Clinical Endoscopy

종설 : 조기위암: Korean J Gastrointest Endosc 1990;10(2):287-295. Published online November 30, 1989

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관상형 식도중복 1예 ( A Case of Tubular Duplication of the Esophagus ): Korean J Gastrointest Endosc 1990;10(2):297-300. Published online November 30, 1989

Abstract PDF: Esophageal duplication is a rare congenital malformation Although the exact etiology of duplication of the esophagus has not been well established, esophageal duplications are due to abnormal outpouching of endoderm from primitive foregut. There are two types of esophageal duplication; cystic and tubular. The former is more common than the latter. Tubular duplication may cause recurrent dysphagia and symptoms of acute mediastinitis. We experienced a case of esophageal duplication, which had tubular esophageal duplication with connection to the esophageal lumen, with esophageal web by the esophagogram after barium swallowing and esophagoscopy. So we report this case with a brief review of the literatures.

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신이식 후 발생한 헤르페스 식도염 1예 ( Herpetic Esophagitis in a Renal Transplant Patient ): Korean J Gastrointest Endosc 1990;10(2):301-304. Published online November 30, 1989

Abstract PDF: Herpetic esophagitis is a rare diaease and is usually deecribed in autopsied reports. Most of the cases are reported in an immunocompromised host. We report a patient with herpetic esophagitis, following renal transplantation and longstanding steroid therapy due to rejectioh phenomenon. The patient complained of dysphagia and odynophagia. Endoscopic finding revealed multiple scattered or confluent erosions and hemorrhagie tendency, diffusely scattered linear or confluent shallow ulcer covered by a whitish exudate on a elevated margin. Microscopic finding revealed uicerated squamous epithelium of ballooning degeneration, ground glass nuclei, multinuclear giant cell and intranuclear inclusion body. The patient responded dramatically to intravenous acyclovir and leading to syniptomatic and endoscopic improvement.

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내시경으로 진단된 상부소화관 이물 ( The Foreign Bodies in the upper Gastrointestinal Tract Diagnosed by Endoscopy ): Korean J Gastrointest Endosc 1990;10(2):305-315. Published online November 30, 1989

Abstract PDF: The foreign bodies in the upper GI tract are produced chiefly by accidental swallowing and rarely produce symptoms. But it is recommended to remove the foreign bodies if they produce symptoms or retained in GI tract for long duration, and if they have the possibilities of producing complications. Nowadays the development of therapeutic endoscopy enables the removal of the foreign bodies easily. We have reviewed 88 cases of foreign bodies diagnosed by endoscopy from January, 1980 to July 1990 and had the following results. 1) The most common foreign bodies were coins and bezoars, common with the ages under 10 years and over 50 years. 2) The foreign bodies were found in the upper gastrointestinal tract in the order of stomach, esophagus and duodenum. 3) The esophageal stricture especially by lye was the most common underlying cause of upper gastrointestinal foreign bodies. 4) The symptoms and complications were more common with esophageal foreign bodies. 5) By therapeutic endoscopy, the success rate for removal of foreign bodies was 98%.

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전 위벽에 산재한 다발성 위황색종 1예 ( A Case of Gastric Xanthomatosis Scattered through Whole Gastric Mucosa ): Korean J Gastrointest Endosc 1990;10(2):317-320. Published online November 30, 1989

Abstract PDF: Xanthoma is characterized by collections in the lamina propria of lipid-laden macrophages or foam cells containing cholesterol land neutral fat, forming plagues or nodules in all regions of the gastrointestinal tract. But it is most common in the stomach. Once thought to be a rare entity, gastric xantoma has been reported with increasing frequency with the advent of increasing utilization of gastrofiberscopy. Because gastric xanthoma appear to be more common in patients with gasritis, gastric ulcer, and with duodenogastric reflux after gastric surgery, mucosal damage has been presumed to play a major role in their pathogenesis. Altough cholesterol and neutral fat are the major constituents of the foam cells, there is no documented relationship between degree of hyperlipidemia or hypercholesterolmia and presence of gastric xanthoma. Gastric xanthoma may be found in any portion of the stomach, and is single or multiple, usually 1 or 2 mm in diameter, rounded or oval, circumscribed, yellow or yeallow-white, and macular or nodular. We report a case of gastric xanthomatosis diagnosed by gastrofibroscopy with forceps biopsy. There are numerous, flat or slightly raised, white or yellow white lesions that range from pinpoint size to several milimeters in diameter and that are scattered through whole gastric mucosa.

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소화성 궤양의 호발 부위에 관한 고찰 ( Evaluation of the Location of Peptic Ulcer ): Korean J Gastrointest Endosc 1990;10(2):321-330. Published online November 30, 1989

Abstract PDF: Peptic ulcer can occur anywhere in the gastrointestinal tract that contact with acid and pepsin. But usually peptic ulcer occurs at the stomach and duodenum and the location of peptic ulcer are localized to specific area within the stomach and duodenum. So I think that predilection of peptic ulcer to localized area may have clue for releaving the pathogenesis of peptic ulcer. So I studied the location of peptic ulcer for the basic reserch of ulcer pathogenesis by means of dividing stomach into antrum, angle, lower body, middle body, upper body and lesser curvature, anterior wall, greater curvature, posterior wall and duodenum into anterior wall, lesser curvature, posterior wall, and greater curvature. The results obtained were as follows: 1) The chronic gastric ulcer was most common in the angle of lesser curvature (22.9%) and second common in the antrum of lesser curvature (22.3%). 2) The location of chronic and acute gastric ulcer was similar. 3) The proximal migration of ulcer site according to increasing age was not observed. 4) Chronic duodenal ulcer was occurred commonly in the lesser curvature (41.8%) and anterior wall (38.3%). 5) As the age increase, the incidence of chronic duodenal ulcer in the lesser curvature was increased and that of chronic duodemal ulcer in the anterior wall was decreased. 6) Acute ulcer of stomach and duodenum has no predilection site.

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십이지장궤양으로 위공장물합술후 (胃空腸物合術) 발생한 조기위암 1예 ( Early Cancer of the Gastric Stump after Gastrojejunostomy for Duodenal Ulcer Obstruction ): Korean J Gastrointest Endosc 1990;10(2):331-335. Published online November 30, 1989

Abstract PDF: Cancer of the gastric stump, first described by Balfour in 1922, is defined as the cancer detected more than 5 years after surgery for a benign disease. We experienced a case of cancer found at the gastric stump after gastrojejunostomy in a 53 years old male patients, proven pathologically as a early cancer. He visited to our hospital with the chief complaint of epigastric pain and indigestion for 1 Months. On past history, he has been received gastrojejunostomy due to duodenal ulcer obstruction, 23 years ago, Gastrofiberscopy was done, and we could find the early gastric cancer lesions at the anterior wall of gastric angle as type Ilc+III and antrum as type IIa. The microscopic finding of the multiple endoscopic biopsies at the gastic angle and antrum revealed the adenocarcinoma of signet ring cell type infiltrated to the level of submucosa. And so, we could diagnose these lesions as a early gastric cancer in the gastric stump after gastrojejunostomy. He was treated with subtotal gastrectomy and discharged with cured condition. Therefore, we report this case with a literature review.

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점막하 종양 소견을 보인 Gastritis Cystica Polyposa 1예 ( A Case of Gastritis Cystica Polyposa , Presenting as a Submucosal Tumor - like Lesion ): Korean J Gastrointest Endosc 1990;10(2):337-340. Published online November 30, 1989

Abstract PDF: Gastritis cystica polyposa (GCP) is a lesion characterized by all the histological features described for hyperplastic polyps, And there is s marked proliferation of muscular elements and entrapment of numerous epithelial cysts. These lesions have been described at gastroenterostomy stomas, at peptic ulcer edges, and in association with carcinoma. It is rare that GCP presenting as a submucosal tumar-like lesion develops in the absence of above mentioned associated conditions. We had experienced a 69 year-old man with GCP. Barium X-ray and endoacopic findings showed submucosal tumor in antrum, and endoscopic ultrasonograpic findings showed markedly thickened mucosal layer with scattered hypoechoeic areas and the submucosal layer well preserved. GCP was confirmed by histological examination of resected stomach.

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위체부에 발생한 이소성 췌장 1예 ( A Case of Heterotopic Pancreas of Gastric Corpus ): Korean J Gastrointest Endosc 1990;10(2):341-344. Published online November 30, 1989

Abstract PDF: Heterotopic pancreas is an aberrant pancreatic tissue that lacks anatomic and vascular continuity with the main pancreas. Although heterotopic pancreas is a relatively rare entity and usually noted as an incidentel findings at autopsy and during surgery for other causes, it is capable of producing symptoms depending on the site and size of lesions as well as various pathological changes occuring in the pancreas itself. We have recently experienced a case of heterotopic pancreas on the mid-body of posterior wall along the lesser curvatrue of stomach in a 30-year-old man, who visited our hospital for the evaluation of postprandial epigastric discomfort and indigestion for two months. Gastrofiberoscopy revealed a 3x4 cm sized submucosal mass, and subtotal gastrectomy gastrojejunostomy was performed and he was discharged without any postoative complication.

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십이지장의 Brunner's Gland 선종 2예 ( Two Cases of Brunner's Gland Adenoma ): Korean J Gastrointest Endosc 1990;10(2):345-350. Published online November 30, 1989

Abstract PDF: So-called Brunners gland adenoma is characterized by a nodular proliferation of histologically normal Brunners gland, accompanied hy duots and scattered stromal elements. This benign tumor of the duodenum is rare and is not eaey to discover because of non-specific symptoms. The clinical presentation can vary from vague upper abdominal symptoms with dyspepsia and nausea to diarrhea, jaundice, obetruction and gastrointestinal bleeding. The diagnosis is usually made by radiologic studies and gastroduodenal endoscopy which can also provide definitive treatment. The management of Brunners gland adenoma is complete removal of the lesion and pathologic examination, always necessary to define the nature of the lesion and exclude malignacy. We experienced two cases of Brunner's gland adenoma in the duodenal bulb. The patients complained of epigastric discomfort and bloating respectively. The endoscopic examination revealed round semipedunculated polypoid mass covered with normal muosa at duodenal bulb. One case with a small adenoma (size: 0.7 x 0.7 cn) had been removed by endoscopic polypectomy and the other case with a relatively large polyp (aize: 2.0x2.0cm) had been treaed by transduodenal exploration and excision of the polyp.

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결핵성 임파선염에 의한 총담관 폐쇄 1예 ( One Case of Biliary Tract Obstruction Caused by Tuberculous Adenitis ): Korean J Gastrointest Endosc 1990;10(2):351-354. Published online November 30, 1989

Abstract PDF: Obstructive jaundice produced by periportal tuberculous adenitis in the absence of pulmonary tuberculosis is quite rare. We are reporting the case of a 58-year-old woman who presented with constitutional symptoms and biochemical evidence of biliary tract obstruction. By abdominal sonogram and CT scan, a mass around the head of pancreas and periportal area was detected. The ERCP showed fistula connected proximal common bile duct to lymph node. The patient underwent laparotomy and recognized tuberculous adenitis of periportal lymph node which caused biliary tract obstruction with fistula.

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잔유 총수담관 결석에 대한 담도내시경 직시하 Electrohydaulic Lithotripsy ( EHL ) 1예 ( Electrohydaulic Lithotripsy ( EHL ) of Retained Common Hile Duct Stone with Choledochoscopy ): Korean J Gastrointest Endosc 1990;10(2):355-357. Published online November 30, 1989

Abstract PDF: Electrohydraulic lithotripsy (EHL) is a method used to breakup the stone by electric discharge in the presence of liquid medium. Recently we experienced a case of successful common bile duct stone removal after EHL during choledochoscopy via T-tube tract, which was the first case of EHL in biliary tract stone in Korea. A 65-year-old female patient was admitted to our hospital because of generalized pruritus after cholcystectomy with T-tube insertion. Obtained cholangiogram showed retained CBD stone which was implssible to remove by Dormian basket and tto dissolute by monooctanoin. After only one session of EHL, we can disintergrat CBD stone into several small pieces and removal of stone was easily done by Basket. After Small cut endoscopic sphincterotomy (EST) remained distal impacted stone was freely passed and control choledochoscopy and cholangiogram showed no remained stone. We think that EHL may be play a potential role in removal of biliary tract stones as in urinary tract stones.

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담도암의 Percutaneous Endoscopic Biliary Stent ( PEBS ) 법 ( Percutaneous Endoscopic Biliary Stent ( PEBS ) - A case report - ): Korean J Gastrointest Endosc 1990;10(2):359-363. Published online November 30, 1989

Abstract PDF: Although endoscopic biliary drainage(ERBD) is the preferred palliative treatment for unresectable malignant obstructive jaundice, the failure of endoprosthesis insertion occurs in 15% of the cases. In most cases, technical failure results from the inability to pass either a guide wire or a stent beyond the bile duct stricture due to high grade biliary stenosis or tumorous extending down to involve the papilia so that no normal orifice can be identified. In instances of technical failure, percutaneous transhepatic biliary drainage (PTBD) can be achieved, but compared to ERBD, prolonged external decompression has important disadvantages, and the placement of large-bore endoprothetic stent is painful, requires a bougination, and has fairly high complication rate. Recently, percutaneous endoscopic biliary stent (PEBS) is more commonly used in these patients because of higher successfulness than ERBD and higher safety than PTBD. So we report a case that was performed PEBS successfully, previously failed ERBD due to high grade stenosis of extrahepatic bile duct resulting from cholangiocarcinoma.

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경피내시경적 위루술을 이용한 담도 위 배액술 1예 ( A Case of External Biliary Gastric Drainage Through a Percutandous Endoscopic Gastrostomy ): Korean J Gastrointest Endosc 1990;10(2):365-368. Published online November 30, 1989

Abstract PDF: Percutaneous transhepatic biliary drainge (PTBD) is a widely accepted technique for the decotnn of biliary obstruction. However, PTBD is most frequently performed in patients whose prognosis is poor becauase of unresectable malignancy, sepsis, or advanced age. And this technique has disadvantages which inclusdes loss of biliary fluids, fat malabsorption, discomfort and psychologic problem for many patients. A 68-year-old man admitted to the hospital because of obstructive jaundice. He had received cholectystectomy two yeas ageo due to the perforation of gallbladder caused by adenocarcinoma of cystic duct. An external PTBD was placed. But because of the chronic bile loss, a percutaneous endoscopic gastrostomy (PEG) was inserted and drainge of bile into the stomach through an extracoporeal circuit utilizing the PTBD as an exit and PEG as an entrance was achieved.

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회장 궤양이 십이지장으로 관통된 Behcet 씨 장염 1예 ( A Case of Behcet's Disease with Ileal Ulcer Penetrated to the Duodenum ): Korean J Gastrointest Endosc 1990;10(2):369-372. Published online November 30, 1989

Abstract PDF: Behcets syndrome is a multisystem disorder presenting with recurrent oral and genital ulcers as well as uveitis, Gastrointestinal involvement associated with ileal ulcer is rare, but its outcome may by fatal. We have recently experienced a 43-year-old man who had Behcets syndrome with ileal ulcer penetrated to 3rd portion of the duodenum. He had been updergone right hemicolectomy and ileocolostomy for ileal inflammation of unknown etiology 20 years ago. Thereafter he had had relapsing oral and genital ulcers, and abdominal pain intermittently. From 15 days ago before visiting our hospital, he had severe abdominal pain and dark blood-colored stool. The colonofiberscopic finding revealed a large, deep penetrating ulcer and multiple shallow ulcers on the ileum. Deal segmental resection, gastro-jejunostomy and jejunal patch at 3rd portion of the duodenum were performed with marked improvement.

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회장에 장폐색을 유발한 Anisakiasis 1예 ( A Case Report of Intestinal Anisakiasis ): Korean J Gastrointest Endosc 1990;10(2):373-375. Published online November 30, 1989

Abstract PDF: Anisakiasis refers to the infestation of humans by species of marine nematode larvae belonging to the subfamily Anisakiae. An acute abdominal symptom may occur after ingestion of raw marine fish containing nematode larvae of the genus Anisakis. Migration of the parasite into the wall of gtomach, small intestine or, less commomly, the colon elicits a striking eosinophilic granulomatous tissue response. A 39 year old man was visited St. Vincent Hospital because of abdominal distension and tenderness. The plain abdominal X-ray showed ileus pattern suggesting intestinal obstruction. Hence we presented a case of intestinal Anisakiasis combined with intstinal obstruction.

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대량의 장출혈을 동반한 공장의 혈관이형성증에서 Intra - operative Endoscopic Transillumination Technique 의 임상경험 ( A Case of Angiodysplasia in the Jejunum ; Intra - operative Endoscopic Transillumination Technique ): Korean J Gastrointest Endosc 1990;10(2):377-380. Published online November 30, 1989

Abstract PDF: Angiodysplsia of the small bowel is uncommon, but provably remains frequently undiagnosed. In the small intestine, angiodysplasia presents a taxing surgical problem and is uauslly diagnosed for unexplained gastrointestinal bleeding. For the surgeon, the main technical problem is that even when identified by frequently impalpable, and invisible to the naked eye unless they are actively bleeding at the time of surgery. Ensocopy is often unfruitful because the majority of lesions are submucosal and rarely exceed a few milimeters in diameter. We described a simple intraoperative endoscopic transillumination technique used successfully to identify an angiodysplasia in the jejunum prior to the small bowel resection. This report summarized our experience and review of literature.

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직장 Carcinoid 종양 6예 ( Report 6 Cases of Rectal Carcinoid Tumor ): Korean J Gastrointest Endosc 1990;10(2):381-386. Published online November 30, 1989

Abstract PDF: Carcinoid tumors arise from enterochromaffin cells that are located predominatly in the gastrointestinal mucosa. The vast majority of rectal carcinoid tumors are benign and can be safely treated by local excision. Lesions larger than 2 cm and invading the museular wall of the rectum should be considered malignancy and treated by more radical surgery such as abominoperined resection. We report 6 cases of rectal carcinoid tumor, three cases of them were less than 1 cm in size without metastasis. Two of these, small carcinoid tumor were treated with endoacopic polypectomy and one was treated with segmental resection. The others were 2.0 cm or larger in size with regional or liver mestasis. They were treated with segmental resection or electrical fugalization for tumor and transcatheter arterial embilization for liver metastasis or none.

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월례집담회 : 위의 간양 선암종 1예 ( Hepatoid Adenocarcinoma of the Stomach ): Korean J Gastrointest Endosc 1990;10(2):387-389. Published online November 30, 1989

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월례집담회 : 위선암과 병발한 원발성 위 소세포암 1예 ( Concurrent Occurrence of Adenocarcinoma and Small Cell Carcinoma in the Stomach ): Korean J Gastrointest Endosc 1990;10(2):390-392. Published online November 30, 1989

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