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Volume 39(1); July 2009
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Endoscopic Biliary Stenting in Patients with Malignant Biliary Obstruction
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Hyung Wook Kim, M.D. and Dae Hwan Kang, M.D.
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Korean J Gastrointest Endosc 2009;39(1):1-7. Published online July 30, 2009
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Abstract
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- Cholangiocarcinoma has an extremely poor prognosis and the majority of patients have an incurable disease at the time of presentation. These patients should be offered palliative drainage management. The aims of palliation are to prevent cholangitis or bile peritonitis in the course of follow-up or chemotherapy, and to preserve the functional volume of the liver as much as possible. Endoscopic or percutaneous drainage has become increasingly important in the palliative care of patients with unresectable cholangiocarcinoma. Compared to the percutaneous approach, endoscopic biliary stenting is less invasive, more comfortable, and results in a reduced hospital stay. Therefore, endoscopic biliary stenting should be considered the first-line therapy for jaundice palliation in unresectable cholangiocarcinoma. (Korean J Gastrointest Endosc 2009;39:1-7)
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Satisfaction Survey of Care Providers for Enteral Feeding by the Use of Percutaneous Endoscopic Gastrostomy
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Suk Jae Hahn, M.D., Yun Jeong Lim, M.D., Chang Heon Yang, M.D. and Jin Ho Lee, M.D.
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Korean J Gastrointest Endosc 2009;39(1):8-13. Published online July 30, 2009
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Abstract
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- Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) is a widely used procedure for enteral feeding that is convenient and safe. We investigated the satisfaction of enteral feeding by the use of a nasogastric tube and PEG as well as PEG-related complications.
Methods
A total of 57 patients (121 cases) who underwent PEG in a teaching hospital were investigated about complications based on the use of electronic medical records. Questionnaires comprised of 11 questions were administered by telephone or by direct contact with care providers.
Results
The median interval period of exchange for PEG was 184.94 days. The causes for exchange included regular exchange (36, 41.86%), accidental or self- removal of the PEG tube (26, 30.23%), profuse discharge, rash or infection around the PEG insertion site (13, 15.12%) and PEG tube malfunction (11, 12.79%). The satisfaction index (VAS scale) for the use of the nasogastric tube was 4.32, while the satisfaction index for the use of PEG was 7.72, which indicates that the care providers were more satisfied with nutrition provided by the use of PEG (p <0.0001). The 28 care providers (80.00%) replied that PEG was a good method to maintain a high quality of life.
Conclusions
Care providers had a high degree of satisfaction for the use of PEG. PEG is safe and effective method for enteral nutrition. If continuous education or management to reduce accidental removal and to lessen complications is enforced, higher satisfaction can be expected. (Korean J Gastrointest Endosc 2009;39:8-13)
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The Usefulness of 64-Multidetector CT Cholangiography for Diagnosis of Distal Common Bile Duct Obstruction: Comparison with Endoscopic Retrograde Cholangiopancreatography
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Jae-Hyun Choi, M.D., Mee Yeon Lee, M.D., Won Joong Jeon, M.D., Hee Bok Chae, M.D., Seon Mee Park, M.D., Sei Jin Youn, M.D., Jae-Woon Choi, M.D.* and Il Heon Bae, M.D.†
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Korean J Gastrointest Endosc 2009;39(1):14-21. Published online July 30, 2009
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Abstract
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- Background
/Aims: The aim of this study was to evaluate the diagnostic accuracy of 64-multidetector CT (MDCT) cholangiography for determining the causes of distal common bile duct (CBD) obstruction.
Methods
Two hundred fifty consecutive patients underwent 64-MDCT for diagnosing the clinical and biochemical signs of bile duct obstruction. The causes of bile duct obstruction were assessed by the pre- and post-enhanced axial and coronal multiplanar reformation images of 64-MDCT. The results were compared with ERCP, biopsy and surgery.
Results
The sensitivity and specificity of MDCT for CBD stones were 96.1% and 84.9%, respectively. In seven patients, The CBD stones in 7 patients could not be detected on MDCT. Eleven patients with stones in the distal CBD, as detected on MDCT, had no stones seen on ERCP. For malignant obstruction, the sensitivity and specificity of MDCT were 97.0% and 98.6%, respectively. Three patients who were diagnosed with periampullary cancers on MDCT were disclosed to have severe papillitis on ERCP. One patient who was diagnosed with CBD stone by MDCT was disclosed to have ampullary cancer. The overall accuracy of MDCT for determining the causes of biliary obstruction was 90.5%.
Conclusions
MDCT cholangiography is a non-invasive method with relatively high sensitivity and high specificity for diagnosing the causes of distal CBD obstruction. (Korean J Gastrointest Endosc 2009;39:14-21)
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Comparison of a Digital Video Transfer System with a Satellite Broadcasting System Used in a Teleconference: From the Trainee Point of View
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Jai Hoon Yoon, M.D., Joon Soo Hahm, M.D., Hang Lak Lee, M.D., Ho Soon Choi, M.D. and Yong Jin Park, Ph.D.*
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Korean J Gastrointest Endosc 2009;39(1):22-29. Published online July 30, 2009
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Abstract
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- Background
/Aims: Telemedicine is a useful tool for remote education to overcome limitations of location. We have shared medical knowledge by the use of a real-time, high quality digital video transfer system (DVTS). The study aim was to evaluate the use of the DVTS by viewer questionnaire.
Methods
After an endoscopic live demonstration using DVTS and satellite broadcasting system (SBS), questions were provided for the degree of satisfaction about image and sound of the presentation. A questionnaire was composed of 11 questions concerning factors such as a comparison of image quality between the two systems. The preference between DVTS with SBS was analyzed.
Results
For image quality, SBS was more preferable than DVTS (65.6% versus 16.7%). However, 16.7% found no difference between the use of DVTS and SBS. For the time delay between the image and sound, 62.5% preferred SBS and 11.5% preferred DVTS. The satisfaction for combining DVTS with SBS were 68% as good and 22% as very good.
Conclusions
We have demonstrated the feasibility of telemedicine by the demonstration of a satisfactory teleconference, although DVTS was utilized as an assistant tool. DVTS should prove to be a promising tool as a useful and economic means to provide remote medicine. (Korean J Gastrointest Endosc 2009;39: 22-29)
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A Case of an Esophageal Stricture Due to Transesophageal Echocardiography
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Hyuk Lee, M.D., Young Soo Moon, M.D., Sang Goo Yoon, M.D., Min Hwan Kim, M.D., Nam-Hoon Kim, M.D., Won Ki Bae, M.D., Kyung-Ah Kim, M.D. and June Sung Lee, M.D.
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Korean J Gastrointest Endosc 2009;39(1):30-33. Published online July 30, 2009
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Abstract
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- Transesophageal echocardiography (TEE) is widely used to assess cardiac function and anatomical relationships. Although monitoring of the heart by the use of TEE is perceived to be safe and noninvasive, there are significant complications associated with the use of a probe in the esophagus. Oropharyngeal trauma, esophageal perforation, difficulty or pain with swallowing, and gastric mucosal injury are adverse events that can occur from TEE probe insertion. However, no reports have shown that placement of a TEE probe in the esophagus can be a cause of an esophageal stricture. We report a case of a 74-year-old woman with an esophageal stricture after intraoperative TEE. Bougie dilatation is generally considered as an effective treatment for a benign esophageal stricture. The benign stricture in the esophagus was treated safely using Savary-Gilliard bougie dilatation. (Korean J Gastrointest Endosc 2009;39:30-33)
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A Case of Ruptured Left Gastric Artery Pseudoaneurysm Complicating Percutaneous Endoscopic Gastrostomy (PEG)
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Seong Hun Hong, M.D., Jae Myung Cha, M.D., Joung Il Lee, M.D., Kwang Ro Joo, M.D., Sung Won Jung, M.D., Hyun Phil Shin, M.D. and Deok Ho Nam, M.D.*
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Korean J Gastrointest Endosc 2009;39(1):34-37. Published online July 30, 2009
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Abstract
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- Percutaneous endoscopic gastrostomy (PEG) is an effective method for delivering enteral nutrition to patients with dysphagia, cerebrovascular accidents, Parkinsonnism, dementia, and head and neck cancer. PEG is generally regarded as safe and it is associated with low risks of morbidity and mortality. The complications of the PEG are known to be mostly minor and they include wound infection, gastric leakage, bleeding, ileus, pneumoperitoneum and aspiration pneumonia. We recently experienced a ruptured pseudoaneurysm of the left gastric artery, which was occurred as a complication during PEG insertion in a 73-year-old female. To the best of our knowledge, this is the first case report in Korea about successful angiographic embolization for a ruptured pseudoaneurysm of the left gastric artery and this was associated with a PEG procedure. (Korean J Gastrointest Endosc 2009;39:34-37)
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A Case of Brunner's Gland Adenoma Causing a Ball-valve Obstruction: Endoscopic Treatment with a Simple Method of Endoclip-assisted Direct Resection with Using an IT-knife
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Do Won Choi, M.D., Jin Ki Hwang, M.D., Jong Jae Park, M.D., Jae-Won Yun, M.D., Min-Jung Kwon, M.D., Hyejin Noh, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.
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Korean J Gastrointest Endosc 2009;39(1):38-41. Published online July 30, 2009
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Abstract
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- Brunner's gland adenoma is a rare benign tumor that is usually asymptomatic and it the result of a benign proliferation of the Brunner's glands of the duodenum. In symptomatic patients, the common clinical presentation is gastrointestinal bleeding and obstructive symptoms. A 48-year-old man presented with abdominal discomfort and vomiting. The endoscopic examination revealed a large pedunculated polypoid mass arising in the bulb and it was prolapsing through the pylorus into the antrum, and this all resulted in a ball-valve obstruction. After endoclips were applied at the peduncle of the mass, this polyp was simply and successfully cut with using an IT-knife without bleeding or perforation. We report here on a case of Brunner's gland adenoma that caused a ball-valve obstruction, and the tumor was removed by a simple and easy method with using endoclips and an IT-knife. (Korean J Gastrointest Endosc 2009;39:38-41)
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A Case of a Duodenal Gastrointestinal Stromal Tumor with a Bleeding Ulcer
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Hyuk Jin Kwon, M.D., Hyeon Geun Cho, M.D., Myong Hwan Kim, M.D., Geun Jun Ko, M.D., Jin Ho Jeong, M.D.* and Ji Sun Song, M.D.†
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Korean J Gastrointest Endosc 2009;39(1):42-45. Published online July 30, 2009
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Abstract
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- Duodenal gastrointestinal stromal tumors (GISTs) are relatively rare tumors that commonly present with gastrointestinal bleeding. Evaluation with endoscopic ultrasonography (EUS) is a useful technique for the differential diagnosis of GISTs from other submucosal tumors. A 58-year-old man presented with melena and anemia. An esophago-gastroduodenoscopy showed the presence of a submucosal tumor in the second portion of the duodenum with central ulceration and a flat spot. EUS showed the presence of a suspicious malignant GIST that originated from the proper muscle layer, which was successfully resected. We report a case of a duodenal GIST with a bleeding ulcer. Positive reactivity for CD117 and S-100 was demonstrated by immunohistochemical staining. (Korean J Gastrointest Endosc 2009;39:42-45)
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A Case of Rectal Suture Granuloma that was Suspected to be a Recurrent Rectal Carcinoma
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Sang Pil Kim, M.D., Chang Kyun Lee, M.D., Jun Young Lee, M.D., Jin Woo Park, M.D., Tae Hoon Lee, M.D., Il-Kwun Chung, M.D., Sun-Joo Kim, M.D. and Sang Won Kim, M.D.*
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Korean J Gastrointest Endosc 2009;39(1):46-49. Published online July 30, 2009
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Abstract
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- Suture granuloma is a benign, rare complication of surgical intervention and it is known to occur after the use of non-absorbable suture materials deep within the skin. Although suture granuloma can occur anywhere in the body after a variety of operations, its incidence has rapidly diminished in recent years since the widespread use of absorbable suture materials. Clinically, making the differential diagnosis with recurrent cancer is obviously important for a cancer patient because postoperative suture granuloma can mimic local tumor recurrence after surgical resection. We recently encountered a case of rectal suture granuloma in a patient with rectal cancer and who underwent low anterior resection 4 years previously. The diagnosis was made according to the characteristic image findings of endoscopic ultrasonography and the abdominal CT scan. The patient was successfully treated with broad-spectrum antibiotics, US-guided incision and drainage. We report here on a rare case of rectal suture granuloma and we briefly review the relevant literature. (Korean J Gastrointest Endosc 2009;39:46-49)
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Pancreatic and Biliary Strictures Associated with Cholangitis and Bile Reflux Following Endoscopic Papillectomy of Ampullary Adenoma
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Dae-Geun Song, M.D., Jei So Bang, M.D., Won Hyeong Park, M.D., Tae Gyoon Kim, M.D., Hyun Gyung Park, M.D., Bo Young Min, M.D., Su Hyun Yang, M.D. and Jong Hoon Byun, M.D.
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Korean J Gastrointest Endosc 2009;39(1):50-54. Published online July 30, 2009
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Abstract
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- Ampullary adenoma is rare but clinically important because it is a premalignant lesion. Use of endoscopic gastroduodenoscopy has increased detection of adenoma of the major duodenal papilla. Endoscopic papillectomy is a promising technique to supplant surgical ampullectomy, because it is less aggressive and more stable. However, various complications include bleeding, perforation, pancreatitis and cholangitis. We describe pancreatic and biliary strictures associated with cholangitis, and bile reflux through the pancreatic duct to the minor duodenal papilla after endoscopic papillectomy. Pancreatic and biliary strictures have not been hitherto reported complications. We performed endoscopic papillary balloon dilatation, minor papilla papillotomy and inserted a drain tube through the accessory pancreatic duct. (Korean J Gastrointest Endosc 2009;39: 50-54)
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A Case of a Pancreatic Abscess Complicating Endoscopic Sphincterotomy
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Mi Hyun Kim, M.D., Gwang Ha Kim, M.D., Seon Kyeong Kim, M.D., Won Lim, M.D., Jin Sup Park, M.D., Seong Hoon Yoon, M.D., Dong Uk Kim, M.D. and Geun Am Song, M.D.
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Korean J Gastrointest Endosc 2009;39(1):55-58. Published online July 30, 2009
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Abstract
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- Endoscopic sphincterotomy (EST) has gained wide acceptance as a valuable tool for the management of disease of the pancreas and biliary tract. Complications associated with an EST include bleeding, perforation, pancreatitis and cholangitis, and the incidence of complications is approximately 5∼10%. A pancreatic abscess can develop rarely after an EST and tends to have a more complicated course, resulting in higher morbidity and mortality. We report a case of a pancreatic abscess that complicated an EST in a 61-year-old woman with a primary common bile duct stone. The patient was successfully cured by treatment with the use of broad-spectrum antibiotics. Although a pancreatic abscess is one of the rare delayed complications that can develop after an EST, it should be considered in the differential diagnosis of patients with a complaint of abdominal pain after an EST because of a high mortality rate and the need for prompt management. (Korean J Gastrointest Endosc 2009;39:55-58)
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