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Volume 41(5); November 2010
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Endoscopic Treatment of Gallstone Diseases
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Byeong Moo Yoo, M.D.
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Korean J Gastrointest Endosc 2010;41(5):255-265. Published online November 30, 2010
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Abstract
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- Gallstone diseases include gallbladder stones, extrahepatic bile duct stones and intrahepatic duct stones. In the past, the main treatment modality was a surgical operation. With the development of endoscopic treatment, the main treatment modality is shifting towards endoscopic treatment. After the development of endoscopic sphincterotomy, endoscopic stone removal using a basket or balloon has been the major treatment modality for extrahepatic bile duct stones. For huge extrahepatic bile duct stones, mechanical or laser lithotripsy are used as ancillary equipment. Direct peroral cholangioscopic methods using a slim endoscopy or a Spyglass system now being rapidly developed instead of the "mother and baby" scope. If extrahapatic bile duct stones fail to be removed with peroral endoscopic treatment, then the stones can be treated via a percutaneous route (a percutaneous transhepatic route or a percutaneous transabdominal route). For intrahepatic duct stones, the location of stones, the site and degree of bile duct stricture and the existence of parenchymal atrophy are important factors to decide the treatment modality. The treatment modality is usually decided on according to the Tsunoda classification. Gallbladder stones usually need cholecystectomy because of recurrence. Endoscopic treatment is an indication for treating inoperable calculous cholecystitis patients. Endoscopic treatment for gallstone disesae will continue to rapidly develop in the future to the benefit of both the patients and endoscopists. (Korean J Gastrointest Endosc 2010;41:255-265)
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Results of Screening Colonoscopy in Asymptomatic Average-risk Koreans at a Community-based Secondary Hospital
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Jong Kyu Kim, M.D., Yong Sung Choi, M.D., Jung Pil Suh, M.D., In Taek Lee, M.D.*, Eui Gon Youk, M.D.* and Doo Seok Lee, M.D.*
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Korean J Gastrointest Endosc 2010;41(5):266-272. Published online November 30, 2010
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Abstract
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- Background
/Aims: Colonoscopy has emerged as the dominant colorectal cancer screening strategy, yet the data on the results of performing screening colonoscopy in asymptomatic average risk Koreans is limited. The aim of this study is to determine the results of screening colonoscopy at a community-based single center in Korea.
Methods
A total of 13,743 individuals (5,935 males and 7,808 females, age: 50.6±11.8 years) who underwent screening colonoscopy at a community based hospital from April 2006 to March 2008 were analyzed.
Results
Of the 13,743 subjects, neoplasia, advanced neoplasia and early colon cancer were detected in 3,270 subjects (23.8%), 315 subjects (2.3%) and 60 subjects (0.5%), respectively. The prevalence of neoplasia and advanced neoplasia increased with age (p＜0.001), and this was higher among males as compared to that of females (p＜0.001). Of the 3,666 subjects with neoplasia, 1,440 subjects (38.3%) had multiple neoplasia. Old age and male gender were associated with multiple neoplasia.
Conclusions
The overall prevalence of colorectal neoplasia in asymptomatic average-risk Koreans at a community based hospital is comparable with that in a health care setting or university hospitals. Old age and male gender are associated with a higher risk of colorectal neoplasia and having multiple neoplasia. (Korean J Gastrointest Endosc 2010;41:266-272)
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Bilateral Biliary Approach in Patients with Hepatolithiasis
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Dong Uk Kim, M.D., Geun Am Song, M.D., Kwang Ha Kim, M.D., Suk Kim, M.D.*, Hyung Wook Kim, M.D. and Dae Hwan Kang, M.D.
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Korean J Gastrointest Endosc 2010;41(5):273-279. Published online November 30, 2010
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Abstract
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- Background
/Aims: Percutaneous procedures for treating patients with hepatolithiasis associated with intrahepatic biliary stricture (IHBS) have been shown to have a relatively lower rate of successful stone removal than without IHBS. The reason is tight stenosis or acute angulation of intrahepatic bile ducts (IHDs). We suggest that a bilateral approach to IHDs would improve the success rate of stone removal in patients with complicated IHBS.
Methods
Conventional cholangioscopic electrohydrolithotripsy (EHL) was performed in 82 patients without IHBS. Percutaneous transhepatic stricture dilation and cholangioscopic EHL through unilateral access was performed to treat 41 patients with hepatolithiasis with IHBS. In 21 patients with complicated stricture and multiple stones, removal of hepatolithiasis was achieved by a bilateral approach. The rate of complete stone clearance and complication was reviewed retrospectively.
Results
Complete stone clearance was achieved in 92.7% (76/82) of patients using a unilateral approach without IHBS, in 61.0% (25/41) of cases using a unilateral approach with IHBS, and in 85.7% (18/21) of cases using a bilateral approach with IHBS (p＜0.05). The number of sessions of PTCS was 2.7±0.3, 3.9±0.3, and 2.7±0.5 respectively. The overall complication rate was 14.6% (21/144), and didn't differ between groups.
Conclusions
A bilateral approach to IHDs may be a useful alternative treatment in unresectable patients with multiple hepatolithiasis associated with complicated IHBS. (Korean J Gastrointest Endosc 2010;41:273-279)
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Simultaneous Herpes Simplex and Candida Esophagitis in Renal Transplant Patients
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Hyun Jung Oh, M.D., Seong-Eun Kim, M.D., Ju Young Choi, M.D., Sun Hee Roh, M.D., Hye-Kyung Jung, M.D., Tae-Hun Kim, M.D., Ki-Nam Shim, M.D. and Sung-Ae Jung, M.D.
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Korean J Gastrointest Endosc 2010;41(5):280-284. Published online November 30, 2010
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Abstract
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- Infectious esophagitis usually occurs in immunocompromised patients with AIDS, malignancy and those receiving immunosuppresive therapy. Common pathogens causing esophagitis include Candida, Herpes simplex virus and Cytomegalovirus. However simultaneous esophageal infection with both Candida and Herpes simplex virus has rarely been reported. The endoscopic findings of Herpes simplex esophagitis combined with Candida infection does not show typical findings due to diffuse whitish or yellowish plaques; hence, accurate diagnosis can be delayed. We observed concomitant infection of Herpes simplex virus and Candida causing esophagitis in a 45-year-old renal transplant patient who had been receiving immunosuppressive therapy. The patient showed marked reductions in clinical symptoms and in endoscopic findings after anti-fungal and acyclovir therapy. (Korean J Gastrointest Endosc 2010;41:280-284)
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A Case of an Exoluminal Gastrointestinal Stromal Tumor That Was Confused with a Metastatic Lymph Node in Early Gastric Cancer
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Jung Soo Park, M.D., Hyojin Park, M.D., Jong Won Kim, M.D.*, Sun Och Yoon, M.D.†, Hyung Soon Park, M.D., Jie-Hyun Kim, M.D., Young Hoon Yoon, M.D. and Eun Na Cho, M.D.
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Korean J Gastrointest Endosc 2010;41(5):285-289. Published online November 30, 2010
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Abstract
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- Gastric adenocarcinoma may coexist with tumors of other histological types. The synchronous occurrence of gastric adenocarcinoma and gastrointestinal stromal tumor (GIST) has rarely been reported in the literature. It is still not known whether such an association represents an incidental coexistence or indicates a similar pathogenesis in the simultaneous development of tumors of different histological types. Here we report a case of an exoluminal GIST that was confused with a metastatic lymph node in early gastric cancer. (Korean J Gastrointest Endosc 2010;41:285-289)
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Portal and Mesenteric Venous Thrombosis Complicating Endoscopic Injection Sclerotherapy
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Seouk Chan Ko, M.D., Bong Roung Kim, M.D., Yoo Hyun Jang, M.D., Jang Eon Kim, M.D., Yoon Jeong Kim, M.D., Seung June Lee, M.D., Seong Tae Lee, M.D. and Hyang-Im Lee, M.D.*
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Korean J Gastrointest Endosc 2010;41(5):290-293. Published online November 30, 2010
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Abstract
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- Endoscopic injection sclerotherapy is an effective and relatively safe modality for controlling bleeding esophageal varices. Injection of sclerosant causes acute mural thrombosis with a necroinflammatory response and subsequent sclerosis in the venous system of the distal esophagus. A few cases of mesenteric venous thrombosis with small bowel infarction after sclerotherapy have been reported, and most of which were fatal. The association between mesenteric venous thrombosis and sclerotherapy has been strongly suggested, but this still remains unproved. We report here on a case of mesenteric venous thrombosis with small bowel infarction that developed after endoscopic injection sclerotherapy. (Korean J Gastrointest Endosc 2010;41:290-293)
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A Case of Duodenal Diverticulitis
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Chang Hyeon Seock, M.D., Hae Kyung Kim, M.D., Tae Il Park, M.D., Byung Min John, M.D., Hyeon U Jo, M.D., Jae Seung Kim, M.D., Kee Bum Kim, M.D.* and Byung Soo Na, M.D.*
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Korean J Gastrointest Endosc 2010;41(5):294-297. Published online November 30, 2010
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Abstract
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- Duodenal diverticulitis is difficult to diagnose because it can mimic other common diseases such as cholecystitis and perforated ulcer. Recently, we experienced a rare case of duodenal diverticulitis that was initially suspected on abdominal computed tomography as focal pancreatitis. Although duodenal diverticulitis has been increasingly recognizable before surgery, with the advent of multi-detector computed tomography, misdiagnosis remains problematic since duodenal diverticulitis is commonly not considered in the differential diagnosis of acute abdominal pain. We have to consider this rare disease entity because delayed diagnosis might be a cause of substantial morbidity and mortality. (Korean J Gastrointest Endosc 2010;41:294-297)
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A Case of Early Esophageal Cancer Treated by Photodynamic Therapy in a Patient with Liver Cirrhosis Accompanied by Esophageal Varix
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Yoon Yung Chung, M.D., Woo Chul Chung, M.D., U-Im Chang, M.D., Ju Hyun Oak, M.D., Yeon Oh Jeong, M.D., Min Ju Kim, M.D., Chang Nyol Paik, M.D. and Kang-Moon Lee, M.D.
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Korean J Gastrointest Endosc 2010;41(5):298-302. Published online November 30, 2010
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Abstract
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- Photodynamic therapy (PDT) is a non-invasive treatment for cancer that works through a photochemical effect after the administration of a photosensitizer. At first, PDT had been used for the relief of obstructive symptoms caused by exophytic esophageal cancer or for control of tumor overgrowth. Recently, several investigators have reported the use of PDT in early esophageal cancer with encouraging results. This report describes a case of a 52-year-old man with early esophageal cancer, who had a long history of liver cirrhosis with esophageal varix. The patient was treated successfully with PDT using porfimer sodium as the photosensitizer. PDT is an alternative to surgical treatment of early esophageal cancer, especially in patients with liver cirrhosis. (Korean J Gastrointest Endosc 2010;41:298-302)
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A Case of Dieulafoy's Lesion with Pseudoaneurysm in the Sigmoid Colon
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Tae Wan Kim, M.D., Hong Joo Kim, M.D., Jae Hoon Min, M.D., Sun Jeong Byun, M.D., Ji Ae Lee, M.D., Seung Hun Jang, M.D. and Sung Youn Choi, M.D.
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Korean J Gastrointest Endosc 2010;41(5):303-307. Published online November 30, 2010
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Abstract
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- Dieulafoy's lesions are characterized by a single large tortuous arteriole in the submucosa, and this arteriole does not undergo normal branching. These lesions are an uncommon cause of massive, sometimes fatal gastrointestinal bleeding; this had been reported to be the cause of 0.3∼1.5% of the cases of major gastrointestinal bleeding. The lesions mainly occur in the proximal stomach, but they may occur in all parts of the gastrointestinal tract, including the small bowel, colon and rectum. Endoscopy is a common method for the diagnosis and treatment of Dieulafoy's lesions. However, in the case of a high risk lesion, angiography, laparoscopy or laparotomy can be performed instead. We experienced a rare case of bleeding from a Dieulafoy's lesion with pseudoaneurysm in the sigmoid colon. Angiography with embolization was performed, but the patient expired due to rebleeding. We report on this case along with a review of the relevant literature. (Korean J Gastrointest Endosc 2010;41:303-307)
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Simultaneous Melanosis Duodeni and Melanosis Ilei in a Patient Taking Oral Iron
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Kyoung Won Lee, M.D., Woo Jin Jeong, M.D., Joung Hwa Lee, M.D., Jong Won Kang, M.D., Kyeong Hee Jang, M.D., Koon Hee Han, M.D., Gil Hyun Kang, M.D.* and Gab Jin Cheon, M.D.
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Korean J Gastrointest Endosc 2010;41(5):308-311. Published online November 30, 2010
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Abstract
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- Melanosis means the accumulation of brown or black pigment in an organ. Melanosis can be observed in virtually all parts of the gastrointestinal tract. However, it most frequently affects the colon. It is said that melanosis in small intestine is very rare, and no case has been reported in which melanosis was simultaneously noted in duodenum and ileum without involving the colonic mucosa. Here we report a case of melanosis duodeni and melanosis ilei which were found simultaneously in a 56-year-old female patient with chronic renal failure and heart failure who had been taking oral ferrous sulfate for 3 years. (Korean J Gastrointest Endosc 2010;41:308-311)
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Two Cases of Pyoderma Gangrenosum Associated with Recurrent Ulcerative Colitis
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Yong Hwan Kwon, M.D., Jae Woo Kim, M.D., So Yeon Park, M.D., Moon Young Kim, M.D., Hyun Soo Kim, M.D., Soon Koo Baik, M.D., Jamshid Abdul-Ghafar, M.D.* and Mee Yon Cho, M.D.*
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Korean J Gastrointest Endosc 2010;41(5):312-318. Published online November 30, 2010
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Abstract
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- Pyoderma gangrenosum (PG) begins with a painful, erythematous skin lesion followed by pustule formation and rapid ulceration in which an erythematous border surrounds a sterile, necrotic center. In most patients, symptoms of ulcerative colitis precede PG, and exacerbations of the bowel disease frequently correlate with worsening of the skin lesions. As PG is not commonly encountered by clinicians, the diagnosis of such lesions is not always straightforward. This case emphasizes the importance of detailed history taking and the consideration of PG as a differential diagnosis of such lesions in patients with a background of related systemic disease. The prognosis of PG is generally good. But, early aggressive therapy can minimize severe complications, and maintenance treatment may prevent some devastating consequences. We report two cases of PG that developed on the entire body and on an anterior chest wall abscess with ulcerative colitis, which improved with corticosteroid and cyclosporine. (Korean J Gastrointest Endosc 2010;41:312-318)
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Rectal Endometriosis That Is Difficult to Differentiate from Endoscopically Resectable Subepitherial Lesion
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Seung Kyu Chung, M.D., Suck-Ho Lee, M.D., Bum Suk Son, M.D., Chang Kyun Lee, M.D., Tae Hoon Lee, M.D., Il-Kwun Chung, M.D., Sun-Joo Kim, M.D. and Ji-Hye Lee, M.D.*
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Korean J Gastrointest Endosc 2010;41(5):319-323. Published online November 30, 2010
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Abstract
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- Endometriosis occurs most frequently in the intestine. In the pelvic organs intestinal endometriosis presents with various symptoms and endoscopic findings. If an asymptomatic submucosal lesion is found in the sigmoid colon or rectum of reproductive women, a differential diagnosis should be done. Owing to advancements in endoscopic therapy, endoscopic excision has been attempted for various subepithelial lesions. To successfully do an endoscopic excision, accurate diagnosis should be obtained through diagnostic tests such as endoscopic ultrasonography prior to excision. Here the authors report a case of rectal endometriosis in an asymptomatic woman of reproductive age. They attempted endoscopic resection based on the endoscopic finding that the subepithelial lesion was limited to the submucosal layer in endoscopic ultrasonography. This conclusion turned out to be a mistaken one. Because of tumor adhesion to the proper muscular layer, we failed to successfully conduct an endoscopic excision. Ultimately, we did surgery and diagnosed rectal endometriosis. (Korean J Gastrointest Endosc 2010;41:319-323)
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A Case of Mucinous Cystic Neoplasm of the Pancreas Communicating with the Main Pancreatic Duct
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Jae Jin Hwang, M.D., Tae Hyo Kim, M.D., Wan Su Kim, M.D., Hyeoun Jung Jang, M.D., Hong Jun Kim, 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 2010;41(5):324-327. Published online November 30, 2010
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- Diagnoses of cystic lesions in the pancreas are increasing in clinical practice because of the wider use of imaging studies. The selection of appropriate treatment depends on the ability to distinguish between benign and malignant cysts. However, cystic pancreatic neoplasms are sometimes misdiagnosed as pseudocysts and treated improperly. We experienced a case of mucinous cystic neoplasm of the pancreas misdiagnosed as a pseudocyst, which had a communication between the cyst and the main pancreatic duct. (Korean J Gastrointest Endosc 2010;41:324-327)
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