D., Chang Soo Choi, M.D.*, You; Korean J Gastrointest Endosc 2003;26(3):177-181. Published online March 31, 2003

Abstract PDF: Granulomatous pancreatitis is a rare disorder and recognized rarely during life or non-operatively. Noncaseating granulomas in the pancreas, histologically indistinguishable from sarcoidosis, can be seen in a variety of diseases such as tuberculosis, fungal infection, berylliosis, Hodgkin's disease, non-Hodgkin's lymphoma and Crohn's disease. Therefore, as with other granulomatous diseases, a tissue biopsy is essential for the diagnosis. Its clinical presentation is often similar to pancreatic cancer, with common presenting symptoms including abdominal pain, weight loss, jaundice, and anorexia. We report a case of idiopathic granulomatous pancreatitis in a 56-year-old women whose clinical and radiographic findings were suggestive of pancreatic cancer. (Korean J Gastrointest Endosc 2003; 26:177⁣181)

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