Clinical Endoscopy

Risk of Adenomatous Polyps in the Proximal Colon according to Age and Gender: Ho Gyun Na, M.D., Chang Hwan Choi, M.D., Sang Kil Lee, M.D., Jong Won Choi, M.D., Tae Il Kim, M.D., Ho-guen Kim, M.D.* and Won Ho Kim, M.D.; Published online February 27, 2005

Abstract PDF: Background
/Aims: Several lines of evidences suggest that the distribution of colorectal adenomatous polyps are different according to age and gender. Therefore, the efficacy of screening sigmoidoscopy for colorectal cancer not considering age and gender necessitates reappraisal. We aimed to evaluate the distributions of colorectal adenomatous polyps according to age and gender. Methods: Total of 1,886 patients (1,322 men, 564 women) who underwent colonoscopy at Severance hospital, Seoul, Korea between July 1995 and September 2002, were included. The proximal colon was defined as the colon proximal to the sigmoid-descending junction. The advanced polyp was defined as the adenomatous polyp with one or more of the following features: (1) 1 cm or larger in diameter, (2) villous histology, (3) high grade dysplasia or adenocarcimoma. Results: The risk of adenomatous polyps in the proximal colon was higher in men than women (OR, 1.63; 95% CI, 1.33∼1.99, p＜0.05), and increased with age (p＜0.05). The risk of advanced polyps in the proximal colon tended to be higher in men than women, and to increase with age, but did not reach statistical significance. Among 1,886 patients with colorectal adenomatous polyps, 587 patients (31.1%) had polyps only in the proximal colon. Among 814 patients with advanced colorectal adenomatous polyps, 217 patients (26.7%) had advanced polyps only in the proximal colon. The risks of adenomatous polyps or advanced polyps found only in the proximal colon were not different according to sex, but tended to increase with age. Conclusions: The risk of adenomatous polyps in the proximal colon was higher in men compared to women and increased with age. About one third of the patients with colorectal adenomatous polyps had polyps only in the proximal colon. Colonoscopy is a better strategy for endoscopic screening for colorectal cancer compared with sigmoidoscopy, especially, in elderly male. (Korean J Gastrointest Endosc 2005;30:66⁣74)

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Factors Affecting the Response to Endoscopic Dilatation Therapy for Benign Esophageal Stricture: Won Chang Shin, M.D.; Korean J Gastrointest Endosc 2005;30(2):53-59. Published online February 27, 2005

Abstract PDF: Background
/Aims: Endoscopic dilatation is an effective therapy for benign esophageal stricture. We analyzed the factors related to the endoscopic dilatation therapy in patients with benign esophageal strictures such as etiology, grade of dysphagia, length of stricture and number of therapeutic sessions. Methods: We retrospectively analyzed the data of 63 patients who received endoscopic esophageal dilatation therapy due to benign esphageal strictures. Results: The grade of dysphagia number was associated with the length of strictures (p=0.012) and therapeutic session (p=0.005). There was a statistically significant correlation between the length of strictures and therapeutic session number (p=0.001). There was no statistical difference in grade of dysphagia or the length of stricture according to the cause of strictures of therapeutic sessions performed. In corrosive stricture, the higher grade of dysphagia, was associated with the in creased number (p=0.028). The length of stricture was longer (p=0.040) and the number of therapeutic sessions were increased (p=0.026) in corrosive stricture than other etiologies. Conclusions: Corrosive esophageal stricture shows long stricture segment and needs increased number of therapeutic session as compared to other etiologies. However, corrosive esophageal stricture can be effectively treated with careful technique and increased number of endoscopic dilatation sessions. (Korean J Gastrointest Endosc 2005;30:53⁣59)

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The Proper Patient Selection for Percutaneous Endoscopic Gastrostomy according to the Complications and Tube Replacement: Sung Jun Kim, M.D., Won Chang Shin, M.D. and Jin Ho Lee, M.D.; Korean J Gastrointest Endosc 2005;30(2):60-65. Published online February 27, 2005

Abstract PDF: Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) is a commonly-performed procedure for patients with swallowing disabilities. Though safe and technically simple, PEG is often associated with some complications, and occasionally requires tube replacement. The aims of this study were to evaluate the complications and the proper indication of PEG by analyzing the success rate and tube replacement. Methods: We reviewed medical records of 81 patients who underwent initial PEG and 92 patients who underwent tube replacement or removal from January 1995 to December 2003. Results: Underlying diseases included cerebrovascular accident (51%), spinal cord injury (12%), hypoxic brain damage (11%), and head trauma (11%). PEG success rate was 93%. Twenty five patients (31%) showed various complications. Wound infection was the most common (10/25, 40%) complication, and most complications (64%) occurred within 10 days, but 24% of complications occurred 1 month after the procedure. Mean duration for tube placement was 7.3 months. The reasons for tube replacement or removal were worn- out (36 cases, 39%), unwanted self extraction (14 cases, 15%), and death (11 cases, 12%). Conclusions: PEG is a safe and effective method for enteral nutrition. However PEG shows some complications, and occasionally needs tube replacement. It is crucial to select the appropriate patient and to perform careful procedure. (Korean J Gastrointest Endosc 2005;30:60⁣65)

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Two Cases of Esophageal Pyogenic Granuloma Treated by Endoscopic Mucosal Resection: Chang Hee Han, M.D., Youn Soo Kim, M.D., Young Kwan Cho, M.D., Chang Beom Ryu, M.D., Kye Won Kwon M.D.*, So Young Jin, M.D.*, Joon Seong Lee, M.D., Moon Sung Lee, M.D. and Chan Sup Shim, M.D.; Korean J Gastrointest Endosc 2005;30(2):75-79. Published online February 27, 2005

Abstract PDF: Pyogenic granulomas are benign in nature and commonly found in the skin and mucosa. They rarely involve the gastrointestinal tract other than oral cavity. There are 30 reports in worldwide and only 4 domestic reports of such matter. Upper gastrointestinal endoscopy revealed the pedunculated masses with various surface changes in a 61-year-old man and a 55-year-old women. Endoscopic ultrasonography and endoscopic mucosal resection using snare were performed for accurate diagnosis and treatment. The tumors were pathologically diagnosed as pyogenic granulomas of the esophagus. (Korean J Gastrointest Endosc 2005;30:75⁣79)

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Three Cases of Secondary Esophageal Tuberculosis Presenting as an Esophageal Submucosal Tumor: Sung Woo Choi, M.D., Hyojin Park, M.D., Sang Bae Lee, M.D., Jun Pyo Chung, M.D., Sang In Lee, M.D. and Soon Won Hong, M.D.*; Korean J Gastrointest Endosc 2005;30(2):80-85. Published online February 27, 2005

Abstract PDF: Although esophageal tuberculosis is a rare disease throughout the world, esophageal tuberculosis should be included as one of differential diagnosis made in Korea where the prevalence of tuberculosis is still high. Esophageal tuberculosis might be mistaken for carcinoma due to lack of specific symptom, diagnostic study or pathologic diagnosis in clinical setting. The diagnosis would be difficult when esophageal ulcerative lesions or submucosal tumor are present, especially. When the result after a biopsy is not confirmative, the diagnosis can be made with the detection of mycobacteria by microbiologic study or polymerase chain reaction. We experienced three patients with esophageal tuberculosis; a 41-year-old woman with dysphagia, a 34-year-old woman with dysphagia and odynophagia, and a 52-year-old woman with epigastric pain. Esophageal submucosal tumors were found in all the patients with upper gastrointestinal endoscopy. The diagnosis of tuberculosis were finally made by removal of tumor and biopsy or tuberculosis polymerase chain reaction. They all got improved after the treatement with anti-tuberculosis medications. Herein, we report 3 cases of esophageal tuberculosis with review of related literatures. (Korean J Gastrointest Endosc 2005;30:80⁣85)

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A Case of Henoch-Schönlein Purpura with Cerebellar and Gastrointestinal Bleeding: Hyun Seok Lee, M.D., Young Sook Park, M.D., Kye Hyoung Kwon, M.D., Chung Hyeon Kim, M.D., Won Wook Choi, M.D., Tae Hun Kim, M.D., Yeon Ho Choo, M.D., Yun Ju Jo, M.D., Seung Jin Lee, M.D.* and Jong Eun Ju, M.D.^†; Korean J Gastrointest Endosc 2005;30(2):86-90. Published online February 27, 2005

Abstract PDF: Henoch-Schönlein purpura is a systemic leukocytoclastic vasculitis involving small vessels. The diagnostic criteria is defined as a typical skin rash of which pathologic examination shows leukocytoclastic vasculitis, accompanied by any two of these major manifestations of the disease, namely gastrointestinal tract, kidney, joint involvement. In elder patient, Henoch-Schönlein purpura shows more serious gastrointestinal tract involvement. There are some reports of brain involvement of Henoch-Schönlein purpura. A 69-year-old man was admitted to department of neurosurgery, because of loss of consciousness. Brain CT showed acute cerebellar hemorrhage with rapid resolution by conservative treatment. Diffuse purpuric eruptions on both low legs were developed after 7 days of hospitalization. He was refered to our department due to epigastric pain and bloody diarrhea. There were multiple longitudinal ulcers with hemorrhage on the stomach and the sigmoid colon of which biopsy showed leukocytoclastic vasculitis. Microscopic hematuria and proteinuria were also noted. He had a fatal course due to recurrent colonic bleeding and poor medical condition. We report an unusual case of cerebellar and gastrointestinal involvement of Henoch-Schönlein purpura in elderly patient. (Korean J Gastrointest Endosc 2005;30:86⁣90)

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A Case of Idiopathic Duodenal Intramural Hematoma: Chang Won Baeck, M.D., Hoon Jai Chun, M.D., Hwang Rae Chun, M.D., Sang Kyun Yu, M.D., Yong Sik Kim, M.D., Yoon Tae Jeen, M.D., Soon Ho Um, M.D., Chang Duck Kim, M.D., Ho Sang Ryu, M.D. and Jin Hai Hyun, M.D.; Korean J Gastrointest Endosc 2005;30(2):91-94. Published online February 27, 2005

Abstract PDF: Duodenal intramural hematoma is mostly caused by blunt abdominal trauma. Spontaneous duodenal intramural hematoma has been reported in the literature in patients with over-anticoagulation and coagulation disorders. The presentation of patients can vary from mild and vague abdominal pain to intestinal tract obstruction and an acute abdomen. The diagnosis is evident by gastroduodenal endoscopy, EUS and abdominal CT scan. We report a case of spontaneous duodenal intramural hematoma without the history of abdominal trauma and coagulation disorders in 54-year-old male patient. After conservative treatment, the patient was discharged without any complications. (Korean J Gastrointest Endosc 2005;30:91⁣94)

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A Case of Type I Duodenal Perforation Treated with Covered Metal Stent: Jun Lee, M.D., Kwang Hyun Ko, M.D., Jeong Ki Kim, M.D., Cheol Kweon Jeong, M.D., Sun Hye Jung, M.D., Jae Hyun Moon, M.D., Sung Pyo Hong, M.D., Seong Gyu Hwang, M.D., Pil Won Park, M.D. and Kyu Sung Rim, M.D.; Korean J Gastrointest Endosc 2005;30(2):95-98. Published online February 27, 2005

Abstract PDF: Endoscopic retrograde cholangiopancreatography (ERCP) has played an important role in diagnosis and management of biliary disease. Traditionally, duodenal perforations, rare complication of ERCP, have been managed surgically. However, in the past decade, there were arguments for surgical and nonsurgical management of ERCP-related duodenal perforations and reports of successful conservative treatment were increasing especially in patients with old age and poor medical conditions. We experienced a case of type I duodenal perforation following ERCP treated with covered metal stent in 74 years old female with duodenal invasion by Klatskin tumor. (Korean J Gastrointest Endosc 2005;30:95⁣98)

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A Case of Malakoplakia Treated by Antibiotics in the Rectum: Dong Hyun Lee, M.D., Jong Yun Cheong, M.D., Won Il Park, M.D., Jin Hong Park, M.D., Hyong Wook Kim, M.D., Jeong Heo, M.D., Gwang Ha Kim, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.; Korean J Gastrointest Endosc 2005;30(2):99-102. Published online February 27, 2005

Abstract PDF: Malakoplakia is a rare chronic inflammatory process, most commonly affecting the urinary tract. This entity was first described by Michaelis and Gutman in 1902. As of 1995, only 85 cases of malakoplakia of the gastrointestinal tract has been reported. The common sites of colonic involvement are the rectum, sigmoid, and right colon, in descending order of frequency. The most common disease associated with malakoplakia is colorectal carcinoma. Surgical resection is the treatement of choice for cases associated with carcinoma or complications. But in other cases, medical treatment could be attempted. Antimicrobial drugs, such as trimethoprime-sufamethoxazole, rifampin, or as recently suggested, ciprofloxacin can be used. We report a case of rectal malakoplakia treated by ciprofloxacin with a review of literatures. (Korean J Gastrointest Endosc 2005;30:99⁣102)

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A Case of Serrated Adenoma Presenting as Colon Cancer: In Seok Seo, M.D., Yang Ho Kim, M.D., Seung Min Park, M.D., Jin Woong Cho, M.D., Young Ung Lee, M.D. and Myoung Jin Ju, M.D.*; Korean J Gastrointest Endosc 2005;30(2):103-107. Published online February 27, 2005

Abstract PDF: Serrated adenoma (SA) is a distinct form of colorectal neoplasia and it is defined as a neoplastic lesion composed of a monotonous cell population with atypical nuclei proliferating in serrated glandular architectures. Hyperplastic polyp is considered a benign lesion with no malignant potential. However, SA progressed into frank carcinoma has been demonstrated in an individual case, and 'serrated neoplasia pathway' is suggested by some authors as an alternative to classical adenoma-carcinoma sequence. Distinguishing between hyperplastic polyp and SA is important because of the different management implications and the increased potential for neoplastic progression in the latter, but sometimes it is very difficult. SA is usually small and sessile polypoid lesion. We report a case of SA presenting as large fungating mass similar to colon cancer, diagnosed as hyperplastic polyp initially by colonoscopic biopsy and confirmed as after SA the surgery. (Korean J Gastrointest Endosc 2005;30:103⁣107)

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Treatment of Rectal Stricture with Crohn's Disease Using Local Steroid Injection Following Dilation by Bougienation: Jin Gook Huh, M.D., You Sun Kim, M.D., Sun Young Kim, M.D., Ju Yeon Cho, M.D., Il Kim, M.D., Soo Hyung Ryu, M.D., Jung Whan Lee, M.D. and Jeong Seop Moon, M.D.; Korean J Gastrointest Endosc 2005;30(2):108-113. Published online February 27, 2005

Abstract PDF: Crohn's disease has shown increased frequency in Korea. When unresponsive to medical therapy, intestinal stricture, a serious complication of Crohn's disease, sometimes requires surgical resection. However, surgical therapy has many problems because the stricture tend to recur frequently. Recently, endoscopic therapy such as bougienation or balloon dilatation has been used in treatment of intestinal stricture, because of its inexpensiveness, simplicity and safety. Combined steroid injection therapy using has shown more effective outcome than endoscopic dilatation alone by suppression of wound healing and reduction of fibrosis. We report a case of complicated rectal stricture in a patient with Crohn's disease, which dilated successfully using injection of triamcinolone following bougienation. (Korean J Gastrointest Endosc 2005;30:108⁣113)

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A Case of Common Bile Duct Stone Caused by Foreign Body in Patient with Adenoma of the Ampulla of Vater: Ju Hyun Park, M.D., Sun Mi Lee, M.D., Jun Hyok Oh, M.D., Sang Youn Hwang, M.D., Seong Hun Lee, M.D., Tae Oh Kim, M.D., Seong Ook Lee, M.D., Won Il Park, M.D., Suk Kim, M.D.*, Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and; Korean J Gastrointest Endosc 2005;30(2):114-117. Published online February 27, 2005

Abstract PDF: Choledocholithiasis caused by a foreign body is rare. The most common type of foreign body in the common bile duct is a residual object from previous surgery such as a metal clip or suture material. Foreign body may enter the biliary system after choledochointestinal anastomosis or endoscopic sphincterotomy. Rarely, penetrating missile fragment or gunshot shrapnel account for another type of foreign body. We experienced a case of common bile duct (CBD) stone caused by foreign meterial in 75-years-old women who had a plant foreign body in the common bile duct. She had no past history of abdominal surgery or penetrating trauma. The foreign body and stone were successfully extracted with Dormia basket after the endoscopic sphincterotomy. (Korean J Gastrointest Endosc 2005;30: 114⁣117)

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