Clinical Endoscopy

A Study of Mucosal Sampling for Helicobacter pylori Using‘Two-bite’Technique in Relation to Time-saving: Mun Hee Bae, M.D., Min Hyung Kim M.D., Jun Haeng Lee, M.D., Hee Jung Son, M.D., Yoon-Ho Choi, M.D.*, Poong-Lyul Rhee, M.D., Jae J. Kim, M.D., Seung Woon Paik, M.D., Byung Cheol Yoo M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2004;29(1):1-5. Published online July 30, 2004

Abstract PDF: Background
/Aims: Multiple passages of biopsy forceps increase wear and tear on both the channel of endoscope and forceps. The two-bite technique can save time in obtaining sufficient specimens and also reduce the wear of the instruments. The aim of this study was to assess prospectively the efficacy of two-bite forceps technique in relation to time-saving. Methods: A total 84 patients needed histopathologic diagnosis for Helicobacter pylori were randomized into two groups (one-bite technique: 41 patients, two-bite technique: 43 patients). An experienced endoscopist carried out upper endoscopy and used same biopsy forceps (FB-25K^Ⱂ, Olympus, Tokyo, Japan). Mucosal biopsy specimens were obtained as follow: two from the antrum followed by two from the body. Rebiopsy was done when biopsy specimen was lost. The mean time in obtaining specimens and missing rate were analyzed. An experienced pathologist blinded to the technique of obtaining the samples evaluated the specimens for diameter, depth, crush artifact, and adequacy for histopathologic diagnosis. Results: A total 336 specimens were obtained from 84 patients. Of these, 12 (7.0%) samples were missed with the two-bite technique but only 1 (0.6%) with the one-bite technique (p=0.003). Regarding histopathologic evaluation, there were no significant differences between samples taken with the two-bite technique and the one-bite technique. The mean time with two-bite technique (47.6 sec) was compared with one-bite technique (62.6 sec)(p＜0.001). But there was no significant time difference if samples were missing during the process (62.5 sec). Conclusions: Although two- bite technique saves the time for biopsy, the main limitation is that there is a significant risk of losing samples. (Korean J Gastrointest Endosc 2004;29:1⁣5)

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Factors Affecting the Diagnostic Accuracy of Endoscopic Ultrasonography for the Depth of Invasion in Early Gastric Cancer: Jong Hoon Lee, M.D., Seok Reyol Choi, M.D., Sung Hun Moon, M.D., Jin Seok Jang, M.D., Sang Young Han, M.D. and Sung Wook Lee, M.D.*; Korean J Gastrointest Endosc 2004;29(1):6-12. Published online July 30, 2004

Abstract PDF: Backgroud/Aims: Endoscopic ultrasonography (EUS) has been used in assessing the depth of cancer invasion of the stomach. The aim of this study was to compare the factors which were likely to affect the diagnostic accuracy of EUS for the depth of invasion in early gastric cancer (EGC). Methods: Seventy eight EGC patients were pre-operatively examined by EUS. The depth of invasion by EUS was compared with the histopathologic finding of the resected specimen. The diagnostic accuracy of EUS was analyzed according to the factors which were likely to affect the accuracy. Results: The diagnostic accuracy of EUS for the depth of invasion was 78% (46/49) in mucosal cancer, 68.4% (13/19) in submucosal cancer (p＜0.05). Overall diagnostic accuracy of EUS in EGC was 75.6%. The diagnostic accuracy of the flat submucosal cancer was 55.6% and was significantly lower than other types of mucosal or submucosal cancers in endoscopic morphology (p＜0.05). Conclusions: The depth of invasion per se with respective endoscopic findings affected the diagnostic accuracy of EUS for the depth of invasion in EGC. Other factors did not affect the diagnostic accuracy of EUS for the depth of invasion in EGC. (Korean J Gastrointest Endosc 2004;29:6⁣12)

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A Case of Gastropericardial Fistula as a Complication after Esophagectomy with Esophagogastrostomy for Esophageal Cancer: Dong Kyun Son, M.D., Jae Kwang Kim, M.D., Ji Sung Chung, M.D., Don Hyoun Jo, M.D., Hyung Keun Kim, M.D., Soo-Heon Park, M.D., Joon-Yeol Han, M.D., Kyu Won Chung, M.D. and Hee Sik Sun, M.D.; Korean J Gastrointest Endosc 2004;29(1):13-16. Published online July 30, 2004

Abstract PDF: The gastric pedicle is commonly used for the reconstruction following the resection of esophageal cancer. We recently experienced a case in which gastric ulcer occurred eighteen months postoperatively. A 60 year-old man complaining of chest pain, dry cough, mild fever and chills was admitted to the emergency room. The patient had a history of esophagectomy and esophagogastrostomy because of esophageal cancer. Chest X-ray and CT scan showed pneumopericardium. Upper GI contrast study showed a fistulous tract between the stomach pedicle and the pericardium. Upper GI endoscopy showed beating heart through the fistulous opening. The patient expired with sepsis on the twenty second days after an emergent operation. Gastropericardial fistula caused by a peptic ulcer perforation after the esophgectomy and esophagogastrostomy operation is a very rare complication and brings a fatal result. Early detection using the chest radiography, electrocardiogram, echocardiography, upper GI study and physical examination, and an immediate treatment are therefore mandatory. (Korean J Gastrointest Endosc 2004;29:13⁣16)

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Endoscopic Removal of a Spoon from the Stomach Using Guidewire: Byung Wook Lim, M.D., Young Soo Moon, M.D., Sang Eun Lee, M.D., Tae Nyun Kim, M.D., Kyung Ah Kim, M.D., Hyun Bae Son, M.D., Jeon Ho Yang, M.D., Jeong Rak Lee, M.D.* and Kyung Tae Kim, M.D.*; Korean J Gastrointest Endosc 2004;29(1):17-21. Published online July 30, 2004

Abstract PDF: Foreign body ingestion is a relatively uncommon, but potentially serious condition. Most of gastrointestinal foreign bodies pass spontaneously. But, large objectives are usually lodged in the stomach and cause perforation, bleeding, and obstruction. Therefore, prompt retrieval of lodged foreign bodies are necessary before complications develop. Particularly, in the case of long metallic spoon, there have been no cases of spontaneous passage reported. Therefore, prompt retrieval of a metallic spoon are necessary. A 28- year-old woman with schizophrenia who ingested a long spoon for suicidal attempt was referred to our hospital. Simple abdomen showed a 18 cm sized long, metallic spoon with saw-toothed end placed in the stomach. We removed a spoon by an endoscopic technique and an extraction maneuver using a guidewire and a Magill forceps. (Korean J Gastrointest Endosc 2004;29:17⁣21)

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A Case of Eosinophilic Gastroenteritis with Eosinophilic Ascites: Youn Ju Na, M.D., Ki-Nam Shim, M.D., Moon Sun Yeom, M.D., Hee Sun Kim, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D., Il Hwan Moon, M.D. and Min Sun Cho, M.D.*; Korean J Gastrointest Endosc 2004;29(1):22-26. Published online July 30, 2004

Abstract PDF: Eosinophilic gastroenteritis is an uncommon disease characterized by the presence of abnormal gastrointestinal symptoms, eosinophilic infiltration in one or more areas of the gastrointestinal tract, an absence of the indentifiable cause of eosinophilia and the exclusion of eosinophilic involvement in organs other than gut. The etiology is unknown, and the pathogenesis is poorly understood. Clinical presentations depend on the region of gastrointestinal tract involved and the depth of bowel involvement. We experienced a case of eosinophilic gastroenteritis involving entire GI tract with eosinophilic ascites in a 72-year-old female with abdominal distention and pain. The patient was treated with corticosteroid successfully. We report this case with a brief review of the literatures. (Korean J Gastrointest Endosc 2004;29:22⁣26)

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Diffuse Intestinal Hemangiomatosis Diagnosed by Endoscopy in a Patient with Anemia: Su Hyun Kim, M.D., Seong Min Kim, M.D., Mi Ae Jo, M.D., Seong Hun Kim, M.D., Seung Heon Lee, M.D., Seon Young Kim, M.D., Se Lim Choi, M.D., Jae Seung Lee, M.D., Seong Ho Choi, M.D.* and Hee Seung Park, M.D.; Korean J Gastrointest Endosc 2004;29(1):27-31. Published online July 30, 2004

Abstract PDF: Gastrointestinal hemangiomatosis is a rare benign vascular lesion, which can produce massive or persistent blood loss. Numerous lesions, usually of the cavernous type, involve stomach, small bowel, and colon. The diagnosis of hemangiomatosis is difficult. It is diagnosed usually by endoscopic study or barium enema for bleeding or anemia evaluation in childhood. A 17-year-old female was admitted to our hospital with anemia and dizziness for several months. She was diagnosed as diffuse intestinal hemangiomatosis by gastroduodenoscopy and colonoscopy. Gastroduodenosocpic findings showed multiple, small, mound-like, reddish-purple hemangiomas on the lower body, fundus and prepyloric area of the stomach. Colonoscopic findings showed similar lesions on the ascending and descending colon. The polypoid lesion on the ascending colon was ligated by detachable snare due to bleeding. No other hemangioma was detected by ultrasonography, abdominal angiography or small bowel series. We report a case of diffuse hemangiomatosis, largely distrubuted in the stomach and colon, but without involvement of skin or other solid organ. The bleeding hemangioma on the ascending colon was treated by endoscopic ligation, and the anemia of the patient was improved. (Korean J Gastrointest Endosc 2004;29:27⁣31)

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Solitary Juvenile Polyp with Adenomatous Change Presenting as Colonic Intussusception: Hyun Taek Lim, M.D., Jung Hwa Lee, M.D., Jeong Eun Kim, M.D., Seong Jin Hong, M.D., Joon Ho Wang, M.D.*, Jae Dong Lee, M.D.*, Young Chil Choi, M.D.^† and Sang Yoon Kim, M.D.^‡; Korean J Gastrointest Endosc 2004;29(1):32-35. Published online July 30, 2004

Abstract PDF: Solitary juvenile polyps are the most common benign hamartomatous polyps in childhood presenting with painless rectal bleeding. It is rare in solitary juvenile polyps with adenomatous change which is associated with increased risk for gastrointestinal cancer. We report a rare case of a solitary juvenile polyp with adenomatous change and causing colonic intussussection in a 6 year old girl, who presented symptoms of lower abdominal pain, vomiting, and hematochezia. The colonic intussussception was reduced during the colon barium study and a polypoid round mass shadow at the splenic flexure was formed. On colonoscopy, it was seen as a single huge polyp impacted to the splenic flexure lumen. Endoscopic polypectomy was performed. The histologic evaluation revealed the characteristic features of a juvenile poloyps with adenomatous change. (Korean J Gastrointest Endosc 2004;29:32⁣35)

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A Case of Cowden Disease Associated with Lhermitte-Duclos Disease: Jin Sun Lee, M.D., Kang Moon Lee, M.D., U-Im Chang, M.D., Woo-Chul Chung, M.D., Hyun Mi Cho, M.D., Sung Kyoung Kim, M.D., Eun Jung Kim, M.D., Kang Hyun Choi, M.D., Sung Hoon Jung, M.D., Hyun Joo Choi, M.D.*, Jin Mo Yang, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2004;29(1):36-40. Published online July 30, 2004

Abstract PDF: Cowden disease (CD), also known as 'multiple hamartoma syndrome', is a rare autosomal dominant disorder with a high risk of breast, thyroid, or genitourinary malignancies. Lhermitte-Duclos Disease (LDD) is believed to be a hamartomatous overgrowth of cerebellar ganglion cells and currently is considered to be a part of CD. However, the report of the association between LDD and CD has been very unusual. We have recently experienced a 53- year-old man with LDD who had acral keratosis of extremities, gastrointestinal polyposis, and multinodular goiter. To our knowledge, it is the second case of CD associated with LDD in Korea. We report it with a review of the literatures. (Korean J Gastrointest Endosc 2004;29:36⁣40)

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A Case of Ischemic Colitis Mimicking Malignancy: Chi Hun Choi, M.D., Ilhyun Baek, M.D., Heung Young Oh, M.D., Gwang Ho Baek, M.D., Jin Bae Kim, M.D. and Myung Seok Lee, M.D.; Korean J Gastrointest Endosc 2004;29(1):41-45. Published online July 30, 2004

Abstract PDF: Ischemic colitis is the most common vascular disorder of intestines, and usually affects older patients. Many predisposing conditions have been implicated in the pathogenesis of colonic ischemia, although many occurrences are spontaneous in nature. Ischemic colitis can induce a wide spectrum of radiological or endoscopic features, depending on the site, extend, and timing of its onset. The coexistence of colonic ischemia with carcinoma of large bowel is well documented. However It is less well recognized that a localized segment of ischemic colon can mimic a carcinoma. Here, we report a case of ischemic colitis mimicking colon cancer in a 66 year-old man. (Korean J Gastrointest Endosc 2004;29:41⁣45)

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A Case of Polyp with High Grade Dysplasia in Ulcerative Colitis: Han-Hyo Lee, M.D., Sung-Ae Jung, M.D., Seong-Eun Kim, M.D., Yoon-Joo Na, M.D., Hee-Sun Kim, M.D., Jun-Sik Nam, M.D., Moon-Sun Yeoum, M.D., Ki-Nam Shim, M.D., Kwon Yoo, M.D. and Il Hwan Moon, M.D.; Korean J Gastrointest Endosc 2004;29(1):46-49. Published online July 30, 2004

Abstract PDF: Patients with ulcerative colitis (UC) have the increased risk of colorectal cancer. The risk of colorectal cancer development in UC is associated with the extent of colitis and duration of disease. It is generally agreed that there is little or no increased risk associated with proctitis or proctosigmoiditis. A dysplasia-associated lesion or mass (DALM) is difficult to distinguish from sporadic adenoma. The DALM indicate a high association with colon cancer. The presence of DALM as a premalignant lesion has been considered as an indication for colectomy because of the high risk of progression to malignancy within a short period. We report a case of polyp with high grade dysplasia in a 27-year-old man of ulcerative colitis confined to rectum and sigmoid colon. (Korean J Gastrointest Endosc 2004;29: 46⁣49)

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