Clinical Endoscopy

The Current Status of Natural Orifice Transluminal Endoscopic Surgery (NOTES): Hoon Jai Chun, M.D., Bora Keum, M.D. and Sanghoon Park, M.D.; Korean J Gastrointest Endosc 2009;38(3):121-127. Published online March 30, 2009

Abstract PDF: Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique that utilizes the natural orifices of the human body (e.g., the mouth, anus, vagina and urethra) for surgical procedures. After insertion of an endoscope into organs such as the esophagus, stomach and urinary bladder, these hollow organs are intentionally cut to reach the peritoneal or thoracic cavity to perform various surgical procedures. NOTES is anticipated to become an important part of future medical procedures to treat diverse conditions that cannot endure ordinary surgery with the use of laparotomy or laparoscopy. To take advantage of this new technology, a number of researchers have devoted time and effort to improve both the basic and clinical aspects of NOTES in order to apply this medicinal art fully in the near future. In this review, we evaluate the status of NOTES and attempt to examine the future use of this promising technique that has also been subject to skepticism. (Korean J Gastrointest Endosc 2009;38:121-127)

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The Efficacy and Safety of Performing Colonoscopy in Patients 80 Years of Age and Older: Yeun Jung Lim, M.D., Young-Ho Kim, M.D., Dong Kyung Chang, M.D., Hee Jung Son, M.D., Poong-Lyul Rhee, M.D., Jae J. Kim, M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2009;38(3):128-132. Published online March 30, 2009

Abstract PDF: Background
/Aims: Optical colonoscopy is considered the gold standard for conducting a colorectal examination. Yet clinicians are often reluctant to refer elderly patients for colonoscopy because of their perception that it is a risky procedure. The aim of this study was to establish the efficacy and safety of performing colonoscopy in patients 80 years of age and older.
Methods
The study data was retrospectively collected from January 2000 to April 2007. Comparisons were made between two groups: The patients were classified based on age: 50~69 years and ≥80 years of age. We collected data on sedation, the total colonoscopy rates, the indication, the colonoscopic findings and the complications.
Results
Three hundred and forty-nine patients (170 elderly patients and 179 patients aged 50~69 years) were enrolled. Compared to the patients aged 50~69 years, the elderly patients had more clinically significant findings (55.9% for the elderly patient and 37.4% for the patients aged 50~80 years). Cecal intubation was done at a similar rate for both groups (94.7% and 96.6%, respectively). Although the elderly patients usually had one or more co-morbid illnesses (p＜0.001), the complication rate was not different between the 2 groups.
Conclusions
Colonoscopy in the elderly is safe and effective and it allows physicians to discover many significant findings. (Korean J Gastrointest Endosc 2009;38:128-132)

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A Case of Primary Malignant Melanoma of the Esophagus: Sang Hee Kim, M.D., Jae Kwang Kim, M.D., Jin Il Kim, M.D., Yong Jai Park, M.D., Seong Yong Woo, M.D., Seung Chul Yu, M.D., Hyeon Seong Kim, M.D. and Chang Young Yoo, M.D.*; Korean J Gastrointest Endosc 2009;38(3):133-136. Published online March 30, 2009

Abstract PDF: Primary malignant melanoma of the esophagus is a rare, but aggressive tumor with a fatal prognosis. Hematogenous and lymphatic metastasis are common. The tumor has multiple black and pigmented lesions. Resection of the tumor with an anastomotic procedure is the treatment of choice. Despite this operation, the prognosis is quite poor with the mean life expectancy being less than 1 year. We describe here a case of a 54-year-old man with esophageal malignant melanoma, and we also include a review of the relevant literature. (Korean J Gastrointest Endosc 2009;38:133-136)

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A Gigantic Gastric Mucosal Rupture When Performing Endoscopy under Conscious Sedation in a Patient with Hiatal Hernia: Pyoung Rak Choi, M.D., Won Moon, M.D., Chan Bok Park, M.D., Eun Ho Park, M.D., Ji Suk Lee, M.D., Kyu Jong Kim, M.D., Moo In Park, M.D. and Seun Ja Park, M.D.; Korean J Gastrointest Endosc 2009;38(3):137-141. Published online March 30, 2009

Abstract PDF: Mallory-Weiss syndrome is a tear in the gastro-esophageal junction or its adjacent mucosa, and this occurs due to nausea or vomiting that is caused by various etiologic factors. It may occur in patients with excessive retching and struggling when undergoing upper gastrointestinal endoscopy, and its underlying factors are esophageal hiatal hernia, atrophic gastritis and old age. There are currently only rare reports about gigantic gastric mucosal rupture during performance of upper gastrointestinal endoscopy in patients with esophageal hiatal hernia. We recently experienced a 76-year-old woman who developed a gigantic gastric mucosal rupture that ranged from the gastro-esophageal junction to the gastric angle. This occurred during performance of standard upper gastrointestinal endoscopy with the patient under sedation and the patient had a concurrent esophageal hiatal hernia. The patient was treated conservatively for the rupture. Herein we report on our case along with a review of the relevant literature. (Korean J Gastrointest Endosc 2009;38:137-141)

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A Case of Splenic Artery Aneurysm Mimicking Gastric Submucosal Tumor: Byeong Chool Park, M.D., Sei Jin Youn, M.D., Seon Mee Park, M.D., Won Joong Jeon, M.D., Jee In Jeong, M.D., Hee Bok Chae, M.D. and Ro Hyun Sung, M.D.*; Korean J Gastrointest Endosc 2009;38(3):142-146. Published online March 30, 2009

Abstract PDF: Splenic artery aneurysm is an uncommon clinical entity. Most of these aneurysms are asymptomatic, but if an aneurysm ruptures, it can be fatal and its mortality rate reaches 70 percent. Regardless of the presence of symptoms, if the size of the asymptomatic aneurysm is larger than 2 cm in diameter or the patient is pregnant, then the anurysm should be treated. A 74-year-old female visited our hospital complaining of nonspecific epigastric discomfort. Endoscopic examination of the stomach revealed a submucosal tumor like protruding mass in the body and it was finally diagnosed as a splenic artery aneurysm by computed tomography. We report here on a case of a splenic artery aneurysm that mimicked a submucosal tumor, and this aneurysm was treated with surgery. (Korean J Gastrointest Endosc 2009;38:142-146)

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A Case of Afferent Loop Syndrome after Inserting a Double-Layered Pyloric Stent for Gastric Outlet Obstruction in a Patient with Stump Gastric Cancer after Undergoing Billroth II Radical Subtotal Gastrectomy: Seok Lee, M.D., Yu Jeong Hwang, M.D., Seong Hun Kim, M.D., In Hee Kim, M.D., Sang Wook Kim, M.D., Seung Ok Lee, M.D., Dae Ghon Kim, M.D. and Soo Teik Lee, M.D.; Korean J Gastrointest Endosc 2009;38(3):147-150. Published online March 30, 2009

Abstract PDF: Stent insertion is an effective method for treating a patient with gastric outlet obstruction that's caused by recurred cancer at the anastomosis site. There are some complications associated with stent insertion, such as perforation, bleeding, ulceration and obstruction. There are only rare Korean case reports of afferent loop syndrome after stent insertion. We report here on a case of afferent loop syndrome that occurred after insertion of a double-layered pyloric stent for gastric outlet obstruction in a patient with stump gastric cancer after undergoing Billroth II radical subtotal gastrectomy.(Korean J Gastrointest Endosc 2009;38:147-150)

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Rectal Leiomyoma Diagnosed by Endoscopic Ultrasonography and Endoscopic Polypectomy: Sung Whan Cho, M.D., Hyung Yook Kim, M.D.* and Ung Suk Yang, M.D.; Korean J Gastrointest Endosc 2009;38(3):151-155. Published online March 30, 2009

Abstract PDF: Leiomyoma of the rectum is a rare tumor and it usually present in 40 to 60 year-old individuals, and it is more frequent in men. It originates from either the muscularis mucosa or muscularis externa and those arising from the muscularis mucosa are typically small and they are identified incidentally in patients who are undergoing sigmoidoscopy. In contrast, the larger leiomyomas arising from the muscularis externa generally present symptoms that are consistent with rectal stenosis or a rectal mass. Endoscopic ultrasonography can help to define the tumor location, extension and size. Surgical resection is the treatment for most leiomyomas of the rectum, but endoscopic electroexcision is a safe and appropriate treatment for small polypoid rectal leiomyoma. We report here on a case of a semipedunculated rectal leiomyoma in a 59 year-old female patient. It was found incidentally during a colonoscopic examination and it was diagnosed by endoscopic ultrasonography. We performed endoscopic mucosal resection with colonoscopic snare electrocoagulation. (Korean J Gastrointest Endosc 2009;38:151-155)

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Concurrent Malignant Carcinoid Tumor and Benign Carcinoid Tumor of the Rectum: Bong Hwan Kim, M.D., Seung Hee Yoo, M.D., Wee Sik Sohn, M.D., Sang Woon Park, M.D., Ki Baik Hahm, M.D., Il Dong Kim, M.D.*, Kye Won Kwon, M.D.^† and Kum Ho Yi, M.D.^‡; Korean J Gastrointest Endosc 2009;38(3):156-160. Published online March 30, 2009

Abstract PDF: Neuroendocrine cells are distributed throughout the body and they are found in the gastrointestinal tract, pancreas, lung, thyroid, adrenal gland and many other organs, and especially the gastrointestinal tract. As a consequence, neuroendocrine tumors of the colon and rectum are common neoplasm. Several cases of the benign carcinoid tumor and a few cases of the malignant carcinoid tumor of the colon and rectum have been reported. Yet there have been no reports on concurrent malignant carcinoid tumor and benign carcinoid tumor at the same site of the colon. A 60-year-old man presented with an asymptomatic rectal mass. After the mass was evaluated and operated on, it was confirmed to be a concurrent malignant carcinoid tumor and benign carcinoid tumor of the rectum, and metastasis to the liver was also found. (Korean J Gastrointest Endosc 2009;38: 156-160)

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Appendiceal Mucocele-Induced Intussusception That Presented as a Huge Mass on the Hepatic Flexure Area: Hearn Kook Kim, M.D., Hyun Soo Kim, M.D., Ki Tae Suk, M.D., Hye Jung Kim, M.D., Kyong Won Park, M.D., Seung Whan Cha, M.D.*, Yosep Chong, M.D.^† and Mee-Yon Cho, M.D.^†; Korean J Gastrointest Endosc 2009;38(3):161-165. Published online March 30, 2009

Abstract PDF: Appendiceal intussusception is a rare disease entity and appendiceal mucocele is one of the causes of this disease. Although computed tomography, ultrasonography, barium enema and colonoscopy can be performed to make a preoperative diagnosis, only a few cases of appendiceal mucocele-induced intussusception have been precisely diagnosed by these diaggnostic tools. Most of all, few such cases have been confirmed by colonoscopic examination. Colonoscopic examination has a supplementary role for the differential diagnosis of acute or chronic appendicitis, tumor or abscess in the ascending colon and cecum that is caused by appendiceal intussusception. We report here on a case of intussusception that was caused by an appendiceal mucocele, and this showed a target appearing structure in the hepatic flexure and a cystic mass inside the intussusceptive lumen on abdominal CT, and a huge mass was discovered on the colonoscopic examination. (Korean J Gastrointest Endosc 2009;38:161-165)

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A Case of Langerhans Cell Histiocytosis That Involved the Colon: Sang Jin Lee, M.D., Kyung-Jo Kim, M.D., Soon Man Yoon, M.D., Byong Duk Ye, M.D., Jeong-Sik Byeon, M.D., Seung-Jae Myung, M.D., Suk-Kyun Yang, M.D. and Jin-Ho Kim, M.D.; Korean J Gastrointest Endosc 2009;38(3):166-170. Published online March 30, 2009

Abstract PDF: A 34-year-old man was referred to our department for evaluation of his elevated liver function test. He was diagnosed with Langerhans cell histiocytosis 7 years ago because of recurrent pneumothorax. A CT scan showed multifocal intrahepatic duct dilatation with soft tissue infiltration in the right lobe of the liver. An ERCP showed diffuse multifocal strictures of the intrahepatic duct intervening among the normal segments of the duct. A percutaneous needle biopsy of the liver disclosed ductular proliferation, inflammatory cell infiltration and focal cholestasis. Therefore, he was diagnosed with sclerosing cholangitis. He underwent colonoscopy to evaluate for the possibility of ulcerative colitis. The colonoscopy showed erosions and erythema on the mucosa of the appendiceal orifice, another site of erosion at 35 cm from the anal verge and multiple 3~8 mm sized sessile polyps. Biopsies of the colon mucosa disclosed an infiltration of Langerhans cell histiocytosis. We report here on a very rare case of colon involvement of Langerhans cell histiocytosis. (Korean J Gastrointest Endosc 2009;38:166-170)

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Two Cases of Rectal Vascular Ectasia in Patients with Liver Cirrhosis and Who Were Treated by Argon Plasma Coagulation: Woong Park, M.D., Chang Il Kwon, M.D., Young Jun Song, M.D., Han Ul Song, M.D., Ju Hee Oh, M.D., Kwang Hyun Ko, M.D. and Kyu Sung Rim, M.D.; Korean J Gastrointest Endosc 2009;38(3):171-175. Published online March 30, 2009

Abstract PDF: The term "vascular ectasia" is defined to include angiodysplasia, gastric antral vascular ectasia (GAVE) and telangiectasis, and these are the leading causes of acute or chronic gastrointestinal bleeding. We describe here the first 2 Korean cases of GAVE with rectal vascular ectasia in patients with liver cirrhosis. A 70-year-old woman was admitted to the hospital with hematochezia. The finding on endoscopy showed diffuse nonconfluent spots with oozing bleeding on the antrum and several vascular spots with oozing bleeding on the rectum. The lesions were successfully treated by argon plasma coagulation (APC). We report on another case of rectal vascular ectasia in a patient with liver cirrhosis. A 77-year-old man was admitted to the hospital with hematochezia. The findings on colonoscopy showed diffuse vascular spots with oozing bleeding on the rectum. The lesions were successfully treated by APC. These two patients have had no bleeding since their treatment, and they are currently being evaluated by follow-up studies at the outpatient department. (Korean J Gastrointest Endosc 2009;38:171-175)

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A Case of Primary Pancreatic Lymphoma That Manifested with Acute Pancreatitis and Obstructive Jaundice: Jun Eul Hwang, M.D., Chang Hwan Park, M.D., Yong Chan Cho, M.D., Sung Kyun Kim, M.D., Hyeun Soo Kim, M.D., Sung Kyu Choi, M.D., Jong Sun Rew, M.D. and Wan Sik Lee, M.D.; Korean J Gastrointest Endosc 2009;38(3):176-178. Published online March 30, 2009

Abstract PDF: Primary pancreatic lymphoma (PPL) is a rare form of extranodal lymphoma, and this accounts for less than 0.5% of all pancreatic tumors. Differentiating PPL from pancreatic adenocarcinoma is important because the prognosis and survival of PPL is much better than those of pancreatic adenocarcinoma. Although the treatment usually consists of a combination of chemotherapy and radiation therapy, PPL patient with biliary tract or gastrointestinal obstruction should undergo biliary or gastric bypass to relieve the symptoms. Herein, we describe a case of PPL with acute pancreatitis and obstructive jaundice, and the patient was successfully managed with endoscopic retrograde pancreatic and biliary drainage. (Korean J Gastrointest Endosc 2009;38:176-179)

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