Clinical Endoscopy

식도열공헤르니아와 역류성 식도염의 임상적 고찰 - 비만, 음주, 흡연, 커피, H. pylori 감염과의 관계 - ( A Clinical Analysis of an Esophageal Hiatal Hernia and Reflux Esophagitis - The relationship with weight, alcohol, smoking, coffee, H. pylori infection ): Korean J Gastrointest Endosc 1999;19(6):861-868. Published online November 30, 1998

Abstract PDF: Background
/Aims: The importance of esophageal hiatal hernias in the pathogenesis of gastroesophageal reflux disease has been debated. It has been reported that a variety of factors are associated with hiatal hernias and esophagitis. The purpose of this study was to determine the correlation between hiatal hernia, reflux esophagitis and weight, alcohol, smoking, coffee and H. pylori infection. Methods: 660 consecutive patients who had undergone an esophagogastroduodenoscopy due to upper gastrointestinal symptoms were reviewed. A diagnosis of hital hernia was made when the distance between the diaphragmatic crus and the tubular esophagus exceeded 1.5 cm, and the presence of a hernia sac at the U turn of the scope. Results: Among the 660 cases, 71 cases (10.8%) of hiatal hernia and 30 cases (4.5%) of reflux esophagitis were noted. The male-to-female ratio was 1.6：1 and 4.3：1, respectively. The most common age group involved the fifth decade and sixth decade. Reflux esophagitis was found in 13 (18.3%) of 71 patients with hiatal hernias. Hiatal hernias were found in 36 (17.9%) of 201 patients who were overweight (BMI＞23) and in 43 (23%) of 187 patients who were smokers. Reflux esophagitis was found in 23 (11.9%) of 194 patients who were alcohol drinkers and in 21 (11.2%) of 187 patients who were smokers. H. pylori infection was present in 36 (50.7%) of 71 patients with hiatal hernias, and 17 (56.2%) of 30 patients with reflux esophagitis. Conclusions: The rate of the hiatal hernia was significantly higher in patients who were overweight and smokers. The rate of reflux esophagitis was significantly higher in patients who were alcohol drinkers and smokers. But in multivariate analysis, none were risk factors associated with hiatal hernias or reflux esophagitis. (Korean J Gastrointest Endosc 19: 861∼868, 1999)

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원발성 점막연관 림프조직형 위 림프종에서 초음파 내시경의 역할 ( The Role of Endoscopic Ultrasonography in Primary Gastric Lymphoma of MALT ): Korean J Gastrointest Endosc 1999;19(6):869-877. Published online November 30, 1998

Abstract PDF: Background
/Aims: Endoscopic ultrasonography (EUS) is a useful diagnostic method for diagnosing local invasion and lymph node metastasis of primary gastric lymphoma including mucosa-associated lymphoid tissue (MALT) lymphoma, but the role of follow-up EUS after histologic regression of MALT lymphoma has not been well established until now. Therefore the usefulness of EUS in initial and follow up studies after Helicobacter pylori eradication therapy was investigated. Methods: From January 1995 to October 1998, nineteen MALT lymphoma patients were investigated. All but four patients underwent EUS exam at diagnosis and 3∼23 months thereafter. 17 patients recieved H. pylori eradication therapy and 2 patients recieved operations without medical treatment. Results: 16 of the 17 patients (94%) were cured of H. pylori infection after antimicrobial therapy. but on the histologic criteria, 13 of the 16 cases (81%) who were cured of H. pylori infection showed complete regression of MALT lymphoma. Histologic regression of MALT lymphoma was observed 6 weeks to 23 months after H. pylori eradication. In follow up EUS exam, gastric wall abnormalities returned to normal in 9 cases (69%) and remained abnormal in 4 cases (31%) among the completely regressed 13 cases. Conclusions: Considerable portion (31%) of follow up EUS exam showed persistent abnormalities of gastric wall such as thickening of mucosa and/or submucosa after histologic regression of MALT lymphoma. To evaluate the usefulness of EUS, follow up EUS exam with regular interval for longer periods after histologic regression is needed. (Korean J Gastrointest Endosc 19: 869∼877, 1999)

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급성 위 아니사키스증의 내시경적 소견 - 인천광역시 개인의원의 39환자를 대상으로 - ( Endoscopic Findings of Acute Gastric Anisakiasis - Thirty-nine cases in Inchon City - ): Korean J Gastrointest Endosc 1999;19(6):878-884. Published online November 30, 1998

Abstract PDF: Background
/Aims: When acute gastric anisakiasis is clinically suspected, endoscopic removal of larva is the only definite treatment method. However, there has been little known for endoscopic findings of gastric anisakiasis. Methods: In 39 patients with gastric anisakiasis, the ingested species of marine products and clinical findings were investigated. The form of larvae, the mucosal changes of the insertion site, close and distant area were also analysed during endoscopic examination. Results: Twelve patients (30.8%) ate raw Astroconger myriaster solely, and the most frequent mucosal insertion site of larvae was around the greater curvature of the body (59.5%). Endoscopic findings of erosion (33.3%), hemorrhagic erosion (33.3%) and redness of the mucosa (11.9%) were observed at the insertion site. The adjacent mucosal changes were edema and fold enlargement. All patients were treated medically. Conclusions: When acute gastric anisakiasis is suspected, the careful endoscopic examination of larva was necessary for confirmatory diagnosis and definite treatment of the disease. (Korean J Gastrointest Endosc 19: 878∼884, 1999)

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1,683예의 대장내시경 검사에서의 대장용종에 대한 전향적 분석 ( Prospective Evaluation of Colorectal Polyps in 1,683 Consecutive Colonoscopies ): Korean J Gastrointest Endosc 1999;19(6):887-896. Published online November 30, 1998

Abstract PDF: Background
/Aims: The colorectal polyp, particularly the adenoma, has been regarded as a precursor of cancer. The incidence of colorectal polyps has been reported at various rates according to investigation centers in foreign countries. In Korea, the incidence of colorectal polyps has been reported as very low according to the few reports, which was involved a few cases and were partial. Therefore, the aim of this study is to evaluate prospectively the incidence and the clinicopathologic features of colorectal polyps. Methods: A colonoscope was inserted up into the cecum in 1,889 patients among 2,001 trials from Oct. 1996 to Aug. 1997 (success rate: 94.4%). Of the 1,889 full colonoscopies, the following were excluded; 1) referred patients with suspicious colorectal cancer or polyps, 2) patients with suspicious rectal cancer determined by rectal examination, 3) patients who had follow-up colonoscopy after a polypectomy or cancer surgery, and 4) patients who had periodic colonoscopy due to FAP or HNPCC. There were a total of 1,683 full colonoscopies in this study. The majority of the total cases involved a colonoscopy due to benign anal disease, irritable bowel syndrome, or routinechecks for health. Results: There were 946 men (56.2%) and 737 women (43.8%). The mean age was 48.2 yrs (13∼88 yrs) for men and 48.1 yrs (18∼89 yrs) for women. 422 patients were found to have 645 colorectal polyps (1.52 polyps per patient). The incidence of polyps was 25.1% (32.0% for men, 16.1% for women) and increased after the 6th decade in men (44.0%) and in women (23.0%). 281 patients were found to have 426 colorectal adenomas. The incidence of adenomas was 16.6% (21.9% for men, 9.9% for women) and increased after the 6th decade, 32.0% in men, and 15.9% in women. Solitary polyps were present in 277 patients (65.6%) while 94 patients (22.3%) had two polyps and 51 patients (12.1%) had between 3 and 8 polyps. The polyp retrieval rate was 96.9%. There were 426 adenomas (66.0%), 75 hyperplastic (11.7%), 120 inflammatory (18.6%), and 24 miscellaneous (3.7%) polyps. Of the 426 adenoma, there were 397 tubular adenoma (93.2%), 18 tubulovillous adenoma (4.3%), 4 villous adenoma (0.9%), 6 in situ carcinoma (1.4%), and 1 invasive carcinoma (0.2%). 6 in situ carcinoma's were detected in tubular adenoma and 1 invasive carcinoma in tubulovillous adenoma. Of 645 polyps, the sessile type was 87.9%. The polyp size varied from 1 mm to 25 mm and 79.2% were under 5mm. Also, 85.7% of adenomas were sessile and 74.7% were under 5mm. 22.0% of polyps were located in rectum, 35.4% in sigmoid colon, 9.5% in descending colon, 13.3% in transverse colon, 19.8% in ascending colon and cecum. The distribution of adenoma was similar to that of polyp. 40.1% of adenoma showed moderate to severe dysplasia. Conclusions: This study revealed that the incidence of polyp in Korea was higher than that in previous reports and 42.6% of polyps were proximal to rectosigmoid colon. Therefore, we suggest that we should try to detect and remove colorectal polyps by more active colonoscopy. (Korean J Gastrointest Endosc 19: 887∼896, 1999)

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S자 결장경검사에서 용종 발견시 대장경검사의 유용성 ( Do Distal Colonic Polyps Predict Proximal Adenomas? ): Korean J Gastrointest Endosc 1999;19(6):897-903. Published online November 30, 1998

Abstract PDF: Background
/Aims: There has been a lot of controversy regarding the significance of hyperplastic or diminutive polyps found during sigmoidoscopy, as markers for synchronous adenomatous polyps. Therefore, prospective colonoscopy was performed in subjects with distal polyps found using sigmoidoscopy to determine the association between synchronous polyps with distal polyps. Methods: A sigmoidoscopy was performed in 2,895 subjects out of 10,705 who visited Samsung Medical Center for a routine check up from Aug. 1994 to Nov. 1995. Distal polyps were found in 590 of 2,895 and colonoscopy was performed in 280 of 590. Results: Of 280 subjects, 73 (26.1%) subjects had synchronous polyps and 55 subjects (19.6%) had synchronous adenomatous polyps. 134 polyps were found during colonoscopy; adenomatous polyps were most common (70.1%): Hyperplastic polyps (18.7%) and inflammatory polyps (11.2%) were also found. A greater percentage of subjects with distal adenomatous polyps had synchronous adenomatous polyps compared with those with distal hyperplastic polyps (25.1% vs. 6.3%, p＜0.05). A greater percentage of subjects with distal large polyps (＞0.5 cm) had synchronous adenomatous polyps compared with those with distal diminutive polyps (≤0.5 cm) (50.0% vs. 16.1%, p＜0.05). Conclusions: Adenomatous polyps found during sigmoidoscopy justify colonoscopy for synchronous polyps. However, diminutive hyperplastic polyps are not significant indicators of risk for synchronous adenomatous polyps. (Korean J Gastrointest Endosc 19: 897∼903, 1999)

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대장종양의 조직병리학적 소견과 선구 형태(Pit Pattern)의 비교 ( The Comparison of Histo-pathologic Findings and Pit Patterns of Colorectal Tumors ): Korean J Gastrointest Endosc 1999;19(6):904-910. Published online November 30, 1998

Abstract PDF: Background
/Aims: To investigate the morphological and histopathological associations between an individual pit seen on stereomicroscopy or magnifying colonoscopy and an individual crypt seen in histological sections of colorectal tumors. Methods: Fifty two colorectal lesions were examined by colonoscopy. The mucosal pits of the lesions were observed using a magnifying colonoscopy with a zoom 1 to 100 magnification after administering indigo carmine spray. The pits of the excised specimens were observed by using a stereomicroscopy after 0.2% cresyl violet stain. The pit patterns were classified into six types: normal round pit (I); asteroid pit (II); small round pit (IIIs); large tubular pit (IIIL); gyrus-like pit (IV); and non-structural pattern or amorphysm (V). Histologic diagnoses were determined by H&E staining under light microscopy. Results: The histologic findings according to the pit patterns were 1 chronic nonspecific inflammation and 1 submucosal tumor in 2 cases with type I pit pattern; 4 hyperplastic polyps in 4 cases with type II; 1 hyperplastic polyp, 16 adenomas with low-grade dysplasia, 3 adenomas with high-grade dysplasia, and 1 carcinoma in situ in 21 cases with type IIIL; 4 adenomas with low-grade dysplasia, 3 adenomas with high-grade dysplasia, and 4 carcinoma in situ in 11 cases with type IV; 1 adenoma with low-grade dysplasia in 1 case with type II IIIL; 3 adenomas with low-grade dysplasia, 4 adenomas with high-grade dysplasia, and 2 carcinoma in situ in 9 cases with type IIIL IV; 1 adenoma with high-grade dysplasia, 2 carcinoma in situ, and 1 adenocarcinoma in 4 cases with type IV V. In assessing the histologic findings according to pit pattern by stereomicroscopy, the overall diagnostic predictive value was 82.6% (43/52), and the diagnostic accuracy in differential diagnosis between nonneoplastic and neoplastic lesions was 98% (51/52). The ratio of agreement of the pit pattern between the magnifying colonoscopy and the stereomicroscopy was 68% (17/25). Conclusions: The results suggest that there was a close correlation between the pit patterns and the histologic findings of colorectal tumors, and that the observation of pit patterns of colorectal lesions provides a differential diagnosis between neoplastic and nonneoplastic lesions. (Korean J Gastrointest Endosc 19: 904∼910, 1999)

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혈변을 주소로 내원한 하부위장관출혈 환자에 대한 임상적 고찰 ( Clinical Characteristics of Lower Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1999;19(6):911-917. Published online November 30, 1998

Abstract PDF: Backgroud/Aims: The frequency of different etiologies of lower gastrointestinal bleeding varies by a number of factors including patient age, the severity of bleeding evaluated, the diagnostic method, and the institution. There were few reports on the clinical analysis of lower gastrointestinal bleeding in Korea. Therefore, this study was conducted to evaluate the frequency of various etiologies, diagnostic methods, and the management of patients with lower gastrointestinal bleeding. Methods: 474 patients with lower gastrointestinal bleeding who were admitted to Samsung Medical Center from September 1994 to April 1998 were reviewed. The inclusion criteria were as follows: 1) age at least 15 years, and 2) patients whose bleeding was attributed to a lesion distal to the ligament of Treitz. The age and sex distribution, etiology, diagnostic methods, treatment, and transfusion were checked. Results: 474 patients (261 males and 213 females) met the inclusion criteria. The average age of the patients was 51 years old. The etiologies of bleeding were as follows: colorectal cancer, 43%; anorectal disease, 32%; inflammatory bowel disease, 6.6%; ischemic colitis, 5%; miscellaneous, 6%; and unknown, 7.4%. Colonoscopy was the most commonly employed diagnostic modality and was used in 245 (52%) patients of the study group. Other tests included sigmoidoscopy in 136 (29%), barium enema in 90 (19%), small bowel radiography in 24, radionuclide bleeding scans in 8, and mesenteric angiography in 7. Patients who improved with conservative and medical treatment were 29%, and 71% required surgery. Patients who required a transfusion were 37%. 139 patients (68.8%) with diagnosed malignant neoplasm received a transfusion. Conclusions: The incidence of lower gastrointestinal bleeding was high in old age. Colorectal cancer was the most common cause and required surgery. Colonoscopy was a valuable diagnostic tool for the evaluation of lower gastrointestinal bleeding. (Korean J Gastrointest Endosc 19: 911∼917, 1999)

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간경변증 환자의 소화성궤양 발병에 있어 Helicobacter pylori의 역할 ( The Role of Helicobacter pylori in Cirrhotic Patients with Peptic Ulcers ): Korean J Gastrointest Endosc 1999;19(6):918-924. Published online November 30, 1998

Abstract PDF: Background
/Aims: The overall age-matched incidence of gastroduodenal ulcers was considerably higher in cirrhotic patients compared to the general population. There are several possible underlying mechanisms which may explain the ulcerogenic factors in cirrhotic patients. Recently, Helicobacter pylori (H. pylori) was proven as the cause of peptic ulcer disease in the general population. But the role of H. pylori infection in the pathogenesis of peptic ulcers of cirrhotic patients has not been clearly elucidated. The purpose of this study was to determine the role of H. pylori infection in cirrhotic patients with peptic ulcers. Methods: From 1995 to 1997, 105 patients with histologically or radiologically proven liver cirrhosis (LC) who received panendoscopic examination due to presence of any upper gastrointestinal symptoms were studied. During endoscopic examination, a CLO (campylobacter like organism) test or gastric antral mucosal biopsy was performed in all patients. The severity of LC assessed by Child's criteria revealed that 31 patients had Child's A, 26 patients Child's B, and the remain 48 patients, Child's C. Child B or C was classified as decompensated LC. An esophageal varix was present in 73 patients or absent in 32. Results: There was no statistical difference in the H. pylori prevalance between the ulcer group and non-ulcer group (67% vs 52%). In Child A group, the H. pylori prevalence was significantly higher in the ulcer group when compared with the non-ulcer group (87% vs 50%, p＜0.05). In contrast, in the Child B or C group, there was no statistical difference between the ulcer group and non-ulcer group. In the abscence of esophageal varix, the ulcer group showed significantly higher prevalence of H. pylori than the non-ulcer group (87% vs 59%, p＜0.05). But in the esophageal variceal group, there was no significant difference in the H. pylori prevalence between the ulcer and non-ulcer group (60% vs 40%). Conclusions: These observations suggest that H. pylori infection may play a role in the pathogenesis of peptic ulcer in compensated cirrhotic patients. However, in cirrhotic patients with decompensation or an esophageal varix, the association between H. pylori infection and peptic ulcers was weak, so other factors (portal hypertension etc.) should be considered as more potent etiology of peptic ulcers in cases of decompensated cirrhosis. (Korean J Gastrointest Endosc 19: 918∼924, 1999)

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내시경적 역행성 담췌관조영술 시 예방적 항생제 투여의 유용성 ( Antibiotic Prophylaxis in Endoscopic Retrograde Cholangiopancreatography ): Korean J Gastrointest Endosc 1999;19(6):925-929. Published online November 30, 1998

Abstract PDF: Background
/Aims: Prophylactic antibiotics are used in an attempt to avoid the septic complications of endoscopic retrograde cholangiopancreatography (ERCP). But, there is individual tendency to choose prophylactic antibiotics due to a lack of definite guidelines for prophylactic antibiotics. Therefore, the effectiveness of ciprofloxacin to prevent post ERCP infectious complications was evaluated. Methods: One hundred patients underwent 75 diagnostic ERCPs and 25, therapeutic ERCPs. They were classified randomly into a group of 51 prophylaxis (ciprofloxacin 200 mg i.v. 30 min before the procedure) and 49 controls. Pre- and post-ERCP blood cultures were prospectively performed and surveyed for infectious complications. Results: Sepsis was detected in 4 patients in each group (p＞0.05). Two cases were related to diagnostic ERCP and the remaining six cases, therapeutic ERCP (p＜0.01). Bacteremia was found in 6 cases, but only two cases (Escherichia coli, Citrobacter freundii) were clinically significant. Conclusions: The frequency of sepsis following ERCP was not significantly reduced by antibiotic prophylaxis (7.8% vs. 8.2%). (Korean J Gastrointest Endosc 19: 925∼929, 1999)

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위에서 식도로 역류한 위석 1예 ( A Case of a Gastric Bezoar Regurgitated from the Stomach to the Esophagus ): Korean J Gastrointest Endosc 1999;19(6):930-934. Published online November 30, 1998

Abstract PDF: Bezoars are persistent concretions of indigestible material, usually seen in the stomach. Esophageal bezoars are very rare and generally occur in elderly patients with anatomic defects such as diverticulum or stricture, or with esophageal motility disorders. However, it is quite unusual that a gastric bezoar would be regurgitated into a normal esophagus during forceful vomiting. Endoscopic removal of a bezoar is safe and successful in most cases. A case of a gastric bezoar regurgitated into the esophagus was recently experienced and removed by an endoscopic polypectomy snare and bezoar (lithotripsy) basket. (Korean J Gastrointest Endosc 19: 930∼934, 1999)

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위내시경 검사 후 발생된 일과성 타액선 종창 2예 ( Two Cases of Unilateral Transient Sialoadenopathy after Gastroscopy ): Korean J Gastrointest Endosc 1999;19(6):935-938. Published online November 30, 1998

Abstract PDF: A case was experienced involving submandibular salivary gland swelling (sialoadenopathy), developing after gastroscopy in a 15-year-old female who was suffering from epigastric pain & diarrhea and a case of parotid salivary gland swelling after gastroscopy in a 25-year-old female who was suffering from dyspepsia and epigastric pain. Both patients were the first two cases among about 5,000 gastroscopic examinations of the stomach conducted by the authors. As soon as the gastroscope was withdrawn, unilateral swelling, which was neither painful nor tender, was found in the left submandibular salivary gland area. This swelling disappeared spontaneously in about few hours later. (Korean J Gastrointest Endosc 19: 935∼938, 1999)

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유문륜으로 탈출된 과오종성 위 용종 1예 ( A Case of Gastric Hamartoma Prolapsing Through the Pylorus ): Korean J Gastrointest Endosc 1999;19(6):941-944. Published online November 30, 1998

Abstract PDF: Gastric hamartoma is usually an asymptomatic, small, sessile polyp, located in the body and fundus of the stomach. A case was experienced involving a solitary large hamartomatous polyp prolapsing through the pylorus in a 63-year old female presented with melena. A gastroendoscopy determined a pedunculated gastric polyp prolapsing through the pylorus with fresh blood oozing and congestion. A UGI series revealed that a 5 cm sized lobulated mass with a long stalk attached at the greater curvature side of the fundus. The polyp was removed by an endoscopic snare polypectomy and diagnosed as a gastric hamartoma. (Korean J Gastrointest Endosc 19: 941∼944, 1999)

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조기 위암을 동반한 십이지장 구부선암의 1예 ( A Case of Primary Adenocarcinoma of the Duodenal Bulb Associated with Early Gastric Cancer ): Korean J Gastrointest Endosc 1999;19(6):945-949. Published online November 30, 1998

Abstract PDF: Multiple primary tumors are defined as cases involving primary malignant tumors of different histologic origins in one person. Recently, the number of reports dealing with multiple primary tumors has been increasing due to more developed diagnostic procedures and patients with longer survival rates. Both the occurrence of multiple primary tumors and the primary adenocarcinoma of the duodenum are infrequent, accounting for less than 1% of all carcinoma of the gastrointestinal tract. Also, It has been reported that duodenal bulb cancer combined with early gastric cancer is extremely rare. One case was experienced involving duodenal bulb cancer combined with early gastric carcinoma, and is herein reported with a review of related literatures. (Korean J Gastrointest Endosc 19: 945∼949, 1999)

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당뇨병과 요독증에 병발한 위 모균증 1예 ( A Case of Gastric Mucormycosis Associated with Diabetes Mellitus and Uremia ): Korean J Gastrointest Endosc 1999;19(6):953-958. Published online November 30, 1998

Abstract PDF: Mucormycosis is an infection caused by fungi of the class Zygomycetes, order Mucorales. These are usual ubiquitous saprophytes but occasionally cause opportunistic infection in immunocompromised patients. Typically, these fungi invade blood vessels, and produce thrombosis and tissue infarction, so causing host fatality. These infections can be categorized into rhinocerebral, pulmonary, widely disseminated, gastrointestinal, cutaneous and miscellaneous form. Most of mucormycosis cases reported in Korea were rhinocerebral form except for three cases, which were gastrointestinal mucormycosis, accompanied with hematologic malignancy or immunosuppressing treatment. We experienced a 58-year-old male with gastric mucormycosis, who had diabetes and mild uremia without hematologic malignancy and immunosuppressive treatments. His chief complaints were abdominal pain and melena, and gastroscopy showed a 3 3 cm irregular edged ulcer considering malignancy. Its histological findings showed large, thin-walled, non-septate and right-angled branching fungal hyphae in necrotic tissue, diagnosed as mucormycosis. Finally he was dead due to severe hematemesis. (Korean J Gastrointest Endosc 19: 953∼958, 1999)

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내시경검사로 진단된 원발성 융모상피암 1예 ( A Case of a Primary Gastric Choriocarcinoma Diagnosed by Endoscopic Biopsy ): Korean J Gastrointest Endosc 1999;19(6):959-963. Published online November 30, 1998

Abstract PDF: A case of primary choriocarcinoma in the stomach of a 60-year-old male is herein presented. The tumor was diagnosed as a choriocarcinoma by histologic examination and the immunohistochemical method of endoscopic biopsy of a specimen. Serum alpha- fetoprotein and beta-human chorionic gonadotropin were found to be significantly elevated. Multiple distant metastasis of the liver, intraabdominal lymph nodes and malignant ascites were also discovered. The high alpha-fetoprotein level in the serum might have been due to the coexistence of embryonal cell carcinoma or hepatoid adenocarcinoma or both in the stomach. (Korean J Gastrointest Endosc 19: 959∼963, 1999)

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십이지장 궤양을 동반한 베체트 증후군 1예 ( A Case of Behcet s Disease Accompanied with a Duodenal Ulcer ): Korean J Gastrointest Endosc 1999;19(6):967-970. Published online November 30, 1998

Abstract PDF: Behcet's disease is a recurrent and multisystemic disorder which usually persists over many years. In 1937 Behcet described a chronic relapsing triple symptom complex of recurrent oral ulceration, genital ulceration and ocular inflammation. Other manifestations of the syndrome include arthritis, cutaneous vasculitis, thrombophlebitis, epididymitis, ulcers of gastrointestinal tract and meningoencephalitis. Recently, a case was experienced involving intestinal Behcet's syndrome with duodenal ulcer bleeding. A 32-year-old male patient was admitted due to hematemesis, and epigastric pain. The patient had ulcers on the oral mucosa, soft palate, external genitalia, and anus. An irregularly marginated ulcer with bleeding was found on the anterior of the duodenal bulb through esophago- gastroduodenoscopic examination. The patient was diagnosed with Behcet's disease and was treated with steroids. In this paper, the case of duodenal bulb involvement of Behcet's disease is reported with a review of relevant literature. (Korean J Gastrointest Endosc 19: 967∼970, 1999)

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충수병변이 선행된 비전형적 궤양성 대장염 1예 ( A Case of Atypical Ulcerative Colitis Initially Presented as the Appendiceal Lesion ): Korean J Gastrointest Endosc 1999;19(6):971-974. Published online November 30, 1998

Abstract PDF: Ulcerative colitis (UC) is an inflammatory disease primarily involving the colonic mucosa. The extension of classic UC is uniform and continuous with no intervening areas of normal mucosa. The rectum is usually involved and the inflammation extends proximally in a continuous fashion for a variable distance. However, as more patients get colonoscoped, it had been reported that there is a wide spectrum to what is called UC. There appear to be a few patients with otherwise typical UC but with rectal sparing. And also there are patients with classic distal UC who have an isolated area of cecal disease and segmental UC with skipped area. We have experienced a case of atypical UC initially presented as a isolated lesion around the appendiceal orifice with the segmental distribution of inflammatory change without an active inflammatory lesion in the rectum. It was considered that understanding of the significance of an isolated lesion in the appendix would contribute to the elucidation of the pathogenesis of UC. (Korean J Gastrointest Endosc 19: 971∼974, 1999)

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충수돌기염과 하부장관 궤양출혈을 동반한 알레르기성 육아종증(Churg-Strauss Syndrome) 1예 ( A Case of Churg-Strauss Syndrome with Appendicitis and Lower Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1999;19(6):977-982. Published online November 30, 1998

Abstract PDF: Churg-Strauss Syndrome is a disorder of hypereosinophilia and systemic vasculitis in subjects with asthma and allergic rhinitis. Clinically, a multiple organ system can be involved with various manifestations of disease of lung, heart, skin, musculoskeletal system, nervous system, gastrointestinal and hepatobiliary tract. We experienced a case of Churg- Strauss syndrome presenting as the appendicitis and the lower gastrointestinal bleeding in a 37-year-old male patient with acute lower abdominal pain. He also showed peripheral eosinophilia, bronchial asthma, and mononeuritis multiplex. He initially received a high dose corticosteroid and was maintained with low doses of corticosteroid, cyclophosphomide and exchange plasmapheresis. (Korean J Gastrointest Endosc 19: 977∼982, 1999)

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십이지장으로 국소 침윤된 췌장의 고형 유두상 상피 종양 1예 ( A Case of a Solid and Papillary Epithelial Neoplasm of the Pancreas with Local Invasion into the Duodenum ): Korean J Gastrointest Endosc 1999;19(6):983-989. Published online November 30, 1998

Abstract PDF: A solid and papillary epithelial neoplasm of the pancreas is a very rare and low-grade type of malignancy, although an increasing number of cases have been reported in recent years. Patients with a solid and papillary epithelial neoplasm of the pancreas have a good prognosis and may be cured if the disease is diagnosed before metastasis and diffuse local invasion. A 23-year-old female who had a 4-year history of recurrent abdominal pain, was admitted due to lower abdominal pain. Incidentally a calcified, 6 4 cm sized ovoid mass was found in the right upper quadrant, from a simple abdominal X-ray. An ERCP, abdominal sonography, and CT were performed, as well as a pylorus preserving pancreatoduodenectomy. Gross pathologic examination revealed a well encapsulated mass with cystic degeneration and hemorrhagic necrosis. Microscopically, the tumor had papillary fronds with a fibrovascular connective tissue core. There was focal infiltration of tumor cells into the duodenal wall and heterotropic pancreatic tissue in the submucosa. Immunohistochemistry revealed positivity for neuron-specific enolase. The patient maintained a healthy status for one year since the operation. (Korean J Gastrointest Endosc 19: 983∼989, 1999)

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악성 복수 및 간 전이를 동반한 췌장의 Mucinous Ductal Ectasia 1예 ( A Case of Mucinous Ductal Ectasia of the Pancreas Associated with Malignant Ascites and Liver Metastasis ): Korean J Gastrointest Endosc 1999;19(6):990-995. Published online November 30, 1998

Abstract PDF: A 71-year-old man was admitted due to abdominal distension and periumbilical pain. He was diagnosed as having mucinous ductal ectasia (MDE) of the pancreas three months prior, but refused an operation. Three months later, an abdominal computed tomography revealed more dilated pancreatic duct, newly developed liver metastasis and ascites in comparison with previous findings. Fine-needle aspiration cytology of the cystic lesion in the pancreatic head was conducted and yielded adenocarcinoma. Also, an ascitic fluid cytology determined adenocarcinoma. This patient was diagnosed to be inoperable and received palliative chemotherapy and pain control. The patient expired 5 months after the initial diagnosis. (Korean J Gastrointest Endosc 19: 990∼995, 1999)

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간문맥의 해면상 변형에 의해 발생된 폐쇄성 황달 1예 ( A Case of Obstructive Jaundice Caused by Cavernous Transformation of the Portal Vein ): Korean J Gastrointest Endosc 1999;19(6):999-1004. Published online November 30, 1998

Abstract PDF: Cavernous transformation of the portal vein is a rare condition probably arising secondary to extrahepatic portal vein thrombosis or obstruction with recannalization and/or collateral veins formation to bypass the obstruction. It is believed that cavernous transformation of the portal vein is caused by a variety of diseases associated with periportal collateral development and hepatopedal flow. It is known that portal vein occlusion, which is the actual cause of cavernous transformation, has a wide variety of etiologies, such as congenital abnormalities, omphalitis, pancreatitis, various carcinoma, and liver cirrhosis. In most cases, the revealing symptom is upper gastrointestinal bleeding. Rarely, however, diagnosis is made from obstructive jaundice. Extensive collateral veins due to portal vein occlusion may compress and narrow the biliary tract. A 39-year-old man was admitted due to jaundice and abdominal discomfort for 1 month. He was confirmed to have obstructive jaundice due to collateral vessels of cavernous transformation of the portal vein. We report a case of obstructive jaundice caused by cavernous transformation of the portal vein. (Korean J Gastrointest Endosc 19: 999∼1004, 1999)

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자발성 담낭출혈로 인한 혈액담즙증 1예 ( A Case of Hemobilia Associated with Spontaneous Gallbladder Hemorrhage ): Korean J Gastrointest Endosc 1999;19(6):1005-1010. Published online November 30, 1998

Abstract PDF: Hemobilia is a hemorrhage into the biliary tract that may follow trauma (including surgical and percutaneous techniques in hepatobiliary system), aneurysms of the hepatic artery (and its branch), tumors of the biliary tract, hepatoma, inflammation, liver abscess, and gallstone disease. But, a case has not been reported involving of hemobilia associated with gallbladder hemorrhage without obvious predisposing factors or causes. A 62-year-old woman was admitted to Kyunghee Medical Center due to intermittent nausea, and right upper quadrant pain for 2 days before admission. She had no history of abdominal trauma. On the second and third day of her stay, she experienced melena of which the amount was about 300 ml. Abdominal ultrasonography revealed a gallbladder with a 8 mm sized cystic lesion attached to the fundus. Computed tomographic (CT) evaluation of the abdomen demonstrated a highly enhanced 7∼8 mm sized nodular mass in the lumen of the gallbladder. The gallbladder, cystic duct, and CBD were dilated due to the filling of blood clots or sludge material. An ERCP was performed and bleeding from the papilla of Vater was confirmed. Subsequently, emergent laparoscopic cholecystectomy was conducted. Pathologic evaluation revealed a grayish-red gallbladder that had a ruptured vessel. The ruptured vessel showed a severe hypertrophic state but there was no evidence of vasculitis, aneurysm, arterio-venous malformation, or malignancy. The case is here in reported of hemobilia associated with spontaneous gallbladder hemorrhage. (Korean J Gastrointest Endosc 19: 1005∼1010, 1999)

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총담관 결석이 동반된 십이지장 구부로 분리 개구한 췌담도관 1예 ( A Case of Anomalous Termination of the Common Bile Duct and the Pancreatic Duct into the Duodenal Bulb, Associated with Common Bile Duct Stones ): Korean J Gastrointest Endosc 1999;19(6):1011-1015. Published online November 30, 1998

Abstract PDF: Usually, the papilla of Vater is located in the midportion or the distal half of the descending duodenum. Isolated cases of common bile duct termination in other sites, including the fourth portion of the duodenum, the pyloric ring, the duodenal bulb and the stomach, have been reported. A case is here in reported involving abdominal pain in the right upper quadrant area, in which an ERCP demonstrated an anomalous termination of the common bile duct and pancreatic duct into the duodenal bulb separately. This anomaly was associated with a bile duct dilatation and single common bile duct (CBD) stone. Trial of CBD stone removal during an ERCP failed. The patient's condition improved after a cholecystectomy and choledochojejunostomy. (Korean J Gastrointest Endosc 19: 1011∼1015, 1999)

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