Clinical Endoscopy

Volume 31(5); November 2005

Clinical Features of Esophagitis and Gastritis in Neonates: Min Jung Kwak, M.D., Su Eun Park, M.D. and Jae Hong Park, M.D.; Korean J Gastrointest Endosc 2005;31(5):283-290. Published online November 30, 2005

Abstract PDF: Background
/Aims: The aim of this study was to determine the risk factors and clinical features related to esophagitis and gastritis in the newborn. Methods: From January 1995 to July 2002, twenty-six neonates were diagnosed as having esophagitis and/or gastritis. The clinical and demographic data of the patients and their mothers were evaluated retrospectively. Results: Twelve males and 14 females were studied. All but one premature infant were full-term. All the babies had a birth weight that was appropriate for their gestational age. The risk factors related to esophagitis and gastritis were not found. The clinical symptoms leading to endoscopy were frequent regurgitation or vomiting, hematemesis and poor feeding. Esophagitis by itself was found in 4 cases, gastritis alone was found in 13 cases and esophagitis associated with gastritis was found in 9 cases. The endoscopic findings of esophagitis showed somewhat severe lesions that consisted of multiple erosions or a fibrinous exudate. The gastric lesions were petechiae and aphthous ulcers on congestive mucosa. All the infants were treated with antisecretory drugs, and transfusion was done in 4 cases and hemoclipping was done in 2 cases. The clinical symptoms resolved rapidly with treatment. All the patients fully recovered without disease recurrence. Conclusion: The clinical features and endoscopic findings of esophagogastritis in the neonates were quite different from those features and findings in the older children and adults. Esophagitis may be characterized by frequent association with gastritis. (Korean J Gastrointest Endosc 2005;31:283⁣290)

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Clinical Review of Percutaneous Endoscopic Gastrostomy (PEG) in Children: Jae Hong Park, M.D., Bung Ho Choi, M.D.*, Kwang Hae Choi, M.D.^† and Jae Young Kim, M.D.^‡; Korean J Gastrointest Endosc 2005;31(5):291-296. Published online November 30, 2005

Abstract PDF: Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) is a simple, safe and rapid method for the placement of a feeding gastrostomy tube and it is a well- established mean of providing enteral nutrition. Although it is frequently used in adults, there is limited experience for this procedure in children. Methods: Twenty five procedures of PEG in 23 patients were performed in four institutions located in Youngnam province. We retrospectively reviewed our experiences of PEG. Results: Fourteen males and nine females were included and their mean age was 5.7⁑4.1 years. The patients aged 1 to 6 years accounted for about a half the subjects. The underlying diseases of the patients were CNS disorders in all except one who was suffering with a neuromuscular disorder. The main reason for PEG was swallowing difficulty and the associated complications of the patients. Nasogastric tube feeding was the most common method of nutritional support before the procedures. The most common complication of PEG placement was wound infection. The patients' nutritional status after PEG placement was satisfactorily improved. The indwelling time of PEG tube was over 6 months in 2 of 3 patients and the tube was switched for a new one after a year. Removal of the tubes by using percutaneous traction was done in 2 of 3 patients. Conclusions: The PEG is a safe, easy to perform, and reliable technique to support enteral nutrition in children. (Korean J Gastrointest Endosc 2005;31:291⁣296)

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Comparison of Patients' Satisfaction for Transnasal or Transoral Endoscopy in Unsedated Patients: Kee Myung Lee, M.D., Sung Jun Sim, M.D., Jeong Woo Choi, M.D., Sung Jun Choi, M.D., Hyeock Choon Kwon, M.D., Sang Jo Choi, M.D., Joon Hyuck Choi, M.D., Jae Youn Cheong, M.D., Byeong Moo Yoo, M.D., Ki Baik Hahm, M.D. and Jin Hong Kim, M.D.; Korean J Gastrointest Endosc 2005;31(5):297-305. Published online November 30, 2005

Abstract PDF: Background
/Aims: The aim of this study was to compare the patient's satisfaction and tolerance of transnasal (TN) and transoral (TO) endoscopy prospectively. Methods: 120 patients were assigned to undergo TN (age: 49.5, M：F=65：55) or TO (age: 47.4, M：F=63：57) endoscopy according to their wishes. Results: The patients' satisfaction was higher in the TN group than in the TO group (8.45 vs. 4.95, p＜0.05). The degree of choking sensation, nausea, and throat soreness was lower in the TN group than the TO group. There was no difference in endoscopists' satisfaction between the two groups. The duration for TN was longer than for TO. Epistaxis and nasal pain were the common complications in the TN group. All complications were mild and were relieved spontaneously. An endoscopic examination could be completed in all patients in the TO group. In the TN group, examination failure was quite common in the early phase but the incidence decreased with increasing experience. It took the experience of at least 20 cases for the endoscopist to adapt to the TN route. Conclusions: TN endoscopy is believed to be a comfortable and safe procedure for improving the patients' satisfaction and for reducing the level of inconvenience. (Korean J Gastrointest Endosc 2005;31:297⁣305)

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Endoscopic Treatment of Benign Hypopharyngeal Tumors: Jong Hwan Choi, M.D., Jong-Jae Park, M.D., Joong Bae Jee, M.D.*, Jong Jin Hyun, M.D., Se Yun Kim, M.D., Ji Hyun Kim, M.D., Byung Kyu Kim, M.D., Ji Hoon Kim, M.D., Yun Jung Chang, M.D., Cheol Hyun Kim, M.D., Youn Suk Seo, M.D., Jin Yong Kim, M.D., Jae Seon; Korean J Gastrointest Endosc 2005;31(5):306-310. Published online November 30, 2005

Abstract PDF: During endoscopy, most endoscopists insert endoscopes into the esophagus without visual aid in order to minimize the discomfort to patients. However, studies have shown that visual guided insertion imposes little discomfort, is safe and can increase the diagnostic rate of abnormal pathology of the throat. As for the treatment of hypopharyngeal lesions, cases of endoscopic treatment are rare and any guidelines have not been clearly defined yet. However, endoscopic treatment may be feasible in selected cases. Several procedures, such as endoscopic mucosal resection with cap (EMR-C) and saline injection polypectomy can be applied. We experienced seven patients who had benign hypopharyngeal masses that were removed endoscopically without serious complications. Compared to surgical treatment, endoscopic removal of the benign hypopharyngeal tumors does not require general anesthesia; it is simple, less invasive and less costly. Therefore, endoscopy should be regarded as a treatment option. However, further studies are required before widespread application of endoscopic removal for the definitive treatment of hypopharyngeal masses, including malignancies. (Korean J Gastrointest Endosc 2005;31:306⁣310)

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A Case of Esophageal Intramural Pseudodiverticulosis: Ji Hyun Kim, M.D., Se Yune Kim, M.D., Jong Hwan Choi, M.D., Jong Jin Hyun, M.D., Byung Gyu Kim, M.D., Ji Hoon Kim, M.D., Yeon Seok Seo, M.D., Jin Yong Kim, M.D., Jong-Jae Park, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.; Korean J Gastrointest Endosc 2005;31(5):311-314. Published online November 30, 2005

Abstract PDF: Esophageal intramural pseudodiverticulosis is a rare condition with an unknown etiology, and it is characterized by the typical morpholgic findings of multiple tiny pseudodiverticula in a portion of, or in the entire length of the esophagus. It has two peaks in incidence, the teen years and between the 5^th and 7^th decade. Most patients present with dysphagia, and radiological narrowing of the esophagus is commonly seen. The clinical course of this condition is benign and dilatation of any strictures, if present, results in an excellent clinical response. We report here on a case of esophageal intramural pseudodiverticulosis in a 76-year-old man who had a 6-year history of dysphagia, and we also include a review of the literature. (Korean J Gastrointest Endosc 2005;31:311⁣314)

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A Case of Boerhaave's Syndrome after Bowel Preparation with Polyethylene Glycol: Chi Hoon Kim, M.D., Jong Hwan Park, M.D., Min Woong Kim, M.D., Hwa Mi Kang, M.D., Ji Hoon Yoon, M.D., Suk Hun Kim, M.D., Jae Hoon Jeong, M.D., Hyung Wook Kim, M.D., Seung Keun Park, M.D. and Hee Ug Park, M.D.; Korean J Gastrointest Endosc 2005;31(5):315-319. Published online November 30, 2005

Abstract PDF: Polyethylene glycol (Colyte^Ⱂ) electrolyte lavage solution is widely used for bowel preparataion before colonoscopy and surgery. The minor complications associated with PEG solution, i.e., nausea and bloating have been reported on. However, major complications such as PEG electrolyte lavage solution-induced Mallory-Weiss tear, esophageal rupture, asystole and aspiration have rarely been reported on. Spontaneous rupture of the esophagus (Boerhaave's syndrome) is a very rare disease and it is often diagnosed late or it is misdiagnosed because of the atypical clinical symptoms. Its mortality increases proportionally to the time between esophageal rupture and treatment. It can cause a fatal outcome unless it is treated early. We authors report here on a case of spontaneous esophageal rupture after bowel preparation with polyethylene glycol. (Korean J Gastrointest Endosc 2005;31:315⁣319)

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A Case of Ectopic Sebaceous Glands in the Esophagus: Sun Moon Kim, M.D., Eui Hyeog Im, M.D., Seung Hyun Jung, M.D., Tae Hee Lee, M.D., Kyu Chan Huh, M.D., Jung Uee Lee, M.D.*, Yun Mi Kim, M.D.*, Young Woo Choi, M.D. and Young Woo Kang, M.D.; Korean J Gastrointest Endosc 2005;31(5):320-322. Published online November 30, 2005

Abstract PDF: Ectopic sebaceous glands have been reported in the organs of an ectodermal origin such as the oral cavity, genitals, eye and orbit, nipples, palm and soles, and the parotid glands. Their presence in the esophagus, which is an organ of endodermal origin, is a very rare and interesting anomaly. Whether ectopic sebaceous glands in the esophagus are the result of congenital misplacement or acquired metaplastic change remains unclear. We report here on a patient with sebaceous glands in the esophagus, and this was diagnosed by endoscopic biopsy. (Korean J Gastrointest Endosc 2005;31:320⁣322)

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A Case of Low-grade Gastric MALT Lymphoma Mimicking as a Advanced Gastric Cancer: Nam-Hoon Kim, M.D., Young-Woon Chang, M.D., Jae Young Jang, M.D., Sang Gil 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 Rin Chang, M.D.; Korean J Gastrointest Endosc 2005;31(5):323-327. Published online November 30, 2005

Abstract PDF: Gastric MALT lymphoma usually presents with various endoscopic morphologic characteristics. The majority of the endoscopic findings of low-grade gastric MALT lymphoma reveal multiple and superficial erosions or ulceration with mucosal nodularity, but high-grade gastric MALT lymphomas show ulceroinfiltrative and fungating lesion. However, low-grade gastric MALT lymphoma that presents as advanced gastric cancer is very rare. We experienced a case of low-grade gastric MALT lymphoma with perigastric lymph node infiltration; it presented as advanced gastric cancer, and it was treated with H. pylori eradication and CHOP chemotherapy. So we report on this case along with a review of related literatures. (Korean J Gastrointest Endosc 2005;31:323⁣327)

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A Case of Gastric Bezoar Formed by Ingestion of Gypsum, and it was Treated Endoscopically Using Electrohydraulic Lithotripsy: Jong Kwan Park, M.D., Min Su Kim, M.D., Young Gyun Kim, M.D., Won Na Suh, M.D., Tae Il Kim, M.D. and Hyojin Park, M.D.; Korean J Gastrointest Endosc 2005;31(5):328-333. Published online November 30, 2005

Abstract PDF: Gastric bezoars are collection of indigestible material in the stomach, and these can be classified into five broad categories: phytobezoar, trichobezoar, pharmacobezoar, lactobezoar and miscellaneous materials such as sand, stone and concrete (gypsum). The treatment of gastric bezoars has recently changed from surgical management to such nonsurgical interventions as enzymatic dissolution, nasogastric suctioning and endoscopic removal by polypectomy snare and basket. Up to the present, electrohydraulic lithotripsy has been a well established method for the treatment of urinary and hepatobiliary stones. We report here on a patient who had a huge gastric bezoar that was formed by the ingestion of gypsum, and this was treated with endoscopic electrohydraulic lithotripsy. (Korean J Gastrointest Endosc 2005;31:328⁣333)

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A Case of Foreign Body Removal Using Latex Glove and Two Endoscopes: In Hwan Kim, M.D., Jeong Soon Kim, M.D., Sang Soon Park, M.D., Yeun Jung Lim, M.D., Sang Jong Park, M.D., Eun Jeong Jang, M.D., Ju Sang Park, M.D. and Hyun Wook Baik, M.D.; Korean J Gastrointest Endosc 2005;31(5):334-338. Published online November 30, 2005

Abstract PDF: Foreign body ingestion is a common clinical problem. Foreign bodies are generally swallowed accidentally and most pass out spontaneously. However, if a sharp object is not eliminated early, it can penetrate the bowel wall and cause severe complications. Endoscopic techniques for removing sharp foreign bodies safely include methods using a protector hood and overtube. An overtube is uncomfortable and has limitations in its diameter. We introduced a method using a latex glove, which is easily available, comfortable, and has no limitations in diameter. In addition, two endoscopes were used to reduce the risk of complications, and the large sharp object was easily wrapped with the latex glove. We report a case of a sharp and large foreign body being removed endoscopically using a latex glove and two endoscopes without any complications. (Korean J Gastrointest Endosc 2005;31:334⁣338)

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A Case of Primary Duodenal Adenocarcinoma Identified by Serially Elevated Serum CEA Levels after Curative Resection for Colon Cancer: See Jin Jang, M.D., Bo In Lee, M.D., Jeong Seon Ji, M.D., Byung Wook Kim, M.D., Hwang Choi, M.D., Se Hyun Cho, M.D., Kyu Yong Choi, M.D., Dae Sung Kim, M.D., Min Huh, M.D., Sang Hun Lee, M.D., In Sik Chung, M.D. and Lee So Maeng, M.D.*; Korean J Gastrointest Endosc 2005;31(5):339-342. Published online November 30, 2005

Abstract PDF: The follow-up of patients after performing potentially curative resection for colon cancer is important, yet the ideal surveillance strategy has not been defined. Periodic clinical examinations, laboratory tests, radiographic imaging, colonoscopy and carcinoembryonic antigen (CEA) testing have been utilized for surveillance, and the serial CEA measurement is the most cost-effective test for identifying the recurrence of disease. However, this test also indicates the development of secondary gastrointestinal malignancy such as gastric cancer or duodenal cancer. We report here on a case of metachronous duodenal adenocarcinoma that was revealed by the serial measurement of the serum CEA after we performed curative resection for colon cancer. (Korean J Gastrointest Endosc 2005;31:339⁣342)

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A Case of Adult Intussusception of the Colon Caused by Cecal Neurofibroma in a Patient with Neurofibromatosis Type 1: Jun Hwan Yoo, M.D., In Ho Jung, M.D.*, Young Bae Kim, M.D.^†, Jai Keun Kim, M.D.^‡, Ju Sung Sun, M.D.^‡, Seung Jun Choi, M.D., Joon Hyuck Choi, M.D., Kee Myung Lee, M.D., Ki Baik Hahm, M.D. and Jin Hong Kim, M.D.; Korean J Gastrointest Endosc 2005;31(5):343-347. Published online November 30, 2005

Abstract PDF: Neurofibromatosis type 1 (NF-1) is an autosomal dominant hereditary disorder and it is characterized by neurofibromas and cafe-au-lait spots on the skin. NF-1 affects the gastrointestinal tract in 25% of the cases and the stomach and jejunum are the commonly involved sites. Yet the occurrence of colon NF is very unusual. Several cases of colon involvement of NF-1 have been reported on and their clinical manifestations were massive or occult bleeding, constipation and asymptomatic rectal or perianal nodules. There was a reported case of colon-to-colon intussusception via an isolated colonic neurofibroma. However, the best of our knowledge, there has been no reported case of colon- to-colon intussusception induced by NF-1. We encountered a case of NF-1 involving the cecum that resulted in colon- to-colon intussusception and secondary acute appendicitis. The patient showed the typical skin lesions and bony abnormalities of NF. We report on this case with a review of the literature. (Korean J Gastrointest Endosc 2005;31: 343⁣347)

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A Case of Acute Pancreatitis Caused by Ascaris Invasion of the Common Bile Duct: Jong Won Byun, M.D., Jae Woo Kim, M.D., Hoon Choi, M.D., Hye Jung Kim, M.D., Kyu Hong Kim, M.D., Myeong Gwan Jee, M.D., Yong Soon Park, M.D., Soon Koo Baik, M.D., Hyun Soo Kim, M.D., Sang Ok Kwon, M.D. and Seong Hyun Kim, M.D.*; Korean J Gastrointest Endosc 2005;31(5):348-352. Published online November 30, 2005

Abstract PDF: Ascaris lumbricoides is the most common intestinal parasite in less-developed countries as well as in areas with poor sanitation. Highly motile mature worms may enter the ampulla of Vater and migrate to the bile or pancreatic ducts causing cholangitis, biliary stones, cholecystitis, pancreatitis and a liver abscess. The incidence of pancreatitis due to biliary ascariasis is relatively common in endemic areas, but only a few cases have been reported in Korea since 1990. A 68-year-old woman was admitted with a sudden onset of epigastric pain. She was diagnosed with acute pancreatits due to ascaris based on computed tomography, the ampulla- impacted state of the worm and an elevated serum amylase level. The patient recovered without complications after the ascaris had been extracted using grasp forceps during endoscopy. The patient also received antihelminthic therapy. We report this case with a review of the relevant literatures.(Korean J Gastrointest Endosc 2005;31:348⁣352)

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A Case of Duodenal Ulcer Bleeding caused by Pancreatic Arteriovenous Malformation: Se Il Oh, M.D., Sang Soo Lee, M.D., Il No Do, M.D., Nae Yun Heo, M.D., Song Yi Han, M.D., Jung Min Ahn, M.D., Young Jun Choi, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D. and Myung-Hwan Kim, M.D.; Korean J Gastrointest Endosc 2005;31(5):353-357. Published online November 30, 2005

Abstract PDF: Arteriovenous malformation (AVM) of the pancreas is an extremely rare disease. It may be asymptomatic, but more than half of the patients present with gastrointestinal bleeding. The most common cause of the gastrointestinal bleeding is variceal bleeding due to the portal hypertension resulting from AVM. Bleeding from a duodenal ulcer and AVM to the pancreatic duct are rare findings. Surgical excision is the treatment of choice, but when portal hypertension has developed, this cannot be corrected even after surgical resection. We experienced a case of recurrent duodenal ulcer bleeding that was due to arteriovenous malformation in the head of the pancreas in a 45 year old man. He was successfully treated with pylorus preserving pancreaticoduodenectomy. (Korean J Gastrointest Endosc 2005;31:353⁣357)

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A Case of Multiple Intrahepatic Duct Stones associated with Portal Biliopathy: Jung Sup Kim, M.D., Dong Won Lee, M.D., Il Young Kim, M.D., Sung Yik Lee, M.D., Tae Oh Kim, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Mong Cho, M.D. and Suk Kim, M.D.*; Korean J Gastrointest Endosc 2005;31(5):358-361. Published online November 30, 2005

Abstract PDF: "Portal biliopathy" is a terminology used to describe the biliary, ductal and gallbladder wall abnormalities seen in patients with portal hypertension. These changes are predominantly seen in patients with extrahepatic portal vein obstruction (EHPVO), and they include abnormalities (stricture and dilatation) of both the extra and intrahepatic bile ducts, and varices of the gallbladder. The majority of the patients are asymptomatic, but these changes occasionally become significant and give rise to overt obstructive jaundice and they possibly contribute to the development of choledocholithiasis and cholangitis. Asymptomatic patients do not need any treatment. If there is persistent elevation of alkaline phosphatase or ductal dilatation on ultrasonography, ERCP or MRCP can be performed to detect choledocholithiasis or biliary stricture. We present here a 43- year-old male patient for whom portal biliopathy with accompanying multiple intrahepatic duct stones was diagnosed by MRCP and choledocoscopy. (Korean J Gastrointest Endosc 2005;31:358⁣362)

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