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Volume 30(1); January 2005
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Is Chromoendoscopy with Indigocarmine Useful for Detecting Additional Lesions in Patients Referred for Endoscopic Resection of Gastric Adenoma or Cancer?
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Jung Ho Park, M.D., Jun Haeng Lee, M.D., Yun Jeong Lim, M.D., Poong-Lyul Rhee, M.D., Jae J. Kim, M.D., Seung Woon Paik, M.D., Jong Chul Rhee, M.D. and Cheol Keun Park, M.D.*
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Korean J Gastrointest Endosc 2005;30(1):1-6. Published online January 30, 2005
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Abstract
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- Background
/Aims: Endoscopic mucosal resection (EMR) is frequently performed for the treatment of gastric adenoma or early gastric cancer. These lesions are commonly associated with atrophic gastritis and synchronous lesions are not uncommon. The aim of this study was to evaluate the usefulness of chromoendoscopy with indigocarmine in detecting additional lesions patients referred for EMR. Methods: Chromoendoscopy was performed in 51 patients (M：F=41：10, mean age= 60 year). After a careful examination, the stomach was stained with a 30 mL of indigocarmine (0.2%) with a spraying catheter. The changes in size of the lesions and the possibility of finding additional lesions were compared between before and after spraying dye. Results: Before dye- spraying, six additional lesions were found. On the other hand, before the chromoendoscopy with indigocarmine. And among these, microscopic examination confirmed the presence of adenomas for additional three lesions. After spraying indigocarmine, eight additional lesions were found suspicious for adenoma, after the dye spraying. However, there was no neoplastic lesions histopathologically. With dye-spraying, the lesions looked bigger in four cases. And the three lesions among them showed similar size compared to the patholgic report. Conclusions: A conventional gastroscopic examination was enough to find additional adenoma or cancer, whereas chromoendoscopy was not so helpful in detecting additional lesions. In addition, because indigocarmine dye-spraying could outline mucosal elevations, chromoendoscopy was benefical in accurately measuring the size of the lesion. (Korean J Gastrointest Endosc 2005;30:16)
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Comparison of Colonoscopy and Virtual Colonoscopy for the Detection of Colorectal Polyps
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In Young Go, M.D., Sang Young Han, M.D., Jung Nam Yoo, M.D., Young Hun Koo, M.D., Seung Hoon Ryu, M.D., Jeong Hwan Cho, M.D., Seung Ho Han, M.D., Dong Hyun Lee, M.D., Sung Wook Lee, M.D., Jin Seok Jang, M.D., Jong Hun Lee, M.D., Myung Hwan Noh, M.D., Seok
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Korean J Gastrointest Endosc 2005;30(1):7-11. Published online January 30, 2005
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Abstract
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- Background
/Aims: Virtual colonoscopy using abdominal spiral computed tomography scanning allows total colonic evaluation with minimal invasiveness. We compared the performance of virtual colonoscopy and colonoscopy for the detection of colorectal polyps. Methods: We performed colonoscopy before the virtual colonoscopy. Virtual colonoscopy was performed immediately before the colonoscopic polypectomy in 24 adults (16 men and 8 women: mean age, 59 years). Results: A total of 48 polyps were found by colonoscopy. Virtual colonoscopy identified 20 of 28 polyps that were 10 mm or more in diameter (71%), 3 of 4 that were 6 to 9 mm (75%), and 9 of 16 that were 5 mm or smaller (56%). Overall sensitivity of virtual colonoscopy for colorectal polyps was 67%. Conclusions: Our result of virtual colonoscopy showed lower sensitivity for detection of significant colorectal lesions than previously reported studies. Further large group study may be needed to determine the usefulness of virtual colonoscopy. (Korean J Gastrointest Endosc 2005;30:711)
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Endosonographic Findings Useful in the Differentiation between Malignant and Benign Causes of Thickened Gallbladder Wall
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Don Lee, M.D., Sung Koo Lee, M.D., Myung-Hwan Kim, M.D., Dong Wan Seo, M.D., Sang Soo Lee, M.D., Young Il Min, M.D. and Jung-Sun Kim, M.D.*
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Korean J Gastrointest Endosc 2005;30(1):12-18. Published online January 30, 2005
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Abstract
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- Background
/Aims: The early diagnosis of possible cancer in thickened gallbladder wall is very important. This study was aimed to confirm the usefulness of endoscopic ultrasonography in differential diagnosis of gallbladder cancer in thickened gallbladder wall, and to find out the findings of endoscopic ultrasonography which favor malignancy. Methods: We reviewed 67 cases of patients who underwent cholecystectomies and who also showed thickened gallbladder wall in their preoperative endoscopic ultrasonography. According to the post-surgical pathologic diagnosis, the cases were classified into malignant and benign diseases, and they were statistically compared with several findings of endoscopic ultrasonography of thickened gallbladder wall. Results: Pathologic diagnosis included 10 cancers and 57 benign diseases. The sensitivity (90%) and specificity (98%) of endoscopic ultrasonography for diagnosis of gallbladder cancer were superior to those of other techniques. Wall thickness, associations of gallstones, loss or preservation of layered structure and irregularity of inner surface of thickened wall were significant variables in the differential diagnosis between malignant and benign causes of thickened gallbladder wall (p＜0.05). Conclusions: Endoscopic ultrasonography is useful to diagnose gallbladder cancer within thickened wall. Loss of layered structure and irregular inner surface of thickened wall are independent predictive factor of gallbladder cancer. (Korean J Gastrointest Endosc 2005;30: 1218)
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Serial Endoscopic Observation in a Case of Spontaneous Submucosal Dissection of the Esophagus
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Chang Soo Jang, M.D., Seok Jeong, M.D., Yong Sun Jeon, M.D.*, Sung Tae Ryu, M.D., Jung Il Lee, M.D., Jin-Woo Lee, M.D., Kye Sook Kwon, M.D., Don Haeng Lee, M.D., Pum-Soo Kim, M.D., Hyung Gil Kim, M.D., Yong Woon Shin, M.D. and Young Soo Kim, M.D.
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Korean J Gastrointest Endosc 2005;30(1):19-23. Published online January 30, 2005
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Abstract
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- Spontaneous submucosal esophageal dissection is a rare disorder, characterized by a longitudinal dissection along the axis of the esophagus between submucosa and muscle layer without an obvious cause. The diagnosis is made by typical esophagographic or endoscopic findings which are double-barreled esophagus in esophagography or mucosal defect in upper esophagus and false lumen running along the distal side of the esophagus on esophagoscopy. The condition usually follows a benign course with good prognosis requiring a supportive treatment, but rarely treated by endoscopy or surgery. A 74-year-old man was admitted to our hospital complaining of chest pain and odynophagia after upper respiratory infection. We diagnosed a case of spontaneous submucosal dissection of the esophagus and observed its healing process by series of endoscopy with a conservative treatment. (Korean J Gastrointest Endosc 2005;30:1923)
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A Case of Esophageal Foreign Body Induced by Glue Ingestion
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Hwang Rae Chun, M.D., Hoon Jai Chun, M.D., Bora Keum, M.D., Sung Woo Jung, M.D., Yong Sik Kim, M.D., Yoon Tae Jeen, M.D., Soon Ho Um, M.D., Chang Duck Kim, M.D. and Jin Hai Hyun, M.D.
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Korean J Gastrointest Endosc 2005;30(1):24-27. Published online January 30, 2005
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Abstract
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- Foreign bodies of the upper gastrointestinal tract are usually discovered in children, persons with esophageal disease, prisoners with a purpose of secondary gain, and mentally disturbed or disabled individuals. In adults, accidentally or intentionally ingested foreign bodies such as dentures, coins, corks, toothbrush, needles, and nails are reported. To our knowledge, there has been one case of gastric bezoar caused by glue ingestion that was removed by surgical operation in Korea. However, there has been no case report of esophageal foreign body caused by glue ingestion neither in Korea nor elsewhere. We report a case of a man with a history of chronic glue inhalation, who ingested glue with suicidal intent, that was solidified from the upper esophagus to the stomach. It was successfully removed by therapeutic endoscopy. (Korean J Gastrointest Endosc 2005;30:2427)
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Three Cases of Gastroesophageal Reflux Disease Treated by Laparoscopic Fundoplication
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Dae Hoon Song, M.D., Hyojin Park, M.D., Jina Park, M.D., Sang Won Ji, M.D., Dong Sup Yoon, M.D.* and Sang In Lee, M.D.
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Korean J Gastrointest Endosc 2005;30(1):28-34. Published online January 30, 2005
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Abstract
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- Medical treatment so far takes the major portion in the treatment of gastroesophageal reflux disease (GERD). Histamine-2 receptor antagonists, proton pump inhibitors and antacids, which are used in the medical treatment of GERD, decreases intragastric acidity, and therefore decreases acid reflux. However, recurrences are frequently observed after the cessation of medication. On the other hand, fundoplication, the surgical management of GERD, aims for physiologic reconstruction of esophagogastric junction, and for correcting the pathogenetic cause of GERD. But fundoplication is linked to risks related to surgery and general anesthesia. Laparoscopic funcoplication minimizes these risks. We recently experienced three cases of GERD improved by laparoscopic 270o fundoplication. One patient was intolerant of long-term proton pump inhibitor treatment, and two patients had hiatal hernia, and one of them showed failure to medical treatment. This report describes these three cases with a brief review of literatures survey. (Korean J Gastrointest Endosc 2005;30:2834)
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A Case of Granular Cell Tumor of the Stomach in a Patient with Extramammary Paget's Disease
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Jun-Sik Nam, M.D., Ki-Nam Shim, M.D., Han-Hyo Lee, M.D., Moon-Sun Yeoum, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D. and Il-Hwan Moon, M.D.
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Korean J Gastrointest Endosc 2005;30(1):35-38. Published online January 30, 2005
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- Granular cell tumor is an uncommon submucosal neoplasm of uncertain etiology and histogenesis. Having been reported in virtually all other sites, granular cell tumors of the gastrointestinal tract are rare. Reported cases in the gastrointestinal tract account for 5∼9% of all granular cell tumors, most commonly in the esophagus. Only one case of gastric granular cell tumor has been reported in Korea. We report a case of asymptomatic gastric granular cell tumor coexisting with gastric adenoma in 56-year-old male who had extramammary Paget's disease in the right scrotum, and it was successfully managed by endoscopic polypectomy. (Korean J Gastrointest Endosc 2005;30:3538)
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Endoscopically Exposed Coil after Embolization for Bleeding Duodenal Ulcer
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Young Chul Jo, M.D., In Du Jeong, M.D., Kun Hyung Cho, M.D., Su Jin Sin, M.D., Hyun Soo Kim, M.D., Hyo Sup Lee, M.D., Jeong Woo Shin, M.D., Sung Jo Bang, M.D., Neung Hwa Park, M.D., Jae Cheol Hwang, M.D.* and Do Ha Kim, M.D.
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Korean J Gastrointest Endosc 2005;30(1):39-42. Published online January 30, 2005
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Abstract
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- Endoscopy has been the method of choice for the initial diagnosis and treatment of gastrointestinal bleeding. However, in the case of difficult localization or endoscopic failure, angiographic or surgical alternative may be recommended. The role of angiography has been emphasized recently to control upper GI bleeding. We experienced a case with deep ulcer displaying exposed vessel along the duodenal bulb, which imposed serious rebleeding risk. Although, active bleeding was controlled by the epinephrine injections in that patient, rebleeding risk was still high. So the patient underwent emergency angiography with embolization of the pancreaticoduodenal artery and gastroduodenal artery using multiple microcoils. Follow-up endoscopic examinations showed a coil protruding into the lumen from the ulcer bed, and the exposed coil at the ulcer base was completely by the regenerated epithelium three months later. Here in, we describe the rare case of a endodcopically exposed coil after embolization for bleeding duodenal ulcer which is the first case ever reported in Korea. (Korean J Gastrointest Endosc 2005;30:3942)
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A Case of Huge Anal Fibroepithelial Polyp with Hemorrhoids Misdiagnosed as Anal Cancer
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Kwan Woo Kim, M.D., Tak Yong Kim, M.D., Jung Ho Park, M.D., Su Chan Bae, M.D., Eun Jin Gang, M.D., Sa Ra Lee, M.D., Min Woong Kim, M.D., Ji Hoon Yoon, M.D., Hwa My Kang, M.D., Jong Hwan Park, M.D., Chi Hoon Kim, M.D.,Seung Keun Park, M.D., Hee Ug Park, M.
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Korean J Gastrointest Endosc 2005;30(1):43-46. Published online January 30, 2005
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- The anal fibroepithelial polyps are well-known polypoid conditions histologically consisting of connective tissue response resulting from local irritation, which is closely associated with hemorrhoids. As previously reported, the size of the polyps ranged from 3 to 19 mm, average 9 mm. A 60-year-old women was admitted complaining of anal bleeding and constipation. Colonoscopy revealed a 3.0⁓2.5 cm sized, subpedunculated polyp on the dendate line. We removed the polyp by per anal local excision due to its hard stalk after failure of colonoscopic removal. The histologic examination was showed mature stratified squamous epithelium with hyalinized vascular changes. We report a case of huge and hard anal fibroepithelial polyp with hemorroids misdignosed as cancer. (Korean J Gastrointest Endosc 2005;30:4346)
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A Case of Gangliocytic Paraganglioma of the Ampulla of Vater Presenting as Jaundice
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Hwang Rae Chun, M.D., Chang Duck Kim, M.D., Chang Won Baeck, M.D., Sang Kyun Yu, M.D., Yong Sik Kim, M.D., Yoon Tae Jeen, M.D., Hoon Jai Chun, M.D., Hong Sik Lee, M.D., Soon Ho Um, M.D., Sang Woo Lee, M.D., Jai Hyun Choi, M.D., Ho Sang Ryu, M.D., Jung Woo
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Korean J Gastrointest Endosc 2005;30(1):47-51. Published online January 30, 2005
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- Gangliocytic paraganglioma is a rare and benign gastrointestinal tumor that usually arises in the second portion of the duodenum. Histogenesis of this tumor is yet unclear. It is incidentally found during radiographic examinations or during endoscopy looking for the cause of gastrointestinal hemorrhage, which usually manifests as mucosal ulcerations. To our knowledge, there was only one case of duodenal gangliocytic paraganglioma presenting with melena in Korea. We experienced a case of gangliocytic paraganglioma arising from the ampulla of Vater, presenting as obstructive jaundice, which was subsequently removed surgically. Thus, we report this case with a review of literatures. (Korean J Gastrointest Endosc 2005;30:4751)
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