Clinical Endoscopy

Changes of Helicobacter pylori-Positive Peptic Ulcer Disease: Based on Data from a General Hospital: Hye-Kyung Jung, M.D., Yoon Ju Na, M.D. and Il-Hwan Moon, M.D.; Korean J Gastrointest Endosc 2006;32(1):1-8. Published online January 30, 2006

Abstract PDF: Background
/Aims: The incidence of Helicobacter pylori (H. pylori)-positive ulcer appears to be decreasing recently in the Western countries, and this has been influenced by the epidemiologic changes of H. pylori infection. Therefore, we aimed to determine the trends for the frequency of H. pylori-positive peptic ulcer disease (PUD) during recent 7 years in Korea. Methods: All 1,723 patients who had an endoscopic diagnosis of PUD from 1997 to 2003 were included in this study. H. pylori was considered present if the CLO test and/or the histology and the urea breath test were positive for H. pylori. Results: H. pylori-positive ulcers were seen in 1,354/1,723 patients (78.6%). The positive rate of H. pylori infection in patients with PUD was 85.9% in 1997, 79.2% in 1999, 76.2% in 2001 and 73.1% in 2003, and this showed a decreasing annual trend (p＜0.001). H. pylori-positive PUD was more prevalent in duodenal ulcer than in gastric ulcer, and in the patients who were aged person and male. During the recent 7 years, H. pylori- positive PUD has decreased in patients with duodenal ulcer, and especially for patients younger than 60 years and in the male group. Conclusions: The frequency of H. pylori-positive PUD is possibly decreasing in the recent 7 years. Prospective, multicenter trial studies are necessary to confirm this trend and find out the cause. (Korean J Gastrointest Endosc 2006;32:1⁣8)

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Comparison of Hemostatic Efficacy between Epinephrine Injection Alone and a Combined Therapy with Hemoclip for Bleeding Peptic Ulcers: Hyang Eun Seo, M.D., Myung Kwon Lee, M.D., Young Doo Lee, M.D., Seong Woo Jeon, M.D., Chang Min Cho, M.D., Won Young Tak, M.D., Young Oh Kwon, M.D., Sung Kook Kim, M.D., Yong Hwan Choi, M.D. and Jong Ryul Eun, M.D.*; Korean J Gastrointest Endosc 2006;32(1):9-14. Published online January 30, 2006

Abstract PDF: Background
/Aims: Many studies have been performed to find the differences between using epinephrine injection alone and a combination therapy with hemoclip for bleeding peptic ulcer, but the results have been controversial. We retrospectively evaluated the hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip for bleeding peptic ulcers. Methods: Four hundred patients were enrolled. They were assigned to one of the two groups: endoscopic hemostasis with injection of epinephrine (group I, n=156) and combined epinephrine injection with hemoclip (group II, n=244). Results: The continuous bleeding rate was significantly higher in group I than in group II. The recurrent bleeding rate was also significantly higher in group I than in group II. There were no statistical differences in the rates of death, emergency surgery and arterial embolization. The rates of continuous bleeding and the initial failure of hemostasis were higher for the patients with active bleeding on the initial endoscopy irrespective of the applied hemostatic methods. Conclusions: A combination of epinephrine injection and hemoclip is more effective than epinephrine injection alone for treating bleeding peptic ulcers. (Korean J Gastrointest Endosc 2006;32:9⁣14)

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The Outcome of Endoscopic Biliary Drainage with Plastic Stents for Irretrievable Common Bile Duct Stones: Sung Moon Jung, M.D., Young-Soo Moon, M.D., Hyun Bae Son, M.D., Jeon Ho Yang, M.D., Kyung-Ah Kim, M.D. and June Sung Lee, M.D.; Korean J Gastrointest Endosc 2006;32(1):15-20. Published online January 30, 2006

Abstract PDF: Background
/Aims: Endoscopic biliary drainage (EBD) using a plastic stent has been proposed for the management of choledocholithiasis when there is difficulty with stone extraction. We investigated the long-term effects and complications of EBD with using a plastic stent in the elderly or high risk patients with common bile duct (CBD) stones. Methods: From January 2000 to June 2004, thirty-one patients with CBD stones underwent EBD with using plastic stents (17 women and 14 men, mean age: 75.2 years). Results: Biliary drainage was successful in all patients. As for the early complications, only minor hemorrhage with no requirement of transfusion occurred in 2 patients. Twelve patients (38.7%) had late complications of EBD. Six of them had cholangitis, five had biliary colics and one had nausea. Of the six patients with cholangitis, three were managed with stent exchange and one was managed by removal of the stent. The remaining two patients died from stent-related sepsis. The mean symptom-free duration was 39.9 months. Conclusions: For the elderly or high risk patients who undergo an operation, EBD proved to be a safe and effective alternative for the treatment of patients with irretrievable bile duct stones. (Korean J Gastrointest Endosc 2006;32:15⁣20)

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Analysis of Factors Influencing the Long Term Outcome after Endoscopic Stenting for Benign Biliary Stricture: Seok Young Lee, M.D., Hyung Suk Lee, M.D., Won Jae Yoon, M.D., Jun Kyu Lee, M.D., Kwang Hyuck Lee, M.D., Jin-Hyeok Hwang, M.D.*, Ji Bong Jeong, M.D.^†, Ji Kon Ryu, M.D., Yong-Tae Kim, M.D. and Yong Bum Yoon, M.D.; Korean J Gastrointest Endosc 2006;32(1):21-26. Published online January 30, 2006

Abstract PDF: Background
/Aims: The problem with endoscopic management for benign biliary stricture is the occurrence of restenosis after removal of biliary stents. However the factors that influence the rate of restenosis have not yet been identified. The aim of this study was to identify the factors that affect patency of the bile duct after removal of an endoscopic stent for management of benign biliary stricture. Methods: The medical records and potential factors that influence biliary restenosis were analyzed in 19 patients with benign biliary stricture. Results: At the time of stent removal, successful stricture resolution was noted in 13 out of 19 patients. Among these 13 patients, good biliary patency, without restenosis, was observed in 10 patients during a mean follow-up of 24 months. The time interval, from biliary surgery to stricture, tended to be shorter in the group with good results compared to the group with poor results (6.2±3.3 months vs. 80.2±139.3 months respectively: p=0.07). Other factors did not affect the rate of restenosis after removal of the stent. Conclusions: The time interval, from biliary surgery to stricture, tends to influence restenosis after endoscopic management for benign biliary stricture. (Korean J Gastrointest Endosc 2006;32:21⁣26)

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Dilatation of Narrowed Pancreatic Duct Using a Soehendra Stent Retriever in Chronic Pancreatitis Patients: Seoung Joon Hwang, M.D., Myung Kwan Ji, M.D.*, Jae Woo Kim, M.D.*, Hyun Soo Kim, M.D.*, Kuen Man Lee, M.D., Young Gyun Kim, M.D., Dae Hoon Song, M.D., Yong Han Paik, M.D., Se Joon Lee, M.D. and Dong Ki Lee, M.D.; Korean J Gastrointest Endosc 2006;32(1):27-32. Published online January 30, 2006

Abstract PDF: Background
/Aims: Endoscopic pancreatic ductal drainage may help alleviate the pain from chronic pancreatitis, but stricture dilatation may be technically difficult. Dilatation of high grade strictures of the pancreatic ducts with using dilating or balloon catheters may result in failure. We evaluated the efficacy of using the Soehendra stent retriever as a dilator. Methods: Fourteen patients with pancreatic stricture had dilation performed with a Soehendra stent retriever. Each patient had sphincterotomy, guidewire placement and stent retriever dilatation. Results: All procedures were successful and none of the patients had complications. Symptom relief was observed after dilation in all patients. There was no complication associated with the use of the stent retriever. None of the patients have relapsed for 6 months. Conclusions: The Soehendra stent retriever is safe and effective as a dilating device for the pancreatic strictures that are resistant to conventional dilation. (Korean J Gastrointest Endosc 2006;32:27⁣32)

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A Case of Cameron Ulcers associated with Iron Deficiency Anemia: Sung Hee Han, M.D., Hang Lak Lee, M.D., Dae Won Jun, M.D., Sun Young Yang, M.D., Oh Young Lee, M.D., Byung Chul Yoon, M.D., Ho Soon Choi, M.D. and Joon Soo Hahm, M.D.; Korean J Gastrointest Endosc 2006;32(1):33-36. Published online January 30, 2006

Abstract PDF: Patients suffering with sliding hiatal hernia may develop Cameron erosions or ulcers. Mechanical trauma, ischemia, and peptic injury have been proposed as the etiology of these lesions. These lesions can be associated with iron deficiency anemia and GI bleeding. An 83-year-old woman was admitted with iron deficiency anemia and intermittent melena. Her past history consisted of pneumonia and pulmonary tuberculosis. She had no current medication history. The laboratory findings were Hb 6.8 g/dL, MCV 75 fL and MCH 23.6 pg. Upon esophagogastroduodenoscopy (EGD), a huge diaphragmatic hernia was noted and multiple ulcers were located at the neck of the hernia. Esophagogram showed a huge diaphragmatic hernia. The bleeding ceased and the anemia was resolved after proton pump inhibitor treatment. (Korean J Gastrointest Endosc 2006;32:33⁣36)

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Two Cases of Huge Polypoid Early Gastric Cancer: Seong Eun Yang, M.D., Chang Whan Kim, M.D., Sok Won Han, M.D., Young Seok Cho, M.D., Dong Soo Lee, M.D., Jin Il Kim, M.D., Soo Heon Park, M.D., Hiun Suk Chae, M.D., Myung Gyu Choi, M.D., Jae Kwang Kim, M.D., Kyu Young Choi, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2006;32(1):37-41. Published online January 30, 2006

Abstract PDF: Gastric cancer is the most frequent cancer seen in Korea. The development of diagnostic procedures such as endoscopy has contributed to the early diagnosis and subsequent treatment of gastric cancer. Early gastric cancer has been defined as a carcinoma that is limited to the gastric mucosa or submucosa, regardless of the presence of lymph node metastasis. The prognosis of gastric cancer mainly depends on the depth of invasion and the lymph node metastasis. However it is difficult to distinguish large type I early gastric cancer from Borrmann type 1 advanced gastric cancer when the distinction is based on the macroscopic appearance. We experienced two cases of huge polypoid early gastric cancer. One case was treated by operation, and the other case was treated by endoscopic mucosal resection. We report here on two cases of huge polypoid early gastric cancer mimicking advanced gastric cancer. (Korean J Gastrointest Endosc 2006;32:37⁣41)

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A Case of Cytomegalovirus Infection associated with Simultaneous Gastric, Duodenal and Colonic Ulcers: Jae Ho Lee, M.D., Eun Taek Park, M.D., Hee Kim, M.D., Sang Bong Lee, M.D., Sung Jae Park, M.D., Sam Ryoung Jee, M.D., Yeon Jae Lee, M.D., Sang Hyuk Lee, M.D., Sang Young Seol, M.D., Jung Myung Chung, M.D. and Soo Jin Jung, M.D.*; Korean J Gastrointest Endosc 2006;32(1):42-47. Published online January 30, 2006

Abstract PDF: Although cytomegalovirus (CMV) infection of the gastrointestinal tract can occur in persons with normal immune function, it almost exclusively affects the immunocompromised host such as transplant recipients and AIDS patients, and it can cause significant clinical illness. CMV remains the single most important pathogen that affects solid organ transplant recipients. While CMV can affect any segment of the gastrointestinal tract, the colon is the most common site of infection, and this is followed by the upper gastrointestinal tract. However, CMV infection associated with simultaneous gastric and colonic ulcer is very rare and this has been reported in only one case, and a case of simultaneous gastric, duodenal and colonic ulcer associated with CMV infection has not yet been reported in Korea. We report here on a case of simultaneous gastric, duodenal and colonic ulcer associated with CMV infection that showed the characteristic histologic findings seen for CMV infection in renal transplant recipients. (Korean J Gastrointest Endosc 2006; 32:42⁣47)

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A Case of Endoscopically Treated Jejunal Bleeding from Polyarteritis Nodosa: Hyeok Choon Kwon, M.D., Jeong Woo Choi, M.D., Seung Jun Choi, M.D., Seung Il Woo, M.D., Joo Sung Sun, M.D.*, Je Hwan Won, M.D.*, Chang Hee Suh, M.D.^†, Kee Myung Lee, M.D., Ki Baik Hahm, M.D. and Jin Hong Kim, M.D.; Korean J Gastrointest Endosc 2006;32(1):48-52. Published online January 30, 2006

Abstract PDF: Polyarteritis nodosa is a necrotizing vasculitis of the small and medium-sized arteries of multiple organ systems. The common symptoms of gastrointestinal involvement are abdominal pain, nausea, and vomiting. However, the symptoms at presentation are sometimes non-specific and vague. The well-known complications of gastrointestinal involvement are mucosal ulceration, bowel infarction, perforation, cholecystitis and hepatitis. We describe a case of a 6-year-old male with jejunal bleeding who was diagnosed with polyarteritis nodosa by angiography. After controlling the systemic symptoms with immunosuppressants and steroids, jejunal bleeding occurred. The jejunal bleeding was treated endoscopically with a hemoclip and increasing the immunosuppressant dose. Generally, massive gastrointestinal bleeding in a patient with polyarteritis nodosa is treated surgically. In this case, the jejunal bleeding was controlled with an endoscope because the bleeding site was located within reach of the endoscope, and systemic symptoms subsided with medication. There is no report of gastrointestinal bleeding from the polyarteritis nodosa in a child in Korea. Therefore, we report this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2006;32:48⁣52)

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Hemorrhagic Small Bowel Tumor Diagnosed with Using Capsule Endoscopy and It was Treated with Laparoscopic Surgery: Report of a Case: Jae Im Lee, M.D., Kyo Young Song, M.D., Cho Hyun Park, M.D., Seung Nam Kim, M.D. and In Seok Lee, M.D.*; Korean J Gastrointest Endosc 2006;32(1):53-56. Published online January 30, 2006

Abstract PDF: For the patients presenting with obscure gastrointestinal bleeding, various diagnostic approaches have been tried such as push enteroscopy, technetium labeled RBC scan and enteroclysis. Capsule endoscopy is an emerging and powerful diagnostic method that enables physicians to investigate the entire small bowel. Therefore, it is useful to make a correct diagnosis of obscure gastrointestinal bleeding in cases with negative findings by endoscopy or colonoscopic examination. We experienced a case of a 30 year-old male patient who presented with obscure intestinal bleeding, and this was diagnosed with capsule endoscopy and he was treated with laparoscopic assisted small bowel resection. (Korean J Gastrointest Endosc 2006;32:53⁣56)

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A Case of Spontaneous Duodenoileal Fistula in Behcet's Disease: Young HwangBo, M.D., Hyo Jong Kim, M.D., Hyo Suk Ahn, M.D., Myung Ryul Lee, M.D., Jae Young Jang, M.D., Nam Hoon Kim, M.D., Sang Kil Lee, M.D., Kwnag Ro Joo, M.D., Seok Ho Dong, M.D., Byung Ho Kim, M.D., Young Woon Chang, M.D., Joung Il Lee, M.D. and Rin; Korean J Gastrointest Endosc 2006;32(1):57-61. Published online January 30, 2006

Abstract PDF: For intestinal Behcet's disease, the common complications are intestinal perforation, bleeding and fistula formation. Among these, fistula formation is mostly associated with previously performed surgeries and it is rare that fistulas form spontaneously. We experienced a case of Behcet's disease with duodenoileal fistula, and the patient does not have any previous surgery. A 57-year-old male patient was admitted due to persistent diarrhea and weight loss. He was diagnosed with intestinal Behcet's disease 6 years ago. On the 2^nd portion of the duodenum, an opening to the colon was found on gastroduodenoscopy. As we rechecked the lesion with performing a gastrograffin upper GI series, there was a fistula between the 2^nd portion of the duodenum and ileum. So we performed right hemicolectomy and duodenojejunostomy and we confirmed the duodenoileal fistula. Overall, we would like to suggest that this case was a case of Behcet's disease with spontaneous duodenoileal fistula. (Korean J Gastrointest Endosc 2006;32:57⁣61)

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A Case of Colonic Metastatic Malignant Melanoma of Unknown Origin: Yong Chan Cho, M.D., Wan Kim, M.D., Eun Taeg Cho, M.D., Young Ho Seo, M.D., Seon Ho Whang, M.D., Young Hwa Ki, M.D., Bong Kyu Lee, M.D., Won Yu Kang, M.D., Da Woon Jeong, M.D.*, Sam Cheol Kim, M.D.*, Hyang Mi Go, M.D.^† and Sung Gwang Chung, M.D; Korean J Gastrointest Endosc 2006;32(1):62-66. Published online January 30, 2006

Abstract PDF: A metastatic melanoma to the gastrointestinal tract is observed in 1.5∼4.4% of all melanoma patients. However, colonic and rectal involvement is less common. A 72-year-old woman was admitted due to abdominal pain and poor oral intake for 20 days. She had a 3⁓4 cm-sized mass on her right inguinal area 4 month ago, which was diagnosed as a malignant melanoma of the inguinal lymph node on excision biopsy. A large exophytic mass with an irregular ulcerlated, whitish patch, erythematous surface was observed in the hepatic flexure during colonoscopy. A histology diagnosis of a metastatic melanoma was made by an optical microscopy examination of the biopsies obtained during the colonscopy, and palliative right hemicolectomy was performed on account of a potential intestinal obstruction. We report a case of a metastatic melanoma of the colon with a review of the relevant literature. (Korean J Gastrointest Endosc 2006; 32:62⁣66)

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A Case of Granular Cell Tumor of the Colon Treated by Colonoscopy: Nam Young Park, M.D., Kyu-Jong Kim, M.D., Yoon Jeong Kim, M.D., Ji Hun Roh, M.D., Dae Gwan Im, M.D., Ji Hyun Nam, M.D., Won Moon, M.D., Moo In Park, M.D., Seun Ja Park, M.D. and Bong Kwon Cheon, M.D.*; Korean J Gastrointest Endosc 2006;32(1):67-70. Published online January 30, 2006

Abstract PDF: Granular cell tumor (GCT) is a relatively rare benign tumor that can be located anywhere throughout the body, but it is uncommon in the gastrointestinal tract, and especially in the colon and rectum. A 41-year-old man visited our hospital with a three-month history of intermittent abdominal discomfort at the left lower quadrant area. Colonoscopic examination revealed a hemispheric, submucosal lesion, about 1.5⁓1.2 cm in size, on the opposite side of the ileocecal valve in the proximal ascending colon. The tumor was removed by an endoscopic snare without any immediate complication. The pathologic findings revealed spindled or polygonal large cells that were positive for S-100, neuron-specific enolase and vimentin, and they were negative for smooth muscle actin and desmin, which was consistent with granular cell tumor. We report here on a case of granular cell tumor of the colon that was successfully treated with endoscopic polypectomy. (Korean J Gastrointest Endosc 2006;32:67⁣ 70)

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Caroli's Disease Combined with Colon Cancer and Polycystic Kidney Disease: Yeong Je Chae, M.D., Cheul Young Choi, M.D., Jong Yeop Kim, M.D., Hyun Weon Shin, M.D., Young Sun Kim, M.D., Min Ho Choi, M.D., Hyun Joo Jang, M.D., Chang Soo Eun, M.D., Sea Hyub Kae, M.D. and Jin Lee, M.D.; Korean J Gastrointest Endosc 2006;32(1):71-74. Published online January 30, 2006

Abstract PDF: Caroli's disease is defined as a communication between congenital cystic dilatation of the bile duct and the biliary system. Caroli's disease accompanied with autosomal dominant polycystic kidney disease is a very rare finding and the differential diagnosis between Caroli's disease with polycystic kidney disease and a polycystic liver is very important. A 67-year-old male patient was admitted to our hospital for hematochezia, and he underwent hemodialysis for chronic renal failure due to his autosomal dominant polycystic kidney disease. On colonoscopy, ulcero-infiltrative tumor was observed in the sigmoid colon. It was diagnosed as adenocarcinoma on tissue biopsy. On abdominal computerized tomography and magnetic resonance cholangiopancreatography, a number of simple cysts was observed in both kidneys and we were able to identify the communication between the dilated intrahepatic ducts and the intrahepatic cystic lesions, and so we diagnosed this patient as having Caroli's disease. (Korean J Gastrointest Endosc 2006;32:71⁣74)

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A Case of Autoimmune Pancreatitis with Eosinophilic Infiltration that Demonstrated Multiple Masses on Endoscopic Ultrasonography: Won Jae Yoon, M.D., Hye-Ryoun Kim, M.D., Jun Kyu Lee, M.D., Kwang Hyuck Lee, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D. and Yong Bum Yoon, M.D.; Korean J Gastrointest Endosc 2006;32(1):75-78. Published online January 30, 2006

Abstract PDF: Autoimmune pancreatitis can be defined as an inflammation of the pancreas that is due to autoimmune mechanisms. Since the first report in 1961, there have been many reports on the autoantibodies, the radiological findings and the pathology of autoimmune pancreatitis. Lymphoplasmacytic infiltration with fibrosis is the characteristic histological feature of autoimmune pancreatitis. Eosinophilic infiltration has been reported in a subset of autoimmune pancreatitis patients. We report here on a case of autoimmune pancreatitis with eosinophilic infiltration, and the endoscopic ultrasonography showed multiple hypoechoic masses throughout the whole pancreas. (Korean J Gastrointest Endosc 2006;32:75⁣79)

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