Clinical Endoscopy

The Difference in Success Rate of Endoscopic Stent Insertion with or without Fluoroscopic Guidance: Kwang Bum Cho, M.D., Byoung Kuk Jang, M.D., Kyung Sik Park, M.D., Woo Jin Chung, M.D., Jae Seok Hwang, M.D., Sung Hoon Ahn, M.D., Gap Chul Kim, M.D.*, Jung Hyeok Kwon, M.D.* and Chang Min Cho, M.D.^†; Korean J Gastrointest Endosc 2004;29(3):107-113. Published online September 30, 2004

Abstract PDF: Backgroud/Aims: Sometimes, the endoscopic stent insertion may be done without fluoroscopic guidance. This study was performed to evaluate the difference in success rate of endoscopic stent insertion with or without fluroscopic guidance. A total of hundred and sixty three patients with upper gastrointestinal obstruction were included. Methods: The group I comprised 82 patients in which the stent insertion was done without fluoroscopy. The group II included 81 patients in which stent was inserted under the fluoroscopy. Results: The locations of obstruction are at esophagus and cardia (group I /group II, 44/40 patients), at pylorus and duodenum (15/34 patients) and at post-operative stenosis of gastro-jejunal anastomosis (23/7 patients). The statistical difference of success rate were not found between the two groups [79/82 (96.3%) in group I, 80/81 (98.2%) in group II, p=0.620]. Among group I, three patients (3.7%) were failed due to incomplete guidewire insertion. These patients were the two cases of jejunal stenosis of esophago-jejunal anastomosis and one case of duodenal obstruction with carcinomatosis peritonei. However, in these cases, the stents were successfully inserted under the fluoroscopic guidance. Conclusion: The success rate of the endoscopic stent insertion with or without the fluoroscopic guidance is not different. But in cases of inaccurate guidewire insertion, especially in patients with pyloric obstruction, the endoscopic stent insertion under the fluoroscopic guidance may be more safe and successful. (Korean J Gastrointest Endosc 2004;29:107⁣113)

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Significance of Endoscopy in the Investigation of Iron Deficiency Anemia: Dong Il Park, M.D., Hee Jung Son, M.D.^†‡, Hong Ghi Lee, M.D.^†, Suk Joong Oh, M.D*, Hyun Joo Suh, M.D.^†, Jung Won Yun, M.D., Jeong Wook Kim, M.D., Yong Kyun Cho, M.D., In Kyung Sung, M.D., Chong Il Sohn, M.D., Woo Kyu Jeon,; Korean J Gastrointest Endosc 2004;29(3):114-118. Published online September 30, 2004

Abstract PDF: Background
/Aims: There is no consensus for the role of endoscopy in the etiologic investigation of iron deficiency anemia (IDA) in Korea. We carried out a retrospective study to evaluate the role of esophagogastroduodenoscopy (EGD) and colonoscopy for their etiologic diagnosis in IDA. Methods: Between January 1998 and September 2003, 129 patients (male：female=19：110, mean age=43.6) had been grew EGD and colonoscopy for exam for the investigation of IDA at Kangbuk Samsung Hospital and Samsung Medical Center Medical records were retrospectively reviewed: Results: Significant findings were found in 8.5% (11 cases: grade B reflux esophagitis by L.A. classification (1), angiodysplasia (1), severe erosive gastritis (2), and gastric ulcer (2) and duodenal ulcer (5), while 70% (89 cases) showed some abnormality in EGD examination. Significant findings were seen in 11% (14 cases: polyps ＞1 cm (2), angiodysplasia (1), bleeding hemorrhoids (5), inflammatory bowel disease (4) and colon cancer (2)), among 36% (46 cases) of patients with some abnormality in colonoscopy. Conclusions: Gastrointestinal lesions were frequently found in patients with IDA and significant proportion of them could be the source of blood loss. Therefore, EGD and colonoscopy should be included in the evaluation of IDA in Korea. (Korean J Gastrointest Endosc 2004;29: 114⁣118)

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Usefulness of Unsedated 6.5 mm Endoscopy Compared with Sedated Standard Endoscopy: Su Youn Nam, M.D., Nayoung Kim, M.D.*, Chang Soo Lee, M.D., Jin-Hyeok Hwang, M.D.*,Jin-Wook Kim, M.D.*, Dong Ho Lee, M.D.*, Hyun Chae Jung M.D. and In Sung Song, M.D.; Korean J Gastrointest Endosc 2004;29(3):119-125. Published online September 30, 2004

Abstract PDF: Background
/Aim: Sedated endoscopy performed for higher compliance requires close monitoring and long recovery time. In addition, several side effects including even mortality could occur. This study was performed to evaluate the usefulness of unsedated 6.5 mm endoscopy compared with sedated standard endoscopy. Methods: One hundred eight patients were randomized into 2 groups (unsedated or sedated); unsedated endoscopy with 6.5 mm endoscope (58 patients); sedated endoscopy with standard endoscope (50 patients). Vital sign, time to recover walking ability and degree of amnesia were evaluated. The endoscopists' and patients' satisfaction and complication were estimated in terms of endoscopic score, visual analogue scale and complication score. Result: Oxygen saturation during the procedure significantly decreased in the sedated group. No difference was noted in endoscopists' and patients' satisfaction, but complication score was significantly decreased in the 6.5 mm scope group. The time for the induction of sedation was 3.4 minutes and the time to recover through walking ability was 36 minutes. Conclusion: From these results, there was no difference in either the endoscopists' or the patients' satisfaction between two groups, but complication and recovery time were significantly reduced in 6.5 mm group. Unsedated 6.5 mm endoscopy could be considered as a substitution for the sedated standard endoscopy. (Korean J Gastrointest Endosc 2004;29:119⁣125)

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Characteristics of Early Colon Cancer in Korea: Heung Up Kim, M.D., Young-Ho Kim, M.D., Sang Yong Song, M.D.*, Chung Hwan Chung, M.D., Jong Hyung Kim, M.D., Kyung Hee Kim, M.D., Sang Goon Shim, M.D.^†, Hee Jung Son, M.D., Poong-Lyul Rhee, M.D., Jae J. Kim, M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2004;29(3):126-132. Published online September 30, 2004

Abstract PDF: Background
/Aims: Recently, early detection and treatment of early colon cancer (ECC) has increased, and the concept of de novo carcinogenesis of colon cancer was introduced. However there were few studies in Korea. So we tried to find the incidence of ECC and the possibility of de novo colon cancer (DCC) in Korea. Methods: From Jun 1995 to Jun 2003, 3072 patients who first treated as colon cancer at Samsung Medical Center were enrolled. We selected ECC by medical record review, and pathologic slides and endoscopic photos were reviewed to evaluate the underlying tissue of cancer focus and morphologic characteristics of ECCs. ECC was defined as the cancer confined to mucosa or submucosa, and DCC was defined as the cancer lesser than 1 cm but had no adenoma component. Results: The 192 patients (6.3%) had 196 cases of ECC. The ratio of mucosal and submucosal (SM) cancers was 36.7%:63.3%. The protruded type was the most frequent type (82.1%). The depressed type was the smallest (12.9⁑6.3 mm), in size and 100% showed and SM involvement. It has significantly higher rate of the cancer without underlying adenoma component (57.1%, p＜0.001). The DCC were 6 cases and all were SM cancer and had 3 cases of protruded and depressed type each other. Conclusions: The most common shape of ECC was protruded type. However, depressed type was smaller and had higher rate of SM involvment and no adenoma component around the cancers. And we found some of DCC although the frequency was very low. (Korean J Gastrointest Endosc 2004;29:126⁣132)

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A Case of Multiple Pedunculated Polypoid Gastric Carcinoids: Su Jin Jeon, M.D., Choon Wook Kim, M.D., Gyu Lee, M.D., Hoon Cho, M.D., Jae Hyeon Moon, M.D., Yeong Muk Kim, M.D. and Joon Sang Lee, M.D.; Korean J Gastrointest Endosc 2004;29(3):133-136. Published online September 30, 2004

Abstract PDF: Gastric carcinoids usually appear as a single polypoid tumor or yellowish rounded submucosal tumor in the fundus or body of the stomach. Multiple gastric carcinoids are associated with pernicious anemia, chronic atrophic gastritis and Zollinger-Ellison syndrome. These are believed to be due to hypergastrinemia. In Korea, carcinoids usually appear as single round-based submucosal tumor or sessile polyps. Multiple pedunculated polypoid carcinoids were rarely reported. A 27-year old woman was admitted to our hospital due to melena. The endoscopy revealed multiple pedunculated polypoid lesions in the fundus and body, predominantly in Yamada type III and IV. The histopathologic examination revealed the diagnosis of gastric carcinoid tumors. Serum fasting gastrin level was normal. We report a case of multiple pedunculated polypoid gastric carcinoids without atrophic gastritis or hypergastrinemia with a review of relevant literatures.
(Korean J Gastrointest Endosc 2004;29:133⁣136)

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Intestinal Graft-Versus-Host Disease after Bone Marrow Transplantation: 7 Cases Proven by Histopathologic Diagnosis: Kyung Hee Kim, M.D., Young-Ho Kim, M.D., Ji Hyang Kim, M.D., Jeong Hwan Kim, M.D., Sang Goon Shim, M.D., Hee Jung Son, M.D., Poong-Lyul Rhee, M.D., Jae Jun Kim, M.D., Seung Woon Paik, M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2004;29(3):137-141. Published online September 30, 2004

Abstract PDF: Graft-versus-host disease (GVHD) is the major cause of morbidity or mortality after marrow transplantation. The intestinal involvement of GVHD is associated with high graft failure. It is usually difficult to diagnose gastrointestinal (GI) GVHD because symptom is nonspecific, and diagnostic criteria in endoscopic and histologic findings lack the gold standard. We reviewed 7 patients with GI GVHD proven by endoscopic biopsy from September 1999 to June 2003. The common GI symptoms at the time of endoscopy were diarrhea and abdominal pain. Four patients were acute GVHD, two acute and chronic GVHD, and one chronic GVHD. The interval from bone marrow transplantation to GVHD diagnosis by histological examination varied from 18 days to 259 days. The skin was involved in 5 patients. Two cases showed normal endoscopic finding. From these results, endoscopic biopsy is a essential tool in evaluating patients with GI complaints after bone marrow transplantation. (Korean J Gastrointest Endosc 2004;29:137⁣141)

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A Case of Tuberculosis Affecting Stomach and Duodenum Simultaneously, Mimicking Malignant Tumor: Hye Young Choi, M.D., Jung Whan Lee, M.D., Jong Sung Lee, M.D., Young Kwan Kim, M.D., Jin-Ho Lee, M.D., Il Kim, M.D., Soo Hyung Ryu, M.D., You Sun Kim, M.D., Jeong Seop Moon, M.D. and Hye Kyung Lee M.D*.; Korean J Gastrointest Endosc 2004;29(3):142-146. Published online September 30, 2004

Abstract PDF: Gastrointestinal tuberculosis has steadily decreased with the development of anti-tuberculous treatment, improvement of personal hygiene resulting from a rise in the standard of living, early diagnosis of pulmonary tuberculosis, and so forth. However, gastrointestinal tuberculosis can occasionally be found clinically in South Korea where the prevalence of tuberculosis is as much as 2.2%. Prevalence of gastric tuberculosis is low, compared with other gastrointestinal tuberculosis. While there have recently been several reports on the occurrence of gastric tuberculosis and duodenal tuberculosis assuming the form of malignancy, few cases have been reported of the tuberculosis affecting stomach and duodenum simultaneously. In this article we report the case in which tuberculosis affects both stomach and duodenum, which was initially misconceived as a double primary cancer. (Korean J Gastrointest Endosc 2004;29:142⁣146)

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A Tubulovillous Adenoma of Duodenal Bulb Treated by Endoscopic Mucosal Resection: Seung Mun Jung, M.D., Bong Gi Cha, M.D., Ji Yong Ahn, M.D., Dae Won Kim, M.D., Hyung Jun Kim, M.D., Jae Hyuk Do, M.D., Jae Gyu Kim, M.D., Se Kyoung Chang, M.D., Sil Moo Park, M.D. and Tae Jin Lee, M.D.*; Korean J Gastrointest Endosc 2004;29(3):147-150. Published online September 30, 2004

Abstract PDF: Solitary tubulovillous adenoma of the duodenal bulb is a rare tumor, which has not been reported in the Korean literature. Most of duodenal adenoma is located in the second portion of the duodenum. We report an unusual case of tubulovillous adenoma of the duodenal bulb. The lesion was treated by the endoscopic mucosal resection and was histologically diagnosed as tubulovillous adenoma. (Korean J Gastrointest Endosc 2004;29:147⁣150)

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A Case of Henoch-Schönlein Purpura with Duodenal Involvement: Su Jin Yoon, M.D., Ki-Nam Shim, M.D., Moon Sun Yeoum, M.D., Ji Young Park, M.D., Myung Shin Kim, M.D., Hee Jung Choi, M.D., Sung-Ae Jung, M.D., Kwoon Yoo. and Il-Hwan Moon, M.D.; Korean J Gastrointest Endosc 2004;29(3):151-155. Published online September 30, 2004

Abstract PDF: Henoch-Schönlein purpura is a form of systemic small- vessel vasculitis characterized by vascular purpura, predominantly occured on the lower limbs and articules with gastrointestinal and renal symptoms. The symptoms occur consecutively and purpura is the most common initial manifestation but if another symptoms prevails, the diagnosis often can be delayed. Any portion of the gastrointestinal tract distal to the esophagus may be involved, but most frequently affected sites are jejunum and ileum. Mucosal lesions found predominantly in the second portion of the duodenum seem to be characteristic of Henoch-Schönlein purpura and may assist the diagnosis in patients with atypical nonspecific symptoms. We report a case of Henoch-Schönlein purpura with the characteristic endoscopic finding in the second portion of duodenum, which helps to make the correct diagnosis and proper management of the patient. (Korean J Gastrointest Endosc 2004;29:151⁣155)

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A Case of Strangulated Intussusception Caused by the Small Intestinal Lipoma in Adult: Tae Hee Kim, M.D., Sung Yeun Yang, M.D., Soo Kyoung Kwon, M.D., Jeong Ha Pak, M.D., Kyung Im Bae, M.D., Sang Heon Lee, M.D., Sam Rong Jee, M.D., Eun Taek Pak, M.D., Sang Hyuk Lee, M.D., Sang Yong Seol, M.D., Jung Myung Chung, M.D., Woon Won Kim, M.D.*, Sa; Korean J Gastrointest Endosc 2004;29(3):156-159. Published online September 30, 2004

Abstract PDF: An intussusception in adulthood is an unusual cause of bowel obstruction. It accounts for up to 5% of all intussusception. Approximately 90% of cases are secondary to a definite lesion such as malignancy or lipoma. Most patients are asymptomatic and the lesion is often detected incidentally at colonoscopy, operation and autopsy. Strangulated intussuscetion is a rare case and also requires emergency operation. A 32-year-old woman visited our emergency room because of severe epigastric pain. Abdominal CT revealed a low density mass in bowel loop and distended small bowel loops filled with fluid. Colonoscopic finding showed huge purple-colored coil-spring lesion in the ascending colon. From this findings, we diagnosed a strangulated intussusception. Surgically removed specimen revealed a small intestinal lipoma. (Korean J Gastrointest Endosc 2004;29:156⁣159)

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