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Volume 37(1); July 2008
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Self-Expandable Metallic Stent Therapy for a Gastrointestinal Benign Stricture
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Hae Won Han, M.D., In Seok Lee, M.D., Jae Myung Park, M.D., Jung Hwan Oh, M.D., Yu Kyung Cho, M.D., Sang Woo Kim, M.D., Myung-Gyu Choi, M.D. and In-Sik Chung, M.D.
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Korean J Gastrointest Endosc 2008;37(1):1-6. Published online July 30, 2008
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Abstract
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- Background
/Aims: It is well known that self-expandable metallic stents are useful for the treatment of malignant strictures. Balloon and bougie dilation have received significant attention as a useful treatments for a gastriointestinal benign stricture, but the use of stents has some complications, including perforation and bleeding. We evaluated the clinical effectiveness and procedure- related complications of the use of self-expandable metallic stent therapy in gastrointestinal benign strictures. Methods: We inserted self-expandable metallic stents in 11 patients with benign strictures during the period from January 2003 to May 2007. Eleven patients were included in this study (six males; mean age, 50.9 years). We observed clinical improvement, as well as complications and restenosis during follow-up. We defined "recurrence" as the return of symptoms. Results: The causes of strictures were peptic ulcers (eight cases), corrosive esophagitis (two cases) and an anastomosis site stricture (one case). Three stents migrated within two weeks after placement. The mean length of time of a stent staying in a stricture was 16.1 days (3∼35 days). After stent dilation, none of the patients had dysphagia to solid food or procedure- related complications. During a mean follow-up period of 12.8 months (3∼35 months), the rate of restenosis was 36.4% (4/11 cases). All restenosis cases (two cases of peptic ulcer and two cases of corrosive esophagitis) occurred within three months after stent placement. Conclusions: We conclude that the use of self-expandable metallic stent therapy can be effective and safe for patients with gastrointestinal benign strictures. Restenosis (36.4%) occurred within three months. Future research on the management of gastrointestinal benign strictures is recommended. (Korean J Gastrointest Endosc 2008;37: 1-6)
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The Clinical Findings of Gastrointestinal Burkitt Lymphoma in Adults
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Jae Hong Jung, M.D., Jun Haeng Lee, M.D., Jae Seung Lee, M.D., Sung Chul Choi, M.D., Dong Kyung Chang, M.D., Young-Ho Kim, M.D., Hee Jung Son, M.D., Poong-Lyul Rhee, M.D., Jae J. Kim, M.D., Jong Chul Rhee, M.D., Young Hyeh Ko, M.D.* and Won Seog Kim, M.D.
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Korean J Gastrointest Endosc 2008;37(1):7-13. Published online July 30, 2008
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/Aims: The endoscopic and clinical findings of gastrointestinal (GI) Burkitt lymphoma in Koreans are not well known. Methods: From January 1995 to July 2007, 80 patients (47 adults and 33 children) were diagnosed with Burkitt lymphoma at our institution. The clinical and endoscopic manifestations were analyzed in the adult patients (n=20, median age=52 yr) with GI Burkitt lymphoma. Results: The most frequent symptom was abdominal pain (50%) followed by epigastic soreness (30%). Among the 20 patients with GI Burkitt lymphoma, 11 (55%) had gastric lesions, 4 (20%) had colonic lesions, 3 (15%) had both gastric and duodenal lesions, 1 (5%) had both gastric and colonic lesions, and 1 (5%) had gastric, duodenal and colonic lesions. For the 13 patients who had endoscopic pictures available, the most common type of disease was the ulcerative type (38.5%) followed by the ulcerofungating and ulceroinfiltrative types (23.1% and 23.1%, respectively). Most of the patients were diagnosed with advanced disease. The most common clinical stage was stage IVE (60%) by the Musshoff staging system. All 20 patients received combination chemotherapy, and the 5-year survival rate was 64%. Conclusions: For patients with GI Burkitt lymphoma, the most commonly involved site was the stomach. Most lesions were ulcerative with or without fungating morphology. Considering the advanced stage of most patients, the prognosis after systemic chemotherapy was favorable. (Korean J Gastrointest Endosc 2008;37:7-13)
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The Pathological Differences of Colorectal Polyps Examined between the Use of a Forcep Biopsy and Endoscopic Resection
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In Do Song, M.D., Jeong Wook Kim, M.D. and In Soo Oh, M.D.
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Korean J Gastrointest Endosc 2008;37(1):14-19. Published online July 30, 2008
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/Aims: Complete excision of colorectal polyps is not always performed for various reasons. We investigated the discrepancy between the histologic findings of polyps excised by a forcep biopsy and histologic findings of polyps excised by endoscopic resection. Methods: We reviewed 137 patients with 206 colorectal polyps removed by endoscopic resection following forcep biopsies. Endoscopic records and pathological reports of patients were analyzed retrospectively. Results: The discrepancy of the histological type was 18.4% between the histologic findings of a polyp evaluated after a forceps biopsy and the histologic findings of a polyp evaluated after endoscopic resection. The discrepancy of high-grade dysplasia (HGD) and a cancerous condition was 22.3% using the two procedures. A total of 15.5% of adenomas without HGD and 3.0% of hyperplasia in the forcep biopsy specimens were identified as adenomas with HGD in the resected specimens. A total of 18.2% of adenomas with HGD and 4.1% of adenomas without HGD in the forcep biopsy specimens were identified as adenomas with carcinoma in the resected specimens. The discrepancy rates of the histological type for HGD and a cancerous condition were high for penduculated polyps with a diameter of less than 10 mm and for polyps with a diameter of greater than 16 mm. Conclusions: Approaches to review the histology of an entire colorectal polyp should be performed, especially for polyps with an adenomatous histology and for polyps of the pedunculated form with a diameter of less than 10 mm and a diameter of greater than 16 mm after a forcep biopsy. (Korean J Gastrointest Endosc 2008;37:14-19)
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A Case of Mucosal Necrosis of the Stomach after Endoscopic Injection Therapy with Hypertonic Saline-Epinephrine (HS-E) for a Bleeding Peptic Ulcer with an Exposed Vessel
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Do Hwae Park, M.D., Sun Taek Choi, M.D., Min Jae Cho, M.D., Jung Hyun Ryu, M.D. and Dong Wok Lee, M.D.
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Korean J Gastrointest Endosc 2008;37(1):20-24. Published online July 30, 2008
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- Peptic ulcer bleeding is a frequent cause of upper G-I bleeding. Endoscopic injection therapy with hypertonic saline-epinephrine (HS-E) is a cost-effective and widely used therapy for hemostasis; however, 1∼3% of patients experience bleeding or perforation. A 70 year-old male patient was admitted with melena and hematemesis. An endoscopy on admission showed the presence of a 1 cm- sized well-demarcated ulcer with pulsatile bleeding at the lesser curvature of the distal antrum. Approximately 28 mL of HS-E solution was injected around the exposed vessel. Follow-up endoscopy performed 7 days later showed the presence of a 2 cm-sized newly developed mucosa necrosis at the lesser curvature of the pyloric channel, which was caused by ischemic necrosis of the gastric mucosa after HS-E injection. Endoscopic injection therapy with HS-E solution is a relatively safe technique, but mucosa necrosis can occur with the use of a dose of HS-E that is considered safe. We report a case of gastric mucosa necrosis following endoscopic HS-E injection therapy of a bleeding peptic ulcer. (Korean J Gastrointest Endosc 2008;37:20-24)
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A Case of Jejunogastric Intussusception that was Diagnosed by Gastroscopy in a Patient who had Undergone Subtotal Gastrectomy
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Kang Kim, M.D., Gun Young Hong, M.D., Sang Chul Choi, M.D., Jun Ho Cho, M.D., Kyung Rok Lee, M.D., Sang Uk Park, M.D., Kang Suk Seo, M.D. and Yun Ken Lym, M.D.
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Korean J Gastrointest Endosc 2008;37(1):25-29. Published online July 30, 2008
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- Jejunogastric intussusception is a rare, but potentially lethal complication after gastrectomy or gastrojejunostomy. In the acute condition, early diagnosis and prompt surgical treatment are mandatory to reduce the incidence of mortality. We present here a case of jejunogastric intussusception that was diagnosed by gastroscopy in a patient with a history of subtotal gastrectomy, and she had experienced increasing epigastric pain and vomiting for 1 day. (Korean J Gastrointest Endosc 2008;37:25-29)
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A Case of Successful Endoscopic Management of Afferent Loop Leakages by Using Hemoclips and a Detachable Snare
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Se Woo Park, M.D., Hang Lak Lee, M.D., Seong Eun Ahn, M.D., So Yeun Park, M.D., Oh Young Lee, M.D., Byung Chul Youn, M.D., Ho Soon Choi, M.D. and Jun Soo Hahm, M.D.
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Korean J Gastrointest Endosc 2008;37(1):30-34. Published online July 30, 2008
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- There are many complications following gastrectomy and one of the most frequent complications is anastomosis site leakage. Postoperative leakage is a serious complication in patients after they undergo gastric surgery. It can lead to the progressive deterioration in the patient's condition and quality of life and the mortality rate is nearly 60%. We encountered a case of a 75 year-old man who had the leakage of the jejunal end of the Roux limb after total gastrectomy. We performed treatment of the leakage endoscopic clipping and detachable snaring. Hemoclips were fixed at the margin of both sides of the lesion. A detachable snare was used to bind both hemoclips, so the interval was made narrow. After snare binding, five hemoclips were used for final closure of the small interval. After treatment, the leakage of the afferent loop end was completely stopped. He resumed an oral intake and was discharged without complications. (Korean J Gastrointest Endosc 2008;37:30-34)
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A Case of a Sharp Denture-Induced Esophageal Perforation Managed by Medical Treatment
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Jae Myung Cha, M.D., Joung Il Lee, M.D., Jae Won Choe, M.D., Kwang Ro Joo, M.D., Sung Won Jung, M.D. and Hyun Phil Shin, M.D.
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Korean J Gastrointest Endosc 2008;37(1):35-39. Published online July 30, 2008
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- Foreign bodies in the esophagus are regarded as clinically important as they cause symptoms such as pain and dysphagia and can cause complications such as perforation. Recent progress in therapeutic endoscopy has made it possible to extract most foreign bodies in the esophagus. However, endoscopic extraction of sharp foreign bodies impacted in the esophagus may be a difficult and complicated procedure. Although rapid surgical intervention is the main treatment for esophageal perforation, medical treatment can be successful for a minor perforation after early diagnosis if the perforation size is small and symptoms or signs associated with the perforation are mild. We report a case of a sharp denture- induced esophageal perforation managed by medical treatment that consisted of parenteral nutrition and antibiotics. This case highlights the necessity for an early diagnosis and treatment for an esophageal perforation, which can occur even after removal of a foreign body. (Korean J Gastrointest Endosc 2008;37:35-39)
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A Case of Peripheral T-cell Lymphoma Presenting with Small Bowel Perforation
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Se Won Kim, M.D., Yun Jeong Lim, M.D., Hyoung Woo Kim, M.D., Do Yeun Kim, M.D., Chang-Hun Yang, M.D., Jin Ho Lee, M.D., Hong-Yong Kim, M.D.*, Eo-Jin Kim, M.D.† and Yong Seok Lee, M.D.‡
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Korean J Gastrointest Endosc 2008;37(1):40-44. Published online July 30, 2008
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- Malignant lymphoma of the gastrointestinal tract is a rare lesion that comprises 1∼4% of all the malignant neoplasms of the gastrointestinal tract. The incidence of intestinal T-cell lymphoma is much lower than that of the B-cell type. Intestinal T-cell lymphoma can sometimes carry a very poor prognosis because these patients are often diagnosed at advanced stages. These patients mostly present with nonspecific symptoms such as weight loss, abdominal pain or diarrhea and more frequently with features of small bowel obstruction or perforation. We report here on a case of a malignant small intestinal T-cell lymphoma that presented with perforation. A 51-year-old female had emergency operation because of small bowel perforation and she was diagnosed withperipheral T-cell lymphoma on the post-operative pathologic report. (Korean J Gastrointest Endosc 2008;37:40-44)
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A Case of Duodenal Amyloidosis Accompanied with Candidiasis that was Diagnosed by Endoscopy
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Sun-Young Kim, M.D., Tae Joo Jeon, M.D., Ji Young Seo, M.D., Min-Geun Kim, M.D., Tae-Hoon Oh, M.D., Dong Dae Seo, M.D., Won-Choong Choi, M.D. and Won Chang Shin, M.D.
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Korean J Gastrointest Endosc 2008;37(1):45-50. Published online July 30, 2008
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- This report describes a case of a 63-year-old female who suffered from gastrointestinal amyloidosis. The patient presented with abdominal pain, nausea, vomiting and watery diarrhea for a week. Previously, the patient had been treated for rheumatoid arthritis. Endoscopy showed the presence of erythematous mucosa and yellowish exudates in the bulb, a finding that was compatible with duodenal candidiasis. Colonoscopy showed diffuse erythematous and easy friability in the entire colon, a finding suggestive of infectious colitis. The pathology report indicated that the lesion had amyloid, which was stained by Congo red. Endoscopic findings of amyloidosis are non-specific, such as friable mucosa, granulation, polyp, erosion and ulceration. Therefore, it is difficult to diagnose amyloidosis with endoscopic findings. However, if the patient has risk factors of secondary amyloidosis such as rheumatoid arthritis, gastrointestinal amyloidosis based on the endoscopic finding should be considered. We report a case of duodenal amyloidosis accompanied with candidiasis, which has not been previously reported. (Korean J Gastrointest Endosc 2008;37:45-50)
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Endoscopic Removal of a Pork Bone from the Sigmoid Colon in a Patient with Ulcerative Colitis
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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;37(1):51-54. Published online July 30, 2008
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- Inflammatory bowel disease is a risk factor for low gastrointestinal foreign body impaction, but such cases are very rare. Impaction of a foreign body in the lower gastrointestinal tract can result in perforation, bleeding, abscess formation and fistula. A risk factor for perforation is inflammatory bowel disease, a sharp foreign body and a long-standing foreign body in the gastrointestinal tract. Thus, a foreign body in the lower gastrointestinal tract should be promptly removed by surgery or endoscopy. Most of these cases can currently be managed by endoscopy because of the development of endoscopic devices and the accumulation of experience. Here we report on a case of successful removal of a pork bone from the sigmoid colon in a patient with ulcerative colitis. (Korean J Gastrointest Endosc 2008;37:51-54)
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Hyponatremia with Seizure and Mental Change after Oral Sodium Phosphate Bowel Preparation: Report of Two Cases
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Su Jung Baik, M.D., Ki-Nam Shim, M.D., Youn Ju Na, M.D., Min-Jung Kang, M.D., Ji Min Jung, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D. and Seung-Jung Kim, M.D.
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Korean J Gastrointest Endosc 2008;37(1):55-60. Published online July 30, 2008
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- Oral sodium phosphate is known to be safe and it is widely used as a colon cleansing agent for colonoscopy. Yet several complicated cases with the development of electrolyte imbalance have been reported. We report here on 2 interesting cases: after administration of oral sodium phosphate, one patient presented with hyponatremia (Na, 122 mEq/L) with seizure and the other patient presented with hyponatremia (Na, 120 mEq/L) with a confused mentality. Brain imaging and electroencephalography showed no evidence of other causes for the seizure and mental change. We report here on two cases of hyponatremia with neurologic side effects, and this was all caused by oral sodium phosphate. We also include a review of the relevant literature. (Korean J Gastrointest Endosc 2008; 37:55-60)
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A Case of Condyloma Acuminatum Presenting as a Rectal Polyp
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Tae Sun Kim, M.D., Il Soon Whang, M.D., Yun Yong Seo, M.D., Su Hee Lee, M.D., Young Ho Hong, M.D., Sung Hoon Jung, M.D., Sung Ran Hong, M.D.* and Eun Ju Kim, M.D.
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Korean J Gastrointest Endosc 2008;37(1):61-64. Published online July 30, 2008
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- Condyloma acuminatum, commonly known as anogenital warts, is caused by human papillomavirus (HPV). The most common location of condyloma acuminatum in women is the vulva. Other locations are the vagina, anus and perianal area, perineum and cervix. Condyloma acuminatum most commonly occur due to receptive anal intercourse, and can enlarge to form exophytic masses on the perianal skin, but rarely involve the rectum. We experienced an occurrence of a 12 mm polypoid lesion in the rectum of a heterosexual woman detected during a colonoscopy. The polypoid lesion was excised and was diagnosed as condyloma acuminatum. The lesion was positive for HPV type 11 based on the use of an HPV DNA chip test. (Korean J Gastrointest Endosc 2008;37: 61-64)
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A Case of Autoimmune Chronic Pancreatitis that was Rapidly AggravatedDespite Oral Steroid Maintenance Therapy
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Jae Chul Hwang, M.D., Byung Moo Yoo, M.D., Kyung Hyun Koh, M.D., Dong Hoon Kim, M.D., Chang Joon Kang, M.D., Jai Hak Jeung, M.D.*, Byoung Joon Park, M.D.* and Jin Hong Kim, M.D.
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Korean J Gastrointest Endosc 2008;37(1):65-70. Published online July 30, 2008
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- In a case of autoimmune chronic pancreatitis that relapsed despite maintenance therapy with low-dose steroid, high- dose steroid can induce remission of the disease, and maintenance therapy of steroid is usually recommended in that case. A 57-year-old man developed epigastric pain and jaundice. The patient was diagnosed with autoimmune chronic pancreatitis. The abnormalities in the clinical, laboratory and radiologic findings improved after oral steroid therapy. After two relapsed episodes, maintenance therapy of steroid with 5 mg prednisolone/day was administrated. In the studies for follow up, the level of serum IgG was increased and abdominal computed tomography showed calcification and pseudocyst in the pancreatic tail. To our knowledge, this is a rare case of autoimmune chronic pancreatitis aggravated rapidly despite oral steroid maintenance therapy. (Korean J Gastrointest Endosc 2008;37:65-70)
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A Case of Chronic Acalculous Cholecystitis Presenting as Hemobilia
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Soo Han Kim, M.D.*, Seok Jeong, M.D.*, Don Haeng Lee, M.D.*,‡, Joon Mee Kim, M.D.†, Kye Sook Kwon, 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;37(1):71-75. Published online July 30, 2008
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- Hemobilia is defined as the presence of blood in the biliary tract and gastrointestinal lumen, which is caused by a communication between the biliary tract and blood vessels. Most cases of hemobilia originating in the gallbladder are related to gallstones, or rarely related to acalculous cholecystitis. A 48-year-old woman presented to the hospital secondary to epigastric pain and melena, and endoscopic retrograde cholangiopancreatography revealed hemobilia originating in her gallbladder. After laparoscopic cholecystectomy was performed, pathologic examination of the gallbladder revealed chronic acalculous cholecystitis. Hence, we report a case of hemobilia caused by chronic acalculous cholecystitis. (Korean J Gastrointest Endosc 2008; 37:71-75)
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A Case of Bleeding from a Periampullary Duodenal Varix that Developed after Biliary Metal Stent Placement in a Patient with Pancreatic Cancer
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Chung Hwon Lee, M.D.*, Seok Jeong, M.D.* and Don Haeng Lee, M.D.*,†
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Korean J Gastrointest Endosc 2008;37(1):76-81. Published online July 30, 2008
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- Duodenal varices bleed less commonly than gastro-esophageal varices in patients with portal hypertension. However, if there is no stigmata of recent esophageal or gastric variceal bleeding, clinicians should suspect the presence of an extra gastro-esophageal site of variceal bleeding. Duodenal variceal bleeding can be difficult to diagnose and treat. Therefore, the bleeding may be life threatening in most cases and has a poor prognosis. We experienced a case of variceal bleeding that developed in a patient with far advanced pancreatic cancer after placement of a self- expanding metal stent into a strictured bile duct via the peroral and transpapillary route. The patient had a duodenal varix near the major papilla and the bleeding was treated with an injection of HistoacrylⰒ. We thought the bleeding of the periampullary varix resulted from injury due to exposure to the free end of the alloy wires in the distal portion of the inserted biliary metal stent. (Korean J Gastrointest Endosc 2008;37:76-81)
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