Clinical Endoscopy

Diagnosis of Cowden's Disease Based on Gastrointestinal Manifestations: Il Gwon Park, M.D., Seung-Jae Myung, M.D., Suk-Kyun Yang, M.D., Hye-Sook Chang, M.D.,; Korean J Gastrointest Endosc 2003;26(4):183-191. Published online April 30, 2003

Abstract PDF: Backgroud/Aims: Cowden's disease is an autosomal dominant hereditary disease characterized by the various hamartomatous and neoplastic lesions of multiple organs. We analyzed gastrointestinal manifestations of 5 cases of Cowden's disease and suggest several findings which are helpful to gastroenterologists for the early diagnosis. Methods: The clinical characteristics of 5 unrelated patients with Cowden's disease were evaluated. Four patients were male, one patient was female, and their ages at the time diagnosis ranged from 17 to 49 years. All patients had the pathognomonic mucocutaneous lesions and thyroid nodules. Results: In all patients, the esophagus was affected by acanthosis. In 4 patients, the stomach was affected by numerous variable sized polyps. In 4 patients, the duodenum was involved by several polyps. In 4 patients, the entire small bowel and in one patients, only the terminal ileum was affected by numerous polyps. In all patients, the colon, especially the sigmoid colon and rectum, showed numerous variable sized polyps. Family history was positive for stomach cancer in two patients. Conclusions: Cowden's disease should be considered in patients with esophageal acanthosis among patients with colonic polyposis, although the mucocutaneous lesions, unfamiliar to gastroenterolgists, are pathognomonic criteria for the diagnosis. (Korean J Gastrointest Endosc 2003;26:183⁣191)

1,756 View
6 Download

Endoscopic Findings and Results of Long-term Follow-up of: Sang Kil Lee, M.D., Yong Chan Lee, M.D., Jae Bock Chung, M.D., Chae Yoon Chon, M.D.,; Korean J Gastrointest Endosc 2003;26(4):192-198. Published online April 30, 2003

Abstract PDF: Background
/Aims: We aimed to evaluate the long-term outcome of patients with MALT lymphoma in respect to various treatment modalities and clinicopathologic characteristics, including endoscopic findings. We also tried to deduce suitable strategic guideline to treat MALT lymphoma. Methods: We retrospectively studied 55 patients (24 males and 31 females) aged 23 to 74 years who had primary low-grade gastric MALT lymphoma that were diagnosed between May 1992 and August 2002. Results: The majority of endoscopic findings showed lesions with ulceration or with color and surface change of mucosa. All but one was H. pylori positive when tested. Treatment modalities included anti H. pylori treatment, radiation, surgery and/or chemotherapy. Eradication was successful in all the 29 patients associated with H. pylori infection. Complete remission was obtained in 24 patients (82.8%). Only one patient suffered a relapse after 28 months during the follow up (2∼74 months). The duration to reach complete remission was 12 months (85 percentile, 2∼33 months). Six patients showed complete remission with radiation therapy. Two of them were H. pylori treatment failure cases. One of 14 patients treated by surgery displayed relapse during follow-up (12∼120 months). Endoscopically, the ulcerative and/or the protruding type showed unfavorable response to anti H. pylori treatment. Conclusion: H. pylori eradication alone should be considered as an initial treatment for MALT lymphoma and radiation therapy could be preferred in patients with no evidence of H. pylori infection or who do not response to H. pylori eradication therapy 12 months after successful eradication. (Korean J Gastrointest Endosc 2003;26:192⁣198)

1,645 View
3 Download

Colonoscopic Miss-rate of Colorectal Polyp and Adenoma: Kyu Yong Choi, M.D., Bo In Lee, M.D., Se Young Lee, M.D.*, Won Chul Lee, M.D.*,; Korean J Gastrointest Endosc 2003;26(4):199-204. Published online April 30, 2003

Abstract PDF: Backgound/Aims: While colonoscopy is the gold standard diagnostic test for the detection of colorectal polyps (especially adenomas), it is also an imperfect method. We prospectively estimated the colonoscopic miss-rate of colorectal polyp and adenoma. Methods: We performed polypectomies in 603 out of 2,006 patients over age of 40 who underwent their first time colonoscopy between September 1999 and June 2001. A follow-up colonoscopy was performed within 60 days in 235 (53.4%) among 440 enrolled patients. Results: Seventy-three (31.0%) of 235 patients with polyps on initial colonoscopy were missed polyps and 37 (23.2%) of 159 patients with adenomas on initial colonoscopy were missed adenomas. As the number of polyps on the initial examination increased, the miss-rate increased significantly (p=0.01). The most frequent size of missed polyp was 3∼4 mm (55.5%, p=0.00) and the most frequent location was sigmoid colon (27.3%, p=0.00). Conclusion: It may be a fallacy to declare that all colorectal polyps are removed just after one session of colonoscopy. Examiners should make every effort to reduce the miss-rate of colorectal polyps during colonoscopy. (Korean J Gastrointest Endosc 2003;26:199⁣204)

1,993 View
1 Download

The Usefulness of Endoscopic Retrograde Biliary Drainage Using Plastic: Seung Jai Yoon, M.D., Sung Tae Ryu, M.D., Ju Hyun Suh, M.D., Seok Jeong, M.D.,; Korean J Gastrointest Endosc 2003;26(4):205-209. Published online April 30, 2003

Abstract PDF: Background
/Aims: Endoscopic sphincterotomy is considered the primary option for treatment of common bile duct (CBD) stones. In some cases, however, complete stone removal is difficult or even impossible. Endoscopic retrograde biliary drainage (ERBD) has been suggested to be an alternative treatment in such cases or in patients with high surgical risks. In this study, we evaluated the effectiveness of ERBD using a plastic stent for treatment of CBD stones. Methods: From Mar. 1996 to Aug. 1999, ERBD was performed in 12 patients with CBD stones. Indications for ERBD were old age in 4, a large perivater diverticulum in 4, refusal of surgery in 2, bleeding risk and biliary stricture in 1 each. Nine had one of the significant associated medical conditions. Results: Six of the 12 patients were symptom-free at the time of evaluation (mean 32.9 months). Of the remaining 6 patients, 3 had operation, 1 had a successful endoscopic stone removal, 1 had a stent exchange, and 1 was lost to follow-up at 26 months. Thus, overall success rate of ERBD for treatment of CBD stones was 75% (9/12). Median symptom-free duration was 41 months (range 18∼59 months). Conclusions: In view of its relatively high success rate and long-term effect, ERBD is an alternative modality for treatment of CBD stones, especially in patients with high surgical risks. (Korean J Gastrointest Endosc 2003;26:205⁣209)

2,682 View
18 Download

A Case of Gastrointestinal Stromal Tumor of the Stomach with a Gastric Fistula: Hee Joung Kim, M.D., Ho Sang Lee, M.D., Hyun Jong Oh, M.D., Chang-Whan Kim, M.D.,; Korean J Gastrointest Endosc 2003;26(4):210-213. Published online April 30, 2003

Abstract PDF: Gastrointestinal stromal tumors (GIST) are mesenchymal gut tumors that lack markers of myogenic differentiation, but express CD34 and CD117, which are products of the c-kit oncogene. They present commonly gastrointestinal bleeding and abdominal pain and/or palpable mass. The other symptoms may include anorexia, weight loss, obstruction, perforation or fever. Fever due to abscess formation is rare complaint of GIST.
We report a case of GIST of stomach with abscess and gastric fistula in a 54-year-old male who presented a three-week history of abdominal pain and fever. Fistula opening site was observed by endoscope, and abdominal CT showed multiple air pockets within the mass representing communication with bowel lumen by fistula. (Korean J Gastrointest Endosc 2003;26:210⁣213)

1,693 View
6 Download

A Case of Massive Bleeding from Jejunal Stromal Tumor: Jae Won Yang, M.D., Hyun Soo Kim, M.D., Yeun Jong Choi, M.D., Jung Min Kim, M.D.,; Korean J Gastrointest Endosc 2003;26(4):214-219. Published online April 30, 2003

Abstract PDF: Gastrointestinal stromal tumors (GISTs) are uncommon tumors that originate from primitive mesenchymal cells. Because GISTs develop throughout the gastrointestinal tract, they present variable heterogenous clinical manifestations such as gastrointestinal bleeding. We report a case of massive gastrointestinal bleeding from jejunal stromal tumor mimicking arteriovenous malformation. (Korean J Gastrointest Endosc 2003;26:214⁣219)

1,845 View
1 Download

A Case of Amyloidosis Presenting with Massive Small Bowel Bleeding: Hye-Sook Chang, M.D., Seung-Jae Myung, M.D., Suk-Kyun Yang, M.D., Tae-Hun Kim, M.D.,; Korean J Gastrointest Endosc 2003;26(4):220-225. Published online April 30, 2003

Abstract PDF: The gastrointestinal (GI) tract is one of the commonly affected organs in amyloidosis. However, it is difficult to make a correct diagnosis of GI amyloidosis because of its varied clinical manifestation and nonspecific endoscopic findings. Moreover, GI bleeding as a presenting symptom is rare, but can be serious in some cases. Therefore, missed diagnosis and delayed management in GI amyloidosis may potentially lead to a critical outcome. We report a 51-year-old man with multiple myeloma whose major symptom was massive hematochezia due to GI amyloidosis. In our case, amyloid deposits could be distinctly visualized endoscopically in the stomach and the colon. They were manifested as submucosal hematomas in the small bowel resulting in massive bleeding that was successfully controlled with the aid of intraoperative endoscopy. (Korean J Gastrointest Endosc 2003;26:220⁣225)

1,866 View
7 Download

Two Cases of Small Intestinal Nodular Lymphoid Hyperplasia: Sung Hun Moon, M.D., Sang Young Han, M.D. Chae Ryung Jang, M.D., Tae Yeong Lee, M.D.,; Korean J Gastrointest Endosc 2003;26(4):226-231. Published online April 30, 2003

Abstract PDF: Pseudolymphoma or lymphoid hyperplasia is a rare clinicopathologic disease which occurs in a variety of sites including the skin, orbit, salivary glands, gastrointestinal tract, lung, and other organs. Lymphoid hyperplasia of the gastrointestinal tract can be categorized into four clinicopathologic groups: focal lymphoid hyperplasia of the stomach, focal lymphoid hyperplasia of the small intestine, focal lymphoid hyperplasia of the rectum, and nodular lymphoid hyperplasia of the gastrointestinal tract. We experienced two cases of nodular lymphoid hyperplasia of the small intestine with hypogammaglobulinemia (IgA deficiency) and without hypogammaglobulinemia presented with epigastric discomfort. Esophagogastroduodenoscopy and small bowel series showed 0.2∼0.5 cm sized small, numerous Yamada-I or Yamada-II polypoid lesions from the duodenal bulb to the terminal ileum in two cases. Histologic finding of the duodenal bulb showed small round mature lymphocyte infiltration and reactive follicle with germinal center in two cases. We report two cases with a brief reviews of literature. (Korean J Gastrointest Endosc 2003; 26:226⁣231)

2,097 View
6 Download

A Case of Iatrogenic Rectal Perforation Repaired by Endoscopic Clipping: Hyun Phil Shin, M.D., Seok Ho Dong, M.D., Jang Ha Kim, M.D., Yo Seb Han, M.D.,; Korean J Gastrointest Endosc 2003;26(4):232-235. Published online April 30, 2003

Abstract PDF: Although colonoscopy is commonly performed, it is an invasive procedure that might produce complications such as hemorrhage and perforation. Colonic perforation is an abdominal emergency with high mortality requiring surgical intervention. Sometimes non-surgical teatment can be applied when perforation is small sized, located in the retoperitoneal spaces or surgical approach is impossible. We are reporting a case of colon perforation in 64-year-old female patient. The patient visited our hospital with symptoms of dizziness and dyspnea. She was anemic and we planned to find the possible cause of anemia. Rectal perforation was developed during the diagnostic colonoscopy. However the operation was not applicable due to arrhythmia and cardiogenic shock. Therefore endoscopic clipping was done at the perforation site. Afterwards nasogastric decompression, intravenous antibiotics and total parenteral nutrition were applied. She was treated successfully without any complications. (Korean J Gastrointest Endosc 2003;26:232⁣235)

2,255 View
10 Download

A Case of Biliary Obstruction Secondary to Shrapnel: Jeong Sik Kim, M.D., Seong Kyu Park, M.D., Yun Oh Bae, M.D., Jin Ho Kim, M.D.,; Korean J Gastrointest Endosc 2003;26(4):236-239. Published online April 30, 2003

Abstract PDF: Obstructive jaundice primarily results from choledocholithiasis, neoplasm, inflammation and infection such as primary sclerosing cholangitis, postsurgical stricture, AIDS cholangiopathy, extrinsic compression of the biliary trees. However, obstructive jaundice secondary to foreign bodies is rare. Especially, shrapnel induced biliary obstruction is very rare and has never been reported in Korea. We report a patient who had biliary obstruction due to metal shrapnel. He had shrapnel injury 52 year ago during the Korean War. For a long time, he had had no symptoms. He was admitted to our hospital for epigastric pain and jaundice. Abdominal CT scan showed a metallic foreign body in the common bile duct. The patient underwent ERCP, and the shrapnel and several stones were successfully extracted with a basket. (Korean J Gastrointest Endosc 2003;26:236⁣239)

1,736 View
3 Download

Previous issues