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Volume 28(5); May 2004
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The Study of Endoscopic Mucosal Resection on Gastric Adenoma and Early Gastric Cancer-The Factors Affecting Complete Resection Rate of EMR and Histological Discrepancybetween the Endoscopic Biopsy and the the Resected Specimen-
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Eun Soon Kim, M.D.*, Jung Whan Lee, M.D., Soo Hyung Ryu, M.D., You Sun Kim, M.D.and Jeong Seop Moon, M.D.
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Korean J Gastrointest Endosc 2004;28(5):223-229. Published online May 30, 2004
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Abstract
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- Background/Aims: Endoscopic mucosal resection (EMR) has been known as a method of local treatment for early gastric cancer (EGC) or gastric adenoma. The purpose of this study was to identify the factors affecting complete resection rate (CRR) of EMR and to identify histological discrepancy between endoscopic biopsy and the resected specimen obtained by EMR. Methods: Forty four gastric adenomas and twenty seven EGCs in 63 patients were treated by EMR from January, 1999 until August, 2002. We analysed the factors affecting CRR on the basis of location, macroscopic type, size, piecemeal resection, and EMR methods. Results: The CRR in antrum was 72%. The CRR of the method using endoscopic resection with hypertonic saline-epinephrine solution, injection, precutting and snaring (ER-HSE) was 78%. The CRR according to en bloc resection was 77%. Sixty six percents of histological coincidence was noted between the endoscopic biopsy and the resected specimen of gastric adenoma. Conclusions: In this study, the CRR of the ER-HSE method and the lesion located in antrum is higher than that other groups. Gastric adenoma should be removed by EMR because of histologic discrepancy between the endoscopic biopsy and the resected specimen. (Korean J Gastrointest Endosc 2004;28:223- 229)
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A Phase III Clinical Trial of StillenTM for Erosive Gastritis
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Sang Yong Seol, M.D.*, Myung Hwan Kim, M.D.†, Jong Sun Rew, M.D.‡ and Myung Gyu Choi, M.D.§
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Korean J Gastrointest Endosc 2004;28(5):230-236. Published online May 30, 2004
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Abstract
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- Background
/Aims: Phase IIb clinical study of StillenTM, a novel cytoprotectant, for gastritis showed 180 mg of Stillen, t.i.d. for 2 weeks results in a significant increase of cure rate when compared with a placebo group. It is reported that antioxidative effect and strengthening the endogenous cytoprotective molecules of the gastric mucosa play a pivotal role for cytoprotective action of StillenTM. The aim of this phase III multicenter, double-blind comparative study was to assess the efficacy of StillenTM for the treatment of erosive gastritis. Methods: Five hundred and twelve patients with erosive gastritis were enrolled and divided into three groups. Each group received 180 mg or 360 mg of StillenTM or 600 mg of cetraxate (NeuerTM) t.i.d. for 2 weeks, respectively and a follow-up endoscopic examination for evaluation. Results: Patients treated with 180 mg and 360 mg of StillenTM had a significantly improved endoscopic cure rate of gastritis (55.6% and 57.5%, respectively) compared with patients treated with 600 mg of cetraxate (35.5%, p＜0.001). Endoscopic improvement rate was also significantly higher in 180 mg group (67.3%) and 360 mg group (65.0%) of StillenTM treated patients than cetraxate treated group (46.4%, p＜0.001). During the study, both StillenTM and cetraxate were well tolerated. Conclusions: These results clearly demonstrate that StillenTM is an efficacious, safe, and well-tolerated treatment for gastritis. (Korean J Gastrointest Endosc 2004;28:230236)
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A Case of Gastric Adenocarcinoma Arising from Gastritis Cystica Profunda
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Hye Jin Cho, M.D., Jung Eun Kim, M.D., Bong Ju Jeong, M.D., Jung Il Lee, M.D., Seok Jeong, M.D., Jin Woo Lee, M.D., Kye Suk Kwon, M.D., Don Haeng Lee, M.D., Pum-Soo Kim, M.D., Hyung Gil Kim, M.D., Yong Woon Shin, M.D. and Young Soo Kim, M.D.
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Korean J Gastrointest Endosc 2004;28(5):237-241. Published online May 30, 2004
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Abstract
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- Gastritis cystica profunda (GCP) is a disease characterized by gastric foveolae elongation along with hyperplasia and cystic dilatation of the gastric glands extending into the tisssue beneath the submucosa. It mainly occurs on the site of gastroenterostomy, but can occasionally be found in an unoperated stomach. GCP may present as a submucosal tumor or polyp, and rarely a giant gastric mucosal fold. This lesion has traditonally been regarded as a benign lesion. However, there are many debates over its malignant potential. Further investigations on the relation between GCP and gastric carcinoma may be necessary. To our knowledge, this is the second description of adenocarcinoma arising from GCP in an unoperated stomach. (Korean J Gastrointest Endosc 2004;28:237241)
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Primary Peripheral T-Cell Lymphoma of the Stomach and Duodenum
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Won Seok Kim, M.D., Kee Myung Lee, M.D., Bo Ram Koh, M.D., Young Jun Song, M.D.,Joon Hyuck Choi, M.D., Jai Keun Kim, M.D.*, Jae Ho Hahn, M.D.†, Ki Baik Hahm, M.D.,Jin Hong Kim, M.D. and Sung Won Cho, M.D.
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Korean J Gastrointest Endosc 2004;28(5):242-246. Published online May 30, 2004
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Abstract
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- About 90% of primary gastrointestinal lymphomas originate from the B-cell and less than 10% from the T-cell. In respect of anatomical location, the stomach is the most common site of gastrointestinal lymphomas followed by the ileum, colon, and rectum. However, esophagus and duodenal lymphomas are infrequently involved. Primary T-cell lymphoma of the duodenum is not common and peripheral T-cell lymphoma of the duodenum is very rare. In Korea, there has been no case report of peripheral T-cell lymphoma which simultaneously involved the stomach and duodenum. In this report, we present a case of primary peripheral T-cell lymphoma of the duodenum and stomach. A 63-year-old man was hospitalized complaining of weight loss of 15 kg and dyspepsia for 2 months. Esophagogastroduodenoscopy showed a large annular infiltrative lesion in the descending portion of the duodenum. At the posterior side of the upper body of the stomach, an ill-defined, broad, flat, and infiltrative lesion was also noted. Microscopic examination of the biopsy specimen showed that atypical bizzare lymphocytes infiltrated the mucosa of the duodenum and stomach. The lymphocyte was positive for CD3, CD5 and negative for CD20, CD23, and CD56 by immunohistochemistry. We made a diagnosis of primary peripheral T-cell lymphoma of the stomach and duodenum. We report a case of peripheral T-cell lymphoma of the stomach and duodenum with a review of the literature. (Korean J Gastrointest Endosc 2004;28:242246)
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Massive Gastric Bleeding Occuring after the Replacement of Percutaneous Endoscopic Gastrostomy Tube
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Young Mi Kim, M.D., Sang Ook Nam, M.D. and Jae Hong Park, M.D.
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Korean J Gastrointest Endosc 2004;28(5):247-250. Published online May 30, 2004
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- Percutaneous endoscopic gastrostomy (PEG) tube placement is preferred one of the standard method for providing enteral nutrition to infants and children with feeding problems. It was introduced into clinical practice in 1980 and now considered as a widely used technique. It is simple to perform and does not require general anesthesia. However, acute complications can occur with the use of PEG tubes such as wound infection, pneumoperitoneum and transient ileus. Because long-term placement of PEG tube is frequently required in pediatric patients with neurologic impairment, late-onset complications should be observed in them. We report a case of massive gastric bleeding occuring after the replacement of the PEG tube in an 8-year-old boy, as one of the late complication of PEG placement. We assumed that the mechanical trauma to hypertrophic gastric mucosa associated with incomplete buried-bumper syndrome was the cause of massive bleeding. (Korean J Gastrointest Endosc 2004;28:247250)
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Ovarian Cystadenofibroma in a Patient with Familial Adenomatous Polyposis
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Yong Soo Kim, M.D., Se Joon Lee, M.D., So Youn Shin, M.D., Cheol Kim, M.D.,Jae Bock Chung, M.D., Jin Kyung Kang, M.D., Nam Kyu Kim, M.D.*,Ho Guen Kim, M.D.† and Nam-Hoon Cho, M.D.†
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Korean J Gastrointest Endosc 2004;28(5):251-256. Published online May 30, 2004
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- Familial adenomatous polyposis (FAP) is a hereditary disease characterized by the appearance of numerous polyps in the large bowel with a high potential for malignant transformation unless untreated. A variety of extracolonic manifestations were reported such as osteoma, epidermoid cyst, desmoid tumor, gastroduodenal polyps, small bowel tumor, congenital hypertrophy of the retinal pigment epithelium, hepatobiliary tumor, thyroid tumor, and tumor of the central nervous system. However, the ovarian involvement of FAP as an extracolonic manifestation was very rare and there have been only few reports. We experienced a rare case of ovarian cystadenofibroma in a patient with FAP as an extracolonic manifestation. We also found colon cancer with multiple hepatic metastasis initially manifested as intestinal obstruction in the same patient. Surgical treatment and subsequent chemotherapy for colon cancer and intraoperative radiofrequency ablation of hepatic metastasis were performed. (Korean J Gastrointest Endosc 2004;28:251256)
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Spontaneously Reduced Invaginated Appendiceal Intussusception after Colonoscopic Examination
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Jong Hyun Park, M.D., Hiun Suk Chae, M.D., Young Seok Cho, M.D., Bo In Lee, M.D., Kang Moon Lee, M.D., Byung Wook Kim, M.D., Hwang Choi, M.D., Sung Soo Kim, M.D., Sok Won Han, M.D., Chang Don Lee, M.D., Kyu Yong Choi, M.D., In Sik Chung, M.D. and Young Mi
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Korean J Gastrointest Endosc 2004;28(5):257-261. Published online May 30, 2004
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- Appendiceal intussusception is an uncommon type of intussusception with the incidence of 0.01% in children and adults. In many cases it was developed by secondary conditions, such as polyps, carcinoma or lymphoma. But some other cases was reduced after barium enema study and had none of initiating causes. Therefore, making an accurate diagnosis is important in providing the optimal treatment for the patient. We present an appendiceal intussusception spontaneously reduced after colonoscpic examination. A 61-year-old woman with indigestion, nausea and right lower quadrant abdominal tenderness was admitted for further evaluation and treatment. Colonoscopic exam revealed a invaginated appendix with normal appearing covring mucosa intraluminaly. Blind mucosal biopsies on the appendiceal orifice yielded mild inflammatory cell infiltration. Two days after the colonoscopic procedure, patient's abdominal symptoms and sign were disappeared. Abdominal CT scan revealed that appendiceal intussusception was spontaneously reduced and a few several reactive mesenteric lymphadenopathy was observed. The ultrasound scan revealed the appendiceal wall swelling. The patient was discharged after the relief of abdominal symptom without further treatment. (Korean J Gastrointest Endosc 2004;28:257261)
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A Case of Psammomatous Carcinoid Tumor of the Ampulla of Vater
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Jon Suh, M.D., Jae Hoon Yang, M.D., Su Jin Hong, M.D., Sang Woo Cha, M.D., Jong Ho Moon, M.D., Yong Deok Cho, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D., Boo Sung Kim, M.D., Hyung Chul Kim, M.D.* and Kye Won Kwon, M.D.†
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Korean J Gastrointest Endosc 2004;28(5):262-266. Published online May 30, 2004
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- Carcinoid tumors of the ampulla of Vater are rare. The variant form of ampullary carcinoid tumors containing psammoma bodies is noted extremely rare and produces somatostatin. Obstructive jaundice is the most common presenting symptom of ampullary carcinoid tumor. It is difficult to diagnose ampullary carcinoid tumor preoperatively because of their relatively small size and submucosal location. We report a case of ampullary psammomatous carcinoid tumor and also review the literature. Deep biopsies were taken from the edges of the papillotomy wound of the protruded ampulla of Vater from a 51- year-old man. The histology was consistent with psammomatous carcinoid. 111In-octreoscan revealed an abnormal focal increased radiouptake in the infrahepatic area which suggested the presence of a somatostain producing tumor. The patient underwent a Whipple's operation. (Korean J Gastrointest Endosc 2004;28:262266)
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A Case of Hemosuccus Pancreaticus Showing Active Bleeding from the Ampulla of Vater
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Hyun Bae Son, M.D., Young-Soo Moon, M.D., Jeon Ho Yang, M.D., Cho-Rhom Ham, M.D., Seuk Hyun Lee, M.D., Ung Ryu, M.D., Jea Wook Roh, M.D., Sang Eun Lee, M.D., Kyung-Ah Kim, M.D. and Yun Hee Han, M.D.*
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Korean J Gastrointest Endosc 2004;28(5):267-272. Published online May 30, 2004
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- Hemorrhage through the pancreatic duct into the duodenum, so called 'hemosuccus pancreaticus', is a rare cause of gastrointestinal bleeding with diagnostic difficulties. We report a 44-year-old man with recurrent upper gastrointestinal bleeding due to rupture of pseudoaneurysm into the pancreatic duct. Initial upper gastrointestinal endoscopy failed to identity the site of the hemorrhage. Active bleeding from the ampulla of Vater in duodenum was found on repeat endoscopy. Abdominal computed tomography disclosed pseudoaneurysm arising from the splenic artery caused by chronic pancreatitis. Splenic angiogram showed large psudoaneurysmal sac with wide neck, arising from distal splenic artery. Angiographic embolization was successful in controlling the arterial hemorrhage. The patient remained symptom-free 5 months after the embolization. Hemosuccus pancreaticus, although rare, remains important in the differential diagnosis of upper gastrointestinal bleeding of obscure orgin. (Korean J Gastrointest Endosc 2004;28:267272)
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Endoscopic Minor Papilla Intervention in a Patient with Traumatic Ductal Leak without Pancreas Divisum
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Jong Ha Park, M.D., Myung-Hwan Kim, M.D., Moon Hee Song, M.D., Do Hyun Park, M.D.,Jung Joon Choi, M.D., Sung Hee Pyo, M.D., Jin Ook Jeong, M.D., Sung Doo Kim, M.D., Hyun Young Son, M.D.,Sang Soo Lee, M.D., Dong Wan Seo, M.D. and Sung Koo Lee, M.D.
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Korean J Gastrointest Endosc 2004;28(5):273-276. Published online May 30, 2004
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- Endoscopic treatment has been performed in a variety of pancreatic ductal diseases such as stones, strictures, sphincter stenosis, and ductal disruption and is known to be an effective therapy in some patients. Endoscopic treatment through the minor papilla is frequently done in patients with pancreas divisum. Few data are, however, available concerning endoscopic minor papilla interventions in patients without pancreas divisum but with difficult access to the main pancreatic duct at the major duodenal papilla. We present a 49-year-old man, who had pancreatic ductal leak caused by previous pancreatic surgery. He was treated by endoscopic naso-pancreatic drainage and pancreatic ductal stenting through the minor papilla, so called pancreatic rendezvous technique. Follow- up ductography after two-weeks of naso-pancreatic drainage showed no leak. This case shows that minor papillar orifice could be an alternative access for therapeutic endoscopic intervention in a patient with traumatic pancreatic ductal leak without pancreas divisum. (Korean J Gastrointest Endosc 2004;28:273276)
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