Clinical Endoscopy

Crohn's Disease of the Upper Gastrointestinal Tract: Endoscopic and Histologic Characteristics and Prevalence of Helicobacter pylori Infection: Yong Hee Joung, M.D., Dong Gun Lee, M.D.^†, Hyo Jong Kim, M.D., Yun Wha Kim, M.D.*, Bynung Ok Lee, M.D., Yo Seb Han, M.D., Seok Ho Dong, M.D., Byung Ho Kim, M.D., Young Woon Chang, M.D., Jung Il Lee, M.D. and Rin Chang, M.D.; Korean J Gastrointest Endosc 2003;27(1):1-9. Published online July 30, 2003

Abstract PDF: Background
/Aims: It is well known that Crohn's disease (CD) can affect all gastrointestinal tract. However, there was no report that evaluated upper gastrointestinal CD in Korea. Therefore, we assessed the endoscopic and histological characteristics of gastrointestinal CD and the prevalence of Helicobacter pylori infection in Korea. Methods: We examined forty-six patients who were diagnosed as having CD in Kyung Hee University Hospital. We analyzed the endoscopic and histological characteristics by endoscopic examination with biopsy and the prevalence of H. pylori infection. We also investigated the immunohistochemical characteristics of the biopsy specimen and assessed the effects of medications on both histologic and bacteriologic status. Results: High proportion (69.6%) of CD patients showed upper gastrointestinal mucosal alterations. Erosive endoscopic alteration was the most common finding with major involvement in the antrum and duodenum. In H. pylori negative CD patients, granuloma and focal gastritis were found in 30.6% and 44.4% of cases, respectively. There were no significant correlations between histologic features and clinical characeteristics of CD. Conclusions: We conclude that histologic demonstration of focal gastritis and/or granuloma on endoscopic biopsy specimens in oligosymptomatic patients, especially in H. pylori negative patients, might be considered as patients with possible CD. (Korean J Gastrointest Endosc 2003;27:1⁣9)

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A Case of Primary Esophageal and Small Bowel Lymphoma Presenting as Bilateral Main Bronchial Obstruction: Young-Ju Choi, M.D., Ki-Nam Shim, M.D., Seock-Ah Im, M.D., Ji Hyun Song, M.D.,; Korean J Gastrointest Endosc 2003;27(1):10-14. Published online July 30, 2003

Abstract PDF: Gastrointestinal involvement has been reported to occur in about 10 to 20% of patients with malignant lymphoma. The most common gastrointestinal site for the lymphoma is the stomach, followed by the small intestine, the ileocecal region and the colon. The esophagus is the least commonly involved gastrointestinal organ, accounting for less than 1% of patients with malignant lymphoma. We describe a case of primary esophageal and small bowel lymphoma presenting with bilateral main bronchial obstruction. The patient was treated with radiation therapy, small bowel segmental resection and combination chemotherapy. We report a case with a review of the relevant literature. (Korean J Gastrointest Endosc 2003;27:10⁣14)

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A Case of Mantle Cell Lymphoma Presenting as Multiple Lymphomatous Polyposis Involving Skeletal Muscles: Hyun Jeung Lim, M.D., Paul Choi, M.D., Jin Wuk Hur, M.D., Dong Wan Kim, M.D.,; Korean J Gastrointest Endosc 2003;27(1):15-20. Published online July 30, 2003

Abstract PDF: Multiple lymphomatous polyposis (MLP) is an uncommon type of primary non-Hodgkin's gastrointestinal B cell-lymphoma characterized by the presence of multiple lymphomatous polyps along the gastrointestinal tract. Unlike MALT-lymphoma, MLP has a strong tendency for histologically monomorphic character, extra-digestive localization, rare lymphoepithelial lesion and poor prognosis. The malignant cells of MLP share morphological, immunohistologic and cytogenetic similarities with cells of node-based mantle cell lymphoma. We report a case of mantle cell lymphoma presenting with MLP involving various segments of the gastrointestinal tract, skeletal muscles of the right thigh and bone marrow observed in a 71-year-old woman who complained of lower abdominal pain and a palpable right thigh mass. (Korean J Gastrointest Endosc 2003;27:15⁣20)

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A Case of Klippel-Trenaunay-Weber Syndrome with Sigmoid Varices: Yong Woo Chung, M.D., Dong Soo Han, M.D., Chang Hee Paik, M.D., Yoon Kyung Park, M.D., Jong Pyo Kim, M.D., Hang Lak Lee, M.D., Jin Bae Kim, M.D., Joo Hyun Sohn, M.D., Joon Soo Hahm, M.D. and Hwon Kyum Park, M.D.*; Korean J Gastrointest Endosc 2003;27(1):21-25. Published online July 30, 2003

Abstract PDF: Colonic varix, which is a rare cause of lower gastrointestinal bleeding, can be developed by various diseases. Colonic variceal bleeding is more fatal than esophageal variceal bleeding. Klippel-Trenaunay-Weber syndrome is a rare congenital vascular malformation characterized by the clinical triad of bony or soft tissue hypertrophy, hemangioma and varicosities or vascular malformations. We report a 42-year-old female patient with fatal sigmoid variceal bleeding. She had dilated vessels over her body and face, and both superior and inferior vena cava were obstructed. She underwent an emergent operation due to uncontrolled massive bleeding from sigmoid varices. We report a case of Klippel-Trenaunay-Weber syndrome with literature review. (Korean J Gastrointest Endosc 2003;27:21⁣25)

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A Case of Gastric Submucosal Tumor Suspected to be Caused by Anisakis: Paul Choi, M.D., Jin Wuk Hur, M.D., Hyun Jung Lim, M.D., Jee Young Lee, M.D., Dong Wan Kim, M.D., Moo In Park, M.D., Seun Ja Park, M.D., Hee Kyung Chang, M.D.*, Kyung Seung Oh, M.D.^†and Ja Young Koo, M.D.; Korean J Gastrointest Endosc 2003;27(1):26-30. Published online July 30, 2003

Abstract PDF: Anisakiasis is a parasitic disease following eating raw fishes infected with Anisakis larvae. The endoscopic features of the gastric mucosa are edema, erosion, ulceration and hemorrhage. Gastric anisakiasis forming submucosal tumor is rare. Twenty six-year-old man who complained of severe epigastric pain was admitted. The pain began approximately three hours after eating slices of raw Astroconger myriaster. Gastric endoscopy revealed a submucosal tumor with central erosion on the gastric fundus. Endoscopic ultrasonography detected a thickening of the gastric wall made of mainly thickened submucosal layer. Abdominal CT scan showed a gastric mass lesion with hypodensity in the gastric fundus and subsequently wedge resection was performed. The pathologic finding of the resected mass was eosinophilic abscess in the submucosal layer. We report a case of gastric submucosal tumor which seems to be caused by Anisakis, with a review of relevant literature. (Korean J Gastrointest Endosc 2003;27:26⁣30)

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Two Cases of Eosinophilic Gastroenteritis and One Case of Hypereosinophilic: Il Young You, M.D., Min Ok Kim, M.D., Ji Young Chai, M.D., Eui Sil Hong, M.D., Hee Bok Chae, M.D., Seon Mee Park, M.D., Mi Kyung Kim, M.D, Sei Jin Youn, M.D., Lee Chan Jang, M.D.* and Ro Hyun Sung, M.D.^†; Korean J Gastrointest Endosc 2003;27(1):31-37. Published online July 30, 2003

Abstract PDF: Eosinophilic gastroenteritis is a rare disorder of unknown origin that is pathologically characterized by marked infiltration of eosinophils in the wall of the gastrointestinal tracts. Eosinophilic gastroenteritis is often classified according to the layer of the bowel wall involved. We experienced two cases of eosinophilic gastroenteritis. One case having whole small bowel wall involvement resulting in small bowel obstruction and eosinophilic ascites underwent bowel resection followed by oral steroid treatment. The other case having mucosal layer involvement with chronic diarrhea and hypoalbuminemia was treated with oral corticosteroid and responded dramatically. In addition, we report one case of hypereosinophilic syndrome involving the gastrointestinal tracts. The patient presented with abdominal pain, ascites, and urticaria. and also showed good response to oral steroid. (Korean J Gastrointest Endosc 2003;27:31⁣37)

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A Case of Gastric Mucinous Adenocarcinoma Presenting as a Characteristic Mucin Pool: Dae Ik Nam, M.D., Ilhyun Baek, M.D., Jin Seok Ko, M.D., Jee Soo Kim, M.D., Myong Sik Kim, M.D., Myung Seok Lee, M.D., Ji Woong Cho, M.D.*, Sang June Shin, M.D.^†and Hye Kyung Ahn, M.D.^‡; Korean J Gastrointest Endosc 2003;27(1):38-41. Published online July 30, 2003

Abstract PDF: Mucinous adenocarcinoma is a rare histologic type of gastric carcinoma. Most mucinous gastric carcinoma is diagnosed by histology after surgical resection. However, in this report, we preoperatively predicted the type of a tumor (mucinous type) from its characteristic endoscopic finding. An endoscopic examination showed a cauliflower-like mass on the upper body of the posterior wall. At first we could not find the mass because it was covered with a thick mucin-like substance. After gastric lavage and mucin aspiration we found a tumor mass which was surrounded with a characteristic mucin pool. Abdominal CT showed a 6 cm sized-mass connected with the gastric fundus. Total gastrectomy with esophagojejunostomy was performed. The pathology of the tumor proved to be a mucinous adenocarcinoma. (Korean J Gastrointest Endosc 2003;27:38⁣41)

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A Case of Duodeno-cecal Fistula Developed due to Foreign Body: Woo Jin Chung, M.D., Hea Won Park, M.D., Jun Young Hwang, M.D., Kyung Sik Park, M.D., Kwang Bum Cho, M.D., Jae Seok Hwang, M.D., Sung Hoon Ahn, M.D. and Soong Kook Park, M.D.; Korean J Gastrointest Endosc 2003;27(1):42-45. Published online July 30, 2003

Abstract PDF: Gastrointestinal foreign bodies are a common problem. It can be managed by observation, endoscopic removal, and/or surgical intervention. Bowel perforation, obstruction, bleeding, fistularization and abscess formation are common significant complications associated with foreign bodies. A 38-year-old woman with a toothbrush in the duodenum was referred to our hospital due to abdominal pain. Three years ago, she ingested a tooth brush. Esophagogastroduodenoscopy showed a tooth brush placed in the second portion of the duodenum. We removed a tooth brush by a snare and found a fistula at the junction of the second and third portion of the duodenum. Upper gastrointestinal series revealed a fistula between the duodenum and cecum. We report a case of duodeno-cecal fistula developed due to a toothbrush ingested 3 years before. (Korean J Gastrointest Endosc 2003;27:42⁣45)

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A Case of Pyoderma Gangrenosum Complicating Crohn's Disease: Yu Kyung Cho, M.D., Sang Woo Kim, M.D., Se Hee Kim, M.D., Nak Ki Kwun, M.D., Won Haing Hur, M.D., Jeong Seon Ji, M.D., In Seok Lee, M.D., Myung-Gyu Choi, M.D. and In-Sik Chung, M.D.; Korean J Gastrointest Endosc 2003;27(1):46-50. Published online July 30, 2003

Abstract PDF: Pyoderma gangrenosum is a rare chronic cutaneous disease with distinctive clinical characteristics. A painful nodule or pustule breaks down to form a progressively enlarging ulcer. The diagnosis is confirmed by exclusion of other diseases that may cause cutaneous ulcers. Associated conditions are common. The most common associated conditions are inflammatory bowel diseases, arthritis, hematologic disorders. Pyoderma gangrenosum develops in approximately 3∼5% of patients with ulcerative colitis and 1% of patients with Crohn's disease. Until now, only one case of pyoderma gangrenosum associated with Crohn's disease has been reported in Korea. Recently, we experienced a case of pyoderma gangrenosum developed in a patient with Crohn's disease. (Korean J Gastrointest Endosc 2003;27: 46⁣50)

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A Case of MALT-lymphoma of the Ampulla of Vater: Mi Ryeong Sim, M.D., Eun Young Jo, M.D., Joo Jin Yem, M.D., Yong Sung Kim, M.D.,; Korean J Gastrointest Endosc 2003;27(1):51-55. Published online July 30, 2003

Abstract PDF: Primary gastrointestinal lymphomas originating from the mucosa-associated lymphoid tissue (MALT) have been reported with increasing frequency. The stomach is the most frequent site of MALT lymphoma, and a relationship with Helicobacter pylori infection has been studied. However, primary MALT lymphoma arising from the ampulla of Vater is extremely rare, and its relationship with Helicobacter pylori infection is still obscure. We report here a case of a 71-year-old man with marginal zone B cell lymphoma of MALT with large B cell lymphoma of the ampulla of Vater that was not associated with Helicobacter pylori. A pancreaticoduodenectomy was performed, and the pathologic examination of the resected specimen confirmed the diagnosis. The patient tolerated just one course of systemic chemotherapy, but has been doing well for 18 months after surgery. (Korean J Gastrointest Endosc 2003;27:51⁣55)

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