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Volume 40(1); January 2010
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EUS-guided Intervention
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Tae Jun Song, M.D. and Dong Wan Seo, M.D.
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Korean J Gastrointest Endosc 2010;40(1):1-8. Published online January 30, 2010
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Abstract
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- Linear array echoendoscopes were developed in the early 1990s and they have facilitated performing EUS-guided interventional procedures. The introduction of linear array echoendoscopes allows performing fine needle aspiration because the device enables tracing the path of the tip of the needle during puncture procedure. In addition to being very useful for diagnostic purpose, this device enabled us to develop various therapeutic endoscopic procedures. Therapeutic drainage procedures, including EUS-guided bile duct drainage, pancreatic pseudocyst drainage and pancreatic duct drainage, have all been more frequently performed in the last decade. In addition to the acquisition of tissue or fluid, various substances can be delivered into the target areas with EUS, with an example being an EUS-guided celiac plexus neurolysis/block. In this review, we describe the present place and role of interventional EUS in clinical practice. (Korean J Gastrointest Endosc 2010;40:1-8)
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Diagnostic Use of Endoscopic Ultrasound-guided Trucut Biopsy in Various Diseases
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Jin Ho Lee, M.D., Jung Hwan Lee, M.D., Jung Hoon Song, M.D., Kyung Sun Ok, M.D., Won Cheol Jang, M.D., Soo Hyung Ryu, M.D., You Sun Kim, M.D. and Jeong Seop Moon, M.D.
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Korean J Gastrointest Endosc 2010;40(1):9-15. Published online January 30, 2010
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Abstract
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- Background
/Aims: Endoscopic ultrasound-guided trucut biopsy (EUS-TCB) is a relatively new method, which facilitates obtaining a core biopsy through the gut wall. We evaluated the diagnostic accuracy of EUS-TCB based on the types of lesions.
Methods
We retrospectively reviewed the database of 37 cases in 35 patients (mean age, 57.2±2.3 years; 23 men) with thoracic and abdominal masses who got EUS-TCB between January 2007 and June 2008. Final diagnoses were determined by malignant positive EUS specimens, surgical pathology, or the clinical course.
Results
Adequate samples were obtained by EUS-TCB in 78.4% (29/37) of the cases. The overall diagnostic accuracies of the EUS-TCB were 73.0%. The mean size of the masses was 3.7±2.6 cm. The diagnostic accuracies of EUS-TCB according to the lesions were as follows: lymph node, 85.7% (18/21); subepithelial lesion, 60.0% (6/10); and solid tumor, 50% (3/6). With respect to accuracy, lymph nodes were significantly superior to non-lymph node lesions (p=0.046). There was a minor bleeding controlled by hemoclipping (2.7%).
Conclusions
EUS-TCB is a useful technique for the diagnosis of lymph nodes, subepithelial tumors, and solid tumors that were not able to be diagnosed by other methods. In addition, EUS-TCB is a safe and minimally invasive method. (Korean J Gastrointest Endosc 2010;40:9-15)
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An Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: The Clinical Features and Endoscopic Treatment
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Sang Soo Lim, M.D., Hong Ja Kim, M.D., Du San Baik, M.D., Ki Chul Shin, M.D., Il Han Song, M.D., Young Woo Choi, M.D.*, Jung Ho Han, M.D.† and Sang Heum Park, M.D.‡
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Korean J Gastrointest Endosc 2010;40(1):16-21. Published online January 30, 2010
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Abstract
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- Background
/Aims: An ectopic opening of the common bile duct (CBD) into the duodenal bulb is known to cause biliary tract diseases or peptic ulcer. Yet such a case is extremely rare and the clinical significance of this malformation has not yet been clarified.
Methods
Ten patients with an ectopic opening in the duodenal bulb and who were treated at 4 hospitals in the Chungcheong province area were enrolled. Their clinical and radiographic features and the treatment for their combined biliary diseases were retrospectively analysed.
Results
The mean age of the ten patients was 73 years (range: 38∼84 years, 8 men, 2 women) Eight of 10 patients had clinical signs and symptoms (RUQ abdominal pain: 5, epigastric pain: 3, fever: 3, Melena: 1). The two patients without symptoms were incidentally found to have an ectopic orifice during the evaluation for bile duct dilatation and a regular health check-up, respectively. Nine had duodenal ulcer scars or bulb deformities. Four had active duodenal ulcers and one of them had bleeding from the active duodenal ulcer, which was treated by endoscopic sclerotheraphy. Six of the 10 patients (60%) had biliary tract diseases (CBD stones: 4, cholangitis without CBD stone: 1, IHD stone: 1). Cholangiography was used for evaluation in 9 patients, and it showed dilatation of the CBD or IHD in 7 (78%), a tapered common bile duct at the distal CBD in 7 (78%) and a hook-shaped distal CBD in 8 (89%). Six patients' biliary tract diseases were treated endoscopically (ERCP: 4, PTCS: 2). Duodenal perforation occurred in 1 (10%), who was successfully managed by medical treatment.
Conclusions
An ectopic opening of the CBD in the duodenal bulb is frequently associated with recurrent duodenal ulcer and biliary tract disease. Combined biliary tract disease can be successfully treated endoscopically. (Korean J Gastrointest Endosc 2010;40:16-21)
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A Case of Pseudomalignant Erosion in an Inflammatory Polyp at the Esophagogastric Junction
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Chang Hoon Lim, M.D., Chang-Whan Kim, M.D., Hong Jun Yang, M.D., Min Kyoung Park, M.D., Hyung Jun Kim, M.D., Tae Ho Kim, M.D., Jeana Kim, M.D.* and Sok Won Han, M.D.
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Korean J Gastrointest Endosc 2010;40(1):22-26. Published online January 30, 2010
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Abstract
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- Some cases of polypoid lesions arisen from the gastric mucosa just below a lower esophageal erosion. This lesion can have various sizes and shapes. It is known as a hyperplastic lesion associated with esophagitis or an inflammatory lesion. Sometimes only a polyp is found without an erosion. This polypoid lesion is often called as sentinel polyp and is usually considered to be a benign lesion. Here we report a case of a pseudomalignant erosion in which an inflammatory polyp at the esophagogastric junction was successfully removed by endoscopic submucosal dissection even though the polyp was initially mistaken for a squamous cell carcinoma. (Korean J Gastrointest Endosc 2010;40:22-26)
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A Case of Gastric Adenocarcinoma in a Patient with X-linked Agammaglobulinemia
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Chang Soo Ok, M.D., Jun Haeng Lee, M.D., Jung Won Noh, M.D., Seo Young Sohn, M.D., Bok Soon Chang, M.D., Bon-Ho Ku, M.D., Won-Jung Koh, M.D. and Chang Ohk Sung, M.D.*
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Korean J Gastrointest Endosc 2010;40(1):27-30. Published online January 30, 2010
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Abstract
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- X-linked agammaglobulinemia is a common type of primary immunodeficiency disorder that's caused by mutation of the BTK gene. The absence of B lymphocytes and plasma cells causes recurrent infections. Patients with X-linked agammaglobulinemia also have a high risk for developing hematological malignancies and, to a lesser degree, carcinoma. We report here on a 26-years-old male patient who suffered with X-linked agammaglobulinemia that was caused by BTK gene mutation, and he developed a gastric cancer in the antrum. He was noted to have chronic atrophic gastritis and diffuse intestinal metaplasia on the endoscopic examination that was done 7 years previously. We recommend regular esophagogastroduodenoscopic evaluation for a patient with X-linked agammaglobulinemia in order to make an early diagnosis of stomach carcinoma. (Korean J Gastrointest Endosc 2010;40:27-30)
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A Case of a Removal of Pyloric Stent That Was Partially Embeded in the Mucosa after Temporary Stenting for the Benign Pyloric Stenosis and It Was Removed Using Argon Plasma Coagulation
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Joo Yeon Oh, M.D., Jong-Jae Park, M.D., Ja In Park, M.D., Won Woo Lee, M.D., Seung Young Roh, M.D., Hyun-Seok Kang, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.
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Korean J Gastrointest Endosc 2010;40(1):31-35. Published online January 30, 2010
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Abstract
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- Generally, self expandable metallic stents (SEMSs) are widely used for the treatment of malignant gastrointestinal stenosis due to their effectiveness and low complication rate. On the contraty, balloon dilatation or Bougie dilatation is commonly used for treating benign gastrointestinal stenosis as non-invasive methods. However, their such complications such as recurrence, hemorrhage and perforation are problematic when these dilation techniques are used. Temporary placement of a SEMS in a benign gastric outlet obstruction is expected to be a promising therapeutic modality despite of several major complications such as migration. Rarely, stent removal can, on rare occasions, be difficult or cause bleeding or perforation when the stent is embeded in the mucosa due to mucosal hyperplasia at the tips of the stent. We report here on a case of a stent, partially embeded in the mucosa after temporary stenting for treating a benign pyloric stenosis, which was successfully removed using argon plasma coagulation. (Korean J Gastrointest Endosc 2010;40:31-35)
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Duodenal Carcinoid Tumor Treated by Endoscopic Mucosal Resection
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Jong Hak Choi, M.D., In Do Song, M.D., In Soo Oh, M.D., Beom Jin Kim, M.D., Hyoung Chul Oh, M.D., Jeong Wook Kim, M.D. and Jae Gyu Kim, M.D.
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Korean J Gastrointest Endosc 2010;40(1):36-40. Published online January 30, 2010
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Abstract
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- Duodenal carcinoid tumors are rare, and they represent only 2.0∼8.9% of all gastrointestinal carcinoid tumors in the western countries. Duodenal carcinoid tumors have previously been treated by surgical resection. The recently recommended treatment for a carcinoid tumor smaller than 1 cm in diameter is endoscopic resection. We experienced a case of a duodenal carcinoid tumor in a 56 year-old man who presented with upper abdominal pain. On the endoscopic examination, a 6 mm sized polypoid lesion with a central depression was noticed on the duodenal bulb. The biopsy confirmed the diagnosis of carcinoid tumor. The endoscopic ultrasound probe showed a hypoechoic tumor that was confined to the submocosal layer. The tumor was completely resected by an endoscopic mucosal resection technique and using a transparent cap. (Korean J Gastrointest Endosc 2010;40:36-40)
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A Case of Bleeding on the Ampulla of Vater Due to Angiodysplasia in a Patient with End Stage Renal Disease
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Sang Bae Kim, M.D., Bu Sug Jun, M.D., Hae Bin Jung, M.D., Hyung Keun Kim, M.D., Young Suk Cho, M.D., Hyun Suk Chae, M.D., Chang Don Lee, M.D. and Sung Soo Kim, M.D.
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Korean J Gastrointest Endosc 2010;40(1):41-44. Published online January 30, 2010
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Abstract
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- Gastrointestinal angiodysplasia is one of the causes of acute and chronic gastrointestinal bleeding, and gastrointestinal angiodysplasia makes up 2∼6% of all the cases of upper gastrointestinal bleeding. Bleeding from the ampulla of Vater is very rare. We report here on an unusual case of bleeding from angiodysplasia at the ampulla of Vater in a 58-aged woman with end stage renal failure. This lesion was successfully treated with endoscopic argon plasma coagulation. (Korean J Gastrointest Endosc 2010;40:41-44)
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A Case of Transparent Cap-fitted Endoscopic Hemoclipping on a Bleeding Dieulafoy's Lesion in the Ampulla of Vater
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Hoon Sup Koo, M.D., Yong Seok Kim, M.D., Gwang Il Kim, M.D., Jung Kyung Yang, M.D., Seung Min Kim, M.D., Sang Yeol Cheon, M.D., Je Hyung Sun, M.D. and Sun Moon Kim, M.D.
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Korean J Gastrointest Endosc 2010;40(1):45-48. Published online January 30, 2010
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Abstract
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- Dieulafoy's lesion is a rare cause of repetitive and massive gastrointestinal bleeding, and this is characterized by an isolated arteriole protruding through a small mucosal defect. Dieulafoy's lesion is generally found in the stomach within 6 cm of the gastroesophageal junction, and usually on the lesser curvature, but many lesions have been reported in extragastric locations, including the esophagus, small bowel and rectum. A Dieulafoy's lesion in the ampulla of Vater is extremely rare, and only one such case has been reported in the Korean population. We experienced a rare case of Dieulafoy's lesion in the ampulla of Vater with massive pulsatile bleeding, and this was successfully treated by transparent cap-assisted endoscopic hemoclipping. We report here on this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2010;40:45-48)
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Undifferentiated Adenocarcinoma of the Colon with Rhabdoid Features
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Seok Ju Lee, M.D., Tae Ho Kim, M.D., Dong Hoon Ko, M.D., Jeung Ah Kim, M.D., Chang Whan Kim, M.D., Jean A Kim, M.D.†, Do Sang Lee, M.D.* and Sok Won Han, M.D.
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Korean J Gastrointest Endosc 2010;40(1):49-53. Published online January 30, 2010
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Abstract
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- Malignant rhabdoid tumors were first described in 1978 by Beckwith and Palmer as a rare variant of Wilms' tumors with a "rhabdomyosarcomatoid" pattern and a particularly poor prognosis. Week reclassified this disease as a distinct disease in 1989 and thereafter, there have been several reports about malignant rhabdoid tumor that occurred in various organs, including the colon. The histologic characteristics of rhabdoid tumor are noncohesive or loosely cohesive cells with high cellularity, an eccentric large nucleus and eosinophilic cytoplasm, and the cytoplasm is usually positive for vimentin and it contain hyaline inclusions. On immunohistochemical staining, the cells are usually positive for vimentin and cytokeratin and they are negative for desmin. This tumor progresses rapidly and it has a very poor prognosis, but survival is better if there is no lymphatic or distant metastasis. We experienced a patient who suffered with undifferentiated adenocarcinoma with rhabdoid features in the ascending colon. (Korean J Gastrointest Endosc 2010;40:49-53)
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A Case of Anticoagulant Ileus Diagnosed by Double Balloon Enteroscopy
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Yong Wook Kim, M.D., Hyun Joo Jang, M.D., Ji Youn Kim, M.D., Seung Hwa Lee, M.D., Seon Wook Park, M.D., Dong Hee Koh, M.D., Min Ho Choi, M.D. and Jin Lee, M.D.
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Korean J Gastrointest Endosc 2010;40(1):54-57. Published online January 30, 2010
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Abstract
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- Anticoagulant ileus is a rare complication that is caused by an intramural hematoma, and the hematoma is due to excessive anticoagulant therapy. The features of anticoagulant ileus vary from slight abdominal pain to vomiting, severe abdominal pain and abdominal rebound tenderness that are due to intestinal obstruction. Anticoagulant ileus is sometimes accompanied by gastrointestinal bleeding, peritoneal bleeding and panperitonitis due to intestinal perforation. The diagnosis of anticoagulant ileus has been made using such radiographic methods as enhanced abdominal computed tomography and small bowel follow-through. We were able to confirm a case of anticoagulant ileus with bleeding by performing double balloon enteroscopy. We report on this case and we review the relevant literature. (Korean J Gastrointest Endosc 2010;40:54-57)
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Small Bowel Obstruction and Capsule Retention by a Small Bowel Ulcer That Was Not Found on Capsule Endoscopy
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Kwan Sik Park, M.D., Ji Hyun Kim, M.D., Choong Heon Ryu, M.D., Hyo Rim Seo, M.D., Yun Jung Choi, M.D., Seoung In Ha, M.D., Sang Heon Lee, M.D. and Sang Young Seol, M.D.
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Korean J Gastrointest Endosc 2010;40(1):58-61. Published online January 30, 2010
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Abstract
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- Capsule endoscopy (CE) is a valuable modality for directly examining the small bowel in a relatively noninvasive and safe manner. CE is being increasingly used for obscure gastrointestinal bleeding, Crohn's disease, drug induced ulcer and small bowel tumor. Although capsule retention is a relatively infrequent complication, small bowel obstruction and strictures have been considered contraindications to CE. But some authors have reported that capsule endoscopy can be safely used to help identify the etiology and site of small bowel obstruction, and the retention of the capsule indicates the presence of a lesion requiring surgery. We report here on a case of small bowel obstruction and capsule retention by a small bowel ulcer, and the small bowel ulcer was not found when performing capsule endoscopy. (Korean J Gastrointest Endosc 2010;40:58-61)
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A Case of Pancreatic Intraepithelial Neoplasia Presenting as Aucte Pancreatitis
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Dong Wook Lee, M.D., Jae Kwon Jung, M.D., Dong Yeub Eun, M.D., Jung Soo Lee, M.D., Jae Kwang Lee, M.D., Sang Man Park, M.D., Hyun Soo Kim, M.D. and Mi Jin Gu, M.D.*
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Korean J Gastrointest Endosc 2010;40(1):62-67. Published online January 30, 2010
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Abstract
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- Pancreatic intraepithelial neoplasia (PanIN) is a precancerous lesion. A 72-year old man was admitted to our hospital because of abdominal pain, and he had an elevated serum level of pancreatic amylase. ERCP showed a focal stricture of the main pancreatic duct without upstream dilatation in the body of the pancreas. Cytologic evaluation with an endoscopic brush at the stricture suggested the presence of adenocarcinoma. After subtotal pancreatectomy, the features of PanIN were observed in the branch pancreatic duct. ERCP with brush cytology seems to be a useful method for detecting PanIN at the precancerous stage. We report here on a case of PanIN associated with a stricture of the main pancreatic duct. (Korean J Gastrointest Endosc 2010;40:62-67)
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