Clinical Endoscopy

Comparison of the Eradication Rates of One-week Low-dose Triple Therapy with Standard-dose Triple Therapy for Helicobacter pylori Infection: Woo Hyun Paik, M.D., Youn Joo Kim, M.D., In Kyoung Kim, M.D., Jae Kyoung Lee, M.D., Chang Hyun Lee, M.D., Goh Eun Chung, M.D., Kyung Sup Hong, 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; Korean J Gastrointest Endosc 2007;35(1):1-5. Published online July 30, 2007

Abstract PDF: Background
/Aims: We can expect to reduce costs and decrease adverse events by using low-dose triple therapy for H. pylori eradication. However, the efficacy of low-dose triple therapy for Koreans is questionable. In this study, we compared the efficacy of low-dose triple therapy with standard-dose triple therapy. Methods: We enrolled 480 patients who were diagnosed as suffering with H. pylori infection via endoscopy with biopsy or CLO testing. Thirty patients were excluded due to malignancy or having undergone previous antibiotics medication. Two hundred and eighty patients received standard-dose triple therapy (pantoprazole 40 mg b.d, amoxicillin 1,000 mg b.d., and clarithromycin 500 mg b.d.), and 170 patients received low-dose triple therapy (pantoprazole 40 mg b.d., amoxicillin 750 mg b.d., and clarithromycin 250 mg b.d.). Eradication was evaluated 4∼6 weeks after administering the medication. Results: The H. pylori eradication rate was 77.9% in the standard-dose group, and 74.7% in the low-dose group. There was no significant difference in the H. pylori eradication rate between the two groups (p=0.444). The adverse events were significantly more frequent in the standard-dose group. One patient each in both groups discontinued medication because of an adverse event. Conclusions: The efficacy of low-dose therapy is similar to standard-dose therapy, and the adverse events are less frequent with low-dose therapy. This suggests that low-dose therapy would be preferred when considering the cost- benefit and low rate of adverse drug events.

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Re-Endoscopic Mucosal Resection for a Residual or Locally Recurrent Gastric Lesion after Endoscopic Mucosal Resection: Jae Hyuck Chang, M.D., In Seok Lee, M.D., Chan Ran You, M.D., Kwan Woo Nam, M.D., Jung Hyun Kwon, M.D., Jung Pil Suh, M.D., Ho Sung Park, M.D., Chang Nyol Paik, M.D., Jae Myung Park, M.D., Yu Kyung Cho, M.D., Sang Woo Kim, M.D., Myung Gyu Choi, M.D. and I; Korean J Gastrointest Endosc 2007;35(1):6-13. Published online July 30, 2007

Abstract PDF: Background
/Aims: Re-endoscopic mucosal resection of a residual or locally recurrent gastric lesion after endoscopic mucosal resection (EMR) is often difficult due to submucosal fibrosis. The aim of this study was to investigate the factors related to the local recurrence of gastric lesions and the results of re-EMR. Methods: We retrospectively reviewed 245 patients with adenoma or early gastric cancer (EGC) treated by EMR. The factors related to local recurrence after EMR were analyzed. Ten patients with local recurrences after complete resection were treated with re-EMR and analyzed. Results: The mean size of the re-EMR lesions was 15.1 mm (5∼30 mm). Seven patients were treated with endoscopic submucosal dissection (ESD) and three were treated with conventional EMR. En bloc resection was performed in eight patients (80%) and complete resection was performed in nine patients (90%). Bleeding was a complication of re-EMR in five patients (50%). There was no recurrent lesion after re-EMR in nine patients over a mean follow-up duration of 14.7 months. The local recurrence rate was significantly higher when the tumor was resected piecemeal (p＜0.001). Conclusions: Local recurrences occurred more frequently when the tumors were resected piecemeal. Re-EMR was a possible tool for the treatment of residual or locally recurrent lesions in 90% of the patients. Re-EMR may be the treatment of choice for a locally recurrent lesion after EMR according to the indication.

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Clinical Feature of Pseudomembranous Colitis with Ascites: Oh Wan Kwon, M.D., Oh Young Lee, M.D., Young Il Kwon, M.D., Jae Yoon Jeong, M.D., Yoo Hum Baek, M.D., Won Moon, M.D., Jung Mi Kim, M.D., Dong Hee Koh, M.D., Hang Lak Lee, M.D., Byung Chul Yoon, M.D., Ho Soon Choi, M.D., Joon Soo Hahm, M.D., Min Ho Lee, M.; Korean J Gastrointest Endosc 2007;35(1):14-18. Published online July 30, 2007

Abstract PDF: Background
/Aims: Ascites is a fairly common condition, but the clinical features of pseudomembranous colitis with ascites are not well-known. The aim of this study was to determine how the existence of ascites is related to the clinical factors. Methods: Between March 2002 and June 2006, 67 pseudomembranous colits patients were diagnosed by performing lower endoscopy and biopsy. The patients' ascites was identified by abdominal plain radiography, ultrasonography or computerized tomography. The extension of colitis was evaluated by ultrasonography or computerized tomography. Results: 16 patients (23.9%) had ascites. The serum WBC (p=0.01), hypoalbuminemia (p＜0.01), CRP (p＜0.01), recurrence (p＜0.01), and extension of colitis (p＜0.01) were associated with the existence of ascites. The four patients who had undergone paracentesis had a low SAAG level and PMN dominant ascites. Conclusions: There were correlations of ascities with leukocytosis, hypoalbuminemia, CRP, extension of colitis and recurrence of PMC.

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A Case of Esophageal Anisakiasis Presenting as Chest Pain Mimicking Angina: Kyoung Deok Shin, M.D.*, Chul Min An, M.D., Sang Woo Nam, M.D., Sang Kyoon Kim, M.D., Seong Hun Kim, M.D., In Hee Kim, M.D., Sang Wook Kim, M.D., Seung Ok Lee, M.D. and Soo Teik Lee, M.D.; Korean J Gastrointest Endosc 2007;35(1):19-22. Published online July 30, 2007

Abstract PDF: Chest pain of a non-cardiac origin is frequently seen in medical practice. This kind of chest pain is often difficult to differentiate from chest pain of a cardiac origin. Esophageal anisakis is a rare finding, but it can cause chest pain. We report here on a patient who had a history of acute myocardial infarction and who also had one stent inserted in his left anterior descending coronary artery two month previously. The patient presented with substernal chest pain that mimicked anginal chest pain. Endoscopic examination revealed a whitish linear worm that had had invaded the esophagogastric junction, and we removed the worm with biopsy forceps. We report here on a patient with an esophageal anisakiasis as a rare cause of noncardiac chest pain that mimicked anginal chest pain.

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A Case of Incidentally Found Esophageal Gastrointestinal Stromal Tumor: Jee Suk Lee, M.D., Moo In Park, M.D., Seun Ja Park, M.D., Kyu Jong Kim, M.D., Won Moon, M.D., Sung Woo Yang, M.D., Hong Jun You, M.D. and Bong Kwon Chun, M.D.*; Korean J Gastrointest Endosc 2007;35(1):23-27. Published online July 30, 2007

Abstract PDF: There are few reports of gastrointestinal stromal tumors (GISTs) in the esophagus. The authors report a patient with an esophageal GIST that was found incidentally during an endoscopy. The endoscopy revealed a 1 cm sized mass with a granular surface at the 32 cm site from the upper incisor. Endoscopic ultrasonography revealed the tumor to be located in the muscularis mucosa of the esophageal wall. Histologically, the tumor consisted of spindle cells, with no mitotic index, that were immunoreactive for KIT and S-100. The tumor was diagnosed as a gastrointestinal stromal tumor with neural differentiation (GINT). An endoscopic mucosal resection was performed and the patient has been on routine follow up at the out patient department for three months.

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A Case of Foreign Body Induced Esophageal Perforation Repaired by Endoscopic Clipping: Woo Sik Han, M.D., Jong-Jae Park, M.D., Beom Jae Lee, M.D., Joo Yeon Oh, M.D., Youn Ho Kim, M.D., Sung Woo Jung, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.; Korean J Gastrointest Endosc 2007;35(1):28-32. Published online July 30, 2007

Abstract PDF: An esophageal perforation is a potentially life threatening condition with a high mortality rate. Although primary surgical repair is the mainstay of treatment, non-surgical management can be attempted in selected patients. The successful endoscopic closure of an esophageal perforation with metallic clips was recently reported. We report a case of an esophageal perforation caused by a dog bone and mediastinitis treated by non-surgical management consisting of parenteral nutrition, antibiotics therapy and endoscopic clipping.

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A Case of Chronic Gastric Eosinophilic Abscess Treated by Endoscopic Submucosal Dissection: Ji Woong Kim, M.D., Young Jae Lee, M.D., Gum Mo Jung, M.D., Yong Keun Cho, M.D., Myoung Jin Ju, M.D.*, Jin Woong Cho, M.D. and Yong Ung Lee, M.D.; Korean J Gastrointest Endosc 2007;35(1):33-37. Published online July 30, 2007

Abstract PDF: Anisakiasis is a parasitic disease caused by ingestion of raw fish infected with anisakis larvae. The endoscopic features of the gastic mucosa are edema, ulceration and hemorrhage. Chronic gastric anisakiasis forming a submucosal tumor is rare. A 53-year old female was diagnosed with having a 1 cm sized gastric submucosal mass-like lesion by gastroscopy. Endoscopic ultrasonography showed an inhomogenous low echoic tumor with an irregular margin in the submucosal layer. The patient underwent an endoscopic submucosal dissection and band ligation. A serological assay with an enzyme-linked immunosorbent assay for an anisakiasis specific IgG antibody were positive. The pathological finding of the resected mass was centrally denatured larvae with eosinophilic abscess in the submucosal layer. We report a case of chronic gastric anisakiasis that presented as a gastric submucosal tumor that was removed by the endoscopic submucosal dissection method, with a review of the relevant literature.

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A Case of Choledochoduodenal Fistula due to Duodenal Ulcer: Hey Jin Jeong, M.D., Seong Hun Kim, M.D., Kyoung Deok Shin, M.D., In Hee Kim, M.D., Sang Wook Kim, M.D., Seung Ok Lee, M.D., Soo Teik Lee, M.D. and Dae Ghon Kim, M.D.; Korean J Gastrointest Endosc 2007;35(1):38-41. Published online July 30, 2007

Abstract PDF: Spontaneous internal biliary fistulas are not an uncommon complication of primary biliary disease. Almost 90% of the abnormal biliary-enteric communications between the gallbladder and the duodenum are caused by perforation via gallstones into an otherwise normal duodenum. However, biliary-enteric communications that are caused by primary duodenal ulcer disease are much less common. We experienced a case of duodenal peptic ulcer disease that perforated into the common bile duct in a 45-year-old woman.

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A Case of Acute Lower Gastrointestinal Bleeding from Appendiceal Ulcer: Dae Seung Lim, M.D., Sun Moon Kim, M.D., Mi Il Kang, M.D., Young Suk Kim, M.D., Seung Hyun Jung, M.D., Yong Moon Kim, M.D., Tae Hee Lee, M.D., Euyi Hyeog Im, M.D., Kyu Chan Huh, M.D., Young Woo Choi, M.D., Young Woo Kang, M.D. and Dae Kyung Ko, M.D.*; Korean J Gastrointest Endosc 2007;35(1):42-45. Published online July 30, 2007

Abstract PDF: The common causes of acute lower gastrointestinal bleeding include diverticulosis, colonic vascular ectasia, neoplasm and colitis. Acute lower gastrointestinal bleeding from the appendix is a very rare malady and the causes are reported as angiodysplasia, diverticulum, appendicitis and endometriosis. We report here on the case of a 47-year-old man, who was taking enteric coated aspirin, with severe lower gastrointestinal bleeding that was due to appendiceal ulcer. An active bleeding was identified as coming from the appendiceal orifice during colonoscopy. He was treated by simple appendectomy. Histologic evaluation showed ulceration with both acute and chronic inflammation, along with thickened vessel walls in the submucosa of the appendix.

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Two Cases of Gastrointestinal Perforation by Foreign Bodies: Hyeong-Cheon Park, M.D., Chang-Hwan Park, M.D., Sung-Bum Cho, M.D., So-Young Joo, M.D., Seon-Young Park, M.D., Suck Cho, M.D., Seung-Hwan Lee, M.D., Kyoung-Won Yoon, M.D., Wan-Sik Lee, M.D., Hyun-Soo Kim, M.D., Sung-Kyu Choi, M.D. and Jong-Sun Rew, M.D.; Korean J Gastrointest Endosc 2007;35(1):46-50. Published online July 30, 2007

Abstract PDF: About 80∼90% of ingested foreign bodies usually pass through the gastrointestinal tract spontaneously without any specific symptoms or gastrointestinal injury. Most of the foreign bodies in the stomach are passed along by gastrointestinal movement, and they are usually evacuated once they pass over the pylorus, Treitz ligament, the ileocecal valve and the rectosigmoid junction. Yet those foreign bodies that are sharp and/or pointed have a high risk of perforation, bleeding and abscess formation. We report here on two cases of a nail in the stomach and toothpicks in the sigmoid colon, and both cases were complicated by perforation. Both patients didn't know that they swallowed the foreign bodies. These patients were treated by surgery and antibiotics. As seen in our cases, we should keep in mind that a sharp, pointed foreign body in the gastrointestinal tract could induce severe complications such as perforation or abscess formation.

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A Case of Pseudosarcomatous Change of an Inflammatory Colon Polyp Associated with Tuberculous Colitis: Hyo June Kwon, M.D., Jung Sik Choi, M.D., Jong Ho Hwang, M.D., Hong Seok Choi, M.D., Sang Yong Lee, M.D., Sang Ho Lee, M.D. and Kyung Un Choi, M.D., Ph.D.*; Korean J Gastrointest Endosc 2007;35(1):51-55. Published online July 30, 2007

Abstract PDF: "Pseudosarcomatous change" occurs when sarcoma-like atypical cell hyperplasia is grossly indistinguishable from malignant tumor. Pseudosarcoma often exists in those areas of the gastrointestinal track where ulcer or erosion commonly takes place. This may indicate atypical granulomatous cell proliferation during a period of healing, as well as benign atypical change in the mesenchyme due to chronic inflammatory reaction. Both the visual appearance and intestinal involvement of tuberculous colitis are variable, and tuberculosis may result in reactive mesenchymal change associated with ulcer or polyp, which is that's induced by chronic inflammation. We report here on a case of a young female pulmonary tuberculosis patient who suffered with a pseudosarcoma of the ascending colon, and this was associated with tuberculous colitis. The patient underwent successful sugical resection. We report on this case, along with a review of the relevant literature.

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Sigmoid Diverticular Bleeding Detected by Capsule Endoscopy: Youn Ju Na, M.D., Ki-Nam Shim, M.D., Min Jung Kang, M.D., Ji Min Jung, M.D., Hae Sun Jung, M.D., Su Jung Baik, M.D., Su Jin Youn, M.D., Hyun Joo Song, M.D., Kum Hei Ryu, M.D., Hye Jung Yeom, M.D., Tae-Hun Kim, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D., Il; Korean J Gastrointest Endosc 2007;35(1):56-59. Published online July 30, 2007

Abstract PDF: Colonic diverticulosis is small outpouching from the lumen of the colon, and this caused by mucosal herniation. Most patients are asymptomatic, but 5∼15% of those affected manifest diverticular bleeding. Because most of them stop bleeding spontaneously, the source of the bleeding can not be found by colonoscopy in 15% of these cases. We report here on a case of sigmoid diverticular bleeding that detected by capsule endoscopy in a 68-year old woman who presented with acute obscure gastrointestinal bleeding.

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