Clinical Endoscopy

Single Blinded, Randomized, Active Drug Comparative, Multi-center Study to Evaluate the Therapeutic Efficacy of GliptideⓡTab (Sulglycotide 200 mg) in Gastritis Patients; Phase IV Study: Jeong Jo Jeong, M.D., Myung-Gyu Choi, M.D., Hwang Choi, M.D., Jae Myung Park, M.D., Jung Hwan Oh, M.D., Eun Jeong Jeon, M.D., Bo In Lee, M.D., In Seok Lee, M.D., Sang Woo Kim, M.D., Sang Wook Choi, M.D., Gyu Yong Choi, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2007;35(3):125-132. Published online September 30, 2007

Abstract PDF: Background
/Aims: Sulglycotide is a sulphoglycopeptide with antiulcer and cytoprotective activity that is derived from the porcine duodenal mucosa. This study carried out a 3-week single blinded, randomized, multicenter, noninferiority trial to compare the efficacy of oral sulglycotide in treating symptomatic erosive gastritis with that of rebamipide. Methods: Seventy-three patients with symptomatic erosive gastritis were randomized to receive 3 weeks of treatment with either sulglycotide or rebamipide. The primary efficacy parameter was the endoscopic cure rate and the endoscopic improvement rate, and the secondary parameter was the improvement rate in the dyspepsia symptom scores. Results: Of the 73 patients recruited, 36 received sulglycotide and 37 received rebamipide. The endoscopic cure rate in the sulgycotide and rebamipide group was 29.6% and 25.0% according to per protocol (PP) analysis, respectively (p=0.69). The endoscopic improvement rate in the sulglycotide and rebamipide group was 63.0% and 62.5% according to PP analysis, respectively (p=0.97). The symptomatic improvement rate in the sulgycotide and rebamipide group was 51.9% and 53.1% according to PP analysis, respectively (p=0.74). The result of 90% CIs for the difference in endoscopic cure rate, endoscopic improvement rate and symptom improvement rate between the two groups met the criteria for the non-inferiority of sulglycotide to rebamipide. Conclusions: Sulglycotide was not inferior to rebamipide in both erosion healing and symptom relief in patients with acute and chronic gastritis. (Korean J Gastrointest Endosc 2007;35:125-132)

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A Risk Factor for Wound Infection after Percutaneous Endoscopic Gastrostomy : Decreased Performance Status: Chan Ran You, M.D., Sang Woo Kim, M.D., Chang Nyol Paik, M.D., Jae Myung Park, M.D.,Yu Kyung Cho, M.D., In Seok Lee, M.D., Myung Gyu Choi, M.D., Kyu Yong Choi, M.D. and In Sik Chung M.D.; Korean J Gastrointest Endosc 2007;35(3):133-139. Published online September 30, 2007

Abstract PDF: Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) has been widely used for long term enteral nutrition. The most common complication is peristomal wound infection. The aim of this study is to investigate the risk factors for peristomal wound infection after PEG. Methods: We reviewed the records of 55 patients who had undergone PEG placement at Kangnam St. Mary's hospital via the Pull-string technique. We analyzed the underlying disease, the performance status and the nutritional state of the patients to determine the risk factors for wound infection. Results: Peristomal wound infection after PEG occurred in 20 (36.4%) of the 55 patients. Methicillin resistant Staphylococcus aureus (MRSA) was the most common isolated microorganism. On univariate analysis, the underlying CNS disease, non-malignant disease and a decreased performance status (ECOG 3, 4) were correlated with wound infection. On multivariate analysis, a decreased performance status was an independent risk factor for wound infection after PEG (p=0.007, OR=6.011, CI: 1.64∼22.09). Conclusions: A decreased performance status was an independent risk factor for peristomal wound infection after PEG. (Korean J Gastrointest Endosc 2007;35:133-139)

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The Endoscopic Ultrasonographic Survey of Benign Mesenchymal Tumor in Upper Gastrointestinal Tract: Soo Jung Lee, M.D., Jin Oh Kim, M.D., Soo Hoon Eun, M.D., Ik Sung Choi, M.D., In Seop Jung, M.D., Bong Min Ko, M.D., Su Jin Hong, M.D., Chang Beom Ryu, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., So Young Jin, M.D., Chan Sup Shim; Korean J Gastrointest Endosc 2007;35(3):140-145. Published online September 30, 2007

Abstract PDF: Background
/Aims: A gastrointestinal mesenchymal tumor contains a leiomyoma and gastrointestinal stromal tumor (GIST). The natural course can vary according to the histology and other characteristics. This study evaluated the natural course of a benign mesenchymal tumor in the upper gastrointestinal tract using endoscopic ultrasonography (EUS). Methods: Submucosal mesenchymal tumors are considered benign according to the following criteria of EUS: 1) the tumor originates from the muscularis mucosa or muscularis propria; 2) is well demarcated, homogenous and hypoechoic; and 3) has a regular surface. In this study, the changes of size, internal echo pattern and marginal regularity were evaluated retrospectively in 26 lesions that all were < 3 cm and were followed up for more than 2 years. Results: The average size of the tumors on EUS was 11.5 mm. The mean follow-up period was 47.4 months. The follow-up EUS revealed no change in echo features in any patient. In only one patient, the size of the tumor increased from 26 to 34 mm without a change in the internal echo or marginal regularity after 24 months. This patient underwent a laparoscopic gastric wedge resection. The pathologic diagnosis was a leiomyoma. Conclusions: Most small submucosal tumors that are compatible with the EUS criteria of a benign GIST/ leiomyoma do not change over a period of 24 months, and the EUS criteria are effective in diagnosing benign GISTs/leiomyomas. A benign GIST/leiomyoma at EUS might be followed up by EUS at an interval of 2 years. (Korean J Gastrointest Endosc 2007;35:140-145)

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The Prevalence and Clinical Features of Colonic Diverticulosis Diagnosed with Colonscopy: Chang Soo Choi, M.D., Eun Young Cho, M.D., Ji Hye Kweon, M.D., Pyoung Suk Lim, M.D., Hye Jung No, M.D., Ki Hoon Kim, M.D., Jeong Geun Lee, M.D., Geom Seog Seo, M.D., Tae Hyeon Kim, M.D. and Suck Chei Choi, M.D.; Korean J Gastrointest Endosc 2007;35(3):146-151. Published online September 30, 2007

Abstract PDF: Background
/Aims: Recently, due to the adoption of a Western lifestyle, the incidence of colonic diverticulosis is increasing in the Korean population. The purpose of this study is to review the prevalence and clinical characteristics of colonic diverticulosis as diagnosed by a colonoscopic examination. Methods: We retrospectely analyzed the medical records of 3,352 patients that had undergone a colonoscopy from 1 January 2002 to 31 July 31 2005. We recorded the extent (1, 2∼5, 6＞) and the location of a diverticulum. We also reviewed the medical records of the patients that had symptoms and other clinical features. Results: A total of 2,831 patients were selected. The overall prevalence of colonic diverticulosis was 10.1%; the mean patient age was 53±11 years and the ratio of males to females was 2.3:1. A diverticulum occurred more frequently in the right side colon (79.0%) than the left side colon (13.9%). The most common symptom was abdominal pain (63.5%). Complications were diverticulitis (2.0%) and bleeding (0.3%). The prevalence of a colon polyp was 39.1% and the prevalence of a fatty liver was 26.4% in the diverticular patients. Conclusions: The prevalence of colonic diverticulosis is increasing in the Korean population and a diverticulum occurred more frequently in the right side colon. (Korean J Gastrointest Endosc 2007; 35:146-151)

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Analysis of Endoscopic Sphincterotomy in Patients with Periampullary Diverticulum: according to the Location of the Diverticulum: Hyun Ah Yoon, M.D., Myung Hwan Roh, M.D., Yang Hyun Baek, M.D., Yung Hoon Kim, M.D., Hyun Seung Yoo, M.D., Sung Wook Lee, M.D., Jin Seok Jang, M.D., Jong Hun Lee, M.D., Sang Yung Han, M.D. and Seok Reyol Choi, M.D.; Korean J Gastrointest Endosc 2007;35(3):152-158. Published online September 30, 2007

Abstract PDF: Background
/Aims: Endoscopic sphincterotomy (EST) involves more complications and medical problems when a periampullary diverticulum (PD) is present. The data about EST for treating a small population of PD patients is controversial and any recent data is rare. The aim of this study is to evaluate the results of performing EST for a large population of PD patients. Methods: We retrospectively enrolled 178 patients with PD and 178 patients without PD and these patients underwent EST for removal of common bile duct (CBD) stones during the years 2003～2005 at Dong-A University Hospital. We classified PD patients, according to the location of the ampulla and diverticulum, into 3 groups and we considered removal of the CBD stones as success. Results: The success rates of EST in the two groups were similar: 91.0% in the PD group and 98.8% in the control group (p=0.0341). Failures were more frequently observed when the papilla was located inside of the diverticulum than for the other locations (p=0.0341). The complications cholangitis and pancreatitis after EST were similar for the two groups, but bleeding was more frequently observed in the PD group (p=0.0067). Conclusions: More skill for performing EST is needed to prevent bleeding in PD patients and it is more difficult to remove CBD stones when the papilla was located inside of the diverticulum. (Korean J Gastrointest Endosc 2007;35:152-158)

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A Case of Esophageal Involvement in Pemphigus Vulgaris: Young Chul Kim, M.D., Woo Chul Chung, M.D., Seok Jin Kang, M.D.*, Chang Kyun Hong, M.D., Kang Moon Lee, M.D., Jin Mo Yang, M.D., Jae Kwang Kim, M.D., Sok Won Han, M.D., Kyu Yong Choi, M.D. and In-Sik Chung, M.D.; Korean J Gastrointest Endosc 2007;35(3):159-164. Published online September 30, 2007

Abstract PDF: Pemphigus vulgaris is a rare chronic disorder that is characterized by the development of bullae on the skin and mucous membrane due to an acantholysis mediated by circulating autoantibodies. It begins as painful, non- healing ulcerations in the mouth. After a period of weeks to months, the condition progresses to the skin. Occasionally, skin lesions may develop as the initial manifestation of this disease. However, esophageal involvement of pemphigus vulgaris is rare. An 84-year-old man was referred due to chest pain, dysphagia, oral ulcerations and facial bullae. The histopathological findings showed a suprabasal blister and acantholysis in the epithelium of the facial skin. An endoscopic examination revealed exfoliated erosions, ulcerations and hemorrhagic bullae on the oral and esophageal mucosa. The patient was started on high dose of corticosteroids and azathioprine, but there was no clinical improvement. The use of cyclophosphamide led to the remission of the lesions. (Korean J Gastrointest Endosc 2007;35:159-164)

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A Case of Tuberculosis of the Esophagus and Duodenum Associated with Pulmonary Tuberculosis: Seok Jin Kang, M.D., Tae Hyo Kim, M.D., Won Hyun Lee, M.D., Seung Suk You, M.D., Jong Ha, M.D., Sun Pil Choi, M.D., Dong O Kang, M.D., In Gye Bae, M.D., Hyun Jin Kim, M.D. and Ok Jae Lee, M.D.; Korean J Gastrointest Endosc 2007;35(3):165-169. Published online September 30, 2007

Abstract PDF: Esophageal and duodenal tuberculosis are rare form of gastrointestinal tuberculosis. The common complications due to esophageal and duodenal tuberculosis are fistulous communications with the adjacent structures, perforation, obstruction, and upper gastrointestinal bleeding. Massive bleeding in esophageal and duodenal tuberculosis is quite rare. We encountered a case of a 55-year-old male who presented with hematemesis and melena. Esophageal and Duodenal tuberculosis with a duodenal fistula was diagnosed by an endoscopic and radiology examination. He improved after treatment with anti-tuberculosis medication over a 9 month period. We report this case of esophageal and duodenal tuberculosis associated with pulmonary tuberculosis with a review of the relevant literature. (Korean J Gastrointest Endosc 2007;35:165-169)

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A Case of Refractory Esophageal Stricture Induced by Lye Ingestion and Treated by Temporary Placement of Newly Designed Self-Expanding Metal Stent and Wetting with Mitomycin C: Seong Bong Pyo, M.D., Hyeung Cheol Moon, M.D., Chang Jun Shin, M.D., Kyoung Wan You, M.D., Dong Hyun Oh, M.D., Sang Wook Park, M.D., Gun Young Hong, M.D., Kang Suk Seo, M.D. and Yeun Keun Lim, M.D.; Korean J Gastrointest Endosc 2007;35(3):170-174. Published online September 30, 2007

Abstract PDF: Ingestion of strong acids or strong alkalies may produces severe inflammation on the mucosa of the esophagus and this may also causes esophageal stricture. Several forms of non-operative dilatations have been utilized for the treatment of esophageal stricture and they have shown good results. Yet some patients do not achieve acceptable symptom relief despite of intensive dilatation. Temporary placement of esophageal stent has recently been used in some of these patients. Furthermore, mitomycin C has been used as a conservative treatment for refractive esophageal stricture in children, yet its efficacy has not been well established. We experienced a case of a 64-year old man with severe, recurrent esophageal stricture, and this was successfully managed by temporary placement of an esophageal stent, together with a spray of mitomycin C. We report on this case along with the review of the literature. (Korean J Gastrointest Endosc 2007;35:170-174)

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Two Cases of Advanced Gastric Carcinomas Showing Features of Submucosal Tumors: Chang Kyun Hong, M.D., Woo Chul Chung, M.D., Hyun Joo Choi, M.D.*, Young Chul Kim, M.D., Kang Moon Lee, M.D., Jin Mo Yang, M.D., Jae Kwang Kim, M.D., Sok Won Han, M.D., Kyu Yong Choi, M.D. and In-Sik Chung, M.D.; Korean J Gastrointest Endosc 2007;35(3):175-180. Published online September 30, 2007

Abstract PDF: Gastric carcinoma showing the features of a submucosal tumor (SMT) is extremely rare. The incidence of this type of tumor has been reported to be 0.1∼0.63%. We report two cases of advanced gastric carcinomas showing the features of SMT. A 58-year-old man visited our hospital with a melena. An endoscopic examination revealed a 3.0 cm sized protruding lesion on the posterior wall of the gastric antrum. Most of the tumor surface was covered with normal mucosa and ulceration was observed in the center. Although the histological diagnosis could not be obtained prior to surgery, a gastrectomy was performed due to the high risk of malignancy. The tumor was diagnosed histologically as a lymphoepithelioma-like carcinoma. The other patient was a 64-year-old man with the chief complaint of epigastric discomfort. An endoscopic examination revealed a SMT like lesion with a central ulceration and hard coated exudate in the high body of the stomach. The microscopic examination revealed a poorly differentiated vimentin-positive adenocarcinoma. Unfortunately, he died from the disease two months later. (Korean J Gastrointest Endosc 2007;35:175-180)

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A Case of Russell Body Gastritis Associated with Helicobacter pylori Infection: Sung Woo Eum, M.D., Jae Hyun Lee, M.D., Kyu Young Kim, M.D., Jong Pil Park, M.D., Jung Soo Lee, M.D., Jin Hong Park, M.D., Hyang Eun Seo, M.D., Se Hwan Kim, M.D., Chang Geun Park, M.D., Hyun Su Kim, M.D. and Mi Jin Gu, M.D.*; Korean J Gastrointest Endosc 2007;35(3):181-185. Published online September 30, 2007

Abstract PDF: Russell body gastritis is a very rare disease with an uncertain cause. The disease is often misdiagnosed as xanthoma, signet ring cell carcinoma, MALT lymphoma and plasmacytoma. Russell body gastritis is characterized by the polyclonic nature of immunoglobulin and usually tests positive to the kappa and lambda light chains. It is different from a Mott cell tumor, which shows monoclonal nature of immunoglobulin. Until now, few cases have been reported and most were associated with a Helicobacter pylori infection. We encountered a case of Russell body gastritis associated with a Helicobacter pylori infection, which showed complete improvement after eradicating the Helicobacter pylori infection. We report this case with review of the relevant literature. (Korean J Gastrointest Endosc 2007;35:181-185)

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A Case of Gastritis Cystica Profunda with a Long Stalk Presenting with Upper Gastrointestinal Bleeding: Ji Eun Yoon, M.D., Min Su Kim, M.D., Kyu Chol Lee, M.D., Hyo Jin Park, M.D. and Chan Il Park, M.D.*; Korean J Gastrointest Endosc 2007;35(3):186-189. Published online September 30, 2007

Abstract PDF: Gastritis cystica profunda (GCP) is a rare disease in which hyperplastic and cystic dilatation of the gastric mucous glands extend into the tissues beneath the submucosa. GCP is mainly observed at the site of a gastroenterostomy; however, it may occur in the stomach without a previous history of surgery. GCP may present not only as a submucosal tumor or as solitary or diffuse polyps but also rarely as a giant gastric mucosal fold. In a patient without a previous history of surgery, GCP presents mainly as a sessile polypoid protrusion or as a submucosal tumor. In addition, GCP presents with non-specific symptoms and is most commonly found incidentally. We present a case of GCP that developed upper gastrointestinal bleeding and showed a long stalk and a focal ulcerative lesion on the surface of a polyp that developed in the stomach without a history of previous surgery. This lesion was removed by the use of an endoscopic polypectomy and was histologically diagnosed as GCP. (Korean J Gastrointest Endosc 2007;35:186-189)

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A Case of Endoscopic Unroofing after Detachable Snare Ligation of a Duodenal Duplication Cyst: Jong Hyeok Park, M.D., Jeong Seop Moon, M.D., Myoung-Ki Oh, M.D., Sun Young Kim, M.D., Jin Gook Huh, M.D., Tae Yeob Jeong, M.D., Kyung Sun Ok, M.D., Soo Hyung Ryu, M.D., Jung Hwan Lee, M.D. and You Sun Kim, M.D.; Korean J Gastrointest Endosc 2007;35(3):190-195. Published online September 30, 2007

Abstract PDF: A duodenal duplication cyst is rare congenital anomaly, which accounts for 5% of all gastrointestinal duplication cysts. Most of the duodenal duplication cysts are usually found during infancy or early childhood, and present with obstructive symptoms. The most common clinical manifestations are an intestinal obstruction or, less commonly, hemorrhage, perforation, biliary obstruction or pancreatitis. The traditional treatment of a duodenal duplication cyst has been complete surgical resection, but very few cases of endoscopic treatment of a duodenal duplication cyst have been previously reported recently in the literature. Moreover, endoscopic treatment of a duodenal duplication cyst has not been reported in Korea. We report our first experience of a duodenal duplication cyst, including diagnosis and endoscopic management with a detachable snare. (Korean J Gastrointest Endosc 2007;35:190-195)

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A Case of Gastric and Colonic Hyperplastic Polyposis Associated with Colonic Adenomas: Jennifer Lee, M.D., Sung Eun Lee, M.D., Ye Ree Park, M.D., Shin Ae Park, M.D., Eui Hyung Kim, M.D., Kon Ho Shim, M.D., Eun Jung Jeon, M.D., Jung Hwan Oh, M.D., Sang Wook Choi, M.D. and Ki Ouk Min, M.D.*; Korean J Gastrointest Endosc 2007;35(3):196-200. Published online September 30, 2007

Abstract PDF: Hyperplastic polyps occur either sporadically or as a symptom of polyposis syndrome. When individuals exceed 50 polyps, they are diagnosed with hyperplasic polyposis. Moreover, since such cases are even more sporadic than hyperplastic polyps, the course toward this occurrence has not been properly evaluated. A change to malignancy in hyperplastic polyps is rare; however, when multiple lesions are present, the tendency increases. Colorectal polyposis syndromes with gastric polyps include familial adenomatous polyposis, Gardners syndrome, Peutz-Jeghers syndrome, juvenile polyposis and others with a non-genetic origin. Three cases of multiple colorectal hyperplastic polyposis with gastric hyperplastic polyposis have been reported worldwide; however, a case associated with multiple colonic adenomas has not yet been reported. This study reviews the existing literature and reports our recent experience of a case, in which a 53 year-old man with colorectal and gastric hyperplastic polyposis with associated multiple colonic adenomas. (Korean J Gastrointest Endosc 2007;35:196-200)

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A Case of Tubular Colonic Duplication: Jeong Yo Min, M.D., Tae Ho Kim, M.D., Chang Whan Kim, M.D., Keun Jong Cho, M.D., Sok Won Han, M.D., Yeon Su Lim, M.D.* and Kyu Yong Choi, M.D.; Korean J Gastrointest Endosc 2007;35(3):201-204. Published online September 30, 2007

Abstract PDF: Colonic duplication is a rare congenital anomaly. Generally, two-thirds of cases manifest before the age of 2 years and only a few cases are encountered in adults. The pathogenesis has not yet been confirmed. Morphologically, the condition is divided into two types, cystic and tubular. Treatment is reserved for symptomatic or complicated cases, and surgical resection is the treatment of choice. Prognosis is generally favorable. We report a case of colonic duplicaton in 59-year-old woman. (Korean J Gastrointest Endosc 2007;35:201-204)

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A Case of Autoimmune Pancreatitis Diagnosed by Immunohistochemical Staining of IgG4: Tae Gun Moon, M.D., Kyu Taek Lee, M.D., Hoi Jin Kim, M.D., June Sang Lee, M.D., Jung Su Ha, M.D., Pung Kang, M.D., Jong Kyun Lee, M.D., Jae J. Kim, M.D., Jong Chul Rhee, M.D. and Kee Taek Jang, M.D.*; Korean J Gastrointest Endosc 2007;35(3):205-209. Published online September 30, 2007

Abstract PDF: Autoimmune pancreatitis is a distinct entity with characteristic morphological, histological and clinical features. Since the first report in 1961, there have been many reports on autoantibodies associated with autoimmune pancreatitis. Lymphoplasmacytic infiltration with fibrosis is the characteristic histological feature of autoimmune pancreatitis. Elevation of immunoglobulin G4 (IgG4), a subtype of IgG, can be seen in autoimmune pancreatitis. A few reports of autoimmune pancreatitis based on immunostaining of IgG4 have been published, but no reports have been published in Korea. We present here the first report of autoimmune pancreatitis, based on an increased serum IgG4 level and plasma cell infiltration that showed IgG4 positivity by immunohistochemical staining of the major papilla. (Korean J Gastrointest Endosc 2007;35:205-209)

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