Clinical Endoscopy

Clinical Features of Duodenopathy Associated with Liver Cirrhosis: Jin Bae Kim, M.D., Dong Soo Han, M.D., Hang Lak Lee, M.D., Jong Pyo Kim, M.D., Joon Yong Park, M.D.,Oh Young Lee, M.D., Joo Hyun Sohn, M.D., Ho Soon Choi, M.D. and Joon Soo Hahm, M.D.; Korean J Gastrointest Endosc 2004;28(6):277-283. Published online June 30, 2004

Abstract PDF: Background
/Aims: Congestive duodenopathy could be associated with liver cirrhosis with portal hypertension. The aims of this study were to assess the incidence of duodenopathy and to evaluate the relationship between duodenopathy and the presence of esophageal varices and portal hypertensive gastropathy in cirrhotic patients. Methods: A total of 56 patients with liver cirrhosis and 481 controls were taken upper endoscopic examination. Results: Prevalence of duodenopathy was significantly higher in the liver cirrhosis group (26.8%) compared to the control group (6.9%), although positive rate of Helicobacter pylori was significantly lower in the liver cirrhosis group. Duodenal erosions in cirrhotic patients were predominately located in 2^nd portion of duodenum compared to contol group and tended to be circular or linear along the Kerck's ring. Vascular congestion was evident in 5 of the 10 cases. Presence of duodenal lesions had no relationship with the size and extent of esophageal varices and congestive gastropathy. Conclusions: Although histology of duodenopathy tends to show vascular congestion in patients with liver cirrhosis, few clinical markers of portal hypertension support them. Therefore, further studies including endoscopic ultrasonogram are needed to demonstrate the pathogenesis of the duodenal lesions in patients with liver cirrhosis. (Korean J Gastrointest Endosc 2004;28:277⁣283)

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The Value of Peracetic Acid (SCOTELIN^Ⓡ) for Endoscope Disinfection: Jin Bae Kim, M.D., Dong Soo Han, M.D., Hang Lak Lee, M.D., Jong Pyo Kim, M.D., Joo Hyun Sohn, M.D., Myung Soon Oh, R.N., Jong Hee Lee, R.N., Joon Soo Hahm, M.D. and Jung Ok Gang, M.D.*; Korean J Gastrointest Endosc 2004;28(6):284-290. Published online June 30, 2004

Abstract PDF: Background
/Aims: Two percent glutaradehyde has been the reference disinfectant for high-level disinfection, but often requires long period of exposure up to 45 minutes. The aims of this study were to evaluate the effectiveness of a new endoscope disinfectant that uses 0.2% peracetic acid, and to compare the culture-positive rate in each different endoscopes and washers used. Methods: Three endoscopes and two washers that differed in purchase year were used. They were cleansed manually and disinfected with peracetic acid for 10 minutes. A total of 86 gastroduodenal endoscopic sessions were included in the study. Results: Overall culture-positive rate was 37.2%, majority of which came from washings of biopsy channel. There was a significant difference in culture-positive rate according to the machine used. Culture positive rate was 11.4% in recently purchased endoscope and washer used. Of the 28 Helicobactor pylori positive cases, there was one Helicobactor pylori DNA PCR positive case, but no Helicobactor pylori was found. Conclusions: When new endoscope and washer is used, peracetic acid is effective as a disinfectant. Significant difference in culture rate according to the different machine used might come from the aging effect and difference of cleansing power of the washer. (Korean J Gastrointest Endosc 2004;28:284⁣290)

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Sensitivity of Two-Time Immunochemical Fecal Occult-Blood Testing with Sigmoidoscopy for the Detection of Advanced Colon Adenoma: Ki Tae Suk, M.D., Hyun Soo Kim, M.D., Jung Kwon Kim, M.D., Jung Min Kim, M.D., Myeong Gwan Jee, M.D., Sang Won Ji, M.D., Soon Koo Baik, M.D.,Dong Ki Lee, M.D. and Sang Ok Kwon, M.D.; Korean J Gastrointest Endosc 2004;28(6):291-297. Published online June 30, 2004

Abstract PDF: Background
/Aims: Because detection and removal of colonic adenoma provided an opportunity to prevent colorectal cancer, advanced adenoma (＞10 mm, villous or high grade dysplasia) should be the major target of screening. In this study, we assessed the diagnostic sensitivity of one- or two-time immunochemical fecal occult blood test (i-FOBT), flexible sigmoidoscopy and their combination in patients with advanced adenoma or non-advanced adenoma. Methods: From January to October 2002, we performed colonoscopy with i-FOBT using latex agglutination method in 879 individuals. Among these, we diagnosed 234 polyps in 93 patients with advanced adenoma and 179 polyps in 109 patients with non-advanced adenoma. After the diagnosis of adenoma, second i-FOBT was done before polypectomy. Based on these data, we evaluated the diagnostic sensitivities of i-FOBT, flexible sigmoidoscopy and their combination for patients with advanced adenoma or non-advanced adenoma. Results: The diagnostic sensitivity of one- or two-time i-FOBT, flexible sigmoidoscopy and flexible sigmoidoscopy with two-time i-FOBT in patients with advanced adenoma vs.non-advanced adenoma were 17.2% vs. 18.3%, 28.0% vs. 29.4%, 70.1% vs. 66.1% and 81.7% vs. 78.0%. Although repeated application of i-FOBT enhanced diagnostic sensitivity for colon adenoma, this test or combination with flexible sigmoidoscopy did not differentiate advanced adenoma from non-advanced adenoma. Conclusions: Although it fails to detect one fifth of colon adenoma, combined two-time i-FOBT testing with flexible sigmoidoscopy is an effective and feasible screening modality for advanced colon adenoma. (Korean J Gastrointest Endosc 2004;28:291⁣297)

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A Comparative Study of Complications after Endoscopic Sphincterotomy according to the Types of Electrosurgical Current: Kil Jong Yu, M.D., Ho Gak Kim, M.D., Jong Seok Bae, M.D., Tae Kyung Won, M.D., Jae Uk Shin, M.D., Eun Young Kim, M.D., Joong Goo Kwon, M.D. and Chang Hyeong Lee, M.D.; Korean J Gastrointest Endosc 2004;28(6):298-306. Published online June 30, 2004

Abstract PDF: Background
/Aims: Endoscopic biliary sphincterotomy (EST) has a very important role in the treatment of pancreatico- biliary diseases, but it has complications. We retrospectively investigated whether the types of electrosurgical currents affect occurence of complications. Methods: In pancreatico- biliary diseases, consecutive 150 patients undergoing EST with pure cutting current (cutting group) and then consecutive 150 patient with blend current (blended group) were studied in respect to post-EST complications and the presence of periampullary diverticulum and papillitis in major papilla. Major bleeding was defined as a decrease in hemoglobin of at least 2 g/dL. Clinical pancreatitis was defined as abdominal pain with elevated serum amylase above three times about the upper normal limit after 48 hour. Results: Major bleeding has not occurred. Minor bleeding occurred in 25/300 patients (8.3%), but was not different in cutting group (n=150) and blended group (n=150). Except 54 patients with elevated amylase before procedure, pancreatitis occurred in 13/246 patients (5.3%), but was not different in cutting group (n=122) and blended group (n=124). Two cases in blended group had moderate pancreatitis. There was no differences of bleeding, pancreatitis, in patients with diverticulum (n=112) and without diverticulum (n=188). Minor bleeding was more common in patients with papillitis (n=24) than without papillitis (n=276) (p=0.000), but the incidence of post EST pancreatitis was similar. In 235 patients with choledocholithiasis, there was no difference in terms of bleeding, pancreatitis in cutting group (n=120) and blended group (n=115). Conclusions: Post- EST bleeding and pancreatitis were not affected by the types of electrosurgical current used. When EST was performed in patient with papillitis, minor bleeding was observed commonly. (Korean J Gastrointest Endosc 2004;28:298⁣306)

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A Case of Small Cell Carcinoma in the Stomach: Sang Seok Bae, M.D., Jae Hong Choi, M.D., Hee Bock Chae, M.D., Seon Mee Park, M.D.,; Korean J Gastrointest Endosc 2004;28(6):307-311. Published online June 30, 2004

Abstract PDF: Small cell carcinoma (SmCC) of stomach is a very rare and aggressive malignancy with extremely poor prognosis. Most patients with gastric SmCC die within 1 year of diagnosis. A standard treatment for gastric SmCC has not been established, but surgical excision and/or combination chemotherapy should be considered to promote long term survival. We report a case of small cell carcinoma of stomach in a 66-year-old woman with dysphagia. A gastroscopic examination revealed a polypoid mass with ulceration on the lesser curvature of the gastric body extending to the gastro-esophageal junction. An endoscopic biopsy showed a solid proliferation of small, monotonous tumor cells with hyperchromatic nuclei and scanty cytoplasm. Immunohistochemically, the neoplastic cells were positive for chromogranin, synaptophysin and NSE, and negative for CD45. No tumor was detected on examination of the chest. Therefore, primary SmCC was diagnosed preoperatively. (Korean J Gastrointest Endosc 2004;28:307⁣311)

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A Case of Gastric Lipoma with Early Gastric Cancer Removed by Subtotal Gastrectomy: Ji Young Park, M.D., Jong Tae Baek, M.D., Dong Soo Lee, M.D., Soon Woo Nam, M.D.,Byung Min Ahn, M.D., Sun Jong Jeung, M.D., Hong Gern Bin, M.D.,In Sik Chung, M.D., Hee Sik Sun, M.D. and Eun Hee Lee, M.D.*; Korean J Gastrointest Endosc 2004;28(6):312-316. Published online June 30, 2004

Abstract PDF: Gastric lipomas account for less than 3% of benign gastric tumor arising from the submucosal layer. Gastric lipomas are usually asymptomatic, but occasionally diagnosed from epigastric pain, obstruction and bleeding by their size and location. A 68-year-old female with melena was diagnosed as gastric lipoma, having a bleeding focus at endoscopy. Endoscopy with biopsy revealed a yellowish fat containing lipoma which was located prepyloric antrum and protruded to the duodenal lumen, and synchoronous adenocarcinoma which was located at the gastric angle and distal body. Adenocarcinoma was confined to the mucosa and seperated from lipoma by normal stomach tissue. The patient received Billroth-II subtotoal gastrectomy, and gastric lipoma and early gastric cancer were resected, completely. (Korean J Gastrointest Endosc 2004;28:312⁣316)

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A Case of Henoch-Schönlein Purpura with Small Bowel Hemorrhage Diagnosed by Capsule Endoscopy: Gun Wha Lee, M.D., Young Koog Cheon, M.D., Hyun Jeong Kim, M.D.,Sang Ho Lee, M.D., Joo Young Cho, M.D. and Chan Sup Shim, M.D.; Korean J Gastrointest Endosc 2004;28(6):317-320. Published online June 30, 2004

Abstract PDF: A 23 year-old female patient complained of recurrent abdominal cramps and underwent emergency appendectomy in a private clinic. Two weeks later, she complained of lower GI bleeding and was referred to our hospital. On admission, she had abdominal pain and arthralgia but no hematuria. On physical examination, she was hemodynamically stable but was pale. There was no specific finding in laboratory test, except slightly lower level of blood hemoglobin. EGD revealed no specific findings. Colonoscopy showed fresh blood in the colon with small ulcers and erosions in the ileocecal valve but no source of active bleeding. On third admission day, she developed palpable macular rash initially over her lower legs, ankles, wrist joints and later on anterior abdominal wall. Capsule endoscopy revealed several small and large ulcers and erosions in the entire small bowel with blood clots. She was diagnosed clinically as a case of Henoch-Schönlein purpura through her clinical history and skin lesions. She was administered prednisolone 40 mg/day for a period of one week. Her symptoms, G-I bleeding as well as the skin lesions responded well to steroid therapy and she remained asymptomatic afterwards. (Korean J Gastrointest Endosc 2004; 28:317⁣320)

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A Case of Extensive Gangrenous Ischemic Colitis Proximal to Rectal Cancer: Young Sun Kim, M.D., Sung-Ae Jung, M.D., Seong-Eun Kim, M.D., Ki-Nam Shim, M.D.,Kwon Yoo, M.D. and Il-Hwan Moon, M.D.; Korean J Gastrointest Endosc 2004;28(6):321-325. Published online June 30, 2004

Abstract PDF: The ischemic colitis occurring proximal to obstructive colon cancer is a rare case, which has the prevalence ranging 1% to 7% of the colon cancer. The pathogenesis is unclear but it is thought that raised intraluminal pressure, distension and bacterial stasis in the partially obstructive bowel play a role in developement of ischemia. The ischemic damage of colon is usually localized and reversible. However we experienced a case of extensive gangrenous ischemic colitis associated with rectal cancer in 48- year-old man, and he developed acute abdominal symptom and needed prompt surgical operation. So we reports this case with a review of literature. (Korean J Gastrointest Endosc 2004;28:321⁣325)

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A Case of Chronic Ulcerative Colitis Complicated by Budd-Chiari Syndrome and Colon Cancer: Rok Son Choung, M.D., Yoon Tae Jeen, M.D., Yong Sik Kim, M.D., Young Sun Kim, M.D., Hong Sik Lee, M.D., Hoon Jai Chun, 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 2004;28(6):326-331. Published online June 30, 2004

Abstract PDF: Ulcerative colitis is a chronic inflammatory bowel disease and may have many intestinal and extraintestinal complications. Compared with general population, patients with longstanding ulcerative colitis have an increased risk of colorectal cancer. Patients with ulcerative colitis have an increased frequency of thromboembolism too. However, hepatic vein thrombosis is a very rare extraintestinal complication. This is the first reported case of a young patient with ulcerative colitis who developed synchronous colonic neoplasm and chronic Budd-Chiari syndrome manifested as esophageal variceal bleeding. We report a case of ulcerative colitis complicated by Budd-Chiari syndrome and colon cancer in a 28-year-old female. (Korean J Gastrointest Endosc 2004;28:326⁣331)

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The Cholecystogastric Fistula and the Transmigration of the Gallstone: Sung Yeun Yang, M.D., Su Kyoung Kwon, M.D. and Ji Hwa Ryu, M.D.*; Korean J Gastrointest Endosc 2004;28(6):332-335. Published online June 30, 2004

Abstract PDF: The internal biliary fistula between the gallbladder or bile duct and intestinal tract is a rare disease. Because symptoms and signs of biliary fistula are not specific, these patients are commonly investigated with computed tomography, endoscopic retrograde cholangiopancreatography (ERCP) and barium study. Among them, a cholecystogastric fistula is a very rare type of biliary fistula. We recently experienced a case of cholecystogastric fistula and transmigration of the gallstone to the stomach. A 53-year- old woman was transferred with the impression of gallbladder cancer. On evaluating the cause of right upper abdominal pain and nausea, we confirmed the cholecystogastric fistula with gastroscopy, upper GI series and ERCP. Cholecystectomy and the repair of the fistula was done. (Korean J Gastrointest Endosc 2004;28:332⁣335)

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