Clinical Endoscopy

The Expression of Melanoma-Antigen Gene A1-6 during the Carcinogenesis of the Colon: Jung Sup Um, M.D.*, Jeen Kyung Park, M.D.†, Moo In Park, M.D.‡, Ja Young Koo, M.D.‡, Min Jung Jeong, M.D.†, Hee Sung Park, M.D.* and Hee Kyung Chang, M.D.†; Korean J Gastrointest Endosc 2003;27(6):509-514. Published online December 30, 2003

Abstract PDF: Background
/Aims: Melanoma antigen gene (MAGE)-A which have more than 12 subtypes is a gene family for tumor specific shared antigens, recognized by the cytotoxic T cell. Since these genes are expressed only in tumor cells and silent in normal adult tissues except in the male germ line, they may be used as diagnostic markers in detecting malignancy. During the carcinogenesis of gastrointestinal tract, the hyperplastic epithelium- adenoma-adenocarcinoma sequence is largely accepted and the molecular studies on each step have been issued. However, in the aspect of carcinogenesis in the gastrointestinal tract, MAGE genes have not studied yet. To explore the functional role and clinical significance of MAGE-A genes in the carcinogenesis of the colon, mRNA expression of MAGE-A1 to -A6 in the mucosal tissues obtained from the colonoscopy was investigated and the relationship between their expressions and clinicopathologic parameters was analysed. Methods: We investigated the expression of MAGE 1∼6 in 65 endoscopically biopsied samples of neoplastic and nonneoplastic tissues from the colon, using a MAGE common primer by the reverse transcription-nested polymerase chain reaction and DNA sequencing. Results: Of the 31 colorectal adenocarcinoma specimens examined, MAGE genes were expressed in 11 cases (36%). In contrast, no expression of these genes was observed in any of the 12 samples of tubular adenoma and 12 of non-specific colitis and 5 cases of normal colonic tissues. There was no significant correlation between the expression of the MAGE genes and clinicopathologic factors, such as gender, disease stage, lymph node metastasis and perineural and vascular invasion in colonic carcinoma. Conclusions: It is postulated that the expression of MAGE genes could reflect the late event of oncogenesis of the colon because no MAGE expression was noticed in chronic inflamamtion and adenomas which might have the important role in the process of malignant transformation. (Korean J Gastrointest Endosc 2003;27:509⁣514)

2,170 View
2 Download

Effectiveness of Single-dose Sodium Phosphate on Bowel Preparation: Kang-Wook Chung, M.D., Jin-Il Park, M.D., Jong-Hyuk Park, M.D., Do-Yeon Hwang, M.D., Hyung-Hwa Lee, M.D., Dong-Soo Lee, M.D., Dong-Hoon Kwack, M.D., Ji-Young Seo, M.D., Jae-Jin Jung, M.D., Young-Hak Lee, M.D., Young-Sung Kim, M.D. and Dong-Hyup Kwak, M.D; Korean J Gastrointest Endosc 2003;27(6):515-520. Published online December 30, 2003

Abstract PDF: Background
/Aims: Oral sodium phosphate has been shown to be effective and safe but causes intravascular volume contraction, changes in serum calcium and phopshate level, and sleep disturbance when given two doses every 12 hours. Because the evening dose is inconvenient for many patients, we gave single morning dose, and compared it with conventional 12-hour-split dose. Methods: Sixty one patients drank 90 mL of sodium phosphate at 7:00 AM and 58 patients drank 45 mL of sodium phosphate at 7：00 PM and 7：00 AM respectively. Results: There was no statistical difference in bowel cleansing between two groups (p=0.871). There was no significant difference in patient's tolerance and symptoms between two groups except sleep deprivation which was more frequent in the split dose group. None of the patients complained of postural dizziness or presyncope in both groups. Serum phosphate levels were increased and serum calcium levels were decreased after preparation in both groups, but patients showed no significant clinical symptoms such as tetany. Conclusion: This study suggests that giving a single morning dose of sodium phosphate is effective, well tolerated and safe in most patients for precolonoscopic cleansing, compared to conventional split dose of 12-hour interval. (Korean J Gastrointest Endosc 2003;27:515⁣520)

1,853 View
6 Download

Identification of Patients More Susceptible to Severe Anal Pain after Colonoscopy and Effect of Topical Treatment of Lidocaine Gel in Reducing the Anal Pain: A Prospective, Randomized, Controlled Study (Identification and Management of Patients Susceptible to Severe Anal Pain after Colonoscopy): Seong-Eun Kim, M.D., Sung-Ae Jung, M.D., Ki-Nam Shim, M.D., Yu Kyung Cho, M.D., Jung Mi Kwon, M.D., Chung Hyun Chun, M.D., Jeong Eun Shin, M.D. and Kwon Yoo, M.D.; Korean J Gastrointest Endosc 2003;27(6):521-526. Published online December 30, 2003

Abstract PDF: Background
/Aims: The aim of this study was to identify which patients are more susceptible to severe anal pain after colonoscopy and to determine the usefulness of lidocaine gel in reducing the anal pain. Methods: A prospective trial was performed with 150 consecutive outpatients who underwent a colonoscopic examination. The patients were randomized into three groups: they received topical treatment of lidocaine gel (n=48) or lubricant gel (chlorhexidine gluconate) (n=48), or no treatment (n=54) just after the procedure. Data regarding the procedures were collected and the patients were phone-interviewed on the next day. Results: Seventy of 150 (46.7%) had moderate to severe pain (VAS score≥4). A multiple regression analysis found that the presence of hemorrhoid was significantly (p＜0.05) associated with severe anal pain after colonoscopy. Among three groups, there was no significant difference of the pain scores on the procedure day on the next day. However, patients' subjective evaluation about the usefulness of the gel was significantly better in the lidocaine group than in the placebo group in patients who had moderate to severe pain (79.2% vs. 43.5%, p＜0.05). Conclusions: A palliative management is more required for patients who complain moderate to severe pain just after colonoscopy or those with hemorrhoid (Korean J Gastrointest Endosc 2003;27:521⁣526)

2,353 View
14 Download

Endoscopic Treatment of Spontaneous Intramural Dissection of the Esophagus: A Case Report: Young Mi Yoon, M.D., Jin Hyung Park, M.D., Dong Woo Hyun, M.D., Chang Keun Park, M.D., Chang Min Cho, M.D., Won Young Tak, M.D., Young Oh Kweon, M.D., Sung Kook Kim, M.D. and Yong Hwan Choi, M.D.; Korean J Gastrointest Endosc 2003;27(6):527-530. Published online December 30, 2003

Abstract PDF: Intramural dissection of the esophagus is a rare esophageal disorder which reveals characteristic endoscopic and radiologic features. Some authors have recognized that this injury is an intermediate stage between a transmural esophageal rupture (Boerhaave's syndrome) and an esophageal mucosal tear (Mallory-Weiss syndrome). Presenting symptoms are sudden severe retrosternal pain, hematemesis, odynophagia, and dysphagia. The diagnosis is made by contrast esophagography, esophageal endoscopy, or both. Conservative management is usually successful. Surgery should be reserved for the cases of protracted disease or perforation with mediastinitis. We report a case of spontaneous intramural esophageal dissection, in which the symptom of dysphagia did not improve with a conservative management. Then we treated with an endoscopic incision of the septum between the true and false lumens using a needle type papillotome. (Korean J Gastrointest Endosc 2003;27:527⁣530)

1,997 View
3 Download

A Case of a Giant Brunner's Gland Hamartoma Originating from the Pyloric Ring: Yon Soo Jeong, M.D., Jun Pyo Chung, M.D., Dok Yong Lee, M.D., Young Kim, M.D., Hee Jung Yoon, M.D., Sang Won Ji, M.D., Yong-Han Paik, M.D., Se Joon Lee, M.D., Kwan Sik Lee, M.D., Sang In Lee, M.D. and Chanil Park, M.D.*; Korean J Gastrointest Endosc 2003;27(6):531-535. Published online December 30, 2003

Abstract PDF: Brunner's gland hamartoma, also called as Brunner's gland adenoma or Brunner's gland hyperplasia, is a relatively rare disease that results from benign proliferation of the Brunner's gland normally present in the duodenum. It is mostly located at the duodenal bulb, occasionally second or third portion, but is rarely found at the pyloric ring, jejunum or proximal ileum. In Korea, total 27 cases of Brunner's gland hamartoma have been reported, but none of them had their origin at the pyloric ring only. We report a case of Brunner's gland hamartoma, found incidentally, originating from the pyloric ring in a 54-year-old woman, which was resected endoscopically after retracting the tumor into the stomach. (Korean J Gastrointest Endosc 2003;27:531⁣535)

2,002 View
2 Download

A Case of Metastatic Gastric Synovial Sarcoma: Yong Leul Oh, M.D., Yoon Tae Jeen, M.D., Yong Sik Kim, M.D., Rok Son Choung, M.D., Young Sun Kim, M.D., Chul Hee Park, M.D., Hoon Jai Chun, M.D., Hong Sik Lee, M.D., Sang Woo Lee, M.D., Soon Ho Um, M.D., Jai Hyun Choi, M.D., Chang Duck Kim, M.D., Ho Sang; Korean J Gastrointest Endosc 2003;27(6):536-540. Published online December 30, 2003

Abstract PDF: Synovial sarcomas are malignant soft tissue neoplasms that develop from tendon and bursa near the large joints and frequently occur in the lower extremities of young male adults. They usually recur within 2 years after surgical treatment. The lung is a common metastatic site and rarely reported as the primary site of synovial sarcoma. The stomach is a very rare primary site of synovial sarcoma and recently only two cases of primary gastric synovial sarcoma were reported. We report a case of metastatic gastric synovial sarcoma in a 53-year-old male 4 years after surgical treatment of primary lung synovial sarcoma. The tumor had histologic, immunohistochemical and ultrastructural features of biphasic synovial sarcoma of the soft tissue. (Korean J Gastrointest Endosc 2003;27:536⁣540)

1,817 View
9 Download

A Case of Gastritis Cystica Polyposa Presenting as Multiple Polypoid Lesions: Hyun Hee Lee, M.D., Hwa Min Kim, M.D., Jae Gun Lee, M.D., Yoo Hyun Jang, M.D., Hae Jin Choi, M.D. and Kye Heui Lee, M.D.; Korean J Gastrointest Endosc 2003;27(6):541-544. Published online December 30, 2003

Abstract PDF: Gastritis cystica polyposa (GCP) is a rare lesion characterized by hyperplastic and cystic dilatation of the gastric mucous glands infiltrating into the underlying submucosa. A cumulative experience suggests that GCP represents a manifestation of a spectrum of reactive inflammatory responses to mucosal injury. The case reported herein is a GCP developed as multiple polypoid lesions with a circular arrangement in the gastric mucosae along the gastrojejunostomy site. (Korean J Gastrointest Endosc 2003;27:541⁣544)

2,039 View
1 Download

A Case of NSAID Induced Small Bowel Ulcer Bleeding Diagnosed by Capsule Endoscopy: Yong Sik Kim, M.D., Hoon Jai Chun, M.D., Yoon Tae Jeen, M.D., Rok Son Choung, 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, M.D. and Jin Hai Hyun, M.D.; Korean J Gastrointest Endosc 2003;27(6):545-548. Published online December 30, 2003

Abstract PDF: The small intestine has always been a problematic segments for endoscopic exploration in patients with obscure gastrointestinal bleeding. Recent emergence of capsule endoscopy has entailed a relevant diagnostic imaging advance for gastrointestinal conditions. Capsule endoscope can be used to detect small bowel bleeding. Some studies report that capsule endoscopy has the high diagnostic yield and is superior to enteroscopy and other diagnostic methods. We report here the first case of small bowel bleeding detected by using capsule endoscope in Korea, in a woman with hematochezia and a history of aspirin ingestion. (Korean J Gastrointest Endosc 2003;27:545⁣548)

2,081 View
8 Download

A Case of Adenomyoma Causing Jejunal Bleeding: Hyoung Jin Kim, M.D., Jin-Woo Lee, M.D.*, Seok Jung, M.D.*, Jung Il Lee, M.D.*, Pum-Soo Kim, M.D.*, Don Haeng Lee, M.D.*, Hyung Gil Kim, M.D.*, Yong Soo Kim, M.D.*, Myung Jun Kim, M.D., Pil Soo Lee, M.D. and Young Sam Kim, M.D.; Korean J Gastrointest Endosc 2003;27(6):549-552. Published online December 30, 2003

Abstract PDF: Adenomyoma, a benign tumor generally considered to be a form of pancreatic heterotopia, is composed of smooth muscle and undifferentiated columnar epithelium. A 62-year-old female was admitted with melena. Small bowel enteroscopy using a pediatric colonoscope revealed a small sized nodular mass with active bleeding in the proximal jejunum. After a endoscopic resection of the tumor, the bleeding ceased. Histologic examination disclosed an adenomyoma. We report a case of the adenom- yoma causing jejunal bleeding with a review of the literature. (Korean J Gastrointest Endosc 2003;27:549⁣552)

1,598 View
2 Download

A Case of Anorectal Actinomycosis: Soon Ok Oh, M.D., Sang Ho Moon, M.D., Su Ho Kim, M.D., Gwang Ho Baik, M.D., Jin Bong Kim, M.D., Dong Joon Kim, M.D., Hae Sung Kim, M.D.*, Hong Ki Kim, M.D.* and Young Hee Choi, M.D.†; Korean J Gastrointest Endosc 2003;27(6):553-557. Published online December 30, 2003

Abstract PDF: Actinomycosis is an indolent, slowly progressive infection caused by actinomyces species that normally colonize the mouth, colon, and vagina, characterized by sulfur granule formation. Actinomycosis can affect multiple organs, with local or systemic manifestations. The abdomen is involved in less than 20% of the cases with the ileocecal area being the site most frequently affected. The anorectal region is less frequently involved. We report a case of anorectal actinomycosis, which was diagnosed by histologic study of sigmoidoscopic biopsy. The patient was a 40-year-old man who took immunosuppressive agents after kidney transplantation. Adequate surgical excision was done, being followed by administration of massive dose of a penicillin. (Korean J Gastrointest Endosc 2003;27:553⁣557)

1,689 View
4 Download

A Case of Retroperitoneal Paraganglioma Accompanying Bile Duct Dilatation: Min Ho Choi, M.D., Je Hyun Ryu, 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;27(6):558-562. Published online December 30, 2003

Abstract PDF: Retroperitoneal paraganglioma is a kind of uncommon tumor that occurs most commonly in the organ of Zuckerkandl located in the paraaortic area between the origin of the inferior mesenteric artery and the origin of the iliac artery. We experienced a case of retroperitoneal paraganglioma with an unusual location in a 52-year-old woman who had epigastric pain. Abdominal CT scan and ERCP showed a hypervascular mass near the distal CBD with bile duct dilatation. The surgically resected mass was diagnosed as paraganglioma. We report this unusual retroperitoneal paraganglioma, with a review of the literature. (Korean J Gastrointest Endosc 2003;27:558⁣562)

1,701 View
2 Download

Previous issues