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Volume 20(4); April 2000
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식도정맥류에 있어서 새로운 소형 박리성계제 결찰용범 ( Mini-detachable snare ligation ) 의 임상적 유용성 ( Clinical Usefulness of the Newly Designed Mini-Detachable Snare Ligation on Esophageal Varices )
Korean J Gastrointest Endosc 2000;20(4):245-253.   Published online November 30, 1999
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Background
/Aims : At present, various methods of endoscopic esophageal variceal treatment have been developed. But a superlative method has yet not been developed for endoscopic esophageal variceal treatment. For overcoming various disadvantages of endoscopic esophageal variceal treatment. We manufactured and reported the usefulness of a newly designed mini-detachable snare (stainless steel) in the treatment of esophageal varices. Methods : In this randomized trial, we performed mini-detachable snare ligation (MDL) on 46 patients who had esophageal varices and we compared the results with the group of multiple band ligation (MBL) performed on 57 patients in the aspects of urgent hemostatic rate, rebleeding rate, eradication rate and recurrence rate etc. from March, 1997 to present. Results: 6 of 7 patients (86%) in mini-detachable snare ligation group and 11 of 13 patients (85%) in multiple band ligation group were successfully controlled by urgent hemostasis. Rebleeding following initiation occured in 2 (5.5%) in MDL group and 3 (5.3%) in MBL group. Esophageal varices were eradicated or reduced to grade I in 96% and 98% by 2-7 snares and 3-10 ligation/one session in 3-9 and 3-8 session (mean+ SD: 4.8±2.1 and 4.5±1.9 session) in the MDL group and MBL group respectively. The recurrence rate was 5 (11%) and 6 (11%) in MDL group and MBL group respectively during 6 to 16 months follow up period. The mean procedure time taken during 5 snares or 5 bands was 4.07±3.8 min and 3.23±1.2 min in MDL group and MBL group respectively. No serious complications occurred in both groups. Conclusions : The mini-detachable snare ligation may be considered as a new and relatively safe, and effective therapeutic modality in the treatment for esophageal varices, Also the mini-detachable snare system is much cheaper than other multi-fire ligation devices but further clinical evaluation and more technical improvements in mini-detachable snare ligation will be needed. (Korean J Gastrointest Endosc 2000;20:245-253)
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베체트 장염의 대장내시경 분류에 따른 내과적 치료 효과 및 누적 수술률 분석 ( Analysis of the Efficacy of Medical Treatment and the Cumulative Operation Rates of Behcet's Colitis According to the Colonoscopic Classification )
Korean J Gastrointest Endosc 2000;20(4):254-261.   Published online November 30, 1999
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Background
/Aims : The lesions of Behcet's colitis showed aphthoid or punched-out ulceration, but the macroscopic types of lesions have not been defined. The aim of this study was to predict the clinical outcome of patients with Behcets colitis according to colonoscopic findings. Methods : We retrospectively reviewed the medical records and colonoscopic photographs of 50 patients with Behcet's colitis. Colonoscopic findings were categorized according to three types: volcano-, geographic- and aphthous-type. The efficacy of medical treatment was assessed by follow-up colonoscopy or double-contrast barium enema 4 to 8 weeks after treatment and recurrence of the lesions was evaluated during the follow-up period. Cumulative operation rates were obtained by the Kaplan-Meier method. Results : Macroscopic types of colonic ulcers revealed 25 out of 50 (50%) patients with volcano-type, 11 (22%) with geographic-type, and 14 (28%) with aphthous-type lesions. Complete remission rates by medical treatment and operation rates in volcano-type ulcerations were 6 of 25 (24%) and 13 of 25 (52%), geographic-type 8 of 11 (73%) and 1 of ll (9%), and aphthous-type 9 of 14 (64%) and 2 of 14 (14%), respectively. The recurrence rate in volcano-type ulcerations was 9 of 19 (47%), geographic-type 1 of 9 (11%) and aphthous-type 1 of 11 (9%), Conclusions: Volcano-type ulcerations in Behcets colitis showed less favorable response to medical treatment and more episodes of operation and recurrence than geographic- and aphthous-type ulcerations. (Korean J Gastrointest Endosc 2000;20:254-261)
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대장 내시경 검사 시 사형 플라스틱 투명관의 임상적 유용성 ( Efficacy of Total Colonoscopy with a Transparent Cap )
Korean J Gastrointest Endosc 2000;20(4):262-266.   Published online November 30, 1999
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Background
/Aims : There were two blind spots during colonoscopy, one was on angulated portion of colon, other was on non-fixated portion of colon. In spite of careful inspection during routine colonoscopy, small lesions behind the semilunar folds can be situated in blind spots, where they are easily overlooked. The aim of this study was to evaluate the efficacy of total colonoscopy with transparent cap in identifying such lesions, in comparison with colonoscopy without the cap. Methods : We performed colonoscopy with or without transparent cap in 30 patients and 30 controls. During colonoscopy, frequencies of ileal intubation, time required for intubation as far as the terminal ileum and degrees of patients discomfort were checked. Results : Colonoscopy with a transparent cap ensured good visual fields during insertion and withdrawal of the colonoscopy. There were no significant differences in the intubation times to the terminal ileum or in the frequencies of terminal ileal intubation, degree of patients discomfort between the two procedures. Conclusions : Total Colonoscopy with a transparent cap allows inspection of the blind area of the colonic mucosa behind the semilunar folds, with good visual fields. But the statistical significance was not found in this study. This method may be potentially useful for both screening and diagnostic purposes. Further study in more cases would be needed. (Korean J Gastrointest Endosc 2000;20:262-266)
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내시경적 담도삽관을 위한 침형절개도를 이용한 누두절개술 ( Infundibulotomy ) 의 유용성 ( Efficacy of Needle-knife Infundibulotomy in Failed Cannulation on Endoscopic Retrograde Cholangiopancreatography )
Korean J Gastrointest Endosc 2000;20(4):267-273.   Published online November 30, 1999
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Background
/Aims : Cannulation failure to biliary tract has been reported in 10% of patients who are performed diagnostic and therapeutic ERCP. Infundibulotomy by use of needle knife is cutting a bulbar part of protruding papilla, which has merit to avoid complete destruction of sphincter of Oddi and serious side effects than general precutting method. We want to know effectiveness and safety of infundibulotomy. Methods : From January 1997 to December 1998, 36 patients who failed cannulation over three times trial by conventional method are included to this study. We compared the success rate of cannulation and procedure related complication according to bile duct dilatation, periampullary diverticulum and shape of ampulla of Vater. Results : 1) Success rate of cannulation to bile duct is 81% (29/36). 2) All patients in group of bile duct dilatation (14) are succeed to cannulation, which is significantly high compare to other group (p=0.0288). 3) There was no statistical difference in success rate according to presence of periampullary diverticulum. 4) In groups of bulging prominent papilla are succeed in 23 among 26 patients, which is tendency of high in patients than other group (p=0.0760). 5) Total occurrence of procedure related complication was 33% (12/36). 6) The complication rate was not different in two groups according to cannulation success 7) The complication rate was tendency of high in patients without bile duct dilatation (p=0.0756). Conclusions : Infundibulotomy by use of needle knife is effeetive and safe cannulation method to patient who failed cannulation to bile duct. Success of cannulation is low and occurrence of complication is tendency of high in patient without bile duct dilation, which propose endoscopists attention in selection of indications. (Korean J Gastrointest Endosc 2000;20:267-273)
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내시경적 유두 괄약근 절개술에 의한 출혈 ; 발생 빈도, 위험 인자 및 내시경적 지혈 효과 ( Sphincterotomy - Induced Hemorrhage ; Prevalence, Risk Factors and Endoscopic Hemostasis )
Korean J Gastrointest Endosc 2000;20(4):274-280.   Published online November 30, 1999
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Background
/Aims : Endoscopic biliary sphincterotomy (EST)-induced hemorrhage occurs in approximately 0.5-12% of procedures. We prospectively investigated the risk factors of EST-induced hemorrhage and evaluated its safety as well as the effectiveness of endoscopic hemostasis. Methods : One thousand three hundred and four patients, who underwent EST between July 1996 and June 1998, were enrolled. As a hemostatic treatment, epinephrine spray was initially used. If bleeding persisted, epinephrine injection was performed consecutively. In patients with exposed vessels, epinephrine injection followed by alcohol injection was given. Results : EST-induced hemorrhage occurred in 136 (10.4%) patients. Types of sphincterotome (needle-knife sphincterotome, p=0.0079) and cutting speed (so-called, zipper cut, p=0.03) were revealed as significant variables for the occurrence of bleeding. Once bleeding occurred, patients with an associated ampullary lesion (impacted stone or cancer) or with coagulopathy were more likely to bleed profusely. Initial hemostasis was achieved in all patients. However, rebleeding occurred in eight patients who were initially classified in the moderate or severe bleeding group. Finally, EST-induced hemorrhage was successfully controlled in all patients after 1-3 treatment sessions (mean: 1.1 sessions). The difference in the incidence of complications between the groups with and without endoscopic hemostasis was not statistically significant. Conclusions : The use of needle-knife sphincterotome and cutting speed were independent risk factors for bleeding occurrence. Once bleeding occurred, its severity was affected by the associated ampullary lesion (impacted stone or cancer) or coagulopathy. Endoscopic hemostasis with epinephrine and/or alcohol was effective and safe in EST-induced hemorrhage. (Korean J Gastrointest Endosc 2000;20: 274-280)
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박리생검법 ( Strip biopsy technique ) 으로 치유한 십이지장 유암종 1예 ( A Case of Small Duodenal Carcinoid Tumor Treated by Strip Biopsy Technique )
Korean J Gastrointest Endosc 2000;20(4):281-284.   Published online November 30, 1999
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Carcinoid tumors of the duodenum are infrequent, represent 2.0-3.0% of all gastrointestinal carcinoid tumors in western countries and 14.8% of those in Japan. Small carcinoid tumors of the duodenum are often asymptomatic, discovered endoscopically, Duodenal carcinoid tumors have been treated by surgical resection or endoscopic resection with strip biopsy or polypectomy. We experience a case of carcinoid tumor of duodenum in 49 years woman. Endoscopic examination, 0.7 cm sized polypoid mass with central depression was noted on duodenal bulb area. We present a case of a small duodenal carcinoid treated with strip biopsy technique. (Korean J Gastrointest Endosc 2000;20:281-284)
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십이지장 구부의 누공형태로 발생한 선암 1예 ( A Case of Tubular Adenocarcinoma on Fistula of Duodenal Bulb )
Korean J Gastrointest Endosc 2000;20(4):285-288.   Published online November 30, 1999
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The first documented case of duodenal carcinoma was described by Hamburger in 1746. Primary adeno-carcinoma of duodenum is rare. Malignant tumors of the small bowel are reported to account for about 1% of all gastrointestinal carcinoma. The autopsy incidence of duodenal adenocarcinoma is about 0.3% of all malignancy. The second and third portions of the duodenum are the usual sites of adenocarcinoma. Cancer in the duodenal bulb is exceedingly rare. Most of them revealed an intraluminal mass or wall thickening. But we have experienced a case of exophytic growth pattern adenocarcinoma such as the fistula of duodenal bulb in 49 year old male patient with hematemesis. For its great rarity, we report this case with review of literatures (Korean J Gastrointest Endosc 2000;20:285-288)
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복강경을 통한 조직 생검으로 진단한 호산구성 소장염 ( Eosinophilic Enteritis Diagnosed by Laparoscopic Biopsy ; Case Report )
Korean J Gastrointest Endosc 2000;20(4):289-293.   Published online November 30, 1999
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Eosinophilic gastroenteritis is a rare disease characterized by the eosinophilic infiltration of the gastro-intestinal tract without involvement of organs outside the gastrointestinal tract and may be misdiagnosed in clinical practice. The pathophysiology of eosinophilic gastroenteritis is not known well. We report a case of serosal eosinophilic enteritis presenting sterile eosinophilic ascites, peripheral eosinophilia and abdominal pain. Diagnosis was confirmed by laparoscopic biopsy of small bowel. The patient was improved dramatically with prednisolone therapy. (Korean J Gastrointest Endosc 2000;20:289-293)
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재발성 하부 위장관 출혈상을 보인 소장의 Mantle Cell Lymphoma 1 예 ( A Case of Mantle Cell Lymphoma of Small Bowel Presenting Recurrent Lower Gastrointestinal Bleeding )
Korean J Gastrointest Endosc 2000;20(4):294-298.   Published online November 30, 1999
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Lower gastrointestinal bleeding is difficult to localize despite advanced diagnostic procedures such as colonoscopy, small bowel series, mesenteric angiography and radionuclide scan. We had experienced a case of mantle cell lymphoma of small bowel. In this case, the cause of recurrent lower gastrointestinal bleeding and abdominal pain was not defined despite extensive preoperative evaluation. We diagnosed this case as mantle cell lymphoma after exploratory laparotomy. (Korean J Gastrointest Endosc 2000;20:294-298)
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위암의 다발성 폴리양 대장 전이 1예 ( Colonic Metastasis from Gastric Carcinoma Presenting as Multiple Polyps )
Korean J Gastrointest Endosc 2000;20(4):299-302.   Published online November 30, 1999
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Colonic metastasis from gastric carcinoma is very rare and usually originated from carcinomas of breast, kidney, prostate and ovary. They generally present as segmental stricture, mimicking granulomatous colitis, polyps, or advanced tumors. There were two cases of metastatic gastric carcinomas of colon reported as multiple polypoid colonic mass. Herein, we reported a case of multiple polypoid colonic metastasis from gastric carcinoma. A 46 year old man presented with symptoms of abdominal distension and hematochezia. After diagnosis of gastric carcinoma, the patient underwent radical total gastrectomy with extranodal radical dissection. One year later, colonoscopy revealed multiple colonic polyps showing metastatic deposits of signet ring cell carcinoma histologically. And it is identical to gastric carcinama histologically which had been resected one year ago. (Korean J Gastrointest Endosc 2000;20:299-302)
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면역기능이 정상인 환자에서의 십이지장 모균증 1예 ( A Case of Duodenal Mucormycosis in a Immunocompetent Patient )
Korean J Gastrointest Endosc 2000;20(4):303-306.   Published online November 30, 1999
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Mucormycosis is a rare and fulminating opportunistic fungal infection that occurs almost in immunocom-promised patients. It is also a highly virulent and rapidly progressive disease with poor prognosis. Its incidence has been increasing in recent years. We have experienced a case of solitary duodenal mucormycosis in a 45 year-old male patient. Mucormycosis was diagnosed by pathology & culture and he was treated with amphotericin B and discharged with clinical improvement. We report this case with a literature review. (Korean J Gastrointest Endosc 2000;20:303-306)
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복부 방사선균증 1예 ( A Case of Abdominal Actinomycosis )
Korean J Gastrointest Endosc 2000;20(4):307-311.   Published online November 30, 1999
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Actinomycosis is a chronic suppurative and granulomatous disease caused by actinomyces species and caracterized by sulfur granule formation which frequently discharged via draining sinus. Actinomyces can affect cervicofacial, pulmonary, abdominal and pelvic area. Most of abdominal actinomycosis is developed after abdominal operation, trauma or inflammatory bowel disease and it must be differentiated from colon cancer, amaeboma, chronic appendicitis or intestinal tuberculosis. We report a case of abdominal actinomycosis, preoperatively impressed as colon carcinoma, which was diagnosed by histological study of the operative specimen. Adequate surgical excision and drainage procedure followed by administration of massive dose of penicilline for weeks. In this case we noted secondary abscess formation after surgery of primary disease. Herein we present our experience with reviewed literatures. (Korean J Gastrointest Endosc 2000;20:307-311)
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폐쇄성 황달을 동반한 폐암의 십이지장 전이 2예 ( Two Cases of Duodenal Metastasis from Lung Cancer with Obstructive Jaundice )
Korean J Gastrointest Endosc 2000;20(4):312-316.   Published online November 30, 1999
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Lung cancer metastatic to the small intestine is uncommon. Despite the widespread nature of metastases that characterize this carcinoma, symptomatic intestinal metastases are extremely rare, but have been reported as a cause of intestinal obstruction, hemorrhage, malabsorption, and perforation. We have recently encountered two cases with squamous cell lung cancer who underwent endoscopic retrograde cholangiopancreatography for obstructive jaundice. Biopsies obtained from concentric ulcerative mass in the duodenum showed metastatic squamous cell carcinoma in the lymphatics. Histologically, the pulmonary and duodenal lesions were identical and this suggests a lymphatic route of dissemination. This is the report of two cases with obstructive jaundice secondary to duodenal metastasis from primary lung cancer. Metastatic squamous cell carcinoma of the lung to the duodenum should be considered in the differential diagnosis of patients harboring such a malignancy who have obstructive jaundice. (Korean J Gastrointest Endosc 2000;20:312-316)
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간내 담도의 유두종으로부터 악성 변화한 유두상 선암 1예 ( A Case of Papillary Adenocarcinoma of Intrahepatic Duct ; Malignant Transformation from Papillary Adenoma )
Korean J Gastrointest Endosc 2000;20(4):317-321.   Published online November 30, 1999
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Biliary papilloma usually consists of single or multiple papillary adenomas in the biliary tract and has a potential for recurrence and malignant transformation. We described herein a case of papillary adenoma of intrahepatic duct that transformed into papillary adenocarcinoma. A 49-year-old male patient was admitted to our hospital because of right upper quadrant pain. A CT scan revealed marked dilatation of S7 segmental duct and cholangioscopy and biopsy revealed mucin-secreting papillary adenoma in the right intrahepatic duct. Three years later, a follow up of CT scan showed aggravated S7 ductal dilatation and inner ill-defined mass. Cholangioscopy revealed multiple papillary mucosal projections with large amount of mucin in the right intrahepatic duct and biopsy revealed well differentiated papillary adenocarcinoma. The patient underwent right lobectomy, the papillary adenocarcinoma was extended in the dilated right intrahepatic duct and also showed hepatic parenchymal invasion. (Korean J Gastrointest Endosc 2000;20:317-321)
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무증상 담낭 - 위 누공 1예 ( A Case of Asymptomatic Cholecystogastric Fistula )
Korean J Gastrointest Endosc 2000;20(4):322-326.   Published online November 30, 1999
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Biliary enteric fistulas which are caused by gallstone, peptic ulcer and carcinoma are an uncommon disease. Their incidence appears to increase recently with the advent of endoscopy. The usual types of the fistulas are choledochoduodenal, cholecystoduodenal and cholecystocolonic. But, cholecystogastric fistulas are very rare. Their symptoms are usually nonspecific and pneumobilia has been considered as a clue, but the diagnosis is difficult in most cases. At present, endoscopy is very helpful to the diagnosis. The treatment of asymptomatic fistulas is still in dispute. Endoscopic management is being used at times in recent days. We recently experienced a case of cholecystogastric fistula accidentally. During the evaluation for the cause of anemia, we suspected a fistula on endoscopy and confirmed it on endoscopic fistulography and managed it by endoscopic papillotomy and stone extraction. (Korean J Gastrointest Endosc 2000;20:322-326)
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단신 ( 제20권 제4호 ) : S상 결장경 검사에서 용종 발견 시 전대장 내시경 검사는 필요한가?
Korean J Gastrointest Endosc 2000;20(4):327-328.   Published online November 30, 1999
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단신 ( 제20권 제4호 ) : 'S상 결장경 검사에서 용종 발견 시 전대장 내시경 검사는 필요한가?'의 답변
Korean J Gastrointest Endosc 2000;20(4):329-329.   Published online November 30, 1999
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