Clinical Endoscopy

Endoscopic Removal of Foreign Bodies in the Upper Gastrointestinal Tract: Tae Hee Lee, M.D., Gi Se Lee, M.D., Eui Hyeog Im, M.D., Kyu Chan Huh, M.D.,Chang; Korean J Gastrointest Endosc 2004;28(2):61-66. Published online March 1, 2004

Abstract PDF: Background
/Aims: Foreign bodies in the upper gastrointestinal tract are produced chiefly by accidental swallowing, but rarely produce symptoms. Although most foreign bodies pass spontaneously, 10∼20% of those need treatment. We evaluated the role of endoscopy for removal of foreign bodies in the upper gastrointestinal tract. Methods: We retrospectively reviewed 80 cases of foreign bodies in the upper gastrointestinal tract who had been treated using endoscopy at Konyang University Hospital from February 2000 to July 2003. Results: The age ranged from 14 months to 75 years (mean 36.8 years-old). Patients over 60 years, under 10 years were 20 cases and 28 cases, respectively and male to female ratio was 1.1：1. Common foreign bodies are coin (20 cases), fishbone (12 cases), animal bone (11 cases) and meat stuff (9 cases). The most common location was the esophagus (68.8%). In most cases (88.8%), foreign bodies were removed using alligator tooth forceps. Fourteen patients had co-morbidities such as esophageal diseases, psychiatric disorders, diabetes mellitus, hypertension, stomach cancer, and subtotal gastrectomy
Conclusions
Endoscopy is a useful tool for removal of foreign bodies in the upper gastrointestinal tract. (Korean J Gastrointest Endosc 2004;28:61⁣66)

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A Case of Plummer-Vinson Syndrome: Je-Wook Chae, M.D., Hyun Wook Jung, M.D., Jun Haeng Lee, M.D., Poong-Lyul Rhee,; Korean J Gastrointest Endosc 2004;28(2):67-70. Published online March 1, 2004

Abstract PDF: The combination of symptomatic hypopharyngeal webs and iron-deficiency anemia in middle-aged women constitutes Plummer-Vinson syndrome. It is uncommon but important syndrome because of inceased risk of squamous cell carcinoma of the pharynx and esophagus. The cause of this syndrome is still not clear. A small sized web is treated by correction of anemia, but a large sized one with dysphagia is treated by breakage of web. Recently, we experienced a 41-year-old woman with Plummer-Vinson syndrome. She complained of dysphagia for 10 years. Esophagogram and endoscopic examination showed a hypopharyngeal web and peripheral blood profile was compatible with iron-deficiency anemia. Her symptom improved after endoscopic balloon dilatation of the upper esophageal web. (Korean J Gastrointest Endosc 2004; 28:67⁣70)

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Two Cases of Endoscopically Diagnosed Gastric Metastatic Malignant Melanoma of: Jae Seong Ryu, M.D.^†, Hyae Ju Oh, M.D.^†, Jin Wuk Hur, M.D., Jee Yeon Kim, M.D., Jee; Korean J Gastrointest Endosc 2004;28(2):71-75. Published online March 1, 2004

Abstract PDF: Although malignant melanoma involving the stomach is commonly mentioned in association with autopsies, endoscopic experience in this gastric malignancy is still limited, and few cases have been illustrated in the literature. This clinical condition is even rarer in Asians who are much less vulnerable to malignant melanoma than Caucasians. We experienced two cases of gastric metastases of malignant melanoma which presented as indigestion and epigastric pain. In the first case, a 75-year-old man visited because of indigestion persisting for 2 months. He had a history of multiple gastric ulcer and was treated at a local medical center, but symptoms did not improved. Endoscopic finding revealed multiple and elevated lesions with central black pigmented bases. In the second case, a 47-year-old man visited because of epigastric soreness and intermittent pain for 1 month. Metastatic melanoma in the stomach was noticed by endoscopic examination. Both patients had multiple metastatic lesions in the liver, thyroid, and brain. These two cases were diagnosed as having metastatic malignant melanoma in the stomach of unknown origin. Therefore, we report these cases with a brief review of the related literature. (Korean J Gastrointest Endosc 2004;28:71⁣75)

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A Case of Primary Peripheral T-cell Lymphoma of the Stomach with Cytotoxic Phenotype: Yoon Jae Kim, M.D., Yong Chan Lee, M.D., Jae Hee Cho, M.D., Ja Kyung Kim, M.D., Kyu; Korean J Gastrointest Endosc 2004;28(2):76-80. Published online March 1, 2004

Abstract PDF: Primary gastric lymphoma is the most common form of extralymphatic non-Hodgkin's lymphoma (NHL). Most cases are of B-cell origin and few cases of lymphoma of T-cell origin have been reported. Peripheral T cell lymphoma is a lymphoma of extrathymic origin. Expression of T-cell intracellular antigen (TIA)-1 can be detected in all cytotoxic cells, and the expression of this cytotoxic protein is associated with extranodal presentation. We report a case of primary peripheral T cell lymphoma of the stomach with cytotoxic T-cell phenotype in a 70-year-old male presenting with upper gastrointestinal bleeding. (Korean J Gastrointest Endosc 2004;28:76⁣80)

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A Case of Gastric Extramedullary Tumor after Lymphoblastic Crisis in a Patient with: Hyuk Lee, M.D., Jun Haeng Lee, M.D., Jeong Hwan Kim, M.D., Sung Chul Choi, M.D.,; Korean J Gastrointest Endosc 2004;28(2):81-85. Published online March 1, 2004

Abstract PDF: A localized extramedullary tumor mass composed of immature cells has been reported in association with acute myeloid leukemia, myeloproliferative disorders, myelodysplasia in blast transformation or chronic myeloid leukemia with trilineage hematopoiesis, as well as in patients with no known hematological disorder. Although this tumor may involve anywhere in the body and give rise to a variety of signs and symptoms, there are several case reports of extramedullary tumor in Korea which described the involvement of the gastrointestinal tract. We report the occurrence of gastric extramedullary tumor and lymphoid blast crisis in a patient with complete remission after lymphoblastic transformation of chronic myelogenous leukemia. Endoscopic biopsy for gastric elevated lesion showed diffuse lymphoblast infiltration with TdT (terminal deoxynucleotidal transfe rase) and CD20 positive immature cells. (Korean J Gastrointest Endosc 2004;28:81⁣85)

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A Case of Polyarteritis Nodosa Involving Entire Gastrointestinal Tract: Won Young Cho, M.D., Tae Hun Lee, M.D., Jae Hoon Yang, M.D., Hyun Gun Kim, M.D.,; Korean J Gastrointest Endosc 2004;28(2):86-91. Published online March 1, 2004

Abstract PDF: Polyarteritis nodosa is a systemic vasculitis that affects mainly small and medium-sized muscular arteries. About half of the cases, it involves gastrointestinal tract, mainly jejunum and ileum. Major clinical manifestations are bleeding, ulcer, infection, necrosis, atrophy and stricture. Gastrointestinal involvement suggests a poor prognosis. We have experienced one case of polyarteritis nodosa involving entire gastrointestinal tract that showed various endoscopic features and confirmed by renal biopsy. (Korean J Gastrointest Endosc 2004;28:86⁣91)

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A Case of Cytomegalovirus Gastric Ulcer Mimicking Gastric Cancer in an: Lae Hyun Phyun, M.D., Kwang Hyun Ko, M.D., Esther Kim, M.D., Sun Young Kwak, M.D.,; Korean J Gastrointest Endosc 2004;28(2):92-96. Published online March 1, 2004

Abstract PDF: A 27-year-old woman presented with epigastric pain. Abdominal computed tomography revealed an irregular ulcer with circumferential thickening of the gastric antral wall. An endoscopy suggested advanced gastric cancer or gastric lymphoma. Biopsy of the lesion showed an inclusion body of the cytomegalovirus and positive immunohistochemical staining of the infected cell for cytomegalovirus. A thorough evaluation of her immune system revealed no abnormality. General supportive treatment for gastric ulcer did not relieve her symptoms. Intravenous infusion of ganciclovir improved her symptoms and healed the ulcer. We report a case of cytomegalovirus-associated gastric ulcer mimicking malignancy in an immunocompetent woman. (Korean J Gastrointest Endosc 2004;28: 92⁣96)

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A Case of Lower GI Bleeding from Portal Hypertensive Colopathy Successfully Treated: Ji Song Ko, M.D., Ju Sang Kim, M.D., Chee Ho Noh, M.D., Do Young Kim, M.D., Jong; Korean J Gastrointest Endosc 2004;28(2):97-101. Published online March 1, 2004

Abstract PDF: Cirrhotic patients with portal hypertension are often found to have changes in their colonic mucosa. Such mucosal changes are termed portal hypertensive colopathy. Most patients with portal hypertension remained asymptomatic but some may show massive bleeding. The mainstay of treatment for portal hypertensive gastropathy include non-surgical methods such as octreotide injection, endoscopic hemostasis, and interventional methods such as TIPS. However, treatment for portal hypertensive colopathy remained unresolved. The authors here report a case of a 41 year old male with liver cirrhosis admitted for fever and abdominal pain, who reported an episode of hematochezia in the course of admisssion period. Subsequent colonoscopy revealed angiodysplasia-like lesions throughout the entire colon. We observed that such lesions were the source of hematochezia and that direct clipping with octreotide injection was successful in controlling the bleeding. (Korean J Gastrointest Endosc 2004;28:97⁣101)

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A Case of Neuroendocrine Carcinoma of the Cecum Manifested as Localized Peritonitis: Hye Ryung Jung, M.D., Dae Won Kim, M.D., Seung Mun Jung, M.D., Ji Yong Ahn, M.D.,; Korean J Gastrointest Endosc 2004;28(2):102-106. Published online March 1, 2004

Abstract PDF: Neuroendocrine carcinomas of the colon and rectum are rare and have been known as either carcinoid tumors or undifferentiated cancers in the past. This type of tumor frequently occurred at cecum and is known for its aggressiveness and poor prognosis, differing from ade nocarcinoma of colon. There has been no literature which describes endoscopic findings of colonic neuroendocrine carcinoma. Therefore, we report a case of neuroendocrine carcinoma of cecum in 36-year-old man with endoscopic findings. After right hemicolectomy followed by adjuvant chemotherapy, we have followed up the patient for 6 months without the evidence of recurrence. (Korean J Gastrointest Endosc 2004;28:102⁣106)

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A Pancreaticobiliary Maljunction (New Komi Classification, Type IIIc3) with a Choledochal: Hyong Wook Kim, M.D., Won Il Park, M.D., Jong Yun Cheong, M.D., Jin Hong Park, M.D.,; Korean J Gastrointest Endosc 2004;28(2):107-111. Published online March 1, 2004

Abstract PDF: A pancreaticobiliary maljunction (PBM) is synonymous with abnormal union of the pancreaticobiliary ducts (AUPBD), anomalous arrangement of the pancreaticobiliary ductal system, etc. PBM is a congenital anomaly defined as a union of the pancreatic and biliary ducts located outside the duodenal wall. Free reflux of pancreatic juice up to the biliary tree and/or bile up to the pancreatic duct occurs. Accordingly, various pathologic conditions occur in the biliary tract and pancreas. Although the common channel is long in most cases, some patients have more complicated junctions of the pancreatic and bile ducts. We report a case of PBM with choledochal cyst and stones of the pancreaticobiliary duct in a 39 year-old woman. (Korean J Gastrointest Endosc 2004; 28:107⁣111)

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