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Volume 23(4); October 2001
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Hemoclip 접근이 어려운 소화성 궤양 출혈에서 EVL 용 투명캡의 사용 ( Endoscopic Hemoclipping Using a Transparent Cap in Techincally Difficult Cases )
Korean J Gastrointest Endosc 2001;23(4):201-206.   Published online November 30, 2000
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Background
/Aims: There was some technical difficulty in applying the hemoclip on the posterior wall of the body, cardia of the stomach and posterior wall of duodenum because the angle of approach was tangential. Use of transparent cap on the tip of the endoscope could reduce some of these problems. The purpose of this study was to examine the efficacy of endoscopic hemoclipping using a transparent cap. Methods: From August 1997 to July 2000, 75 patients with bleeding peptic ulcer and stigmata of recent hemorrhage were treated with endoscopic hemoclipping. There was technical difficulty in applying the hemoclip in 18 patients and the transparent cap was used. Results: There was no statistically significant difference between the patients treated with cap and the patients treated withoup cap in initial hemostasis rate (91.1% vs 94.4%), rebleeding rate (11.8% vs 11.7%), and permanent hemostasis rate (92.9% vs 94.4%). Conclusions: Use of transparent cap on the tip of the endoscope was an efficient method when the angle of approach was tangential. (Korean J Gastrointest Endosc 2001;23:201-206)
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요소호기 검사로 평가한 치료 기간에 따른 Helicobacter pylori 제균율의 분석 - OAC 7 , 10 , 14 일간 병합요법의 비교 - ( Analysis of Eradication Rate of Helicobacter pylori According to Treatment Duration by Using 13C - urea Breath Test - Comparison of OAC 7 , 10 , 14 days regimen - )
Korean J Gastrointest Endosc 2001;23(4):207-212.   Published online November 30, 2000
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Background
/Aims: Efficacy of triple therapy with omeprazole, amoxicillin, and clarithromycin (OAC) for helicobacter pylori (H. pylori) varies among different geographic regions and patient populations. And, there is no full con sensus on how long this treatment should be maintained. We assessed the efficacy of the OAC regimen according to the treatment duration (7, 10 or 14 days) using 13C-urea breath test (13C-UBT). Methods: Two hundred fifty five H. pylori positive patients with peptic ulcer were randomly assigned to a OAC (omeprazole 20 mg b.d., amoxicilln 1.0 g b.d.) . Eradication of H. pylori was assessed by 13C-UBT 4 weeks after the completion of the completion of therapy. Results: 140 male and 115 female (mean age, 51.3) patients were enrolled. The overall eradication rate of H. pylori in each group was significantly higher in OAC 14 days regimen than OAC 7 and 10 days regimen (91.9% in OAC 14 days, 74.4% in OAC 7 days, and 80.2% in OAC 10 days, respectively, p<0.05). Conclusions: The overall eradication rate of H. pylori was highest in OAC 14 days regimen in our study. We have found significant differences in eradication rates with previous reports, using CLO and histology, in Korea. Thus, further studies focusing on the treatment period may be warranted. (Korean J Gastrointest Endosc 2001;23:207-212)
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대장 및 직장의 악성 폐쇄의 치료를 위한 경내시경적 자가확장형 니티놀 인공관 유치의 유용성 ( Usefulness of a Self - expandable Nitinol Stent Through an Endoscope for the Treatment of a Malignant Colorectal Obstruction )
Korean J Gastrointest Endosc 2001;23(4):213-219.   Published online November 30, 2000
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Background
/Aims: Expandable stents were inserted for temporary decompression of the colorectum before single-stage surgery or for palliation. The aim of this study was to evaluate the usefulness of a self-expandable nitinol stent, which can be placed through the working channel of an endoscope, for treatment of malignant colorectal obstructions. Methods: From May 2000 to April 2001, twenty patients (eleven female, nine male, aged 39~81 years) with malignant colorectal obstructions were treated for relief from the obstructions with endoscopically guided intubation of a expandable nitino stent through the working channel of an endoscope. Of twenty patients, thirteen underwent placement of the stent for presurgical decompression; seven, for palliative decompression. Results: The site of obstructions were on the rectum (n=8), sigmoid colon (n=6), descending colon (n=2), transverse colon (n=3) and ascending colon (n=1). Stent placenment was successful in 18 (90%) of the 20 patients. Failure occurred in two patients with long and tortuous lesions involving hepatic flexure or splenic flexure. All patients tolerated placement of the stent well, with no procedure-related complications. Is patients with successful placement of the stent, symptoms of obstruction resolved within 72 hours. Twelve patients underwent the formal bowel preparation and elective single-stage surgery without complications 4~7 days after stent placement. In six patients, the stents provided palliative decompression of the colorectum. There was stent migration in two patients during follow-up. Conclusions: placement of a self-expandable nitinol stent through the working channel of an endoscope is technically feasible and safe. Stent placement allowed patients with malignant colorectal obstruction to undergo single-stage surgery in cases of operable disease and to provide palliative decompression in cases of inoperable disease. (Korean J Gastroitest Endosc 2001;23:213-219)
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원발성 식도 소세포암 2 예 ( Two Cases of Primary Esophageal Small Cell Carcinoma )
Korean J Gastrointest Endosc 2001;23(4):220-224.   Published online November 30, 2000
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Primary extrapulmonary small cell carcinoma have been described in the esophagus, stomach, pancreas, salivary gland, paranasal sinus, small bowel, uterus, urinary bladder and skin. Primary small cell carcinoma of the esophagus has rarely been reported since McKeown had reported the first 2 cases of small cell carcinoma of the esophagus in 1952. Primary small cell cancer of esophagus is extremely aggressive tumor with grave prognosis. Because of the highly malignant potency, multimodality treatment including chemotherapy for the primary therapy is accepted generally. We experienced 2 cases of small cell carcinoma of the esophagus. One patient was a 57 year-old male without metastasis and we treated him with a multi-drug regimen (cisplatin and VP-16) being used in small cell carcinoma of the lung at our hospotal. But the other patient was a 67 year-old male with bone metastasis, and he refused all management. (Korean J Gastroitest Endosc 2001;23:2201-224)
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내시경적 조기 진단으로 내과적 치료에 성공한 급성 봉소염성 위염 ( Acute Phlegmonous Gastritis Diagnosed Early Endoscopically and Treated Successfully with Antibiotics )
Korean J Gastrointest Endosc 2001;23(4):225-229.   Published online November 30, 2000
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Phlegmonous gastritis is a rare disorder caused by suppurative bacterial infection of the gastric wall. The mortality rate remains extremely high and the gastrectomy has been thought to be an effective form of treatment. We report a case of acute phlegmonous gastritis developed in a patient with advanced alcoholic liver cirrhosis, and recovered with early endoscopic diagnosis and antibiotics alone. (Korean J Gastrointest Endosc 2001;23:225-229)`
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점막하 종양으로 보인 십이지장 결핵에 동반된 결핵성 림프절염 1 예 ( A Case of Duodenal Tuberculosis Conceived as Submucosal Tumor Accompanied by Tuberculous Lymphadenitis )
Korean J Gastrointest Endosc 2001;23(4):230-234.   Published online November 30, 2000
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In spite of decrease in prevalence, yet tuberculosis is not rare disease in Korea and the morbidity is over one percent. Because extrapulmonary tuberculosis is less common than that of lung, quick and accurate diagnosis is not easy and there may be some problems in selecting the methods and the times to treat it. Especially, each or combination of abdominal lymphadenitis and duodenal tuberculosis are so rare that differential diagnosis from other common or rare diseases is difficult, and much attention is required to diagnose and treat those. Recently we experienced a case of tuberculous lymphadenitis accompanied by duodenal bulbar tuberculosis which had been conceived as submu cosal tumor at endoscopy and diagnosed by explorative operation. So we report this case with review of related literatures. (Korean J Gastrointest Endosc 2001;23:230-234)
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Trocar 를 이용하여 수술 중 내시경적 용종절제술을 시행한 Peutz - Jeghers 증후군 1 예 ( Intraoperative Endoscopic Resection of Small Bowel Polyps through Trocar in Patient with Peutz - Jeghers Syndrome )
Korean J Gastrointest Endosc 2001;23(4):235-239.   Published online November 30, 2000
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The Peutz-jeghers syndrome is an autosomal dominant disease characterized by mucocutaneous pigmentation and gastrointestinal hamartomatous polyps. This syndrome is clinically important because of the complications caused by polyps and of an increased risk of cancer. We experienced a typical case of Peutz-Jeghers syndrome in a 24-year-old female patient who presented with jejunojejunal intussusception. With the use of combined surgery and intraoperative endoscopy through trocar, 60 polyps were removed, performing only 2 enterotomies. We apply a modified endosocopic technique of intraoperative endoscopic resection of small-bowel polyps using conventional 10 mm metal trocar in conjunction with a corrugated anesthetic tube. This allows fully visualized and optically controlled removal of all small intestnal polyps without air leakage. The usefulness of this technique reduces the complications associated with multiple laparotomies and resections. (Korean j Gastrointest Endosc 2001;23:235-239)
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내시경적 대장용종절제 후 지연발견된 천공을 내시경적 치료로 호전된 1 예 ( A Case of Successful Endoscopic Therapy in Delayed Diagnosed Perforation after Endoscopic Colon Polypectomy )
Korean J Gastrointest Endosc 2001;23(4):240-244.   Published online November 30, 2000
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With the wide use of colonoscopy and develoment of technology, colon tumors and colon polyps are being found frequently and for the treatment of colon polyp, endoscopic polypectomy is used at present. The most common complications of endoscopic colon polypectomy are hemorrhage and perforation. Colon perforation is an abdominal emergency with high mortality. When colon perforation happens, surgical resection was being used at past. But when colon perforations are resulted from therapeutic colonoscopy, devoid of down stream obstacles with a perfectly prepared colon, and the patient's general condition is satisfactory, colon porforation is successfully treated by conservative measures. But, in delayed diagnosed perforation endoscopic treatment is controversial yet. We report here a case which sustained iatrogenic delayed diagnosed perforation of the sigmoid colon caused by polypectomy that was successfully treated by endoscopic clip therapy. (Korean J Gastrointest Endosc 2001;23:240-244)
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특발성 과호산구 증후군 환자에서 발생한 장 폐색증 1 예 ( A Case of Idiopathic Hypereosinophilic Syndrome Accompanied with Intestinal Obstruction )
Korean J Gastrointest Endosc 2001;23(4):245-250.   Published online November 30, 2000
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The idiopathic hypereosinophlic syndrome (HES) is a disease defined by three diagnostic criteria, first, sustained blood eosinophilia is greater than 1,500/mm3 present for longer than 6 months, second, other apparent etiologies for eosinophilia must be absent, including parasitic infection and allergic disease, third, patients must have signs and symptoms of organ involvement. It is associated with cytotoxic granule proteins released by mature eosinophils. HES mainly affects cardiovascular, neurologic, pulmonary system, liver and apleen while low incidence of gastrointestinal involvement is found, and the development of severe complications such as intestinal obstruction after peritonitis or intestinal perforation is extremely rare. We have experienced a case of HES involving hepatic and digestive system, 39 year old man patient who was operated due to intestinal obstruction that was followed by HES, so we report this case with a review of the literature. (Korean J Gastrointest Endosc 2001;23:245-250)
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비특이성 증상의 장광의 포상 기종 1 예 ( A Case of Pneumatosis Cystoides Intestinalis Presented with Nonspecific Symptom )
Korean J Gastrointest Endosc 2001;23(4):251-254.   Published online November 30, 2000
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Pneumatosis cystoides intestinalis is a relatively rare condition, characterized by multiple gas-filled cysts of varying size in the wall of gastrointestinal tract. Although the etiology of pneumatosis intestinalis remains uncertain, the possibility that both the gas-forming bacteia and mechanical theories develop pneumocysts has recently been advocated. We experienced a case of pneumotosis cystoides in testinalis found by colonoscopy in a 31-year old woman with intermittent abdominal pain. (Korean J Gastrointest Endosc 2001;23:251-254)
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악성종양과 유사한 형태를 보인 S 상 결장 게실염 1 예 ( A Case of Diverticulitis of Sigmoid Colon Mimicking Carcinoma )
Korean J Gastrointest Endosc 2001;23(4):255-258.   Published online November 30, 2000
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Diverticular disease of the colon in Korea is different from developed Western countries. Diverticulosis leads to the complications in about 20% of cases. The diverticulitis of the right colon is difficult to be differentiated from acute appendicitis. According as increase of elderly populations, incidence of the diverticulitis of the left colon increase. Therefore we should be differenciated from other diseases. In very rare case, frequent recurrence and recovery of the diverticulitis leads to a chronic state with complications such perforation, microabscess, fistula, adhesion and fibrous hypertrophy. These findings may be misdiagnosed as malignancy because of protruding mass and stricture on colonoscopy. We present a case of an pseudotumor that looks like a malignancy in the sigmoid on colonoscopy. After surgical resection, the lesion turned out to be a complicated diverticulitis. (Korean J Gastrointest Endosc 2001;23:255-258)
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십이지장 유두선종의 내시경적 유두절제술 후 발생한 총담관 결석을 동반한 담도 협착 1 예 ( Biliary Stricture Associated with Common Bile Duct Stone Caused by Endoscopic Snare Papillectomy of Ampullary Adenoma )
Korean J Gastrointest Endosc 2001;23(4):259-262.   Published online November 30, 2000
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Neoplasms of the major duodenal papilla or the ampulla of Vater are rare but are clinically important since they are premalignant. Recently endoscopic snare papillectomy for the ampullary adenoma is being increasingly performed. The procedure is now regarded as a clinically effective treatment, however, various complications such as bleeding, perforation, colangitis, and pancreatitis have been reported. To our knowledge, biliary stricture of this case has not been reported as a complication of endoscopic snare papillectomy for ampullary adenoma. Also, secondary common bile duct stone was formed by biliary stasis associated with biliary stricture in our case. We performed the balloon dilation at the biliary stricture site and could remove the stone successfully by endoscopic method. (Korean J Gastrointest Endosc 2001;23:259-262)
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만성췌장염에서 발생한 진단이 어려웠던 가성동맥류 2 예 - 천자와 hemosuccus pancreaticus 로 확인된 가성동맥류 - ( Two Difficultly Diagnosed Cases with Pseudoaneurysm in Chronic Pancreatitis - Pseudoaneurysms Identified Inadvertently during Percutaneous Drainage and Hemosuccus Pancreaticus - )
Korean J Gastrointest Endosc 2001;23(4):263-268.   Published online November 30, 2000
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Pseudoaneurysm is a rare life-threatening complication of chronic pancreatitis. It can be diagnosed by various imaging modalities including computerized tomography (CT), ultrasound, and angiography. Early diagnosis and radiologic or surgical treatment can promise better outcomes. However, pseudoaneurysm is not easily diagnosed. It can be misdiagnosed as a pseudocyst with secondary infection. Rarely, the correct diagnosis is made by an inadvertent trial with percutaneous drainage. The endoscopically identified hemosuccus pancreaticus is also a rare finding. Recently, we experienced two cases of pseudoaneurysm in patients with chronic pancreatitis. They did not have any evidence of bleeding in the initial eddoscopy or evidence of pseudoaneurysms in the initial ultrasound and CT scan. In one case, the pseudoaneurysm was identified during a percutaneous drainage procedure, performed to diagnose and manage a cystic lesion which apperared to be an infected cyst. In the other case, the pseudoaneurysm was suspected after the hemosuccus pancreaticus was found during endoscopy performed due to recurrent hematemesis. Both cases were successfully treated with arterial embolization of the pseudoaneurysms. (Korean J Gastrointest Endosc 2001;23:263-268)
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위벽에 종양으로 발현한 췌장 가성 낭종 1 예 ( A Gastric Intramural Pancreatic Pseudocyst : An Unuaual Presentation as a Gastric Intramural Tumor )
Korean J Gastrointest Endosc 2001;23(4):269-272.   Published online November 30, 2000
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We report a case of pancreatic pseudocyst presenting as an intramural gastric tumor on upper gastrointestinal examination, endoscopic ultrasound and computed tomography of the abdomen. Pancreatic pseudocysts in the stomach wall is rare and the most of them presented as a cystic mass, but this case was presented as a gastric mural solid tumor. Exploration revealed an about 4´4´2 cm sized round mass at the midbody of great curvature of stomach, it was in the muscle layer, and removed by surgical operation. The correct diagnosis of this case was established postoperately on the pathologic examination revealed pancreatic pseudocyst. (Korean J Gastrointest Endosc 2001;23:269-272)
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