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Volume 34(1); January 2007
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Association between Gastroesophageal Flap Valve and Gastroesophageal Reflux
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Kyung Yup Kim, M.D., Kee Tae Park, M.D., Tae Oh Kim, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.
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Korean J Gastrointest Endosc 2007;34(1):1-8. Published online January 30, 2007
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Abstract
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- Background
/Aims: Endoscopic grading of the gastroesophageal flap valve (GEFV) was suggested to be a good predictor of the gastroesophageal reflux status. The aim of this study was to examine the association between the GEFV and gastroesophageal reflux. Methods: A total of 599 patients (245 men and 354 women; mean age 51.0⁑0.5 years) who underwent endoscopy, esophageal manometry, and ambulatory pH monitoring were included. GEFV was graded I through to IV using Hill's classification. The GEFV was classified into main 2 groups: the normal GEFV (grade I and II) and the abnormal GEFV groups (grade III and IV). The findings of endoscopy, esophageal manometry, and ambulatory pH monitoring were compared. Results: An increased GEFV grade was significantly associated with reflux esophagitis and Barrett's epithelium (p＜0.001). The LES pressure was significantly lower in the abnormal GEFV group (p＜0.001). All variables showing gastroesophageal reflux in the probe were significantly higher in the abnormal GEFV group (p＜0.001). The frequency of gastroesophageal reflux disease (GERD) was higher in the abnormal GEFV group (p＜0.001). Conclusions: There is an association between the altered geometry of the GEFV and the presence of GERD. The endoscopic grading of the GEFV is easy and provides useful information on the gastroesophageal reflux status.
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Expression of Mutant p53 Protein, p21waf1/cip1 and Cyclin D1 in Dysplasia and Adenocarcinoma of Stomach
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Ki Jung Yun, M.D., Hun Soo Kim, M.D., Hyang Jeong Jo, M.D. and Suck Chei Choi, M.D.*
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Korean J Gastrointest Endosc 2007;34(1):9-13. Published online January 30, 2007
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Abstract
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/Aims: Gastric carcinoma is a major cause of morbidity and mortality in Korea. It evolves through dysplasia to an invasive adenocarcinoma. The carcinogenesis of dysplasia and adenocarcinoma in the stomach was investigated by examining the levels of mutant p53 protein, p21waf1/cip1, and cyclin D1 expression in gastric dysplasia and invasive adenocarcinoma. Methods: Formalin- fixed paraffin-embedded tumors were examined immunohistochemically using the monoclonal antibodies to the 53 protein, p21waf1/cip1 and cyclin D1. Results: Mutant p53 protein, p21waf1/cip1 and cyclin D1 expression were found in 66.6% (12/18), 72.2% (13/18) and 33.8% (6/18) of dysplasia, and 45.0% (9/20), 15.0% (3/20) and 30.0% (6/20) of invasive adenocarcinoma, respectively. Conclusions: These results suggest that p21waf1/cip1, which is controlled by the p53 protein, plays a more important role in the carcinogenesis of the stomach than cyclin D1.
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The Usefulness of Colonoscopy as a Colon Cancer Screening Test for Asymptomatic Adults
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Hyun-Ho Cho, M.D., Seok Young Lee, M.D., Jeong Kwon Huh, M.D., Jung Hoon Kim, M.D.,Hee Hwan Lim, M.D., Hee Sun No, M.D., Jang Hyun Cho, M.D., Sung In Cho, M.D., Duck Ryung Kim, M.D., Su Cheol Park, M.D., Jin Kim, M.D., Chul Ju Han, M.D. and You Cheoul Kim
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Korean J Gastrointest Endosc 2007;34(1):14-18. Published online January 30, 2007
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Abstract
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/Aims: This study evaluated the prevalence and location of colonic adenomatous polyps in asymptomatic adults. Methods: A total of 2,849 asymptomatic adults underwent colonscopic screening as a part of health evaluation from January 2003 to September 2005. Completed questionnaires as well as the colonoscopic and pathologic findings were analyzed. Results: There were 406 (14.3%) subjects with adenomatous polyps including 78 (2.7%) with advanced polyps. There was a trend toward an increased prevalence of adenomatous polyps with age. The relative risk of a proximal polyp according to the distal findings was 5.7 (95% CI 4.3∼7.4) for adenoma, 4.9 (95% CI 3.0∼7.7) for advanced adenoma compared with that for no adenomatous polyp. There were no index polyps at the distal colon in 30% of the 406 subjects. Conclusions: Though distal polyps are associated with the proximal polyps, 30% of asymptomatic adults with proximal polyps are not associated with any distal index polyps. For those without any contraindication to the procedure, colonoscopy performed by experienced colonoscopists as a screening test is feasible for detecting those patients with colorectal polyps.
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Expression of β-catenin, hMLH1, p53, Bcl-2, Bax and COX-2 in Serrated Adenomas of Colon
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Kyo Won Choi, M.D., Byung Ik Jang, M.D., Jong Ryul Eun, M.D., Jung Hoon Lee, M.D., Young Kyung Bae, M.D*. and Tae Nyun Kim, M.D.
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Korean J Gastrointest Endosc 2007;34(1):19-27. Published online January 30, 2007
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Abstract
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/Aims: Serrated adenoma of the colorectum is a recently proposed entity that is characterized by a saw-toothed structure of hyperplastic polyp and also the cytologic atypia of conventional adenoma. In contrast to conventional adenomas, the molecular features of serrated adenomas have been poorly studied. Methods: The expression of β-catenin and the DNA mismatch repair protein hMLH1, apoptosis regulating protein Bcl-2, Bax, p53 and COX-2 were analyzed in 28 serrated adenoma specimens and 28 tubular adenoma specimens. Results: No differences were observed in the frequency of β-catenin loss in the cell membrane between the serrated and tubular adenoma specimens. The frequency of hMLH1 loss was significantly higher in the serrated adenomas than in tubular adenomas (p＜0.05). The frequency of p53 overexpression was not significantly different between the serrated and tubular adenoma specimens. The frequencies of the Bax and Bcl-2 overexpressions were significantly lower in the serrated adenomas than in the tubular adenomas. The COX-2 levels were not different between the serrated and tubular adenomas. In the serrated adenoma specimens, the frequency of Bax overexpression was reduced in the older age group (＞60 years old). In the tubular adenoma specimens, the frequency of p53 overexpression was increased in the dysplastic epithelium. Conclusions: The expressions of hMLH1, Bax and Bcl-2 were decreased in the serrated adenoma than in the tubular adenoma. Our data suggest that the serrated adenoma and tubular adenoma may have different pathway in their development. However, further studies including normal mucosa, hyperplastic polyp and cancer specimens are needed.
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A Case of Esophageal T-cell Lymphoma Presenting as Multiple Discrete Ulcers on a Background of Normal Mucosa
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Sang Bong Lee, M.D.*, Sung Jae Park, M.D., Sam Ryong Jee, M.D., Eun Taik Park, M.D.,Youn Jae Lee, M.D., Sang Hyuk Lee, M.D., Sang Young Seol, M.D., Seok Woo Kang, M.D.,Ji Hun Park, M.D. and Kyung Im Pae, M.D.
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Korean J Gastrointest Endosc 2007;34(1):28-32. Published online January 30, 2007
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Abstract
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- Gastrointestinal involvement by a lymphoma occurs in 20% of patients with a lymphoma and frequently involves the stomach, small bowel or colon, but rarely involves the esophagus. Esophageal lymphomas are usually secondary to an adjacent lymph node invasion or the contiguous spread from a gastric lymphoma. Primary involvement of the esophagus by a lymphoma is quite rare. Primary versus secondary esophageal involvement by a lymphoma is difficult to determine. The radiological features of esophageal lymphomas may manifest nodules of various sizes, enlarged folds, polypoid mass, ulceration, stenosis, varicoid appearance, and aneurysmal dilatation. The presentation of multiple discrete ulcers in the esophagus on the background of the normal mucosa is most unusual. We describe a case of an esophageal T-cell lymphoma with multiple discrete ulcers on the background of the normal mucosa. The patient was treated with chemotherapy. After chemotherapy, the endoscopic findings of the esophagus showed a normal esophageal mucosa. We report this case with a review of the relevant literature.
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A Case of Double Primary Cancer that Occurred Continuously at the Esophagogastric Junction
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Hyeok Jin Kwon, M.D., Chang Woo You, M.D., Sang Kyoon Kim, M.D., Hye Jin Jeong, M.D., Seung Hun Kim, M.D., In Hee Kim, M.D., Sang Wook Kim, M.D., Seung Ok Lee, M.D.,Soo Teik Lee, M.D. and Dae Ghon Kim, M.D.
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Korean J Gastrointest Endosc 2007;34(1):33-37. Published online January 30, 2007
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Abstract
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- The occurrence of multiple primary cancers associated with the esophagus and stomach is a well known phenomenon. However, the majority of those lesions are located apart each other. Finding of esophageal cancer and gastric cancer occurring simultaneously at the esophagogastric junction is extremely rare. In this case, the endoscopic findings showed that the cancer of the gastric cardia had invaded to the lower esophagus, but after the operation, the pathology report show the synchronous occurrence of esophageal squamous cell carcinoma and gastric adenocarcinoma. Therefore, we report here on a rare case of double primary cancer, and this double primary cancer occurred at the esophagogastric junction of a 67 year-old woman.
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A Case of Gastric Bezoar Treated by an Endoscopic Coca-Cola Injection
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Sue Jin Kim, M.D., Jun Haeng Lee, M.D., Woo Ik Chang, M.D., Kyoung A Choi, M.D., A-Reum Han, M.D., Young Bong Song, M.D. Jae J. Kim, M.D. and Jong Chul Rhee, M.D.
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Korean J Gastrointest Endosc 2007;34(1):38-42. Published online January 30, 2007
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- Bezoars are the most common foreign bodies in the stomach as seen endoscopically with a frequency of approximately 0.4%. They consist of persistent concretions or hard accumulations of non-digestible vegetable matter, hair or more unusual materials. Gastric bezoars develop in patients with previous gastric surgery, gastric outlet obstruction, or poor gastric emptying such as gastroparesis due to hypothyroidism, diabetes mellitus or mixed connective tissue disease. The clinical presentations of gastric bezoars include epigastric pain, a palpable mass, a gastrointestinal obstruction and peptic ulceration. The treatment options include surgery, enzymatic dissolution or endoscopic mechanical fragmentation and/or removal. Recently, the efficacy of the administration or lavage of 'Coca-Cola' for the effective dissolution of gastric bezoars has been reported. We report a case of a 27-year-old woman with a large gastric bezoar that was successfully removed by the direct endoscopic injection of a carbonated beverage ('Coca-Cola light', a sugar free product; Coca cola Co., Seoul, South Korea) into the bezoar, which led to fragmentation.
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A Case of Successful Non-surgical Management of Iatrogenic Gastric Perforation with Fluid Collection after Endoscopic Mucosal Resection
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Back Jin Seong, M.D., Il Soo Lee, M.D., Jung Cheol Lee, M.D., In Key Choi, M.D., Gum Mo Jung, M.D., Yong Keun Cho, M.D., Ji Woong Kim, M.D. and Jin Woong Cho, M.D.
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Korean J Gastrointest Endosc 2007;34(1):43-46. Published online January 30, 2007
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Abstract
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- An endoscopic mucosal resection (EMR) is considered to be a potential alternative to surgery for a gastrointestinal tumor on account of it being an improved technique. Since its introduction in Japan in the early 1980s, it is now an accepted modality for removing precancerous lesions or early gastric cancer from the GI tract because it is minimally invasive and preserves the patient's quality of life. The major complications of EMR is bleeding and perforation. The treatment guidelines for iatrogenic perforation after EMR have not been established. Herein, we report a successful case of EMR induced gastric perforation with fluid collection that was successfully treated with non-surgical management.
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A Case of Giant Brunner's Gland Hamartoma Presenting as Gastrointestinal Hemorrhage
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Sang Yong Lee, M.D., Jung Hyun Lee, M.D., Hyo Jin Jung, M.D., Joo Ho Lee, M.D., Tae Oh Kim, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.
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Korean J Gastrointest Endosc 2007;34(1):47-50. Published online January 30, 2007
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- Brunner's gland hamartoma is also called Brunner's gland adenoma and Brunner's gland hyperplasia of Brunneroma, and it is a rare tumor of the duodenum. This tumor is caused by a benign proliferation of Brunner's glands, and the disease is normally present on the duodenum. These tumors arise mainly in the duodenal bulb and only rarely in the jejunum and proximal ileum. The clinical manifestations are nonspecific gastrointestinal complaints such as bloating or epigastric pain, and the tumor often gives rise to melena or obstruction. We report here on a case of a giant Brunner's gland hamartoma in a 48 year-old woman, and it was treated by endoscopic polypectomy. We also include a review of the related literatures.
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A Case of Eosinophilic Gastroenteritis in a Patient with Traumatic Hypopituitarism
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Seok Ju Lee, M.D., Woo Chul Chung, M.D., Kang Moon Lee, M.D., Bo In Lee, M.D., Young Chul Kim, M.D., Chang Kyun Hong, M.D., U-Im Chang, M.D.,Jin Mo Yang, M.D., Kyu Yong Choi, M.D. and In-Sik Chung, M.D.
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Korean J Gastrointest Endosc 2007;34(1):51-55. Published online January 30, 2007
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- Eosinophilic gastroenteritis is a rare gastrointestinal disorder that can present with a variety of symptoms such as abdominal pain, vomiting, diarrhea and ascites. It is characterized by eosinophilic infiltration of the gastrointestinal wall. Its incidence has increased recently. However, the etiology and pathogenesis of this disease are not well understood. The relationship between hypopituitarism and eosinophilic gastroenteritis is unclear. A corticotropin deficiency and eosinophilia are observed in approximately 90% of traumatic hypopituitarism. We encountered a case of eosinophilic gastroenteritis with eosinophilic ascites in a patient with traumatic hypopituitarism including central diabetes incipidus. Abdominal computed tomography showed diffuse wall thickening of the esophagus, stomach and small bowel with a large amount of ascites. Cytologic examination of ascites showed heavy dense infiltration of eosinophils. The patient was treated with corticosteroid and responded rapidly. Two months later, she was admitted again with a relapse of symptoms. We report this case with a brief review of the relevant literature.
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A Case of Lower Gastrointestinal Bleeding with Ileal Ulceration in Scrub Typhus
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Su Jung Baik, M.D., Ki-Nam Shim, M.D., Min Jung Kang, M.D., Hyun Joo Song, M.D., Kum Hei Ryu, M.D., Hye Jung Yeom, M.D., Tae Hun Kim, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D., Il Hwan Moon, M.D. and Kyu Won Chung, M.D.
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Korean J Gastrointest Endosc 2007;34(1):56-59. Published online January 30, 2007
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- Scrub typhus, an acute febrile illness caused by Orientia tsutsugamushi-induced vasculitis, is common in Korea, Asia and Pacific Islands. Endoscopic mucosal lesions or mucosal damages have rarely been reported in Scrub typhus. However, four cases of upper gastrointestinal bleeding, controlled by hemoclipping, in Tsutsugamushi-infected patients have been reported in Korea; although, no case of lower gastrointestinal bleeding in Scrub typhus has been reported. We experienced massive hematochezia in a 77-year-old female patient with Scrub typhus. Special studies, including upper gastroduodenoscopy, colonoscopy, abdominal CT scan, and SMA angiography were performed, but the focus of the bleeding could not be found. An RBC scan showed suspicious small bowel bleeding, but a capsule endoscopy could not reveal the focus of the bleeding focus; however, a colonoscopy showed active bleeding at the terminal ileum, with multiple ileal ulcerations. After conservative therapy, the patient's condition was stable and the hematochezia disappeared.
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Two Cases of the Endoscopic Treatment of Type I Mirizzi Syndrome
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Chang Gyun Chun, M.D., Do Hyun Park, M.D., Ji Won Lyu, M.D., Yun Suk Shim, M.D., Jeong Hoon Park, M.D., Suck-Ho Lee, M.D., Hong-Soo Kim, M.D., Sang-Heum Park, M.D. and Sun-Joo Kim, M.D.
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Korean J Gastrointest Endosc 2007;34(1):60-64. Published online January 30, 2007
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- Mirizzi syndrome is commonly defined as a common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct. Mirizzi syndrome has traditionally been treated surgically. However, there are several case reports and small series describing endoscopic and percutaneous alternatives to open surgery. We encountered two cases of type I Mirizzi syndrome that was successfully treated endoscopically. We report these cases with a review of the relevant literature.
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