Clinical Endoscopy

The Perspectives on the Development of the Korean Society of Gastrointestinal Endoscopy: Jin Il Kim, M.D., Yong Chan Lee, M.D.*, Hoon Jai Chun, M.D.^† and Chang Duck Kim, M.D.^†; Korean J Gastrointest Endosc 2011;42(1):1-5. Published online January 30, 2011

Abstract PDF: The Korean Society of Gastrointestinal Endoscopy was established in 1976 for academic exchanges between endoscopic specialists. It joined the Korean Academy of Medical Science in 1988 and founded The Gastrointestinal Endoscopy Research Foundation of Korea in 2009 for academics, education, and research on gastrointestinal endoscopy. The Korean Academy of Medical Science rated this academic society 250 out of 275 points, which is equivalent to 91 points when converted to a 100 point scale. Globalization is the recommendation of the Korean Academy of Medical Science. To pursue globalization, this academic society will publish and register English journals on Index Medicus and encourage the use of English during symposiums. Such efforts will allow this academic society to better cooperate and exchange knowledge with academic societies of other countries. Moreover, this academic society must contribute socially by enlightening the public about endoscopy. (Korean J Gastrointest Endosc 2011;42:1-5)

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The Long-term Outcome and Predictors for Increased Survival after PDT for Hilar Cholangiocarcinoma: Ji Ho Ahn, M.D., Young Koog Cheon, M.D., Young Deok Cho, M.D., Hyun Jong Choi, M.D., Jong Ho Moon, M.D., Tae Hoon Lee, M.D., Sang Heum Park, M.D. and Chan Sup Shim, M.D.*; Korean J Gastrointest Endosc 2011;42(1):6-10. Published online January 30, 2011

Background/Aims: Photodynamic therapy (PDT) has a promising effect on nonresectable cholangiocarcinoma (CC) but its long term data is not yet available. This study examined the long term outcome and factors associated with increased survival after performing PDT for hilar cholangiocarcinoma.

Methods: A list of 393 patients with a diagnosis of hilar CC was retrieved from the database of Soonchunhyang University Hospital (Seoul, Korea) and these patients were seen from January 1, 2001, to April 1, 2010. We retrospectively reviewed the records of 74 patients who underwent PDT in addition to biliary stenting with/without chemoradiation.

Results: The median overall survival from the date of diagnosis to death or to the last follow-up was 11.7 months (range: 2.2∼78.4). After performing PDT, a complete remission was observed in 1.3% (1/74) of the patients who had a superficial depth of tumor without lymph node involvement. On multivariate analysis using the Cox regression model, increasing the time to treatment after the diagnosis was a statistically significant predictor of shorter survival after PDT [Odds ratio: 3.25, 95% confidence interval (CI): 1.90∼4.71, p=0.034].

Conclusions: Although PDT does not prevent progression of CC, it appears to control the cholestasis. The early treatment of PDT after the diagnosis showed a survival benefit for patients with advanced hilar CC. (Korean J Gastrointest Endosc 2011;42:6-10)

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The Efficacy and Safety of Fully Covered Self-expandable Metal Stents in Benign Extrahepatic Biliary Strictures: Byeong Uk Kim, M.D., Ja Chung Goo, M.D., Young Shim Cho, M.D., Jung Ho Han, M.D., Soon Man Yoon, M.D., Hee Bok Chae, M.D., Seon Mee Park, M.D. and Sei Jin Youn, M.D.; Korean J Gastrointest Endosc 2011;42(1):11-19. Published online January 30, 2011

Abstract PDF

Background/Aims: For the endoscopic treatment of benign biliary strictures (BBS), it has been a drawback to use plastic stents or uncovered self-expandable metal stents. We investigated the efficacy and safety of temporary placing fully covered self-expandable metal stents (FCSEMS) in BBS.

Methods: We enrolled 12 cases that followed up more than 6 months after insertion of a FCSEMS in BBS via ERCP. The cohort consisted of 9 patients with recurrent cholangitis, 2 patients with postcholecystectomy and 1 patient with chronic pancreatitis. The efficacy was assessed according to the resolution of strictures and also the restricture after stent removal, and the safety was evaluated according to the complications associated with stent placement. Finally, the removability of FCSEMSs was assessed.

Results: The median time of FCSEMS placement was 6.0 months. Resolution of the BBS was confirmed in 8 cases (67%) after a median post-removal follow-up of 8.5 months. Restricture after stent removal happened in 4 cases (33%). The complications were severe abdominal pain (n=2), pancreatic abscess (n=1) and stent migration (n=6). In 7 cases, all the FCSEMSs were successfully removed by grasping them with forceps.

Conclusions: Temporary placement of a FCSEMS in BBS showed good therapeutic effects, relative safety and easy removability. Further evaluation is needed for determining the causes of restricture and for developing a new stent with antimigration features. (Korean J Gastrointest Endosc 2011;42:11-19)

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Extrinsic Indentation at Gastric Fundus by Splenic Lymphangioma: Shi Heon Dong, M.D., Hee Man Kim, M.D., Jae Hee Cho, M.D., Hee Woo Lee, M.D., Seung Won Lee, M.D., Beo Deul Kang, M.D., Sun Ok Song, M.D. and Sang Yeop Yi, M.D.; Korean J Gastrointest Endosc 2011;42(1):20-23. Published online January 30, 2011

Abstract PDF: Splenic lymphangioma is a very rare benign condition, and it is classified as one of the cystic proliferations of the spleen. This is considered to result from developmental malformation of the lymphatic system. Splenic lymphangioma is usually seen in children and it is often found incidentally. Herein, we report on an unusual case of splenic lymphangioma in an adult. A 66-year-old woman presented with abdominal pain. On esophagogastroduodenoscopy, the gastric fundus was externally compressed by an extrinsic mass. Computed tomography revealed multiple cystic masses in the spleen. Laparoscopic splenectomy was then performed. The histology revealed multiple splenic lymphangiomas. This case showed an unusual presentation of splenic lymphangioma as gastric extrinsic compression, and this should be examined by imaging studies. (Korean J Gastrointest Endosc 2011;42:20-23)

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A Case of Argon Plasma Coagulation Therapy for Hemorrhagic Radiation-induced Gastritis: Mi Young Jang, M.D., Yong Keun Cho, M.D., Sung Jun Goh, M.D., Min Gyu Park, M.D., Dong Yup Lee, M.D., Yong Woo Seo, M.D., Gum Mo Jung, M.D. and Jin Woong Cho, M.D.; Korean J Gastrointest Endosc 2011;42(1):24-27. Published online January 30, 2011

Abstract PDF: Hemorrhagic radiation-induced gastritis is a rare but serious complication of upper gastrointestinal radiation treatment, and no simple and effective treatment method has yet been developed. Studies on effective treatment methods for achieving hemostasis in patients with hemorrhagic radiation-induced gastritis are necessary, because the new indications for upper gastrointestinal radiotherapy in the field digestive oncology can potentially lead to an increased incidence of radiation- induced gastric vasculopathy. For the first time in Korea and to the best of our knowledge, we report here on a 59-years-old male patient with hemorrhagic gastritis that was induced by external radiotherapy for ampullary adenocarcinoma. This was all well-treated using Argon plasma coagulation (APC). (Korean J Gastrointest Endosc 2011;42:24-27)

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A Case of Synchronous Colorectal Adenocarcinoma with Anal Squamous Cell Carcinoma: Bo Yong Jung, M.D., Suck-Ho Lee, M.D., Chang Kyun Lee, M.D., Eun Seo Park, M.D., Il-Kwun Chung, M.D., Sun-Joo Kim, M.D., Moo Jun Baek, M.D.* and Ji Hye Lee, M.D.^†; Korean J Gastrointest Endosc 2011;42(1):28-32. Published online January 30, 2011

Abstract PDF: Synchronous anal squamous cell carcinoma with colorectal adenocarcinoma is a very rare and interesting disease entity because these neoplasms are essentially different from each other in terms of their anatomical locations, clinical behaviors, histopathological characteristics and treatment. To date, there have been very few case reports regarding the concurrent occurrence of these two distinct neoplasms. Nonetheless, it is recommended that patients with squamous cell carcinoma of the anus and who are older than 50 years should undergo colonoscopy in order to rule out a synchronous colorectal neoplasm. We recently encountered a 72-year-old woman who presented with synchronous squamous cell carcinoma of the anal canal and adenocarcinoma of the rectosigmoid junction. The patient underwent curative surgical resection for the colorectal adenocarcinoma and chemoradiotherapy for the concurrent anal squamous cell carcinoma. We describe here our clinical experience with this unusual case and we also conduct a short review of relevant literature. (Korean J Gastrointest Endosc 2011;42:28-32)

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Cytomegalovirus Colitis Causing Cecal Perforation and Massive Lower Gastrointestinal Bleeding: Jung Won Jeon, 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., Kwan Mi Pack, M.D. and Jun Uk Lim, M.D.; Korean J Gastrointest Endosc 2011;42(1):33-37. Published online January 30, 2011

Abstract PDF: Cytomegalovirus (CMV) infection is associated with significant morbidity and mortality in immunocompromised patients. It may cause serious illness including bleeding, ulceration and perforation of the gastrointestinal tract. However, bowel perforation, toxic megacolon, and massive lower gastrointestinal bleeding caused by CMV in one patient is not common. In this report, we present a case of CMV colitis causing cecal perforation and massive lower gastrointestinal bleeding in a patient with lupus nephritis. In our case, severe lower gastrointestinal bleeding developed during successful treatment of CMV infection with ganciclovir. Even though the outcome of CMV colitis has improved since ganciclovir has been available for immunocompromised patients, reductions in gastrointestinal bleeding from colonic ulcers of CMV colitis may be possible during successful treatment with ganciclovir. This case suggests the possibility of lower gastrointestinal bleeding from a colon ulcer of CMV colitis should be considered during successful treatment with ganciclovir in immunocompromised patients. (Korean J Gastrointest Endosc 2011;42:33-37)

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Pneumothorax, Pneumomediastinum, Subcutaneous Emphysema, Pneumoretroperitoneum Secondary to Colonoscopic Perforation: Ju Kyeon Yim, M.D., Yeong Muk Kim, M.D. and Sung Nam Park, M.D.; Korean J Gastrointest Endosc 2011;42(1):38-42. Published online January 30, 2011

Abstract PDF: A colonoscopic perforation is rare but can cause a fatal outcome. A perforation can be intraperitoneal or retroperitoneal. Air in the retroperitoneal space by perforation can spread to the mediastinum, pleura, and subcutaneous tissue through the visceral space. Therefore, a colonoscopic perforation may manifest as a pneumomediastinum, a pneumothorax, or subcutaneous emphysema without a peritoneal irritation sign. Although a colonoscopic perforation is treated mainly with an operation, medical treatment may be possible in selected cases, especially for a perforation to the retroperitoneal area or that under peritoneal reflexion. Clipping of a perforation is effective for medical treatment. We experienced a case of pneumothorax, pneumomediastinum, subcutaneous emphysema and pneumoretroperitoneum without peritoneal irritation following a diagnostic colonoscopy, which was diagnosed after 3 days because of atypical symptoms but was successfully managed with medical treatment and clipping. (Korean J Gastrointest Endosc 2011;42:38-42)

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A Case of Colonic Obstruction Due to Phytobezoars: Jung Min Chae, M.D., Jae Myung Cha, M.D., Joung Il Lee, M.D., Kwang Ro Joo, M.D., Sunyong Kim, M.D., Uk Jo, M.D., Min Kyung Kim, M.D. and Jung Sun Yoo, M.D.; Korean J Gastrointest Endosc 2011;42(1):43-46. Published online January 30, 2011

Abstract PDF: Colonic phytobezoars are defined as conglomerate masses of fruit or vegetable matter in the colon, and these have rarely reported as a cause of colon obstruction. Because it is extremely rare, its correct diagnosis might be delayed even with the aid of abdominal computed tomography. We report here on a case of diagnosed colonic obstruction due to colonic phytobezoars in a 67-year-old female with diabetic end stage renal disease and chronic constipation. Although abdomino-pelvic computed tomography did not demonstrate the presence of phytobezoars, multiple phytobezoars impacted in the colon were found and these were removed by colonoscopy. This is a rare case in that colonic obstruction due to phytobezoar was diagnosed early and it was treated by colonoscopy. (Korean J Gastrointest Endosc 2011;42:43-46)

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Jejunal Metastasis of Lung Cancer Diagnosed with Double Balloon Enteroscopy: Sun Gyo Lim, M.D., Sung Jae Shin, M.D., Kyung Hyun Koh, M.D., Sung Jun Choi, M.D., Jeong Woo Choi, M.D., Ki Myung Lee, M.D. and Jin Hong Kim, M.D.; Korean J Gastrointest Endosc 2011;42(1):47-51. Published online January 30, 2011

Abstract PDF: Metastasis from lung cancer to the small bowel is rare and this accounts for 0.2% to 0.5% of all the cases of metastasis from lung cancer. In most cases, the patients are asymptomatic and they can show signs of bleeding, intestinal obstruction, perforation and so on. A better diagnostic approach to the small bowel has recently been made possible through capsule endoscopy and double balloon enteroscopy (DBE), and they have a higher diagnostic rate for small bowel bleeding compared with that of the previous diagnostic tests. DBE makes it possible to diagnose precisely due to the high quality endoscopic images and biopsy specimens. In addition, therapeutic DBE with a 2.8 mm channel enables performing more kinds of therapeutic procedures than diagnostic DBE with a 2.2 mm channel. If small bowel metastasis is suspected on ¹⁸FDG-PET/CT, then DBE can be considered for making a pathologic diagnosis. We report here on a case of small bowel metastasis from non small cell lung cancer in a 39-year-old woman who complained of hematochezia and we review the relevant literature. (Korean J Gastrointest Endosc 2011;42:47-51)

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Diagnosis of a Transverse Colon Penetration and Tube Displacement 4 Months after Percutaneous Radiologic Gastrostomy: Jong Sam Hong, M.D., Koon Hee Han, M.D., Hong Yeul Lee, M.D., Jong Kyu Park, M.D., Sang Jin Lee, M.D., Young Don Kim, M.D., Woo Jin Jeong, M.D. and Gab Jin Cheon, M.D.; Korean J Gastrointest Endosc 2011;42(1):52-56. Published online January 30, 2011

Abstract PDF: Percutaneous radiologic gastrostomy (PRG) is an enteral nutritional method that can be applied to a patient with dysphagia due to cerebrovascular accident, Parkinsonism, dementia, or head and neck cancer. PRG is a safe and cost-effective method with low morbidity and mortality rates compared with surgical gastrostomy, because it require less sedation and less invasive placement technique. PRG complications include wound infections, peritonitis, tube malfunctions, peristomal leakage, bleeding, ileus, pneumoperitoneum, aspiration pneumonia, and bowel perforation. But, bowel perforation after PRG is rare. We recently experienced a case of transverse colon penetration and tube displacement, which occurred as a PRG complication in a 60-year-old male with a cerebrovascular accident. (Korean J Gastrointest Endosc 2011;42:52-56)

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Three Cases of Successful Treatment of Iatrogenic Duodenal Perforation: Choong Heon Ryu, M.D., Do Hyun Park, M.D., Myung-Hwan Kim, M.D., Dong Wan Seo, M.D., Sang Soo Lee, M.D., Sung Koo Lee, M.D. and Hong Jun Kim, M.D.; Korean J Gastrointest Endosc 2011;42(1):57-61. Published online January 30, 2011

Abstract PDF: Endoscopic retrograde cholangiopancreatography has become a standard procedure for the diagnosis and treatment of pancreatobiliary disease. Like any invasive procedure, it carries a small, but significant rate of serious complications such as duodenal perforation. Primary surgical closure is the treatment of choice for the cases of duodenal perforation. However, there have been some case reports in which endoscopic metal clip closure of an iatrogenic duodenal perforation was successful. We experienced three cases of successful treatment of the iatrogenic duodenal perforation using endoscopic clipping and fibrin glue injections during a duodenoscope insertion. (Korean J Gastrointest Endosc 2011;42:57-61)

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Successful Bile Duct Cannulation Guided by Indigocarmine Injection via PTGBD: Bum Suk Son, M.D., Sang-Heum Park, M.D., Tae Hoon Lee, M.D., Seung Kyu Chung, M.D., Jae Man Park, M.D., Il-Kwun Chung, M.D., Hong Soo Kim, M.D. and Sun-Joo Kim, M.D.; Korean J Gastrointest Endosc 2011;42(1):62-65. Published online January 30, 2011

Abstract PDF: Even though percutaneous transhepatic gallbladder drainage (PTGBD) is performed prior to ERCP or following ERCP because of the patients' medical condition or failed bile duct cannulation, there are no definite endoscopic landmarks that are useful for successful bile duct cannulation in some cases. We report here on 4 patients in whom selective bile duct cannulation, as guided by the endoscopic landmarks, was successful following indigocarmine injection via PTGBD. (Korean J Gastrointest Endosc 2011;42:62-66)

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