Clinical Endoscopy

The Usefulness of Endoscopic Subtumoral Dissection for En-bloc Resection of Upper Gastrointestinal Submucosal Tumors: Hyo Joong Yoon, M.D., Chang Beom Ryu, M.D., Hyun Sik Na, M.D., Ju Hee Maeng, M.D., Sang Hoon Han, M.D., Bong Min Ko, M.D., Su Jin Hong, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.; Korean J Gastrointest Endosc 2008;36(4):193-199. Published online April 30, 2008

Abstract PDF: Background
/Aims: The removal of esophageal and gastric submucosal tumors is difficult using conventional endoscopic mucosal resection methods. This study examined the usefulness of an endoscopic subtumoral dissection for an en-bloc resection of submucosal tumors. Methods: An endoscopic subtumoral dissection was attempted for an en-bloc resection in 15 submucosal tumors (M：F=10：5, 13 stomach, 2 esophagus). Before the procedures, endoscopic ultrasonography was performed in all cases. The procedure was carried out using various electrosurgical knives, such as an endoscopic submucosal dissection. Results: Pathological and immunohistochemical studies confirmed a gastrointestinal stromal tumor in 6 cases. Other pathological diagnoses were made in 9 patients with submucosal lesions: leiomyoma (4), ectopic pancreas (3), lipoma (1), and hemangioma (1). An en-bloc resection was performed in 13 of the 15 tumors (86.7%). The mean specimen size was 29.5×21.1 mm. The mean procedure time was 49.4 minutes (range: 8∼103 minutes). Gastric perforation was a complication in 2 cases with GIST. However, the two perforated cases were treated with endoscopic closure using endoclips and recovered without the need for surgery. Conclusions: An endoscopic subtumoral dissection technique is useful for an en-bloc resection of esophageal and gastric submucosal tumors. However, sufficient attention should be paid to the detection of perforations in the case of tumors with a proper muscle origin. (Korean J Gastrointest Endosc 2008;36:193-199)

2,408 View
7 Download

Clinical Factors That Potentially Affect the Treatment Outcome of Helicobacter pylori Eradication Therapy with using a Standard Triple Regimen in Peptic Ulcer Patients: Taek Man Nam, M.D., Dong Ho Lee, M.D., Kyung Phil Kang, M.D., Jung Hoon Lee, M.D., Jae Il Chung, M.D., Hyun Cheul Choi, M.D., Sang Hyub 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., H; Korean J Gastrointest Endosc 2008;36(4):200-205. Published online April 30, 2008

Abstract PDF: Background
/Aims: Proton pump inhibitor (PPI) based triple therapy for Helicobacter pylori eradication has an approximately 20% treatment failure rate. The aim of this study is to examine the clinical factors that influence eradication of H. pylori in patients with peptic ulcers. Methods: We reviewed the medical records of 597 endoscopy-proven peptic ulcer and H. pylori-positive patients who were treated at our hospital between July 2004 and March 2007. The eradication rate and the effect of age, gender, smoking, alcohol drinking, activity and the location of ulcer and the kind of PPIs were examined. Results: 597 patients were treated with one-week triple therapy (PPI, amoxicillin 1 g, clarithromycin 500 mg all twice daily). The overall eradication rate was 80.2%. Eradication was significantly more successful in the patients with an age under 60, and in patients over 60 and who had a duodenal ulcer (83.2% vs 73.2%, respectively, p=0.005) or a gastric ulcer (82.5% vs 73.6%, respectively, p=0.041). There was no statistically significant difference according to gender, smoking, alcohol, the activity of the ulcer and the kind of PPIs. Conclusions: An age over 60 and gastric ulcer were associated with a lower H. pylori eradication rate in patients with peptic ulcers. Therefore, H. pylori eradication in old age patients and in patients with gastric ulcer should be managed differently and the treatment duration should be extended or a new treatment regime developed to overcome the lower eradication rate. (Korean J Gastrointest Endosc 2008;36:199-205)

2,287 View
15 Download

The Effects of Flumazenil on the Recovery Time and Satisfaction of the Use of Sedative Endoscopy with Midazolam: Dae-Kyoum Kim, M.D., Hwoon-Yong Jung, M.D.*, Hyo Mi Ko, R.N., Ji Yun Jo, M.D., Seog Gyun Kim, M.D., Don Lee, M.D., Hye-Sook Chang, M.D., Hye-Kyung Song, M.D., Hyun Ju Lee, M.D., Eun Ju Chung, M.D., Hye Won Park, M.D. and Jin Ho Kim, M.D.*; Korean J Gastrointest Endosc 2008;36(4):206-212. Published online April 30, 2008

Abstract PDF: Background
/Aims: Treatment with flumazenil results in rapid reversal from sedation. In addition, the use of flumazenil can prevent accidents or memory loss after endoscopy. This study was conducted to evaluate the role of flumazenil according to dose. Methods: A total of 150 consecutive outpatients were randomly allocated into three groups: patients given normal saline (control group), patients given 0.25 mg flumazenil (0.25 mg flumazenil group) and patients given 0.5 mg flumazenil (0.5 mg flumazenil group). Flumazenil or normal saline was injected 10 minutes after the completion of endoscopy. We evaluated the recovery time, time to discharge, patient satisfaction, and memory loss after discharge. Results: The control group consisted of 44 subjects, the 0.25 mg flumazenil group consisted of 46 subjects and the 0.5 mg flumazenil group consisted of 45 subjects. The recovery time was significantly shorter in the two flumazenil groups as compared to the control group (28.5±15.0 min, 13.8±3.7 min, 12.4±1.7 min for the control group, 0.25 mg flumazenil group and 0.5 mg flumazenil group, respectively)(p＜0.001). The time to discharge after an examination was shorter in the flumazenil groups and showed dose-dependency (41.2±20.5 min, 22.1±10.9 min, 16.4±2.2 min for the control group, 0.25 mg flumazenil group and 0.5 mg flumazenil group, respectively) (p＜0.001). There was no significant difference in patient satisfaction among the three groups. The degree of memory recall was better in the 0.5 mg flumazenil group than in the other two groups (p＜0.001). Conclusions: Flumazenil reversal of midazolam sedative endoscopy results in fast recovery and is helpful to minimize memory loss after an examination without interference of satisfaction. (Korean J Gastrointest Endosc 2008;36:206-212)

1,951 View
18 Download

A Case of Dysphagia Lusoria Caused by an Aberrant Right Subclavian Artery in an Adolescent: Eun Jung Shin, M.D., Hyung Keun Kim, M.D., Jin Soo Kim, M.D., Young Seok Cho, M.D., Woo Hyung Choi, M.D., Yong Wan Park, M.D., Hye Suk Son, M.D., Hiun Suk Chae, M.D. and Kyu Yong Choi, M.D.; Korean J Gastrointest Endosc 2008;36(4):213-218. Published online April 30, 2008

Abstract PDF: Dysphagia lusoria is used to describe the symptomatic compression of the esophagus from an anomalous vessel of the aortic arch. A right aortic arch with an aberrant left subclavian artery is the most common type of aortic arch abnormalities, followed by double aortic arch, and then an aberrant right subclavian artery. These anomalous vessels may cause dysphagia from the compression of the esophagus in adults, but they usually do not produce symptoms and they are usually found incidentally. Several cases of adult dysphagia lusoria have been reported in Korea, but there has been no reported case in an adolescent. We experienced a case of a 17-year-old female who suffered from dysphagia. We evaluated the possible causes of her dysphagia by performing esophagogastroduodenoscopy, esophagoraphy, esophageal manometry and chest computed tomography. We finally diagnosed this case as dysphagia lusoria caused by an aberrant right subclavian artery. (Korean J Gastrointest Endosc 2008;36:213-218)

1,929 View
10 Download

A Case of Gastric Huge Intramucosal Hematoma after Snare Polypectomy: Chang Kyun Lee, M.D., Jae Young Jang, M.D., Young Hwangbo, M.D., Jaejun Shim, M.D., Sung Hoon Jung, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byung-Ho Kim, M.D.,Young Woon Chang, M.D. and Rin Chang, M.D.; Korean J Gastrointest Endosc 2008;36(4):219-223. Published online April 30, 2008

Abstract PDF: Endoscopic polypectomy is a widely used therapeutic modality for the treatment of polypoid lesions in the gastrointestinal tract. Postpolypectomy bleeding is the most common procedure-related complication. Bleeding can occur immediately after the polypectomy or be delayed from hours to up to days. The severity of bleeding ranges from slight oozing to spurting arterial bleeding that requires immediate endoscopic hemostasis. Because severe hemorrhage can be a cause of repeat endoscopy, blood transfusion, hospitalization or surgery, endoscopists must carefully observe the patient's symptoms and hemodynamic status after an endoscopic polypectomy. Here, we report a large intramucosal hematoma and subsequent huge ulcer in the stomach as a rare complication of endoscopic snare polypectomy. (Korean J Gastrointest Endosc 2008;36: 219-223)

2,411 View
19 Download

A Case of Esophageal and Gastric Foreign Bodies Induced by Cyanoacrylate Ingestion: Kil Sang Wang, M.D., Myoung Hwan Kim, M.D., Myoung Lyeol Woo, M.D., Ja Sung Choi, M.D., Hyeon Geun Cho, M.D. and Young Myoung Moon, M.D.; Korean J Gastrointest Endosc 2008;36(4):224-227. Published online April 30, 2008

Abstract PDF: Foreign bodies of the upper gastrointestinal tract are found in all age groups, and the foreign bodies can be ingested incidentally or intentionally. They are usually common in children, but they have also been discovered in adults with esophageal disease, artificial teeth, mental retardation, in patients seeking secondary gains and in alcoholics. The types of foreign bodies vary for different social and cultural conditions, and can include coins, corks, toys, fish bones, toothbrushes, needles, nails and pens. Foreign bodies of the upper gastrointestinal tract are usually passed into the intestinal tract spontaneously, but sometimes intervention is required. We report a case of an 80-year-old man with a past medical history of depressive disorder that had ingested adhesives. The adhesives present in the esophagus were removed by the use of therapeutic endoscopy. However, the adhesives in the stomach were too large to remove by the use of an endoscopic procedure, and gastrotomy was performed. (Korean J Gastrointest Endosc 2008;36:224-227)

2,055 View
8 Download

A Case of Small Intestinal Obstruction due to Bezoars Accompanied with Sump Syndrome: Joo Hee Kim, M.D., Kyo-Sang Yoo, M.D., Hyoung-Chul Park M.D.*, Tae Kyung Lim, M.D., Sun You Moon, M.D., Youn Son Chung, M.D., Su Mi Yoon, M.D., Kyoung Oh Kim, M.D., Yong Woo Chung, M.D., Cheol Hee Park, M.D., Taeho Hahn, M.D., Sang Hoon Park, M.D., Jong H; Korean J Gastrointest Endosc 2008;36(4):228-232. Published online April 30, 2008

Abstract PDF: Sump syndrome is one of the late complications of a side to side choledochoduodenostomy, but it is a rare malady. The anastomosis of the bile duct and small bowel results in exclusion of the distal limb of the common bile duct from drainage of bile with the potential formation of a sump. Food material and bile sludge may accumulate in distal segment of common bile duct and so this cause recurrent bile duct stones. Bezoars frequently result from disturbed passage of the gastrointestinal tract, especially after surgery, and it may develop various symptoms by irritating or obstructing the gastrointestinal tract. The bezoar accompanied with sump syndrome after choledochoenterostomy has not yet been reported in the literature. We report here on a case of small intestinal obstruction due to bezoars accompanied with sump syndrome. (Korean J Gastrointest Endosc 2008;36:228-232)

2,119 View
5 Download

A Case of Amyloidosis with Recurrent Intestinal Bleeding: Song Mi Moon, M.D., Chang Kyun Lee, M.D., Jae Young Jang, M.D., Seok Ho Dong, M.D., Byung Ho Kim, M.D., Young Woon Chang, M.D., Rin Chang, M.D. and Hyo Jong Kim, M.D.; Korean J Gastrointest Endosc 2008;36(4):233-237. Published online April 30, 2008

Abstract PDF: Amyloidosis is characterized by deposition of amyloid in the intercellular space and vascular wall. Amyloid deposition provokes dysfunction of the accumulated organ and causes variable clinical symptoms that depend on the involved organ. Although intestinal bleeding may occur with amyloidosis, it is relatively rare as a presenting symptom or as the sole manifestation of the disease. We experienced a case of recurrent intestinal bleeding in a 68-year-old female patient with lambda type primary amyloidosis. A colonoscopy revealed the presence of multiple large circular ulcers in the transverse colon and nonspecific submucosal hemorrhage and edema at the rectum. An endoscopic biopsy established the diagnosis of amyloidosis. A case of recurrent intestinal bleeding in a patient with primary amyloidosis is presented, with a review of the literature. (Korean J Gastrointest Endosc 2008;36:233-237)

2,225 View
9 Download

A Case of Sarcoidosis Presenting as a Rectal Polyp: Wonseok Kang, M.D., Beom Kyung Kim, M.D., Min Ju Kim, M.D.^†, Jae Hee Cheon, M.D.*, Yong Chan Lee, M.D.*, Won Ho Kim, M.D.* and Sang Kil Lee, M.D.*; Korean J Gastrointest Endosc 2008;36(4):238-241. Published online April 30, 2008

Abstract PDF: Sarcoidosis is a multi-systemic syndrome with an unknown etiology that is characterized by the formation of multiple non-caseating granulomas that disrupts the architecture and function of the tissues. A 58-year-old woman was referred for a skin rash and papules. No specific findings were observed on the initial skin biopsy. On gastroscopy and colonoscopy, gastric erosion and rectal polyp were noted. The rectal biopsy revealed non-caseating granulomas without acid-fast bacilli, indicating a differential diagnosis of Crohn's disease and other granulomatous diseases. A repeat skin biopsy of the papular lesion showed non-caseating granulomas that was consistent with sarcoidosis. The chest x-ray and computed tomography (CT) revealed cardiomegaly without hilar lymphadenopathy. The serum angiotensin converting enzyme level was 122 U/L (normal: 8∼52 U/L) with normal liver chemistry as well as normal electrolyte, serum calcium and c-reactive protein levels. Finally, the patient was diagnosed with sarcoidosis with rectal involvement. We report this rare case of sarcoidosis that presented as a rectal polyp. (Korean J Gastrointest Endosc 2008;36:238-241)

1,977 View
8 Download

A Case of Giant Colonic Lipoma Endoscopically Removed Using an Unroofing Technique in Phases: Young Kook Shin, M.D., Eun Young Kim, M.D., Seung Woon Jeon, M.D., Chang Jae Huh, M.D., Byung Seok Kim, M.D., Jae Uk Shin, M.D.^†, Jin Tae Jung, M.D., Joong Goo Kwon, M.D. and Chang Ho Cho, M.D.*; Korean J Gastrointest Endosc 2008;36(4):242-247. Published online April 30, 2008

Abstract PDF: Gastrointestinal lipomas are benign adipose tumors that are usually submucosal, and most commonly found in the colon. However, they have also been discovered in the small bowel, stomach and very rarely in the esophagus. Although most of gastrointestinal lipomas are asymptomatic and are found incidentally at time of endoscopy, surgery or autopsy, large lipomas can cause acute abdominal pain, bowel habit changes, gastrointestinal bleeding, intussusception or bowel obstruction. Lipomas can be diagnosed by colonoscopy, abdominal CT, barium series and endoscopic ultrasonography (EUS). Large lipomas need to be treated using various techniques. However, the best treatment modality for large lipomas has not yet been established. A surgical resection of lipomas should be considered for a giant lipoma ＞2 cm in diameter due to the risk of perforation or hemorrhage. Currently, endoscopic snare polypectomy or endo-loop ligation is used to treat symptomatic lipomas, which may reduce the risk of complications associated with endoscopic treatment. We report a case of giant colonic lipoma that was diagnosed successfully with EUS and treated safely using an endoscopic unroofing technique, endoloop ligation and snare polypectomy in phases. (Korean J Gastrointest Endosc 2008;36:242-247)

1,956 View
8 Download

A Case of Colonic Stricture due to Ischemic Colitis: Won-Joon Lee, M.D., Hyun Jeong Lee, M.D., So-Mi Kim, M.D., Seok-Young Kim, M.D., Ji-Yoen Lee, M.D., Il Young Chon, M.D., Dong Joon Oh, M.D. and Seung Jin Choi, M.D.; Korean J Gastrointest Endosc 2008;36(4):248-251. Published online April 30, 2008

Abstract PDF: Ischemic colitis is the most common form of ischemic injury to the gastrointestinal tract and this frequently occurs in the elderly. It manifests with sudden, left lower abdominal pain, diarrhea and hematochezia. Radiologic modalities such as barium enema may be helpful in delineating the degree and location of ischemic colitis, but colonoscopy is the procedure of choice for making the diagnosis. Ischemic colitis generally runs a benign course lasting a few days and it requires only supportive treatment in most cases. Complications of ischemic colitis and recurrence are rare. We report here on a case of colonic stricture that was caused by ischemic colitis, and we include a brief review of the relevant literature. (Korean J Gastrointest Endosc 2008;36:248-251)

2,215 View
18 Download

A Case of Complete Agenesis of the Dorsal Pancreas: Sun Jung Kim, M.D., Byung Hoon Han, M.D., Hyun Joo Jung, M.D., Hong Jun You, M.D., Sung Woo Yang, M.D., Se Young Park, M.D. and Sang Uk Lee, M.D.; Korean J Gastrointest Endosc 2008;36(4):252-255. Published online April 30, 2008

Abstract PDF: The pancreas with the complete absence of its body and tail is the result of underdevelopment or agenesis of the dorsal pancreatic bud during embryogenesis, and this is a rare anomaly. We report here on a case of a 38-year-old man who had a pancreas with the total absence of the body and tail. On the abdominal computed tomography (CT), only a pancreatic head portion with speckled calcifications was seen, and the pancreatic body and tail were not visualized at all. Endoscopic retrograde cholangiopancreatography (ERCP) showed only a short major pancreatic duct with smooth tapering and terminal arborization. The Ampulla of Vater had a normal appearance and it was located at the medial side of the second portion of the duodenum. There was no difficulty to perform cannulation. Any minor papilla was not found. On magnetic resonance cholangiopancreatography (MRCP), the duct of Santorini and the duct in the body and tail were not visualized. (Korean J Gastrointest Endosc 2008;36:252-256)

2,001 View
4 Download

Previous issues