Clinical Endoscopy

Has Any Improvement been Made in the Clinical Outcome of Patients with Bleeding Peptic Ulcer in the Part 10 Years?: Jin Wook Choi, M.D., Hak Yang Kim, M.D., Kyung Ho Kim, M.D., Ja Young Lee, M.D.,Gwang Ho Baek, M.D., Myoung Kuk Jang, M.D., Joon Young Park, M.D.,Jin Heon Lee, M.D. and Jae Young Yoo, M.D.; Korean J Gastrointest Endosc 2005;30(5):235-242. Published online May 30, 2005

Abstract PDF: Background
/Aims: Bleeding still remains as one of the major medical problems in peptic ulcer diseases, despite of the advances in therapeutic options and endoscopic therapy. The aim of this study was to compare the clinical outcomes of bleeding peptic ulcer between two distinct periods in the past ten years. Methods: We divided the among 10 years, we selected the two distinct periods; the first (1993∼1995) and the second (2000∼2002). The clinical and endoscopic characteristics in patients with bleeding peptic ulcer were compared between the two periods. We also analyzed the changes in the clinical outcomes as well. Results: The age of patients during the second period was significantly older compare to the first period. In subgroup analysis, proportions of patients older than 60 years and of female patients were significantly higher in the second period. The percentage of the patients with co-morbid illness, such as diabetes mellitus, cardiovascular diseases, or users of non-steroidal anti- inflammatory drugs, was higher in the second period. Despite the decreasing the frequency of urgent surgery in the second period, there was no significant difference in the rate of re-bleeding and mortality between both periods. Conclusions: Despite the advances in therapeutic options in the second period, no significant difference was found in the prognosis of bleeding ulcer, compared to the first period. Old age, co-morbid illness, and increasing usage of NSAIDs has may contributed to this. Taken together, it might be more important to apply preventive measures to the patients who have risk factors for bleeding peptic ulcer. (Korean J Gastrointest Endosc 2005;30:235⁣242)

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The Analysis of Appendiceal Mucocele with Emphasis on the Colonoscopic Findings: Bong Luck Paik, M.D.*, Ae Ran Kim, M.D., Jae Ho Lee, M.D., Sang Bong Lee, M.D., Hee Kim, M.D., Sung Jae Park, M.D., Sam Ryong Ji, M.D., Eun Tack Park, M.D., Youn Jae Lee, M.D., Sang Hyuk Lee, M.D., Sang Young Seol, M.D., Jung Myung Chung, M.D. and Soo Jin; Korean J Gastrointest Endosc 2005;30(5):243-248. Published online May 30, 2005

Abstract PDF: Background
/Aims: Appendiceal mucocele is relatively rare disease, however early diagnosis and adequate treatment is important because the rupture of mucocele during operation may results in pseudomyxoma peritonei which is fatal. Colonoscopy is very important tool to diagnose the mucocele of appendix earlier period. Methods: We retrospectively analysed the medical records of ten cases of appendiceal mucoceles which were suspected by colonoscopy and surgically confirmed from January 1997 to March 2004. Results: There was no gender difference and mean age was 55 years old. The colonoscopic findings of appendiceal mucocele were a type of submucosal tumor and the orifice of appendix was not seen in all the cases. The size was variable from 2.5 cm to 5.0 cm and the shape was spherical in majority, but one case of appendiceal mucocele lately diagnosed as mucinous cystadenocarcinoma had elongated, oval shape. The histologic diagnosis after resection were as follows: mucosal hyperplasia 4 cases (40%), mucinous cystadenoma 5 cases (50%) and mucinous cystadenocarcinoma 1 case (10%). Conclusions: Colonoscopy is an important diagnostic tool for suspecting appendiceal mucocele. It is important to confirm by surgical resection of appendiceal mucocele which is found even incidentally by colonoscopy. (Korean J Gastrointest Endosc 2005;30:243⁣248)

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The Usefulness of Endoscopic Ultrasonography in the Diagnosis of Common Bile Duct Stones: Sung Soo You, M.D., Eun Young Kim, M.D., Jong Woon Cheon, M.D., Chang Jin Seo, M.D., Ja Kyoung Cho, M.D., Hyung Keun Ha, M.D., Jin Tae Jung, M.D., Joong Goo Kwon, M.D.,Chang Hyeong Lee, M.D. and Ho Gak Kim, M.D.; Korean J Gastrointest Endosc 2005;30(5):249-256. Published online May 30, 2005

Abstract PDF: Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosis and treatment of common bile duct stones (CBDS). However it is associated with some complications. Endoscopic ultrasonography (EUS) is an efficient diagnostic tool for CBDS with better accuracy than ultrasonography (USG) or computed tomography (CT) and lower complication rate than ERCP. We evaluated the diagnostic usefulness of EUS in suspicious CBDS. Methods: From Oct. 2001 to Mar. 2004, 84 patients with the suspicion of CBDS, without definite evidence on CT and/or USG were evaluated with EUS. The reports were reviewed retrospectively. Results: Patients were 38 males, 46 females with mean age of 56 years old. CBDS were found in 25 (29.8%) patients. In the diagnosis of CBDS undetected in CT and/or USG, EUS gave 96% sensitivity, 96.6% specificity, 92.3% positive predictive value and 98.3% negative predictive value. When CBDS were found in EUS, the average sizes of CBD and CBDS were 8.8 mm (4∼16.7) and 6.4 mm (3.3∼9.1) respectively. Diagnostic ERCP was avoided in 54 (64.3%). EUS provided additional diagnosis such as gallbladder stones, gallbladder cancer, ampullary cancer and adenoma. No complication was associated with EUS. Conclusions: EUS is reasonably safe and accurate procedure in detecting CBDS. EUS may possibly replace diagnostic ERCP in CBDS. (Korean J Gastrointest Endosc 2005;30:249⁣256)

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A Comparison of Covered Expandable Metal Stent and Uncovered Expandable Metal Stent for the Management of Distal Malignant Biliary Obstruction: Won Jae Yoon, M.D., Kwang Hyuck Lee, M.D., Jun Kyu Lee, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D., Woo Jin Lee, M.D.* and Yong Bum Yoon, M.D.; Korean J Gastrointest Endosc 2005;30(5):257-261. Published online May 30, 2005

Abstract PDF: Background
/Aims: Covered self-expandable metal stents (CEMS) were developed to overcome tumor ingrowth which is a problem of uncovered EMS (UEMS). However, the efficacy of CEMS is controversial, and CEMS have problems such as migration and development of cholecystitis. Methods: We evaluated 77 cases of endoscopic retrograde biliary drainage using EMS for unresectable distal malignant biliary obstruction in a retrospective setting. Polyurethane-covered Wallstents were used on 36 patients and uncovered Wallstents were used on 41 patients. Early complications and stent patency were analyzed. The end points of this study were stent obstruction or death of the patient. Results: Stent migration occurred in three of the CEMS group and one of the UEMS group. Cholecystitis occurred in one of the CEMS group but in none of the UEMS group. Acute pancreatitis and bleeding did not occur in both groups. Stent occlusion occurred after a mean of 271 days in the CEMS group and 263 days in the UEMS group. Conclusions: Stent patency was comparable between covered and uncovered Wallstent. A large-scale prospective randomized study is needed to evaluate the efficacy and indication of covered Wallstent. (Korean J Gastrointest Endosc 2005;30:257⁣261)

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A Case of Syndrome of Inappropriate Antidiuretic Hormone Secretion and Pneumomediastinum Complicated by Bougienation in Malignant Esophageal Stricture: Do Youn Kang, M.D., Kyoung Ah Jung, M.D., Hong Jun Kim, M.D., Hyung Joon Kim, M.D., Ji Hun Lee, M.D., Hyun Jin Kim, M.D., Tae Hyo Kim, M.D., Ok Jae Lee, M.D., Joong Hyun Cho, M.D. and Woon Tae Jung, M.D.; Korean J Gastrointest Endosc 2005;30(5):262-266. Published online May 30, 2005

Abstract PDF: Bougienation is generally an effective method providing temporary relief of obstruction to facilitate stent insertion in patients with malignant esophageal stricture. The complicated by after bougienation such as esophageal perforation, mediastinitis, bronchoesophageal fistula, pneumomediastinum, pneumothorax were reported. However, syndrome of inappropriate antidiuretic hormone secretion (SIADH) complicated by bougienation has rarely been reported. Thus, we report a case of SIADH and pneumomediastinum complicated by bougienation in a patient with malignant esophageal stricture. (Korean J Gastrointest Endosc 2005;30:262⁣266)

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Endoscopic Ultrasonographic Findings of Two Cases of Parasitic Eosinophilic Granuloma in the Stomach: Jong Won Choi, M.D., Byung Kyu Park, M.D., Yu Ri Kim, M.D., Seung Woo Park, M.D., Se Joon Lee, M.D., Si Young Song, M.D., Beom Jin Lim, M.D.* and Jae Bock Chung, M.D.; Korean J Gastrointest Endosc 2005;30(5):267-272. Published online May 30, 2005

Abstract PDF: Anisakiasis is a disease of the alimentary tract caused by nematode larva belonging to the subfamily Anisakinae. It is possible for Anisakis larva to be transmitted to man through eating raw sea fish that is preferred by Korean people. The clinical symptoms are characterized by severe cramping abdominal pain, nausea, vomiting, diarrhea, tarry stool, and epigastric fullness. The endoscopic examination has played a important role in the diagnosis of anisakiasis. However, gastric anisakiasis is undetected due to unspecific symptom and delayed endoscopy. Endoscopic ultrasonography is probably the choice of investigative tool for the evaluation of submucosal mass. However distinctive feature of parasitic infectation presenting an submucosal tumor has not been reported. Recently, we experienced two cases of gastric anisakiasis. We found gastric submucosal tumors by endoscopy, differentiated them by endoscopic ultrasonography and treated by endoscopic submucosal resection. (Korean J Gastrointest Endosc 2005;30: 267⁣272)

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A Case of Proximal Jejunal Diverticular Bleeding Diagnosed by Double Balloon Enteroscopy and Treated by Colonoscopic Hemoclipping: Hyun Joo Jang, M.D., Hyun Woo Byun, M.D., Min Ho Choi, M.D., Guen Sook Kim, M.D., Chang Soo Eun, M.D., Sea Hyub Kae, M.D. and Jin Lee, M.D.; Korean J Gastrointest Endosc 2005;30(5):273-276. Published online May 30, 2005

Abstract PDF: Although the development of wireless capsule endoscopy made it possible to visualize the entire small bowel endoscopically, capsule endoscopy has some limitations such as the impossibility of taking biopsies and carrying out therapeutic interventions. The new double-balloon method of enteroscopy has advantages over capsule endoscopy or push enteroscopy. This method is possible to take biopsies and perform therapeutic procedures such as thermal coagulation, injection, or polypectomy. It is also possible to visualize entire small bowel through oral and anal approach and improve endoscopic image by rinsing and air insufflation. We herein report a case of proximal jejunal diverticular bleeding diagnosed by double-balloon enteroscopy. (Korean J Gastrointest Endosc 2005;30:273⁣276)

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A Case of Hydrogen Peroxide Induced Proctocolitis: Nam Hoon Kang, M.D., Byung Won Hur, M.D.*, Hee Soo Kim, M.D., Chang Hoon Kim, M.D.*, Young Woo Kwon, M.D.*, Hae Kyung Kim, M.D.* and Ho Jung Kim, M.D.; Korean J Gastrointest Endosc 2005;30(5):277-280. Published online May 30, 2005

Abstract PDF: Hydrogen peroxide is commonly used for cleansing superficial wounds because of its antimicrobial action attributed to oxidizing capacity. In the past, hydrogen peroxide was used for the management of meconium ileus and fecal impaction because liberated oxygen tend to break up impaction and initiate peristaltic reflux. During 1980s, hydrogen peroxide was also introduced for disinfection of endoscope but this stronger solution has a caustic action. Several authors reported hydrogen peroxide induced colitis. We report a case of hydrogen peroxide induced chemical colitis in a 28-year-old man who complained bloody stools and lower abdominal pain after introducing hydrogen peroxide solution into the rectum to relieve rectal bleeding. His symptoms were improved with conservative treatment. (Korean J Gastrointest Endosc 2005;30:277⁣280)

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A Case of Inflammatory Fibroid Polyp of the Cecum Causing Intussusception: Se Young Park, M.D., Hyon Goo Kang, M.D., Hyun Jai Lee, M.D., Gyoung Jun Na, M.D., Chae Yong Yi, M.D., Dong Hyeon Lee, M.D., Tae Yeong Lee, M.D., Sang Hyun Kim, M.D., Chul Soo Song, M.D., Min Seok Kim, M.D.* and Ji Young Seo, M.D.^†; Korean J Gastrointest Endosc 2005;30(5):281-285. Published online May 30, 2005

Abstract PDF: Inflammatory fibroid polyp is a polypoid lesion of the gastrointestinal tract, composed of fibrous tissue, blood vessels, and inflammatory infiltration often dominated by eosinophilic leukocytes. It is infrequent, localized, and non-neoplastic condition. It is most often formed in the gastric antrum and ileum, and rarely in the esophagus, small bowel or colon. The polyp in the stomach is mainly located in the submucosa of the antrum, and may cause intermittent epigastric pain, vomiting, antral obstructive symptoms or rarely bleeding. When present in small bowel, it is usually localized in the ileum and presents with obstructive symptoms but clincal manifestations are different according to the location. Intussusception resulting from the mass is not common. We report a case of inflammatory fibroid polyp of the cecum causing intussusception. A 42-year-old male patient was referred to the hospital for the evaluation of right lower quadrant abdominal pain and palpable mass. A contrast-enhanced CT scan of the whole abdomen and colonoscopic examination revealed intussusception with a cecal mass. Inflammatory fibroid polyp causing intussusception was histologically confirmed by surgical wedge resection. (Korean J Gastrointest Endosc 2005;30:281⁣285)

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Choledocho-duodenal Fistula Caused by Tuberculosis: Sang Jeong Yoon, M.D., Byung Min John, M.D., Sung Hee Jung, M.D., Anna Kim, M.D., Byeong Seong Ko, M.D., Hyeon Woong Yang, M.D., Young Sook Park, M.D., Hoon Go, M.D., Gi Young Choi, M.D., Jun Hyoung Kim, M.D., Jae Min Lee, M.D., Hyo Jung Nam, M.D. and Soo; Korean J Gastrointest Endosc 2005;30(5):286-288. Published online May 30, 2005

Abstract PDF: Choledocho-duodenal fistula is a rare condition. It is usually developed as a complication of the gallstone disease, and rarely developed by penetrating peptic ulcer, trauma and neoplasm. Tuberculosis as a etiology of choledocho-duodenal fistula is very rare, and only a few cases were reported. We experienced a case of choledocho-duodenal fistula due to tuberculous lymphadenitis in a 26 year-old man presented with epigastric pain. After 6 months of anti-tuberculous medication, He was free of symptom and the fistula was closed spontaneously. We report the case with a review of literatures. (Korean J Gastrointest Endosc 2005;30:286⁣289)

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