Clinical Endoscopy

An Evaluation of Websites about Endoscopy under Conscious Sedation: Hyun Jeong Lee, M.D., Young Jae Oh, M.D., Il Chol Hong, M.D., Jun Haeng Lee, M.D., Poong-Lyul Rhee, M.D., Jae J. Kim, M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2006;32(5):307-312. Published online May 30, 2006

Abstract PDF: Background
/Aims: The internet has become an important source of medical information not only for doctors but also for patients. Therefore, this study evaluated the quality of medical information on endoscopy under conscious sedation on the internet in Korea. Methods: 147 patients (mean age: 51 years, male：female 76：71) who visited the gastroenterology clinic were surveyed using a questionnaire about use of medical information on the Internet. The first 20 Internet sites using the key word 'endoscopy under sedation' were retrieved from the 5 most frequently used Internet search engines. The quality of information from a total of 63 websites was evaluated using a checklist. Results: Among a total 63 sites about endoscopy under sedation, 46 sites (73.0%) were made by private hospitals or private clinics and 60 sites (95%) were made for patients. The definition of endoscopy under conscious sedation was accurately mentioned in only 7 sites (11%). The complications and risk factors were mentioned in 29 sites (46%). Conclusions: Most websites made by private hospitals or private clinics overemphasized the merits of sedation. Websites with a more balanced point of view by official organizations may help improve the quality of medical information on the Internet. (Korean J Gastrointest Endosc 2006;32:307⁣312)

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Endoscopic Ultrasonography in Upper Gastrointestinal Subepithelial Lesions: Tae Kyoung Won, M.D., Eun Young Kim, M.D., Chang Jin Seo, M.D., Byung Seok Kim, M.D., Young Sup Kim, M.D., Kyu Hyun Cho, 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 2006;32(5):313-319. Published online May 30, 2006

Abstract PDF: Background
/Aims: Endoscopic ultrasonography (EUS) is known for its value to characterize incidentally found subepithelial lesions, and we so reviewed our data to validate the norm. Methods: We analyzed the records of the patients with suspected subepithelial lesions at the time of endoscopy, which was performed from Aug. 2001 to Oct. 2004. Results: The data includes 622 patients (248 males) with average age of 52 years (age range 15∼83 years). Extraluminal compression was noted in 10.1% of the patients. Intraluminal lesions were dominant in the stomach and their average size was 14.8 mm. The inner three wall layers were the predominant layers of origin. Mesenchymal tumors were the most frequent EUS impression. Pathologic findings were available for 88 patients and 80.7% of them were benign. Compared with the pathology, the diagnostic accuracy of EUS was 78.4%. The differentiation of malignant and benign GISTs by the EUS findings was 56.3%. Among the 60 EUS cases that had follow up data available (at mean interval of 12.2 months) and who also had less than 3 cm benign lesions, growth was detected only in 10 cases (17%). Pathology confirmed that the lesions in 3 of them were benign. Conclusions: More than 10% of the subepithelial lesions found from endoscopy were extraluminal compression. The majority of intramural lesions were benign. The EUS impression was relatively accurate and helpful for the management of upper gastrointestinal submucosal lesions. (Korean J Gastrointest Endosc 2006;32:313⁣319)

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Risk Factors for Upper Gastrointestinal Rebleeding in Critically Ill Patients: Seong Joon Koh, M.D., Jae Hee Cheon, M.D., Joo Sung Kim, M.D., Byong Duk Ye, M.D., Hae Yeon Kang, M.D., Bo Hyun Kim, M.D., Jeong Hoon Lee, M.D., Ki Young Yang, M.D., Sang Gyun Kim, M.D., Hyun Chae Jung, M.D. and In Sung Song, M.D.; Korean J Gastrointest Endosc 2006;32(5):320-325. Published online May 30, 2006

Abstract PDF: Background
/Aims: To determine the incidence and risk factors associated with rebleeding after upper gastrointestinal bleeding (UGIB) in critically ill patients. Methods: This study retrospectively reviewed the medical records of 60 patients undergoing bedside esophagogastroduodenoscopy between April 2000 and February 2004 for UGIB that developed whilst in the intensive care unit (ICU). Results: Eight out of 60 patients died within 7 days, and an additional 7 patients died within 30 days after the initial bleeding. Two of these 15 patients (13.3%), died from GI bleeding. The 7-day and 30-day rebleeding rates were 34.6% (18/52 patients), and 51.1% (23/45 patients), respectively. Multiple logistic regression using the significant variables revealed, anemia (Hb＜9.0 g/dL) and hypoalbuminemia (＜3.0 g/dL) to be significant factor for 7-day rebleeding, and hypoxia (＜80 mmHg), anemia (Hb＜9.0 g/dL), blood transfusion (≥3 units) to be significant independent risk factor for 30-day rebleeding. Conclusions: The rebleeding rates in the ICU setting were as high as 34.6% at 7 days and 51.1% at 30 days. This suggests that the underlying conditions of the critically ill patients affect the rebleeding rate more than the endoscopic features. Therefore, adequate general ICU care including the prevention and correction of hypoxia, anemia, and hypoalbuminemia, and minimizing blood loss can reduce the risk of rebleeding after UGIB in an ICU setting. (Korean J Gastrointest Endosc 2006;32:320⁣325)

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Endoscopic Submucosal Dissection for Gastric Tumors: Complete Resection Rate, Resection Time and Complications in Comparison with Endoscopic Mucosal Resection after Circumferential Mucosal Incision with a Needle Knife: Kwi-Sook Choi, M.D., Hwoon-Yong Jung, M.D., Kee Don Choi, M.D., Jun-Won Chung, M.D., Tae Hoon Oh, M.D., Ji-Yun Jo, M.D., Ho June Song, M.D., Gin Hyug Lee, M.D., Jeong-Sik Byeon, M.D., Seung Jae Myung, M.D., Suk-Kyun Yang, M.D. and Jin Ho Kim, M.D.; Korean J Gastrointest Endosc 2006;32(5):326-332. Published online May 30, 2006

Abstract PDF: Background
/Aims: Endoscopic submucosal dissection (ESD) is a novel technique for an en bloc resection of mucosal tumors over 2 cm in diameter. The aim of this study was to evaluate the efficacy, resection time and complications of ESD using a needle knife (needle-ESD) with a comparison those encountered using endoscopic mucosal resection (EMR) after a circumferential mucosal incision with a needle knife (needle-EMR). Methods: Thirty-three consecutive patients with early gastric cancer or gastric adenoma who underwent needle-ESD at the Asan Medical Center between December 2004 and March 2005 were retrospectively reviewed, and compared with the data from 33 consecutive patients who underwent needle-EMR between March 2001 and June 2001. Results: Both the en bloc resection and complete resection could be achieved by needle-ESD in all the patients, while the corresponding percentages were 76% (en bloc resection, 25/33) and 94% (complete resection, 31/33) in the needle-EMR group. The resection time was longer (22.7 vs. 11.6 min) in the needle-ESD group than in the needle-EMR group. However, there was no significant difference in the complication rate between the two groups. Conclusions: Compared with the needle-EMR, needle-ESD has significant benefits, particularly regarding the en bloc and complete resection rate despite the technical difficulty and longer resection time. (Korean J Gastrointest Endosc 2006;32:326⁣332)

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A Case of Triple Cancers of the Esophagus, Stomach and Duodenum: Hong Sug Lee, M.D., Dong Choon Kim, M.D., Seong Yeol Kim, M.D., Yeong Seok Lee, M.D., Kang Wook Chung, M.D., Byoung Kuk Jang, M.D., Woo Jin Chung, M.D., Kyung Sik Park, M.D., Kwang Bum Cho, M.D., Jae Seok Hwang, M.D. and Sung Hoon Ahn, M.D.; Korean J Gastrointest Endosc 2006;32(5):333-337. Published online May 30, 2006

Abstract PDF: Multiple primary cancer is defined as the multiple occurrence of malignant neoplasm in the same individual. The incidence of multiple primary cancer is 0.26∼1.43% in Korea, but this malady is increasing due to development of diagnostic modalities, the treatment of cancer and the recording of accurate cancer statistics. The most common site of multiple primary cancer in Korea is the stomach, colon, breast, cervix, liver and lung. We report here on a case of triple cancer that was located at the middle esophagus, stomach and duodenum in 75 year-old man. (Korean J Gastrointest Endosc 2006;32:333⁣337)

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A Case of High Grade Dysplasia in Sporadic Fundic Gland Polyp: Hyung Keun Ha, M.D., Jin Tae Jung, M.D., Young Sup Kim, M.D., Byung Seok Kim, M.D., Kyu Hyun Cho, M.D., Joong Goo Kwon, M.D., Eun Young Kim, M.D., Chang Hyeong Lee, M.D., Ho Gak Kim, M.D. and Chang Ho Cho, M.D.*; Korean J Gastrointest Endosc 2006;32(5):338-341. Published online May 30, 2006

Abstract PDF: Fundic gland polyps (FGP) are the most common type of gastric polyps, with an incidence on endoscopy of 0.8∼1.9%. They have been considered as benign lesions, without the potential for malignant transformation. High grade dysplasia and gastric adenocarcinomas associated with FGP have been described in patients with familial, as well as attenuated adenomatous polyposis (FAP). In contrast, dysplasia associated with FGP in non-FAP patients is extremely rare, and there have been no reports of sporadic FGP with high grade dysplasia in the Korean literature. Herein, we report one case of high grade dysplasia associated with sporadic FGP in a non-FAP patient treated with an endoscopic polypectomy. (Korean J Gastrointest Endosc 2006;32:338⁣341)

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A Case of Gastric Syphilis Mimicking Advanced Gastric Cancer: Jeong Hoon Ji, M.D., Young Soo Park, M.D.*, Nayoung Kim, M.D.*, Dong Ho Lee, M.D.*, Hyun Chae Jung, M.D., In Sung Song, M.D. and Hye Seung Lee, M.D.^†; Korean J Gastrointest Endosc 2006;32(5):342-346. Published online May 30, 2006

Abstract PDF: Gastric syphilis has been reported to be relatively rare due to the difficulty in making a histological diagnosis. However if a serologic test for syphilis is positive and the ulcer regresses after anti-syphilitic treatment, it can be assumed that the gastritis was caused by Treponema Pallidum. The clinical diagnosis of gastric syphilis ranges from a benign ulcer to mimicking an infiltrative carcinoma or lymphoma. We encountered a 21-year-old woman who was referred for linitis plastica with epigastric pain and weight loss. The gastroduodenoscopy revealed multiple irregular gastric mucopurulent shallow ulceration and several nodular lesions mimicking linitis plastica. The appropriate antibiotic treatment resulted in a dramatic improvement and a complete reversal of gastric lesions. This recent case of gastric syphilis emphasizes the importance of remaining alert to the manifestations of syphilis. (Korean J Gastrointest Endosc 2006;32:342⁣346)

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A Case of Sigmoid Volvulus Treated by Emergency Endoscopic Reduction and Surgical Colonic Resection: Mi Ra Cho, M.D., Jung Youn Moon, M.D., Keun Mo Park, M.D., Suk Hun Kim, M.D., Jung Nam Lee, M.D., Chun Kwan Lee, 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 2006;32(5):347-351. Published online May 30, 2006

Abstract PDF: An intestinal obstruction is a common cause of acute abdominal diseases which need emergency measures. Sigmoid volvulus is one of rare causes of colonic obstruction and occupies 2∼3% of its causes in Korea. Volvulus requires a prompt diagnosis and decompression in order to prevent its progression to strangulation and gangrene. Although 90% of sigmoid volvulus can be diagnosed just by plain abdominal x-ray, computed tomography or barium enema can be done for more accurate diagnoses. For the successful treatment, accurate early examination, endoscopic reduction and surgical colonic resection are required. Endoscopic reduction has low mortality but is liable to recur, whereas emergency colonic resection has little recurrence rate but a high mortality. We experienced a case of a sigmoid volvulus in a 55-year-old male who companied of sudden abdominal pain. After diagnosed as sigmoid volvulus through plain abdominal x-ray and abdominal computed tomography, endoscopic reduction was done in the early period of development, and the sigmoid resection was performed after 7 days. We report our experience with a review of the literature regarding the diagnosis and treatment of sigmoid volvulus. (Korean J Gastrointest Endosc 2006; 32:347⁣351)

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A Case of Anomalous Drainage of the Common Bile Duct into the Duodenal Bulb with Pancreatic Duct Anomaly: Sang Yon Hwang, M.D., Hyeon Geun Cho, M.D., Hyuk Jin Kwon, M.D., Geun Jun Ko, M.D., Chang Hwan Choi, M.D., Chang Woo Gham, M.D., Ki Joon Han, M.D., Jin Ho Jeong, M.D.* and Mi Sung Kim, M.D.^†; Korean J Gastrointest Endosc 2006;32(5):352-356. Published online May 30, 2006

Abstract PDF: The common bile duct normally enters the posteromedial aspect of the second part of the duodenum. However, anomalous drainage of the common bile duct into the stomach, pyloric channel, duodenal bulb and fourth portion of the duodenum has been reported in the literature. An anomalous pancreatic duct, with ectopic drainage of the common bile duct, is particularly rare. Herein, we report the case of a 69-year-old woman who showed pancreatic ductal variation and anomalous drainage of the common bile duct into the duodenal bulb. The patient required a cholecystectomy and choledochoenteric anastomosis to relieve the obstructive jaundice and abdominal pain. (Korean J Gastrointest Endosc 2006;32:352⁣356)

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A Case of Endoscopic Management of Dieulafoy's Lesion in the Ampulla of Vater: Ki Won Hwang, M.D., Jae Hyung Lee, M.D., Joo Ho Lee, M.D., Sang Yong 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. and Mong Cho, M.D.; Korean J Gastrointest Endosc 2006;32(5):357-359. Published online May 30, 2006

Abstract PDF: Dieulafoy's lesion is an uncommon but important cause of massive upper gastrointestinal bleeding. The lesion usually occurs in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction but extragastric locations of Dieulafoy's lesion are rare. In this study, diagnosis of Dieulafoy's lesion was frequently made by endoscopy instead of surgery. Hemostasis was achieved by endoscopic treatment in more than 90% of patients. We report the successful application of endoscopic hemoclipping for treatment of active bleeding from Dieulafoy's lesion in the ampulla of Vater of the duodenum. (Korean J Gastrointest Endosc 2006;32:357⁣360)

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