Clinical Endoscopy

The Role of Intraoperative Colonoscopy in Patients with Left Side Colon Cancer Obstruction: Sung Mok Kim, M.D., Jun Hwan Kim, M.D., Byung Ik Jang, M.D., Tae Nyeun Kim, M.D., Moon Kwan Chung, M.D. and Jae Hwang Kim, M.D.*; Korean J Gastrointest Endosc 2004;28(3):113-117. Published online March 31, 2004

Abstract PDF: Background
/Aims: The aim of this study was to evaluate the role of an intraoperative colonoscopy for a single stage operation in patients with a left-side colon cancer obstruction. Methods: From September 1999 to August 2002, 62 patients (mean age=61⁑14 year old, M：F=30：32) underwent an intraoperative colonoscopy during a single stage operation for a left side colon cancer. Intraoperative colonic irrigation method and colonoscopy with NICI (new intraoperative colonic irrigator, MITech Co., Ltd, Seoul, Korea) were used. Results: The locations of the left-side colon cancers were the rectum in 33 (53.2%), sigmoid colon in 20 (32.3%), and descending colon in 9 (14.5%). Synchronous polyps were found in 31 patients (50%). Six patients (9.7%) had a synchronous colon cancer and 2 (3.2%) had a high grade dysplasia. Of these 62 patients, 11 (17.7%) required more extensive surgery than dictated by the primary tumor. Altered operative methods were a total colectomy in 2 patients, an extended resection in 8 patients, and a wedge resection in 1 patient. Conclusions: An intraoperative colonoscopy in patients with a left-side colon cancer is a useful adjunct in diagnosing a synchronous lesions, which should allow a more appropriate surgical procedure. (Korean J Gastrointest Endosc 2004;28:113⁣117)

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A Gastric Foreign Body Incidentally Diagnosed by a Follow-up Abdominal Computed Tomography for Hepatoma: Jung Won Jeon, M.D., Yo Seb Han, M.D., Woo Young Heo, M.D., Nam Hoon Kim, M.D., Yong Hee Joung, M.D., Keun Woo Lim, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byung-Ho Kim, M.D., Young Woon Chang, M.D., Joung Il Lee, M.D. and Rin Chang, M.D.; Korean J Gastrointest Endosc 2004;28(3):118-122. Published online March 31, 2004

Abstract PDF: Foreign bodies in the stomach usually are accidentally swallowed and rarely produce symptoms. For diagnosis, suspicion and report of related history with abdominal symptoms are important. Simple radiographs and endoscopy easily identify foreign objects. Abdominal computed tomography may be useful in some cases, although it is not essential. We experienced a case of a gastric foreign body incidentally diagnosed by a follow-up abdominal computed tomography (CT) for hepatoma. A 53-year-old male with B viral liver cirrhosis and hepatoma, visited our hospital for a routine follow-up check of hepatoma. He had a symptom of epigastric discomfort for two weeks. An abdominal CT showed a foreign body penetrating the stomach wall, and it was successfully removed endoscopically. (Korean J Gastrointest Endosc 2004;28:118⁣122)

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A Case of Gastric Lymphoepithelioma-like Carcinoma Presenting as a Submucosal Tumor: Won Il Park, M.D., Hyong Wok Kim, M.D., Jin Hong Park, M.D., Dong Hyun Lee, M.D., Jong Yun Cheong, 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 2004;28(3):123-126. Published online March 31, 2004

Abstract PDF: Lymphoepithelioma-like carcinoma (LELC) occurs in esophagus, stomach, bile duct, salivary gland, lung, uterus, skin, and so on. The incidence of gastric LELC is 1∼4 percents of all stomach cancers. Gastric LELC has a lymphoid stroma and shows a good prognosis and high association with Epstein-Barr virus. We experienced a case of patient with gastric LELC. The patient was 49- year-old woman. and the endoscopic finding showed a submucosal tumor with central erosion. The histologic findings of endoscopic biopsies were suggestive of low grade MALT lymphoma. but the histologic findings of the surgical specimen were consistent with gastric LELC. We report a case of gastric LELC presenting as a submucosal tumor, with a brief review of the literature. (Korean J Gastrointest Endosc 2004;28:123⁣126)

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A Case of Spurting Duodenal Variceal Bleeding Treated with an Endoscopic Sclerotherapy in a Patient with Biliary Cirrhosis: Chan Sik Weon, M.D., Soon Goo Baik, M.D., Sang Ha Kim, M.D., Jung Koun Kim, M.D., Houn Soo Joo, M.D., Mi Young Lee, M.D., Hyun Soo Kim, M.D., Dong Ki Lee, M.D. and Sang Ok Koun, M.D.; Korean J Gastrointest Endosc 2004;28(3):127-130. Published online March 31, 2004

Abstract PDF: Duodenal varices can result from portal hypertension regardless of the etiologies of liver cirrhosis. Bleeding from duodenal varices is rare but often severe and life threatening. Treatment modalities of duodenal varices include endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and surgery. As an initial treatment, endoscopic sclerotherapy is recommended due to easy accessibility but has limited success in controlling active duodenal variceal bleeding. In this case, we report a spurting duodenal varix treated with Histoacryl^Ⱂ injection in a 48-year-old woman with secondary biliary cirrhosis. Endoscopic sclerotherapy with Histoacryl^Ⱂ is a useful therapeutic measure in the treatment of bleeding duodenal varix. (Korean J Gastrointest Endosc 2004;28:127⁣130)

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A Case of Duodenal Fistula Caused by Intestinal Tuberculosis: Du Young Kwon, M.D., Hea Won Park, M.D., Sang Hyuck Seo, M.D., Byung Kuk Jang, M.D., Jun Young Hwang, M.D., Jung Min Lee, M.D., Yun Seok Hong, M.D., Kyung Sik Park, M.D., Kwang Bum Cho, M.D., Jae Seok Hwang, M.D. and Sung Hoon Ahn, M.D.; Korean J Gastrointest Endosc 2004;28(3):131-135. Published online March 31, 2004

Abstract PDF: Intestinal hemorrhage, fistula formation, and intestinal obstruction are the common complications associated with intestinal tuberculosis. However, duodenal fistula due to intestinal tuberculosis is very rare. We experienced a case of 26-year-old woman with a fistula in the duodenum referred to our hospital due to abdominal pain. Esophagogastroduodenoscopy showed a fistula at the duodenum with lymph node. After 2 months of anti-tuberculous medication, abdominal pain was improved and fistula size decreased. We report a case of fistula caused by duodenal tuberculosis. (Korean J Gastrointest Endosc 2004;28:131⁣135)

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A Case of Acute Small Bowel Bleeding Diagnosed by Capsule Endoscopy: Chang Soo Lee, M.D., Nayoung Kim, M.D.*, Jin-Hyeok Hwang, M.D.*, Jin-Wook Kim, M.D.*, Dong Ho Lee, M.D.*, Su Youn Nam, M.D., Kee Don Choi, M.D., Ho June Song, M.D., Sang Gyun Kim, M.D., Hyun Chae Jung, M.D. and In Sung Song, M.D.; Korean J Gastrointest Endosc 2004;28(3):136-140. Published online March 31, 2004

Abstract PDF: Although small bowel is an uncommon origin of gastrointestinal bleeding, it is a predominant source of obscure gastrointestinal bleeding. Endoscopy is a mainstay of diagnosis and treatment of gastrointestinal bleeding, but small bowel is beyond the reach of the standard upper endoscopy and colonoscopy. Recently wireless capsule endoscopy has been known as a useful method in the diagnosis of small bowel bleeding. A 51-year-old man was admitted with acute abdominal pain and hematochezia. In spite of the conventional endoscopic and radiologic investigations, the bleeding source was not identified. Finally, wireless capsule endoscopy demonstrated drug induced enteropathy as a cause of small bowel bleeding. We report a case of drug induced small bowel bleeding diagnosed by capsule endoscopy with a review of the relevant literature. (Korean J Gastrointest Endosc 2004;28:136⁣140)

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Chronic Bleeding due to Jejunal Gatrointestinal Stromal Tumor Diagnosed by Capsule Endoscopy: Nam Young Cho, M.D., Hoon Jai Chun, M.D., Yong Sik Kim, M.D., Yoon Tae Jeen, M.D., Soon Ho Um, M.D., Chang Duck Kim, M.D., Jin Hai Hyun, M.D. and Kwang Il Kim, M.D.*; Korean J Gastrointest Endosc 2004;28(3):141-145. Published online March 31, 2004

Abstract PDF: Obscure gastrointestinal bleeding accounts for 2∼10% of chronic GI bleeding. Conventional upper and lower endoscopy can not find bleeding focus. Because early diagnosis of the bleeding focus is difficult, repeated admission and transfusion cause psychological and economical burden. Recently developed capsule endoscopy has made painless imaging of the entire small intestine possible. Capsule endoscopy as a non-invasive test will be the preferred method of small bowel evaluation. We report a case of jejunal gastrointestinal stormal tumor, in a 69- year-old woman with history of chronic bleeding for nine years, which was not detected with conventional methods, but diagnosed with capsule endoscopy. (Korean J Gastrointest Endosc 2004;28:141⁣145)

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A Case of Gastrointestinal Bleeding Caused by Dieulafoy-like Lesions of theStomach and Rectum in a Patient with Chronic Renal Failure: Chul Hyun Lim, M.D., Young Seok Cho, M.D., Hyun Jin Kim, M.D., Sung Jin Moon, M.D., Seung Woo Lee, M.D., Chee Ho Noh, M.D., Dong Il Shin M.D., Jong Hyun Park, M.D., Chang Whan Kim, M.D., Sung Soo Kim, M.D., Young Ok Kim, M.D., Sun Ae Yoon, M.D., Hiun Suk; Korean J Gastrointest Endosc 2004;28(3):146-150. Published online March 31, 2004

Abstract PDF: Dieulafoy's lesion is a very rare cause of gastrointestinal bleeding that occurs after rupture of an exposed submucosal artery. The majority of lesions are found in the stomach, but rarely it has also been identified in the duodenum, small bowel, colon and rectum. We describe a 78-year-old female with chronic renal failure who presented with melena and was subsequently found to have a Dieufaloy-like lesion in the stomach. The bleeding was successfully managed by endoscopic hemoclipping. During the follow-up, massive gastrointestinal bleeding was developed by a Dieulafoy-like lesion in the rectum. This lesion was managed by endoscopic band ligation, but there was recurrent bleeding from the ulcer site. The ulcer site was locally excised and primary closure was carried out. (Korean J Gastrointest Endosc 2004;28:146⁣150)

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A Case of Iatrogenic Bronchobiliary Fistula: Hee Bok Chae, M.D., Ki Won Moon, M.D., Sang Seok Bae, M.D., Seon Mee Park, M.D., Sei Jin Youn, M.D., Il Hun Bae, M.D.*, Jae Woon Choi, M.D.^†and Jun Ho Wang, M.D.^‡; Korean J Gastrointest Endosc 2004;28(3):151-155. Published online March 31, 2004

Abstract PDF: Bronchobiliary fistula is a rare condition. It is defined by the presence of a passage between the biliary tract and the bronchial tree. Many conditions can give rise to the developement of such a communication. The patient was a 71-year-old man who had obstructive jaundice due to liver mass. At first, we inserted an uncovered metallic stent for biliary drainage. However, the bile duct was perforated due to the trapping of a catheter in the distal end of the deployed stent. The operation was performed immediately, but only the sump draingage was placed in the retroperitoneum because the perforation site could not be found. After 20 days from the procedure, the patient complained of bilioptysis because of a bronchobiliary fistula. We inserted a covered stent into the previous uncovered metallic stent. Bilioptysis rapidly resolved after the successful procedure. We report a case of iatrogenic bronchobiliary fistula which was managed by endoscopic biliary stenting. (Korean J Gastrointest Endosc 2004;28:151⁣155)

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A Case of Sigmoid Colonic Perforation due to Migration of a Plastic Stent for Endoscopic Retrograde Biliary Drainage: Hyun Sweung Jeong, M.D., Sang Jong Park, M.D., IL Dong Kim, M.D.*, Sang Bae Lee, M.D., Jin Kwang Lee, M.D. and Hoi Jin Kim, M.D.; Korean J Gastrointest Endosc 2004;28(3):156-160. Published online March 31, 2004

Abstract PDF: Placement of an endoprosthesis for billiary obstruction has been advocated as an effective alternative for internal- external drainage catheters or surgical procedure. Endoscopic retrograde biliary drainage (ERBD) is a method of transpapillary insertion and placement of drainage tube in the billiary tree under the direct view of endoscope. Early complications following ERBD that develop within 4 weeks include obstruction of the stent, cholangitis, hemorrhage, acute pancreatitis, and bile duct or duodenal perforation. Late complications include obstruction of the stent and cholangitis, migration of the stent, and intestinal perforation. We expierenced a case of sigmoid colonic perforation following ERBD in a patient with multiple biliary tract stone and cholangitis. Thus we report this case with a brief review of the literature. (Korean J Gastrointest Endosc 2004;28:156⁣160)

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