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Volume 33(6); December 2006
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Conventional EGD versus Small-caliber EGD -The Thinner, the Better?-
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Kang Moon Lee, M.D., Woo Chul Chung, M.D., You Joung Kim*, Bo In Lee, M.D., U-Im Chang, M.D., Jin Sun Lee, M.D., Jin Mo Yang, M.D., Sok Won Han, M.D., Kyu Yong Choi, M.D. and In-Sik Chung, M.D.
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Korean J Gastrointest Endosc 2006;33(6):333-338. Published online December 30, 2006
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Abstract
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- Background
/Aims: Small-caliber esophagogastroduodenoscopy (scEGD) was developed to facilitate unsedated EGD, and has many advantages over sedated EGD in terms of costs and complications. This study compared the feasibility and tolerance of scEGD with unsedated conventional EGD (cEGD), and examined the effect of the endoscopic diameter on the patients' tolerance. Methods: A total of 114 patients who were referred for a diagnostic EGD was randomly allocated to undergo either scEGD (GIF XP260, Olympus, diameter 6.5 mm; n=57) or cEGD (GIF XQ240, Olympus, diameter 9.0 mm; n=57). After EGD, the patients and endoscopists completed questionnaires on the level of discomfort, satisfaction and acceptance of the examination. Results: Patients in the scEGD group reported significantly less discomfort (choking, pain and nausea) and more overall satisfaction than those in the cEGD group. Patients in the scEGD group were more willing to choose the same procedure again if medically indicated. According to multivariate analysis, the ultrathin endoscopic diameter itself was positively associated with the increased patients' satisfaction (odds ratio 3.07, p=0.003). Conclusions: scEGD has comparable feasibility and accuracy but is more tolerable than cEGD. scEGD may have a role in clinical practice by minimizing the level of discomfort during unsedated EGD. (Korean J Gastrointest Endosc 2006;33:333338)
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A Survey on the Interval of Post-polypectomy Surveillance Colonoscopy
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Mun Su Kang, M.D., Dong Il Park, M.D., Jung Ho Park, M.D., Hong Joo Kim, M.D., Yong Kyun Cho, M.D., Chong Il Sohn, M.D., Woo Kyu Jeon, M.D. and Byung Ik Kim, M.D.
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Korean J Gastrointest Endosc 2006;33(6):339-345. Published online December 30, 2006
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Abstract
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- Background
/Aims: Colonoscopy is the golden standard used as a surveillance test and screen for colon cancer, and the current demand for colonoscopy exceeds its availability. This study is an assessment of the colonoscopic surveillance intervals currently practiced. Methods: A multiple choice survey of the colonoscopic surveillance interval used in six case scenarios [hyperplastic polyp; two 0.5 cm tubular adenomas (TAs); a 1.5 cm TA; 0.8 cm triple TAs; a 1.5 cm TA with high grade dysplasia; current normal exam after polypectomy of a ＜1 cm sized TA 3 years ago] was sent via e-mail to members of the KASID. Results: A total of 131 colonoscopists (104 men, 27 women) replied, and the mean age of the respondents was 36 years (range 28∼58). All respondents were board- certified in their respective specialties (internal medicine 75, general surgery 3, and GI subspecialty 53). When compared with the AGA guidelines, 90.1∼99.2% of the respondents performed the first post-polypectomy surveillance colonoscopy prematurely, and 75.6% of respondents performed the second surveillance prematurely. Conclusions: Most post-polypectomy surveillance colonoscopies were performed prematurely. It is quite possible that unnecessary surveillance may account for a significant portion of the demand for colonoscopy. (Korean J Gastrointest Endosc 2006;33:339345)
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The Causes and Endoscopic Management of Bile Leak
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Jong Ryul Eun, M.D., Tae Nyeun Kim, M.D., Sun Taek Choi, M.D.* and Byung Ik Jang, M.D
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Korean J Gastrointest Endosc 2006;33(6):346-352. Published online December 30, 2006
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Abstract
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- Background
/Aims: This study evaluated the efficacy of endoscopic treatment in a bile leak that occurred through various causes. Methods: The medical records of 35 patients (mean age 55.4 years; male/female 25/10), who were diagnosed with a bile leak by endoscopic retrograde cholangiopancreatography in Yeungnam University Hospital from January 1998 to January 2006, were reviewed. Results: The most common cause of the bile leak was an open cholecystectomy (n=13, 37.1%) followed by a laparoscopic cholecystectomy (n=10, 28.6%), trauma (n=2, 5.7%), transarterial chemoembolization (n=3, 8.6%), spontaneous (n=3, 8.6%), and a hepatic resection (n=4, 11.4%). Thirty-four patients were treated endoscopically by the insertion of a plastic stent with/without a sphincterotomy (70.6%, 24/34), a nasobiliary drainage (11.8%, 4/34), or a sphincterotomy alone (17.6%, 6/34). Of these 34 patients, 30 were cured by the endoscopic treatment, 2 patients died from liver failure despite the use of nasobiliary drainage and 2 patients did not improve after endoscopic treatment. One patient underwent surgery without endoscopic treatment because of a transsection of the common bile duct. With the exception of the two who died from liver failure, the overall cure rate of endoscopic treatment was 90.9% (30/33). There were no complications associated with the endoscopic treatment. Conclusions: Endoscopic treatment for a bile leak is safe and effective regardless of the cause. (Korean J Gastrointest Endosc 2006;33:346352)
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A Case of Nonsurgical Treatment in Boerhaave's Syndorme during Diagnostic Endoscopy
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Yong Bum Park, M.D., Jin Il Kim, M.D., Hye Young Sung, M.D., Byung Hwa Ha, M.D., Eun Mi Hwang, M.D., You Kyoung Oh, M.D., Dae Young Cheung, M.D., Se Hyun Cho, M.D., Soo-Heon Park, M.D., Joon-Yeol Han, M.D., Jae Kwang Kim, M.D. and Kyu Yong Choi, M.D.
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Korean J Gastrointest Endosc 2006;33(6):353-356. Published online December 30, 2006
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Abstract
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- Boerhaave's syndrome is a rare spontaneous rupture of the esophagus that requires an immediate diagnosis and surgical repair. It might result from a severe and uncoordinated contraction of the esophagus and stomach. The rate of mortality and morbidity can increase with increasing time between the onset and treatment. In recent years, there have been some reports of non-surgical treatment in cases with perforation but with minimal symptoms and clinical evidence of the systemic effects such as sepsis. We experienced a case of Boerhaave's syndrome occurring during an endoscopic examination that was treated successfully using non-surgical measures. (Korean J Gastrointest Endosc 2006;33:353356)
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A Case of Exophytic Squamous Cell Carcinoma of the Stomach
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Jeong-Hoon Lee, M.D., Ki Young Yang, M.D., Bo Hyun Kim, M.D., Seong Joon Koh, M.D., Hae Yeon Kang, M.D., Bhumsuk Keam, M.D., Sang Gyun Kim, M.D., Joo Sung Kim, M.D., Hyun Chae Jung, M.D. and In Sung Song, M.D.
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Korean J Gastrointest Endosc 2006;33(6):357-360. Published online December 30, 2006
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Abstract
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- Squamous cell carcinoma of the stomach has been reported to occur at a younger age and have a worse prognosis than gastric adenocarcinoma. Even though squamous cell carcinoma of the stomach has several different clinical characteristics, it is difficult to distinguish it from gastric adenocarcinoma by radiological or endoscopical methods without a histopathological confirmation. Primary squamous cell carcinoma of the stomach is a rare type of cancer. To date, only six cases have been reported in Korea. Gastric cancer seldom grows exophytically and there are no reports of squamous cell carcinoma of the stomach with exophytic growth in Korea. We report a case of pure squamous cell gastric cancer with exophytic growth with a brief review of the relevant literature. (Korean J Gastrointest Endosc 2006;33:357360)
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A Case of Pseudolipomatosis in the Gastric Mucosa
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Seung Kyun Song, M.D., Hae Won Han, M.D., Jin Ho Jeon, M.D., Jae Ha Maeng, M.D., Chang Jung Lee, M.D. and Suk Joon Park, M.D.
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Korean J Gastrointest Endosc 2006;33(6):361-363. Published online December 30, 2006
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Abstract
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- Mucosal pseudolipomatosis is a recently described endoscopic finding consisting of benign transient lesions. This condition, resembling fatty infiltration, is characterized by the presence of small gas voids in the gastrointestinal wall, particularly in the mucosa. The frequency of colonic pseudolipomatosis is higher than the frequency of pseudolipomatosis of the stomach. Both mechanical and chemical theories have been offered to explain the pathogenesis of colonic pseudolipomatosis. The mechanical theory pertains to an air pressure-related complication of the colonoscopy procedure. The chemical theory concerns a drug-related complication of the detergent used during colonoscopies. However, the pathogenesis of gastric pseudolipomatosis is still unclear. Recently, we had a patient who experienced gastric pseudolipomatosis after endoscopoy and biopsy procedures. In the following report we discuss this interesting case of gastric pseudolipomatosis. (Korean J Gastrointest Endosc 2006;33:361363)
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A Case of Gastrogastric Fistula as a Complication of Benign Gastric Ulcer
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Sun Taek Choi, M.D., Jong Ryul Eun, M.D., Jung Hoon Lee, M.D., Yoon Seon Park, M.D., Jae Won Choi, M.D., Kook Hyun Kim, M.D., Byung Ik Jang, M.D., Tae Nyun Kim, M.D. and Heon Ju Lee, M.D.
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Korean J Gastrointest Endosc 2006;33(6):364-367. Published online December 30, 2006
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Abstract
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- Gastrogastric fistula is an extremely rare complication of benign gastric ulcer. We report a case of gastrogastric fistula in a 67-year-old male who presented with symptoms of dyspnea on exertion, pretibial pitting edema, and dyspepsia. He suffered from a peptic ulcer 9 years ago and from a gastric outlet obstruction 5 years ago. A gastrogastric fistula was observed by endoscopy, and the biopsy forceps were passed through the fistulous tract. The patient was treated with proton pump inhibitors, and H. pylori was eradicated. Gastrogastric fistula, unlike other types of gastric fistulas, can be cured using non-surgical therapy as long as complications such as peritonitis, gastric outlet obstruction, and bleeding do not occur. (Korean J Gastrointest Endosc 2006;33:364367)
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A Case of Gastric Adenocarcinoma Presenting as a Submucosal Tumor
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Eun Mi Hwang, M.D., Jin Il Kim, M.D., Eun Chul Jang, M.D., Myung Suk Kim, M.D., Soon Sub Kim, M.D., Dae Young Cheung, M.D., Se Hyun Cho, M.D., Soo Heon Park, M.D., Joon Yeol Han, M.D., Jae Kwang Kim, M.D. and Kyu Yong Choi, M.D.
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Korean J Gastrointest Endosc 2006;33(6):368-371. Published online December 30, 2006
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Abstract
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- Neoplasms of the stomach can originate from both epithelial and subepithelial cells. These two types of tumors have different morphological characteristics according to their origin including the mucosal surface texture and contour of the mass in endoscopic examination. However, on rare occasions, neoplasms of an epithelial origin manifest the features of a submucosal tumor on a gross examination, and require additional and more invasive approaches, such as a strip biopsy, computed tomography, and endosonography, to define their nature. We encountered a case of a gastric adenocarcinoma in a 44 year-old woman, which was initially considered to be submucosal tumor by the endoscopic examination and was finally diagnosed after resecting the tumor. (Korean J Gastrointest Endosc 2006;33:368371)
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Two Cases of Juvenile Retention Polyp of Right Colon in Adult
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Gum Mo Jung, M.D., Yang Ho Kim, M.D., Ji Woong Kim, M.D., Yong Keun Cho, M.D., Seung Min Park, M.D., Eun Young Ko, M.D., Myoung Jin Ju, M.D.*, Jin Woong Cho, M.D. and Yong Ung Lee, M.D.
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Korean J Gastrointest Endosc 2006;33(6):372-376. Published online December 30, 2006
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- Colorectal polyps are classified histologically as either neoplastic or nonneoplastic polyps. A juvenile polyp, which is sometimes referred to as a retention polyp, is a type of nonneoplastic polyp. Juvenile polyps are found most commonly in children less than 10 years of age. However, they are also encountered, albeit rarely, in adolescents or adults of all ages. The most common clinical problem is painless rectal bleeding. Most juvenile polyps are found in the rectosigmoid colon, and more than 90% are detected within 20 cm from the anal verge. In Korea, there are some reports of juvenile polyps located in the rectosigmoid colon in adults. We report two cases of juvenile colon polyps in adult that presented as a hematochezia, which were located at the hepatic flexure and ascending colon. (Korean J Gastrointest Endosc 2006;33:372376)
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A Case of Angiomyolipoma of the Colon Manifested by Intussusception
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Seong Deuk Baek, M.D.
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Korean J Gastrointest Endosc 2006;33(6):377-380. Published online December 30, 2006
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- Angiomyolipomas are a form of mesenchymal hamartoma that consists of blood vessels, smooth muscle cells, and mature fat cells. The vast majority of these tumors occur in the kidney. Extrarenal angiomyolipomas are extremely rare and have been reported in the liver, nasal cavity, vagina, spermatic cord, skin, and mediastinum. We report a case of symptomatic angiomyolipoma manifestated caused by colonic intussusception. A 67-year-old male was admitted because of lower abdominal pain that began 10 days prior. Abdominal computed tomography showed intussusception, and colonofiberscopic finding showed a lumen filled with a smooth surfaced pedunculated mass in the left side colon. The patient underwent a partial segmental resection of the sigmoid colon. I report a case of angiomyolipoma that was confirmed by the pathology findings. (Korean J Gastrointest Endosc 2006;33:377380)
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Biliary Cast Successfully Removed by Percutaneous Transhepatic Cholangioscopy, and This Developed in a Patient Who Received Orthotopic Liver Transplantation
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Hong Jeoung Kim, M.D., Ki Tae Yoon, M.D., Seungmin Bang, M.D., Seung Woo Park, M.D., Si Young Song, M.D. and Jae Bock Chung, M.D.
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Korean J Gastrointest Endosc 2006;33(6):381-384. Published online December 30, 2006
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Abstract
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- "Biliary cast syndrome" describes a cast formed from retained lithogenic material, and this cast is morphologically confined to the bile duct; this develops in 4∼18% of liver transplant recipients. The pathogenesis of cast formation is not clearly understood. The proposing etiological factors for biliary cast syndrome include acute cellular rejection, a prolonged cold ischemic time, use of postoperative biliary drainage tubes and biliary infection. These casts are more likely to develop in the setting of hepatic ischemia and biliary stricture. Endoscopic and percutaneous cast extraction might achieve favorable results and this should be attempted before surgical therapy. We report here on a case of biliary cast syndrome that was secondary to orthotopic liver transplantation; this was successfully treated via percutaneous choledochoscopic removal. We also include a review of the literature. (Korean J Gastrointest Endosc 2006;33:381384)
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Endoscopic Argon Plasma Laser Trimming of Biliary Self Expanding Metallic Stent
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Jung Hyun Kwon, M.D., In Seok Lee, M.D., Jae Myung Park, M.D., Chang Nyol Paik, M.D., Jung Pil Suh, M.D., Jae Hyuck Chang, M.D., Ho Sung Park, M.D., Kwan Woo Nam, M.D., Chan Ran You, M.D., Song Wook Chun, M.D., Yu Kyung Cho, M.D., Sang Woo Kim, M.D., Myun
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Korean J Gastrointest Endosc 2006;33(6):385-390. Published online December 30, 2006
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- A self-expanding metal stent is an effective treatment for biliary stenosis, improving obstructive jaundice and maintaining the long term patency of the bile duct. The complications of the metal stent are a perforation, distal migration, restenosis and duodenal mucosa injury from the contralateral wall impaction or trauma. However, the metal stent is a relatively permanent device and its removal is technically challenging. We report a case of protrusion of biliary stents into the duodenal lumen of a distal common bile duct cancer patients that was managed successfully by endoscopic argon plasma laser trimming. (Korean J Gastrointest Endosc 2006;33:385389)
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