Clinical Endoscopy

소화관문합부 반흔성협착에 대한 내시경적 마이크로파응고법 - 치험 2예 - ( Endoscopic Microwave Coagulation Therapy for Anastomotic Stenosis after Gastrointestinal Operation - Report of 2 cases - ): Korean J Gastrointest Endosc 1988;8(1):1-4. Published online November 30, 1987

Abstract PDF: Endoscopic microwave coagulation therapy was applied to two cases of postoperative anastomotic stenosis. Clinical symptoms and endoscopic findings were improved by endoscopic microwave coagulation tberapy in both cases. It is concluded that this method will be a safe and sure method for the treatment of anastomotic stenosis after gastrointestinal operation

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식도 점막하 종양의 절개핵출술 ( Endoscopic Incisional Enucleation of Esophageal Submucosal Tumor ): Korean J Gastrointest Endosc 1988;8(1):5-10. Published online November 30, 1987

Abstract PDF: Endoscapic polypectomy or incisional enucleation was performed to 10 cases of esophageal submucosal tumor, from March, 1984 to January, 1988, using biopsy forcep, loop snare with high frequency electric current. The results were as follows. 1) In 10 cases 3 were male and 7 were female, with mean age 49. 2) Tumors were located lower esophagus in 5 cases and middle esophagus in 5 cases. 3) The presenting symptoms were mainly nonspecific, not related to underlying submucosal tomor. 4) In 8 of 10 cases, the procedure was performed completely, and so tumors were removed successfully. And in 2 cases, only biopsy for pathologic diagnosis was performed. 5) Results of histologic examination of these tumors were leiomyoma in all cases, In conclusion, we recommand endoscopic polypectomy or incisional enucleation as safe and effective method for esophageal submucosal tumor to make correct pathologic diagnosis and to treat the tumor.

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상부 위장관 내시경 검사의 전처치 약물에 대한 고찰 ( Study on the Premedication for the Upper Gastrointestinal Endoscopic Procedure ): Korean J Gastrointest Endosc 1988;8(1):11-17. Published online November 30, 1987

Abstract PDF: In order to assess the effects of diazepam and meperidine as premedication for upper gastrointestinal endoscopy, eighty eight patients undergone an elective upper gastrointestinal endoscopy were studied. Studied patients were divided into two groups; one group was premedicated with buscopan and stropine(group I), and the other group was premedicated with diazepam and meperidien (group II). The results obtained were summarized as follows; 1) 83.0% of the group II (44/53) did not eomplain any discomfort by the procedure, but only 23.9% (8/35) of the group I showed no discopmort. The difference between two groups is statiatieally significant (p<0.005). 2) In 41 patients with previous experience of endoscopy, 22 patients from 27 of the graup Il(81.5%) did not feel any discomfort but it wes only 3 patients among 14 of the group I (21.4%) who did not feel discomfart (p<0,005). 3) In 47 patients without previous experience of endoscopy, 23 patients from 26 of the group II (88. 5%) did not show discomfort but it way only 5 patients among 21 of the group I (23.7%) (p<0.005). 4) In the patients with previous experience of endoscopy, 21 patients among 27 of the group II (77. 8%) felt better than that of the previous experience but it was only 3 patients among 14 of the group I (21.4%) (p<0.005). From the above results, we would emphasize that it is more effective to use diazepam and, meperidien as premendication for the gastrointestinal endoscopic procedure since it removes pstients apprehension rendering them a good cooperation with very minimal side effects,

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염산에 의한 부식성 위염 1예 ( A Case of Corrosive Gastritis Caused by Hydrochloric Acid ): Korean J Gastrointest Endosc 1988;8(1):19-23. Published online November 30, 1987

Abstract PDF: Recently the use of hydrochloric acid as a toilet disinfectant has become more common, and the risk of its ingestion is though to be increasing. We experienced a case of 67 year-old man who accidentally ingested hydrochloric acid and as a result developed a postprandial epigastric fullness end pain 3 weeks thereafter, The patient underwent an UGI series, fiberoptic gastroscope and abdominal ultrasonography and was found to have a gastric midbody stricture. A total gastreetomy and Roux-en- Y esophagojejunostomy was performed. We report this case with brief review of the literature.

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위궤양반흔부에서 진단되고 악성 Cycle 일부를 보인 조기위암 1예 ( A Case of Early Gastric Cancer Diagnosed from the Area of Ulcer Scar and Showing Part of Malignant Cycle ): Korean J Gastrointest Endosc 1988;8(1):25-27. Published online November 30, 1987

Abstract PDF: In the case of IIc type of early gastric cancer occuring from the area of ulcer sear, endoscopic differentiation between it and beoign ulcer scar is occasionally very difficult, due to the absence of characteristic malignant features. The presence of the irregular granular mucosal changes on the area of ulcer scar may be very helpful in the differential diagnosis between early gastric cancer and benign ulcer sear. And underetanding of the malignant cycle of early gaetric cancer is very important for the diagnosis of the depressed forms of early gastric cancer, We experienced and report a cases of IIc type of early gastric cancer diagnosed before operation by the endoscopic finding of irregular granular mucoeal changes on the area of ulcer scar and showing part of malignant cycle.

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내시경검사상 조기위암에서 진해위암으로 이행된 1예 보고 ( A Case of Advanced Gastric Cancer , Developed from Endoscopic Diagnosis of Early Gastric Cancer ): Korean J Gastrointest Endosc 1988;8(1):29-32. Published online November 30, 1987

Abstract PDF: Early gastric cancer is defined carcinoma that is limited to the gastric mucosa and submucosa and that does not extend into the muscularis propria. The development and widespread use of upper gnstrointestinal endoscopy with biopsy and cytology have enhanced our ability to make early diagnosis of gastrie carcinoma. Gastric cancinoma is being diagnosed at an ealry stage aad the survival rates for these patients are significantly greater than those with advanced gastric carcinoma. These ealry lesion can be cured in over 90% of the cases. In fact, it is almost impossible to follow up cases of early gastric cancer without surgical treatment. We report a case developed advanced gastric carcinoma 34 months after initial endoseopic diagnosis of early gastric cancer. A, 48-year-old woman was diagnosed early gaatrie cancer on June 21, 1985 by endoscopy. Proper surgical intetvention was not carried out due to her liver cirrhosis. The follow-up endoscopic examination was done on March 16, 1988. The gastric cancer looked like an advanced stomach and extended to other site.

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pm 위암 34예에 관한 임상적 고찰 ( Clinical Studies on the 34 Cases of pm - Gastric Cancer ): Korean J Gastrointest Endosc 1988;8(1):33-38. Published online November 30, 1987

Abstract PDF: The records of 34 patients with histologically proven pm-gastric cancer were reviewed from Chonnam University Hospital during the recent 6 year period, 1981, to 1986. The male outnumbered female in a ratio of 2.4:1.0. The peak incidence was 6th decade and mean age were 53.8 years in male, 48.7 years in female respectively. pm-gastric cancer was most often seen on the lesser curvature side, eapecially in the lower 1/3 of the stomach. Macroscopically, it can be divided into early-cancer-like type and Borrmann type. Early-cancer-like type was more frequent than Borrmann type. Early-cancer-like type IIc+III was most often seen with a rate of 20.6%, followed in the order of frequency by Borrman type II, early-cancer-like type IIc, IIa+IIc, and Ile+ IIa. The incidence of lymph node involvement was 26.4% and were related to the macroscopic types and/or histologic differentiation degrees. 5 cases out of 34 pm-gastric cancer expired during the follow up period, and their mean survival time was 32.8 months. The type of operation and the extent of resection were closely related to survival. Five year survival rate was 54.0%. These results shows the significance of the pm-gastrie cancer as a early simulating advanced cancer.

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위평활근육종 1예 ( A Case of Leiomyosarcoma in Stomach ): Korean J Gastrointest Endosc 1988;8(1):39-43. Published online November 30, 1987

Abstract PDF: Leiomyosarcomas of the stomach are unusual tumors, accounting for 1% to 3% of all malignant tumors and 17% to 20% of all smooth muscle tumors of the stomach. It is difficult to diagnosis these tumors preoperatively because of its vague symptoms and signs or producing symptoms only late. Despite their rarity and difficulty in diagnosis, thier diagnosis is important due to more favorable prognosis aasociated with these tumors than that of gastric carcinoma. Recently, endoscopy is being used with increasing frequency, but because these are submucosal lesions the diagnosis of thease tumors cannot be easily made through the endoscope. We experienced a case of relatively full-brown leiomyosarcoma in gastric fundus. Endoscopy showed 6x6cm sized, definite margined, protruding mass on gastric fundus, with central deep ulceration coated with blood clots. The mucosa overlying the mass was intact, smoothly effaced and the bridging fold was also visible. Postoperative ultrasound showed large protruding mixed echogenic solid mass with contral deep excavation due to ulcer, and intact serosa, so suggestive of endogastric tumor. We believed endoscopy combined with endoscopic ultrasound is probably useful method in early diagnosis of gastric submucosal tumors, especially exogastric type or early small tumors

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위 평골근아제포종 1예 ( A Case of Gastric Leiomyoblastma ): Korean J Gastrointest Endosc 1988;8(1):45-48. Published online November 30, 1987

Abstract PDF: A 48 year-old man was admitted with the chief complaint of epigastric pain for 10 days. With upper gastrointetinal series and gastrofiberscopy, there noted a round hemispherical submucosal tumar at lesser curvature side of stomach. Because of continuous epigastric pain and large submucosal mass with mucosal ulceration the patient undewent operation. After subtotal gastrectomy, we found the round well-demarcated tumor with mucosal ulceratian and hemarrhage, which located at muscular layer. Microscopically, dominent cells of tumor are round or polygonal epithelioid cells, which cytoplasm was lightly eosinophilic and was tightly coadenced about nucleus so that the bulk of the cell appeared clear. In the immunohistochemistry with desmin, the tumor cells are positive. Histological diagnosis was leiomyoblastoma of stomach. In 1960 Martin et al. described six cases of unusual round cell myogenic tumor of stomach. In 1962, Stout report a series of 69 similar cases and he proposed the term leiomyoblastoma'. Until recent, leiomyoblastoma are rare and largely misdiagnosed as leiomyoma or leiomyosarcoma. A careful histological study is recommended in case of smooth muscle cell tumor of stomach

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십이지장게실과 관련된 총담관폐쇄 1예 ( A Case of Common Bile Duct Obstruction Associated with Duodenal Diverticulum ): Korean J Gastrointest Endosc 1988;8(1):49-52. Published online November 30, 1987

Abstract PDF: The Duodenal diverticulum is the rare cause of the common bile duct obstruction. We experienced a case of the diverticulum of the second portion of duodenum in a 59-year-old male, who complained recurrent attacks of right upper abdominal pain and fever since 16 months prior to admission. Duodenoscopic finding and UGI study revealed a typical duodenal diverticulum just side to the papilla of Vater. Diverticulectomy and cholecystectomy was performed and after than, he has been free front above mentioned symptoms. We reported a case of duodenal diverticulum which caused recurrent common bile duct obstruction.

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유두주위 담관 십이지장 누공의 (瘻孔) 임상적 중요성 ( Clinical Significance of Periampullary Choledochoduodenal Fistula ): Korean J Gastrointest Endosc 1988;8(1):53-58. Published online November 30, 1987

Abstract PDF: Sine 1976, 2380 eases of ERCP were performed at the Kwangju Chrietian Hospital. Nighty eight patients with periampullary choledochaduodenal fistula diagnosed at ERCP were revewed, Following result were obtained 1) Cases were most commonly noted from fifth decade to seventh decade, and sex distribution was similar. 2) Right upper quadrant abdominal was most common clinical manifestation, and duration of illness prior to diagnosis were from 2 months to 20 years. Several weeks or days before ERCP, sudden disappearance of pain suggeeted spontaneous extrustion of a stone from the common bile duct to the duodenum with resultant PACD formation. 3) On past history, various types biliay operations had carried out in 26 patients. Subtotal gastrectomy with gastrojejunostomy in 1 patients, operation for CBD ascaris removal in 1 patient. 4) Most PACDF had finding formed recently on ERCP and fibrosis, inflamation, granulation, atrophic change, adhesive stenosis were noted additionally. 5) Most common cause of PACD by ERCP was biliary teact stone. 6) Endoscopic sphincteropapillotomy(EST) were performed in 39 patients with PACDF due to CBD stone and surgical intervention were done in 36 patients due to CBD stone also. It was interesting that EST were performed in 3 patients with old stenotic fistula.

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총수담관 및 담낭정맥류 - ERCP 및 Doppler 초음파 소견을 중심으로 - ( Common bile duct and Gall Bladder Varices - Findings of ERCP and Doppler ultrasonography - ): Korean J Gastrointest Endosc 1988;8(1):59-62. Published online November 30, 1987

Abstract PDF: After portal vein occlusion, portal to portal collaterals (hepatopetal) develop from preexisting periportal vessels or recanalization of the thrombosed portal vein, undergo compensatory enlargement, bypass the obstructed extrahepatic occlusion and reconstitute the intrahepatic portal branches. Angiographically, collateral veins are seen as multiple tortous winding veins in the porta hepatis and are described as a cavemous transformation of the portal vein. When the common bile duct or gall bladder is compressed by collateral veins, a cholangiogram demonstrates multiple smooth intramural defects and jaundice can develop due to the partial obstruction of the bile duct. Demonstration of the cavernous transformation of the portal vein can be done by ultrasonography, abdominal computed tomography and nuclear magnetic resonance, but Doppler ultrasonography and direct or indirect portography are needed to evaluate its hemodynamic change. We present a 35-year-old female patient complaining repeated jaundice, in whom common bile duct and gall bladder varices accompanied by cavernous transformation of the portal vein and intrahepatic stones were diagnosed by ultrasonography, abdominal computed tomography, ERCP, and Doppler ultrasonograpy and confirmed by surgery. ERCP demonstrated the irregular contour of the common bile duct and gall bladder due to multiple smooth intramural defects. Doppler utrasongraphy revealed the unique flow signal of portal vasculature from the tortous vessls in the porta hepatis and from the vascular structures on the wall of the gall bladder.

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염증성 국소 췌장 종괴 3예 ( 3 Cases of Focal Pancreatic Masses Demonstrated a Inflammation - Problems in differentiating focal pancreatitis from carinoma - ): Korean J Gastrointest Endosc 1988;8(1):63-69. Published online November 30, 1987

Abstract PDF: When ultrasound or computed tomographic (CT) scans demonstrate a focal mass within the pancreas, the radiologist or gastroenterologist assumes that it is carcinoma. Statistically this is the correct diagnosis. However, distinguishing pancreatitis from carcinoma by ultrasound and CT is occassionally impossible. Similarly, abnormalities seen on ERCP, such as simultaneous obstruction of both the common bile duct and adjacent pancreatic duct (double duct sign), has been shown to occur in pancreatitis as well as in the more commonly diagnosed pancreatic carcinoma. We experienced 3 cases af focal pancreatic masses that mistaken a carcinoma. And so, knowledge that such a mass can be benign in a clinical setting sbould result in an organiged approach to the correct diagnosis and avoidance of any unnecessary operations.

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간디스토마증을 동반한 담관세포암 1예 ( A Case of Cholangiocarcinoma Associated with Clonorchiasis - A Case Report - ): Korean J Gastrointest Endosc 1988;8(1):71-74. Published online November 30, 1987

Abstract PDF: A fifty-five year old male was admitted because of fever and chill for one month. He complained of upper abdominal pain, malaise, anorexia and weight loss. So diagnostic procedures were performed: stool exam., bload chemistry testing, ultrasonography, radionuclide scintigraphy. ERCP, abdominal CT, and sonoguided liver aspiration, which revealed intrahepatic cholangiocarcinoma associated with clonorchiasis.

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간세포성 간암의 내장복막 전이 1예 ( A Case of Hepatocellular Carcinoma with Visceral Peritioneal Metastasis ): Korean J Gastrointest Endosc 1988;8(1):75-77. Published online November 30, 1987

Abstract PDF: Although extrahepatic metastasis of hepatocellular carcinoma are frequent as about 64%, implants involving the peritoneum are rare. We presented a cases, whieh is hepatocellular carcinoma with metastasis to visceral peritoneum revealing multiple, hard, variable-sized and nodular mass including large mass over 10 cm in size. The presence of tumor was diagnosed by serum alpha fetoprotein, abdaminal CT, celiac and SMA angiography and biopsy with laparoscopy.

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장결핵의 임상적 고찰 ( A Clinical Study on Intestinal Tuberculosis ): Korean J Gastrointest Endosc 1988;8(1):79-83. Published online November 30, 1987

Abstract PDF: Intestinal tuberculosis is an infectious disease which is still prevalent in the developing countries including Korea. It may occur insidously, have a vague clinical marofestation, and take a chronic course. We have analyzed 101 cases of intestinal tuberculosis. proven by clinical and histopathologic diagnosis for 10yrs since 1977. The results are as follows: 1) Intestinal tbc was prevalent in the age of 20-30 and the male to female ratio was 1:1.7. 2) Among clinical manifestations, abdominal pain, and tenderness, general malaise and abdominal mass were observed in order of frequency. 3) Active pulmonary lesion was associated in 73 cases (73.3%). 4) Ileocecal region was the most frequent site of involvement in barium study and in colonoscopy. 5) The most frequent colonoscopic finding was multiple ulceration and pseudopolyposis and chronic granulomatous inflammation was noted in 58% on hitopathology. 6) Ulcerative type was the most common type 45.4% by intestinal x-ray and colonofiberscopic examination

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