Clinical Endoscopy

Endoscopic Treatment of Esophageal Foreign Bodies in Adult: Management of 257 Cases: Hyun Jin Kim, M.D., Ok Jae Lee, M.D., Hyun Ju Min, M.D., Do Hyun Kang, M.D., Eun Jeong Lee, M.D., Ji Hun Lee, M.D., Tae Hyo Kim, M.D., Woon Tae Jung, M.D. and Joong Hyun Cho, M.D.; Korean J Gastrointest Endosc 2004;29(2):51-57. Published online August 30, 2004

Abstract PDF: Background
/Aims: The majority of foreign body ingestions occur in pediatric population. We assessed the characteristics and endoscopic treatment outcome of esophageal foreign bodies in adults. Methods: Medical records of consecutive 257 patients who received trial of endoscopic treatment for esophageal foreign bodies, from January 1998 through November 2003 in Gyeongsang National University Hospital, were analyzed retrospectively. Results: Among 257 cases, 132 were male. The incidence was highest in 5th decade, and mean age was 54.6 years. Most common location was upper esophagus (84.6%). Accidental ingestion accounted for 92.2%. Twenty cases (7.8%) of voluntary ingestion were all prisoners or in psychiatric problems. Fish bone was the most common type. Endoscopic treatment was successful in 253 cases (98.4%) and 4 were managed with rigid esophagoscopy. Four cases who complicated by acute mediastinitis or pneumomediastinum at presentation had sharp-pointed or long objects lodged in upper esophagus, and almost presented at 48 hours after the ingestion. Full esophagogastroduodenoscopy could find 37 organic lesions in 35 cases. Conclusions: Majority of esophageal foreign bodies in adults developed accidentally during meals. Voluntary ingestion of foreign bodies was not related to meals, and developed by prisoners or psychiatric patients. The sharp-pointed or long objects lodged in upper esophagus with delayed presentation may cause complication. Endoscopic treatment is safe and beneficial, and a full endoscopic evaluation should be recommended for the evaluation of a synchronous organic disease. (Korean J Gastrointest Endosc 2004;29:51⁣57)

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Interpretation of Capsule Endoscopy: Expert versus Novice: Sung Woo Jung, M.D., Hoon Jai Chun, M.D., Bora Keum, M.D., Sung Chul Park, M.D.,Rok Son Choung, M.D., Yoon Tae Jeen, M.D., Hong Sik Lee, M.D., Yong Sik Kim, 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,; Korean J Gastrointest Endosc 2004;29(2):58-62. Published online August 30, 2004

Abstract PDF: Background
/Aims: Capsule endoscopy (CE) is a new method enabling noninvasive diagnosis of small bowel diseases. There have been few studies examining the possibility of interobserver variation according to proficiency. We evaluated the interobserver variability between expert and novice for reviewing CE images. Methods: Among patients who were taken CE from June 2003 to July 2003, twenty patients were randomly selected. Captured images were assessed by an expert and a novice separately. The expert has experience of more than 150 CE interpretation and the novice only had experience in performing EGD and colonoscopy. The novice had trained on interpretation of the CE with 5 cases before this study. Interobserver agreement was evaluated using kappa coefficient. Results: CE findings were divided into normal/ abnormal groups. Abnormal groups were classified into small focal, large focal, multiple diffuse, structural deformity groups. Compared with the expert, the novice missed 2 cases (Meckel's diverticulum and angiodysplasia). There was no disagreement in other cases. Conclusion: There is 90% (18/20) interobserver agreement between the expert and the novice for the interpetation of findings CE (k=0.737). Normal findings and diffuse large lesions tended to have higher concordance, whereas small focal lesion and structural deformities were more likely to be a source of disagreement. (Korean J Gastrointest Endosc 2004;29:58⁣62)

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The Clinical Course of ERCP-related Bowel Perforation: Jung Sik Choi, M.D., Myung-Hwan Kim, M.D., Sang Soo Lee, M.D., Do Hyun Park, M.D., Moon Hee Song, M.D., Hyoung-Chul Oh, M.D., Dae Keun Pyun, M.D., Min Kyung Kim, M.D., Young Sun Yeo, M.D.,Ji Min Han, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D. and Young; Korean J Gastrointest Endosc 2004;29(2):63-69. Published online August 30, 2004

Abstract PDF: Background
/Aims: The management of small-bowel perforations associated with endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic sphincterotomy (EST) is still controversial. The purpose of this study was to analyze the treatment and outcome of patients with ERCP -related perforations in a single tertiary medical center. Methods: Of 18,379 cases of ERCPs performed between January 1990 and December 2003, twenty-six patients (0.14%) with perforation were identified and medical chart were reviewed retrospectively. Results: EST were performed in 10,231 patients and perforation occurred in 18 patients. Four out of 18 patients with small-bowel perforation related to EST underwent surgical operation and the rest 14 patients recovered with conservative treatment alone. Of the rest 8 perforation patients unrelated to EST, perforation occurred during the insertion of endoscope in 7 patients and catheter manipulation in 1 patient. All but one perforations associated with mechanical injury by endoscope itself were managed with an emergent laparotomy, and the one patient with perforation related to catheter manipulation recovered with conservative treatment. Conclusions: A small-bowel perforation related to endoscope per se usually required a surgery, but sphincterotomy related perforations rarely did so. The prevalence and mortality rate of small-bowel perforations associated with ERCP and/or EST were 0.14% and 0%, respectively, in a single tertiary medical center. (Korean J Gastrointest Endosc 2004;29:63⁣69)

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Pyloric Injection of Botulinum Toxin for Treatment of Diabetic Gastroparesis: A Report of Four Cases: Min Su Kim, M.D., Yong Chan Lee, M.D., Hyojin Park, M.D., Jung Eun Lee, M.D., Yon Soo Jeong, M.D., Jong Kwan Park, M.D., Chul Woo Ahn, M.D. and Hyun Chul Lee, M.D.; Korean J Gastrointest Endosc 2004;29(2):70-74. Published online August 30, 2004

Abstract PDF: Gastroparesis is a disorder of gastric motility that results in delayed gastric emptying. Up to 58% of patients with diabetes mellitus may have diabetic gastroparesis, a syndrome characterized by nausea, vomiting, early satiety, and bloating. The pathophysiology of this disorder is not completely understood, but it is believed to include fundic dysaccommodation, a decrease in gastroduodenal pressure gradient and antral hypomotility. In addition to antral and fundic dysfunction, patients with diabetes may typically have pyloric dysfunction or spasm. Treatment consists of a change in diet to small volume, frequent meals and the use of the prokinetic agents. This case report describes the four patients with severe diabetic gastroparesis whose symptoms persisted despite of dietary changes and the use of prokinetic agents in high doses. All of them were treated with pyloric injection of botulinum toxin and three had significant symptomatic and scintigraphic improvement. (Korean J Gastrointest Endosc 2004;29:70⁣74)

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A Case of Gastric MALT Lymphoma Presenting as a Submucosal Tumor (SMT)-like Lesion, Diagnosed by Endoscopic Mucosal Resection: Yon Soo Kim, M.D., Chang Hee Han, M.D., Jeong Hoon Park, M.D., Young Kwan Cho, M.D., Hyun Soo Joo, M.D., Seong Hwan Kim, M.D., Young Hong Lee, M.D., In Seop Jung, M.D.,Joo Young Cho, M.D., Joon Seong Lee, M.D., So Young Jin, M.D.*,and Chan Sup Shim, M.D.; Korean J Gastrointest Endosc 2004;29(2):75-79. Published online August 30, 2004

Abstract PDF: Gastric MALT lymphoma usually presents with various endoscopic morphologic characteristics. The majority of gross findings reveal multiple and superficial erosions or ulcerations. However gastric MALT lymphoma, presenting as a submucosal tumor, is very rare. We recently experienced a case of low-grade gastric MALT lymphoma, presenting as a submucosal tumor-like lesion without definite mucosal lesion, confirmed by endoscopic mucosal resection. So we report this case with a review of the related literatures. (Korean J Gastrointest Endosc 2004; 29:75⁣79)

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A Case of Successful Treatment of a Bleeding Duodenal Ulcer with Endoscopic Hemoclipping in a Child: Kon Ho Shim, M.D., Young Seok Cho, M.D., Chul Hyun Lim, M.D., Yoon Seok Koh, M.D.,Jun Chang Song, M.D., Jong Hyun Park, M.D., Sung Soo Kim, M.D., Hiun Suk Chae, M.D.,Myung Gyu Choi, M.D., Chang Don Lee, M.D., Kyu Yong Choi, M.D.,In Sik Chung, M.D. and Jin; Korean J Gastrointest Endosc 2004;29(2):80-84. Published online August 30, 2004

Abstract PDF: Upper gastrointestinal bleeding in infant and children is much less common than that in adults. Upper gastrointestinal bleeding in infants and young children is most often acssociated with stress ulcer or erosions, but in older children it may also be caused by duodenal ulcer, esophagitis, and esophageal varices. Because the total blood volume of a child is relatively small and can deplete rapidly, gastrointestinal bleeding is a catastrophic event. However, it is not associated with significant mortality except in those with a severe primary illness. Data on therapeutic endoscopy for pediatric gastrointestinal bleeding are limited to case reports. The hemoclip has recently been added to armamentaria of endoscopic devices. This method has several advantages, including fewer complication and the fact that less expertise is needed to achieve permanent hemostasis. We report a case of successful endoscopic control of a bleeding duodenal ulcer using with a hemoclip in a 22-month-old boy. Endoscopic hemoclipping would be a safe and efficacious treatment for control of bleeding from peptic ulcers in children. (Korean J Gastrointest Endosc 2004;29:80⁣84)

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Atypical Duodenal Ulcer after Anaphylactic Shock: Young Hye Byun, M.D., Yun Ju Jo, M.D., Tae Hyun Kim, M.D., Young Sook Park, M.D.,Jong Eun Joo, M.D.*, Sang Won Park, M.D., Jong Yong Lee, M.D. and Yong Il Kim, M.D.; Korean J Gastrointest Endosc 2004;29(2):85-89. Published online August 30, 2004

Abstract PDF: Anaphylaxis is an acute life-threatening event, presenting with various clinical symptoms. However, each pathophysiologic mechanism has not been completely understood. We report a case of atypical duodenal ulcers after cephradine induced anaphylactic shock. A 33-year- old woman was injected intravenously of cephradine and propofol for genoplasty, and anaphylactic reaction developed. After the recovery of shock, the patient who complained severe epigastric pain showed unusual endoscopic findings which were are multiple, irregular and shallow ulcerations at the bulb and the second portion of the duodenum. The symptom got improved after ulcer treatment. Histologically, the ulcerating inflammation was detected with eosinophilic infiltration and vascular thrombi. The skin provocation test for cephradine was positive. We suggest that the atypical duodenal ulcer was induced by transient ischemic mucosal injury and chemical damage due to the anaphylactic reaction. (Korean J Gastrointest Endosc 2004;29:85⁣89)

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A Case of Crohn's Disease with Giant Pseudopolyposis and Ileocolic Fistula: Moon-Sun Yeoum, M.D., Sung-Ae Jung, M.D., Han-Hyo Lee, M.D., Jun-Sik Nam, M.D.,Seong-Eun Kim, M.D., Seung-Yon Back, M.D.*, Ki-Nam Shim, M.D.,Kwon Yoo, M.D. and Il-Hwan Moon, M.D.; Korean J Gastrointest Endosc 2004;29(2):90-93. Published online August 30, 2004

Abstract PDF: Pseudopolyp is a common association of ulcerative colitis but may also occur in Crohn's disease, ischemic colitis and infective colitis. Pseudopolyps are results of the repair process, representing islands of granulation tissue surrounded by mucosa with ulceation. When a pseudopolyp is larger than 1.5 cm, it is often called a "giant pseudopolyp". Such lesions of inflammatory origin are often confused with polypoid carcinoma or infiltrating submucosal malignancy. We report a case of asymptomatic Crohn's disease as giant pseudopolyposis mimicking malignancy on sigmoid colon, with a review of relevant literatures. (Korean J Gastrointest Endosc 2004;29:90⁣93)

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A Case of Ileocecal Burkitt's Lymphoma with Intussusception in an Adult: Jin Hong Park, M.D.*, Hyong Wook Kim, M.D., Won Il Park, M.D., Jong Yun Cheong, M.D.,Dong Hyun Lee, M.D., Jeong Heo, M.D., Gwang Ha Kim, 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;29(2):94-98. Published online August 30, 2004

Abstract PDF: Burkitt's lymphoma is a distinct pathologic entity characterized by a diffuse proliferation of small, noncleaved cells of B-lymphocytes origin. It was first reported as "jaw sarcoma" in East African children and described as endemic in tropical Africa. Burkitt's lymphoma usually occurs in youth and children, but it is very rare in an adult gastrointestinal tract of an adult. We recently experienced an unusual case of Burkitt's lymphoma in a 69-year-old male with lower abdominal pain and a mass. A colonoscopy and abdominal CT scan detected an ileocecal fungating mass with intussusception, and the histologic examination of the resected and biopsy specimens showed infiltration of medium-sized lymphoblasts with characteristic "starry sky" machrophages. So we report it with a brief review of literatures. (Korean J Gastrointest Endosc 2004;29:94⁣98)

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A Case of Rectal Dieulafoy's Lesion Treated by Endoscopic Band Ligation: Won Min Hwang, M.D., Hoon Seop Kuh, M.D., Tae Hee Lee, M.D., Ki Se Lee, M.D., Euyi Hyeog Im, M.D., Kyu Chan Huh, M.D., Young Woo Choi, M.D. and Young Woo Kang, M.D.; Korean J Gastrointest Endosc 2004;29(2):99-102. Published online August 30, 2004

Abstract PDF: Dieulafoy's lesion is a relatively uncommon disease which is minor cause of massive acute lower gastrointestinal bleeding. The lesion comprises mainly of an abnormally exposed submucosal artery associated with a minute mucosal defect on the top in the stomach, and it is a rare cause of profuse but intermittent gastrointestinal bleeding. Less commonly, similar lesions have also been identified in the duodenum, jejunum, colon, and in rare cases, the rectum. In this report, 70 year-old man is described, who has an massive hematochezia from a small rectal mucosal defect with an exposed vessel. Control of the bleeding was successfully achieved with endoscopic band ligation. The fact that rectal Dieulafoy's disease is rare but one of the causes of massive hematochezia should serve as a reminder in the future cases in the elderly. (Korean J Gastrointest Endosc 2004;29:99⁣102)

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