Clinical Endoscopy

The feasibility and safety of trans-colorectal endoscopic ultrasound-guided fine-needle aspiration: a retrospective study of Japan: Takashi Kondo, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Yoshitaro Yamamoto, Minako Urata, Keigo Oshiro, Tomoki Ogata, Ren Kuwabara, Indria Melianti, Yousik Myung, Adwoa Afrakoma Agyei-Nkansah; Clin Endosc 2025;58(6):890-897. Published online November 27, 2025; DOI: https://doi.org/10.5946/ce.2025.042

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective diagnostic technique; however, few studies have evaluated the efficacy of trans-colorectal EUS-FNA. This study assessed the feasibility of trans-colorectal EUS-FNA.
Methods
We retrospectively analyzed 76 consecutive patients who underwent trans-colorectal EUS-FNA for pelvic lesions between January 2013 and September 2023.
Results
A total of 76 pelvic lesions were identified. The median number of EUS-FNA punctures was 3 (1–8). The median lesion size was 18.9 (8.2–100.0) mm. The success rate was 98.7% (75/76), with no reported adverse events. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 94.3% (50/53), 100% (22/22), 100% (50/50), 88.0% (22/25), and 96.0% (72/75), respectively. Malignancy was initially suspected in 65 patients before EUS-FNA; however, 25 patients showed benign results. Of these, three were later reexamined and diagnosed with malignancy, three underwent surgery and were found to have benign pathology, and 19 avoided unnecessary surgery.
Conclusions
Trans-colorectal EUS-FNA is a safe and effective diagnostic procedure.

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Endoscopic Full Thickness Resection for Gastrointestinal Tumors - Challenges and Solutions: Hung Leng Kaan, Khek Yu Ho; Clin Endosc 2020;53(5):541-549. Published online February 17, 2020; DOI: https://doi.org/10.5946/ce.2019.161

Standard polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are established techniques for the treatment of gastrointestinal tumors. However, resection of submucosal tumors via ESD often results in low rates of microscopically margin-negative (R0) resection and high rates of perforation. Endoscopic full thickness resection (EFTR) overcomes this adverse event and aids in the therapeutic management of complex tumors.
Multiple techniques for EFTR have been developed, each with its own advantages and disadvantages. Submucosal tunneling and nonexposed techniques are generally preferable, because the layer of overlying intact mucosa reduces the incidence of intraperitoneal contamination by the gastric fluid and dissemination of the tumor cells. However, adoption of EFTR by endoscopists in clinical practice remains low. The major challenge seems to be the technical difficulty in performing laparoscopic and/or endoscopic suturing using the currently available instruments.
We developed a novel robotic endoscopic platform with suturing capabilities to overcome the technical challenges of suturing. This platform allows easy maneuvering and triangulation of the instruments, thus facilitating endoscopic suturing using robotic arms. Our studies have demonstrated that this robotic endoscopic platform with suturing capabilities is an effective and safe method for performing EFTR with endoscopic suturing.

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Kengo Hayashi, Saki Hayashi, Roberto Passera, Chiara Meroni, Rebecca Dallorto, Chiara Marafante, Carlo Alberto Ammirati, Alberto Arezzo, Noriyuki Inaki
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Gastrointestinal Endoscopy.2024; 99(2): 186. CrossRef
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Tian-Wen Liu, Xiao-Feng Lin, Shu-Ting Wen, Jing-Yi Xu, Zhao-Li Fu, Shu-Min Qin
World Journal of Clinical Cases.2024; 12(16): 2738. CrossRef
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Jin Woong Cho
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Shumin Qin, Xiaofeng Lin, Shuting Wen, Tianwen Liu
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Hung Leng Kaan, Khek Yu Ho
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Atsushi Sawada, Kingo Hirasawa, Chiko Sato, Sho Sato, Tsutomu Sato, Kazuya Sugimori, Chikara Kunisaki, Shin Maeda
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Jinyan Wu, Boneng Mao, Tao Jin, Xinfang Xu, Xiao Xu, Shengjun Jiang, Weiguo Li
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Li-Jun Zhou, Fei Xing, Dan Chen, Yan-Na Li, Shoaib Mohammad Rafiq
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Partha Pal, Mohan Ramchandani, Pradev Inavolu, Duvvuru Nageshwar Reddy, Manu Tandan
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Over-the-Scope Clip-Associated Endoscopic Muscular Dissection for Seven Cases of Small Gastric Submucosal Tumor: A Video-Based Case Series
Xin Li, Rongfen Wei, Jianfu Qin, Fei Qin, Peng Peng, Mengbin Qin, Shiquan Liu, Jiean Huang, Piero Chirletti
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Hung Leng Kaan, Khek Yu Ho
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Twin Rectal Tonsils Mimicking Carcinoid or Mucosa-Associated Lymphoid Tissue Lymphoma: Masanori Takehara, Naoki Muguruma, Shinji Kitamura, Tetsuo Kimura, Koichi Okamoto, Hiroshi Miyamoto, Yoshimi Bando, Tetsuji Takayama; Clin Endosc 2017;50(5):500-503. Published online February 28, 2017; DOI: https://doi.org/10.5946/ce.2016.157

Abstract PDF PubReader ePub

The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosaassociated lymphoid tissue (MALT) lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.

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Long-term Prognosis of Localized Lymphoid Hyperplasia of the Rectum
Ji Taek Hong, Eun Ran Kim, Sung-Wook Park, Ji Won Kim, Sung Noh Hong, Dong Kyung Chang, Young-Ho Kim, Jun Hun Cho
Gut and Liver.2021; 15(1): 77. CrossRef
Normal gastrointestinal tract inflammatory cells and review of select benign hematolymphoid proliferations
Jennifer Y. Ju, Edward B. Stelow, Elizabeth L. Courville
Seminars in Diagnostic Pathology.2021; 38(4): 6. CrossRef

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Evaluation and Endoscopic Management of Esophageal Submucosal Tumor: Weon Jin Ko, Ga Won Song, Joo Young Cho; Clin Endosc 2017;50(3):250-253. Published online November 7, 2016; DOI: https://doi.org/10.5946/ce.2016.109

Abstract PDF PubReader ePub

Submucosal tumors (SMTs) originate from tissues that constitute the submucosal layer and muscularis propria, and are covered by normal mucosa. Esophageal SMTs are rare, accounting for <1% of all esophageal tumors. However, the recent widespread use of endoscopy has led to a rapid increase in incidental detection of SMTs in Korea. Esophageal SMTs are benign in ≥90% of cases, but the possibility of malignancies such as gastrointestinal stromal tumor and malignant leiomyosarcoma still exists. Therefore, patients undergo resection in the presence of symptoms or the possibility of a malignant tumor. For resection of esophageal SMTs, surgical resection was the only option available in case of possible malignancy, but minimally invasive surgery by endoscopic resection is becoming more preferable to surgical resection with the development of endoscopic ultrasonography, endoscopic techniques, and other devices.

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Endoscopic Ultrasound-Guided Fine Needle Aspiration in Submucosal Lesion: Jeong Seop Moon; Clin Endosc 2012;45(2):117-123. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.117

Abstract PDF PubReader ePub

A submucosal lesion, more appropriately a subepithelial lesion, is hard to diagnose. Endoscopic ultrasonography is good to differentiate the nature of submucosal lesion. For definite diagnosis, tissue acquisition from submucosal lesion is necessary, and many methods have been introduced for this purpose mainly by endoscopic ultrasonography, such as endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), EUS-guided Trucut Biopsy (TCB), and EUS-guided fine needle biopsy (FNB). For EUS-FNA, adequate processing of specimen is important, and for proper diagnosis of EUS-FNA specimen, both cytologic and histologic examinations, including immunohistochemical stains, are important. All gastrointestinal stromal tumors have some degree of malignant potential, so there have been a lot of efforts and methods to increase diagnostic yields of submucosal lesion. We herein review the current hot topics on EUS-FNA for submucosal tumor, such as needles, on-site cytopathologists, immunohistochemical stains, EUS-TCB, EUS-FNB, Ki-67 labelling index, DOG1, and combining EUS-FNA and EUS-TCB.

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A Case of Solid Pseudopapillary Tumor of the Pancreas Presenting as a Submucosal Tumor with Hemorrhage: Jong Han Kim, M.D., Sang Heon Lee, M.D., Ji Hyun Kim, M.D., Byoung Jin Choi, M.D., Young Jin Song, M.D., Sang Bun Choi, M.D., Jae Ik Lee, M.D. and Su Jin Jung, M.D.^*; Korean J Gastrointest Endosc 2011;42(6):446-449. Published online May 25, 2011

Abstract PDF: A solid pseudopapillary tumor is a rare pancreatic tumor with a low malignant potential that occurs commonly in young females. We report a case of 12-year-old girl with a solid pseudopapillary tumor of the pancreas associated with symptoms of anemia. She was suspected to have a 7×4.5 cm mass growing from the head of the pancreas based on an esophagogastroduodenoscopy, a radiological imaging study, and an immunohistochemical stain examination. She was finally diagnosed with a solid pseudopapillary tumor after a pancreaticoduodenectomy as the definitive treatment.

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A Large Hematoma Due to Benign Ulcer Perforation of the Gastric Fundus Resembling Submucosal Tumor: Nam Yong Kim, M.D., Jung Hwan Oh, M.D., Soo Jin Choi, M.D., Seung Kyoung Kim, M.D., Youn Mi Song, M.D., Byung Soo Jie, M.D., Seung Hyun Oh, M.D. and Sang Wook Choi, M.D.; Korean J Gastrointest Endosc 2010;41(3):159-162. Published online September 30, 2010

Abstract PDF: The gastric fundus is a rare site for benign ulcer and perforation to occur. A 47 year-old male presented to the emergency department with epigastric pain. An endoscopic examination revealed a submucosal tumor-like lesion with friable, superficial ulceration in the high body of the stomach. We performed surgical resection to rule out malignancy because of the lesion's large size and we found chronic gastric ulcer perforation, which was pathologically diagnosed. We presumed that the formation of the large hematoma, which mimicked a submucosal tumor, was a result of repeated bleeding, perforation and healing. We report here on a case of a large hematoma due to a benign gastric ulcer perforation in the fundus, and this all mimicked a submucosal tumor. (Korean J Gastrointest Endosc 2010;41:159-162)

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A Case of Splenic Pseudoaneurysmal Rupture Misrecognized as Bleeding from Gastric Submucosal Tumor: Kwang Jae Lee, M.D., Tae Yeong Lee, M.D., Young Seok Bae, M.D., Dong Wan Kim, M.D., Jung Bin Yoon, M.D., Sang Hoon Bae, M.D., Dong Hyun Kim, M.D. and Seok Reyol Choi, M.D.*; Korean J Gastrointest Endosc 2010;40(6):387-390. Published online June 30, 2010

Abstract PDF: Splenic arterial pseudoaneurysm is an uncommon life-threatening complication of acute and chronic pancreatitis. Pseudoaneurysm can lead to massive bleeding into the abdominal cavity and the retroperitoneum. Less commonly, it may rupture directly into the stomach, small bowel or pancreatic duct and may present as an acute gastrointestinal hemorrhage. It can be diagnosed by various imaging modalities including computerized tomography, ultrasound and angiography. Percutaneous transvascular embolization of the pseudoaneurysm is one of the alternative treatment methods. Here we present a case of splenic arterial pseudoaneurysmal rupture misrecognized as bleeding from a gastric submucosal tumor in patient with hematemesis. We also review the literature. (Korean J Gastrointest Endosc 2010;40:387-390)

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Endoscopic Ultrasonographic Findings of Esophageal Tuberculosis: Case Report: Kyu Hyun Cho, M.D., Jin Tae Jung, M.D., Chang Jae Hur, M.D., Joong Goo Kwon, M.D., Eun Young Kim, M.D. and Hoon Kyu Oh, M.D.*; Korean J Gastrointest Endosc 2010;40(5):312-315. Published online May 30, 2010

Abstract PDF: Esophageal tuberculosis is a rare disease that is difficult to diagnose with esophagogastroduodenoscopy (EGD), endoscopic ultrasonography (EUS), and computerized tomography. The patients with esophageal tuberculosis show diverse endoscopic findings, but ulcerative lesion in the middle esophagus is usually found. In Korea, the endoscopic ultrasonographic findings of esophageal tuberculosis have not been described. The main endoscopic ultrasonographic findings of esophageal tuberculosis include heterogeneous or homogeneous hypoechoic masses in the esophageal wall with hyperechoic spots inside, interruption of the esophageal adventitia, and mediastinal lymphadenopathy. In this report, we describe two patients with esophageal tuberculosis, and they presented with submucosal tumor. In these patients, esophageal tuberculosis was diagnosed by EGD, EUS, and performing tuberculosis phase chain reaction on the endoscopic biopsies. (Korean J Gastrointest Endosc 2010;40:312-315)

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A Case of a Submucosal Ganglioneuroma of the Ampulla of Vater That Was Treated by Endoscopic Resection: Hye Jin Cho, M.D., Jae Seon Kim, M.D., Tae Jung Yun, M.D., Seok Bae Yoon, M.D., Hyun-Seok Kang, M.D., Jae Young Moon, M.D., Jong-Jae Park, M.D. and Young-Tae Bak, M.D.; Korean J Gastrointest Endosc 2009;39(6):393-397. Published online December 30, 2009

Abstract PDF: Submucosal tumors in the gastrointestinal tract are covered with a mucous membrane such as the surrounding tissue. Therefore, the use of endoscopic biopsy to diagnose submucosal tumors is not as effective as that for epithelial tumors. Although imaging tools such as ultrasonography or computed tomography have made great advances, it is still difficult to diagnose submucosal tumors before resection. The surgical resection of tumors is the most accurate diagnostic method, yet less invasive endoscopic resection has been preferred in recent years. We report herein on a rare case of ganglionueroma arising from the Ampulla of Vater and this lesion was incidentally found during performance of routine esohagogastroduodenoscopy. The lesion was diagnosed as a ganglioneuroma, and it was successfully removed through endoscopic resection. (Korean J Gastrointest Endosc 2009;39: 393-397)

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A Case of Eosinophilic Esophagitis Found Incidentally during the Evaluation of a Gastric Submucosal Tumor: Su Bum Park, M.D., Gwang Ha Kim, M.D., Mun Ki Choi, M.D., Hyung Seok Nam, M.D., Hyun Seok You, M.D., Bong Eun Lee, M.D., Geun Am Song, M.D. and Do Youn Park, M.D.; Korean J Gastrointest Endosc 2009;39(4):212-216. Published online October 30, 2009

Abstract PDF: Over the last several years, eosinophilic esophagitis in adults is an increasingly recognized disease in various parts of world. A 77-year-old male with a gastric submucosal tumor was referred to our department for endoscopic ultrasonography. During the examination, there was some resistance in inserting the echoendoscope into the esophagus. Detailed endoscopic examination of the esophagus showed narrow lumen and scattered whitish plaques, and biopsy of the esophagus revealed more than 20 eosinophils per high-power field. We diagnosed this case as eosinophilic esophagitis and treated successfully by topical steroid. We report a case of eosinophilic esophagitis found incidentally during endoscopic ultrasonography for a gastric submucosal tumor. (Korean J Gastrointest Endosc 2009; 39:212-216)

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A Case of an Esophageal Bronchogenic Cyst Presenting with Dysphagia: Hee Jung Lee, M.D., Hee Seok Moon, M.D., Jae Kyu Sung, M.D., Hyun Yong Jeong, M.D., Hyun Jung Lee, M.D.* and Dae Young Kang, M.D.*; Korean J Gastrointest Endosc 2009;39(3):154-157. Published online September 30, 2009

Abstract PDF: Bronchogenic cysts are rare congenital anomalies that are formed due to abnormal budding of the endodermal foregut during embryogenesis. These cysts are found at various sites because the location of the cyst depends on the embryological state of the abnormal budding. Submucosal tumors (SMTs) of the esophagus that originate from the submucosa or the intramural layer account for less than 1% of all esophageal neoplasms, and bronchial cysts of the esophagus usually present as a type of SMT or as external compression. We report here on an interesting case of bronchogenic cyst presenting with dysphagia in an adult. (Korean J Gastrointest Endosc 2009;39:154-157)

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A Case of a Gastric Glomus Tumor with a Positive Cushion Sign: Mi Ra Kim, M.D., Gwang Ha Kim, M.D., Geun Am Song, M.D., Jae Hoon Cheong, M.D., Do Youn Park, M.D.*, Mi Hyun Kim, M.D., Seon Kyeong Kim, M.D. and Seong Hoon Yoon, M.D.; Korean J Gastrointest Endosc 2009;38(5):294-298. Published online May 30, 2009

Abstract PDF: Glomus tumors are commonly observed in the dermis or subcutis but are only rarely found in the stomach. A 52-year-old woman presented with an incidental finding of a submucosal tumor that showed a positive cushion sign in the stomach. Endoscopic ultrasonography (EUS) showed a 1.8×1.0 cm sized well-circumscribed homogenous hypoechoic tumor with side halos in the fourth sonographic layer of the gastric wall. Contrast enhanced abdominal computerized tomography (CT) demonstrated high enhancement of the tumor with the same level of enhancement as the portal vein for the arterial phase, with persistence of enhancement in the portal phase. For treatment, laparascopic wedge resection was performed. Histological findings of a biopsy specimen were compatible with a glomus tumor. Although it is difficult to diagnose a glomus tumor preoperatively, these characteristic findings determined with the use of EUS and CT seem to be useful to distinguish a glomus tumor from other tumors that arise from the third or fourth sonographic layer of the gastric wall. (Korean J Gastrointest Endosc 2009;38:294-298)

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Colonic Carcinoma and Tubular Adenoma with High Grade Dysplasia Resembling Submucosal Tumor: Eun Ran Kim, M.D., Dong Kyung Chang, M.D., Kyoung-Mee Kim, M.D.*, Jin Yong Kim, M.D., Young-Ho Kim, M.D., Jae Jun Kim, M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2009;38(4):229-233. Published online April 30, 2009

Abstract PDF: Colorectal carcinoma arises from the epithelium of the colorectal mucosa, and so it displays various macroscopic appearances with abnormal mucosal changes. But submucosal tumor-like colorectal carcinoma is very rare. We report here on two such cases along with a review of the relevant literature. The first case was submucosal tumor-like colorectal carcinoma that was initially diagnosed as rectal submucosal tumor, but the follow-up endoscopic exam revealed ulceroinfiltrative type adenocarcinoma. The second case was an endoscopically determined polypoid lesion combined with submucosal tumor, but it was found to be tubular adenoma with high grade dysplasia combined with a mucin pool collection in the submucosa after surgical resection. (Korean J Gastrointest Endosc 2009;38:229- 233)

2,912 View
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A Case of Giant Gastric Lipoma Showing Upper Gastrointestinal Bleeding: Hee Seok Moon, M.D., Jae Kyu Sung, M.D., Hyun Yong Jeong, M.D. and Dae Young Kang, M.D.*; Korean J Gastrointest Endosc 2009;38(4):214-217. Published online April 30, 2009

Abstract PDF: Gastric lipoma is a typical benign submucosal tumor that is usually asymptomatic and it is generally detected incidentally when performing upper GI endoscopy. However, depending on its size and location, an atypical gastrointestinal lipoma can cause abdominal pain, diarrhea, constipation, intestinal obstruction, intussuception and life-threatening gastrointestinal bleeding. This tumor is diagnosed and differentiated from other malignant and submucosal tumors on the basis of its characteristic findings at endoscopy and on computed tomography, magnetic resonance imaging and endoscopic ultrasonography. We report here on the case of a 58-year-old female with epigastric discomfort and melena; a 4.5×4 cm ulcero-fungating mass was detected on the anterior wall of the gastric antrum. Surgical subtotal gastrectomy was performed and the lesion was diagnosed as gastric lipoma. (Korean J Gastrointest Endosc 2009;38:214-217)

2,671 View
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A Case of Splenic Artery Aneurysm Mimicking Gastric Submucosal Tumor: Byeong Chool Park, M.D., Sei Jin Youn, M.D., Seon Mee Park, M.D., Won Joong Jeon, M.D., Jee In Jeong, M.D., Hee Bok Chae, M.D. and Ro Hyun Sung, M.D.*; Korean J Gastrointest Endosc 2009;38(3):142-146. Published online March 30, 2009

Abstract PDF: Splenic artery aneurysm is an uncommon clinical entity. Most of these aneurysms are asymptomatic, but if an aneurysm ruptures, it can be fatal and its mortality rate reaches 70 percent. Regardless of the presence of symptoms, if the size of the asymptomatic aneurysm is larger than 2 cm in diameter or the patient is pregnant, then the anurysm should be treated. A 74-year-old female visited our hospital complaining of nonspecific epigastric discomfort. Endoscopic examination of the stomach revealed a submucosal tumor like protruding mass in the body and it was finally diagnosed as a splenic artery aneurysm by computed tomography. We report here on a case of a splenic artery aneurysm that mimicked a submucosal tumor, and this aneurysm was treated with surgery. (Korean J Gastrointest Endosc 2009;38:142-146)

2,573 View
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A Case of a Jejunal Dieulafoy's Lesion Mimicking a Submucosal Tumor: Hae Won Jeong, M.D., Jin Yong Kim, M.D., Sang Jung Kim, M.D., Tae Hoon Jang, M.D., Won Seok Choi, M.D. and Ji In Lee, M.D.; Korean J Gastrointest Endosc 2008;37(6):438-442. Published online December 30, 2008

Abstract PDF: Dieulafoy's lesion is a rare cause of severe gastrointestinal bleeding. In most cases, Dieulafoy's lesion is typically found in the stomach within 6 cm from the gastroesophageal junction, but the presence of lesions has also been described throughout the gastrointestinal tract. A jejunal Dieulafoy's lesion is extremely rare, and only a few cases have been reported in the Korean population. We experienced a case of a jejunal dieulafoy's lesion mimicking a submucosal tumor that presented with massive gastrointestinal bleeding. The lesion was diagnosed by the use of double balloon enteroscopy and was then confirmed by a pathological examination of the surgical specimen. (Korean J Gastrointest Endosc 2008;37:438-442)

2,741 View
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A Case of Gastritis Cystica Profunda Presenting with a Submucosal Cystic Tumor: Ji Hyun Lee, M.D., Gye Sung Lee, M.D., Eom Seok Lee, M.D., Hyun Mo Kang, M.D., Jae Su Kim, M.D., Young Gul Yoon, M.D., In Sung Jung, M.D. and Mi Seon Lee, M.D.*; Korean J Gastrointest Endosc 2008;37(4):280-283. Published online October 30, 2008

Abstract PDF: Gastritis cystica profunda (GCP) is a lesion characterized by elongation of the gastric foveolae with hyperplasia and cystic dilatation of the gastric glands that extends into the submucosal layer. In most cases, gastritis cystica profunda develops in patients who have undergone a gastroenterostomy, with or without gastric resection. GCP may present not only as a submucosal tumor or as solitary or diffuse polyps, but GCP is also rarely seen as a giant gastric mucosal fold. A patient arrived at our hospital with dyspepsia. Gastroduodenoscopy (EGD) showed the presence of a submucosal tumor measuring 3 cm in the widest diameter in the body of the stomach. A CT scan demonstrated the cystic nature of the lesion and endoscopic ultrasound (EUS) depicted a homogeneous hypoechoic, unilocular cystic mass without any internal solid component. EGD, CT and EUS findings suggested that the lesion was more likely to be benign than malignant. The lesion was treated with an endoscopic mucosal resection (EMR), and the lesion was finally diagnosed as gastritis cystica profunda. A follow-up EGD demonstrated that all mucosal surfaces were well healed four weeks after the EMR. (Korean J Gastrointest Endosc 2008;37:280-283)

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A Patient with Jejunal Mucinous Adenocarcinoma Metastatic to the Stomach Presenting with Submucosal Tumors in the Stomach and Jejunum: Gwang Sil Kim, M.D., Tae Joo Jeon, M.D., Tae-Hoon Oh, M.D., Won Chang Shin, M.D., Won-Choong Choi, M.D., Eunah Shin, M.D.*, Jung Yeon Kim, M.D.* and Hong-Joo Kim, M.D.^†; Korean J Gastrointest Endosc 2008;37(3):192-197. Published online September 30, 2008

Abstract PDF: The small bowel is the least common site for cancer to arise. Only approximately 1% of all gastrointestinal neoplasms arise in the small bowel. Mucinous adenocarcinoma is diagnosed when the amount of extracellular mucin in a tumor is over 50%. Because it is a very rare disease, there is little data available concerning its incidence, most common site of origin, and common sites of metastasis. There are no case reports describing primary mucinous adenocarcinoma of the jejunum in Korea. We report a case of jejunal mucinous adenocarcinoma metastatic to the stomach presenting as a submucosal tumor. (Korean J Gastrointest Endosc 2008;37:192-197)

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A Case of an Eosinophilic Granuloma Mimicking a Submucosal Tumor in the Ascending Colon Probably Caused by Anisakis: Sang Chul Choi, M.D., Kang Kim, M.D., Kyung Rok Lee, M.D., Jun Ho Cho, M.D., Sang Wook Park, M.D., Gun Young Hong, M.D., Kang Suk Seo, M.D. and Yeun Keun Lim, M.D.; Korean J Gastrointest Endosc 2008;37(2):127-131. Published online August 30, 2008

Abstract PDF: Anisakiasis in the gastrointestinal tract is caused by the ingestion of raw marine fish that contain Anisakis lavae. In rare cases, Anisakiasis is found as an eosinophilic granuloma that mimics a submucosal tumor. The diagnosis is usually made after surgical resection. Several cases of gastric anisakiasis imitating a submucosal lesion have been reported. However, colonic anisakiasis forming a submucosal lesion is very rare and only a few cases have been reported. All of the cases were confirmed after surgery. Recently, we encountered a male patient with a submucosal lesion on the ascending colon during a health screening. Several biopsies were performed on the same site as the lesion. The pathological finding was eosinophilic granuloma. We tentatively diagnosed the patient with eosinophilic granuloma due to Anisakis as the patient consumed raw seafood and eosinophilia was detected on a laboratory test. We decided not to perform any procedure. One month later, the eosinophilic granuloma disappeared as seen on a follow-up colonoscopy. (Korean J Gastrointest Endosc 2008;37:127-131)

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The Usefulness of Endoscopic Subtumoral Dissection for En-bloc Resection of Upper Gastrointestinal Submucosal Tumors: Hyo Joong Yoon, M.D., Chang Beom Ryu, M.D., Hyun Sik Na, M.D., Ju Hee Maeng, M.D., Sang Hoon Han, M.D., Bong Min Ko, M.D., Su Jin Hong, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.; Korean J Gastrointest Endosc 2008;36(4):193-199. Published online April 30, 2008

Abstract PDF: Background
/Aims: The removal of esophageal and gastric submucosal tumors is difficult using conventional endoscopic mucosal resection methods. This study examined the usefulness of an endoscopic subtumoral dissection for an en-bloc resection of submucosal tumors. Methods: An endoscopic subtumoral dissection was attempted for an en-bloc resection in 15 submucosal tumors (M：F=10：5, 13 stomach, 2 esophagus). Before the procedures, endoscopic ultrasonography was performed in all cases. The procedure was carried out using various electrosurgical knives, such as an endoscopic submucosal dissection. Results: Pathological and immunohistochemical studies confirmed a gastrointestinal stromal tumor in 6 cases. Other pathological diagnoses were made in 9 patients with submucosal lesions: leiomyoma (4), ectopic pancreas (3), lipoma (1), and hemangioma (1). An en-bloc resection was performed in 13 of the 15 tumors (86.7%). The mean specimen size was 29.5×21.1 mm. The mean procedure time was 49.4 minutes (range: 8∼103 minutes). Gastric perforation was a complication in 2 cases with GIST. However, the two perforated cases were treated with endoscopic closure using endoclips and recovered without the need for surgery. Conclusions: An endoscopic subtumoral dissection technique is useful for an en-bloc resection of esophageal and gastric submucosal tumors. However, sufficient attention should be paid to the detection of perforations in the case of tumors with a proper muscle origin. (Korean J Gastrointest Endosc 2008;36:193-199)

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A Benign Ulcer of the Gastric Fundus Reminiscent of a Malignant Submucosal Tumor: Yun Hwa Jung, M.D., Byung Wook Kim, M.D., Hyung Gil Kim, M.D.*, Hyoung Jin Chang, M.D., Do Seon Song, M.D., Min Huh, M.D., Min Kuk Kim, M.D., Hyun Jung Jung, M.D., Jeong Seon Ji, M.D., Jeong Won Jang, M.D., Hwang Choi, M.D., Kyu Yong Choi, M.D. and In Sik; Korean J Gastrointest Endosc 2008;36(3):150-153. Published online March 30, 2008

Abstract PDF: The gastric fundus is a rare site for benign ulcer occurrence as it consists of parietal cells, which secret gastric acid. It is resistant to gastric acid and pepsin, and has an abundant blood supply. Varices or other vascular lesions, such as polyps and submucosal tumors, are more frequently found in the gastric fundus. When an ulcer is found in the gastric fundus, it is important to consider underlying conditions such as a malignancy. In this case, a benign gastric ulcer in the gastric fundus dome formed a protruding mass-like lesion with central necrosis, which was reminiscent of a malignant submucosal tumor. Proper follow-up gastroscopy with endoscopic ultrasonography helped to differentiate these similar lesions. We report here a case of a benign gastric ulcer in the fundus dome that was reminiscent of a malignant submucosal tumor, with a review of the literature. (Korean J Gastrointest Endosc 2008;36:150-153)

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A Case of Submucosal Tumor-like Gastric Mucinous Adenocarcinoma Showing Mucin Waterfall: Hyung Ha Jang, M.D., Sang Hyun Lee, M.D., Gwang Ha Kim, M.D., Chul Woong Choi, M.D., Chan Ho Park, M.D., Jae Sup Eum, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Dae Hwan Kim, M.D.*, Suk Kim, M.D.^† and Kyung Un Choi, M.D.^‡; Korean J Gastrointest Endosc 2008;36(2):87-91. Published online February 27, 2008

Abstract PDF: Muinous gastric carcinoma (MGC) is a rare histological type that accounts for approximately 3∼7% of all gastric carcinomas. The results of clinicopathological studies suggest that the overall survival rate for patients with MGC is worse than that for patients with non-mucinous tumors as MGC is more frequently diagnosed in the advanced stage. In this report, we preoperatively predicted the type of a tumor from its endoscopic finding. An endoscopic ultrasonographic examination showed a submucosal tumor like mass showing mucin waterfall on the gastric cardia. A total gastrectomy with splenectomy was performed. The pathology of the tumor identified the lesion as a mucinous adenocarcinoma. (Korean J Gastrointest Endosc 2008;36:87-91)

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A Case of Gastric Suture Granuloma Suspected of Malignant Submucosal Tumor: In Kyu Moon, M.D., Tae Hyo Kim, M.D., Kyoung Ah Jung, M.D., Jae Min Lee, M.D., Hyun Chin Cho, M.D., Ki Shik Shim, M.D., Hyun Ju Min, M.D., Hyun Jin Kim, M.D., Woon Tae Jung, M.D. and Ok Jae Lee, M.D.; Korean J Gastrointest Endosc 2007;35(6):395-398. Published online December 30, 2007

Abstract PDF: A gastric suture granuloma is an uncommon postsurgical complication. When nonabsorbable sutures are used, the inflammation can persist months after the original procedure with the subsequent formation of an abscess around the sutures surrounded by granulation tissue. Suture granulomas are usually asymptomatic, and have clinical importance as a differential diagnosis of a gastric submucosal tumor. The incidence of suture granuloma is low using absorbable sutures in gastrointestinal anastomosis. We report a case of a 70 year old man diagnosed with a suture granuloma. Approximately 30 years earlier, he underwent primary closure due to gastric ulcer perforation. When a gastroscopy was performed to assess upper abdominal soreness, it revealed a submucosal tumor that indicated a malignancy, which was diagnosed as a suture granuloma after surgery. (Korean J Gastrointest Endosc 2007;35:395-398)

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A Case of Early Gastric Adenocarcinoma Mimiking a Submucosal Tumor: Joon Hyuk Lee, M.D., Jeong Eun Shin, M.D., Bae Hwan Kim, M.D., Dong Woo Kim, M.D., Ki Chul Shin, M.D., Se Young Yun, M.D., Suk Bae Kim, M.D., Il Han Song, M.D., Chang Hwan Lee, M.D.* and Won Ae Lee, M.D.^†; Korean J Gastrointest Endosc 2007;35(4):250-253. Published online October 30, 2007

Abstract PDF: Early gastric adenocarcinoma with the endoscopic features resembling a submucosal tumor is extremely rare and is characterized by erythema, central depression and erosion on the surface of the lesion, which can be distinguished from submucosal tumor. When a tumor is completely covered with normal mucosa, it is extremely difficult to obtain endoscopic biopsy specimens from the underlying lesion. EUS alone is not necessarily diagnostic. Various techniques have been advocated to overcome this problem, including US-guided biopsy, partial removal by an endoscopic snare excision, endoscopic mucosal resection as well as EUS with FNA. We encountered a case of an early gastric adenocarcinoma with well differentiation, presenting as a submucosal tumor. The early gastric adenocarcinoma was evaluated by endoscopy and EUS, and was confirmed by a surgical resection. We report this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2007;35:250-253)

2,734 View
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Two Cases of Gastric Schwannomas - with Ulcer and without Ulcer -: Pyo Jun Kim, M.D., Gwang Ha Kim, M.D., Jin Kang, M.D., Tae Ik Park, M.D., Dong Hoon Shin, M.D., Tae Yong Jeon, M.D. and Geun Am Song, M.D.; Korean J Gastrointest Endosc 2007;35(4):243-249. Published online October 30, 2007

Abstract PDF: A Schwannoma is a benign tumor that originates from Schwann cells in the gastric wall. The tumor is mainly asymptomatic but sometimes can cause bleeding of the upper GI tract. We encountered a Schwannoma that was identified by gastroscopy as a submucosal mass that might be malignant. Therefore, surgery was considered as the primary treatment. The Schwannoma was confirmed retrospectively by a pathologic examination after excising the mass. This case report is a comparative study into Schwanoma with and without central ulceration. Pathologically, atypia of the cell was discovered in the case accompanied by an ulcer, which is a secondary phenomenon caused by the degeneration that does not indicate the malignancy. (Korean J Gastrointest Endosc 2007; 35:243-249)

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Two Cases of Advanced Gastric Carcinomas Showing Features of Submucosal Tumors: Chang Kyun Hong, M.D., Woo Chul Chung, M.D., Hyun Joo Choi, M.D.*, Young Chul Kim, M.D., Kang Moon Lee, M.D., Jin Mo Yang, M.D., Jae Kwang Kim, M.D., Sok Won Han, M.D., Kyu Yong Choi, M.D. and In-Sik Chung, M.D.; Korean J Gastrointest Endosc 2007;35(3):175-180. Published online September 30, 2007

Abstract PDF: Gastric carcinoma showing the features of a submucosal tumor (SMT) is extremely rare. The incidence of this type of tumor has been reported to be 0.1∼0.63%. We report two cases of advanced gastric carcinomas showing the features of SMT. A 58-year-old man visited our hospital with a melena. An endoscopic examination revealed a 3.0 cm sized protruding lesion on the posterior wall of the gastric antrum. Most of the tumor surface was covered with normal mucosa and ulceration was observed in the center. Although the histological diagnosis could not be obtained prior to surgery, a gastrectomy was performed due to the high risk of malignancy. The tumor was diagnosed histologically as a lymphoepithelioma-like carcinoma. The other patient was a 64-year-old man with the chief complaint of epigastric discomfort. An endoscopic examination revealed a SMT like lesion with a central ulceration and hard coated exudate in the high body of the stomach. The microscopic examination revealed a poorly differentiated vimentin-positive adenocarcinoma. Unfortunately, he died from the disease two months later. (Korean J Gastrointest Endosc 2007;35:175-180)

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A Case of Chronic Gastric Eosinophilic Abscess Treated by Endoscopic Submucosal Dissection: Ji Woong Kim, M.D., Young Jae Lee, M.D., Gum Mo Jung, M.D., Yong Keun Cho, M.D., Myoung Jin Ju, M.D.*, Jin Woong Cho, M.D. and Yong Ung Lee, M.D.; Korean J Gastrointest Endosc 2007;35(1):33-37. Published online July 30, 2007

Abstract PDF: Anisakiasis is a parasitic disease caused by ingestion of raw fish infected with anisakis larvae. The endoscopic features of the gastic mucosa are edema, ulceration and hemorrhage. Chronic gastric anisakiasis forming a submucosal tumor is rare. A 53-year old female was diagnosed with having a 1 cm sized gastric submucosal mass-like lesion by gastroscopy. Endoscopic ultrasonography showed an inhomogenous low echoic tumor with an irregular margin in the submucosal layer. The patient underwent an endoscopic submucosal dissection and band ligation. A serological assay with an enzyme-linked immunosorbent assay for an anisakiasis specific IgG antibody were positive. The pathological finding of the resected mass was centrally denatured larvae with eosinophilic abscess in the submucosal layer. We report a case of chronic gastric anisakiasis that presented as a gastric submucosal tumor that was removed by the endoscopic submucosal dissection method, with a review of the relevant literature.

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A Case of Gastric Schwannoma in a Male Patient: Soo-youn Moon, M.D., Young-Woon Chang, M.D., Chang Kyun Lee, M.D., Jae Young Jang, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byoung-Ho Kim, M.D. and Rin Chang, M.D.; Korean J Gastrointest Endosc 2007;34(4):210-213. Published online April 30, 2007

Abstract PDF: Gastric schwannoma that originates from nerve sheath comprises about 0.2% of all gastric tumors and 4% of all benign gastric tumors. It is difficult to precisely diagnose gastric schwannoma via endoscopic biopsy or imaging studies. A 57-year-old male was referred to our hospital from a private clinic for further evaluation of a gastric tumor-mass that was diagnosed by gastroscopy. Gastroscopy and endoscopic ultrasonography showed a submucosal mass larger than 3 cm in size at the low body of the stomach. That the mass had malignant potential could not be excluded because of its size and shape. The patient underwent subtotal gastrectomy. The tumor cells showed immunoreactivity to S-100 protein. This submucosal tumor was diagnosed as a gastric schwannoma on the basis of these findings. Gastric schwannoma is known to occur more frequently in females than males. This is the first reported case of gastric schwannoma that's occurred in a Korean male patient. (Korean J Gastrointest Endosc 2007;34:210⁣213)

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Two Cases of a Submucosal Tumor-like Gastric Adenocarcinoma: Ji Hyeon Nam, M.D., Seun Ja Park, M.D., Ji Eun Park, M.D., Nang Hee Kim, M.D., Sung Hoon Kim, M.D., Seo Ryong Han, M.D., Won Moon, M.D., Kyu-Jong Kim, M.D., Moo In Park, M.D. and Hee Kyung Chang, M.D.*; Korean J Gastrointest Endosc 2007;34(2):94-98. Published online March 2, 2007

Abstract PDF: The gastric carcinoma displays various macroscopic appearances ranging from well defined protuberant to diffuse infiltrating tumors but its histological diagnosis is usually simple when performing an endoscopic biopsy. A few gastric cancinomas resemble submucosal tumors (SMT). A gastric carcinoma with a SMT-like appearance is extremely rare, and reportedly accounts for 0.1% to 0.63% of all resected gastric carcinomas in Japan. A histological diagnosis of a SMT-like gastric carcinoma by repeated endoscopic biopsies is often difficult as the tumors are almost entirely covered with normal mucosa. When one sees the lesions in an upper gastrointestinal endoscopy, one should be careful about the location of depression, redness and coating that deviates from the top of the tumor. Here we report two cases of SMT-like gastric carcinomas, diagnosed by the usual endoscopic biopsy method and treated with surgery, with an accompanying review of the recent literature.

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A Case of Gastric Adenocarcinoma Presenting as a Submucosal Tumor: Eun Mi Hwang, M.D., Jin Il Kim, M.D., Eun Chul Jang, M.D., Myung Suk Kim, M.D., Soon Sub Kim, M.D., Dae Young Cheung, M.D., Se Hyun Cho, M.D., Soo Heon Park, M.D., Joon Yeol Han, M.D., Jae Kwang Kim, M.D. and Kyu Yong Choi, M.D.; Korean J Gastrointest Endosc 2006;33(6):368-371. Published online December 30, 2006

Abstract PDF: Neoplasms of the stomach can originate from both epithelial and subepithelial cells. These two types of tumors have different morphological characteristics according to their origin including the mucosal surface texture and contour of the mass in endoscopic examination. However, on rare occasions, neoplasms of an epithelial origin manifest the features of a submucosal tumor on a gross examination, and require additional and more invasive approaches, such as a strip biopsy, computed tomography, and endosonography, to define their nature. We encountered a case of a gastric adenocarcinoma in a 44 year-old woman, which was initially considered to be submucosal tumor by the endoscopic examination and was finally diagnosed after resecting the tumor. (Korean J Gastrointest Endosc 2006;33:368⁣371)

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Three Cases of Gastric Anisakiasis Mimicking Submucosal Tumor: Sang Wook Park, M.D., Young Eun Joo, M.D., Pil Jin Jung, M.D., Min Ho Park, M.D., Nam Hun Lee, M.D., Im Kwan Jhu, M.D., Geun Soo Park, M.D., Chang Hwan Park, M.D., Wan Sik Lee, M.D., Hyun Soo Kim, M.D., Sung Kyu Choi, M.D., Jong Sun Rew, M.D. and Sei Jong; Korean J Gastrointest Endosc 2006;32(6):381-386. Published online June 30, 2006

Abstract PDF: Gastric anisakiasis is a parasitic infestation that occurs after eating raw marine fish that contain Anisakis larvae. The diagnosis is usually confirmed by endoscopy, which often reveals the presence of the larvae itself, mucosal edema, erosion, ulceration, and hemorrhage. However, gastric anisakiasis mimicking submucosal tumor is extremely rare. To date, six cases have been reported in Korea. We report three additional cases of gastrtic anisakiasis mimicking submucosal tumor. An asymptomatic 56-year-old man and a 40-year-old woman underwent endoscopis examination during a physical checkup, and a 63-year-old woman visited our hospital complaining of epigastric discomfort. The endoscopic findings indicated submucosal tumors in all cases. Endoscopic ultrasonography revealed inhomogeneous, hypoechoic lesions in submucosal layer (1 case) and muscle layer (2 cases). A laparoscopic and endoscopic resection was carried out for definite diagnosis and treatment. The pathologic findings of the resected specimens were eosinophilic granuloma caused by Anisakis. (Korean J Gastrointest Endosc 2006;32:381⁣386)

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A Case of Submucosal Tumor-like Early Gastric Adenocarcinoma Diagnosed by Endoscopic Mucosal Resection: Se Yune Kim, M.D., Jong-Jae Park, M.D., Yongik Cho*, M.D., Jong Hwan Choi, M.D., Ji Hyun Kim, M.D., Byung Kyu Kim, M.D., Ji Hoon Kim, M.D., Yun Jung Chang, M.D., Cheol Hyun Kim, M.D., Youn Suk Seo, M.D., Jin Yong Kim, M.D., Jae Seon Kim, M.D. and Young-Ta; Korean J Gastrointest Endosc 2005;31(6):404-408. Published online December 30, 2005

Abstract PDF: In rare cases, early gastric cancer resembles the endoscopic features of a submucosal tumor (SMT). A correct histological diagnosis is difficult with repeated biopsy specimens because they are covered with normal mucosa. Some features known to suggest malignant SMT include a size greater than 3 to 5 cm, a rapid growth rate, echoheterogeneity and irregular margins on endoscopic ultrasonography (EUS). Various techniques including US- guided biopsy, partial removal by an endoscopic snare excision, as well as EUS with a fine needle aspiration were used to enhance the diagnostic accuracy. We recently experienced a case of early gastric cancer, presenting as a submucosal tumor-like lesion, which was confirmed by endoscopic mucosal resection. We report this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2005;31:404⁣408)

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Endoscopic Ultrasonographic Findings of Two Cases of Parasitic Eosinophilic Granuloma in the Stomach: Jong Won Choi, M.D., Byung Kyu Park, M.D., Yu Ri Kim, M.D., Seung Woo Park, M.D., Se Joon Lee, M.D., Si Young Song, M.D., Beom Jin Lim, M.D.* and Jae Bock Chung, M.D.; Korean J Gastrointest Endosc 2005;30(5):267-272. Published online May 30, 2005

Abstract PDF: Anisakiasis is a disease of the alimentary tract caused by nematode larva belonging to the subfamily Anisakinae. It is possible for Anisakis larva to be transmitted to man through eating raw sea fish that is preferred by Korean people. The clinical symptoms are characterized by severe cramping abdominal pain, nausea, vomiting, diarrhea, tarry stool, and epigastric fullness. The endoscopic examination has played a important role in the diagnosis of anisakiasis. However, gastric anisakiasis is undetected due to unspecific symptom and delayed endoscopy. Endoscopic ultrasonography is probably the choice of investigative tool for the evaluation of submucosal mass. However distinctive feature of parasitic infectation presenting an submucosal tumor has not been reported. Recently, we experienced two cases of gastric anisakiasis. We found gastric submucosal tumors by endoscopy, differentiated them by endoscopic ultrasonography and treated by endoscopic submucosal resection. (Korean J Gastrointest Endosc 2005;30: 267⁣272)

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The Comparison of Sizes Measured by Esophagogastroduodenoscopy and Endoscopic Ultrasonography in Small Submucosal Tumors: Gi Se Lee, M.D., Hyun Ju Yoon, M.D., Tae Hee Lee, M.D., Euyi Hyeng Im, M.D., Kyu Chan Huh, M.D., Young Woo Kang, M.D. and Young Woo Choi, M.D.; Korean J Gastrointest Endosc 2005;30(4):183-187. Published online April 30, 2005

Abstract PDF: Background
/Aims: Endoscopic ultrsonography (EUS) can provide detailed information about submucosal tumors such as size, echo pattern, wall of origin and relation to adjacent organs. However, EUS is not a cost effectiveness and time-consuming procedure and many patients experience discomfort during the procedure. We tried to verify the usefulness of Esophagogastroduodenoscopy (EGD) in the measurement of submucosal tumor size in comparison with EUS. Methods: We compare the size of small submucosal tumors from 68 patients measured by EGD and EUS at Konyang University Hospital from year 2000 to 2003. Results: Most of submucosal tumors were located in muscularis propria layer. The size of submucosal tumor measured by gastroscopy correlated well with the size by EUS (r=0.91). Submucosal tumor measured by EGD was slightly larger than EUS measurement (p=0.008). Conclusions: The size of submucosal tumors measured by EGD was slightly larger than that by EUS due to covering mucosa, but both sizes were linearly correlated. So we think that gastroscopy plays as one strategy for the surveillance or follow-up procedure of small sized submucosal tumors which do not exhibit the suspicion of malignant potential. (Korean J Gastrointest Endosc 2005; 30:183⁣187)

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Three Cases of Secondary Esophageal Tuberculosis Presenting as an Esophageal Submucosal Tumor: Sung Woo Choi, M.D., Hyojin Park, M.D., Sang Bae Lee, M.D., Jun Pyo Chung, M.D., Sang In Lee, M.D. and Soon Won Hong, M.D.*; Korean J Gastrointest Endosc 2005;30(2):80-85. Published online February 27, 2005

Abstract PDF: Although esophageal tuberculosis is a rare disease throughout the world, esophageal tuberculosis should be included as one of differential diagnosis made in Korea where the prevalence of tuberculosis is still high. Esophageal tuberculosis might be mistaken for carcinoma due to lack of specific symptom, diagnostic study or pathologic diagnosis in clinical setting. The diagnosis would be difficult when esophageal ulcerative lesions or submucosal tumor are present, especially. When the result after a biopsy is not confirmative, the diagnosis can be made with the detection of mycobacteria by microbiologic study or polymerase chain reaction. We experienced three patients with esophageal tuberculosis; a 41-year-old woman with dysphagia, a 34-year-old woman with dysphagia and odynophagia, and a 52-year-old woman with epigastric pain. Esophageal submucosal tumors were found in all the patients with upper gastrointestinal endoscopy. The diagnosis of tuberculosis were finally made by removal of tumor and biopsy or tuberculosis polymerase chain reaction. They all got improved after the treatement with anti-tuberculosis medications. Herein, we report 3 cases of esophageal tuberculosis with review of related literatures. (Korean J Gastrointest Endosc 2005;30:80⁣85)

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A Case of Endometriosis Presenting as Constipation: Sang Hyen Joo, M.D., Woo Jin Jeong, M.D., Jeong Soo Kim, M.D., Won Il Park, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Mong Cho, M.D., Suk Kim, M.D.* and Do Youn Park, M.D.^†; Korean J Gastrointest Endosc 2004;29(6):534-538. Published online December 30, 2004

Abstract PDF: Endometriosis is the abnormal growth of endometrial tissue outside of uterine cavity. The incidence of endometriosis is estimated about 8∼15% of the reproductive women. The intestinal invasion is showed at about 3∼34%. The intestinal invasion may be involved in rectosigmoid colon, appedix, ileum, and cecum in order of decreasing frequency. Until now, only 7 cases have been reported in Korea. Most cases are diagnosed after surgery. And then the diagnosis need to be confirmed by surgical pathology. Recently, a 42 year-old woman visited due to severe constipation. A flexible sigmoidoscopy revealed submucosal tumor on rectosigmoidal juction 20 cm above the anal verge. The surgical resection was performed and the biopsy showed the endomtriosis involving mucosa, submucosa, muscularis, serosa, subserosa and lymph node. (Korean J Gastrointest Endosc 2004;29:534⁣538)

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A Case of a Submucosal Tumor in the Ascending Colon Probably Caused by Anisakis: Yo Ahn Suh, M.D., Hyun Joo Jang, M.D., Chang Soo Eun, M.D., Woo Young Jang, M.D.*,; Korean J Gastrointest Endosc 2004;28(4):202-207. Published online April 30, 2004

Abstract PDF: Anisakiasis refers to a parasitic infestation by nematode larvae that belong to the subfamily Anisakinae. Colonic anisakiasis is very rare, and it is hard to diagnose compared with gastric anisakiasis. Endoscopic or radiologic findings, history of raw fish intake and ELISA test might be helpful, however, exploratory operations were needed to confirm the diagosis in the many cases of colonic anisakiasis. Colonoscopy and endoscopic ultrasonography showed a submucosal tumor in the ascending colon in a 47-year-old woman who complained of right upper quadrant abdominal pain. Right hemicolectomy was performed to diagnose and cure the lesion. Pathologic examination revealed some destructed cuticle of a parasite and dense eosinophilic abscess showing central necrosis. She had a history of raw squid intake recently. We report a case of submucosal tumor in the ascending colon probably caused by Anisakis. (Korean J Gastrointest Endosc 2004;28:202⁣207)

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A Case of Gastric Lymphoepithelioma-like Carcinoma Presenting as a Submucosal Tumor: Won Il Park, M.D., Hyong Wok Kim, M.D., Jin Hong Park, M.D., Dong Hyun Lee, M.D., Jong Yun Cheong, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Mong Cho, M.D. and Ung Suk Yang, M.D.; Korean J Gastrointest Endosc 2004;28(3):123-126. Published online March 31, 2004

Abstract PDF: Lymphoepithelioma-like carcinoma (LELC) occurs in esophagus, stomach, bile duct, salivary gland, lung, uterus, skin, and so on. The incidence of gastric LELC is 1∼4 percents of all stomach cancers. Gastric LELC has a lymphoid stroma and shows a good prognosis and high association with Epstein-Barr virus. We experienced a case of patient with gastric LELC. The patient was 49- year-old woman. and the endoscopic finding showed a submucosal tumor with central erosion. The histologic findings of endoscopic biopsies were suggestive of low grade MALT lymphoma. but the histologic findings of the surgical specimen were consistent with gastric LELC. We report a case of gastric LELC presenting as a submucosal tumor, with a brief review of the literature. (Korean J Gastrointest Endosc 2004;28:123⁣126)

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Small Sized Submucosal Tumor에서 EUS 추적 검사의 필요성에 관한 고찰: Korean J Gastrointest Endosc 2003;27(5):403-403. Published online November 20, 2003

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A Case of Gastric Submucosal Tumor Suspected to be Caused by Anisakis: Paul Choi, M.D., Jin Wuk Hur, M.D., Hyun Jung Lim, M.D., Jee Young Lee, M.D., Dong Wan Kim, M.D., Moo In Park, M.D., Seun Ja Park, M.D., Hee Kyung Chang, M.D.*, Kyung Seung Oh, M.D.^†and Ja Young Koo, M.D.; Korean J Gastrointest Endosc 2003;27(1):26-30. Published online July 30, 2003

Abstract PDF: Anisakiasis is a parasitic disease following eating raw fishes infected with Anisakis larvae. The endoscopic features of the gastric mucosa are edema, erosion, ulceration and hemorrhage. Gastric anisakiasis forming submucosal tumor is rare. Twenty six-year-old man who complained of severe epigastric pain was admitted. The pain began approximately three hours after eating slices of raw Astroconger myriaster. Gastric endoscopy revealed a submucosal tumor with central erosion on the gastric fundus. Endoscopic ultrasonography detected a thickening of the gastric wall made of mainly thickened submucosal layer. Abdominal CT scan showed a gastric mass lesion with hypodensity in the gastric fundus and subsequently wedge resection was performed. The pathologic finding of the resected mass was eosinophilic abscess in the submucosal layer. We report a case of gastric submucosal tumor which seems to be caused by Anisakis, with a review of relevant literature. (Korean J Gastrointest Endosc 2003;27:26⁣30)

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지상발표 / 소장 : Benign Stromal Tumor and Bleeding Due to Submucosal Telangiectasia: Korean J Gastrointest Endosc 2001;22(5):389-389. Published online November 30, 2000

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식도 점막하 종양의 내시경적 치료 - 15 년간 경험과 추적 결과 -: Korean J Gastrointest Endosc 2001;23(5):295-295. Published online November 30, 2000

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점막하 종양으로 보인 십이지장 결핵에 동반된 결핵성 림프절염 1 예 ( A Case of Duodenal Tuberculosis Conceived as Submucosal Tumor Accompanied by Tuberculous Lymphadenitis ): Korean J Gastrointest Endosc 2001;23(4):230-234. Published online November 30, 2000

Abstract PDF: In spite of decrease in prevalence, yet tuberculosis is not rare disease in Korea and the morbidity is over one percent. Because extrapulmonary tuberculosis is less common than that of lung, quick and accurate diagnosis is not easy and there may be some problems in selecting the methods and the times to treat it. Especially, each or combination of abdominal lymphadenitis and duodenal tuberculosis are so rare that differential diagnosis from other common or rare diseases is difficult, and much attention is required to diagnose and treat those. Recently we experienced a case of tuberculous lymphadenitis accompanied by duodenal bulbar tuberculosis which had been conceived as submu cosal tumor at endoscopy and diagnosed by explorative operation. So we report this case with review of related literatures. (Korean J Gastrointest Endosc 2001;23:230-234)

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증례 / 점막하 종양양상의 위 과오종 1예 ( A Case of Gastric Hamartoma Presenting as a Submucosal Tumor ): Korean J Gastrointest Endosc 2001;22(3):169-173. Published online November 30, 2000

Abstract PDF: Hamartomatous polyps in the stomach have been described as gastric lesions of familial polyposis coli or not associated with polyposis coli. However, submucosal tumor-like lesion of the gastric hamartoma is very rare. We have experienced an unusual hamartoma in the stomach in a 69-year-old man. He was hospitalized with epigastric discomfort. Endoscopy revealed a submucosal mass at the greater curvature of the high body of the stomach. The resected mass measured 3 X 2 X 1.5 cm and was characterized by cystic dilation of glandular structures, The glandular structures consisted of various types of lining cells, including surface foveolar cell types, pyloric cell types and parietal-like cells, and irregularly arranged smooth muscle bundles and collagen fibers were noted. We report this unusual gastric hamartoma presenting as a submucosal tumor with a review of literatures. (Korean J Gastrointest Endosc 2001;22:169 - 173)

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증례 : 점막하 종양상을 보인 위궤양반흔 2예의 내시경적 초음파 단층촬영술상 ( Endosonographic Findings of Submucosal Tumor-like Gastric Lesion Caused by Fibrotic Ulcer Healing ): Korean J Gastrointest Endosc 2000;20(6):460-463. Published online November 30, 1999

Abstract PDF: It is known that multiple ulcers of the gastric antrum are often accompanied by marked submucosal fibrosis during the healing process, and that this may result in a deformity of the gastric wall. Thus, benign antral ulcers may be misinterpreted as intramural tumors, or even malignant ulcers when the surrounding edema is pronounced and sharply defined. It is possible for an endoscopic ultrasonography (EUS) to detect which layer has a submucosal tumor (SMT) in the five-layer structures of the digestive tract wall. In the diagnosis of SMT of the upper digestive tract, EUS allows for the visualization of the structures underlying the gastrointestinal wall in a noninvasive manner and has a great advantage over conventional modalities such as endoscopy and X-ray examination. The EUS findings of 2 cases of submucosal tumor-like gastric lesion caused by fibrotic ulcer healing are herein reported with a brief review of relevant literature. (Korean J Gastrointest Endosc 2000;20:460-463)

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원저 : 점막하종양양 벽외성 압박의 진단에 있어서 내시경적 초음파차단층촬영술 ( Diagnostic Usefulness of Eedoscopic Ultrasongraphy for Extraluminal Compressions Mimicking Submucosal Tumors ): Korean J Gastrointest Endosc 2000;20(6):437-442. Published online November 30, 1999

Abstract PDF: Background
/Aims: When a submucosal lesion is discovered through an upper gastrointestinal endoscopy, it may be often difficult to differentiate an extra-gastric compression from a true submucosa1 tumor (SMT). An endoscopic ultrasonography (EUS) provides information about the relationship between a lesion and the gastric or esophageal wall. Furthermore, EUS helps in identifying the compression caused by surrounding organs. The diagnostic usefulness of EUS for extralumina1 compressed lesion was assessed. Methods: The 261 patients who received an endoscopic diagnosis of submucosal tumors had EUS examinations performed. The results of EUS to additional diagnostic procedures such as UGI, USG, CT scan or tissue biopsy were then compared. Results: Of 261 patients who received endoseopic diagnosis as SMT, extraluminal compression existed in 46 (17.6%) cases and true intramural lesion were found in 215 (82.4%) cases on EUS. The causes of extraluminal compression are lymph nodes (2 case.), the gallbladder (12 cases), the pancreas (9 cases), the spleen (6 cases), a pancreatic pseudocyst (5 cases), pancreatic cancer (2 cases), a hepatic cyst (2 cases), the left lobe of the liver (4 cases), hepatoma (1 case), a mesenteric tumor (2 caws) and a splenic vein (1 case). Conclusions: EUS is considered to be a useful diagnostic method not only for differential diagnosis of extraluminal compression from true SWT, but also for clarifying the cause of extraluminal compressed lesions. (Korean J Gastrointest Endosc 2000;20:437--442)

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점막하 종양소견을 보인 위 과오종: Korean J Gastrointest Endosc 2000;20(5):391-391. Published online November 30, 1999

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위내시경 검사상 점막하 종양으로 표현되었던 스파르가눔양 병변 1예 ( A Case of Intraabdominal Sparganosis Presenting as Submucosal Tumor on Gastroscopy ): Korean J Gastrointest Endosc 1999;19(5):783-788. Published online November 30, 1998

Abstract PDF: Sparganosis in humans is caused by migrating larvae of the cestode Spirometra. Humans are considered the second intermediate host that are incidentally infected. Sparganosis usually infestates the subcutaneous tissues and visceral organs have rarely been reported to be involved. A case is herein reported however, a 67-year old female patient with sparganosis in the gastric wall and perigastric region, presented as a submucosal tumor upon gastrofiberscopy. The diagnosis was made after surgery by the pathologic findings determining a characteristic degenerated Sparganum and multiple tunnel-shape cavities surrounded by many inflammatory cells and necrotic materials. (Korean J Gastrointest Endosc 19: 783∼788, 1999)

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위 점막하 종양으로 발현된 동정맥 기형 1예 ( A Case of Arteriovenous Malformation Presented as a Submucosal Tumor ): Korean J Gastrointest Endosc 1999;19(4):606-612. Published online November 30, 1998

Abstract PDF: Arteriovenous malformations (AVM) are an unusual cause of gastrointestinal (GI) bleeding. But most GI AVM can occur with GI bleeding. When conventional diagnostic studies have failed to reveal the source of GI bleeding, AVM have been one of the most common causes. But the incidence of AVM presented as bleeding of a gastric submucosal tumor is very low. A case of gastric submucosal tumor was experienced and reported as an AVM. This case is herein discussed with review of corresponding literature. (Korean J Gastrointest Endosc 19: 606∼610, 1999)

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