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Volume 31(4); October 2005
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소화관 내시경 점막절제술 좌담회
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Korean J Gastrointest Endosc 2005;31(4):6-8. Published online September 30, 2005
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병리학적 검색
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Korean J Gastrointest Endosc 2005;31(4):9-11. Published online September 30, 2005
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Primary Duodenal Malignant Tumors Missed at Initial Upper Endoscopy
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Dong Hyun Sinn, M.D., Jun Haeng Lee, M.D., Tae Wook Kang, M.D., Jeong Kim, M.D., Yong Sung Choi, M.D., Moon Kyung Park, M.D., Kyung-Mok Sohn, M.D., Poong-Lyul Rhee, M.D., Jae J. Kim, M.D., Seung Woon Paik, M.D. and Jong Chul Rhee, M.D.
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Korean J Gastrointest Endosc 2005;31(4):211-215. Published online October 30, 2005
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Abstract
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- Background
/Aims: Upper endoscopy is an effective method for diagnosing duodenal cancer, however endoscopy sometimes overlook the lesion. Methods: We did a retrospective review of sixty-eight patients with non-ampullary primary malignant duodenal tumors treated at Samsung Medical Center between 1994 to 2003. Thirteen of 68 patients (20%), whom were not diagnosed by initial endoscopy were analyzed. Results: Twelve were male and mean age were 52.7⁑11.4 years. Histopathologic analysis revealed adenocarcinoma in 10 patients, stromal tumor 2, and lymphoma 1. Weight loss, abdominal pain, bleeding, and vomiting were the presenting symptoms. Initial endoscopy missed the lesion in 9 patients. In 5 patients, location of the lesions were third and fourth portion of the duodenum, difficult to be locations seen by usual endoscopic examination. Four were in the duodenal second portion, and undiagnosed without specific reason. The lesions were seen at initial endoscopy in 4 patients, however biopsy was done in only one patient because the lesion was considered as benign, initially. The median interval to diagnosis from initial upper endoscopy were 35 days (7∼109 days). Conclusions: Some duodenal lesions were missed at initial endoscopic examination. Our study suggests that it is crucial to examine beyond the duodenal bulb and biopsy should be considered when the lesion is not typically looking as benign. (Korean J Gastrointest Endosc 2005;31:211215)
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The Endoscopic Findings and Clinical Characteristics of Gastrointestinal Amyloidosis
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Won Moon, M.D., Oh Young Lee, M.D., Yun Ju Cho, M.D.*, Sun Young Yang, M.D., Ho Yong Park, M.D., Sung Hee Han, M.D., Hang Lak Lee, M.D., Byoeng Chul Yoon, M.D., Ho Soon Choi, M.D., Joon Soo Hahm, M.D., Min Ho Lee, M.D., Dong Hoo Lee, M.D. and Choon Suhk K
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Korean J Gastrointest Endosc 2005;31(4):216-220. Published online October 30, 2005
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- Background
/Aims: Gastrointestinal involvement is common in systemic amyloidosis. However, there have not been reports of any specific endoscopic findings which indicate amyloidosis in the gastrointestinal tracts in Korea. We aimed to find out the endoscopic findings and clinical characteristics of gastrointestinal amyloidosis. Methods: We analyzed seventeen histologic proven amyloidosis cases that all performed the endoscopy in Hanyang Medical Cencer. Results: The main findings of gastroscopy were multiple erosions (5 cases), ulcer (3 cases), nodularities and hyperemic mucosa (1 case). Colonoscopic findings were hyperemic mucosa (8 cases), nodularities (3 cases), hemorrhagic spots (3 cases) and ulcers (3 cases). Conclusions: When a patient undergoing chronic inflammatory diseases has various abdominal symptoms, endoscopic biopsy should be done in every case because grossly normal looking mucosa dose not preclude the histologic evidence of amyloidosis. (Korean J Gastrointest Endosc 2005;31:216220)
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Comparison of Hemostatic Effects between a Combination Therapy Including Endoscopic Injection Therapy and Omeprazole and a Single Intravenous Omeprazole Therapy in Patients with Bleeding Peptic Ulcers
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Seon Hee Lim, M.D., Nayoung Kim, M.D.* and Kye Heui Lee, M.D.†
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Korean J Gastrointest Endosc 2005;31(4):221-228. Published online October 30, 2005
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- Background
/Aims: This study was performed to test whether there is some difference between combined endoscopic therapy with PPI infusion and intravenous PPI therapy alone. Methods: A total of seventy-three high-risk patients with ulcer bleeding and non-bleeding visible vessels or fresh adherent clots resistant to irrigation were randomized to medical therapy [intravenous omeprazole therapy alone: 40 mg IV per day for 3∼5 days] or to endoscopic combination therapy [endoscopic epinephrine (1：10,000 in normal saline) or ethanol injection followed by intravenous omeprazole infusion]. Results: Patients were similar at study entry. Ulcer bleeding recurred in two patients who received combined endoscopic therapy (2/35, 5.7%) while ulcer bleeding recurred in ten patients who received intravenous omeprazole alone (10/38, 26.3%) (p＜0.05). Two patients (2/35, 5.7%) in the combined therapy group and five patients (5/38, 13.2%) in the omeprazole infusion alone group had surgery for intractable bleeding (p=0.281). One patient in each group died within the hospital stays (p=0.953). Conclusions: The combination of endoscopic injection therapy with omeprazole infusion is superior to omeprazole infusion alone for preventing recurrent bleeding from ulcers with nonbleeding visible vessels or adherent clots. (Korean J Gastrointest Endosc 2005;31:221228)
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Prospective Comparing the Efficacy of CT Colonography and Colonoscopy for Detecting Colorectal Adenomatous Polyp in Asymptomatic Adults
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Young Sun Kim, M.D., Nayoung Kim, M.D.*, Sae Hyoung Kim, M.D.‡, Min Jung Park, M.D., Seon Hee Lim, M.D., Jeong Yoon Yim, M.D., Kyung Ran Cho, M.D., Sun Sin Kim, M.D., Hyo Won Eun, M.D., Kyoung Soo Cho, M.D., Byung Inhn Choi, M.D.‡, H
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Korean J Gastrointest Endosc 2005;31(4):229-236. Published online October 30, 2005
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/Aims: The purpose of this study is to evaluate the efficacy of CT colonography (CTC) in comparison with colonoscopy for the detection of colorectal adenomatous polyp in asymptomatic adults. Methods: A total 208 asymptomatic adults underwent successive CTC and colonoscopy, on the same day. Results: On the analysis of adenomatous polyps per subject, the sensitivity of CTC was 90% (9/10) in case of polyps ≥10 mm in size, and 67.7% (21/31) in case of polyps ≥6 mm in size. Those values of colonoscopy were 100% and 93.5%, respectively. The per-patient specificity of CTC was 98.0% (194/198) in case of polyps ≥10 mm in size and 88.1% (156/177) in case of polyps ≥6 mm in size. CTC missed 4 (3 flat adenomas and, 1 sessile adenoma) out of 17 adenomatous polyps ≥10 mm in size in 2 subjects. Conclusions: In asymptomatic adults, the sensitivity of CTC for detecting adenomatous polyps was lower than that of colonoscopy, particularly for the small lesions below 10 mm in size, and also for the flat adenomas ≥ 10 mm in size. However, CTC showed a high sensitivity and specificity for detecting the subjects with clinically important colorectal adenomatous polyps ≥ 10 mm in size. These results suggest that CTC has potential as a screening method for colorectal neoplasm. (Korean J Gastrointest Endosc 2005;31:229236)
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A Case of Endoscopic Mucosal Resection for Esophageal Adenocarcinoma Arising from Barrett's Esophagus
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Shin Ae Kang, M.D., Do Young Kim, M.D., Jie Hyun Kim, M.D., Byung Chang Kim, M.D., Jae Bock Chung, M.D., Hae Ryoung Kim, M.D.* and Ho Guen Kim, M.D.*
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Korean J Gastrointest Endosc 2005;31(4):237-242. Published online October 30, 2005
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- Barrett's esophagus is defined as the replacement of normal squamous epithelium of distal esophagus with metaplastic columnar epithelium. It is a well known risk factor of esophageal adenocarcinoma. If high grade dysplasia or early stage esophageal cancer develops in a patient with Barrett's esophagus, esophagectomy shoud be performed. However, operative procedures have various complications and the patients may suffer resulting in poor quality of life. Therefore, if the cancer is detected at an early stage such as superficial mucosal lesion, it is possible to resect the tumor with the use of endoscopic technique. Furthermore, endoscopic mucosal resection (EMR) also can be performed for the patients with mucosal or submucosal cancer who can not receive esophagectomy due to old age or poor general condition. We experienced a case of esophageal adenocarcinoma from Barrett's esophagus which had been successfully resected endoscopically. (Korean J Gastrointest Endosc 2005;31:237242)
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A Case of Esophageal Obstruction after Cyanoacrylate Injection Sclerotherapy
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Won Joong Jeon, M.D., Jeong Chul Seo, M.D., Seong Woo Lim, M.D., Ki Man Lee, M.D., Hee Bok Chae, M.D., Seon Mee Park, M.D., Il Hun Bae, M.D.*, Seong Jin Kim, M.D.* and Sei Jin Youn, M.D.
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Korean J Gastrointest Endosc 2005;31(4):243-247. Published online October 30, 2005
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- Cyanoacrylate is well recognized for its effect in the treatment of the gastric variceal bleeding rather than the esopahgeal variceal bleeding. We used endoscopic injection sclerotherapy (EIS) with cyanoacrylate for the control of esophageal variceal bleeding in which endoscopic variceal ligation (EVL) was difficult due to severe post-EVL scar changes of the esophageal mucosa. The hemostasis by EIS with cyanoacrylate was successfully achieved despite the massive bleeding. However, esophageal obstruction occurred after the EIS treatment. Later, the obstruction resolved spontaneously as the polymer was expelled into the esophageal lumen. We report this case with a brief review of the literatures. (Korean J Gastrointest Endosc 2005;31:243247)
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A Case of Primary Upper Esophageal Small Cell Cancer with Cervical Lymph Node Metastasis
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Byung Hyo Cha, M.D., Do Ho Moon, M.D., Seung Min Jeon, M.D., Na Ri Lee, M.D., Kil Hyo Park, M.D., Jin Nam Hyun, M.D. and U Ju Yoo, M.D.
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Korean J Gastrointest Endosc 2005;31(4):248-251. Published online October 30, 2005
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- Esophageal small cell carcinoma is a very rare disease. Primary extra-pulmonary small cell carcinoma was reported to account for 4% of primary small cell carcinoma and only 2% of all esophageal malignancy. Because the rate of early distant metastasis is very high, the prognosis is very poor. In Korea, 20 cases were reported. Seventeen cases were located at the mid or lower esophagus and 3 cases were located at the upper esophagus. We have experienced a case of primary upper esophageal small cell cancer, a 65-year-old female with cervical lymph node metastasis, which were diagnosed by endoscopy, open surgical lymph node biopsy and immunohistochemical analysis. (Korean J Gastrointest Endosc 2005;31:248251)
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A Case of Esophageal Tuberculous Abscess
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Jong Hwan Park, M.D., Hwa Mi Kang, M.D., Min Woong Kim, M.D., Chi Hoon Kim, M.D., Ji Hoon Yoon, M.D., Hyung Wook Kim, M.D., Seung Keun Park, M.D., Hee Ug Park, M.D. and Jong Han Ok, M.D.
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Korean J Gastrointest Endosc 2005;31(4):252-256. Published online October 30, 2005
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- Primary esophageal involvement by tuberculosis is rare. Clinical symptoms are variable and nonspecific in which dysphagia is the most common presenting symptom. Endoscopic findings are also diverse and nonspecific and ulcerative form is a common manifestation. For a definite diagnosis, Endoscopic biopsies are useful but typical granuloma is seen in approximately 50% of cases and acid-fast bacilli are demonstrated in less than 25% of patients. Fine needle aspiration cytology and polymerase chain reaction are helpful for diagnosis. A 54-year-old man was presented with throat discomport. Endoscopy demonstrated hematoma like lesion with pus discharge from ulceration in the proximal esophagus. Esophageal tuberculosis was confirmed based on the biopsy and culture results, and he was treated with antituberculous medications. At the follow-up endoscopy, 6 months later, previous lesion was completely healed to scar. (Korean J Gastrointest Endosc 2005;31:252256)
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A Case of Hepatic Angiosarcoma Presenting as Submucosal Tumor Resulting from Gastric Invasion
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Hwa Mi Kang, M.D., Jung Nam Lee, M.D., Min Woong Kim, M.D., Chi Hoon Kim, M.D., Jong Hwan Park, M.D., Ji Hoon Yoon, M.D., Hyung Wook Kim, M.D., Seung Keun Park, M.D., Hee Ug Park, M.D. and Hye Sook Kim, M.D.*
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Korean J Gastrointest Endosc 2005;31(4):257-262. Published online October 30, 2005
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- Angiosarcoma accounts for 1% of all soft tissue sarcoma. Common sites of occurrence include the skin, breast, soft tissue, and liver. It metastasizes to the lungs, bone, and spleen. The cause of hepatic angiosarcoma in the 60% of cases is unknown, although specific risk factors such as vinyl chloride, arsenic, thorotrast and external-beam irradiation have been identified. Since 1986, about eight cases of hepatic angiosarcoma have been reported in Korea, but it had not been reported in which the hepatic angiosarcoma invaded to the stomach, yet. So we report a case of histopathologically confirmed primary hepatic angiosarcoma with gastric involvement. In this case, a sixtythree-year-old female was presented with indigestion and epigastric soreness for 1 year. Endoscopic examination of the stomach revealed a submucosal tumor-like protruding mass from the antrum to angle. The mucosal surface showed severe hyperemia and shallow ulcerative change was seen. Endoscopic biopsy and percutaneous liver biopsy confirmed the diagnosis of hepatic angiosarcoma invading the gastric wall. (Korean J Gastrointest Endosc 2005;31:257262)
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A Case of Colorectal Villous Adenoma Found with PET-CT
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Tae Ho Kim, M.D., Soo-Heon Park, M.D., Hyun Jong Oh, M.D., Dae Young Cheung, M.D., So Yeon Lee, M.D., Jin Il Kim, M.D., Joon-Yeol Han, M.D., Jae Kwang Kim, M.D., Kyu Won Chung, M.D. and Hee Sik Sun, M.D.
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Korean J Gastrointest Endosc 2005;31(4):263-267. Published online October 30, 2005
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- Adenomatous polyp in colorectal area is clinically important as being a precursor of colorectal cancer. Early detection of cancer reduces colorectal cancer mortality. Finding and removing precursor adenomas reduces colorectal cancer incidence especially in high risk groups. FDG-PET/CT is a new imaging technology in which a number of clinical applications has been recognized in oncologic imaging. FDG-PET has been shown to detect a wide variety of tumor foci including lymphoma, melanoma, lung cancer and colorectal cancer. Colorectal adenoma can also be detected by FDG-PET. In this case, we describe a colorectal villous adenoma, which was found by FDG-PET/CT. There was a mass of intensely increased FDG uptake in rectal area. The adenoma was confirmed with sigmoidoscopy and removed by polypectomy. (Korean J Gastrointest Endosc 2005;31:263267)
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A Case of Clonorchiasis Presenting as Common Hepatic Duct Mass
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Choul Woong Hwang, M.D., Byung Wook Lim, M.D., Ung Ryu, M.D., Jong Hoon Kim, M.D., Hye Yeon Park, M.D., Kyung Il Park, M.D., Sung Moon Jung, M.D., Kyung-Ah Kim, M.D., Jeon Ho Yang, M.D., June Sung Lee, M.D., Young Soo Moon, M.D., Young Bin Jeon, M.D.*, Sa
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Korean J Gastrointest Endosc 2005;31(4):268-272. Published online October 30, 2005
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- The liver fluke, Clonorchis sinensis is an important human parasite and is endemic in Eastern Asia including Korea, China, and Japan. Patients acquire the infestation by eating raw or undercooked freshwater fish. Radiologic examinations usually reveal dilated peripheral intrahepatic bile ducts and normal extrahepatic bile duct. The diagnosis of clonorchiasis may sometimes be difficult and a presentation as an obstructive mass at the common hepatic duct is a rare event. Here we report a case of clonorchiasis of 54-year- old woman presented with epigastric pain. Endoscopic retrograde cholangiography revealed a mass at the common hepatic duct with dilatation of the intrahepatic ducts mimicking cholangiocarcinoma. Using an endoscopic basket, muddy, sludge-like materials were extracted through the papillary orifice. We report this case with a review of literatures. (Korean J Gastrointest Endosc 2005;31:268272)
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Rupture of a Bleeding Pancreatic Pseudocyst into the Stomach: a Case Report
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Young Don Kim, M.D., Byung Kyu Nah, M.D., Jung Won Hwang, M.D., Hyun Il Hong, M.D., Sung Kyu Yoon, M.D., Koon Hee Han, M.D., Hye Young Choi, M.D., Kwang Seok Kim, M.D., Jae Hong Ahn, M.D.* and Gab Jin Cheon, M.D.
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Korean J Gastrointest Endosc 2005;31(4):273-277. Published online October 30, 2005
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- Pancreatic pseudocyst is a well-known complication of pancreatitis. However spontaneous perforation and/or fistularization is rare. Perforations into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity, and through the abdominal wall have been reported. Rupture of pseudoaneurysm or bleeding pseudocyst following pancreatitis is a severe complication that can lead to massive gastrointestinal bleeding. Especially, rupture of a bleeding pseudocyst into the stomach combined with splenic artery pesudoaneurysm is very rare. We experienced a case of massive bleeding from pancreatic pseudocyst with pseudoaneurysmal rupture into the stomach which was controlled nonoperatively by splenic artery coil embolization and conservative treatment. We report the case with the literatures review. (Korean J Gastrointest Endosc 2005;31:273277)
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A Case of Hepatocellular Carcinoma Invading Intrahepatic Duct Complicated by Hemobilia
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Soo-Jeong Cho, M.D., Ji Kon Ryu, M.D., Sun-Jung Myung, M.D., Cheol Min Shin, M.D., Dong Won Ahn, M.D., Su Jong Yu, M.D., Ji-Won Yu, M.D., Jin Ho Paik, M.D.*, Gyeong Hoon Kang, M.D.* and Hyo-Suk Lee, M.D.
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Korean J Gastrointest Endosc 2005;31(4):278-280. Published online October 30, 2005
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- A seventyone-year-old male presented with sudden epigastric pain followed by jaundice and intermittent right upper abdominal pain. He was diagnosed as hepatocellular carcinoma 7 years ago, and has been treated with transarterial chemoembolization, percuaneous ethanol injection and segmentectomy. On admission, the level of serum bilirubin, amylase and lipase were 8.7 mg/dL, 560 IU/L, and 13,297 IU/L, respectively. Stool occult blood test was positive. Abdominal computed tomography revealed newly- appeared intraductal soft tissue mass with ductal dilatation. Endoscopic retrograde cholangiography demonstrated filling defects in the common hepatic and distal common bile duct (CBD). Endoscopic sphincterotomy was performed and the clots in the distal CBD were removed. An intraductal stent was inserted at the common hepatic duct. The obstructive jaundice and pancreatitis were resolved. Our case suggests that intraductal hepatocellular carcinoma may induce hemobilia as a possible cause of acute pancreatitis. (Korean J Gastrointest Endosc 2005;31:278281)
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