Clinical Endoscopy

원저 : 식도 위장관 ; O-형 고무 밴드 결찰에 의한 잡견위벽의 변화 ( Original Articles : Esophagus , Stomach & Intestine ; Results of Experimental Canine Gastric Wall Ligation using 0-shaped Rubber Band ): Korean J Gastrointest Endosc 1996;16(2):145-155. Published online November 30, 1995

Abstract PDF: Objectives
Endoscopic variceal ligation is well established metbod of treatment for esophageal varices whereas for gastric varices there has not been any systematic report of its use as a method of treatment. To evaluated its possible clinical application, the band ligation(banding) and the method of band ligation in conjuction with submucosal ethanolamine injection(banding with sclero) were tested on canine stomach, and results were assessed.(Korean J Gastrointest Endosc 16: 145-155, 1996)

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원저 : 식도 위장관 ; 원발성 위 림프종의 내시경적 진단 ( Original Articles : Esophagus , Stomach & Intestine ; Endoscopic Diagnosis of Primary Gastric Lymyhoma ): Korean J Gastrointest Endosc 1996;16(2):156-167. Published online November 30, 1995

Abstract PDF: Primary gastric lymphorna represents one to 7% of all gastric cancer and is the most common type of extranodal lymphoma. In attempt to evaluate the endoscopic characteristics, we analysed clinical and endoscopic findings in 35 patients with primary gastric lymphoma between January 1980 and August 1994 at the Yonsei Medical Center. The results were as follows: 1) The mean age of patients was 47.1 years with male to female ratio of 1.5: l. 2) Gastroscopy was performed in all 35 patienits, which revealed polypoid lesion in one case(2.9%), ulcerative lesion in 15 cases(42.9%), ulcero-infiltrative lesion in 6 cases(17.1%) and diffuse infiltrative lesion in 2 cases(5.7%). Gastric lymphoma was suggested in 6 cases, advanced gastric cancer in 21 cases, early gastric cancer in 5 cases and benign gastric ulcer in 3 cases. Pathologic diagnosis of biopsy specimens were gastric lymphoma in 24 cases, adenocarcinoma in 5 cases and chronic superficial gastritis in one case. 3) The characteristics of the endoscopic findings in gastric lymphoma were intractable or recurrent ulcer in 10 cases, thickened and mounded ulcer margin in 9 cases, multiple ulcers in 9 cases, giant rugae in 7 cases and polypoid or depressed lesion with central ulceration in 4 cases. In conclusion, recognition of specific endoscopic findings such as intractable or recurrent ulcer, volcano-like ulcer, multiple ulcers, giant rugae and combined lesion, the possibility of a lymphoma should be considered and vigorous biopsy attempts should be carried out. Then if the first microscopic report does not suggest this diagnosis, a second investigation including jumbo biopsies, perhaps by diathermy, should be undertaken, (Korean J Gastrointest Endosc 16: 156-165, 1996)

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원저 : 식도 위장관 ; 양성 위궤양으로 진단된후 내시경검사로 경과 관찰중 확인된 위암에 대한 검토 ( Original Articles : Esophagus , Stomach & Intestine ; Study on the Gastric Cancer Initially Diagnosed as Benign Gastric Ulcer during Endoscopic Follow-up ): Korean J Gastrointest Endosc 1996;16(2):169-179. Published online November 30, 1995

Abstract PDF: To examine the relationship between gastric ulcer and gastric cancer, we investigated petients with gastric ulcer diagnosed from 1986 to l993. We reviewed the endoscopic reports and films of patients with gastric ulcer retrospective1y. We excluded the patients who was diagnosed as gastric cancer in two years follow-up. The results were as follaws; 1) During follow-up of the original cohort, there were 5 patients(0.5~%) in whom gastric cancer developed at the same site initially diagnosed as gastric ulcer. The gross type of the lesion was early gastric cancer in two and advanced gastric cancer in three patients 2) The time interval between the initia1 diagnosis of gastric ulcer and cancer development was from 31 months to 70 months (average 51 months). 3) At the initial examination of 5 gastric cancer patients, the diagnosis was active gastric ulcer in four, multiple gastric ulcer in one, and linear gastrie ulcer in one patient. Characteristic endoscopic findjngs were gastric ulcer with clubbing mucosal folds in three and gastric ulcer with bleeding in one patient. 4) During the follow-up period, endoscopicailly and histologically healing of gastric uleer was observed in one patient and histologic finding showed chronic superficial gastritits with intestinal metaplasia. These results suggest that gastric ulcers rarely progress to gastric cancer. However if the endoscopic findings are suspicious for malignancy, then follow-up endoscopy until complete healing should be done, (Korean J Gastrointest Endosc l6: 169 ~177, 1996)

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원저 : 식도 위장관 ; 상부 위장관 내시경 검사시 전처치로서의 Midazolam 의 효과 ( Original Articles : Esophagus , Stomach & Intestine ; Midazolam as Premedication for Upper Gastrointestinal Endoscopy ): Korean J Gastrointest Endosc 1996;16(2):181-190. Published online November 30, 1995

Abstract PDF: The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy. (Korean J Gastrointest Endoec 16: 181-190, 1996)

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원저 : 식도 위장관 ; 대장직장암 수술후 대장선종의 발생양상 ( Original Articles : Esophagus , Stomach & Intestine ; Pattern of Adenomas after Colorectal Cancer Surgery ): Korean J Gastrointest Endosc 1996;16(2):191-198. Published online November 30, 1995

Abstract PDF: Postoperative colonoscopy is an effective tool for management of colonic adenomas. Authors analyzed the pattern of colonic adenomas detected during follow-up colonoscopy after colorectal cancer surgery and evaluated the characteristics of adenornas, risk groups, and effective fo1low-up schedule. Study group were 222 patients and colonoscopy was performed 389 times. Patterns of adenornas were analyzed by variables as age, sex, preoperative serum CEA level, location of primary colorectal cancer, Borrmann type, Duke's stage, histologic differentiation, DNA ploidy, recurrence and histology. Metachronous adenomas were detected in 79 patients(35.6%) and both metachronous and syachronous adenomas were observed in 29 cases(13.1%). High risk variables for adenomas were male, old age and presence of synchronous adenoma. There were 2 patients with maligant change of adenomas. Yearly follow-up by complete colonoscopy over 3 years or more is recommended and follow-up interval should be shortened in the high risk groups. (Korean J Gastrointest Endosc 16: 191-108, 1996)

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원저 : 담도 췌장 ; 총담관 및 주췌관 괄약근 운동성의 동시 측정을 통한 운동 지표 비교 ( Original Articles : Biliary Tract & Pancreas ; Simultaneous Measurement of Choledochal and Pancreatic Sphincter Motility ; Comparative Study of Manometric Parameters ): Korean J Gastrointest Endosc 1996;16(2):199-203. Published online November 30, 1995

Abstract PDF: If manometric profiles of sphincter of Oddi(SO) measured from the pancreatic duct and the bild duct are essentially equal, then measurement of manometric profiles from only one duct would be adequate in evaluating SO dysfunction. We report a series of 9 patients whom we evaluate with SO manometry. Cannulation of both the biliary sphincter segment and pancreatic sphincter segment was archived consecutively in one session and we compared the manometric parameters of choledochal sphincter from those of pancreatic sphincter. 1) In 7 out of 9 patients(78%), normal manometric finding of SO were seen in both choledochal and pancreatic sphincters. However, in 2 out of 9 cases(22% ) abnormal manometric findings were noted in only one sphincter segment. Elevation of basal pressure(n = l ) and increased retrograde propagation(n = 1) were found in the pancreatic sphincter segment alone. 2) Tbe mean intraductal pressure in the pancreatic duct was significantly greater(12.6+-5.8mmHg) than that of common bile duct(3.8+-3.3mmHg)(p<0.01). However, basal pressure, amplitude, frequency and propagation sequence in the phasic contraction of SO were not different significantly between choledochal and pancreatic sphincter segment. In conclusion, SO manometry of both the pancreatic and bile duct is needed if complete manometric information is desired. Selective cannulation of common bile duct and pancreatic duct during SO manometry is necessary in order to diagnose segmental 50 dysfunction. (Korean J Gaetrointest Endosc 16: 198~203,1996)

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원저 : 담도 췌장 ; 췌장 질환에 있어서 순수 췌액의 종양 표지자 측정에 관한 연구 ( Original Articles : Biliary Tract & Pancreas ; Tumor Marker Study of Pure Pancreatic Juice in Patient with Pancreatic Diaeases ): Korean J Gastrointest Endosc 1996;16(2):204-211. Published online November 30, 1995

Abstract PDF: Several reports have described the usefulness of tumor markers detected in pancreatic juice for diagnosis of pancreatic cancer. We performed this study to evaluate the usefulness of tumor markers in pure pancreatic juice collected by duodenoscopic cannulation of pancreatic duct before and after injection of secretin. From April 1993 to July 1995, 8 cases of pancreatic cancer, 5 cases of benign pancreatic lesions, and 5 cases of benign biliary diseases without pancreatic lesion were involved. CEA and CA 19-9 immunoreactivity were measured by radioimmunoassay. Concentrations of CA 19-9 in pure pancreatic juice were significantly higher in patients with pancreatic cancer(median value; 3582, range 88.4-10410 IU/ml) than in control patients(median value 231, range 30.4-682 IU/ml)(p<0.05). Concentrations of CEA in pure pancreatic juice were not significantly different between patients with pancreatic cancer(median value: 6,5, range 1.0-152ng/ml) and control patients(median value: 4.0, range 1-17.2 ng/ml)(p>0.05). There was no significant correlation between levels of CA19-9, CEA in pancreatic juice and those levels in serum. The amounts of juice collected by duodenoscopic cannulation in patients with pancreatic cancer were 1.5+-0.9ml during 5 minutes before infusion of secretin, 11.3+-3.9ml, 10.8+-4.0ml, 10.6+-4.0ml in 5 minute interval after infusion of secretin. These results indicated that measurement of CA19-9 in pure pancreatic juice may be used as a marker for pancreatic cancer. Adequate amount of pancreatic juice was collected by duodenoscopic cannulation for evaluation of tumor marker, enzyme studies and cytology. (Korean J Gastrointest Endosc 16: 204~211, 1996)

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원저 : 담도 췌장 ; 상부 위장관 및 췌담도계 질환의 내시경적 초음파 단층술 진단 589예 ( Original Articles : Biliary Tract & Pancreas ; 589 Cases of Endoscopic Ultrasound Diagnosis in Upper Gastrointestinal Tract and Pancreaticobiliary System Diseases ): Korean J Gastrointest Endosc 1996;16(2):212-220. Published online November 30, 1995

Abstract PDF: Endoscopic ultrasonography (EUS)-a combination of endoscopy a.nd ultrasonography was one of the most useful tools for diagnosis of digestive system diseases. This technique was known to be very effective in the assessment of depth of invasion in gastric cancer and in pancreatico-biliary diseases. We performed EUS in 589 patients with upper gastrointestinal and pancreatico-biliary tract lesion prior to surgery for past 22 months and examined the diagnostic accuracy of EUS, respectively. The results were compared to surgical histology in esophagus and stomach cancer,to concordance witb endoscopic retrograde cholangiopancreatography(ERCP ) results for pancreaticobiliary diseases. 1) In 589 patients diagnosed with EUS, the mean age of the patients was 55.9 years with a male to female ratio of 1.7: 1. 2) Patients were divided into three groups; post-upper gastrointestinal endoscopy, post ERCP and undiagnosed with other diagnostic tools. 3) Among post-upper gastrointestinal endoscopy, 64 cases were operated due to esophageal and gastric cancer and then compared to surgical histology. After compared, EUS accuracy on depth of invasion was 78.1% and sensitivity and specificity on lymph node metastasis in gastric cancer were 76.9% and 74.3%, respectively. 4) In post-ERCP cases, EUS results were compared to ERCP results and then concordance rate was 95.4%. 5) In undiagnosed cases, EUS was performed and results were reported. ( Korean J Gastrointest Endosc 16; 212~220, 1996)

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증례 : 식도 위장관 ; 위의 거대점막주름을 보인 Gastritis Gystica Profunda 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Gastritis Cystica Profunda Showing Giant Gastric Mucosal Fold ): Korean J Gastrointest Endosc 1996;16(2):221-227. Published online November 30, 1995

Abstract PDF: Gastritis cystica profunda is a rare condition in which mature glandular epithelium extends ino the tissues beneath the muscularis mucosae. It is analogous to similar conditions affecting the small and large intestines that are called, enteritis and colitis cystica profunda. Macroscopically, gastritis cystica profunda may present not only as a submucosal tumor or as solitary or diffuse polyps, but also as a giant gastric mucosal fold rarely These lesion have been found not only at the site of a gaatroenterostony but also in the stomach of patients without previous surgery. We present herein a patient having gastritis cystica profunda without any previous surgery, in which it present as a giant gastric mucosal fold. ( Korean J Gastrointest Endosc 16; 221~225, 1996)

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증례 : 식도 위장관 ; 위에서 발생한 사중암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Synchronous Multiple Gastric Cancer ; Quadruple Cancer ): Korean J Gastrointest Endosc 1996;16(2):229-235. Published online November 30, 1995

Abstract PDF: According to Moertel's classification, synchronous multiple gastric cancer is eonsidered to be a sort of multiple primary cancer, The clinical signifieance of multiplicity in gastric cancer was its location relative to the resection line. Compared with patients with single gastric cancer, multiple gastric cancer were more frequently found among the older men, and they were more commonly found in early gastric cancer. The frequency of multifocality in gastric cancer is 2.2-9% in the world literature reports and is increasing recently, with advance in the diagnostic method of gastric cancer. However, synchronous multiple gastric cancer which has more than four foci is rare. In Korea, there has been only one case reported about quadruple gaatric cancer. Recently, we experienced a case of a 58-year-old male patient with synchronously developed-quadruple gastric cancer on the body of stomach, for whom radical total gastrectomy and esophagojejunostomy was done. All of them were moderately differentiated adenocarcinoma. The mapping about four lesions showed that Borrmanin type III AGC extending to the serosa was placed on the posterior wall of higher body; EGC IIc invading the submucosa, the anterior wall of mid body, EGC III confined to the mucosa, the lesser curvature side of mid to lower body; EGC III localizing to the mucosa, the posterior wall of lower body. So we reported this case with a review of literatures. (Korean J Gastrointest Endosc 16: 229~234, 1996)

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증례 : 식도 위장관 ; 십이지장 구부에 발생한 Carcinoid 종양 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Duodenal Carcinoid Tumor ): Korean J Gastrointest Endosc 1996;16(2):237-241. Published online November 30, 1995

Abstract PDF: Carcinoid tumors are well-differentiated epithelial neoplasms that usually can be diagnosed without difficulty based on their distinctive histologic patterns. These tumors are composed of variable numbers of calls that contain endocrine secretory granules in their cytoplasm, which can be identified by histochemistry, immunohistochemistry, and electron microscopy, Carcinoid tumors of the duodenum are relatively rare, the reported incidence being 2.0-8.9% of all gastrointestinal carcinoid tumors dianosed in Western countries. The rate of occurrence among all duodenal tumors is 3-5.5%. We experienced a case of carcinoid tumor of the duodenum in a 53 year-old male patient. He was admitted to our hospital because of epigastric pain. On the gastrofiberscopic examination, 0.7 cm sized Yamada type II polyp with central ulceration was noticed on the duodenal bulb. The biopsy specimen revealed carcinoid tumor. He was treated with polypectomy. (Korean J Gastrointest Endosc 16: 237~241, 1996)

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증례 : 식도 위장관 ; 상부 위장관을 침범한 아니사키스증 7예 ( Case Reports : Esophagus , Stomach & Intestine ; Report on 7 Cases of Anisakiasis Involved the Upper Gastrointestinal Tract ): Korean J Gastrointest Endosc 1996;16(2):242-247. Published online November 30, 1995

Abstract PDF: The anisakiasis disease that is infected through various kinds of larvae of the anisakis family when sea fish ia eaten uncooked or half-cooked. Sinee Van Thiel, a Netherlander, found in 1960 that anisakis larvae parasitize upon the human intestinal tract of the patients who suffer from ahdomieal pain after eating herrings, there have been a number of similar reports in North America and Japan, and the clinical importance of anisakis larvae for the acute gastrontestinal infection is rising. In general, as raw sea fish is not regarded as a source of parasite infestation, the patients who had eaten it and suffered from acute abdominal pain and vomiting are considered as and to be treated of food poisoning. But it is highly possible that some of them suffer from the acute gastrointestinal symptom caused by anisakis larvae. Thereby we report on 7 examples of anisakiasis taken through endoscopic diagnosis of the patients who have the acute upper abdominal pain after eating raw sea fish. (Ko rean J Gostrointest Endosc 16: 242~245, 1996)

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증례 : 식도 위장관 ; 수술전 대장내시경으로 진단이 가능했던 대장의 비특이성궤양 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Nonspecific Colonic Ulcer Diagnosed by Preoperative Colonofiberscopy ): Korean J Gastrointest Endosc 1996;16(2):249-253. Published online November 30, 1995

Abstract PDF: Because nonspecific colonic ulcer is an unusual condition and varies markedly in clinical presentation and course, preoperative clinical diagnosis of nonspecific colonic ulcer is very difficult, But now, preoperative clinical diagnosis can he made by advent of colonofiberscopy. And, it is very important to diagnose this disease early, because late diagnosis make a poor prognosis. We report a case of nonspecific colonic ulcer diagnosed by repeated colonofiberscopy and treated with surgery.(Korean J Gastrointest Endosc 16; 249~253, 1996)

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증례 : 식도 위장관 ; 직장의 연반증 ( Case Reports : Esophagus , Stomach & Intestine ; Malakoplakia ): Korean J Gastrointest Endosc 1996;16(2):254-259. Published online November 30, 1995

Abstract PDF: Malakoplakia is an uncommon granulomatous disease most frequently found in the bladder or ureter. Howevcr, it has been reyorted in almost every ather organ and structure, the colon is the most common site of malakoplakia outside the urogenital tract and colonic carcinoma is the most commonly associated disease. A case of malakoplakia of the colon in a 54-year-old female is reported. Sigmoidoscopy revealed multiple whiteyellowish nodules simulating polypoid lesion at 10cm from the anal verge. The biopsy showed characteristically comprised submucosal proliferations of histiocyte and chronic inflammatory cells with typical cytoplasmic inclusions known as Michaelis-Gutmann bodies. Intravenous pyelogram showed no evidence of involvement of the urinary system. These nodules were removed by endoscopic polypectomy, So far, this is the first case of isolated colonic malakoplakia in Korea. (Korean J Gastrointest Endosc 16: 254~257, 1996)

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증례 : 담도 췌장 ; 26개월 유아에서의 내시경적 역행성 담도췌관조영술과 유두괄약근절개술의경험 ( Case Reports : Biliary Tract & Pancreas ; A Case of Endoscopic Retrograde Cholangiopancreatography and Endoscopic Sphincterotomy in Infant Having Choledochal Cyst and CBD Stones ): Korean J Gastrointest Endosc 1996;16(2):261-267. Published online November 30, 1995

Abstract PDF: ERCP may provide more definite diagnosis, preoperative guidance, and endoscopic therapy in many children with known and suspected disorders of the pancreas or biliary tract. To our knowledge, there has been rare case of ERCP in children and no reported case of ERCP performed in inf~int less than 2 years old in Korea. We report a case of KRCP performed in 26 month old girl who was admitted to evaluate jaundice. We diagnosed CBD stones and choledochal cyst, Todani type III containiaig stones by ERCP. After endoscopic sphincterotomy(EST), removal of stones, and endoscopic nasobiliary drainage(END) her bilirubin level normalized about 2 months later. (Korean J Gastrointest Endosc 16: 261~267, 1996)

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증례 : 담도 췌장 ; 담낭 , 담낭관 및 총담관 결석이 동반된 환자에서의 내시경적 담석제거술 ( Case Reports : Biliary Tract & Pancreas ; Endoscopic Biliary Lithotripsy in a Patient with Gallstones of Gallbladder , Cystic Duct , and Common Bile Duct ): Korean J Gastrointest Endosc 1996;16(2):268-276. Published online November 30, 1995

Abstract PDF: Endoseopic sphincterotomy(EST) has been an accepted procedure in patients with current or recurrent common bile duct stones. The success rate of sphineterotomy and of subaequent stone extraction were reported upto 90%. Percutaneous transhepatic cholecystoscopy-lithotripsy(PTCCS-L) could be one of the non-surgical treatment modalities for gallbladder stones, and has been considered as a safe, reliable and technically easy therapeutic procedure through improvement in PTCCS-L manipuiatian and through the development of new devices for this technique. PTCCS-L could be usually performed in the sgrgically high risk groups with gallbladder stones. In this report, we presented successful endoscopic biliary lithotripsy in a 60-year-old male with gallstones of gall bladder, cystic duct, and common bile duct, who was highly risk for surgery, because he has been suffered from advanced liver disease. Endoseopic sphincterotomy and stone removal with basket were done for the removal of common bile duct stones. PTCCS was performed and complete removal of gallbladder stones was achieved. Cystic duict stone was successfully removed after bougie dilation of cystic duct. There has been no recurrence of gallstones until 1 year of follow-up. (Korean J Gastrointest Endosc 16: 268~276, 1996)

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증례 : 담도 췌장 ; 십이지장 이중 주유두 1예 ( Case Reports : Biliary Tract & Pancreas ; The Double Papilla of Vater ): Korean J Gastrointest Endosc 1996;16(2):277-283. Published online November 30, 1995

Abstract PDF: The common bile duct and the duct of Wirsung cojoin at the level of the duodenum, forming the major. papilla of Vater. Existence of a double major papilla, i.e., two neighboring independent papillary structure:, is infrequent. In our endoscopy unit we have experienced one case of double papilla of Vater wherein canulation of the common bile duct and pancreatic duct could be accom plished through either orifice independently. (Korean J Gastrointest Endosc 16: 277-281, 1996)

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