Clinical Endoscopy

The Clinical Effect of Supplementary Argon Plasma Coagulation after Endoscopic Mucosal Piecemeal Resection of a Gastric Adenoma and Carcinoma: Sang Joon Park, M.D., Kee Myung Lee, M.D., Deok Ki Kim, M.D., Sung Jae Sin, M.D., Jae Ho Jung, M.D., Sung Hyeon Jung, M.D., Byeong Moo Yoo, M.D., Ki Baik Hahm, M.D. and Jin Hong Kim, M.D.; Korean J Gastrointest Endosc 2007;34(6):291-297. Published online June 30, 2007

Abstract PDF: Background/Aims: This study was designed to determine the effect of supplementary argon plasma coagulation (APC) after piecemeal resection of a gastric adenoma or an intramucosal adenocarcinoma. Methods: Cases of 62 lesions of 56 consecutive patients with either a gastric adenoma or carcinoma were retrospectively reviewed at the Ajou University Medical Center. APC was performed after an endoscopic complete resection using the piecemeal method of endoscopic mucosal resection (EMR) for patients in the EMR-APC group. For patients in the EMR group, APC was not performed. Results: There was no significant difference in the recurrence rate of the cancers for both groups (9.7%, for the EMR group, 6.5% for the EMR-APC group). The recurrence rate of a low grade dysplasia was 6.7% (EMR group) and 6.3% (EMR-APC group) (p=1.000), the recurrence rate for a high grade dysplasia was 11.1% (EMR group) and 25.0% (EMR-APC group) (p=1.000), and the recurrence rate for an intramucosal adenocarcinoma was 14.3% (EMR group) and 0% (EMR-APC group) (p=0.389). The recurrence rates of lesions in which the lesion size was less than 20 mm and over 20 mm for each group were 6.7% and 9.1% (EMR group) (p=1.000) versus 12.5% and 0% (EMR-APC group) (p=0.520). There was also no significant statistical difference in the recurrence rates for both groups according to the location and macroscopic type of lesion. Conclusions: Supplementary treatment with APC could not significantly reduce the recurrence rate after complete piecemeal resection determined macroscopically. A large- scale and prospective study is necessary to elucidate the clinical significance of supplementary APC for gastric neoplasm treatment.

2,445 View
10 Download

Conscious Sedation with Midazolam Combined with Propofol for Colonoscopy: Ja Seol Koo, M.D., Jai Hyun Choi, M.D., Sung Woo Jung, M.D., Woo Sik Han, M.D., Jong Sup Lee, M.D., Hyung Joon Yim, M.D., Yoon Tae Jeen, M.D., Hoon Jai Chun, M.D., Hong Sik Lee, M.D., Sang Woo Lee, M.D., Chang Duck Kim, M.D. and Ho Sang Ryu, M.D.; Korean J Gastrointest Endosc 2007;34(6):298-303. Published online June 30, 2007

Abstract PDF: Background/Aims: There is increasing interest in the use of propofol as a sedative agent for colonoscopy. We evaluated the safety and efficacy of the synergistic sedation with midazolam combined with low-dose propofol versus that of midazolam alone. Methods: A total of 56 patients from among those who underwent total colonoscopy between August 2004 and October 2004 were randomly assigned to one of three medication treatment groups. Group A (n=18) received low-dose midazolam (0.03 mg/kg IV) plus propofol, group B (n=19) received high-dose midazolam (0.07 mg/kg IV) plus propofol, and group C (n=19) received high-dose midazolam alone. The patients' vital signs were monitored throughout the course of the study. The recovery time and quality as well as the patients' comfort level were also assessed. Results: There were no significant differences in baseline characteristics among the treatment groups. There were also no differences in the duration and insertion time of the colonoscopy among the three groups. The patients' comfort level and cardiorespiratory parameters during colonoscopy were similar among the three groups. The sedation efficacy and recovery times were also similar among the three groups. Conclusions: Midazolam combined with low-dose propofol as a sedative for colonoscopy exhibits similar effects on safety, patient' comfort level and recovery time to those of midazolam alone.

2,259 View
29 Download

The Effect of Second Look Endoscopy in Patients with Peptic Ulcer Bleeding: Seung Yup Lee, M.D.*, Ji Hyun Park, M.D., Jong Hyup Lee, M.D., Se Hwan Kim, M.D.*, Chang Keun Park, M.D.*, Chang Min Cho, M.D., Won Young Tak, M.D., Young Oh Kweon, M.D., Sung Kook Kim, M.D. and Yong Hwan Choi, M.D.; Korean J Gastrointest Endosc 2007;34(6):304-311. Published online June 30, 2007

Abstract PDF: Background/Aims: Performing second look endoscopy has been suggested in order to reduce recurrent bleeding. We assessed whether second look endoscopy reduces the risks of recurrent bleeding and the mortality rate for patients suffering with peptic ulcer bleeding. Methods: From February 2003 to June 2004, we have performed a prospective, randomized, controlled study of 141 patients with bleeding peptic ulcers, and these patients had been admitted to Kyungpook National University Hospital. Seventy patients in the study group were randomized to receive scheduled second look endoscopy. Seventy one patients in the control group were observed closely. Results: Seventeen of the admitted 141 patients were found to have rebleeding after initial therapeutic endoscopy. The overall rebleeding rate was 12.1%. Although the duration of the hospital stay was significantly lower for the study group than for the control group (p＜0.05), the rebleeding rate was similar for both groups (p＞0.05). The two groups were similar in respect to the mortality during the period of hospitalization, the volume of hypertonic saline epinephrine that was injected and the number of hemoclips that were used. Conclusions: From these results, we can conclude that scheduled second look endoscopy with retreatment did not reduce the risk of recurrent bleeding for patients with peptic ulcer bleeding. Therefore, scheduled second look endoscopy should be selectively performed for the patients who are at a high risk for peptic ulcer bleeding.

2,257 View
9 Download

Phase III Clinical Trial of Revaprazan (Revanex^Ⱂ) for Gastric Ulcer: Rin Chang, M.D.*, In Sik Chung, M.D.^†, Soo-Heon Park, M.D.^†, Sung-Kook Kim, M.D.^‡, Seok-Reyol Choi, M.D.^§, Geun-Am Song, M.D.^∥, Ki-Baik Hahm, M.D.^¶, Yong-Chan Lee, M.D.**, Hyun-Soo Kim, M.D; Korean J Gastrointest Endosc 2007;34(6):312-319. Published online June 30, 2007

Abstract PDF: Background/Aims: This randomized, double-blind, phase III, multicenter trial was carried out to compare the efficacy and safety of revaprazan, a novel acid pump antagonist, with that of omeprazole in patients with more than one of gastric ulcers. Methods: Two hundred and ninety two subjects were randomized to 4∼8 weeks of treatment with either revaprazan 200 mg or omeprazole 20 mg. The primary efficacy parameter was the cumulative healing rate determined by endoscopy after 4 and 8 weeks of treatment, and the secondary efficacy parameter was an improvement rate of pain. Results: The intention-to-treat analysis revealed revaprazan and omeprazole to have similar cumulative healing rates (93.0% and 89.6%, respectively; p=0.3038). The per-protocol analysis revealed revaprazan and omeprazole to also have similar cumulative healing rates (99.1% and 100%, respectively; p= 0.3229). In both analyses, there were no significant differences in an improvement rate of pain between the two groups. Both drugs were well tolerated. Conclusions: Revaprazan has similar efficacy to omeprazole in the treatment of patients with gastric ulcer with a once a day application of revaprazan 200 mg or omeprazole 20 mg over a 4 to 8-week period. In terms of safety, revaprazan was well tolerated.

3,052 View
71 Download

Esophageal Perforation and Empyema after Fish Bone Swallowing: Yeon Soo Kim, M.D., Seung Woo Lee, M.D., Sang Bum Kang, M.D., Soon Woo Nam, M.D., Dong Soo Lee, M.D. and Kun Park, M.D.*; Korean J Gastrointest Endosc 2007;34(6):320-323. Published online June 30, 2007

Abstract PDF: Most foreign bodies accidentally ingested are eliminated naturally but 10∼20% of cases require endoscopic treatment. Esophageal perforation due to the indigestion of a foreign body is rare and might be followed by mediastinitis, broncho-esophageal fistula, pneumomediastinum, peritonitis, and empyema. Rapid surgery is important because the morbidity and mortality depend on the duration from perforation to treatment. A 64 year-old woman sustained odynophagea after swallowing a fish bone. Empyema due to an esophageal perforation developed, and she died despite aggressive treatment. This case highlights the need for an early diagnosis and treatment to reduce the morbidity and mortality.

2,078 View
15 Download

A Case of Esophageal Carcinoma Coexisting with Leiomyoma Removed by Endoscopic Resection: So Young Joo, M.D., Wan Sik Lee, M.D., Seon Young Park, M.D., Hyeong Cheon Park, M.D., Sung Beom Cho, M.D., Hyun Soo Kim, M.D., Sung Kyu Choi, M.D. and Jong Sun Rew, M.D.; Korean J Gastrointest Endosc 2007;34(6):324-328. Published online June 30, 2007

Abstract PDF: The coexistence of esophageal submucosal tumors and carcinomas is rare and the association between them is still unclear. Here, we report a case of a superficial esophageal carcinoma that developed over an esophageal leiomyoma, which was removed successfully by an endoscopic mucosal resection. A 76-year-old man was admitted for the treatment of an esophageal carcinoma. The endoscopic examination revealed a 1 cm-sized round, flat, elevated lesion located at the 25 cm mark of the endoscopy. Endoscopic ultrasonography revealed the carcinoma to be limited to the mucosal layer. Interestingly, a 1.2 cm sized, hypoechoic, subepithelial mass was present beneath the carcinoma. An endoscopic resection was performed simultaneously using a suction and snaring method with a transparent cap attached to the tip of the endoscope. A histopathology examination revealed a squamous cell carcinoma restricted to the mucosa immediately over the benign leiomyoma arising from the muscularis mucosa. The patient has remained well during 1 year follow-up period and has shown no evidence of recurrence.

2,146 View
5 Download

A Case of Endoscopic Hemoclip Management of Dieulafoy-like Lesion on the Hyperplastic Polyp in the Duodenum: Nam Seon Park, M.D., Jung Hoon Song, M.D., Eun Bin Lee, M.D., Byung Kook Kang, M.D., Dae Ho Jin, M.D., Tae Hong Ahn, M.D., Yoon Ju Han, M.D. and Hyung Suk Lee, M.D.; Korean J Gastrointest Endosc 2007;34(6):329-333. Published online June 30, 2007

Abstract PDF: Dieulafoy's lesion (DL) is an uncommon but important cause of massive upper gastrointestinal bleeding that has been reported to be involved in 0.3∼6.7% of cases of major gastrointestinal bleeding. The lesion usually occurs in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been observed in the esophagus, duodenum, small intestine, colon, and rectum. Most DLs encountered in the duodenum occur in the bulb. Recently, with the advances in endoscopic techniques, the successful management of DL has been achieved through the application of a hemoclip or elastic band ligation. In particular, the application of a hemoclip is considered to be a safe and effective treatment for DL located on a relatively narrow and thin walled canal such as the duodenum. We report the successful application of endoscopic hemoclipping for the treatment of a rare Dieulafoy-like lesion on a hyperplastic polyp in the 2nd portion of the duodenum.

2,486 View
16 Download

A Case of Gastrointestinal Stromal Tumor of the Jejunum with Obscure Gastrointestinal Hemorrhage Diagnosed by Exploratory Laparotomy: Hae Bin Jung, M.D., Sun Young Kim, M.D., Shin Ae Park, M.D., Sang Mi Park, M.D., Kon Ho Shim, M.D., Eui Hyung Kim, M.D., Eun Jung Jeon, M.D., Jung Hwan Oh, M.D., Jeong Jo Jeong, M.D. and Sang Wook Choi, M.D.; Korean J Gastrointest Endosc 2007;34(6):334-338. Published online June 30, 2007

Abstract PDF: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract, and they represent about 2% of all neoplasms of the gastrointestinal tract. GISTs primarily affect the stomach (50∼60%), but they can also affect the small intestine (20∼30%), large intestine (7%) and esophagus (1%). The clinical manifestations of GISTs vary according to the location and size of the mass. GISTs are generally KIT (CD117)-positive and are diagnosed by immunohistochemistry. Tumor size and mitotic activity are the best predictive prognostic features. The treatment of choice for primary GIST is complete surgical resection with a negative margin. A 78-year-old man who presented with melena and diffuse abdominal pain was admitted to our hospital. Esophagogastroduodenoscopy, colonoscopy, angiography and an RBC scan were performed but we were unable to locate the focus of the hemorrhage. A gastrointestinal stromal tumor (GIST) of the jejunum was diagnosed after laparotomy.

2,081 View
8 Download

Tuberculous Meningitis in a Patient with Crohn's Disease, Which was Treated with Infliximab: Youn Ho Kim, M.D., Beom Jae Lee, M.D., Jong-Jae Park, M.D., Won Woo Lee, M.D., Woo Sik Han, M.D., Sung Nam Oh, M.D., Do Won Choi, M.D., Jae Seon Kim, M.D., Young-Tae Bak, M.D. and Hee Jin Cheong, M.D.*; Korean J Gastrointest Endosc 2007;34(6):339-342. Published online June 30, 2007

Abstract PDF: Clinical trials of tumor necrosis factor (TNF) inhibitor have demonstrated significant efficacy in those patients with Crohn's disease that is not responsive to other anti- inflammatory drug. Infliximab is a human-murine chimeric monoclonal antibody with a high binding affinity and specificity for TNF-α. Yet therapy with infliximab is associated with an increased risk of opportunistic infection, and especially tuberculosis. Here we reported on a case of tuberculous meningitis in 26-year-old man, and he was treated with infliximab for uncontrolled and fistulous Crohn's disease. We also include a review of the literature.

1,900 View
10 Download

Sigmoidoscopic Removal of Migrated Plastic Biliary Stents: Chang Nyol Paik, M.D., Jong Young Choi, M.D., Jae Myung Park, M.D., Yu Kyung Cho, M.D., In Seok Lee, M.D., Sang Woo Kim, M.D., Myung Gyu Choi, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2007;34(6):343-345. Published online June 30, 2007

Abstract PDF: Endoscopic retrograde biliary drainage is a well-established, minimally invasive procedure for treating biliary obstructions caused by malignant or benign diseases. Al though there is a low rate of complications with biliary stenting, late complications of stent migration can occur, occasionally resulting in bowel inflammation, obstruction or perforation. We report a case of a migrated biliary stent that induced an obstruction of the colon following ERBD in the stricture of hepatic ducts after a liver transplant, and was removed endoscopically.

2,025 View
7 Download

A Case of Intramural Duodenal Hematoma Complicated with Obstructive Jaundice and Pancreatitis following Endoscopic Hemostasis: Hyung Chul Lee, M.D., Kook Hyun Kim, M.D.*, Youn Sun Park, M.D., Hee Jung Moon, M.D., Tae Nyeun Kim, M.D. and Byung Ik Jang, M.D.; Korean J Gastrointest Endosc 2007;34(6):346-350. Published online June 30, 2007

Abstract PDF: An intramural duodenal hematoma is rarely observed in adults and may occur as an iatrogenic complication after endoscopic treatment for duodenal ulcer bleeding, particularly in patients with bleeding disorders or undergoing anticoagulant therapy. Upper gastrointestinal endoscopy, abdominal CT scan and hypotonic duodenography are used to establish a diagnosis. We report a case of an intramural duodenal hematoma complicated with obstructive jaundice and pancreatitis after endoscopic hemostasis in a patient with a cerebral infarction. A 64-year-old male had duodenal ulcer bleeding, which was treated by a local injection of epinephrine followed by hemoclipping. One to three days after the endoscopic treatment, he complained of abdominal pain and jaundice. The abdominal CT scan revealed acute, edematous pancreatitis and a huge hematoma in the 2nd to 4th portion of the duodenum. The follow-up endoscopy revealed severe stenosis of the duodenal lumen caused by an intramural hematoma. He was treated with conservative management for 18 days. There was gradual improvement in the hematoma that had been complicated by jaundice and pancreatitis.

1,992 View
7 Download

Strangulation of Umbilical Hernia after Therapeutic Endoscopic Retrograde Cholangiopancreatography of Acute Biliary Pancreatitis: Dae Hee Choi, M.D., Sang Huyb Lee, M.D., Joo Kyoung Park, M.D., Ji Won Yoo, M.D., Sang Myung Woo, M.D., Ji Kon Ryu, M.D., Yong-Tae Kim, M.D., Yong Bum Yoon, M.D. and Kyu Joo Park, M.D.*; Korean J Gastrointest Endosc 2007;34(6):351-355. Published online June 30, 2007

Abstract PDF: Endoscopic retrograde cholangiopancreatography (ERCP) is a safe procedure with life-threatening complications rarely occurring after the procedure. There are several reports of complications with ERCP, including bleeding, perforation, pancreatitis, cholangitis and cholecystitis. In our case, an umbilical hernia was strangulated after therapeutic ERCP had been performed in a patient with acute pancreatitis by a biliary stone, which required a surgical resection. To the best of our knowledge, this is the first report of such a case in Korea. This case highlights the need for close and careful observations for the early detection of possible complications after ERCP.

1,908 View
5 Download

Previous issues