Clinical Endoscopy

Endoscopic Mucosal Resection Using Insulated-tip Electrosurgical Knife: Young Soo Park, M.D., Seung Woo Park, M.D., Si Young Song, M.D., Tae Il Kim, M.D., Se Joon Lee, M.D., Jae Bock Chung, M.D. and Jin Kyung Kang, M.D.; Korean J Gastrointest Endosc 2003;26(6):397-404. Published online June 30, 2003

Abstract PDF: Background
/Aims: Endoscopic mucosal resection (EMR) has become a standard treatment for gastric mucosal neoplasm. A new EMR technique, using an insulated-tip electrosurgical knife (IT-EMR), was developed for large mucosal lesions. The aim of this study was to evaluate the efficacy and complication of IT-EMR. Methods: IT-EMR was performed for 28 gastric mucosal lesions in 27 patients. En bloc resection rate, complete resection rate and complications were evaluated. Results: IT-EMR was performed successfully in 27 lesions, and one lesion was failed because of the presence of a non-lifting sign. En bloc resections were achieved in 24 lesions (88.9%), and piecemeal resections in 3 lesions. Complete resections were achieved in 23 lesions (85.2%). There were 6 episodes (22%) of bleeding which were controlled completely by endoscopic treatment, and there was no perforation. Ten lesions (37%) were adenocarcinoma, 4 (14.8%) were high- grade dysplasia, and 12 (44.5%) were low-grade dysplasia. Conclusion: IT-EMR for large gastric mucosal neoplasm is a useful method for wide safety margin completeness of resection by en bloc resection. (Korean J Gastrointest Endosc 2003;26: 397⁣404)

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A Study on Clinical Characteristics of Mallory-Weiss Syndrome with Complicated Course: Hang Lak Lee, M.D., Dong Soo Han, M.D., Jong Pyo Kim, M.D., Jin Bae Kim, M.D., Joon Yong Park, M.D., Joo Hyun Sohn, M.D. and Joon Soo Hahm, M.D.; Korean J Gastrointest Endosc 2003;26(6):405-409. Published online June 30, 2003

Abstract PDF: Background
/Aims: Mallory-Weiss syndrome is a benign and self-limiting disease, but occasionally cases with complications are encountered. The aim of this study was to identify the risk factors for complicated course and predisposing factors of Mallory-Weiss syndrome, and its associated conditions. Methods: Fifty-nine patients diagnosed as having Mallory-Weiss syndrome were subjects of this study. Patients' medical records were reviewed retrospectively. A complicated course was defined if there was a need for transfusion of ＞6 pints, evidence of shock, rebleeding or angiographic or surgical interventions. Results: Risk factors for a complicated Mallory-Weiss syndrome in univariate analysis were the followings; low hemoglobin, melena, presence of visible vessel or active bleeding on initial endoscopy. In multivariate analysis, the presence of visible vessel and active bleeding on initial endoscopy were the only significant risk factors. Predisposing factors of Mallory-Weiss syndrome were as follows: vomiting after alcohol intake (62.7%), vomiting without alcohol (18.6%), nausea (1%), cough (1%), seizure (1%) and unknown etiology (13.6%). Associated medical conditions were as follows: alcoholic liver disease (45.8%), hiatal hernia (27.1%) and liver cirrhosis (18.6%). Conclusions: We suggest that the presence of visible vessel and active bleeding on initial endoscopy are a independent risk factors of Mallory-Weiss syndrome with a complicated course. In such patients, aggressive treatment and careful observations are essential. (Korean J Gastrointest Endosc 2003;26:405⁣409)

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Clinical Characteristics and Endoscopic Findings of Impacted Papillary Stone: Kwang Ro Joo, M.D., Dae Hyun Kim, M.D., Do Ha Kim, M.D. and Neung Hwa Park, M.D.; Korean J Gastrointest Endosc 2003;26(6):410-417. Published online June 30, 2003

Abstract PDF: Background
/Aims: Impacted papillary stone (IPS) may lead to complete biliary obstruction and acute cholangitis. We evaluated clinical characteristics and endoscopic findings of IPS. Methods: Data were obtained from patient recordings, radiologic and endoscopic reports in 14 patients. Results: All patients had severe epigastric pain, but only 3 patients showed typical presentation of acute cholangitis. Radiologically, IPS was not found in 6 patients, but subsequently found as be a single IPS (n=5) and sandy stones filled in the bile duct and gallbladder (n=1). All patients showed a bulging and swollen papilla. Patients (n=9) without peripapillary diverticulum, or with extradiverticular papilla showed more posteriorly displaced papillary orifice and more frequent mucosal changes compared with patients (n=5) with intradiverticular papilla or juxtapapillary diverticulum. The stones were completely removed in 11 patients endoscopically, and the remainders, who had intradiverticular papilla, underwent surgical treatment. Conclusions: To predict IPS, clinical assessment is very important because the only characteristic manifestation is severe epigastric pain and radiological studies seem to be occasionally insufficient for detecting IPS. The characteristic endoscopic findings of IPS are bulging and swollen papillae with posterioriy displaced orifice and frequent mucosal changes, which may be influenced by presence or absence, and types of peripapillary diverticulum. (Korean J Gastrointest Endosc 2003;26:410⁣417)

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Endoscopic Retrograde Cholangiopancreatography in Thirty-four Children: Sung Hee Jung, M.D.^‡, Kyung Mo Kim, M.D.*, Dong Wan Seo, M.D., Bo Hwa Choi, M.D.*, Chong Hyun Yoon, M.D.^†, Ji Yeol Yoon, M.D., Jung Ho Kim, M.D., Sung Koo Lee, M.D., Myung Hwan Kim, M.D. and Young Il Min, M.D.; Korean J Gastrointest Endosc 2003;26(6):418-425. Published online June 30, 2003

Abstract PDF: Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is being used with increasing frequency as a diagnostic and therapeutic tool in children with suspected disorders of the pancreaticobiliary tract. We reviewed ERCPs performed in children and investigated clinical indications and usefulness of ERCP. Methods: A total of 80 ERCPs were performed in 34 patients (age: 17 months∼15 yrs) at Asan Medical Center from 1994 to 2001. Adult side-viewing duodenoscope, Olympus JF or TJF, was used for all procedures. General anesthesia was used in 73% of the patients, whereas intravenous sedation was employed in the remainder. Results: Cannulation was successful in 77 attempts (96%). ERCP was commonly indicated for the evaluation of pancreatic disease (18 cases) such as acute pancreatitis (4), recurrent pancreatitis (4), chronic pancreatitis (9), and non-resolving acute pancreatitis (1). Biliary tract diseases (15 cases) were common bile duct stones (4), choledochal cyst (8), and traumatic or nontraumatic common bile duct stricture (3). Therapeutic ERCP (n=20) included sphincterotomy (55.9%), insertion of stents (12%), and removal of common bile duct stones or pancreatic duct stones with balloon or basket (32%). The complications were developed in 12 out of 80 attempts (15%) and resolved with medical management. Conclusions: ERCP seems to be a useful and relatively safe procedure in the evaluation of pancreaticobiliary disorders in children and also can be used for nonoperative treatment of these diseordrs. (Korean J Gastrointest Endosc 2003;26:418⁣425)

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Two Cases of Alimentary Tract Fistula Treated by Endoscopic Local Injection Therapy: Hyun Gun Kim, M.D., Jin Woong Cho, M.D.*, Soo Jin Park, M.D., Tae Hoon Lee, M.D., In Seop Jung, M.D., Bong Min Koh, M.D., Su Jin Hong, 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 S; Korean J Gastrointest Endosc 2003;26(6):426-430. Published online June 30, 2003

Abstract PDF: Gastrointestinal fistula is a disease of varying etiologies. It may occur spontaneously or as a result of an iatrogenic cause. Spontaneous fistula occurs as a result of an inflammatory process, malignancy or radiotherapy. The majority of fistula are caused by iatrogenic causes, most frequently as a complication of surgical intervention. Treatment of gastrointestinal fistulae usually consists of surgery and conservative management such as nutritional support and control of inflammation. Recently, it has been reported that gastrointestinal fistulae can be treated endoscopically using tissue adhesive agents such as Histoacryl^Ⱂ and fibrin glue. We report two cases of gastrointestinal fistulae that were successfully treated by endoscopic local injection therapy with a review of literature. (Korean J Gastrointest Endosc 2003;26:426-430)

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A Case of Metastatic Gastric Cancer Resulting from Mixed Germ Cell Tumor: Do Young Kim, M.D., Seong-Eun Yang, M.D., Chang-Whan Kim, M.D., Ji-Hoon Kim, M.D., Soon-Woo Nam, M.D., Jin Il Kim, M.D., Soo-Heon Park, M.D., Joon-Yeol Han, M.D., Jae Kwang Kim, M.D., Kyu Won Chung, M.D., Hee Sik Sun, M.D. and Kyo Young Lee, M.D.*; Korean J Gastrointest Endosc 2003;26(6):431-434. Published online June 30, 2003

Abstract PDF: Majority of metastatic stomach tumor is direct invasion from adjacent malignant lesions such as pancreatic carcinoma, hepatoma, colonic carcinoma which invade the stomach via gastrocolic ligament. Otherwise, metastatic involvement of the stomach as a result of solid tumors of extra-gastrointestinal origin is a rare occurrence, in about 0.2% to 1.7% of patients dying of solid tumors. The tumors which were most commonly reported hematogenous metastatic malignancy of the stomach are melanoma, lung carcinoma, breast carcinoma. We have experienced an unusual case in which a metastatic gastric germ cell tumor presented as an upper gastrointestinal bleeding in a 29-year-old man. He was hospitalized with complaints of melena and severe anemic appearance. We performed gastroscopy which revealed an fungating mass covered with dark pigmentation at the anterior wall of lower body of the stomach. Pathologic findings of the biopsy showed a metastatic mixed germ cell tumor of the stomach. We report this unusual metastatic mixed germ cell tumor of the stomach with a review of literatures. (Korean J Gastrointest Endosc 2003;26:431⁣434)

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A Case of Gastric Stricture Caused by Chemical Fertilizer: Jinwoong Cho, M.D. and Yongung Lee, M.D.; Korean J Gastrointest Endosc 2003;26(6):435-438. Published online June 30, 2003

Abstract PDF: Gastric stricture is caused by the ingestion of caustic materials, or by the involvement of a gastric infiltrating carcinoma. Corrosive injury-induced stricture is uncommon and the gastric injury caused by calcium fertilizer has not been reported in Korea. Once the diagnosis of gastric stricture is confirmed, an early definitive surgical intervention should be performed. Sometimes balloon dilatation on stricture may be attempted in suitable cases. We report a case of gastric stricture caused by ingestion of chemical fertilizer containing calcium and managed with radiologic balloon dilatation in a 73-year-old man. (Korean J Gastrointest Endosc 2003;26:435⁣438)

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A Case of Granular Cell Tumor of the Ascending Colon: Je Hyun Ryu, M.D., Min Ho Choi, M.D., Geun Suk Kim, M.D., Chang Soon Choi, M.D., Yo Ahn Suh, M.D., Hyun Joo Jang, M.D., Chang Soo Eun, M.D., Sea Hyub Kae, M.D. and Jin Lee, M.D.; Korean J Gastrointest Endosc 2003;26(6):439-442. Published online June 30, 2003

Abstract PDF: A 40-year-old woman was admitted with a history of intermittent abdominal pain at the right lower quadrant area. Colonoscopy showed a 1.5⁓1.5 cm sized polypoid lesion that had yellowish surface, central depression, and normal mucosal covering. The tumor was removed by endoscopic tumorectomy following injection of hypertonic saline solution with epinephrine for lifting the lesion. The tumor consisted of granular tumor cells which were positive for S-100 protein, NSE, and PAS stain. We report a case of granular cell tumor of the ascending colon with a review of the literature. (Korean J Gastrointest Endosc 2003; 26:439⁣442)

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A Case of Sporadic Adenomatous Polyposis Coli Combined with Rectal Cancer: Chul Young Kim, M.D., Yoon Tae Jeen, M.D., Ik Yoon, M.D., Ju Young Kim, M.D., Sun Min Park, M.D., Rok Sun Jung, M.D., Yong Sik Kim, M.D., Hong Sik Lee, M.D., Hoon Jai Chun, M.D., Sang Woo Lee, M.D., Soon Ho Um, M.D., Jai Hyun Choi, M.D., Chang Duk Kim, M.; Korean J Gastrointest Endosc 2003;26(6):443-447. Published online June 30, 2003

Abstract PDF: Adenomatous polyposis coli (APC) is a rare autosomal dominant disorder in which about 20∼30% of affected individuals do not have a family history. It is characterized by hundreds to thousands of adenomas in the colon. APC usually develops during the second or third decade of life. If the polyposis is not treated surgically, colorectal cancer can develop in almost all patients before age 40. We experienced a case of adenomatous polyposis coli combined with rectal cancer in a 26-year-old male patient complaining of low abdominal pain without a family history of APC. (Korean J Gastrointest Endosc 2003;26:443⁣447)

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A Case of Primary Pure Cholesterol Hepatolithiasis: Chul Ho Hyung, M.D., Myung-Hwan Kim, M.D., Gi Deog Kim, M.D., Sung Hee Pyo, M.D., Sung Hoon Moon, M.D., Hyeong-Su Kim, M.D., Young Ju Jung, M.D., Moon Hee Song, M.D., Sang Soo Lee, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D. and Young Il Min, M.D.; Korean J Gastrointest Endosc 2003;26(6):448-453. Published online June 30, 2003

Abstract PDF: In the past, most hepatolithiasis had been brown pigment stones in Korea. However, stones with high cholesterol content are found with increasing frequency. Abdominal ultrasonography is superior to CT for detection of cholesterol hepatolithiasis. The characteristic gross morphology of pure cholesterol hepatolithiasis shown by cholangioscopy is diagnostic. An effective medical management consists of stone removal by percutaneous transhepatic cholangioscopy and ursodeoxycholic acid for the prevention of recurrence. We here report a case of primary pure cholesterol hepatolithiasis with a review of the literature. A 29-year-old woman presented with right upper quadrant pain. Abdominal ultrasonography showed right intrahepatic duct stones. A cholangioscopy revealed typical cholesterol stones, mucosal hyperemia, and mild narrowing in stone-bearing intrahepatic duct. Cholangioscopic stone removal via the percutaneous transhepatic route was successfully performed. To prevent recurrence, ursodeoxycholic acid was administered. (Korean J Gastrointest Endosc 2003;26:448⁣453)

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