Clinical Endoscopy

Photodynamic Therapy for Superficial Gastrointestinal Tumors: Young Koog Cheon, M.D., Dae Hee Han, M.D., In Seop Jung, M.D., Chang Beom Ryu, M.D., Joo Young Cho, M.D., Yun Soo Kim, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.; Korean J Gastrointest Endosc 2006;32(2):81-86. Published online February 27, 2006

Abstract PDF: Background
/Aims: Although photodynamic therapy (PDT) has been used for the endoscopic treatment of digestive cancer, its curative efficacy remains uncertain. This study evaluated the curative role of PDT in superficial gastrointestinal cancer. Methods: Fifteen lesions in 14 patients with a histologically proven carcinoma (early esophageal cancer 6, early gastric cancer 8, ampulla of Vater cancer 1) were injected with an intravenous hematoporphyrin derivative (2 mg/kg), and PDT was performed 48 hours later. The response to treatment was assessed by gastroscopy with biopsies. Results: The median follow-up time was 273 days (42∼1,030 days). According to the TNM stage of endoscopic ultrasonography, there were 14 T1 cases and 1 T2 case. Complete remission was observed in 13 cases after the initial and consecutive PDT. There were 2 cases of failure. The recurrence rate was 15.4% (2/13), and the median time from the initial PDT to recurrence was 349 days. Conclusions: PDT using a hematoporphyrin derivative as a photosensitizer is a safe and efficient method for treating early cancer. However, a long-term follow up period using a large population sample will be needed for confirmation. (Korean J Gastrointest Endosc 2006;32:81⁣86)

1,961 View
4 Download

Endoscopic Papillectomy for Tumors of the Duodenal Major Papilla: Myoung Hwan Kim, M.D., Chang Mo Moon, M.D., Seungmin Bang, M.D., Byung Kyu Park, M.D., Seung Woo Park, M.D., Si Young Song, M.D. and Jae Bock Chung, M.D.; Korean J Gastrointest Endosc 2006;32(2):87-93. Published online February 27, 2006

Abstract PDF: Background
/Aims: A surgical resection has traditionally been used to treat tumors of the duodenal major papilla. However, radical surgery may cause significant morbidity and mortality. Endoscopic papillectomy has been reported in patients with benign papillary tumors. We evaluated the safety and outcomes of endoscopic papillectomy in patients with a papillary tumor. Methods: Between January 1994 and December 2003, fifteen patients with ampullary tumors underwent an endoscopic papillectomy using a snare resection. Endoscopic papillectomy was performed in 13 patients diagnosed with an adenoma and in 2 patients diagnosed with an adenocarcinoma, who were contraindicated for surgery. Results: Endoscopic papillectomy was performed in fifteen patients (11 men, 4 women: median age 61.7 years). All the tumors were removed either "en bloc" (14 tumors) or in a "piecemeal" fashion (one tumor). Ten patients were available for follow-up (median, 20.9 months: range, 1∼62 months). The procedure-related complications were bleeding (n=1), pancreatitis (n=3), and a duodenal perforation (n=1). The follow-up endoscopy revealed a recurrent adenocarcinoma in 2 patients after 13 months (20%). Conclusions: Endoscopic papillectomy is a useful alternative for treating a papillary adenoma. The relatively high incidence of pancreatitis this study suggests that stenting into the pancreatic duct will be needed to prevent postprocedure pancreatitis. (Korean J Gastrointest Endosc 2006;32:87⁣93)

1,815 View
6 Download

Biliary Complications after Adult Liver Transplantation: Sang Soo Lee, M.D., Kyu Taek Lee, M.D., Sun-Young Lee, M.D., Tea Wook Kang, M.D., Won Moon, M.D., Ji Young Hwang, M.D., Min Kyu Yu, M.D., Jong Kyun Lee, M.D., Seung Woon Paik, M.D., Jae-Won Joh, M.D.*, Suk-Koo Lee, M.D.*, Sang Heum Kim, M.D.^† a; Korean J Gastrointest Endosc 2006;32(2):94-100. Published online February 27, 2006

Abstract PDF: Background
/Aims: Recently, living donor liver transplantation (LDLT) has been frequently performed in Korea because of the limited availability of a cadaveric donor (CD). We evaluated the clinical features of patients with biliary complications after liver transplantation and we compared the incidence of biliary complications according to the type of donor and the anastomotic type of the biliary tract. Methods: Between May 1996 and July 2004, 300 patients (CDLT 102/LDLT 198) underwent liver transplantation at Samsung Medical Center. The patients who experienced biliary complications during the follow-up period were enrolled to the study and we retrospectively reviewed their cases. Results: Sixty-seven cases (23%) of biliary complications were noticed in 53 patients (18%). The complications consisted of 20 cases (7%) of bile leakage, 38 cases (13%) of biliary strictures, 7 cases (2%) of biliary stones, and 2 cases (1%) of biliary stenosis due to other cause. There was no significant difference on the incidence of complications between CDLT (15/102; 14.7%) and LDLT (38/198; 19.2%) (p=0.42). In addition, there was no significant difference between choledocho-choledochostomy (43/237; 18.1%) and hepatico-jejunostomy (10/ 63; 15.9%)(p=0.85) Conclusions: The incidence rate of biliary complication after liver transplantation was 23%, and there was no difference according to the type of donor and the anastomotic type of biliary tract. (Korean J Gastrointest Endosc 2006;32:94⁣100)

2,244 View
15 Download

Comparative Cholangiocytotoxicity between Ioxithalamate and Iopromide with Short-term Exposure: Young Min Ju, M.D., Sung Koo Lee, M.D., Myung Hwan Kim, M.D., Dong Wan Seo, M.D., Sang Soo Lee, M.D., Jae Myung Cha, M.D., Eun Kwang Choi, M.D. and Seok Won Jung, M.D.; Korean J Gastrointest Endosc 2006;32(2):101-108. Published online February 27, 2006

Abstract PDF: Background
/Aims: In a previous study examining long- term exposure to contrast media, high-osmolar ionic contrast media were reported to be more cytotoxic to gallbladder epithelial cells than low-osmolar nonionic contrast media. However, biliary epithelial cells are rarely exposed to contrast media for such long periods in clinical practice. This study compared the cytotoxicity of two types of contrast media to gallbladder epithelial cells exposed for a short-term. Methods: Ioxithalamate and iopromide were tested, and dog gallbladder epithelial cells were used as the test cells. The cells were exposed to the two contrast agents with increasing iodine concentration and osmolality for 30 minutes. The number of cells, aneuploidy and supernatant LDH activities were measured each day. Results: The growth of cells exposed to the two contrast media was significantly reduced but there was no difference between the two contrast media at the same iodine concentration. The level of cell lysis measured by the supernatant LDH activities before the triton X-100 treatment was similar with the two contrast media. No aneuploidy fraction was detected in any of the cell groups treated with the two contrast media for 5 days. Conclusions: In contrast to previous results, high-osmolar ionic and low-osmolar nonionic contrast media with short- term exposure were found to have a similar cytotoxicity to biliary epithelial cells. (Korean J Gastrointest Endosc 2006;32:101⁣108)

1,565 View
5 Download

Can EUS Help to Differentiate Macrocystic Serous Cystadenoma from Mucinous Cystadenoma of the Pancreas by Its Morphologic Characteristics?: Seok Won Jung, M.D., Sang Soo Lee, M.D., Kyu Pyo Kim, M.D., Moon Hee Song, M.D., Jimin Han, M.D., Jong Cheol Kim, M.D., Eun Kwang Choi, M.D., Young Min Joo, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D., Myung-Hwan Kim, M.D. and Se Jin Jang, M.D.*; Korean J Gastrointest Endosc 2006;32(2):109-115. Published online February 27, 2006

Abstract PDF: Background
/Aims: A macrocystic variant of a serous cystadenoma (M-SCA) is usually indistinguishable from a mucinous cystadenoma (MCA) as a result of their morphologic similarity on conventional imaging studies. However, a MCA requires a resection due to its malignant potential. The aim of this study was to determine the EUS morphological characteristics of a M-SCA to determine if they could be used to help differentiate it from MCA. Methods: The clinical and EUS morphologic characteristics were examined in 31 consecutive patients with M-SCA and MCA who underwent surgery. Results: Resected specimens were available from 11 M-SCAs and 20 MCAs. Significant differences were observed with regard to the age and location within the pancreas. On EUS, most of the M-SCA contained microcysts (82%) compared with only 15% of MCA cases, and a lobulated configuration of the cyst was observed more frequently in the M-SCA cases than in the MCA (91% vs. 25%). The combination of microcysts and the lobulated configuration of the cysts had a 100% specificity and positive predictive value for differentiating M-SCA from MCA. Conclusions: M-SCA tends to occur at a relatively younger age than MCA, and is located mainly in the head of the pancreas. Although there is considerable morphological similarity between M-SCA and MCA on the conventional imaging modalities, the morphological characteristics obtained from EUS including microcysts with a lobulated configuration may help to make a distinction between M-SCA and MCA. (Korean J Gastrointest Endosc 2006;32:109⁣115)

1,867 View
4 Download

A Case of Anisakiasis Concurrently Invading Esophagus and Stomach, and Another Case of Esophageal Anisakiasis: Jong Hyun Kim, M.D., Jung Up Hwang, M.D., Sang Hyun Kim, M.D., Kyu Hak Kim, M.D., Seong Joo Kang, M.D., Kab Sik Kim, M.D., Jong Hyun Hur, M.D. and Seong Ho Choi, M.D.; Korean J Gastrointest Endosc 2006;32(2):116-119. Published online February 27, 2006

Abstract PDF: Human anisakiasis may occur after ingestion of raw marine fish infected with the nematode larvae of Anisakidae. Clinical symptoms such as cramping abdominal pain, nausea, vomiting, diarrhea and epigastric fullness, usually develop within 12 hours after having eaten infected raw sea fish. Anisakiasis is most commonly found in the stomach, and is rarely identified in the small intestine, large intestine, and esophagus. We report two cases of of anisakiasis, one with concurrent invasion of the stomach and esophagus, and the other case with esophageal anisakiasis. Both were treated by endoscopic extraction of the larvae. (Korean J Gastrointest Endosc 2006;32:116⁣119)

2,215 View
12 Download

A Case of Gastritis Cystica Profunda Associated with Tubular Adenoma: Min Jai Lee, M.D., Sang Ho Lee, M.D., Bong Gap Kim, M.D., Jin Man Kim, M.D., Sung Won Jang, M.D., Sun Hee Choi, M.D. and Jung Gun Youn, M.D.; Korean J Gastrointest Endosc 2006;32(2):120-123. Published online February 27, 2006

Abstract PDF: Gastritis cystica profunda (GCP) is a rare disease in which mature glandular epithelium extends into the muscularis mucosae or below. GCP lesions mainly develop at the gastroenterostomy stomas. These lesions show malignant histologic features such as metaplastic and even dysplastic alteration, however they usually exhibit benign behavior. We report a case of a patient with GCP who had not previously undergone gastric surgery. A 63-year- old woman visited our hospital for anorexia and epigastric discomfort. The esophagogastroduodenoscopy revealed two polyps on the anterior wall of the greater curvature, antrum. The polyps were removed by snare polypectomy and the histology findings showed the character of a tubular adenoma and a hyperplastic polyp with an associated GCP. (Korean J Gastrointest Endosc 2006;32:120⁣123)

1,945 View
13 Download

A Case of Gastric Syphilis Manifested by Upper Gastrointestinal Bleeding: Seung Woo Lee, M.D., Sang Beom Kang, M.D., Soon Woo Nam, M.D., Joo Yong Song, M.D., Sung Jin Moon, M.D., Dong Soo Lee, M.D. and Hye Kyung Lee, M.D.*; Korean J Gastrointest Endosc 2006;32(2):124-127. Published online February 27, 2006

Abstract PDF: Syphilis is a chronic systemic infection caused by Treponema pallidum; it is sexually transmitted and characterized by episodes of active disease interrupted by periods of latency. Syphilitic involvement of the stomach can occur via the blood flow in the primary or secondary period of syphilis, but its incidence is very rare. Because gastric syphilis has no pathognomic clinical findings and it shows variable gastroscopic findings, it's not so easy to diagnose. After gastric syphilis is correctly diagnosed, it can be easily cured by appropriate antibiotic therapy. The clinicians need to be aware of this disease entity when the patient has mucosal inflammation and ulceration of stomach with the past history of syphilis, or if the patient has lived in edemic areas of syphilis. We report on a case of gastric syphilis that manifested with upper gastrointestinal bleeding. It was initially thought to be stomach cancer, but it was correctly diagnosed by serologic testing and the histopathologic findings. (Korean J Gastrointest Endosc 2006;32:124⁣127)

2,476 View
26 Download

A Case of Appendicular and Rectal Metastasis from Gastric Cancer Detected by Endoscopic Resection: Eun Young Ko, M.D., Yong Keun Cho, M.D., Seung Min Park, M.D., In Seok Seo, M.D., Yang Ho Kim, M.D., Jin Woong Cho, M.D. and Yong Woong Lee, M.D.; Korean J Gastrointest Endosc 2006;32(2):128-131. Published online February 27, 2006

Abstract PDF: A hematogenous or lymphogenous metastasis and a direct or disseminated invasion can occur in cases of a gastrointestinal metastasis. Moreover, a hepatic or peritoneal metastasis is common in advanced gastric cancer. However, a colonic metastasis, particularly an appendicular metastasis, is quite rare. Recently, we experienced a case with an appendicular submucosal tumor-like elevated lesion and multiple rectal elevated lesions during a colonoscopy in an advanced gastric cancer patient. The appendicular lesion was resected endoscopically and a biopsy of the rectal lesions was performed. The pathologic diagnosis was an appendicular and rectal metastasis of a signet ring cell carcinoma. We describe a case of appendicular and rectal metastasis from gastric cancer. The results highlight the importance of considering a metastatic carcinoma when an appendicular or rectal mass is found incidentally in a malignant neoplasm patient. (Korean J Gastrointest Endosc 2006;32:128⁣131)

2,087 View
4 Download

Upper Gastrointestinal Bleeding Due to Gastric Ectopic Pancreas in a Young Aged Person: Jung Won Yun, M.D., Young Bum Park, M.D., Um Seok Lee, M.D., Choong Hyeon Lee, M.D., Dal Yeon Won, M.D.*, Ji Hoon Kim, M.D.^† and Jae Min Song, M.D.^‡; Korean J Gastrointest Endosc 2006;32(2):132-135. Published online February 27, 2006

Abstract PDF: An ectopic pancreas is the presence of pancreatic tissue outside of its usual location. This condition rarely causes clinical symptoms, and the most commonly reported sites of these lesions are the stomach, the duodenum and jejunum. The presence of this ectopic tissue is not a rare condition, but its unusual locations, clinical symptoms, and complications are of clinical interest. We report a case of a gastric ectopic pancreas with recurrent upper gastrointestinal bleeding in a 20-year-old man. (Korean J Gastrointest Endosc 2006;32:132⁣135)

2,088 View
5 Download

A Case of Synchronous Triple Primary Cancer of Gastric Adenocarcinoma, Carcinoid Tumor of the Ampulla of Vater and Renal Cell Carcinoma: Cheul Young Choi, M.D., Yeong Je Chae, M.D., Jong Yeop Kim, M.D., Hyun Won Shin, M.D., Min Ho Choi, M.D., Hyun Joo Jang, M.D., Chang Soo Eun, M.D., Sea Hyub Kae, M.D. and Jin Lee, M.D.; Korean J Gastrointest Endosc 2006;32(2):136-140. Published online February 27, 2006

Abstract PDF: Multiple primary cancer is defined as the multiple occurrence of malignant neoplasm in the same individual. Synchronous cancers are usually defined as finding the second cancer at the same time or within a 6-month period after the diagnosis of the primary lesion, and metachronous cancers are found at more than 6 months after the initial diagnosis. Multiple primary cancers have been increasing reported on due to prolonged lifespans and the improvement of diagnostic techniques. Nevertheless, triple synchronous cancers have been regarded as a relatively rare finding. We report here on an unusual case of triple synchronous cancer of early gastric cancer, carcinoid tumor of the ampulla of Vater and renal cell carcinoma. (Korean J Gastrointest Endosc 2006;32:136⁣ 140)

2,151 View
11 Download

A Case of Capsule Retention for 31 Days Due to Stricture of Crohn's Disease: Jung Hwan Oh, M.D., In Seok Lee, M.D., Jae Myung Park, M.D., Jae Ho Yoon, M.D., Hae Won Han, M.D., Yu Kyung Cho, M.D., Sang Woo Kim, M.D., Myung Gyu Choi, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2006;32(2):141-146. Published online February 27, 2006

Abstract PDF: Conventional modalities for examination of the small bowel have significant limitations. Capsule endoscopy can allow visualization of areas of the small bowel, and is used to diagnose the etiology of gastrointestinal bleeding, small bowel involvement of Crohn's disease, small bowel tumors, polyposis syndromes as well as drug induced ulcers. The problems associated with capsule endoscopy are capsule retention after ingestion and inability to visualize an entire small bowel due to limitation of battery capacity and inadequate image generation. There are no guidelines for procedures to remedy capsule retention. We report a case of natural passage of a capsule after 31 days in a patient with small bowel ulcer due Crohn's disease using medical treatment. (Korean J Gastrointest Endosc 2006;32:141⁣146)

1,743 View
10 Download

A Case of Giant Pedunculated Submucosal Lipoma Causing Intussusception of the Colon: Joong Ho Bae, M.D., Dong Soo Han, M.D., Chang Hee Baek, M.D., Yong Woo Chung, M.D., Jong Pyo Kim, M.D., Joo Hyun Sohn, M.D., Yong Cheol Jeon, M.D. and Joon Soo Hahm, M.D.; Korean J Gastrointest Endosc 2006;32(2):147-151. Published online February 27, 2006

Abstract PDF: Intussusception is a relatively common cause of intestinal obstruction in children. However, it is quite uncommon in adults, representing ≤1% of intestinal obstructions in this patient population. Colonic lipoma is rare, usually small, and occurs mainly in the right colon, particularly in the cecum. They often occur in elderly women. Intermittent episodes of intussusception are not uncommon in patients with colonic lipoma but they are usually caused by larger pedunculated lipomas. Almost all gastrointestinal lipomas are submucosal or subserosal, and most are asymptomatic, even though they can cause abdominal pain, bowel obstruction, and gastrointestinal bleeding. Colonic lipoma with a dramatic presentation requiring urgent surgery is rare. Symptomatic lipomas or complicated cases require surgical or endoscopical intervention. We report a case of symptomatic giant pedunculated colonic lipoma causing intussusception requiring surgical intervention, with a successful recovery after surgery. (Korean J Gastrointest Endosc 2006;32:147⁣151)

2,114 View
7 Download

A Case of Cecal Colon Cancer Causing Intussusception and Synchronous Sigmoid Colon Cancer: Jae Hong Park, M.D., Sang Ho Lee, M.D., Bong Gap Kim, M.D., Jin Man Kim, M.D., Sung Won Jang, M.D., Sun Hee Choi, M.D. and Jung Gun Youn, M.D.; Korean J Gastrointest Endosc 2006;32(2):152-155. Published online February 27, 2006

Abstract PDF: The incidence of intussusception in adults is quite low. A preoperative diagnosis was quite difficult due to the atypical clinical features, but the success rate of preoperative diagnosis of intussusception has improved with the advances in abdominal US and CT. However, the value of colonoscopy in making a preoperative diagnosis is unclear. The incidence of multiple primary cancer of the colon and rectum can vary widely. We report a case of intussusception in a patient who had synchronous cecal and sigmoid colonic cancer. A 71-year-old man was visited our hospital for diarrhea and general weakness. The abdominal US and CT revealed a mass lesion in the cecal area. Preoperative colonoscopy confirmed the lesion to be cecal cancer with a synchronous sigmoid colon cancer. In conclusion, the rarity of these synchronous cancers may result in a misdiagnosis. Therefore, a preoperative colonoscopy or postoperative colonoscopy might be useful. (Korean J Gastrointest Endosc 2006;32:152⁣155)

2,429 View
14 Download

A Case of Rectal Anisakiasis: Suk Tae Jang, M.D., Ik Jun Choi, M.D., Woo Tae Kim, M.D., Hyeug Lee, M.D., Seoung Woo Lee, M.D., Sang Bum Kang, M.D., Soon Woo Nam, M.D. and Dong Soo Lee, M.D.; Korean J Gastrointest Endosc 2006;32(2):156-158. Published online February 27, 2006

Abstract PDF: Anisakiasis refers to the infestation of humans by a species of marine nematode larvae belonging to the subfamily Anisakidae, and this condition is seen in people who eat inadequately prepared or raw salt-water fish and squid. Because Koreans like to eat raw fish, anisakiasis of the stomach has been reported occasionally, but involvement of the small bowel or colon is relatively rare. In the case of the colon, anisakiasis of the ascending colon or the transverse colon has been only infrequently reported, and the incidence of rectal anisakiasis is very rare. The present case is a 58-year-old man with no definite abdominal symptoms who visited our hospital for a medical checkup. A 2 cm sized whitish linear live larva was revealed in the rectum and it was removed by colonoscopy. (Korean J Gastrointest Endosc 2006;32:156⁣159)

1,825 View
8 Download

Previous issues