Clinical Endoscopy

Our Experience of Gastritis Cystica Profunda Cases and Its Clinical Study: Yeon Soo Kim, M.D.*, Won Seok Heo, M.D., Kyung Hoon Chae, M.D., Jae Hoon Jung, M.D., Youn Se Gang, M.D., Seok Hyun Kim, M.D., Jae Koo Seong, M.D., Byung Seok Lee, M.D., Hyun Yong Jeong, M.D., Kyu Sang Song, M.D.^†, Kyung Sook Shin, M.D.^‡; Korean J Gastrointest Endosc 2006;33(3):135-139. Published online September 30, 2006

Abstract PDF: Background
/Aims: Gastritis cystica profunda (GCP) is a rare disease that is characterized by a hyperplastic and cystic dilatation of the pseudopyloric gland with submucosal invasion. GCP is regarded as a benign lesion. However, there is some controversy regarding its malignant potential. This study reviewed the clinical features and association with malignancy. Methods: From January 2001 to June 2005, 1,010 cases of resected and 1,228 cases of an endoscopic mucosal resection or polypectomy were examined. Results: Thirty-nine cases (1.7%) were confirmed pathologically and were not associated with prior gastric surgery mostly. The mean age was 60.0±11.4 years old and there were 29 male patients. The body was most commonly located on the longitudinal axis (57.1%). Eleven cases (28.2%) were not associated any other gastric lesion, the majority of which were the polypoid type (82.0%). However, two cases were found as a hypertrophic mucosal fold, and a submucosal tumor, respectively. Seventeen cases (43.6%) were associated with early gastric cancer. Conclusions: Despite its rarity, GCP should be considered when an endoscopically polypoid lesion or submucosal tumor (SMT) is found. Because of its association with early gastric cancer or adenoma, more study will be needed to examine the relationship between GCP and gastric carcinogenesis. (Korean J Gastrointest Endosc 2006;33:135⁣139)

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An Analysis Based on Hospital Stay in Ischemic Colitis: Byung Hun Do, M.D., Seong Woo Jeon, M.D., Sang Gi Kim, M.D., Si Wook Jung, M.D., Seung Soo Ha, M.D., Chang Min Cho, M.D., Won Young Tak, M.D., Young Oh Kwon, M.D., Sung Kook Kim, M.D. and Yong Hwan Choi, M.D.; Korean J Gastrointest Endosc 2006;33(3):140-144. Published online September 30, 2006

Abstract PDF: Background
/Aims: Ischemic colitis is the most prevalent form of gastrointestinal ischemia, accounting for approximately 50 to 60% of all gastrointestinal ischemic episodes. There are many conditions that predispose an individual to ischemic colitis as well as a wide variety of clinical and endoscopic presentations. This study reviewed the risk factors associated with ischemic colitis, the site of colonic involvement and the effect of antibiotics on the hospital stay. Methods: 34 inpatients with ischemic colitis during October 2001 and November 2004 were analyzed retrospectively. All patients had intestinal bleeding. Results: The mean age of the patients was 56⁑14. Among the 34 cases, 15 cases had the risk factors associated with ischemic colitis. The presenting symptoms were mainly abdominal pain and diarrhea. The endoscopic findings revealed four cases with pancolitis. One case with chronic liver disease died from septic shock. The mean hospital stay was 12⁑5 days, which was reduced by early admission and colonoscopic diagnosis, bowel rest and fluid therapy. However, patient's age, clinical presentations, location of the involved colon, the presence of risk factors and the use of antibiotics did not influence the hospital stay. Conclusions: If ischemic colitis with intestinal bleeding is suspected, an early colonoscopic diagnosis and medical treatment such as bowel rest and fluid therapy can reduce the hospital stay. (Korean J Gastrointest Endosc 2006;33:140⁣144)

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Clinical Features of Ischemic Colitis: A Comparision with Colonoscopic Findings: Kum Hei Ryu, M.D., Ki-Nam Shim, M.D., Sung-Ae Jung, M.D., Seong-Eun Kim, M.D., Hee Jung Oh, M.D., Hyun Joo Song, M.D., Ji Hyun Song, M.D., Hye Jung Yeom, M.D., Tae Hun Kim, M.D. and Kwon Yoo, M.D.; Korean J Gastrointest Endosc 2006;33(3):145-151. Published online September 30, 2006

Abstract PDF: Background
/Aims: The aim of this study was to investigate the relationships between the clinical manifestations and the colonoscopic findings of ischemic colitis. Methods: From March 2000 to June 2005, the data of 69 patients diagnosed with ischemic colitis were analyzed retrospectively. Statistical analysis was done by dividing the patients into two groups according to involved segments and also by again dividing the patients into two groups according to the mucosal findings that were gangrenous or not. Results: The most common involved segment was the sigmoid colon (82.6%). The levels of total protein and albumin were significantly lower in the multisegmented group than in the non-multisegmented group (p=0.012, p=0.030, respectively), but there was no significant difference in the operation rate between the two groups. The WBC count and the level of serum glucose were significantly higher in the gangrenous group than in the non-gangrenous group (p=0.007, p=0.048, respectively). The operation rate was also higher in the gangrenous group (33.3%) than in the non-gangrenous group (3.5%) (p=0.011). Conclusions: Evaluating the severity of mucosal damage by colonoscopy may be helpful in predicting the clinical status and prognosis of the patients with ischemic colitis. (Korean J Gastrointest Endosc 2006;33:145⁣151)

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The Roles of Endoscopic Sphincterotomy and Cholecystectomy in Acute Biliary Pancreatitis: Ji Bong Jeong, M.D.*, Ji Kon Ryu, M.D., Joo Kyung Park, M.D., Won Jae Yoon, M.D., Sang Hyub Lee, M.D., Jin-Hyeok Hwang, M.D.^†, Jun Kyu Lee, M.D.^‡, Yong-Tae Kim, M.D. and Yong Bum Yoon, M.D.; Korean J Gastrointest Endosc 2006;33(3):152-158. Published online September 30, 2006

Abstract PDF: Background
/Aims: Stone removal can prevent recurrence of acute biliary pancreatitis. This study examined the natural course of acute biliary pancreatitis and compared the results obtained using endoscopic sphincterotomy (EST) and cholecystectomy. In addition, the incidence and risk factors associated with acute cholecystitis were estimated when a cholecystectomy had not been performed. Methods: The medical records of 113 patients diagnosed with acute biliary pancreatitis in Seoul National University Hospital from January 1990 to April 2005 were reviewed retrospectively. Results: Twenty-five patients received no specific treatment of which 15 (60.0%) experienced a recurrence during a mean follow-up period of 36.0 months. Fifty-two patients received EST only and did not experience a recurrence during a mean follow-up of 29.8 months. Thirty-six patients underwent a cholecystectomy, and 1 (2.8%) patient experienced a second attack during a follow-up of 35.2 months. The clinical factors predictive of pancreatitis recurrence in patients without treatment could not be identified. Acute cholecystitis developed in 7 out of 77 (9.1%) patients who did not receive a cholecystectomy during a mean follow-up period of 33.3 months, and patients with both gallbladdor and common bile duct stones were found to be more prone to a recurrence. Conclusions: Sixty percent of patients with acute biliary pancreatitis without treatment experienced a second attack, which could be prevented by EST. A cholecystectomy is not always necessary as a routine treatment after EST for preventing pancreatitis, and is recommended for patients with both visible gallbladdor and common bile duct stones at the time of the first attack. (Korean J Gastrointest Endosc 2006;33:152⁣158)

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A Case of Zenker's Diverticulum Treated by Argon Plasma Coagulation: Jin Nam Kim, M.D., Jong-Jae Park, M.D., Seung Young Kim, M.D., Jae Youn Park, M.D., Moon Kyoung Joo, M.D., Jin Soo Chang, M.D., Do Won Choi, M.D., Seong Nam Oh, M.D., Woo Sik Han, M.D., Youn Ho Kim, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.; Korean J Gastrointest Endosc 2006;33(3):159-162. Published online September 30, 2006

Abstract PDF: Zenker's diverticulum occurs mainly in elderly patients with typical symptoms including dysphagia, regurgitation, chronic cough, aspiration, and weight loss. A diagnosis is easily established on upper endoscopy or barium studies. The treatment is surgery or endoscopic cricopharyngeal myotomy. Endoscopic procedures include staple assisted diverticulostomy, CO₂ laser, transparent oblique-endhood attached endoscopic diverticulostomy, and argon plasma coagulation. Minimally invasive endoscopic treatments are associated with a shorter operating time, shorter postoperative hospital stay, quicker resumption of oral intake, and fewer overall complications. Argon plasma coagulation can be performed in any regular endoscopy unit and is less invasive, economical, faster, and well-tolerated. In particular, older patients in a poor general condition, at high surgical risk or with contraindications to general anesthesia can be treated with argon plasma coagulation. (Korean J Gastrointest Endosc 2006;33:159⁣162)

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A Case of Gastrointestinal Stromal Tumor of the Proximal Jejunum Diagnosed by Double Balloon Enteroscopy: Min Ho Choi, M.D., Cheul Young Choi, M.D., Hyeon Woo Byun, M.D., Hyun Joo Jang, M.D., Chang Soo Eun, M.D., Woo Young Jang, M.D.^†, Jae Jung Lee, M.D.*, Sea Hyub Kae, M.D. and Jin Lee, M.D.; Korean J Gastrointest Endosc 2006;33(3):163-167. Published online September 30, 2006

Abstract PDF: A gastrointestinal stromal tumor (GIST) is a rare disease but is the most common nonepithelial neoplasm in the gastrointestinal tract. GIST accounts for 0.1∼3.0% of gastrointestinal malignancies, and 20∼30% of GISTs are found in the small intestine. GIST with extraluminal growth is difficult to diagnose. We report a case of a jejunal GIST with obscure bleeding that was diagnosed using double balloon enteroscopy. (Korean J Gastrointest Endosc 2006;33:163⁣167)

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Basaloid Squamous Cell Carcinoma of the Rectum Manifesting as Multiple Submucosal Lesions: Soon Min Park, M.D., Sung Eun Hur, M.D., Bum June Kwon, M.D., Hyung Jun Kim, M.D., Seong Eun Yang, M.D., Chang-Whan Kim, M.D., Jean A Kim, M.D.* and Sok Won Han, M.D.; Korean J Gastrointest Endosc 2006;33(3):168-172. Published online September 30, 2006

Abstract PDF: Basaloid squamous carcinoma is a rare, pooly differentiated variant of squamous cell carcinoma. It occurs in various sites, including the upper digestive tract, the esophagus, lung, anus, cervix and thymus. It has been postulated that basaloid carcinoma may arise from outside of the anal canal, such as at where the cloacogenic embryologic cells rest, the squamous metaplastic epithelium, or the totipotential basal cells. This tumor is a distinct entity that should be carefully distinguished from basal cell carcinomas of the anal canal, which is a condition that has a very good prognosis, and anal or perianal squamous cell carcinomas, which have a different path of spread and they vary considerably in their behavior. We report here on a patient with basaloid squamous carcinoma in the distal rectum that manifested as multiple submucosal lesions, and the patient presented with abdominal pain and blood tinged stool. (Korean J Gastrointest Endosc 2006;33:168⁣172)

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A Case of Non-traumatic Hemobilia due to Pseudoaneurysm of the Hepatic Artery: Gwon Hyun Cho, M.D., Jong Jun Lee, M.D., Sang Kyun Yu, M.D., Kwang An Kwon, M.D., Dong Kyun Park, M.D., Yeon Suk Kim, M.D., Yang Suh Ku, M.D., Yu Kyung Kim, M.D. and Ju Hyun Kim, M.D.; Korean J Gastrointest Endosc 2006;33(3):173-177. Published online September 30, 2006

Abstract PDF: Hemobilia is a cause of obscure gastrointestinal hemorrhage. Most cases have an iatrogenic or traumatic origin but cases of hemobilia with non-traumatic causes are rare. The non-traumatic causes of hemobilia are inflammation, gallstones, neoplasm and vascular lesions. Currently, various therapeutic options are available for hemobilia, and transarterial embolization is now the first line of intervention used to stop the bleeding of hemobilia, which shows a high success rate of approximately 80% to 100% with a lower morbidity and mortality rate than with surgery. We report a rare case of non-traumatic hemobilia caused by a pseudoaneurysm of the hepatic artery that was successfully treated with transarterial embolization. (Korean J Gastrointest Endosc 2006;33: 173⁣177)

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A Case of Cystic Duct Carcinoma with Hepatic Duct Invasion: Chang Hyun Lee, M.D., Youn Joo Kim, M.D., Woo Hyun Paik, M.D., Jae Kyung Lee, M.D., Goh Eun Chung, M.D., Sang Hyup Lee, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D., Yong Bum Yoon, M.D., Dong Chul Kim, M.D.*, Se Hyung Kim, M.D.^† and Jin Young Jan; Korean J Gastrointest Endosc 2006;33(3):178-182. Published online September 30, 2006

Abstract PDF: A primary carcinoma of the cystic duct is extremely rare, accounting for 2.6% of all biliary carcinomas. However, the prognosis is better than other biliary carcinomas. The median survival is 20.4 months. In Korea, three cases have been reported and there is no case where a pre-operative MRI has been performed. We report a case of a primary carcinoma of the cystic duct with hepatic duct invasion, which presented as a painless right upper quadrant mass, that was diagnosed by MRCP in a pre-operative situation. (Korean J Gastrointest Endosc 2006;33:178⁣182)

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A Case of Acute Pancreatitis Associated with Fasciola Hepatica: Seong Yong Woo, M.D., Hyun Jung Jung, M.D., Woo Tae Kim, M.D., Hae Seong Nam, M.D., Sung Hyun Son, M.D., Hyung Keun Kim, M.D., Young Seok Cho, M.D., Sung Soo Kim, M.D., Hiun Suk Chae, M.D. and Chang Don Lee, M.D.; Korean J Gastrointest Endosc 2006;33(3):183-186. Published online September 30, 2006

Abstract PDF: Fascioliasis is a zoonotic helminthiasis caused by the trematode Fasciola hepatica, which is a parasite that infects the hepatobiliary system of herbivorous animals such as cattle and sheep. Humans are accidentally infected after ingestion of the water, raw aquatic plants and raw liver of herbivorous animals that are all contaminated by metacercaria. Fascioliasis produces no symptoms in most patients, but adult Fasciola hepatica occasionally gives rise to intestinal obstruction or pancreatobiliary disease. The metacercaria can migrate along the vessels or lymphatic ducts, and they can induce disease of the liver, lung and heart. We report here on a rare case of a 68-year-old male who presented with acute abdominal pain. He was diagnosed as acute pancreatitis associated with Fasciola hepatica. (Korean J Gastrointest Endosc 2006;33:183⁣186)

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A Case of Acute Pancreatitis Associated with Aberrant Cystic Duct Opening into the Right Hepatic Duct: Kyung-Phil Kang, M.D. and Won-Chung Choi, M.D.; Korean J Gastrointest Endosc 2006;33(3):187-190. Published online September 30, 2006

Abstract PDF: Congenital anomalies of the pancreaticobiliary structure may go undetected until adulthood, and they can be the cause of unexplained jaundice, abdominal pain, nausea and vomiting. In addition to such associated disease, as cholangitis, gallstone, cholangiocarcinoma and pancreatitis, recognition of these variant anatomies is clinically important for planning surgery and for preventing inadvertent surgical injury. Although congenital abnormalities and variations of the biliary ducts are common, and variations in the drainage and course of the cystic duct are also frequently seen, variation of the cystic duct opening into the right hepatic duct is rare; further, it is important to avoid erroneous ligation of the hepatic duct during surgery. We report here on a case of aberrant cystic duct opening into the right hepatic duct along with acute pancreatitis. (Korean J Gastrointest Endosc 2006;33:187⁣190)

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Intraductal Papillary Mucinous Neoplasm in a Patient with an Incomplete Pancreatic Divisum: Sung-Min Nam, M.D., Woo-Chul Chung, M.D., Hyung-Min Chin, M.D.*, Kang-Moon Lee, M.D., Bo-In Lee, M.D., U-Im Chang, M.D., Jin-Mo Yang, M.D., Kyu-Yong Choi, M.D. and In-Sik Chung, M.D.; Korean J Gastrointest Endosc 2006;33(3):191-195. Published online September 30, 2006

Abstract PDF: Intraductal papillary mucinous neoplasms (IPMNs) are premalignant lesions that require a surgical resection. IPMN can cause abdominal pain or pancreatitis as a result of either mucin production or a papillary growth, resulting in a ductal obstruction. Most IPMNs arise from the main pancreatic duct. However, IPMNs arising from the accessory pancreatic duct are extremely rare. Pancreatic divisum occurs when the ventral and dorsal ducts of the pancreas fail to fuse during organogenesis. It is the most common congenital variant of pancreatic-ductal development, and occurs in approximately 10∼14% of individuals. Although pancreatic divisum has no clinical relevance, some patients present with acute recurrent or chronic pancreatitis. In most cases, it is discovered incidentally during an examination of pancreatitis, and is occasionally accompanied by a pancreatic tumor. We report the first case of IPMN in a patient with an incomplete pancreatic divisum in Korea. (Korean J Gastrointest Endosc 2006;33:191⁣196)

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