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Volume 34(2); February 2007
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The Evalution of Patient Anxiety Associated with Upper Gastrointestinal Endoscopy
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Jin Su Jang, M.D., Moon Kyung Joo, M.D., Jin Nam Kim, M.D., Yong Sik Kim, M.D., Yoon Tae Jeen, M.D., Hoon Jai Chun, M.D., Hong Sik Lee, M.D., Sang Woo Lee, M.D., Jai Hyun Choi, M.D., Chang Duck Kim, M.D. and Ho Sang Ryu, M.D.
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Korean J Gastrointest Endosc 2007;34(2):65-70. Published online March 2, 2007
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Abstract
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- Background
/Aims: Upper gastrointestinal (UGI) endoscopy is a necessary procedure for making the diagnosis of UGI diseases. However, it may evoke anxiety due to the procedural discomfort before endoscopy. There have been few detailed studies that have evaluated the anxiety of patients who undergo UGI endoscopy in Korea. The aim of this study is to evaluate the patient's anxiety associated with UGI endoscopy and to determine the methods to improve the tolerance of patients to UGI endoscopy. Methods: From May to September 2004, we assessed 38 patients who received UGI endoscopy for the first time as outpatients at Korea University, Anam Hospital. One group was examined with UGI endoscopy after being sedated. The patient's anxiety was rated at baseline and immediately before the procedure. Results: Endoscopy was associated with a significant increase in anxiety (prior to procedure, 48.53 vs. baseline, 43.58, p＜0.001) but not trait anxiety (43.92 vs. 43.63, p=0.70). The procedural anxiety was not influenced by gender, age or the education level, but it was correlated with conscious sedation (without CS, 5.67±0.23 vs. with CS, 4.06±0.16, p＜0.05). Conclusions: Sedating the patient during UGI endoscopy is an effective method to lower procedural anxiety.
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Clinical Usefulness of Proton Pump Inhibitor Intravenous Treatment in Bleeding Peptic Ulcer
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Hang Lak Lee, M.D., Dong Soo Han, M.D., Byoung Kwan Son, M.D., Oh Young Lee, M.D., Yong Chul Jeon, M.D., Ju Hyun Sohn, M.D., Byung Chul Yoon, M.D., Ho Soon Choi, M.D., Joon Soo Hahm, M.D. and Jin Bae Kim, M.D.*
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Korean J Gastrointest Endosc 2007;34(2):71-75. Published online March 2, 2007
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Abstract
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- Background
/Aims: Recently, high dose PPI intravenous (IV) infusion after endoscopic hemostasis was found to decrease the recurrent bleeding rate. Therefore, we conducted this study to define the effect of endoscopic hemoclipping with PPI IV infusion on the recurrent bleeding rate. Methods: We conducted a double-blinded prospective randomized control study. A total of 35 patients were endoscopically diagnosed with bleeding peptic ulcer of Forrest classification Ia, Ib, IIa between Jan. 2003 and Sep. 2003 in our hospital. We carried out epinephrine injection therapy around the ulcer, followed by hemoclipping at the exposed vessel. After controlling for endoscopic bleeding, we randomly divided the patients into two groups. One group received a PPI IV infusion (pantoprazole 80 mg/day) and the other group received a placebo for three days. Results: Only one PPI IV-infused patient and one patient receiving placebo showed recurrent bleeding at two days after endoscopic therapy. The PPI IV infusion group showed 100% (17/17) initial hemostatic rate, 5.8% (1/17) recurrent bleeding rate within 3 days, 0% (0/17) recurrent bleeding rate after 3 days, and 0% (0/17) complication rate. For these same values, the placebo group showed 100% (18/18), 5.5% (1/18), 0% (0/18), and 0% (0/18), respectively. Conclusions: PPI IV infusion showed no addictive hemostatic effect. We think hemoclipping is a very effective hemostatic method, and PPI IV infusion may not be required after appropriate endoscopic management.
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Characteristics of Colorectal Cancer in Elderly Patients in Comparision with Younger Patients
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Hyung Suk Lee, M.D.*, Seokyoung Lee, M.D., Ji-Hyun Seo, M.D., Kyeng Kunn Kwack, M.D., Su Jin Chung, M.D., Kwang Hyuck Lee, M.D., Young-Soo Park, M.D., Jin-Hyeok Hwang, M.D., Jin-Wook Kim, M.D., Sook Hyang Jung, M.D., Nayoung Kim, M.D., Dong Ho Lee, M.D.,
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Korean J Gastrointest Endosc 2007;34(2):76-82. Published online March 2, 2007
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Abstract
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- Background
/Aims: Considering the increasing age of the general population and the incidence of colorectal cancer (CRC), this study examined the characteristics of CRC in the aged, by comparing the clinical, endoscopic and histologic findings of CRC of younger and old patients. Methods: The records of 232 patients diagnosed with CRC from March 2003 to September 2004 were reviewed retrospectively. Two cohorts based on age, under and over 65 years, were compared for the patient and tumor characteristics. Results: The bowel habit change was significant (p=0.018) and there was a high prevalence of hematochezia in the older patients. The rate of cancer detection via a routine checkup was higher in the younger patients (p=0.015). The incidence of right colon cancer increased with age, and substantially higher in females. More older patients had Dukes stage C disease (p=0.007), while more younger patients had stage D (p=0.022). The incidence of metastasis was high in those with right colon cancer (p=0.009), and significantly higher in female. In females, high-risk tumor such as mucinous or signet-ring was more common in the older patients. The older patients had significantly low CEA levels in the advanced stage. Synchronous CRC was more common in the older patients (8.1% vs. 3.4%) and was located within the adjacent segment. Conclusions: CRC must be considered when older patients present with changes in their bowel habits or hematochezia. The right colon must be examined closely in older patients, particularly in females. A metastasis should be checked in right colon cancer, particularly in females. In older patients, advanced disease should be considered even in those with a low CEA level, and synchronous CRC must be searched for in the same or adjacent segment to that of the primary cancer.
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A Case of Early Gastric Adenocarcinoma and Intraabdominal Schwannoma in a Patient with Neurofibromatosis Type I
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Dong Han Im, M.D., Hyun Chul Whang, M.D., Joon Seok Oh, M.D., Hyun Ju Kim, M.D., Hwa Mock Lee, M.D., Jin Kwang An, M.D., Kwang Jin Kim, M.D., Jong Yun Cheong, M.D., Won Il Park, M.D. and Ung Suk Yang, M.D.
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Korean J Gastrointest Endosc 2007;34(2):83-87. Published online March 2, 2007
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Abstract
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- Neurofibromatosis is an autosomal dominant hereditary disorder with an overall incidence of one in 3,000∼4,000, and type 1 (Von Recklinghausen's neurofibromatosis) characterized by the presence of multiple cutaneous neurofibromas, axillary and groin freckling, and cafe- au-lait spot. The neurofibromatosis type 1 gene is a tumor suppressor gene. Patients with the neurofibromatosis type 1 are at increased risk of developing nervous system neoplasm, including plexiform neurofibromas, optic gliomas, ependymomas, meningiomas, astrocytomas, and pheochromocytomas. Neurofibromas may undergo secondary malignant degeneration and sarcomatous changes. Patients with neurofibromatosis type 1 show a high incidence of Wilm's tumor, rhabdomyosarcoma, nonlymphocytic leukemia, and pheochromocytoma but the gastrointestinal involvement appears to be relatively rare and usually consists of neurofibroma, ganglioneuroma, and leiomyoma. We have identified a case of early gastric adenocarcinoma and intraabdominal schwannoma in a 65-year-old man afflicted with neurofibromatosis type 1.
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A Case of Huge Gastric Phytobezoar Removed by Endoscope using Argon Plasma
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Byung Wook Ha, M.D., Ji Hoon Kim, M.D., Young Tak Seo, M.D., Mi Jin Kim, M.D., Young Hwan Ham, M.D., Sang Su Bae, M.D. and Hyung Jun Chu, M.D.
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Korean J Gastrointest Endosc 2007;34(2):88-93. Published online March 2, 2007
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Abstract
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- Bezoars are persistent concretions of indigestible material that are usually found in the stomach. With the significant development of endoscopic techniques, many authors have reported the removal of bezoars using methods such as endoscopic forceps, snares, electrohydraulic lithotripsy, laser. However, there are no reports of using argon plasma to remove a bezoar in Korea. Argon plasma coagulation is a non-contact electrosurgical technique, which is an inexpensive, easily learned, and effective method in gastrointestinal endoscopy. In addition, this method is associated with a decreased risk of perforation and tissue damage by maintaining a controllable depth of coagulation. We report a 71-year-old man with a 11×11×8 cm sized huge gastric phytobezoar found by endoscopy. The bezoar was broken into pieces using the argon plasma coagulator. Endoscopic forceps and a basket were then used to crush and extract its fragments. The bezoar was removed safely without any complications. We report this case with a review of the relevant literature.
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Two Cases of a Submucosal Tumor-like Gastric Adenocarcinoma
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Ji Hyeon Nam, M.D., Seun Ja Park, M.D., Ji Eun Park, M.D., Nang Hee Kim, M.D., Sung Hoon Kim, M.D., Seo Ryong Han, M.D., Won Moon, M.D., Kyu-Jong Kim, M.D., Moo In Park, M.D. and Hee Kyung Chang, M.D.*
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Korean J Gastrointest Endosc 2007;34(2):94-98. Published online March 2, 2007
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Abstract
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- The gastric carcinoma displays various macroscopic appearances ranging from well defined protuberant to diffuse infiltrating tumors but its histological diagnosis is usually simple when performing an endoscopic biopsy. A few gastric cancinomas resemble submucosal tumors (SMT). A gastric carcinoma with a SMT-like appearance is extremely rare, and reportedly accounts for 0.1% to 0.63% of all resected gastric carcinomas in Japan. A histological diagnosis of a SMT-like gastric carcinoma by repeated endoscopic biopsies is often difficult as the tumors are almost entirely covered with normal mucosa. When one sees the lesions in an upper gastrointestinal endoscopy, one should be careful about the location of depression, redness and coating that deviates from the top of the tumor. Here we report two cases of SMT-like gastric carcinomas, diagnosed by the usual endoscopic biopsy method and treated with surgery, with an accompanying review of the recent literature.
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Gastric Diverticulum in an Infant
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Joon Sung Kim, M.D. and Sang Kyu Park, M.D.
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Korean J Gastrointest Endosc 2007;34(2):99-102. Published online March 2, 2007
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- Gastric diverticulum is an uncommon form of diverticular disease that can occur at all ages but is generally encountered between the ages of 20 to 60 years. Only 4% of gastric diverticula occur in patients younger than 20 years old. Apart from Meckel's diverticulum, gastrointestinal tract diverticula are extremely rare, particularly during infancy and childhood with the stomach being the least common site of occurrence. We report a case of gastric diverticulum in a 40-day-old infant who presented with frequent vomiting and a failure to thrive. An upper gastrointestinal contrast study revealed a diverticulum on the posterior wall of the stomach located approximately 2 cm below the esophagogastric junction. The same lesion was also identified by esophagogastroduodenoscopy. Congenital gastric divertilulum should be considered in a differential diagnosis of vomiting and/or a failure to thrive in infancy.
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A Case of Diffuse Large B Cell Lymphoma Transformed from a Duodenal Low Grade MALT Lymphoma
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Soon Joo Kim, M.D., Gin Hyug Lee, M.D., Sang Hyun Park, M.D., Hyun Deok Shin, M.D., Chang Lae Jo, M.D., Tae Hyup Kim, M.D., Ho June Song, M.D., Kee Don Choi, M.D., Hwoon-Yong Jung, M.D. and Jin Ho Kim, M.D.
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Korean J Gastrointest Endosc 2007;34(2):103-107. Published online March 2, 2007
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Abstract
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- Duodenal mucosa-associated lymphoid tissue (MALT) lymphoma is a very rare neoplasm. We report here a case of a 67-year-old woman with a diffuse large B cell lymphoma arising in a low grade MALT lymphoma in the duodenal bulb. She was asymptomatic and on a general health evaluation an upper endoscopy showed an extensive erosive lesion on the duodenal bulb. The biopsy specimen showed lymphocyte infiltration with lymphoepithelial lesions suggesting a low grade MALT lymphoma. A second upper endoscopy with biopsy discovered a focal diffuse large B cell lymphoma in the background of a low grade MALT lymphoma. A meticulous staging work-up revealed that the lymphoma was confined to the duodenum and regional lymph nodes. Finally, the patient was diagnosed as having a diffuse large B cell lymphoma transformed from a duodenal low grade MALT lymphoma. The patient was undergoing combination chemotherapy including the use of an anti-CD20 monoclonal antibody.
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Appendiceal Stump Bleeding That was Treated by Endoscopic Hemoclipping
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Se In Kim, M.D., Sang Kyoon Kim, M.D., Chang Woo You, M.D., Hyeok Jin Kwon, M.D., Sang Wook Kim, M.D. and Soo Teik Lee, M.D.
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Korean J Gastrointest Endosc 2007;34(2):108-110. Published online March 2, 2007
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Abstract
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- Appendiceal stump bleeding is a rare, but occasionally life-threatening complication. Significant lower gastrointestinal hemorrhage from an ulcerated appendiceal stump may occur after uncomplicated appendectomy. The common management includes ligation of the bleeding vessel or cecal resection by either emergency laparotomy or laparoscopy. Angiographic embolization of the bleeding vessel is an alternative therapeutic option. We report here on a case of gastrointestinal hemorrhage from an appendiceal stump, and this occurred six days after appendectomy. The bleeding was controlled endoscopically by placing hemoclips on the distinct vessel. The patient recovered thereafter without further intervention. Endoscopic hemoclipping is an effective and safe procedure, and it can replace emergency laparotomy, laparoscopy or angiographic embolization for treating appendiceal stump bleeding.
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Mucocele of the Appendix Secondary to Obstruction by Cecal Endometriosis
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Hyun-Min Lim, M.D. and Won-Choong Choi, M.D.
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Korean J Gastrointest Endosc 2007;34(2):111-114. Published online March 2, 2007
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- The mucocele of the appendix is an uncommon abnormality caused by a dilatation of the appendiceal lumen caused by the abnormal accumulation of mucus. It can be associated with other colorectal tumors. Endometriosis of the gastrointestinal tract is also rare, particularly in the cecum. An appendiceal mucocele is usually diagnosed by a radiological study or surgery, however, recently, a colonoscopy is becoming an important diagnostic tool for colon diseases. We report a case of appendiceal mucocele. It is believed that the condition developed as a result of an obstruction of the appendicecal lumen caused by endometriosis, and might have been the cause of the intermittent right lower quadrant pain experience by the patient, which was aggravated during the menstrual period.
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A Case of Polypoid Angiolipoma of the Distal Descending Colon as Cause of Hematochezia
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Bong Hwan Kim, M.D., Won-Kyu Lee, M.D., Young Sam Kim, M.D., Yun-Hyoung Kim, M.D.,Yoo-Soon Ko, M.D., Tae Sik Won, M.D., Dae Jin Kim, M.D., Hyo Seung Kang, M.D., Dong Il Byun, M.D., In Sik Park, M.D.* and Soo Nam Lee, M.D.†
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Korean J Gastrointest Endosc 2007;34(2):115-118. Published online March 2, 2007
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- Angiolipoma is a benign tumor that is mainly observed in the subcutaneous tissue and is composed of mature adipose tissue and proliferative blood vessels. However, the condition is rare in the gastrointestinal tract including the colon. There was a case report of angiolipoma of the proximal ileum but there are no reports of angiolipoma of the colon in Korea. A 47-year-old man, who presented with intermittent left lower quadrant pain and hematochezia, underwent contrast enhancement CT, which revealed a huge mass with inhomogeneous density in the distal descending colon. The colonoscopy viewed a large polypoid mass with vascular engorgement, and a laparotomy was performed urgently due to the persistent abdominal pain, intussusception and hematochezia. The histology examination disclosed a benign angiolipoma. We report this case of symptomatic angiolipoma of the distal descending colon.
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A Case of Choledochocele with Parapapillary Diverticulum Presenting as Pancreatitis
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Hyeon Geun Cho, M.D., Seong Il Hong, M.D., Jin Yi Choi, M.D., Myoung Hwan Kim, M.D., Ki Joon Han, M.D., In Suh Park, M.D. and Mi Sung Kim, M.D.*
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Korean J Gastrointest Endosc 2007;34(2):119-124. Published online March 2, 2007
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- Choledochocele, classified as choledochal cyst: type III, is a rare cystic or diverticular dilatation of the terminal biliary tree that causes abdominal pain, recurrent pancreatitis, and obstructive jaundice. It is the rarest of the choledochal cysts and has lower malignant potential than any other type of choledochal cyst. Although its anatomic structure does not fit the criteria for pancreatobiliary maljunction, pancreaticobiliary reflux may occur in patients with choledochocele. Herein, we report the case of a 63-year-old woman with recurrent episodes of acute pancreatitis that were caused by a choledochocele with two parapapillary diverticula. She was successfully treated by endoscopic needle-knife sphincterotomy without severe complications and remained asymptomatic at the 6-month follow-up.
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