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Volume 36(5); May 2008
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The Re-infection of Helicobacter pylori and the Presence of Metachronous Lesions after Endoscopic Mucosal Resection of Gastric Neoplasias
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Min Huh, M.D., Byung Wook Kim, M.D., Bo In Lee, M.D., Hwang Choi, M.D., Se Hyun Cho, M.D., Jeong Seon Ji, M.D., Kyu Yong Choi, M.D., Min Kuk Kim, M.D., Hyun Jung Jung, M.D., Jeong Won Jang, M.D., Hiun Suk Chae, M.D. and In Sik Chung, M.D.
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Korean J Gastrointest Endosc 2008;36(5):257-261. Published online May 30, 2008
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Abstract
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/Aims: The aims of this study were to determine the H. pylori re-infection rate in patients that underwent endoscopic mucosal resection (EMR) due to a gastric adenoma and gastric adenocarcinoma, and to define the correlation between H. pylori re-infection and the presence of metachronous lesions. Methods: An endoscopic examination with a biopsy was performed at six months, 12 months, and every year thereafter to determine if H. pylori re-infection occurred and if metachronous lesions were present in patients that had undergone EMR (EMR group). At least a three-year follow-up examination was performed, and patients with an on-site recurrent lesion were excluded. The re-infection rate was compared to the rate in patients with peptic ulcers (control group). Results: Six patients (24%) among the 25 patients included in this study had H. pylori re-infection, an indication of a high re-infection rate as compared to the rate in patients with peptic ulcers (p=0.03). Two patients (33.3%) who were re-infected with H. pylori had metachronous lesions (p=0.009). Conclusions: Determination of the H. pylori status during a follow-up study after EMR is essential and re-eradication therapy is recommended in patients with H. pylori re-infection to prevent metachronous lesions. (Korean J Gastrointest Endosc 2008;36: 257-261)
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Clinical Overview of Acute Lower Gastrointestinal Bleeding
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Kyeong Ok Kim, M.D., Byung Ik Jang, M.D., Tae Nyeun Kim, M.D., Jong Ryul Eun, M.D., Kyu Hyung Lee, M.D., Si Hyung Lee, M.D., Jae Won Choi, M.D. and Youn Sun Park, M.D.
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Korean J Gastrointest Endosc 2008;36(5):262-267. Published online May 30, 2008
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Abstract
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- Background
/Aims: Acute lower gastrointestinal bleeding (LGIB) is a common disorder that requires hospitalization. Colonoscopy is considered as the procedure of choice for diagnosing acute LGIB. The aim of this study was to analyze the clinical characteristics, endoscopic diagnosis and clinical course of acute LGIB. Methods: From January 2000 to August 2007, 117 patients with hematochezia, who visited Yeungnam University hospital emergency center and underwent colonoscopy or sigmoidoscopy, were reviewed retrospectively. The male to female ratio was 2.25 (81:36). The mean age was 59.1±16.9 years. Results: The mean time from presentation to endoscopy was 12.6 hours. The cause of bleeding was identified in 88.9% of the cases after endoscopy. The causes of the acute LGIB were colitis: 26 cases, post polypectomy bleeding: 17 cases, colon ulcer: 16 cases, diverticular bleeding: 13 cases, colon cancer: 9 cases, angiodysplasia: 7 cases and hemorrhoid: 6 cases. Thirty six patients were treated by the endoscopic method; the mean duration of admission was 10.6±10.0 days and the mean amount of transfusion was 3.0±1.9 U. Those numbers showed statistically significant differences according to the diagnosis. Conclusions: The most common cause of acute LGIB was colitis and the causes of bleeding were a significant factor that affects the severity of bleeding and the duration of admission. (Korean J Gastrointest Endosc 2008;36:262-267)
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Usefulness and Cost-effectiveness of Colorectal Stent Followed by Curative Resection for Left-sided Malignant Colorectal Obstruction
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Soon Man Yoon, M.D., Jeong-Sik Byeon, M.D., Jong Wook Kim, M.D., Do Hoon Kim, M.D., Mi Young Do, M.D., Byunggyu Kim, M.D., Seunghyun Kwon, M.D., Byong Duk Ye, M.D., Seung-Jae Myung, M.D., Suk-Kyun Yang, M.D., Hee Cheol Kim, M.D.*, Chang Sik Yu, M.D.*, Jin
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Korean J Gastrointest Endosc 2008;36(5):268-273. Published online May 30, 2008
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Abstract
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- Background
/Aims: We aimed to evaluate the cost-effectiveness of preoperative stent insertion for treating left-sided malignant colorectal obstruction. Methods: Patients with left-sided malignant colorectal obstruction were included in this study. The stent group (ST, n=24) included those patients who were treated with preoperative stent insertion followed by curative surgical resection. The clinical course and management cost of the ST group was compared to those of the emergency operation group (EO, n=22). Results: The patients' age (60.6±3.1 yrs vs. 62.1±3.2 yrs, p=0.74) and the male to female ratio (12：12 vs. 15：7, p=0.25) were not different between the ST and EO groups. The distribution of the postoperative pathologic stages was also not different. All the patients in the ST group underwent only one surgical operation, while 6 patients (27.3%) in the EO group underwent 2 or more surgeries (p＜0.01). The mean hospital stay in the ST group was 22.0±0.8 days compared to 26.3±2.4 days in the EO group (p=0.09). Postoperative care in the intensive care unit was necessary for one patient (4.2%) in the ST group, while 7 patients (31.8%) in EO group needed postoperative care (p=0.02). Postoperative complications developed in one patient in the ST group, while 6 patients in the EO experienced postoperative complications (p=0.04). The mean total cost per patient was 7,974,236 won for the ST group while this was 9,271,630 won for the EO group (p=0.06). Conclusions: Preopreative stent insertion for treating left-sided malignant colorectal obstruction is more cost-effective than an emergency operation. (Korean J Gastrointest Endosc 2008;36:268-273)
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The Effect of Self-Expanding Metallic Stent Insertion for the Treatment ofMalignant Colorectal Obstruction
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Kee Myung Lee, M.D., Tae Il Kim, M.D.*, Bong Min Ko, M.D.†, Sung Jae Shin, M.D., Won Ho Kim, M.D.*, Jin Hong Kim, M.D., Moon Sung Lee, M.D.†, Hyun Soo Kim, M.D.‡, Young Soo Park, M.D.§, Ka
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Korean J Gastrointest Endosc 2008;36(5):274-281. Published online May 30, 2008
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Abstract
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- Background
/Aims: The aim of this study was to evaluate the clinical and cost effectiveness of the use of stent insertion for malignant colorectal obstruction as compared with performing emergency surgery. Methods: We retrospectively reviewed the medical records of 201 patients. Malignant colorectal obstructions caused by a resectable tumor were treated with preoperative stenting followed by surgery (group A, n=55) or emergency surgery (group B, n=59). Malignant obstructions caused by an unresectable cancer were treated with palliative stenting (group C, n=58) or palliative emergency surgery (group D, n=29). Results: The one-staged radical resection rate was significantly higher in group A patients than in group B patients (87.3% vs. 52.5%, p＜0.05). Post-operative complications were more frequent in group A patients than in group B patients (9.1% vs. 32.2%, p＜0.05). The admission period was significantly shorter for group A patients than for group B patients (25.0 days vs. 33.7 days, p＜0.05). The medical cost was not different for group A and group B patients. Life-long stoma formation was necessary for 15.5% of group C patients and 69% of group D patients, respectively. The admission period was significantly shorter for group C patients than group D patients (10.5 days vs. 22.7 days, p＜0.05). The medical cost was not different for group C and D patients. Conclusions: Stent insertion was an effective treatment modality for malignant colorectal obstruction. (Korean J Gastrointest Endosc 2008;36:274- 281)
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A Case of Eosionophilic Gastroenteritis Involving Entire Gastrointestinal Tract with Eosinophilic Ascites
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Cheol Hong Park, M.D., Seung Jae Lee, M.D., Hyoung Jin Chang, M.D., Guk Jin Lee, M.D., Hyeug Lee, M.D., Hong Seok Song, M.D., Eun Jung Jeon, M.D., Jung Hwan Oh, M.D., Jeong Jo Jeong, M.D., Sang Wook Choi, M.D. and Eun Joo Seo, M.D.*
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Korean J Gastrointest Endosc 2008;36(5):282-287. Published online May 30, 2008
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Abstract
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- Eosinophilic gastroenteritis is a rare condition of unknown cause characterized by pheripheral eosinophilia and eosinophilic infiltration of the gastrointestinal tract. Eosonophilic gastroenteritis is generally classified according to the layer of the gastrointestinal tract that is involved. Serosal eosinophilic infiltration is the rarest form of presentation and can result in the development of eosinophilic ascites. We experienced a case of eosinophlilic gastroenteritis involving the entire gastrointestinal tract in a 34-year-old female patient with abdominal pain that was confirmed by multiple biopsies of the gastrointestinal tract with eosinophilic ascites. The patient was successfully treated with corticosteroids. We report this case with a brief review of the literature. (Korean J Gastrointest Endosc 2008;36:282- 287)
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A Case of a Gastric Metastasis of a Renal Cell Carcinoma
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Won Ook Ko, M.D., Ung Suk Yang, M.D., Nam Sik Kim, M.D., Jin Kwang An, M.D., Kwang Jin Kim, M.D., Hyung Wook Kim, M.D. and Won Il Park, M.D.
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Korean J Gastrointest Endosc 2008;36(5):288-291. Published online May 30, 2008
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- A gastric metastasis is an extremely rare event accounting for 0.2 to 0.7% of gastric neoplasms seen at necropsy. Primary origins of a gastric metastasis are pancreatic cancers, colon cancers, lung cancers and malignant melanomas. A renal cell carcinoma is renowned for its metastatic potential to spread to almost any organ of the body. However, a gastric metastasis of a renal cell carcinoma is very rare. It is believed that a renal cell carcinoma metastasizes hematogenously and it spreads through a renal vein to the stomach via the inferior vena cava and hemiazygos vein. A metastasis to the stomach is frequently located in the greater curvature of body. Endoscopic findings of a gastric metastasis often resemble a submucosal tumor with or without ulcer. Presenting symptoms are bleeding, anemia, or pyloric obstruction, but often the patient is asymptomatic. We report a case and review of the literature of a metastatic renal cell carcinoma to the stomach in a 71-year-old man who complained of a palpable abdominal mass. (Korean J Gastrointest Endosc 2008;36:288-291)
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Duodenal Variceal Bleeding Treated with a Combination of Endoscopic Ligation and Injection Sclerotherapy - Two Case Reports and a Review of the Korean Clinical Literature -
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Jae Min Lee, M.D., Tae Hyo Kim, M.D., Chang Min Lee, M.D., Dong O Kang, M.D., Hyun Ju Min, M.D., Hyun Jin Kim, M.D., Woon Tae Jung, M.D. and Ok Jae Lee, M.D.
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Korean J Gastrointest Endosc 2008;36(5):292-297. Published online May 30, 2008
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- A duodenal varix is a rare cause of hemorrhage in patients with intrahepatic and extrahepatic portal hypertension. However, bleeding in these patients is serious and often life threatening. Treatments for duodenal variceal bleeding include endoscopic injection sclerotherapy, endoscopic ligation, surgical procedures and interventional radiology. We report two cases of duodenal variceal bleeding in a 53- year-old male patient and a 63-year-old female patient with liver cirrhosis that presented with hematemesis and melena. Emergency upper endoscopy examinations revealed the presence of large nodular varices with ruptured erosion on the top of the second portion of the duodenum. A combination of the use of endoscopic ligation and endoscopic injection sclerotherapy was performed and successful hemostasis and eradication of duodenal varices was possible in all cases. Another 19 cases of duodenal variceal bleeding that have been reported in the Korean clinical literature were reviewed. (Korean J Gastrointest Endosc 2008;36:292-297)
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A Case of Granulomatous Liver Disease Combined with Crohn's Disease
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Kyung-Yup Kim, M.D., Hyo Jong Kim, M.D., Jae Young Jang, M.D., Chang Kyun Lee, M.D., Sung Hoon Jung, M.D., Seok Ho Dong, M.D., Byoung-Ho Kim, M.D., Young-Woon Chang, M.D. and Rin Chang, M.D.
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Korean J Gastrointest Endosc 2008;36(5):298-301. Published online May 30, 2008
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- Crohn's disease is a chronic intestinal inflammation and its etiology and pathogenesis have not been defined. Clinical manifestations of Crohn's disease involve abdominal pain, diarrhea, weight loss, intestinal stenosis, presence of fistulas and gastrointestinal hemorrhage. Crohn's disease is also associated with a variety of extraintestinal manifestations such as ankylosing spondylitis, uveitis and primary sclerosing cholangitis. We report a case of Crohn's disease associated with noncaseating granulomatous liver disease that is rare in Korea. (Korean J Gastrointest Endosc 2008;36:298-301)
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A Case of Primary Rectal Diffuse Large B Cell Lymphoma Presented as Multiple Polypoid Lesions
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Si Hyung Lee, M.D., Byung Ik Jang, M.D. and Tae Nyeun Kim, M.D.
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Korean J Gastrointest Endosc 2008;36(5):302-306. Published online May 30, 2008
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- Primary gastrointestinal lymphoma is a rare disease, and a primary rectal diffuse large B cell lymphoma is rarely encountered. We report a case of a 60-year-old woman with diffuse large B cell lymphoma in the rectum. The patient underwent a low anterior resection six years ago due to a sigmoid colonic adenocarcinoma. The patient had multiple polypoid lesions on the rectum, and the patient was diagnosed with primary rectal diffuse large B cell lymphoma after a biopsy. There were no other lesions detected on a chest and abdomen CT scan. After the administration of combination chemotherapy, the polypoid lesions disappeared. (Korean J Gastrointest Endosc 2008;36: 302-306)
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Intestinal Amyloidosis Treated with High-Dose Steroids and Azathioprine: A Case Report
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Seong-Kyu Kim, M.D., Joong Goo Kwon, M.D., Chang Ho Cho, M.D.*, Ji-Hye Oh, M.D. and Soo-Kyung Kim, M.D.
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Korean J Gastrointest Endosc 2008;36(5):307-312. Published online May 30, 2008
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Abstract
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- Amyloidosis is a rare disease characterized by deposition and accumulation of insoluble fibrils in various organs and tissues. Variations in the precursor proteins composing each fibril account for the diverse character of amyloidosis. Amyloidosis light chain (AL) and amyloid A amyloidosis (AA) are two clinical entities representative of this diversity. We present a case of a 58-year-old woman presenting with refractory diarrhea and abdominal pain. She was ultimately diagnosed with intestinal amyloidosis diffusely involving the small and large intestines. Even though a definitive therapeutic strategy has not been established for gastrointestinal amyloidosis, this particular patient has been successfully managed with high-dose steroids and azathioprine. (Korean J Gastrointest Endosc 2008; 36:307-312)
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A Case of Hemobilia Caused by Clonorchiasis
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Kyoung Won Yoon, M.D., Chang Hwan Park, M.D., Seok Cho, M.D., Seung Hwan Lee, M.D., Wan Sik Lee, M.D., Hyeun Soo Kim, M.D., Sung Kyu Choi, M.D. and Jong Sun Rew, M.D.
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Korean J Gastrointest Endosc 2008;36(5):313-317. Published online May 30, 2008
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- Clonorchiasis is a trematodasis caused by ingestion of a raw fish that contains the infective cysts. In cases of early infection, the patients complained non-specific gastrointestinal symptoms, including anorexia, epigastric pain or diarrhea. In cases of long-standing infection, an association with gallstones, choledocholithiasis, cholangitis and cholangiocarcinoma has been reported. However, acute hemorrhagic complications of clonorchiasis are extremely rare. Herein, we report on a case of hemobilia that was caused by Clonorchis sinensis, and this was confirmed by operation. (Korean J Gastrointest Endosc 2008;36:313- 317)
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Two Cases of Percutaneous Transhepatic Choledochoscopy Treatment of Intrahepatic Duct Stones that Occurred after Living Donor Liver Transplantation
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Byung Jun Lee, M.D., Jong Yun Won, M.D.*, Nu Ri Chon, M.D., Se-Joon Lee, M.D. and Dong Ki Lee, M.D.
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Korean J Gastrointest Endosc 2008;36(5):318-323. Published online May 30, 2008
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- Percutaneous transhepatic cholangioscopy (PTCS) is the primary treatment option for general cases of intrahepatic duct stones. However, there are no reports on the use of PTCS for intrahepatic duct stones in patients who had undergone living donor liver transplantation (LDLT). We experienced two cases of successful intrahepatic stone removal by the use of PTCS in LDLT patients. With these cases, we have confirmed that PTCS management can be safely performed not only for a general bile duct stone, but also for a bile duct stone that develops in a patient that had previously undergone liver transplantation. (Korean J Gastrointest Endosc 2008;36:318-323)
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Migration of a Biliary Self-Expanding Metal Stent into the Stomach after Stent Placement in a Patient with Periampullary Cancer
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Sung Ho Ki, M.D., Seok Jeong, M.D., Don Haeng Lee, M.D.*, Jung Il Lee, M.D., Jin-Woo Lee, M.D., Hyung Gil Kim, M.D., Yong Woon Shin, M.D. and Young Soo Kim, M.D.
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Korean J Gastrointest Endosc 2008;36(5):324-327. Published online May 30, 2008
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- Migration of a biliary self-expanding metallic stent (SEMS) may occur proximally or distally after placing a stent for the palliative treatment of patients with unresectable periampullary malignancy. However, migration of a biliary SEMS into the stomach has not yet reported in the English medical literature. Herein we report on a case of periampullary cancer for which a stent that was placed to treat this malady migrated into the stomach. A biliary SEMS had been placed in the distal common bile duct in an 82-year-old woman who was diagnosed with periampullary cancer. The abdominal CT and esophagogastroduodenoscopic findings disclosed that the biliary SEMS had migrated into the stomach and there was marked luminal narrowing of the second portion of the duodenum due to the enlarged periampullary tumor. The migrated stent was easily removed by using a polypectomy snare. We presume that the distally migrated SEMS might have moved into the stomach against the normal direction of peristaltic movement instead of migrating to the intestine because of the duodenal obstruction caused by the growing mass. (Korean J Gastrointest Endosc 2008;36:324-328)
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