Clinical Endoscopy

Incidence of Lymphocytic Gastritis in Endoscopic Corporeal Varioliform Gastritis: Hae Won Han, M.D., In Seok Lee, M.D., Nak Gi Kwan, M.D., Jae Myung Park, M.D., Jung Hwan Oh, M.D., Yu Kyung Cho, M.D., Sang Woo Kim, M.D., Myung-Gyu Choi, M.D. and In-Sik Chung, M.D.; Korean J Gastrointest Endosc 2005;30(6):291-296. Published online June 30, 2005

Abstract PDF: Background
/Aims: Lymphocytic gastritis is characterised by the accumulation of small lymphocytes in the surface and foveolar epithelium. It is a common finding in a subtype of gastritis characterized by the presence of nodules and erosions in the body, relative to which the antrum was spared-'varioliform gastritis'. Lymphocytic gastritis usually follows a chronic course and presents severe clinical symptoms including hypoproteinemia. The aim of this study was to investigate the incidence and clinical manifestations of lymphocytic gastritis in patients who showed endoscopic apprearance of enlarged folds, erosions, and aphthoid nodules in the body. Materials and Methods: The clinical and histological findings of varioliform gastritis with presence of nodules and erosions in the body were analyzed. The ratio of 25 lymphocytes/100 epithelial cell was used as the criteria for the diagnosis of lymphocytic gastritis in the study. Results: Twenty nine cases were classified as varioliform gastritis (there were 20 men/9 women and average age was 48.9 years). Among the 29 varioliform gastritis, 9 corresponded to lymphocytic gastritis. H. pylori infection rate was 44% (4/9) in lymphocytic gastritis and 65% in non lymphocytic gastritis. There was no difference in H. pylori infection rate between the lymphocytic gastritis and non lymphocytic gastritis. Clinical laboratory findings of lymphocytic gastritis were normal. The patients with lymphocytic gastritis had absence of mild degree of symptoms. Among 4 patients with follow-up endoscopy, erosions in body were completely disappreared in 3 patients. Conclusions: Lymphocytic gastritis occurred in about 30% of patients with varioliform gastritis. Most patients with lymphocytic gastritis had no symptoms or only mild symptoms and had no significant abnormality in clinical or laboratory finding. (Korean J Gastrointest Endosc 2005;30:291⁣296)

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Risk Factors Related to Bleeding after Endoscopic Mucosal Resection of Gastric Tumors: Young Doo Lee, M.D., Hyang Eun Seo, M.D., Seong Woo Jeon, M.D., Myung Kwon Lee, M.D., Dong Seok Lee, M.D., Ki Tae Kwon, M.D., Chang Min Cho, M.D., Won Young Tak, M.D., Young Oh Kweon, M.D., Sung Kook Kim, M.D. and Yong Hwan Choi, M.D.; Korean J Gastrointest Endosc 2005;30(6):297-304. Published online June 30, 2005

Abstract PDF: Background
/Aims: Endoscopic mucosal resection (EMR) has been widely used for treatment of gastric mucosal tumors because of its relative safety and minimal invasiveness. However, the bleeding after EMR has been regarded as a major complication. Herein, we assessed the bleeding rates and risk factors related to bleeding after EMR. Methods: We retrospectively analyzed the medical records of two hundred and fortynine patients with 283 lesions who underwent EMR for flat adenoma (78.8%), hyperplastic polyp (4.9%), and early gastric cancer (16.3%) from January 1999 to August 2003. Bleeding during EMR was defined as an immediate bleeding while bleeding on follow-up day endoscopy after EMR was considered as an delayed bleeding We evaluated risk factors related to bleeding using univariate and multivariate analysis. Results: Bleeding after EMR occurred in 99 patients (35%). Immediate bleeding occurred in 31.8% and was more frequent in the case of beginners, upper part of the stomach or EMR prcedures using needle knife. Delayed bleeding occurred in 7.1% and was more frequent in the case of flat or depressed lesions, or occurrence after the incidence of immediate bleeding. Risk factors related to EMR bleeding were experience of operator (beginner vs. expert, p= 0.001), anatomical location (upper vs. lower, p=0.018), and methods of procedure (needle-knife vs. snare or band, p=0.001). Conclusions: We concluded that experience of operator, anatomical location, and method of procedure were the risk factors related to bleeding after EMR. (Korean J Gastrointest Endosc 2005;30:297⁣304)

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Efficacy of Percutaneous Cholangioscopic Ethanol Injection in Hepatocellular Carcinoma Invading the Bile Duct: Jung Min Choi, M.D., Sung Koo Lee, M.D., Sang Soo Lee, M.D., Jang Han Lee, M.D., Moon Hee Song, M.D., Dae Keun Pyun, M.D., Tae Jun Song, M.D., Jung Sik Choi, M.D., Do Hyun Park, M.D., Dong Wan Seo, M.D., Myung Hwan Kim, M.D. and Young Il Min, M.D.; Korean J Gastrointest Endosc 2005;30(6):305-311. Published online June 30, 2005

Abstract PDF: Background
/Aims: To evaluate the clinical outcomes of the percutaneous cholangioscopic ethanol injection in the hepatocellular carcinoma (HCC) invading the bile duct, we conducted a retrospective study. Methods: Ten patients who received the percutaneous cholangioscopic ethanol injection were selected patients were diagnosed as HCC invading the bile duct between January 1998 and February 2004. Treatment response, complications, survival or death and survival time were analyzed. Results: Ten patients received mean of 5.3 sessions (range 2∼19) of cholangioscopic ethanol injection. Eight patients had decreased tumor mass, and the rest 2 patients had no response. Complications were pain (n=10), hemobilia (n=6: bleeding was minimal), cholangitis (n=2), bile duct rupture (n=1), and bile duct stricture (n=1). Nine patients died from severe hepatic failure and sepsis, one patient has survived for 19 months as of now. Median survival time was 5 months (range 2∼19 months). Percutaneous transhepatic biliary drainage (PTBD) could be removed in two patients. Conclusions: Percutaneous cholangioscopic ethanol injection in HCC invading the bile duct showed size reduction of mass. PTBD could be no longer needed in some patients. However, supportive cares such as PTBD may be appropriate considering their short survival period and risk of procedure. (Korean J Gastrointest Endosc 2005;30: 305⁣311)

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Diagnostic Use of Endoscopic Ultrasonography in the Evaluation of Common Bile Duct Dilatation: Joo Jin Yeom, M.D., Chang Soo Choi, M.D., Mi Ryeong Sim, M.D., Eun Young Cho, M.D., Hyo Jeong Oh, M.D., Suck Chei Choi, M.D., Tae Hyeon Kim, M.D., Haak Cheol Kim, M.D. and Yong-Ho Nah, M.D.; Korean J Gastrointest Endosc 2005;30(6):312-318. Published online June 30, 2005

Abstract PDF: Backgound/Aims: The aim of this study was to assess the diagnostic use of endoscopic ultrasonograpy (EUS) in detecting the cause of common bile duct (CBD) dilatation in patients in whom abdominal ultrasonography or abdominal CT scan could not identify the cause of dilatation. Methods: Thirty-seven patients (23 men, 14 women, mean age 62.2 years) with uncertain causes of CBD dilatation on abdominal sonogram and CT scan between October 1999 and November 2003 were enrolled. All patients were evaluated by EUS and endoscopic retrograde cholangiopancreatography (ERCP). Final diagnosis were determined by ERCP, surgical exploration and clinical follow-up. Results: The following diagnosis were made by EUS: choledocholithiasis in 11 patients, CBD dilatation only in 12, benign stricture of distal CBD in 8, periampullary tumor in 6. The definitive diagnosis of choledocholithiasis (n=11), benign stricture of distal CBD (n=10), ampullary tumor (n= 5) were determined by ERCP with or without sphincterotomy and surgical exploration. EUS provided the accurate explanation for CBD dilatation in 32 of the 37 patients (86%). Conclusions: When the diagnosis of biliary obstruction remains obscure on abdominal sonography or CT scan, EUS may be useful. (Korean J Gastrointest Endosc 2005;30:312⁣318)

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A Pure Case of Gastric Carcinoid Tumor Presented with Intestinal Pseudoobstruction: Ki Deuk Nam, M.D., Young-Woon Chang, M.D., Joo Young Moon, M.D., Myung Jong Chae, M.D., Jae Young Jang, M.D., Nam Hoon Kim, M.D., Sang Kil Lee, M.D., Kwang Ro Joo, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byung-Ho Kim, M.D., Joung Il Lee, M.D. and Ri; Korean J Gastrointest Endosc 2005;30(6):319-324. Published online June 30, 2005

Abstract PDF: Clinical significance and prevalence of gastric carcinoid tumor are considerably rising. This is reflective of both their increased identification, with the widespread availability of upper gastrointestinal endoscopy, as well as the development of immunohistochemical study. The improvements in survival rates of gastric carcinoid tumor indicate an ability to develop optimal therapeutic strategies and regimens. Usually, the recommended treatment is surgical or endoscopic excision of the tumor. We experienced a case of intestinal pseudoobstruction combined with gastric carcinoid tumors in a 45 year-old man. He was successfully treated with endoscopic polypectomy. (Korean J Gastrointest Endosc 2005;30:319⁣324)

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A Case of Epoxy Resin Induced Thermal Injury in Upper Gastrointestinal Tract: Ji Hun Lee, M.D., Hyun Jin Kim, M.D., Tae Hyo Kim, M.D., Ok Jae Lee, M.D., Hong Jun Kim, M.D., Hyung Joon Kim, M.D. and Woon Tae Jung, M.D.; Korean J Gastrointest Endosc 2005;30(6):325-329. Published online June 30, 2005

Abstract PDF: Epoxy resins has been used as a adhesive material in industry. Toxic effects for epoxy resin are known as respiratory, dermatologic, ophthalmologic and allergic symptoms. Ingestion of epoxy resin has been known to induce moderate toxic effect, but reports are very rare. Toxic injury due to ingestion in gastrointestinal tract is usually caused by suicidal attempt or incidental ingestion in young ages and alcoholics. Herein, we report a case of diffuse mucosal injury in upper gastrointestinal tract caused by thermal injury from epoxy resin with a review of relevant literatures. (Korean J Gastrointest Endosc 2005;30:325⁣329)

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A Case of Rifampicin-Associated Pseudomembranous Colitis: Hyung Keun Kim, M.D., Jin Woo Kim, M.D., Ok Ran Shin, M.D.*, Young Seok Cho, M.D., Sung Hyun Son, M.D., Sung Soo Kim, M.D., Hiun Suk Chae, M.D., Kwan Hyung Kim, M.D., Kyu Yong Choi, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2005;30(6):330-335. Published online June 30, 2005

Abstract PDF: Pseudomembranous colitis is a rare disease and is caused by abnormal overgrowth of toxin producing Clostridium difficile colonizing the large bowel of patients undergoing antibiotic therapy. Rifampicin is one of the first line anti- tuberculous agents, used worldwide. However, pseudomembranous colitis related to rifampicin usage is rare. We report a case of pseudomembranous colitis which developed in a 70-year-old male patient during the first line anti-tuberculous therapy including rifampicin. The patient was diagnosed with active pulmonary tuberculosis thirty days earlier. On admission, he suffered watery diarrhea and intermittent abdominal pain for 10 days. Sigmoidoscopic examination revealed diffusely scattered whitish to yellowish pseudomembrane with skipped areas or edematous hyperemic mucosa from rectum to descending colon, and histopathologic findings were consistent with pseudomembranous colitis with typical volcano-like exudate. Symptoms improved after excluding rifampicin and treatment with metronidazole. In patients with persistent diarrhea and abdominal pain receiving anti-tuberculous therapy including rifampicin, rifampicin-associated pseudomembranous colitis should be considered. (Korean J Gastrointest Endosc 2005;30:330⁣335)

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A Case of Pneumatosis Cystoides Intestinalis: In Hae Park, M.D., Jae Hee Cho, M.D., Chang Hwan Choi, M.D., Sang Kil Lee, M.D., Tae Il Kim, M.D., Ho Guen Kim, M.D.* and Won Ho Kim, M.D.; Korean J Gastrointest Endosc 2005;30(6):336-339. Published online June 30, 2005

Abstract PDF: Pneumatosis cystoides intestinalis (PCI) is a rare condition defined as the presence of multiple gas-filled cysts in the wall of gastrointestinal tract. The etiology and pathogenesis of PCI remain uncertain. It is associated with various medicosurgical conditions, including various pulmonary and gastointestinal diseases, connective tissue diseases and endoscopic procedures. The diagnosis is confirmed by endoscopic puncture and biopsy. PCI in adults, for the most part, show a benign clinical course and better prognosis if the associated disease is well controlled. Infantile PCI is more serious condition and especially associated with necrotizing enteritis. The treatment is usually conservative, However surgical intervention is needed when complications such as intussusception, obstruction, bleeding and perforation develope. We experienced a case of PCI found during the follow-up colonoscopy in a patient taken right hemicolectomy and systemic adjuvant chemotherapy due to colon cancer. (Korean J Gastrointest Endosc 2005;30:336⁣339)

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Preoperatively Diagnosed Asymptomatic Early Extrahepatic Bile Duct Cancer: Kyung Ran Cho, M.D., Ho Soon Choi, M.D., Sun Young Yang, M.D., Jai Hoon Yoon, M.D., Hang Lak Lee, M.D., Oh Young Lee, M.D., Byung Chul Yoon, M.D., Jun Soo Hahm, M.D., Min Ho Lee, M.D., Dong Hoo Lee, M.D. and Chun Suk Kee, M.D.; Korean J Gastrointest Endosc 2005;30(6):340-344. Published online June 30, 2005

Abstract PDF: Cholangiocarcinoma is usually diagnosed at the advanced stage because early symptoms and signs are relatively infrequent. The preoperative diagnosis of early extrahepatic bile duct cancer in common bile duct is uncommon. Also, an extrahepatic bile duct cancer arising from the lower portion of the common bile duct is usually papillary and rarely nodular or sclerosing. We decribe a case, preoperatively diagnosed as early extrahepatic bile duct cancer in lower portion of common bile duct, nodular type on endoscopic retrograde cholangiography. It was incidentally detected by the slight elevation ofγ-glutamyl transpeptidase without any symptoms. An endoscopic retrograde cholangiography showed abrupt narrowing of the intrapancreatic portion of the common bile duct with irregular and nodular filling defect. The lesion was confined to mucosa on the endoscopic ultrasonography. This patient was diagnosed as early extrahepatic bile duct cancer and underwent Whipple's operation. A histopathologic examination of resected specimen revealed to be moderately differentiated adenocarcinoma at stage 1 (T1N0Mo) in the extrahepatic bile duct. (Korean J Gastrointest Endosc 2005;30:340⁣344)

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A Case of Lymphoepithelial Cyst of the Pancreas Showing Characteristic Findings on Endoscopic Ultrasonography: Woong Sik Oh, M.D., Hae Kyung Kim, M.D., Seong Tae Ryu, M.D.*, Jung Hwan Lee, M.D., Sung Woo Park, M.D.*, Tae Il Park, M.D., Byung Won Hur, M.D., Jin Wook Choi, M.D.*, Ho Jung Kim, M.D.*, Sin Hee Park, M.D.^† Soo Jeong Jeong, M.D.^‡and; Korean J Gastrointest Endosc 2005;30(6):345-349. Published online June 30, 2005

Abstract PDF: Lymphoepithelial cyst of the pancreas is a rare benign cystic tumor which is histologically characterized by cyst containing keratin, lined by mature squamous epithelium surrounded by lymphoid tissue, often with prominent follicles. Cystic lesions of the pancreas are more often detected because sensitive abdominal imaging tests are used for multiple indications, but preoperative differential diagnosis is difficult despite the advancements of imaging technologies. We herein report a case of lymphoepithelial cyst incidentally found on routine abdominal ultrasonography which showed characteristic findings on endoscopic ultrasonography preoperatively and discuss the radiologic features of lymphoepithelial cyst. (Korean J Gastrointest Endosc 2005;30:345⁣349)

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Three Cases of Santorinicele without Pancreas Divisum: Ran Song, M.D., Kwang Ro Joo, M.D., Jae Young Jang, M.D., Ki Duk Nam, M.D., Nam Hoon Kim, M.D., Sang Kil Lee, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byoung-Ho Kim, M.D., Young-Woon Chang, M.D., Joung Il Lee, M.D. and Rin Chang, M.D.; Korean J Gastrointest Endosc 2005;30(6):350-353. Published online June 30, 2005

Abstract PDF: Santorinicele is defined as a focal cystic dilatation of the terminal portion of the dorsal pancreatic duct at the minor papilla. It is unclear whether a santorinicele is congenital or an acquired lesion secondary to relative obstruction and a weakness of the distal dorsal duct wall. Because almost all santorinicele reported to date have been associated with pancreas divisum, it has been assumed that santorinicele is related to the obstruction of pancreatic outflow and resultant pancreatitis that occurs in the pancreas divisum. We describe three cases of santorinicele without pancreatic divisum which were identified incidentally. (Korean J Gastrointest Endosc 2005;30:350⁣354)

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