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Volume 34(5); May 2007
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Prevalence of the Endoscopic Barrett's Esophagus Determined by Palisading Vessel and Inter-observer Variation
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Jun-Won Chung, M.D., Gin Hyug Lee, M.D., Kee Don Choi, M.D., Ho June Song, M.D., Benjamin Kim, M.D., Kwi-Sook Choi, M.D., Hwoon-Yong Jung, M.D. and Jin-Ho Kim, M.D.
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Korean J Gastrointest Endosc 2007;34(5):239-243. Published online May 30, 2007
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Abstract
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- Background/Aims: The Barrett's esophagus is confirmed by performing a biopsy when the gastroesophageal junction (GEJ) and Z-line do not coincide. In Japan, the GEJ is at the distal end of the palisading vessel while Western countries define it as the proximal tip of the gastric fold. However, there is little data on the prevalence of an endoscopic Barrett's esophagus and the inter-observer variation. Methods: Four experienced endoscopists reviewed the endoscopic still images of 111 consecutive patients. The level of inter-observer agreement was expressed as a kappa value. Results: The average percentage of patients with an endoscopically confirmed esophagus was 34.2%. The level of inter-observer agreement was substantial (kappa=0.698). Conclusions: The prevalence of an endoscopic confirmed Barrett's esophagus was high, and the inter-observer variation was substantial when the GEJ was defined as the distal end of the palisading vessel. Considering the low incidence of esophageal adenocarcinoma and the risk of hemorrhage from a biopsy, a more specific marker is needed in this high-risk group. (Korean J Gastrointest Endosc 2007;34:239243)
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The Usefulness of Endoscopic Ultrasonoraphy for Discriminating Gastric Mucosal Cancer from Submucosal Invasion
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Seung Hyun Lee, M.D., Yong Seok Jang, M.D., Sang Hoon Jeon, M.D., Seong Yeol Kim, M.D., Byoung Kuk Jang, M.D., Woo Jin Chung, M.D., Kwang Bum Cho, M.D., Kyung Sik Park, M.D. and Jae Seok Hwang, M.D.
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Korean J Gastrointest Endosc 2007;34(5):244-250. Published online May 30, 2007
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- Background/Aims: Endoscopic ultrasonography (EUS) has been used to discriminate gastric mucosal cancer (T1m) from submucosal invasion (T1sm). Thus the aims of this study are 1) to determine the accuracy of EUS for diagnosing tumor depth, 2) to compare the accuracy of EUS with the endoscopic impressions of variously experienced endoscopists and 3) to compare the accuracy of performing EUS by one doctor according to the experience. Methods: The EUS and pathologic reports of early gastric cancer patients were analyzed. The same endoscopic images were reviewed again by 3 endoscopists, who had one-, three- and five-years experience, respectively. The accuracies of EUS and conventional endoscopy were analyzed. Results: 77 patients were included from November 2003 to October 2005. The κ of the EUS for actual examiner and conventional endoscopy for reviewer 1, reviewer 2 and reviewer 3 were 0.421, 0.134, 0.359 and 0.307, respectively and accuracies were 68.8%, 45.5%, 67.5% and 62.3%, respectively. Of the 52 T1m patients, 23 (44.2%) were overstaged as T1sm with performing EUS. But of 25 T1sm patients, only 1 (4.0%) was understaged as T1m with performing EUS. The accuracy and κ of the EUS for one doctor during the first-year experience were 60.6% and 0.316, respectively, and they were 75.0% and 0.508, respectively during the second-year experience. Conclusions: EUS is useful for complementing the conventional endoscopic discrimination of gastric mucosal cancer from submucosal invasion. Yet physician should keep in mind the relatively common overstaging. (Korean J Gastrointest Endosc 2007;34:244250)
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The Effect of Simethicone as a Bowel Preparative: Is a Higher Dosage More Helpful?
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Dae Ik Nahm, M.D., Jin Bae Kim, M.D., Sung Won Jung, M.D., Yun Jung Chang, M.D., Il Hyun Baek, M.D., Joo Ree Kim, R.N. and Myung Seok Lee, M.D.
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Korean J Gastrointest Endosc 2007;34(5):251-255. Published online May 30, 2007
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- Background/Aims: Simethicone has been effectively used as a preprocedure drink during colonoscopy because it causes bubbles in the lumen to coalesce. We tried to confirm whether simethicone could effectively lessen the bubble formation and shorten the procedure time. In addition, we tried to determine the proper dose of this medication. Methods: Patients were randomized to receive 0 mg as a control group (group I), 200 mg of simethicone at 7 PM in the evening before the procedure (group II), or 200 mg at 7 PM in the evening and 200 mg at 7 AM in the next morning (group III). The bubbles were scored as follows: 0, none or small amounts of bubbles that don't require any jet of water; 1, moderate amounts of bubbles that require two or three jets of water due to the focal distribution; And 2, large amounts of bubbles that require repeated jets (≥4) of water due to the extensive distribution. Results: 101 patients were included in this study. The number of patients in groups I, II and III were 38, 35 and 28, respectively. The procedure time was statistically similar among the three groups. Severe bubbles (score 2) were significantly more likely to occur in group I than in groups II and III (p=0.014). On the other hand, the presence of significant bubbles (≥1) was not different between groups II and III. Conclusions: Simethicone significantly diminished the presence of bubbles. We recommend using 200 mg of simethicone in the evening before the colonoscopy. (Korean J Gastrointest Endosc 2007;34:251255)
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Comparison of Complication between Automatically Controlled Cut System (Endocut) and Conventional Blended Cut Current over Endoscopic Sphincterotomy
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Woo Jin Jeong, M.D., Sang Soo Lee, M.D., Tae Yoon Lee, M.D., Hyoung Chul Oh, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D. and Myung-Hwan Kim, M.D.
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Korean J Gastrointest Endosc 2007;34(5):256-262. Published online May 30, 2007
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- Background/Aims: Endoscopic sphincterotomy (EST) is a common therapeutic technique for biliary and pancreatic diseases. However, it is associated with complications such as bleeding, pancreatitis, and perforation. Automatically controlled cut system (Endocut) is known to reduce the level of hemorrhage but lead to pancreatitis. This study examined whether or not the Endocut can reduce the rate of complications of EST compared with that of the conventional blended cut current. Methods: From September 2005 to July 2006, 519 patients were treated with EST using either Endocut (ERBE VIO 300D, 144 patients) or the conventional blended cut current (Olympus UES-30, 375 patients). Two groups were compared retrospectively for the complications of EST. Results: There were no significant differences in age, gender, and the indications for EST between the two groups. Endoscopically observed bleeding and clinically evident bleeding occurred in 6.9% (10/144), 1.4% (2/144) in the Endocut group and 8.5% (31/375), 2.2% (8/375) in the conventional blended cut current group, respectively (p=0.62 and 0.58, respectively). Clinical bleeding occurred in 2 patients in the Endocut group but it was mild and easily controlled by endoscopic treatment. Mild, moderate, and severe clinical bleeding occurred in 3, 4, and 1 patient in the blended group, respectively. Pancreatitis was encountered in 6.0% (8/134) of the Endocut group and in 5.7% (21/352) of the blended group (p=0.83). Perforation only occurred in 2 patients in the blended group. Conclusions: There were a similar number of complications from EST in the Endocut and conventional blended cut current groups. (Korean J Gastrointest Endosc 2007;34: 256262)
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A Case of Gastroesophageal Amyloidosis with Upper Gastrointestinal Bleeding in a Patient with Multiple Myeloma
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Sang Ok Lee, M.D., Young Sook Lee, M.D., Sung Hee Jung, M.D., Yun Jung Lee, M.D., Hoon Go, M.D., Gi Young Choi, M.D., Anna Kim, M.D., Hyeon Woong Yang, M.D., Sang Woo Cha, M.D., Seong Ho Kim, M.D.* and Sung Soo Chang, M.D.†
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Korean J Gastrointest Endosc 2007;34(5):263-268. Published online May 30, 2007
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- Amyloidoses are disorders for which homogeneous amorphous fibrillar proteins accumulate in multiple organs. These diseases are classified into systemic and localized disease by their extent, the primary disease and their association with multiple myeloma, and the secondary and familial disease are classified by their association with the underlying diseases. Amyloidoses can develop in association with multiple myeloma, but only rare cases have been reported on that involve the gastroesophageal tract. Amyloidosis can involve the kidney, heart, liver, skin, gastrointestinal tract and nervous system, and they can involve the small intestine, duodenum, stomach, colon, rectum and esophagus when there is disease of the gastrointestinal tract. We may overlook gastrointestinal involvement of amyloidoses if there are few symptoms and laboratory abnormalities because of the diverse clinical courses and features. Amyloidoses can manifest abdominal pain, diarrhea, vomiting and perforation, but gastrointestinal hemorrhages are rare. We report here on a case of gastroesophageal amyloidosis with upper gastrointestinal hemorrhage and paralytic ileus due to multiple myeloma. (Korean J Gastrointest Endosc 2007;34:263268)
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A Case of Duodenal Intramural Hematoma and Hemoperitoneum after Therapeutic Endoscopy in a Patient with Chronic Renal Failure
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Dong Seon Park, M.D., Woon Geon Shin, M.D., Min Kwan Kim, M.D., Jeang A Lee, M.D., Gyeong Mi Heo, M.D. and Hak Yang Kim, M.D.
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Korean J Gastrointest Endosc 2007;34(5):269-273. Published online May 30, 2007
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- Duodenal intramural hematoma is mostly caused by blunt abdominal trauma. It is also less commonly reported as a complication of anticoagulation therapy or as a blood dyscrasia, and as a complication of diagnostic/ therapeutic endoscopy. The presentation of these patients is abdominal pain, vomiting, fever and hematochezia, and this is rarely accompanied with intestinal obstruction, severe pancreatitis and acute peritonitis as its complications. The diagnosis is made clear by performing abdominal ultrasonography and abdominal computed tomography. We reported here on one case of intramural duodenal hematoma and hemoperitoneum after performing endoscopic hemostasis in a chronic renal failure patient who was on maintenance hemodialysis. (Korean J Gastrointest Endosc 2007;34:269273)
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A Case of Metastatic Adenocarcinoma of the Appendix from Stomach Adenocarcinoma
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Gyoung Jun Na, M.D., Chae Yong Yi, M.D., Hyun Choul Baek, M.D., Jeong Hoon Kim, M.D., Sang Hoon Bae, M.D., Dong Hyun Kim, M.D., In Soo Je, M.D., Byung Pyo Kwon, M.D., Tae Yeong Lee, M.D., Sang Hyun Kim, M.D., Chul Soo Song, M.D., Min Seok Kim, M.D.* and J
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Korean J Gastrointest Endosc 2007;34(5):274-277. Published online May 30, 2007
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- Adenocarcinoma of the appendix is a rare neoplasm. Metastatic adenocarcinoma of the appendix from stomach adenocarcinoma is also a very rare finding. A 72-year-old man complained of right lower quadrant abdominal pain for 10 days, and he was diagnosed with acute appendicitis. Appendectomy was performed by a general surgeon. Adenocarcinoma was found on the postoperative biopsy. Subsequently, gastric adenocarcinoma was diagnosed on the gastroscopy with biopsy, and this was proven to be the original site of the appendiceal adenocarcinoma. (Korean J Gastrointest Endosc 2007;34: 274277)
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A Case of Choledocho-Duodeno-Colonic Fistula
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Jeong Sook Seo, M.D., Sung Yeun Yang, M.D., Jae Hwan Kim, M.D., Su Kyoung Kwon, M.D., Sang Bun Choi, M.D., Su Kyoung Jo, M.D., Yang Cheon Han, M.D. and Eun Ju Lee, M.D.
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Korean J Gastrointest Endosc 2007;34(5):278-281. Published online May 30, 2007
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- Biliary-enteric fistula is a rare disease, and the common causes of biliary-enteric fistula are gallstone, peptic ulcer, malignancy and trauma. It is known that the most common type of biliary-enteric fistula is the cholecysto- duodenal fistula, yet the combination of choledocho- duodeno-colonic fistula is a rare finding. A 78-year-old woman was admitted because she had suffered with right upper quadrant pain, a febrile sense and chills for 2 days. We confirmed the choledocho-duodeno-colonic fistula by performing gastroduodenoscopy, abdominal CT and an upper GI series. So, we report here on an usual case of choledocho-duodeno-colonic fistula, along with a review of the relevant literatures. (Korean J Gastrointest Endosc 2007;34:278281)
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A Case of Tension Pneumothorax Complicating Duodenal Microperforation after ERCP
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Ho Hak Lee, M.D., Sang Hyub Lee, M.D., Sang Myung Woo, M.D., Ji Won Yoo, M.D., Joo Kyoung Park, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D. and Yong Bum Yoon, M.D.
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Korean J Gastrointest Endosc 2007;34(5):282-285. Published online May 30, 2007
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- Endoscopic retrograde cholangiopancreatography (ERCP) has become a commonly performed endoscopic procedure for the diagnosis and treatment of pancreatobiliary disease. ERCP is a relatively safe procedure. However, there are chances of potentially severe complications such as pancreatitis, hemorrhage, infection and perforation. Duodenal perforation is an uncommon, but serious complication of ERCP, and this has occurred in 0.3 to 1.1% of most of the previous series. There are various clinical course and treatments depending on the cause of perforation. However, the development of pneumothorax in patients undergoing ERCP is rare. There are no reports of tension pneumothorax complicating ERCP in Korea. We experienced a case of tension pneumothorax with complicating duodenal microperforation following ERCP, and the patient (a 77 year old female with suspicious dysfunction of the sphincter of Oddi) was treated with conservative treatment. (Korean J Gastrointest Endosc 2007;34:282285)
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Endoscopic Removal of a Severed, Impacted Lithotomy Basket in the Pancreatic Duct in a Patient with Pancreas Divisum -Endoscopic Removal of Severed, Impacted Basket-
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Soo Jung Park, M.D., Sung Koo Lee, M.D., Jeung Hye Han, M.D., Kyung Uk Jo, M.D., Sang Soo Lee, M.D., Dong Wan Seo, M.D. and Myung-Hwan Kim, M.D.
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Korean J Gastrointest Endosc 2007;34(5):286-290. Published online May 30, 2007
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- Therapeutic endoscopy in patients with pancreas divisum has continued to evolve with the availability of minor papilla endoscopic sphincterotomy, stenting, or sphinteroplasty. A combination of a sphincterotomy followed by balloon/basket deployment and emergency mechanical lithotripsy had facilitated the removal of impacted or large stones in the pancreatic and biliary ducts. The impaction of the basket with captured stones or rupture of the basket traction-wire during mechanical lithotripsy are rare complications. We report the successful retrieval of a center-severed and impacted lithotomy basket in the duct of Santorini in a 47-year-old patient with pancreas divisum. Endobiliary biopsy forceps were introduced into minor papilla, the basket was drawn and the stone was removed successfully after 2 months. To the best of our knowledge, this is a first report of the removal of a center-severed and impacted lithotomy basket in the pancreatic duct. (Korean J Gastrointest Endosc 2007;34:286290)
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