Clinical Endoscopy

A Prospective Randomized Trial Comparing Divided Dose of Polyethylene Glycol Solution with Stimulant Laxative Plus Low Dose Polyethylene Glycol Solution for Colon Cleansing: Jin Kwan Kim, M.D., Hoon Cho, M.D., Yeung Muk Kim, M.D., Kang Min Kim, M.D., Sung Nam Park, M.D., Moo Yeol Lee, M.D. and Joon Sang Lee, M.D.; Korean J Gastrointest Endosc 2006;33(1):1-5. Published online July 30, 2006

Abstract PDF: Background
/Aims: This study compared the efficacy and patient's tolerance between those given a divided dose of a polyethylene glycol solution (PEG) and those given a stimulant laxative plus a reduced dose of PEG. Methods: 190 consecutive patients for colon cleasing were randomized into 3 groups. In group A, 2 L of PEG was administered on the evening prior to the colonoscopy followed by 2 L of the same solution on the morning of colonoscopy. In group B, 2 L of PEG was administered in the morning only. In group C, 2 bisacodyl tablets (10 mg) were administered on the evening prior to colonoscopy and 2 L of PEG was administered in the morning. The patients completed a questionnaire to assess their tolerance to the bowel preparation before the colonoscopy. The endoscopists scored the adequacy of the bowel preparation using the Ottawa scale along with their satisfaction with the quality of the procedure. Results: While 4 patients (6.7%) could not completely take the recommended dose in group A, all patients in groups B and C could take the recommended dose (p=0.012). The patients in Group B had a better tolerance and fewer side effects than those in Group A (p=0.01). A higher adequacy of bowel preparation was observed in group A than in group B (p=0.000) and there appeared to be a higher adequacy of bowel preparation in Group C than in Group B (p=0.06). Conclusions: The 2 L PEG solution only does not appear to be as effective as a bowel cleansing agent for colonoscopy compared with the divided 4 L PEG solution. No statistical difference in the side effects and efficacy was observed between the divided 4 L PEG solution and the combination of bisacodyl 10 mg with 2 L of a PEG solution. (Korean J Gastrointest Endosc 2006;33:1⁣5)

1,961 View
22 Download

A Comparison of the Effect of High-dose Oral and Intravenous Proton Pump Inhibitor on the Prevention of Rebleeding after Endoscopic Treatment of Bleeding Peptic Ulcers: Jae Young Jang, M.D., Kwang Ro Joo, M.D., Young Hwangbo, M.D., Lae Ik Jeong, M.D., Sun Young Choi, M.D., Ji Heon Jung, M.D., Myung Jong Chae, M.D., Sang Kil Lee, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byung-Ho Kim, M.D., Young Woon Chang, M.D., Jou; Korean J Gastrointest Endosc 2006;33(1):6-11. Published online July 30, 2006

Abstract PDF: Background
/Aims: The use of proton pump inhibitor (PPI) prevents rebleeding by elevating the intragastric pH in patients with bleeding peptic ulcers after hemostasis has been achieved. We assessed if high-dose oral pantoprazole is as effective as high-dose intravenous pantoprazole for their ability to prevent rebleeding after having achieved initial hemostasis in patients with active bleeding or nonbleeding visible vessels. Methods: Thirty eight patients with bleeding peptic ulcers who had achieved initial hemostasis were enrolled in this randomized controlled trial. In the high-dose oral pantoprazole group (n=19), 40 mg of pantoprazole was given orally twice daily for 5 days. In the high-dose intravenous pantoprazole group (n=19), an 80 mg intravenous bolus of pantoprazole was given; this was followed by 8 mg/hour of continuous infusion daily for 3 days. Thereafter, 40 mg of pantoprazole was given orally once daily for 8 weeks. Results: The two groups were similar with respect to all the background variables. Rebleeding occurred in 2 patients (10.5%) in the intravenous group and in 1 patient in the oral group (5.3%) by day 30 after enrollment (p=1.000). There was no significant difference in terms of the number of therapeutic endoscopic sessions (1 vs. 1.13⁑0.52), the surgery (0% vs. 0%), the bleeding related mortality (0% vs. 0%), and the mean number of units of transfused blood. Conclusions: The high-dose oral pantoprazole is as effective as an intravenous administration in reducing rebleeding episodes in patients with bleeding peptic ulcers after successful endoscopic therapy. (Korean J Gastrointest Endosc 2006;33:6⁣11)

2,337 View
52 Download

Combined Endoscopic Submucosal Dissection and Snaring for the Resection of Colorectal Lesions: Hye Won Park, M.D.*, Jeong-Sik Byeon, M.D., Seung-Jae Myung, M.D., Suk-Kyun Yang, M.D., Ji-Yun Jo, M.D., Kee Don Choi, M.D., Gin Hyug Lee, M.D., Hwoon-Yong Jung, M.D., Weon-Seon Hong, M.D. and Jin-Ho Kim, M.D.; Korean J Gastrointest Endosc 2006;33(1):12-19. Published online July 30, 2006

Abstract PDF: Background
/Aims: Endoscopic en-bloc resection of the large colorectal lesions is technically difficult. The aim of this study is to evaluate the usefulness of combined endoscopic submucosal dissection (ESD) and snare resection for treating colorectal lesions. Methods: We enrolled 23 patients (M：F=14：9, age range: 46∼76 years) with 25 colo rectal tumors that were around or above 20 mm in diameter. A combined treatment of ESD and snare resection was performed. Results: The mean size of the 25 lesions was 22.6⁑8.2 mm (range: 15.0∼44.0 mm). Ten lesions were laterally spreading tumors and 15 lesions were found in the rectum. On the histopathologic examination, 16 lesions were adenocarcinoma, 2 lesions were villous adenoma, 1 lesion was a villotubular adenoma, 5 lesions were tubular adenoma and 1 lesion was a hyperplastic polyp. The mean resection time was 27⁑22 min (range: 10∼91 min). En bloc resection was possible for 19 lesions (76%). Of these, 18 specimens showed clear resection margins and 1 showed a positive deep resection margin. Of the 6 piecemeal resection cases, 2 showed positive lateral resection margins. Therefore, an 88% tumor free resection rate was obtained. Conclusions: Combined ESD and snare resection may be an effective and safe modality for the resection of large colorectal lesions. (Korean J Gastrointest Endosc 2006;33:12⁣19)

2,602 View
13 Download

Conservative Treatment of Colonoscopic Perforations: Yong Keun Cho, M.D., Sang Woo Nam, M.D.*, Hyun Chul Kim, M.D.*, Eun Young Ko, M.D., Yang Ho Kim, M.D., Seung Min Park, M.D., Yong Ung Lee, M.D. and Jin Woong Cho, M.D.; Korean J Gastrointest Endosc 2006;33(1):20-25. Published online July 30, 2006

Abstract PDF: Background
/Aims: Colonoscopic perforation can be treated by both operative or non-operative methods. Non-operative management, and especially conservative management, may be appropriate for selected individuals. We wanted to verify the usefulness of performing conservative management for treating colonoscopic perforations. Methods: We reviewed the medical records of the colonoscopic perforation cases that occurred in the recent 5 yrs. 11 cases of perforation occurred from among 8,536 colonoscopic procedures. Results: Ten cases occurred from a therapeutic procedure (five from polypectomy and another five occurred from an endoscopic (submucosal dissection) and one case occurred from a diagnostic procedure. The perforation sites were the ascending colon (three cases), transverse colon (two cases), descending colon (one case), sigmoid colon (two cases), and rectum (three cases). There were five intraperitoneal perforations and five retroperitoneal perforations. All the cases were detected within 12 hours and all the cases had received good bowel preparation. 10 cases were managed conservatively (nothing by mouth, broad spectrum antibiotics and, Levin tube suction). One case was managed by an operative procedure due to the large size of the defect and the patient's wish. All the patients recovered without complications. The mean hospital stay was 9.5 days. Conclusions: Colonoscopic perforation can managed conservatively in selected cases, such as for those cases that will undergo post-therapeutic colonoscopy and those cases that have undergone good bowel preparation. (Korean J Gastrointest Endosc 2006;33:20⁣25)

2,915 View
35 Download

Usefulness of Percutaneous Transhepatic Cholangioscopy for Treatment of Intrahepatic Duct and Common Bile Stones and Diagnosis of Intrahepatic Duct Lesions with Biopsy: Hyeon Woong Yang, M.D.*, Byung Seok Lee, M.D., Seon Moon Kim, M.D., Yoon Sae Kang, M.D., Jae Hoon Jung, M.D., Yeon Soo Kim, M.D., Gi Oh Park, M.D., Jae Kyu Seong, M.D., Seok Hyun Kim, M.D. and Heon Young Lee, M.D.; Korean J Gastrointest Endosc 2006;33(1):26-31. Published online July 30, 2006

Abstract PDF: Background
/Aims: Despite several limitations, percutaneous transhepatic cholangioscopy (PTCS) has been useful in patients with intrahepatic stone, common bile duct stone or intrahepatic bile duct stricture. We investigated the usefulness and limitation of PTCS, and the recurrence rate after stone removal. Methods: PTCS was performed on 49 patients with intrahepatic duct (IHD) stones or common bile duct (CBD) stones and 11 patients undergoing biopsy who visited Chung Nam university hospital between 1999 and 2003. Results: Complete removal rate of patients with IHD and CBD stones was 75% (21/28) and 91% (19/21), respectively. Biopsy results by PTCS were in agreement with the final result in 86% (6/7). In patients with IHD stones, the PTCS complication rate was 29% (8/28). Bleeding was most common (21%) but was self limited. In patients with CBD stones, the PTCS complication rate was 9% (2/9). One case was bleeding and the other was death by aggravation of general condition. In patients with IHD stones, the recurrence rate was 29% (5/17). Conclusions: In conclusion, PTCS is useful to treat patients with IHD stones, as well as the few patients with failed CBD stone removal by ERCP and diagnosis of stricture in the bile duct. (Korean J Gastrointest Endosc 2006;33:26⁣31)

2,789 View
19 Download

Two Cases of Vocal Cord Paralysis Complicated by Upper Gastrointestinal Endoscopy: Sung Won Jung, M.D.; Korean J Gastrointest Endosc 2006;33(1):32-36. Published online July 30, 2006

Abstract PDF: Upper Gastrointestinal endoscopy is extensively used these days and its various complications, including cardiopulmonary disease, bleeding, perforation and infection, have been reported on, but vocal cord paralysis as a complication of endoscopy has not been reported on. The pressure on the larynx by the endoscopic tip itself or the gag reflex during endoscopy could cause vocal cord paralysis as the endoscopic tip passes through the pyriform sinus, which is close to the recurrent laryngeal nerve and arytenoid cartilage. We experienced two cases of vocal cord paralysis as complications of upper Gastrointestinal endoscopy and we report on them here. (Korean J Gastrointest Endosc 2006;33:32⁣36)

3,183 View
106 Download

A Case of Photodynamic Therapy as a Curative Treatment of Early Esophageal Cancer: Chang Nyol Paik, M.D., Myung Gyu Choi, M.D., Kye Weol Kim, M.D., In Seok Lee, M.D., Jung Hwan Oh, M.D., Jae Myung Park, M.D., Joon Wook Lee, M.D., Yu Kyung Cho, M.D., Sang Woo Kim, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2006;33(1):37-41. Published online July 30, 2006

Abstract PDF: Although the surgical treatment of early esophageal cancer is a well-known curative modality, less invasive endoscopic methods have attracted significant attention recently on account of the fewer postoperative complications, better quality of life and preservation of the integrity of the esophagus. Among the various endoscopic techniques employed, photodynamic therapy (PDT) has been used to allow the selective destruction of malignant tissue through a photochemical effect after the administration of a photosensitizer for curative and palliative treatment purposes. This report describes a case of a 73-year-old man with early esophageal cancer, which had been diagnosed by fluorodeoxyglucose-positron emission tomography (FDG-PET) and endoscopy and a long history of chronic pulmonary diseases such as emphysema and radiation fibrosis. The patient was cured successfully with photodynamic therapy using porfimer sodium as the photosensitizer. (Korean J Gastrointest Endosc 2006;33: 37⁣41)

2,548 View
7 Download

A Case of Gastric Duplication Cyst: Do Hyung Kim, M.D., Woong Park, M.D., Joo Young Kim, M.D., Yeo Kyung Lee, M.D., Yun Ho Bae, M.D., Sung Pyo Hong, M.D., Tae Heon Kim, M.D.* and Sung Won Kwon, M.D.^†; Korean J Gastrointest Endosc 2006;33(1):42-45. Published online July 30, 2006

Abstract PDF: Duplicated cyst is a rare congenital disease that makes up 4% of all gastrointestinal duplications. It is two times more prevalent in women than in men. The majority of cases are detected by such symptoms as an abdominal mass, nausea, abdominal pain and anemia in infants, but these symptoms are uncommon in adults. Obstruction, hemorrhage and perforation are possible complications and malignancy can develop on rare occasions. Most cases are controlled by surgical resection. We report here on a case of gastric duplication cyst in a 20-year-old woman who presented with severe nausea and vomiting. She was managed by surgical resection after evaluation was done via endoscopic ultrasonography. (Korean J Gastrointest Endosc 2006;33:42⁣45)

2,232 View
12 Download

A Case of Mesenteroaxial Gastric Volvulus Diagnosed Using Endoscopic Procedure: Yang Ho Kim, M.D., Yong Ung Lee, M.D., Chin Woong Cho, M.D., In Seok Seo, M.D., Seung Min Park, M.D., Yong Keun Cho, M.D., Eun Yong Go, M.D. and Jong Myeoung Lee, M.D.*; Korean J Gastrointest Endosc 2006;33(1):46-49. Published online July 30, 2006

Abstract PDF: Gastric volvulus is characterized by an abnormal rotation of the stomach typically 180^oleft to right around a line joining the relatively fixed pylorus and the esophagus. Gastric volvulus can be classified anatomically as organoaxial, mesenteroaxial or combined, and symptomatically as acute or chronic. Acute gastric volvulus is an extremely rare emergency surgical condition. The classical triad of gastric volvulus are severe nausea with a paradoxical inability to vomit, localized epigastric pain and an inability to pass a nasogastric tube. Gastric volvulus may be suspected on a plain radiological examination of the abdomen as well as by its symptoms. It is confirmed by the specific findings on the esophagogastroduodenoscopy. We report a case of acute mesenteroaxial gastric volvulus, that was treated using laparoscopic reduction and anterior gastropexy. (Korean J Gastrointest Endosc 2006;33:46⁣49)

2,156 View
17 Download

A Case of Intra-abdominal Desmoid Tumor after Total Colectomy in a Patient with Familial Adenomatous Polyposis: In Du Jeong, M.D., Sung Jo Bang, M.D., Jung Woo Shin, M.D., Neung Hwa Park, M.D., Dae Hwa Choi, M.D.*, Hee Jeong Cha, M.D.^† and Do Ha Kim, M.D.; Korean J Gastrointest Endosc 2006;33(1):50-53. Published online July 30, 2006

Abstract PDF: Familial adenomatous polyposis (FAP) arises from germline mutations of the adenomatous polyposis coli (APC) gene. FAP is characterized by the occurrence of hundreds to thousands of adenomas throughout the colorectum, and there is nearly a 100% risk of colorectal cancer. In addition to polyposis coli, patients with FAP can develop a variety of extracolonic manifestations. Recent advances in screening and surgery have reduced the colon cancer occurrence and death in FAP patients, leaving desmoid tumors as a leading cause of their morbidity and mortality. Treatment of desmoid tumors is generally considered to be challenging for both the doctor and the patient. We report here on an 18 year old man with resectable intra-abdominal desmoid tumor that developed after total colectomy due to FAP and we include a review of the relevant literature. (Korean J Gastrointest Endosc 2006;33:50⁣53)

2,195 View
17 Download

Two Cases of Rectal Dieulafoy's Lesion Treated Sucessfully with Hemoclip: Yong Sung Ahn, M.D., Ji Young Park, M.D., Jung Hyun Lee, M.D., Hyo Jin Jung, 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;33(1):54-57. Published online July 30, 2006

Abstract PDF: Dieulafoy's lesion is a rare cause of massive gastrointestinal bleeding. It is usually identified within the proximal stomach but has been reported in the esophagus, duodenum, small intestine, colon and rectum. Surgery was originally the treatment of choice for this lesion. However, recently, most case can be treated using endoscopic techniques including an injection of a sclerosing agent, clipping, band ligation, heater probe, and bipolar coagulation. We report 2 cases of a rectal Dieulafoy's lesion that were treated sucessfully by endoscopic clipping without complications. (Korean J Gastrointest Endosc 2006; 33:54⁣57)

1,795 View
9 Download

Endoscopic Retrieval of a Proximally Migrated Stent in the Dorsal Duct of Pancreas Divisum: Chul Sung Park, M.D., Jong Hyeok Kim, M.D., Na Rae Joo, M.D., Chin Woo Kwon, M.D., Hae Geun Song, M.D., Joon Ho Moon, M.D., Jae One Jung, M.D., Woon Geon Shin, M.D., Jong Pyo Kim, M.D., Kyoung Oh Kim, M.D., Cheol Hee Park, M.D., Taeho Hahn, M.D., Kyo-Sang; Korean J Gastrointest Endosc 2006;33(1):58-61. Published online July 30, 2006

Abstract PDF: Endoscopic treatment of chronic pancreatitis by stent insertion is an accepted procedure, but various complications can be induced, including proximal migration of the stent. Many techniques are used to retrieve proximally migrated, pancreatic stents. We here report a case of a proximally migrated stent into the dorsal duct of a pancreas divisum, which was retrieved endoscopically by using a mini-snare. A 39-year-old female patient had chronic pancreatitis with divisum. A stent was inserted into the dorsal duct to relieve the chronic pain. After two months, sudden epigastric pain developed due to proximal migration of the stent. The pancreatic stent was retrieved successfully with one endoscopic attempt using a mini- snare. The epigastric pain resolved after retrieval of the stent. Our observation is that pancreatic stent migration may cause severe abdominal pain and that endoscopic retrieval is possible. (Korean J Gastrointest Endosc 2006;33:58⁣62)

2,328 View
15 Download

Previous issues