Clinical Endoscopy

The Role of Endoscopy in Obscure Gastrointestinal Bleeding: Chang Soo Eun, M.D.; Korean J Gastrointest Endosc 2010;41(6):329-337. Published online December 30, 2010

Abstract PDF: Obscure gastrointestinal bleeding (OGIB) is defined as occult or overt bleeding of unknown origin that persists or recurs after an initial negative endoscopic evaluation by gastroscopy or colonoscopy. Most of these problems occur in the small bowel, and it is not an uncommon condition encountered by gastroenterologists, accounting for approximately 5% of all GIB. Traditional endoscopic techniques, including push enteroscopy, have a limited role in diagnosing patients with OGIB because of the inaccessibility of a large part of the small bowel using an endoscopic procedure. The recent introduction of new enteroscopic modalities including capsule endoscopy (CE) and double balloon enteroscopy have allowed mucosal visualization of the entire small bowel, revolutionizing the diagnosis and treatment of patients with OGIB. The respective roles of CE and deep enteroscopy in patients with OGIB are discussed in this review. (Korean J Gastrointest Endosc 2010;41:329-337)

2,285 View
18 Download

Is Endoscopic Resection Currently Available in Non-tertiary or Non-academic Hospitals?: Seong Woo Jeon, M.D., Min Kyu Jung, M.D., Sung Kook Kim, M.D., Tae Nyeun Kim, M.D.*, Byung Ik Jang, M.D.*, Si Hyung Lee, M.D.*, Kyeong Ok Kim, M.D.*, Eun Soo Kim, M.D.^†, Kwang Bum Cho, M.D.^†, Kyung Sik Park, M.D.^†; Korean J Gastrointest Endosc 2010;41(6):338-343. Published online December 30, 2010

Abstract PDF: Background
/Aims: Endoscopic mucosal resection (EMR) has been gaining popularity with the advances in the technique and the accumulating experience. The objectives of this study are to assess the current situation of endoscopic resection (ER) in primary clinics and community-based hospitals and to suggest an affordable training program.
Methods
A questionnaire about the indications to perform ER for gastric or colonic lesions was sent to the doctors working in the non-tertiary hospitals by mail. Results: The responders who were performing EMR or polypectomy for gastric lesions accounted for 43% (31/72) and 44.8% (47/101), respectively, of the total responders. The percentage of responders who had experience with performing EMR or polypectomy for colonic lesions accounted for 56.6% (30/53) and 87.3% (62/71), respectively, of the total responders. The indication for ER for treating gastric and colonic lesions was restricted to the size of 1∼2 cm irrespective of the type or location of lesion. Most of the responders assumed that ER should be performed in their clinics and they wanted to have a chance to improve these techniques.
Conclusions
The infrastructure for therapeutic endoscopy, such as ER, should be progressively expanded. Therefore, well designed schematic training programs are currently needed to advance using ER more commonly in clinical practice. (Korean J Gastrointest Endosc 2010;41:338-343)

2,054 View
10 Download

Cap-assisted ERCP in Surgically Altered Anatomy: Eun Seo Park, M.D., Tae Hoon Lee, M.D., Sang-Heum Park, M.D., Gyu Bong Ko, M.D., Bum Suk Son, M.D., Yun Suk Shim, M.D., Sae Hwan Lee, M.D., Hong-Soo Kim, M.D. and Sun-Joo Kim, M.D.; Korean J Gastrointest Endosc 2010;41(6):344-349. Published online December 30, 2010

Abstract PDF: Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a difficult procedure to perform on patients who have undergone a Billroth II gastrectomy, Whipple's operation or Roux-en-Y gastrobypass surgery. Our study was designed to evaluate the clinical usefulness of cap-assisted ERCP for beginner endoscopists in cases of surgically altered anatomy.
Methods
From April 2008 to March 2010, 16 patients with biliary diseases and who had previously undergone abdominal surgery such as Billroth II gastrectomy or Roux-en-Y operation were analyzed. A single endoscopist performed all the procedures using a cap-assisted gastroscope, after ERCP training.
Results
Cap-assisted ERCP was attempted in 24 sessions of 16 patients. Afferent loop intubation and selective bile duct cannulation was successfully achieved in 19 sessions (79.1%). Among the patients who had undergone a Billroth II gastrectomy, 19 out of 20 sessions were successfully conducted. Only 4 patients who had undergone a previous Roux-en-Y operation failed afferent loop intubation. Duodenal free wall perforation developed in one case. There were no cases of mortality.
Conclusions
Therapeutic cap-assisted ERCP was useful in patients who had previously undergone a Billroth II gastrectomy and this may be helpful for inexperienced endoscopists. (Korean J Gastrointest Endosc 2010;41:344-349)

1,815 View
20 Download

Synchronous Incidental Occurrence of Gastric Gastrointestinal Stromal Tumor and Colon Adenocarcinoma: Joune Seup Lee, M.D., Woo Chul Chung, M.D., Kang Moon Lee, M.D., Chang Nyol Paik, M.D., Hyung Jin Kim, M.D.*, Kyong-Hwa Jun, M.D.*, Hyeon-Min Cho, M.D.* and Hyung Min Chin, M.D.*; Korean J Gastrointest Endosc 2010;41(6):350-354. Published online December 30, 2010

Abstract PDF: A few cases of gastrointestinal stromal tumor (GIST) synchronous cancers with other malignancies have been reported, such as gastric cancer, pancreatic cancer, renal cell carcinoma, colon cancer, and carcinoid tumor. However, little is known about their coincidence with other tumors with a different histogenesis. A 62-year-old man visited our hospital with generalized weakness and intermittent hematochezia. A colonoscopic examination showed an ulcerating mass in the ascending colon, and a biopsy specimen revealed adenocarcinoma. A lobulated submucosal mass in the gastric fundus was found incidentally during the preoperative staging procedures, including computed tomography (CT) and positron emission tomography-CT. The colon cancer and gastric tumor were removed simultaneously (laparoscopy assisted right hemicolectomy and total gastrectomy). Immunohistochemical studies on the gastric tumor surgical specimen showed that it was CD117 (+) and CD34 (+), and the final diagnosis was a GIST of the stomach. Herein, we report a case of the synchronous occurrence of colon adenocarcinoma and gastric GIST. (Korean J Gastrointest Endosc 2010;41:350-354)

2,409 View
13 Download

A Case of Gastric Undifferentiated Carcinoma with Choriocarcinomatous and Hepatoid Carcinomatous Differentiation: Su Youn Lee, M.D., Hee Seok Moon, M.D., Eui Sik Kim, M.D., Yun Jeung Kim, M.D., Pyung Gohn Goh, M.D., Byung Seok Lee, M.D., Hyun Yong Jeong, M.D. and Heon Young Lee, M.D.; Korean J Gastrointest Endosc 2010;41(6):355-359. Published online December 30, 2010

Abstract PDF: Here we report a case of a patient with gastric undifferentiated carcinoma associated with choriocarcinomatous and hepatoid carcinomatous differentiation. A 62-year-old man was referred after a healthcare screening gastroscopy. Gastroscopy revealed an approximately 3×3 cm ulcerofungating mass in the posterior wall of the antrum. Biopsy results revealed a moderately differentiated adenocarcinoma. The initial serum Ձ-FP levels were above 350 ng/mL. An abdominal CT scan revealed focal wall thickening along the greater curvature of the gastric antrum, with perigastric fat invasion and enlarged multiple perigastric lymph nodes. He underwent a palliative radical subtotal gastrectomy and gastroduodenostomy with dissection of the enlarged lymph nodes. Postsurgical histological examination revealed an undifferentiated carcinoma associated with choriocarcinomatous and hepatoid carcinomatous differentiation. Immunohistochemical staining revealed that the tumor cells were positive for human chorionic gonadotropin (hCG), Ձ-FP, and anti-hepatocyte antibody. (Korean J Gastrointest Endosc 2010;41:355-359)

1,775 View
8 Download

A Case of Rectal Cancer in a Patient with X-linked Agammagloubulinemia: Byung Jun Jeon, M.D., Sang Wook Kim, M.D.*, Kang Suk Ko, M.D., Seong Hun Kim, M.D.*, In Hee Kim, M.D.*, Seung Ok Lee, M.D.*, Soo Teik Lee, M.D.* and Dae Ghon Kim, M.D.*; Korean J Gastrointest Endosc 2010;41(6):360-363. Published online December 30, 2010

Abstract PDF: X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disorder caused by germline mutation of the Bruton tyrosine kinase (BTK) gene. Most of the patients diagnosed X-LA suffer from recurrent infections of the respiratory and gastrointestinal tracts. Increased risk of malignancy in X-LA patients include lymphoma, gastric cancer, colorectal cancer. We report a case of 32-years-old male patient with X-linked agammagolbulinemia and rectal cancer. Agammaglobulinemia was diagnosed at 13 years old. He underwent colonoscopy for hematochezia. An ulceroinfiltrative mass was found during colonscopy and biopsy revealed moderately differentiated adenocarcinoma. Subsequently, he underwent a anterior resection. (Korean J Gastrointest Endosc 2010;41:360-363)

1,997 View
7 Download

Two Cases of Ischemic Colitis after Colonoscopy: Kyoung Won Lee, M.D., Koon Hee Han, M.D., Jong Won Kang, M.D., Joung Hwa Lee, M.D., Kyeong Hee Jang, M.D., Young Don Kim, M.D., Gil Hyun Kang, M.D.* and Gab Jin Cheon, M.D.; Korean J Gastrointest Endosc 2010;41(6):364-367. Published online December 30, 2010

Abstract PDF: Ischemic colitis is the most common form of ischemia in the gastrointestinal tract. It results from inadequate blood flow in the colon that leads to inflammation of the colon. Though this disease frequently affects the elderly with risk factors of ischemia, younger patients may be affected too. Several conditions such as major vascular occlusion, small vessel disease, shock, some medications, colonic obstructions and hematologic disorders can predispose individuals to ischemic colitis. Ischemic colitis following colonoscopy is rare. Here we report 2 cases of ischemic colitis which developed after colonoscopic procedures in patients without risk factors of ischemia. (Korean J Gastrointest Endosc 2010;41:364-367)

2,533 View
48 Download

A Case of Endometriosis with Chylous Ascites: Yoon Jung Lee, M.D., Young Cheol Jo, M.D., Tae Hoon Jang, M.D., Bon Ho Ku, M.D., Chi Hoon Kim, M.D., Hye Yon Park, M.D., Kwang Hyuk Lee, M.D. and Jeong Won Lee, M.D.*; Korean J Gastrointest Endosc 2010;41(6):368-372. Published online December 30, 2010

Abstract PDF: Chylous ascites is the extravasation into the peritoneal cavity of milky chyle that is rich in triglycerides. Sixty to seventy percent of chylous ascites cases are caused by cirrhotic liver disease, congestive heart failure, or malignancy. The most common malignancy associated with chylous ascites is lymphoma. Rarely, tuberculosis has been reported as a cause of chylous ascites. Appropriately, lymphoma, ovarian cancer or tuberculosis is considered first in the differential diagnosis when a young woman of reproductive age presents with chylous ascites. Recently, we examined a 26-year-old woman who visited our hospital because of abdominal distension. Ascites tapping, esophagogastroduodenoscopy, colonoscopy and diagnostic laparoscopic biopsy led to a diagnosis of intraperitoneal endometriosis with chylous ascites. To date, some cases of endometriosis complicated by massive ascites have been reported. However, endometriosis complicated by chylous ascites has not been previously reported. The case was successfully treated using a gonadotropin-releasing hormone agonist and diuretics. (Korean J Gastrointest Endosc 2010;41:368-372)

2,383 View
6 Download

A Case of Rectal Metastasis from Primary Signet Ring Cell Carcinoma of the Colon: Kwan Mi Pack, M.D., Jae Myung Cha, M.D., Joung Il Lee, M.D., Kwang Ro Joo, M.D., Hyun Phil Shin, M.D., Jae Jun Park, M.D., Jung Won Jeon, M.D. and Gou Young Kim, M.D.*; Korean J Gastrointest Endosc 2010;41(6):373-377. Published online December 30, 2010

Abstract PDF: Rectal metastasis of colon cancer without peritoneal carcinomatosis is a rare condition whose initial clinical presentation may mimic inflammation. To the best of our knowledge, there was no report on such cases. A 45-year-old man with a history of left hemicolectomy and adjuvant chemotherapy for primary signet ring cell carcinoma (SRCC) of the descending colon, admitted to have constipation and abdominal pain for 3 weeks. His colonoscopic findings did not show local tumor recurrence at the anastomsis site, however, a hard, concentric luminal narrowing of the lower rectum was encountered. Endoscopic biopsies revealed chronic inflammations, and positron emission tomography with ¹⁸F-fluorodeoxyglucose revealed diffuse mildly hypermetabolic lesion in the rectum, suggesting inflammation. Magnetic resonance image showed submucosal wall thickening with multiple perirectal lymph nodes. Rectal metastasis of colon cancer was highly suspected clinically and a surgical biopsy confirmed SRCC which was surgically removed thereafter. (Korean J Gastrointest Endosc 2010;41:373-377)

2,436 View
15 Download

Colonic Stent Insertion Through a Colostomy in a Patient with Recurred Malignant Obstruction: Nam Chul Jin, M.D., Dae Hyun Kim, M.D., Young A Song, M.D., Ho Seong Ryu, M.D., Sung Bum Cho, M.D., Wan Sik Lee, M.D., Hyun Soo Kim, M.D. and Young Eun Joo, M.D.; Korean J Gastrointest Endosc 2010;41(6):378-381. Published online December 30, 2010

Abstract PDF: Colorectal self-expanding metal stents have been used for palliation or preoperative decompression as a bridge-to-surgery in patients with malignant obstruction due to primary or recurred colorectal cancer. The usual attempt to implant of the stent is through the anus under endoscopic guidance, but that is difficult or impossible in patient who have undergone laparoscopic abdominoperineal resection (APR) and who have a colostomy. Especially, to advance and position the stent in the target lesion through the colostomy is very difficult because of the tortuosity and anatomical alteration of the proximal bowel caused by surgery. We herein report on a case of recurred malignant colonic obstruction with stent placement through a preformed colostomy. To date, this approach through a colostomy for the deployment of a stent has not been described in the Korean literature. (Korean J Gastrointest Endosc 2010;41:378-381)

2,289 View
15 Download

A Case of Splenic Rupture after Diagnostic Colonoscopy: Sun Bean Kim, M.D., Won Joong Jeon, M.D.*, Hyun Kim, M.D.^†, Kyung Ho Song, M.D.*, Jeong Rok Lee, M.D.*, Sang Jin Lee, M.D.*, Young Nam Kim, M.D.* and Byung Hyo Cha, M.D.*; Korean J Gastrointest Endosc 2010;41(6):382-384. Published online December 30, 2010

Abstract PDF: Splenic injury during colonoscopy is a rare, but potentially life-threatening complication. We report here on the case of a 75-year-old female patient with a ruptured spleen after screening colonoscopy and we review the relevant literature. (Korean J Gastrointest Endosc 2010;41:382-384)

2,497 View
15 Download

Cytomegalovirus Colitis with Ulcerative Colitis in the Steroid Naïve Immunocompetent Patient: Hyo Keun Lee, M.D., Won Ki Bae, M.D., Woo Sun Rou, M.D., Tae Jun Song, M.D., Nam-Hoon Kim, M.D., Kyung-Ah Kim, M.D., June Sung Lee, M.D. and Mee Joo, M.D.*; Korean J Gastrointest Endosc 2010;41(6):385-389. Published online December 30, 2010

Abstract PDF: Ulcerative colitis is an idiopathic chronic inflammatory bowel disease that exclusively involves the colon. It is characterized by diffuse mucosal inflammation and a recurrent course of remission and relapse. Factors such as smoking, diet, genetic factors and miocrobial infection have all been suggested as causes of ulcerative colitis. One of the important issues in the treatment of ulcerative colitis is opportunistic infection associated with the usage of corticosteroid and immunosuppresant. In most cases, opportunistic cytomegalovirus infection after treatment with corticosteroid or immunosuppressant worsens the course of ulcerative colitis. However, cytomegalovirus infection is uncommon in immunocompetent patients and it is rare in immunocompetent patients with corticosteroid naive ulcerative colitis. We report here on a case in which an immunocompetent patient was newly diagnosed with ulcerative colitis and cytomegalovirus coinfection simultaneously. (Korean J Gastrointest Endosc 2010;41:385-389)

2,383 View
12 Download

The Solitary Polypoid Ganglioneuroma of the Ascending Colon: Yong Wook Jung, M.D., Byung Ik Jang, M.D., Kyung Ae Chang, M.D., Kyeong Ok Kim, M.D. and Mi Jin Kim, M.D.*; Korean J Gastrointest Endosc 2010;41(6):390-393. Published online December 30, 2010

Abstract PDF: Ganglioneuromas are neuroectodermal tumors composed of varying amount of ganglion cells, nerve fibers, supporting cells of the enteric nervous system. Ganglioneuromas of the GI tract are rare tumors. A 50-year-old man came to our hospital due to the mass of liver and adrenal gland which was examined with ultrasonography at local medical center. On admission, abdominal magnetic resonance imaging was taken and liver biopsy was done. The mass of liver was hyperplastic nodule. At colonoscopy, about 0.3∼0.8 cm sized six polyps were noted. Except the 0.6 cm sized semipedunculated polyp of the ascending colon, the others were tubular adenomas. Histological examination of the polyp of the ascending colon revealed localized proliferation of nerve fibers and ganglion cells. These cells are positive for S-100 protein by immunihistochemistry. Therefore, he was diagnosed with polypoid ganglioneuroma of the ascending colon. We report this case because the solitary ganglioneuroma in large intestine without systemic disease was rare. (Korean J Gastrointest Endosc 2010;41:390-393)

1,954 View
17 Download

Previous issues