Clinical Endoscopy

Controlled Comparison of Endoscopic Epinephrine Injection and Endoscopic Argon Plasma Coagulation for the Treatment of Acute Peptic Ulcer Bleeding: Kyung Im Pae, M.D., Sang Hyuk Lee, M.D., Hee Kim, M.D., Sang Bong Lee, M.D., Jae Ho Lee, M.D., Sung Jae Park, M.D., Sam Ryong Jee, M.D., Eun Taek Park, M.D., Yeon Jae Lee, M.D., Sang Young Seol, M.D. and Jung Myung Chung, M.D.; Korean J Gastrointest Endosc 2006;32(4):239-245. Published online April 30, 2006

Abstract PDF: Background
/Aims: Endoscopic injection therapy with hypertonic saline Epinephrine (HSE) is the easiest and most widely used procedure for the management of peptic ulcer bleeding. Argon plasma coagulation (APC) is a recently introduced endoscopic hemostatic procedure. Thus, we performed a prospective trial to compare the hemostatic efficacy of APC and HSE. Methods: Forty patients with the diagnosis of bleeding ulcer were randomly assigned to receive either HSE (n=20) or APC (n=20) treatment during the period of September 2003 to April 2004. The two groups were matched for gender, age, site of bleeding, the endoscopic findings and the initial hemoglobin at the study baseline. Results: The bleeding was initially controlled in 18 patients (90%) of the APC group, and in 20 patients (100%) of the HSE group. Rebeeding occurred in one patient (5%) of the APC group and in 3 patients (15.5%) of the HSE group. The lengths of stay in the hospital were 11.7 days in the APC group and 10.7 days in the HSE group. Death occurred in 1 case in the APC group and in 1 case in the HSE group. The initial hemostatic efficacy showed no difference between the two groups. Conclusions: Argon plasma coagulation is as effective as hypertonic saline epinephrine injection for the initial management of acute peptic ulcer bleeding. (Korean J Gastrointest Endosc 2006;32:239⁣245)

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Endoscopic Features of Ectopic Gastric Mucosa in the Duodenum: Hae Jung Song, M.D., Ji Hyun Lee, M.D., In Seop Jung, M.D., Su Jin Hong, M.D., Chang Beom Ryu, M.D., Jin Oh Kim, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D., Boo Sung Kim, M.D. and So Young Jin, M.D.*; Korean J Gastrointest Endosc 2006;32(4):246-252. Published online April 30, 2006

Abstract PDF: Background
/Aims: The origin of gastric mucosa outside of the stomach may be developmental (heterotopic gastric mucosa) or acquired (gastric metaplasia). The aim of this study was to evaluate the endoscopic features, according to the subtypes, of the gastric mucosa outside the stomach in the duodenum. Methods: A total of 30 consecutive patients who underwent esophagogastroduodenoscopy from January 2002 to August 2004 and who were confirmed histopathologically as having gastric mucosa outside the stomach were retrospectively analyzed. Twenty three patients were males and seven were females. Results: Nine patients had heterotopic gastric mucosa and 21 patients had gastric metaplasia. Seven patients with heterotopic gastric mucosa were asymptomatic and 2 patients had dyspepsia, whereas 21 patients with gastric metaplasia had dyspepsia. The dyspepsia rate showed a significant difference between the two groups (p＜0.001). Endoscopically, the appearance of the heterotopic gastric mucosa tended to resemble area gastricae (p=0.08). However, there were no statistically differences between the two groups for the endoscopic features of the duodenum. Other abnormal lesions in stomach and duodenum appeared more frequently in the gastric metaplasia than in the heterotopic gastric mucosa (p=0.004, p＜0.001). There was no difference in the prevalence of Helicobacter pylori infection between the two groups. Conclusions: There are no specific endoscopic findings to differentiate heterotopic gastric mucosa from gastric metaplasia. The presence of symptoms and the associated gastroduodenal inflammatory lesions were more prominent in the gastric metaplasia compared with the heterotopic gastric mucosa. (Korean J Gastrointest Endosc 2006;32:246⁣252)

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Clinical Outcomes of Self-Expanding Metal Stent Insertion for Obstructive Left-Sided Colorectal Cancer: Comparison with Emergency Operation: Do Young Kim, M.D., Tae Il Kim, M.D., Kyu Won Kim, M.D., Kyung Kyu Kim, M.D., Byung Chang Kim, M.D., Sung Jae Shin, M.D., Seung Woo Park, M.D., Yong Chan Lee, M.D., Si Young Song, M.D., Won Ho Kim, M.D., Kang Young Lee, M.D.* and Nam Kyu Kim, M.D.*; Korean J Gastrointest Endosc 2006;32(4):253-259. Published online April 30, 2006

Abstract PDF: Background
/Aims: The aim of this study was to compare the outcome of colorectal stenting with that of performing emergency operation for the patients with malignant left-sided colon obstruction. Methods: The patients with obstructing left-sided colorectal cancer were treated with 'bridge to surgery stenting' and this was followed by operation (group A, n=20), emergency operation (group B, n=21), palliative stenting (group C, n=16), and emergency palliative operation (group D, n=15). Results: The primary anastomosis rate was significantly higher for group A than for group B (65.0 vs. 33.3%, respectively, p＜0.05). None of the patients in group A required intensive care and 3 patients in group B required intensive care. Post-operative complications occurred in 2 and 3 patients in group A and B, respectively. The mean hospital stay showed the tendency to be shorter for group A than for group B (24 vs. 31 days, respectively, p＞0.05). In regard to palliative treatment, the stoma creation rate was 86.7% for group D, and 2 patients in group D needed intensive care. The mean hospital stay was significantly shorter for group C than for group D (9.3 vs. 20.7 days, respectively, p＜0.05). Conclusions: Stent placement is a useful alternative to emergency surgery for the management of malignant colorectal obstruction. (Korean J Gastrointest Endosc 2006;32:253⁣259)

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The Relationship between Endoscopic Degrees and Prognostic Factors in Pseudomebranous Colitis: Jeong Hoon Park, M.D., Won Yeop Bae, M.D., Jae Hak Lee, M.D., Do Hyun Park, M.D., Suck Ho Lee, M.D., Il Kwun Chung, M.D., Sang Heum Park, M.D. and Sun Joo Kim, M.D.; Korean J Gastrointest Endosc 2006;32(4):260-265. Published online April 30, 2006

Abstract PDF: Background
/Aims: Leukocytosis and hypoalbuminemia are known to be poor prognostic factors. The aim of this study was to determine how the leukocyte counts and albumin level are related to the colonic endoscopic findings. Methods: Fifty three pseudomembranous colitis (PMC) patients confirmed by a lower endoscopy were analyzed. Endoscopic degree of pseudomembranous plaque was classified into four grades. The endoscopic severity was classified into two groups (group A: G I∼II, group B: G III∼IV). Results: The mean age was 64.9 years, the mean onset of diarrhea after exposure to antibiotics was 12.9 days, the reasons for admission were medical (58.5%, 31) and surgical (41.5%, 22). Frequently the causative antibiotic was cephalosporin (81.1%, 43/53), and the mean WBC counts and albumin level were 13,045/mm³ and 3.13 g/dL, respectively. The endoscopic degrees of PMC was grade I (9.4%, 5), grade II (32.1%, 17), grade III (41.5%, 22), and grade IV (17%, 9). The patients' WBC counts and albumin level were not associated with the endoscopic severity. The age, gender, causative antibiotics, diabetes showed no correlation. Conclusions: There were no correlations between the known poor clinical prognostic factors (leukocystosis and hypoalbuminemia) and the endoscopic severity. (Korean J Gastrointest Endosc 2006;32:260⁣265)

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Risk Factors for Post-ERCP Pancreatitis after Needle Knife Sphincterotomy following Repeated Probing: Jun Kyu Lee, M.D., Joo Kyoung Park, M.D., Sang Hyub Lee, M.D., Won Jae Yoon, 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(4):266-270. Published online April 30, 2006

Abstract PDF: Background
/Aims: Needle knife sphincterotomy (NKS) following repeated probing due to difficult cannulation during ERCP increase the risk of post-ERCP pancreatitis. However, the risk factors for post-ERCP pancreatitis are not well-known. The aim of this study is to investigate the incidence and risk factors of post-ERCP pancreatitis in patients who underwent NKS. We also evaluated the effect of gabexate on the prevention of post-ERCP pancreatitis. Methods: Medical records from a total of 200 patients who underwent NKS following repeated probing during ERCP were reviewed retrospectively. The potential risk factors for post-ERCP pancreatitis were investigated. The effect of gabexate infusion after ERCP procedure on the incidence of post-ERCP pancreatitis was also evaluated. Results: A total of 13 (6.5%) patients out of 200 patients developed post-ERCP pancreatitis. Gender, age, the presence of pancreatitis at procedure, underlyng disease, direction of sphincterotomy, success or failure of cannulation, diameter of CBD, pancreatic duct status and the presence of acinar filling were proved unrelated with pancreatitis. Post-ERCP pancreatitis developed in 9 out of 38 (23.7%) when gabexate was given, while 4 out of 160 (2.5%) experienced pancreatitis without administration of gabexate. Conclusions: We couldn't determine any risk factor for pancreatitis in patients who underwent NKS following repeated probing during ERCP. The gabexate infusion after ERCP procedure might be associated with the increased risk of pancreatitis. (Korean J Gastrointest Endosc 2006;32:266⁣270)

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A Case of Endoscopic Removal of Impacted Sengstaken-Blakemore Tube: In Hee Kim, M.D., Kang Hun Koh, M.D., Seong Hun Kim, M.D., Sang Wook Kim, M.D., Seung Ok Lee, M.D. and Soo Teik Lee, M.D.; Korean J Gastrointest Endosc 2006;32(4):271-274. Published online April 30, 2006

Abstract PDF: A Sengstaken-Blakemore (S-B) tube has been widely used to treatment of bleeding esophageal varices. It controls bleeding in 50∼92% of cases and provide more time to plan future management. However, there are a number of complications with its use, some of which are lethal. We recently observed a very unusual complication of a S-B tube, namely an impaction of the gastric balloon at the gastroesophageal junction, which could not be deflated by removing the clamps and suctioning the air with a syringe. The gastric balloon was punctured endoscopically with needle knife and deflated. The S-B tube was then be easily removed. (Korean J Gastrointest Endosc 2006;32:271⁣274)

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A Case of Ingested Two Magnets Attracted Each Other that were Holding Gastric Mucosa: Min-Ji Goo, M.D., Ji-Sook Park, M.D., Seok-Jin Kang, M.D.*, Hyun-Jin Kim, M.D.*, Ji-Hyun Seo, M.D., Hyang-Ok Woo, M.D. and Hee-Shang Youn, M.D.; Korean J Gastrointest Endosc 2006;32(4):275-277. Published online April 30, 2006

Abstract PDF: Foreign body ingestion is common in children. About 80% of ingested foreign bodies spontaneously pass through gastrointestinal tract. The management of an ingested magnet depends on its size, the same as for other foreign bodies. However, it has been reported that magnetic foreign body ingestion can lead to gastrointestinal fistula. We report here on the case of a 13-month-old boy who ingested two magnet bars that attracted to each other, and they were holding the gastric mucosa. A simple abdomen X-ray revealed that the location of two magnet bars was not changed according to the patient's positional change. The magnet bars were removed with an alligator forcep under gastroduodenal endoscopy. (Korean J Gastrointest Endosc 2006;32:275⁣277)

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A Case of Duodenal Obstruction Induced by the Short-term Use of a Nonsteroidal Anti-inflammatory Drug: Ji Hyun Song, M.D., Ki Nam Shim, M.D., Hyun Joo Song, M.D., Hee Jung Oh, M.D., Kum Hei Ryu, M.D., Hye Jung Yeom, M.D., Seong-Eun Kim, M.D., Tae Hun Kim, M.D., Hye Kyung Jung, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D. and Il Hwan Moon, M.D.; Korean J Gastrointest Endosc 2006;32(4):278-282. Published online April 30, 2006

Abstract PDF: Giant duodenal ulcer can be defined as a variant of peptic ulceration that exceeds 2 cm at the greatest diameter. The high mortality and morbidity of giant duodenal ulcer are directly related to the resultant perforation, obstruction and massive hemorrhage. The patient usually has a long history of an inadequately treated or neglected peptic ulcer, but this malady is rarely induced by nonsteroidal anti- inflammatory drugs (NSAIDs). A 60-year-old man was referred to us due to epigastric pain. He underwent appendectomy 1 week ago, and he was administered ketorolac (tarasyn^Ⱂ) for 5 days to control the postoperative pain. Esophagogastroduodenos copy (EGD) revealed a giant duodenal ulcer encircling the lumen from the pylorus to the postbulbar portion of the duodenum, and he was then treated with proton pump inhibitor. Two weeks later, the follow-up EGD showed complete duodenal obstruction at the bulb. He was treated by laparoscopic gastrojejunostomy. We report here on this case of duodenal obstruction that was induced by the short-term use of NSAIDs. (Korean J Gastrointest Endosc 2006;32:278⁣282)

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A Case of Multiple Cystic Brunner's Gland Hyperplasia: Chi Hoon Maeng, M.D., Jae Young Jang, M.D., Kwang Ro Joo, 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., Rin Chang, M.D. and Youn Wha Kim, M.D.*; Korean J Gastrointest Endosc 2006;32(4):283-286. Published online April 30, 2006

Abstract PDF: Hyperplasia of Brunner's glands is considered an uncommon finding; its wide range of morphological variation has led to confusing identifying terminology which includes: hyperplasia, adenoma, and hamartoma. Some investigators have suggested that hyperplasia of Brunner's glands is hamartomatous in nature, whereas others have favored a causative relationship that results from gastric acid hypersecretion. Although most commonly an incidental finding, that appears as multiple small submucosal sessile nodules, usually located in the duodenal bulb, it can lead to clinically significant symptoms including gastrointestinal bleeding, abdominal pain, and intestinal obstruction. Here, we report a case of hyperplasia of multiple cystic Brunner's glands on the duodenal bulb in a patient with acute pancreatitis; they were discovered incidentally on abdominal CT and duodenoscopy. This is the first report of hyperplasia of Brunner's glands with these morphological characteristics. (Korean J Gastrointest Endosc 2006;32:283⁣286)

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A Case of Enteropathy-Associated T-cell Lymphoma (EATL) Presenting Perforation after Chemotherapy for Primary Intestinal Lymphoma: Hyung Jun Kim, M.D., Sok Won Han, M.D., Soon Min Park, M.D., Chang-Whan Kim, M.D., Sung Eun Yang, M.D., Hyeong Geun Kim, M.D., Keun-Jong Cho, M.D., Tae Ho Kim, M.D., Sang Bum Kang, M.D., Young Seok Cho, M.D., Sung Soo Kim, M.D., Dong Soo Lee, M.D., Hiun S; Korean J Gastrointest Endosc 2006;32(4):287-292. Published online April 30, 2006

Abstract PDF: Intestinal T-cell lymphomas are fairly uncommon, and can sometimes be associated with enteropathy. Enteropathy- associated T-cell lymphoma (EATL) is commonly accompanied by a nonspecific mucosal ulceration, similar to that observed as a complication of celiac disease. The clinical course of EATL is quite unfavorable, and tends to have a generally poor prognosis. When a tumor invades the bowel wall and is treated with corticosteroids and chemotherapy, cell lysis with perforation often occurs, particularly in case of lymphoma. Recent data indicate that extensive resection may improve local control, and eliminate the risk of early mortality due to visceral perforation or hemorrhaging in unresected lesions during chemotherapy. Here, we report the case of a 51-year-old male who was diagnosed with primary gastrointestinal lymphoma after colonoscopy, and presented with EATL after emergent exploratory laparatomy. We also include a review of the literature regarding this uncommon entity. (Korean J Gastrointest Endosc 2006;32:287⁣292)

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A Case of Cowden Syndrome Associated with Breast Cancer and Thyroid Cancer: Eun-Jung Hong, M.D., Hyung-Keun Kim, M.D., Young-Seok Cho, M.D., Jeong-Seon Ji, M.D., Chang-Wook Kim, M.D., Chang-Whan Kim, M.D., Bo-In Lee, M.D., Hiun-Suk Chae, M.D., Sok-Won Han, M.D. and Kyu-Yong Choi, M.D.; Korean J Gastrointest Endosc 2006;32(4):293-297. Published online April 30, 2006

Abstract PDF: Cowden syndrome, which is also known as 'multiple hamartoma syndrome', is an autosomal dominant condition with variable expression resulting from a mutation in the PTEN gene on the chromosome arm, 10q23. Cowden syndrome causes hamartomatous neoplasms of the skin and mucosa, breast, thyroid, and gastrointestinal tract, and is associated with the development of several types of malignancy. In particular, a marked increase in the incidence of breast carcinoma in women and of thyroid carcinoma in both men and women has been reported. We report a case of Cowden syndrome associated with both carcinomas with a review of the relevant literature. (Korean J Gastrointest Endosc 2006;32:293⁣297)

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Anisakiasis of the Colon: Report of Two Cases: Eun Young Cho, M.D., Woo Kern Song, M.D.*, Yong Hwan Ahn, M.D., Hyo Jung Oh, M.D., Geom Seog Seo, M.D., Tae Hyeon Kim, M.D., Suck Chei Choi, M.D. and Yong Ho Nah, M.D.; Korean J Gastrointest Endosc 2006;32(4):298-301. Published online April 30, 2006

Abstract PDF: Anisakiasis is a rare finding in the colon in comparison with its involvement in the stomach. Also, anisakiasis of the colon is usually incidentally diagnosed during either endoscopy or on operation for intestinal obstruction due to the fact that anisakiasis of the colon does not have typical clinical features. In other words, the diagnosis of colonic anisakiasis is usually made after surgical exploration. We herein report on two cases of anisakiasis of the colon that were treated successfully by colonoscopic removal of the worm without any surgery. A review of the related literature is included. (Korean J Gastrointest Endosc 2006;32:298⁣301)

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Linear Array Endoscopic Ultrasound-Guided Drainage of a Pancreatic Pseudocyst without Using Fluoroscopy: Kwi-Sook Choi, M.D., Sang Soo Lee, M.D., Sung Hee Pyo, M.D., Ja Young Kim, M.D., Jong Cheol Kim, M.D., Eun Kwang Choi, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D. and Myung-Hwan Kim, M.D.; Korean J Gastrointest Endosc 2006;32(4):302-305. Published online April 30, 2006

Abstract PDF: Endoscopic drainage of pancreatic pseudocysts is the initial treatment of choice for symptomatic pancreatic pseudocysts and nonresolving pseudocysts. Recently, endoscopic ultrasound (EUS) has been used as a guide for transmural entry and the safer drainage of pancreatic pseudocysts. We report a case of therapeutic linear array EUS- guided pseudocyst drainage without the use of fluoroscopy in a patient with portal hypertension. (Korean J Gastrointest Endosc 2006;32:302⁣306)

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