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Volume 34(3); March 2007
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The Histologic Discrepancy before and after Endoscopic Submucosal Dissection of Gastric Adenoma and Early Gastric Cancer
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Eun Hee Park, M.D., Ki Tae Kang, M.D., Byoung Hee Kim, M.D., Kyoung Tae Kim, M.D., Sung Wook Lee, M.D., Jong Hun Lee, M.D., Myung Hwan Roh, M.D., Sang Young Han, M.D., Seok Reyol Choi, M.D., Jin Sook Jeong, M.D.* and Jin Seok Jang, M.D.
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Korean J Gastrointest Endosc 2007;34(3):125-131. Published online March 30, 2007
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Abstract
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- Background
/Aims: We wanted to investigate of discrepancy rate between the histology of the endoscopic biopsy and that of the resected specimen obtained from the same lesion by endoscopic submucosal dissection (ESD). Methods: 69 gastric adenomas and 38 early gastric cancers (EGC) that were treated by ESD from July, 2004 to February, 2006 were reviewed to analyze the relation between the histologies of the endoscopic biopsy and the resected specimen. Results: The discrepancy rate between the histology of the endoscopic biopsy and the resected specimen was 40.6% for the gastric adenoma and 23.7% for the EGC. Among the 43 cases of low grade dysplasia, 6 cases (14%) were confirmed as gastric cancer after ESD. Conclusions: The histologic discrepancy between the endoscopic biopsy and resected specimen was 40.6% for the gastric adenoma and 23.7% for the EGC. Though the endoscopic biopsy may reveal low grade dysplasia, gastric adenoma should be removed by endoscopic mucosal resection because of the histological discrepancy between the endoscopic biopsy and the resected specimen. (Korean J Gastrointest Endosc 2007;34:125131)
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Usefulness of Medium Incision Endoscopic Sphincterotomy with Endoscopic Papillary Balloon Dilatation for the Removal of Common Bile Duct Stones
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Jeong Seon Ji, M.D., Hiun Suk Chae, M.D., Hyung Keun Kim, M.D., Young Seok Cho, M.D., Chang Wook Kim, M.D., Bo In Lee, M.D., Hwang Choi, M.D., Byung Wook Kim, M.D., Suk Won Han, M.D. and Kyu Yong Choi, M.D.
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Korean J Gastrointest Endosc 2007;34(3):132-137. Published online March 30, 2007
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Abstract
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/Aims: Recent meta-analysis data has shown that there was no significant difference in the rate of overall successful stone removal between endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD). However, bleeding occurred more frequently in the EST group, and post-ERCP pancreatitis more commonly occurred in the EPBD group. Thus, we hypothesized that medium incision EST modestly combined with EPBD (m-ESTEPBD) could overcome the drawbacks of both techniques. Methods: Fifty eight patients who underwent m-ESTEPBD for removal of common bile duct stones were compared with sixty patients who underwent EST only. Medium incision EST was performed with a pure cut mode and then a 12 mm diameter balloon was used for the EPBD. Results: Complete bile duct stone clearance was achieved in 96.7% of the patients in the EST group and in 96.5% of the patients who underwent m-ESTEPBD (p＞0.05). There was no significant difference between the two groups for procedure-related pancreatitis. The rate for procedure- related hemorrhage was 0% in the both groups. Conclusions: m-ESTEPBD showed the possibility of being alternative to EST for the removal of common bile duct stone. To establish effectiveness and safety of m-ESTEPBD, further randomized large scaled clinical studies for comparing EST and m-ESTEPBD are needed. (Korean J Gastrointest Endosc 2007;34:132137)
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Bile Duct Cannulation Guided by a Percutaneous Transhepatic Biliary Drainage (PTBD) Tube: Modified Rendezvous Procedure
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Hong Joo Kim, M.D., Seon Hyeong Choi, M.D.*, Jung Ho Park, M.D., Dong Il Park, M.D., Yong Kyun Cho, M.D., Chong Il Sohn, M.D., Woo Kyu Jeon, M.D. and Byung Ik Kim, M.D.
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Korean J Gastrointest Endosc 2007;34(3):138-142. Published online March 30, 2007
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Abstract
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- Background
/Aims: To describe a simple and useful modification of the rendezvous technique using a PTBD tube as guidance. Methods: From January 2005 to August 2006, a total of 436 ERCPs were performed. A diagnosis of choledocholithiasis was made in 235 cases. Deep cannulation of the bile duct using standard techniques was unsuccessful in 27 patients (11.5%). A precut papillotomy led to successful cannulation in 16 out of these 27 patients (59.3%). The remaining 11 patients (40.7%) underwent PTBD with the tube tip placed in the second portion of the duodenum. Bile duct cannulation was attempted with the guidance of a PTBD tube in 9 cases. In the other 2 cases, the transduodenal approach was impossible due to a previous Billroth II operation. Results: Bile duct cannulation guided by a PTBD tube, which is also known as a modified rendezvous procedure, was successful in 9 out of 11 patients (81.8%). Deep cannulation of the bile duct was achieved in 100% of patients, who could be treated by endoscopy. There were 7 cases of transient hyperamylasemia (77.8%) but no procedure-related major complications or mortality. Conclusions: Bile duct cannulation guided by a PTBD tube in patients with choledocholithiasis can be recommended when ERCP is unsuccessful using the standard technique. (Korean J Gastrointest Endosc 2007;34:138142)
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A Case of Esophageal Obstruction Caused by an Ingested Canine Gallbladder
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Jong In Yang, M.D., Ji Won Kim, M.D.*, Kook Lae Lee, M.D.*, Jung Mook Kang, M.D., Yong Jin Jung, M.D.*, Ji Bong Jeong, M.D.* and Byung Kwan Kim, M.D.*
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Korean J Gastrointest Endosc 2007;34(3):143-145. Published online March 30, 2007
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Abstract
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- Endoscopic intervention is a very important and effective tool for evaluating and treating an esophageal foreign body. The size of a cystic foreign body filled with liquid can be reduced by needle puncture and fluid spillage. We report a rare case of an acute total obstruction of the esophagus by an ingested canine gallbladder that was removed by endoscopic intervention. (Korean J Gastrointest Endosc 2007;34:143145)
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A Case of the Endoscopic Removal of a Duodenal Heterotopic Gastric Mucosa Presenting as a Polypoid Lesion
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Sung Hoon Kim, M.D., Seun Ja Park, M.D., Nang Hee Kim, M.D., Ji Hyeon Nam, M.D., Ji Eun Park, M.D., Seo Ryong Han, M.D., Won Moon, M.D., Kyu-Jong Kim, M.D., Moo In Park, M.D. and Min Jung Jung, M.D.*
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Korean J Gastrointest Endosc 2007;34(3):146-150. Published online March 30, 2007
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Abstract
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- Ectopic gastric mucosa is known to occur throughout the gastrointestinal tract. Ectopic gastric mucosa in the duodenum is classified into the developmental (heterotopic gastric mucosa) and acquired types (gastric metaplasia). Gastric metaplasia may be present in up to 64% of normal individuals but heterotopic gastric mucosa is quite rare. A heterotopic gastric mucosa in the duodenum may be asymptomatic but can give rise to perforation, hemorrhage, and intestinal obstruction in rare cases. Therefore, periodic endoscopic surveillance is recommended in these cases. Endoscopically, the appearance of a heterotopic gastric mucosa shows a mainly elevated lesion with multiple nodularity. We report a case of 1.5⁓1.2 cm sized polypoid lesion of the duodenum in an asymptomatic 31 year-old man. The mass was resected endoscopically and diagnosed as a heterotopic gastric mucosa. (Korean J Gastrointest Endosc 2007;34:146150)
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A Case of Acute Colonic Pseudo-obstruction Treated by Percutaneous Endoscopic Colostomy
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Sung Joon Kim, M.D., Suck Ho Lee, M.D., Myung Jin Kang, M.D., Yong-Ho Choi, M.D., Jeong Hoon Park, M.D., Do Hyun Park, 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(3):151-155. Published online March 30, 2007
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- Acute colonic pseudo-obstruction (Ogilvie's syndrome) results in massive colonic dilation without mechanical obstruction. In most cases, a conservative treatment with or without endoscopic decompression is efficient. Rarely, surgery has to be performed. A surgical treatment is associated with high morbidity and mortality. However, a percutaneous endoscopic colostomy could be an interesting alternative treatment. We report the case of a 88-year-old female with colonic pseudo-obstruction for which both the conservative and the colonoscopic treatments were unsuccessful. A percutaneous endoscopic colostomy was performed, and symptomatic improvement was observed. We have shown that percutaneous endoscopic colostomy is a safe and effective treatment for acute colonic pseudo- obstruct. Korean J Gastrointest Endosc 2007;34:151155)
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Rectal Polypoid Endometriosis Mimicking Malignant Rectal Tumor
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Eun Sun Kim, M.D., Yoon Tae Jeen, M.D., Donghun Lee, M.D., Young Jin Kim, M.D., Jae Youn Park, M.D., Jin Nam Kim, M.D., Sanghoon Park, M.D., Bora Keum, M.D., Young Jig Cho, M.D., Hwi Kong, M.D., Chang Don Kang, M.D.*, Yong Sik Kim, M.D., Hoon Jai Chun, M.
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Korean J Gastrointest Endosc 2007;34(3):156-160. Published online March 30, 2007
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- Endometriosis is a disorder that presents as endometrial glands and stroma outside the uterine cavity and its musculature. It is a common gynecologic disease affecting approximately 15% of fertile women. However, polypoid endometriosis is rare. Our patient visited the hospital due to bowel habit changes and bloody stools. The colonoscopy revealed a large ulcerating polypoid mass in the rectum. Image studies including CT scan, MRI, and PET-CT suggested rectal cancer but the biopsy was negative for a malignancy. Finally, she was diagnosed with rectal polypoid endometriosis by a surgical rectal mass resection. We report a case of rectal polypoid endometriosis mimicking a rectal polypoid cancer. (Korean J Gastrointest Endosc 2007;34:156160)
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Acute Renal Failure Caused by Oral Polyethylene Glycol Ingestion
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Yeon Joo Chun, M.D., Min Kyung Pak, M.D., Jin Su Kim, M.D., Hyung Keun Kim, M.D., Young Seok Cho, M.D., Hiun Suk Chae, M.D., Sok Won Han, M.D., Kyu Yong Choi, M.D. and Hye Kyung Lee, M.D.*
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Korean J Gastrointest Endosc 2007;34(3):161-163. Published online March 30, 2007
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- Polyethylene glycol (PEG) electrolyte lavage solution and sodium phosphate solution are used for bowel cleansing before performing colonoscopy. PEG electrolyte lavage solution is the most widely used because PEG is absorbed by intestinal mucosa in only very small amounts and it very well cleans the bowels. The minor side-effects associated with PEG solution, i.e., nausea, vomiting and abdominal distention, are relatively common. However, PEG electrolyte lavage solution-induced acute renal failure has rarely been reported on. We report here on a case of acute renal failure after bowel preparation with using polyethylene glycol. (Korean J Gastrointest Endosc 2007; 34:161163)
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Two Cases of Endoscopic Resection of Submucosal Tumor of the Minor Papilla
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Yong Ho Choi, M.D., Do Hyun Park, M.D., Seong Jun Kim, M.D., Meong Jin Kang, M.D., Hyun Deuk Jo, M.D.*, Mee Hye Oh, 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(3):164-169. Published online March 30, 2007
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Abstract
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- Tumors of the minor papilla are very rare and these tumors have generally been known as neuroendocrine tumors such as carcinoid tumor and somatostatinoma. As these are mostly submucosal tumors, their diagnosis is difficult by just performing endoscopic forceps biopsy, but diagnosis is possible by surgery or endoscopic resection. EUS and ERCP is an essential tool for the diagnosis of these tumors, and abdominal CT or MRI is also useful because there is the possibility of malignant tumors such as carcinoid tumor. For our present two cases, screening endoscopy revealed the polypoid lesion of the minor papilla. EUS disclosed that the submucosal tumor was limited to the submucosal layer and no abnormality was found from the abdominal CT and ERCP. Herein, we performed endoscopic resection for making the diagnosis and treatment. Histologically, these 2 tumors were diagnosed as ectopic pancreas and gangliocytic paraganglioma, respectively. (Korean J Gastrointest Endosc 2007;34:164-169)
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Two Cases of Double Papilla of Vater
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Kwang Ro Joo, M.D., Hyun Phil Shin, M.D., Hyun Jeong Kim, M.D., Jae Myung Cha, M.D., Jong Beom Park, M.D. and Joung Il Lee, M.D.
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Korean J Gastrointest Endosc 2007;34(3):170-173. Published online March 30, 2007
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- The Vaterian system consists of the common bile duct and the duct of Wirsung as they conjoin at the level of the duodenum, forming the major papilla of Vater. A double papilla of Vater with separate openings that form the bile duct and the pancreatic duct is a rare anatomic anomaly, which is observed in 0.18% of patients during endoscopic retrograde cholangiopancreatography. When a double papilla is noted, the additional problem is to determine if it is an anatomic variant or a choledochoduodenal fistula. We report two cases of a double papilla; one was associated with choledocholithiasis, and the other was identified incidentally during screening upper gastrointestinal endoscopy. (Korean J Gastrointest Endosc 2007;34:170173)
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A Case of Hemobilia Caused by Calculous Cholecystitis
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Chang Soo Choi, M.D., Geom Seog Seo, M.D., Meyoung Cho, M.D., Tae Hyeon Kim, M.D., Suck Chei Choi, M.D., Ki Jung Yun, M.D.* and Haak Cheoul Kim, M.D.
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Korean J Gastrointest Endosc 2007;34(3):174-178. Published online March 30, 2007
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- Hemobilia is a status of bleeding into the biliary tract, which is caused by abnormal communication between the intrahepatic blood vessels and biliary tract, and is a rare cause of upper gastrointestinal hemorrhage. Most cases of the hemobilia originating in the gallbladder are related to gallstones. However, hemobilia is a rare complication of calculous cholecystitis. We report a case of hemobilia as a complication of calculous cholecystitis in a patient given continuous aspirin medication. (Korean J Gastrointest Endosc 2007;34:174178)
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A Case of Focal Autoimmune Chronic Pancreatitis Improved with Oral Steroid Therapy
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Sang Hyun Park, M.D., Jung Ho Kim, M.D., Soon Joo Kim, M.D., Jin Kyung Ryu, M.D., Sang Hyo Shin, M.D., Hyun Deok Shin, M.D., Chang Lae Jo, M.D., Tae Yoon Lee, M.D., Sang Soo Lee, M.D., Dong Wan Seo, M.D., Sung Koo Lee, M.D. and Myung-Hwan Kim, M.D.
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Korean J Gastrointest Endosc 2007;34(3):179-183. Published online March 30, 2007
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- Clinically, patients with pancreatic cancer and focal autoimmune chronic pancreatitis share many features, such as being elderly, painless jaundice, new-onset diabetes mellitus, and weight loss. Hence, it is difficult to differentiate between the two conditions. Nevertheless, it is very important to distinguish between focal autoimmune chronic pancreatitis and pancreatic cancer because they have different treatment modalities and prognoses. We encountered a case of a 72-year-old man who developed painless jaundice. The patient was diagnosed with focal autoimmune chronic pancreatitis instead of pancreatic cancer from the CT, ERCP, MRCP findings accompanying with an increased IgG4 level. The abnormalities in the clinical, laboratory, and radiological findings improved after 2 weeks of oral steroid treatment. After 3 months of oral steroid treatment, his disease showed further improvement. To our knowledge, this is a rare case of focal autoimmune chronic pancreatitis that improved with oral steroid treatment. (Korean J Gastrointest Endosc 2007;34:179183)
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