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Volume 28(4); April 2004
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Interobserver Agreement in Gastric Lesions by Magnifying Endoscopy
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Bong Min Ko, M.D., Jae Young Jang, M.D., Kwang An Kwon, M.D., Seong Hawn Kim, M.D.,
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Korean J Gastrointest Endosc 2004;28(4):161-167. Published online April 30, 2004
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Abstract
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- Background
/Aims: Various magnifying endoscopic classifications have been introduced in
esophageal and gastric lesions. However, studies on an agreement between observers according to
the form classification of magnifiying endoscopic findings have not been performed yet. The aim of
this study was to determine the interobserver agreement for magnifying endoscopic classifications.
Methods
The patients were divided into 3 groups. The first group of patients had post-EMR ulcer
scar (50 cases), the second group, elevated gastric lesion (38 cases), and the third group, gastritis
(43 cases). Two mucosal patterns were used in the post-EMR ulcer scar group, 6 mucosal patterns
in the elevated gastric lesion group, and 3 patterns of the collecting venule in the gastritis group.
Three experienced observers (A, B, C) blinded to the patients' data participated in this study. The
agreement between observers was evaluated by calculated kappa. The kappa value of 0.75 or
greater was rated excellent, 0.4∼0.74, fair to good, and 0.4 or less, poor. Results: Regarding 2
mucosal pattern in post- EMR ulcer scar, agreements between A and B, A and C, and B and C
were 0.896, 0.793, and 0.901, respectively (p＜0.01). Regarding 6 mucosal patterns in elevated
gastric lesion, agreements between A and B, A and C, and B and C were 0.607, 0.458, and 0.557,
respectively (p＜0.01). Regarding 3 collecting venule pattern in gastritis, agreements between A and
B, A and C, and B and C were 0.822, 0.823, and 0.751, respectively (p＜0.01). Conclusions:
Interobserver agreement is good to excellent in mucosal pattern and collecting venule by magnifying
endoscopy. However magnifying endoscopic classification needs to be refinded in order to improve
an agreement between observers. (Korean J Gastrointest Endosc 2004;28:161167)
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Colon Cancer and Amidated Gastrin: Correlation with AtrophicGastritis and Helicobacter
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Chung Hwan Chung, M.D., Young-Ho Kim, M.D., Hyuk Lee, M.D., Ju Ik Sohn, M.D.,Heung Up
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Korean J Gastrointest Endosc 2004;28(4):168-172. Published online April 30, 2004
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Abstract
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- Background
/Aims: It has recently been reported that non-amidated gastrin is associated
with the development of colon cancer. However it is not known whether amidated gastrin, atrophic
gastritis, and the status of Helicobacter pylori (H. pylori) infection are related to colon cancer. The
aims of this study were to determine whether plasma level of amidated gastrin is elevated in patients
with colon cancer compared with controls and to determine whether H. pylori infection and/or
atrophic gastritis affect the relationship between amidated gastrin and colon cancer. Methods:
Twenty-two patients with colon cancer and twenty-two controls were enrolled in this study and their
plasma amidated gastrin titers were measured by 125I radioimmunoassay. H. pylori infection was
determined by histology. The degree of mucosal atrophy was determined by Sidney classification.
Results
Amidated gastrin levels were not different between the patients with colon cancer and
controls. The status of H. pylori infection did correlate with amidated gastrin levels. Antral mucosal
atrophy was not also correlated with amidated gastrin levels, but there was a tendency (p=0.074).
Conclusions
Amidated gastrin is not related to the development of colon cancer. (Korean J
Gastrointest Endosc 2004;28:168172)
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Colonoscopic Findings in Anemia Patients without Active Rectal Bleeding
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In Sook Kang, M.D., Sung-Ae Jung, M.D., Seock-Ah Im, M.D.*, Seong Eun Kim, M.D.,
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Korean J Gastrointest Endosc 2004;28(4):173-178. Published online April 30, 2004
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Abstract
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- Background
/Aims: For evaluation of anemia, esophagogastroduodenoscopy (EGD) is
widely used. However, there is no sufficient information on the efficiency and role of colonoscopic
evaluation for these anemia patients. We aimed to evaluate the diagnostic yield of colonoscopy in
anemia patients with nonactive rectal bleeding. Methods: This was a retrospective study from January
2001 to December 2002. We reviewed 147 patients who underwent colonoscopy for anemia
evaluation. Results: The mean age was 48⁑17 years (range 15∼90), and male to female ratio was
1：4.3. Ninety-four patients (63.9%) had iron deficiency anemia and 21.8% of them have less than
7 g/dL of hemoglobin. Abnormal colonoscopic findings were observed in 84 patients (57.1%)
including hemorrhoid (35), polyp (31), tuberculosis (9), cancer (8), diverticulum (8), endometriosis
(1), angiodysplasia (1), and ulcerative colitis (1). The presence of abnormal colonoscopic findings
was more frequently observed in older population (≥55 years old, p=0.034). Intestinal tuberculosis,
endometriosis, and ulcerative colitis were observed only in younger population (＜55 years old), and
2 of 8 cancer patients were 39 and 49 years old males. Conclusions: Although the diagnostic yield
of colonoscopy is relatively higher in older population, colonoscopy is one of the valuable tools in
anemia evaluation of both older and younger populations. (Korean J Gastrointest Endosc 2004;28:173
178)
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Colonoscopic Missing Rate of Colorectal Polyps
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Choon Sik Chung, M.D., Jin Seok Yoon, M.D., Yong Geul Joh, M.D., Yoon Jung Cha, M.D.,
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Korean J Gastrointest Endosc 2004;28(4):179-182. Published online April 30, 2004
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Abstract
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- Background
/Aim: Colonoscopy has been known as the best diagnostic and therapeutic
modality for colorectal polyps. However, it has been difficult to assess its accuracy. Methods: We
studied the data from patients who had colonoscopic polypectomy within 30 days after the initial
examination. Results: From 218 patients, a total of 362 polyps were found, 51 (14.1%) of which
were missed. There were 17 patients with missed polyps among 59 patients who had two or more
polyps on the initial examination. According to the location, the missing rates were variable: the
splenic and hepatic flexure had the highest missing rates, and the sigmoid colon had the lowest
missing rate. In our study, there was no difference of missing rate according to the size and shape.
Conclusions
There is a significant colonoscopic missing rate for colorectal polyps in routine clinical
practice, especially in patients with multiple colonic polyps and at the site of the colonic flexure.
(Korean J Gastrointest Endosc 2004;28:179182)
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Two Cases of Intussusception Occurring through the Stoma after Gastric Surgery
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Sung-Jo Bang, M.D., Do Ha Kim, M.D., Gin Hyug Lee, M.D.*, Jeong-Sik Byeon, M.D.*,
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Korean J Gastrointest Endosc 2004;28(4):183-187. Published online April 30, 2004
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Abstract
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- Intussusception is a rare but potentially serious complication of gastric surgery, and 6
case
s have been reported in Korea. Diagnosis can be made by endoscopy, upper gastrointestinal
series or computed tomography, but it needs a high index of suspicion for diagnosis. Early
diagnosis and prompt surgical intervention is mandatory to avoid mortality. We report two cases of
intussusception occurring through the stoma after gastric surgery. A 58-year-old woman presented
with epigastric pain and vomiting followed by hematemesis, 30 years after gastrojejunostomy for
pyloric obstruction caused by duodenal ulcer. Endoscopy showed jejunogastric intussusception and
CT scan was compatible with the diagnosis. She was managed by segmental resection and
anastomosis of the jejunum. Another 60-year-old man presented with epigastric pain and
hematemesis, 7 years after total gastrectomy with a Roux-en-Y anastomosis for advanced gastric
cancer. He was diagnosed as having chronic type jejunal intussusception by endoscopy and CT
scan, and intussusception was resolved spontaneously. (Korean J Gastrointest Endosc 2004;28: 183
187)
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A Gastric Hyperplastic Polyp with Intramucosal Adenocarcinoma
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Sung Sook Lee, M.D., Myoung Kuk Jang, M.D., Gin Hyug Lee, M.D., Chan Sun Park,
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Korean J Gastrointest Endosc 2004;28(4):188-192. Published online April 30, 2004
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Abstract
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- Adenomatous polyps have been well known to be premalignant, but it is still controversial
how to treat and follow them up. Up to date, endoscopic resection has been the choice of
treatment, particularly exceeding 2 cm, though there is no concensus on the indications for the
excision of hyperplastic polyps. The incidence of malignant tissue found in hyperplastic polyps has
been reported to be less than 3%, which is considerably lower than the incidence of greater than
6% reported in adenomas. There have been few reports of hyperplastic polyps in which malignant
changes developed during endoscopic surveillance. We report a case of hyperplastic gastric polyp
with intramucosal, well- differentiated adenocarcinoma with reviewing references. (Korean J Gastrointest
Endosc 2004;28:188192)
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A Case of Ileal Diverticulitis Causing Small Bowel Stenosis
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Ki Hun Kim, M.D., Jae Hwan Kim, M.D., Min Young Her, M.D., Sang Hyuk Lee, M.D., Bong
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Korean J Gastrointest Endosc 2004;28(4):193-196. Published online April 30, 2004
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Abstract
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- Diverticuli may be either congenital or acquired and may affect either the small or large
intestines. Recently, the incidence of colonic diverticular disease is increasing in Korea but that of
the small bowel, especially ileum, is very rare. We experienced a case of ileal diverticulitis causing
small bowel stenosis. A 62-year-old woman was referred to our hospital because of diffuse
abdominal pain for several months. Abdominal CT and small bowel series showed thickening of
mucosal folds in the distal ileum. Colonoscopic findings revealed edema, mucosal thickening, blood
clots, irregular dimpling, and stenosis in the distal ileum. The lesion was resected surgically and
diagnosed as diverticulitis with microperforation. (Korean J Gastrointest Endosc 2004;28: 193196)
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A Case of Lower Gastrointestinal Bleeding due to Angiodysplasia in the Terminal Ileum
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Anna Kim, M.D., Jong Min Lee, M.D., Jane Oh, M.D. and Gye Sung Lee, M.D.
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Korean J Gastrointest Endosc 2004;28(4):197-201. Published online April 30, 2004
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Abstract
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- Angiodysplasia has been recognized as an important cause of lower gastrointestinal
bleeding, but it is difficult to confirm the lesions. Angiodysplasia in the small bowel could be the
most probable cause of bleeding particularly in the elderly patients when usual methods fail to
document the focus. Small bowel angiodysplasias have been diagnosed by angiography and/or
surgery at the sites where usual endoscope could not reach, and treated by medical therapy,
angiographic embolization or surgery. We experienced a case of a bleeding angiodysplasia in the
terminal ileum in a 51-year-old man who was taking anti-platelet agents. The lesion was diagnosed
by colonoscopy, and bleeding was easily controlled with hemoclipping. (Korean J Gastrointest Endosc
2004;28:197201)
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A Case of a Submucosal Tumor in the Ascending Colon Probably Caused by Anisakis
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Yo Ahn Suh, M.D., Hyun Joo Jang, M.D., Chang Soo Eun, M.D., Woo Young Jang, M.D.*,
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Korean J Gastrointest Endosc 2004;28(4):202-207. Published online April 30, 2004
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Abstract
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- Anisakiasis refers to a parasitic infestation by nematode larvae that belong to the
subfamily Anisakinae. Colonic anisakiasis is very rare, and it is hard to diagnose compared with
gastric anisakiasis. Endoscopic or radiologic findings, history of raw fish intake and ELISA test might
be helpful, however, exploratory operations were needed to confirm the diagosis in the many cases
of colonic anisakiasis. Colonoscopy and endoscopic ultrasonography showed a submucosal tumor in
the ascending colon in a 47-year-old woman who complained of right upper quadrant abdominal
pain. Right hemicolectomy was performed to diagnose and cure the lesion. Pathologic examination
revealed some destructed cuticle of a parasite and dense eosinophilic abscess showing central
necrosis. She had a history of raw squid intake recently. We report a case of submucosal tumor in
the ascending colon probably caused by Anisakis. (Korean J Gastrointest Endosc 2004;28:202207)
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A Case of Ischemic Colitis with Deep Vein Thrombosis and Patent Foramen Ovale
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Sang Hoon Lee, M.D., Hyo Jong Kim, M.D., Mi Na Park, M.D., Nam Hoon Kim, M.D., Yong
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Korean J Gastrointest Endosc 2004;28(4):208-212. Published online April 30, 2004
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Abstract
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- Colonic ischemia is the most prevalent form of gastrointestinal ischemia and causes 3∼
9% of all acute lower intestinal bleeding. Most common cause is known to be cardiac embolus. A
67-year-old female patient presented with rectal bleeding. The patient had cerebral infarction 15
days ago. A colonoscopy showed a large ulcer with hemorrhage in the rectum. Computed tomography
showed deep vein thrombosis from the left popliteal vein to infrarenal inferior vena cava.
Transthoracic echocardiography was carried out, but no abnormal feature was found. Then, tran
sesophageal echocardiography, with agitated saline contrast to find out a right to left shunt, was
performed, patent foramen ovale was found. This patient was treated with anticoagulation and
inferior vena cava filtering. We suggest this ischemic colitis may be due to arterial embolization from
deep vein thrombosis through PFO. (Korean J Gastrointest Endosc 2004;28:208212
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A Case of Obstructive Jaundice after Insertion of Metallic Stent for Duodenal Obstruction
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Jin Kwang Lee, M.D., Sang Jong Park, M.D., Kwang Hyun Ryu, M.D., Sang Bae Lee, M.D.,
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Korean J Gastrointest Endosc 2004;28(4):213-218. Published online April 30, 2004
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Abstract
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- Insertion of self-expandable metallic stent has been performed as a palliative therapeutic
modality for cases with gastrointestinal obstruction caused by inoperable malignancies such as
pancreatic cancer, stomach cancer, and cholangiocarcinoma. Although the clinical efficacy is not
established yet, it can also be performed for benign gastroduodenal obstruction. Especially, when
balloon dilatation is failed and patients are at high risk for surgery or general anesthesia, and when
patients refuse operation, insertion of metallic stent can be considered. Complications of this
therapeutic modality include intestinal perforation, hemorrhage, migration or malposition of metallic
stent, and occlusion of stent by ingrowth and overgrowth of tumor or impaction of food. We report
a rare case of obstructive jaundice developed after the insertion of gastroduodenal stent for
duodenal obstruction caused by recurrent duodenal ulcer. (Korean J Gastrointest Endosc 2004;28:213
217)
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A Case of Juxtapapillary Duodenal Duplication Cyst Manifested by Recurrent Pancreatitis
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Hyun Soo Kim, M.D., Kwang Ro Joo, M.D., Do Ha Kim, M.D., Sung-Jo Bang, M.D., Jong
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Korean J Gastrointest Endosc 2004;28(4):218-219. Published online April 30, 2004
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Abstract
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- Duodenal duplication cyst is an uncommon congenital anomaly that is usually encountered
during infancy or in early childhood. The clinical manifestation is that of duodenal obstruction or,
less commonly, obstructive jaundice, acute pancreatitis, or gastrointestinal bleeding. Here, we report
a case of duodenal duplication cyst on the juxtapapillary region in a 19-year-old woman with an
unusual clinical manifestation of recurrent pancreatitis and peculiar endoscopic finding of the cyst.
(Korean J Gastrointest Endosc 2004;28:218222)
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