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Volume 28(1); January 2004
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Cost-Effectiveness Analysis of Colon Cancer Screening by Colonosopic Examination in Korea
Dong Soo Han, M.D., Joon Yong Park, M.D., Hyung Ran Yun, M.D.and Sang Cheol Bae, M.D.*,†
Korean J Gastrointest Endosc 2004;28(1):1-8.   Published online January 30, 2004
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Background
/Aims: The mortality of colon cancer is reduced by a proper screening test. Recently, colonoscopic screening was reported more cost-effective than stool occult blood test or sigmoidoscopy in America. In this study, we performed cost-effectiveness analysis of colonoscopy as a colon cancer screening test in Korea by using Markov model. Methods: A hypothetical population of 50 years of age divided into 2 groups. Markov model was applied to those with colonoscopic screening and consecutive polypectomy or without screening. The effect of screening test to the general health was expressed as quality-adjusted life years (QALYs). The variables during the screening test and treatment were regarded carefully by sensitivity analysis. Results: The mean cost estimates for colonoscopic exam was 75,164 won and colon cancer treatment was 10,867,177 won. From the analysis using Markov model, the mean cost required for the screening group was 166,717 won and 76,938 won for non-screening group. The QALY in screening group was 18.49. The incremental cost-effectiveness was 1,097,992 won/QALY. Conclusions: Regular colonoscopic exam requires higher medical cost than non-screening group, with its property of reducing mortality from colorectal cancer, however, colonoscopy is a cost-effective means of colorectal cancer screening. (Korean J Gastrointest Endosc 2004;28:1⁣8)
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Definitive Treatment of Infected Pancreatic Fluid Collection by Endoscopic Transmural Drainage
Jeong Han Kim, M.D., Jong-Jae Park, M.D., Sang Kyun Yu, M.D., Young Kul Jung, M.D., Ji Yeon Lee, M.D., Ik Yoon, M.D., Kyung Oh Kim, M.D., Hyung Joon Yim, M.D., Jin Yong Kim, M.D, Jong Eun Yeon, M.D., Jae Seon Kim, M.D., Kwan Soo Byun, M.D., Young-Tae Bak,
Korean J Gastrointest Endosc 2004;28(1):9-17.   Published online January 30, 2004
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Background
/Aims: Recent experience with endoscopic transmural drainage of pancreatic pseudocysts prompted the use of a similar technique for the primary treatment of infected pancreatic fluid collection (PFC) such as pancreatic abscess and infected pancreatic necrosis (IPN). The aim of this study was to determine the safety and effectiveness of endoscopic transmural drainage for the primary treatment of infected PFC complicating acute pancreatitis. Methods: In 11 patients, a total of 13 infected PFC (11 pancreatic abscesses and 2 IPNs) compressing the stomach, duodenum, or both were drained endoscopically by means of an endoscopic fistulization followed by stent (s) placement alone or additional nasopancreatic catheter insertion. Complete resolution of PFC was defined as the absence of symptoms and no residual collection on the follow-up computed tomography. Results: Complete resolution was achieved in 12 infected PFC (92%) (10 pancreatic abscesses and 2 IPNs) after stent placement for a mean duration of 31 days. For IPN and 2 pancreatic abscess, insertion of a nasopancreatic catheter was required to irrigate thick pus or necrotic debris. There was 1 case of bleeding (8%) but no mortality. Conclusions: Endoscopic transmural drainage is an effective therapy with minimal morbidity for infected pancreatic fluid collection compressing the gut lumen and is a valuable alternative to surgical drainage. (Korean J Gastrointest Endosc 2004;28:9⁣17)
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Two Cases of Adenocarcinoma Arising from Short Segment Barrett's Esophagus
Young Kul Jung, M.D., Jong-Jae Park, M.D., Jeong Han Kim, M.D., Sang Kyun Yu, M.D., Ji Yeon Lee, M.D., Ik Yoon, M.D., Ki Ho Park, M.D., Jin Yong Kim, M.D., Jae Seon Kim, M.D., Young-Tae Bak, M.D., Woon Yong Jeong, M.D.*, Chul Hwan Kim, M.D.* and Chang Hon
Korean J Gastrointest Endosc 2004;28(1):18-24.   Published online January 30, 2004
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Barrett's esophagus is considered as a premalignant condition in which columnar epithelium replaces the normal esophageal squamous epithelium. The diagnosis of Barrett's esophagus is based on the endoscopic finding of columnar epithelium lining the distal esophagus and histologic confirmation of the presence of specialized intestinal metaplasia. According to the extent of the metaplastic lining from the esophagogastric junction, Barrett's esophagus has been divided into long-segment (≥3 cm in length) and short-segment (<3 cm in length). Long- segment Barrett's esophagus can be easily identified at endoscopy, but it is difficult to separate short-segment Barrett's esophagus from intestinal metaplasia of cardia. It has been reported that Barrett's CK 7/20 pattern is an objective marker of Barrett's mucosa, and can differentiate Barrett's mucosa from gastric intestinal metaplasia. We report here two cases of adenocarcinoma of esophagus arising from short-segment Barrett's esophagus, diagnosed by endoscopic and histologic findngs, and treated by endoscopic mucosal resection. (Korean J Gastrointest Endosc 2004;28:18⁣24)
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Esophageal Ulcer Induced by Alendronate
Yong Hee Joung, M.D., Young Woon Chang, M.D., Joo Young Han, M.D., Byoung Wook Lee, M.D., Yo Seb Han, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byung Ho Kim, M.D., Joung Il Lee, M.D. and Rin Chang, M.D.
Korean J Gastrointest Endosc 2004;28(1):25-28.   Published online January 30, 2004
AbstractAbstract PDF
Alendronate sodium (Fosamax) is an aminophosphonate used in treatment of postmenopausal osteoporosis by inhibition of osteoclastic activity. Esophageal ulcers related to alendronate use have been reported at the rate of 2∼6%. However, there have been no reports of esophagitis or esophageal ulcer by alendronate in Korea. We present a case of esophageal ulcer caused by alendronate. The patient presented with retrosternal pain and severe odynophagia for a few days. Esophagogastroduodenoscopy revealed multiple deep ulcers at the esophagus. Her symptoms resolved completely after stopping alendronate. A follow-up esophagogastroduodenoscopy 6 weeks later revealed complete healing of the ulcers. (Korean J Gastrointest Endosc 2004;28:25⁣28)
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A Case of Improved Menetrier's Disease after the Eradication of the Helicobacter pylori and Long Term Treatment with Proton Pump Inhibitor
Kang-Hyu Lee, M.D., Na-Ri Lee, M.D., Jae-yong Kwak, M.D., Chang-yeol Yim, M.D. and Seung-Ok Lee, M.D.
Korean J Gastrointest Endosc 2004;28(1):29-33.   Published online January 30, 2004
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Menetrier's disease is a protein losing hypertrophic gastropathy characterized by hypoproteinemia, and often is associated with the development of gastric cancer. Though the cause of Menetrier's disease has been unknown, the association with Helicobacter pylori was reported. A 30- year-old man was hospitalized for the evaluation of progressive dyspepsia for 2 years, hypoproteinemia, and recently aggravated epigastric pain with weight loss. Gastroscopy revealed prominent folds and multiple variable sized polypoid eminence in the body and antrum with positive CLO test. Histological findings revealed gastritis with erosions and foveolar hyperplasia. Any other diseases causing protein losing enteropathy were excluded. After the eradication of the H. pylori and long term treatment with proton pump inhibitor, clinical, endoscopic, and biochemical resolution ensued. Thus, we suggest that H. pylori eradication should be tried in patients with Menetrier's disease before invase treatment modalities such as surgical resection. (Korean J Gastrointest Endosc 2004; 28:29⁣33)
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Emphysematous Gastritis Developed in a Patient with Klatskin's Tumor
Jong Yun Cheong, M.D., Dong Hyun Lee, M.D., Won Il Park, M.D., Jin Hong Park, M.D., Hyong Wook Kim, M.D., Jeong Heo, M.D., Gwang Ha Kim, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Mong Cho, M.D. and Ung Suk Yang, M.D.
Korean J Gastrointest Endosc 2004;28(1):34-38.   Published online January 30, 2004
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Emphysematous gastritis is a rare disease characterized by air in the wall of the stomach due to gas-forming microorganisms. This lethal entity was first described by Fraenkel in 1889. Forty-six cases have been reported so far in the literature. The predisposing factors include corrosive ingestion, immunocompromized state, alcohol abuse, cancer, diabetes and so on. Computed tomography is the procedure of choice for early diagnosis. Only prompt diagnosis and treatment can avoid mortality. Initial antibiotic therapy should cover gram-negative organisms and anaerobes. We report a case of emphysematous gastritis in a 41-year-old man with Klatskin's tumor. (Korean J Gastrointest Endosc 2004;28:34⁣38)
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A Case of Pseudomelanosis Duodeni
Sang Kyun Yu, M.D., Young Kul Jung, M.D., Jeong Han Kim, M.D., Ji Yeon Lee, M.D., Kiho Park, M.D., Kyoung Oh Kim, M.D., Hyung Joon Yim, M.D., Jin Yong Kim, M.D., Jong-Jae Park, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.
Korean J Gastrointest Endosc 2004;28(1):39-42.   Published online January 30, 2004
AbstractAbstract PDF
Pseudomelanosis duodeni is a rare benign condition in which dark pigments accumulate in macrophages located in the lamina propria of the duodenal mucosa. Most reported cases had hypertension with or without chronic renal failure, and were taking antihypertensive agents and iron supplements. Therefore, it has been assumed that pseudomelanosis duodeni is associated with these medications. Our case was a 77 year-old female patient diagnosed as having hypertension, congestive heart failure, iron deficiency anemia, and depression, who had been treated with antihypertensive agents and iron supplement. Upper gastrointestinal endoscopy revealed many tiny discrete dark macules scattered throughout the first and second portions of the duodenum. Endoscopic mucosal biopsy disclosed macrophages with Prussian blue and Fontana- Masson stain positive pigments, which suggested that the nature of pigment was iron sulfide. (Korean J Gastrointest Endosc 2004;28:39⁣42)
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A Case of Anisakiasis Concurrently Invading the Stomach, Ileocecal Valve and Transverse Colon
Byeong Hun Kim, M.D., Chan Ung Park, M.D.* Jong Hyo Lee, M.D., Sang Min Yeom, M.D., Dong Yeol Chae, M.D., Sang Pil Kim, M.D.,Won Jeong Jeon, M.D., Gyu Hyeon Lee, M.D., Ho Dong Kim, M.D. and Jun Yeong Im, M.D.
Korean J Gastrointest Endosc 2004;28(1):43-46.   Published online January 30, 2004
AbstractAbstract PDF
Anisakiasis of the gastrointestinal tract is caused by the ingestion of raw fish or uncooked foods infested with Anisakis larvae belonging to the subfamily Anisakidae. With the increasing popularity of Japanese cuisine such as sashimi in Korea, the incidence of anisakiasis is expected to increase. The entire gastrointestinal tract from the esophagus to the rectum can be involved. Colonic anisakiasis is rare in comparison with gastric involvement. We report the anisakiasis concurrently invading the stomach, ileocecal valve and transverse colon treated by endoscopy with a brief review of the relevant literature. (Korean J Gastrointest Endosc 2004;28:43⁣46)
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A Case of Cavernous Hemangioma of the Colon
Sang Won Lee, M.D.*, Jong Won Choi, M.D.*, Yong Suk Cho, M.D., Jung Hun Seo, M.D., Sun Young Won, M.D., Chun Gyun Lee, M.D. and In Suh Park, M.D.
Korean J Gastrointest Endosc 2004;28(1):47-51.   Published online January 30, 2004
AbstractAbstract PDF
Gastrointestinal cavernous hemangiomas are rare, with an incidence of about 1 per 15,000 persons and the second most common vascular lesions of the colon. They are generally congenital, with their origin in embryologic sequestrations of mesodermal tissue. Enlargement occurs by projection of budding endothelial cells. These lesions are a significant cause of rectal bleeding with anemia, obstruction and rarely platelet sequestration, although approximately 10% of patients remain asymptomatic. On endoscopy, cavernous hemangiomas characteristically present as deep violet-blue nodular, compressible lesions that are associated with mucosal congestion and edema. Unfortunately chronic inflammatory changes often mask findings that could lead to proper diagnosis. The results of several kinds of treatment have not been satisfactory, although abdominoperineal resection is the most often recommended procedure. We report a case of relatively huge cavernous hemangioma of the colon that developed in an old aged patient with intermittent hematochezia. (Korean J Gastrointest Endosc 2004;28:47⁣51)
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Three Cases of Autoimmune Pancreatitis
Won Jae Yoon, M.D., Yong-Tae Kim, M.D., Yong Bum Yoon, M.D., Ji Kon Ryu, M.D., Jin-Hyeok Hwang, M.D., Hyoun Woo Kang, M.D., Su Hwan Kim, M.D., Jin Hyun Kim, M.D., Sun Whe Kim, M.D.*, Woo Ho Kim, M.D., Byung Ihn Choi, M.D. and Ji Bo
Korean J Gastrointest Endosc 2004;28(1):52-59.   Published online January 30, 2004
AbstractAbstract PDF
Autoimmune pancreatitis is a distinct entity with characteristic histologic, morphologic, and clinical features. It may be isolated or associated with Sjögren syndrome, primary biliary cirrhosis, primary sclerosing cholangitis, Crohn's disease and ulcerative colitis, or other immune-mediated disorders. Recent studies have reported the profiles of autoantibodies in autoimmune pancreatitis. Also a number of reports on single cases or small series of cases have been published. We report three cases of autoimmune pancreatitis; one case was associated with primary sclerosing cholangitis, which was misdiagnosed as pancreatic cancer; the other two cases were improved with steroid therapy. (Korean J Gastrointest Endosc 2004;28:52⁣59)
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