Clinical Endoscopy

Efficacy of Niti-S ComVi Stents for Palliation of Malignant Gastrointestinal Obstruction: Seong Eun Kim, M.D., Jeong Seop Moon, M.D., Jin Kwang Lee, M.D., Jin Gook Huh, M.D., Jong Sung Lee, M.D., Tae Yeob Jeong, M.D., Soo Hyung Ryu, M.D., Jung Whan Lee, M.D. and You Sun Kim, M.D.; Korean J Gastrointest Endosc 2007;34(4):185-192. Published online April 30, 2007

Abstract PDF: Background
/Aims: Niti-S ComVi stents are flexible and retain the shape-memory of the original configuration. ComVi stents are effective in preventing tumor ingrowth because polytetrafluoroethylene is inserted between two stent wires. The aim of this study was to examine the efficacy of Niti-S ComVi stents for the palliation of a malignant gastrointestinal obstruction. Methods: Between April 2004 and April 2006, 17 patients (20 cases) underwent Niti-S ComVi stenting, using a through-the- scope method. The technical and clinical success, complication, and outcome were analyzed. Results: Stent insertion was technically successful in 18 cases (90%). Malposition to the afferent loop occurred in 2 cases. Symptomatic improvement was achieved in 14 cases (70%). The mean gastric outlet obstruction score was 0.2 before stenting and 1.6 after stenting. The complications encountered were stent migration (2 cases) and obstruction (5 cases), which were treated by re-stenting and balloon dilatation. Twelve patients died with a median survival of 67 days. Five patients were still alive with a median follow up of 151 days. The overall median stent patency time was 60 days. The mean waist diameter of the stents was expanded to 57% of full expansion immediately after deployment, and 77% after 36 hours. Conclusions: Niti-S ComVi stenting is an effective palliative technique for inoperable or postoperative recurrent tumors, and significantly improves the quality of life. (Korean J Gastrointest Endosc 2007; 34:185⁣192)

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Clinical Features and Course of Crohn Disease in Children: Na Young Lee, M.D. and Jae Hong Park, M.D.*; Korean J Gastrointest Endosc 2007;34(4):193-199. Published online April 30, 2007

Abstract PDF: Background
/Aims: The aim of this study was to evaluate the clinical features and course of Crohn disease (CD) in children. Methods: The medical records of 30 patients diagnosed with CD between January 1996 and December 2005 were reviewed retrospectively. Results: The actual number of newly diagnosed patients with CD has increased during the 8-year period. The male/female ratio was 2：1 and the mean age at diagnosis was 10.6⁑4.3 years. The major symptoms of CD at diagnosis were abdominal pain (79.2%), weight loss (54.2%), perianal lesion (54.2%), diarrhea (45.8%), hematochezia (41.7%), anemia (29.2%), and fever (23.3%). The disease location of CD was the small bowel in 33.3%, the large bowel in 12.5% and both the small and large bowel in 54.2%. Granuloma was found in 54.2% of patients. The relapse rate of CD in the group with a higher pediatric Crohn disease activity index (PCDAI) at diagnosis (≥30) was higher than in the group with a lower PCDAI (＜30). The cumulative relapse rates of the patients with granuloma were 30.2% within 1 year and 53.8% within 5 years after the diagnosis. Conclusions: The incidence of CD in children appears to be increasing. Granuloma formation and a higher score of the PCDAI are associated with a more severe disease course. Pediatric CD may have a somewhat different clinical presentation from older-onset CD. (Korean J Gastrointest Endosc 2007;34:193⁣199)

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Massive Upper Gastrointestinal Bleeding from a Traction Type of Diverticulum in the Midesophagus: Chang Soo Jang, M.D., Kwang An Kwon, M.D., Soo Jin Choi, M.D.*, Yeon Suk Kim, M.D., Yang Suh Ku, M.D., Kee Sup Song, M.D., Uk Sun Chang, M.D., Sang Kyun Yu, M.D., Dong Kyun Park, M.D., Yu Kyung Kim, M.D. and Ju Hyun Kim, M.D.; Korean J Gastrointest Endosc 2007;34(4):200-204. Published online April 30, 2007

Abstract PDF: The common sites of esophageal diverticula are the pharyngoesophageal junction, midesophagus and epiphrenic. The pathophysiological mechanisms of acquired esophageal diverticula are traction and pulsion forces. Traction diverticula of the midesophagus are usually asymptomatic, and found incidentally on an esophagogastroduodenoscopy or barium contrast esophagogram. Midesophageal traction diverticula are caused by inflammatory processes between the external wall of the esophagus and the adjacent structure. Pneumonia, bronchoesophageal fistula and gastrointestinal bleeding can occur due to an extension of inflammatory process into the lung or blood vessels. There are a few reports of midesophageal diverticular bleeding. We present a case of massive upper gastrointestinal bleeding from a traction diverticulum of the midesophagus that was successfully managed by endoscopic treatment. (Korean J Gastrointest Endosc 2007;34:200⁣204)

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A Case of Aggravated Esophageal Candidiasis and Gastric Yeast Bezoar Formation following Gastric Outlet Obstruction due to Duodenal Stenosis: Jung Hoon Song, M.D., Eun Bin Lee, M.D., Nam Seon Park, M.D., Byung Kook Kang, M.D., Dae Ho Jin, M.D., Tae Hong Ahn, M.D., Yoon Ju Han, M.D., Kyu Chel Lee, M.D. and Hyung Suk Lee, M.D.; Korean J Gastrointest Endosc 2007;34(4):205-209. Published online April 30, 2007

Abstract PDF: Esophageal candidiasis is the most common disease among all candida infections of the gastrointestinal tract, and generally develops in immunocompromised patients. The prevalence of esophageal candidiasis has increased in patients undergoing antibiotic therapy, diabetes, adrenal dysfunction, alcohol intoxication, old age, esophageal injury, esophageal stasis, gastric surgery, and acid suppressive therapy. However, the overall prevalence is not higher than that of immunocompromised patients. Gastric candidiasis is uncommon because of the strong acidity of the gastric juices. The most common clinical setting for gastric candidiasis is in patients with neoplastic disease. However, there are some case reports suggesting an increase in the prevalence of gastric candidiasis after gastric ulcer therapy with surgery or acid suppressive agents. Delayed gastric emptying, increased intragastric pH, and reflux of the duodenal contents into the stomach are factors indicative of the pathophysiology of gastric candidiasis after gastric surgery. We encountered a case of aggravated esophageal candidiasis and the formation of a gastric yeast bezoar following a gastric outlet obstruction due to a duodenal stenosis. We herein report this case along with an overview of the relevant literature. (Korean J Gastrointest Endosc 2007;34:205⁣209)

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A Case of Gastric Schwannoma in a Male Patient: Soo-youn Moon, M.D., Young-Woon Chang, M.D., Chang Kyun Lee, M.D., Jae Young Jang, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byoung-Ho Kim, M.D. and Rin Chang, M.D.; Korean J Gastrointest Endosc 2007;34(4):210-213. Published online April 30, 2007

Abstract PDF: Gastric schwannoma that originates from nerve sheath comprises about 0.2% of all gastric tumors and 4% of all benign gastric tumors. It is difficult to precisely diagnose gastric schwannoma via endoscopic biopsy or imaging studies. A 57-year-old male was referred to our hospital from a private clinic for further evaluation of a gastric tumor-mass that was diagnosed by gastroscopy. Gastroscopy and endoscopic ultrasonography showed a submucosal mass larger than 3 cm in size at the low body of the stomach. That the mass had malignant potential could not be excluded because of its size and shape. The patient underwent subtotal gastrectomy. The tumor cells showed immunoreactivity to S-100 protein. This submucosal tumor was diagnosed as a gastric schwannoma on the basis of these findings. Gastric schwannoma is known to occur more frequently in females than males. This is the first reported case of gastric schwannoma that's occurred in a Korean male patient. (Korean J Gastrointest Endosc 2007;34:210⁣213)

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Composite Tumor of Gastric Adenoma with Carcinoid Tumor: Hee Jeong Hwang, M.D., Woo Chul Chung, M.D., Hyun Joo Choi, M.D.*, Kang Moon Lee, M.D., Jin Mo Yang, M.D., Jae Kwang Kim, M.D., Sok Won Han, M.D., Kyu Yong Choi, M.D. and In-Sik Chung, M.D.; Korean J Gastrointest Endosc 2007;34(4):214-218. Published online April 30, 2007

Abstract PDF: A gastric carcinoid is a rare disease that accounts for only 0.3% of all primary gastric tumors. It can be multiple or occur with other types of tumor. However, there has been a recent increase in incidence. While carcinoids of the appendix and rectum are accompanied by adenoma or adenocarcinoma, a gastric carcinoid rarely occurs with an adenocarcinoma, particularly with a gastric adenoma. We encountered a case of a gastric adenoma and carcinoid mixed as a composite tumor, which became a lesion. The lesion resembled a type IIc early gastric cancer at the endoscopic examination and was removed by an endoscopic mucosal resection. We report a composite tumor of the gastric antrum composed of areas of adenoma and carcinoid, with an analysis of the histological components by immunohistochemical staining. Microscopically, the lesion was composed of a gastric adenoma and carcinoid as a composite tumor. (Korean J Gastrointest Endosc 2007;34:214⁣218)

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A Case of Bleeding from Proximal Jejunal GIST Diagnosed by Colonoscopy through the Oral Approach: Hae Sun Jung, M.D., Ki-Nam Shim, M.D., Su Jung Baik, M.D., Kum Hei Ryu, M.D., Hyun Joo Song, M.D., Yoo Kyung Cho, M.D., Seong Eun Kim, M.D., Sung-Ae Jung, M.D., Kwon Yoo, M.D. and Il Hwan Moon, M.D.; Korean J Gastrointest Endosc 2007;34(4):219-222. Published online April 30, 2007

Abstract PDF: Gastrointestinal bleeding from small bowel lesions is uncommon but it is the most common cause of obscure gastrointestinal bleeding that can go undiagnosed using traditional upper endoscopy and colonoscopy. Recently, various new methods, including wireless capsule endoscopy and double-balloon enteroscopy have been used to detect and manage small bowel lesions. A 51-year-old man was admitted with hematochezia. The source of bleeding could not be identified using conventional upper endoscopy and colonoscopy. Wireless capsule endoscopy revealed a mass-like lesion with active blood spurting in the proximal jejunum. Finally, a tumor with central ulceration was detected at the proximal jejunum using a clean colonoscope through the oral approach. This lesion was surgically resected, and the histology findings were consistent with a gastrointestinal stromal tumor. We report a case of gastrointestinal bleeding from a proximal jejunal GIST diagnosed by clean colonoscopy through the oral approach with a review of the relevant literature. (Korean J Gastrointest Endosc 2007;34:219⁣222)

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A Case of Melanosis Ilei: Ji Hwan Yoon, M.D., Sung Hyeon Eum, M.D., Sang Yup Kim, M.D., Cheul Yeon Kim, M.D., Hong Seok Hwang, M.D., Hyung Hwa Lee, M.D., Ji Young Seo, M.D., Yeong Sung Kim, M.D. and Dong Hyup Kwak, M.D.; Korean J Gastrointest Endosc 2007;34(4):223-226. Published online April 30, 2007

Abstract PDF: Melanosis ilei is a condition that's characterized by gross greyish-black or brownish-black pigmentation of the mucosa of the terminal ileum. There were several substances that produce gastrointestinal tract pigmentation such as lipofuscin, iron sulphide (FeS), Hemosiderin and exogenous material such as silicates and titanium. We report here on a case of a 58-year-old female who ingested charcoal for a long time, and she was diagnosed with melanosis ilei by colonoscopy. Her condition improved after she stopped ingesting the charcoal. (Korean J Gastrointest Endosc 2007;34:223⁣226)

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A Case of Right Diaphragmatic Hernia of Sigmoid Colon Showed by Colonoscopy: Hae Jung Song, M.D., Joon Seong Lee, M.D., Jeong Ho Ham, M.D., Sun Hae Lee, M.D., Chang Beom Ryu, M.D., Jin Oh Kim, M.D., Joo Young Cho, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D., Jae Jun Kim, M.D.* and Jung Hoon Kim, M.D.^†; Korean J Gastrointest Endosc 2007;34(4):227-232. Published online April 30, 2007

Abstract PDF: A 53-year-old man complained of constipation and abdominal pain including the right flank area for three days. He had suffered multiple rib and clavicular fractures on the right side 10 years earlier. Colonoscopy was performed to assess the constipation, which showed a twisted constricted lumen in the sigmoid colon or descending colon. Passing through it, the saccular dilated bowel wall demonstrated edematous, erythematous changes in the mucosa with a purplish color and necrosis. The proximal part of the saccular lumen also showed a twisted stricture with necrotic materials. The abdominal CT showed subsegmental atelectasis in the right lung, right pleural effusion and a diaphragmatic hernia of the colon. In addition, multiple dilated bowel loops were observed in the abdomen. The patient underwent emergency surgery with a segmental resection of the sigmoid colon. We report this case of delayed traumatic right diaphragmatic hernia of the sigmoid colon with strangulation, which is extremely rare and was revealed by colonoscopy. (Korean J Gastrointest Endosc 2007;34:227⁣232)

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A Small Rectal Carcinoid Tumor with Multiple Liver Metastases: Du San Baik, M.D., Joon Hyuk Lee, M.D., Soon Il Lee, M.D., Jeong Eun Shin, M.D., Sang Won Park, M.D. and Won Ae Lee, M.D.*; Korean J Gastrointest Endosc 2007;34(4):233-238. Published online April 30, 2007

Abstract PDF: Rectal carcinoid tumors are relatively uncommon and make up 1∼2% of tumors found in the rectum. Approximately 50% of the tumors are asymptomatic and are found incidentally. In most cases, the tumors are slowly growing in nature and thus have a favorable outcome. Anywhere from 66 to 80% of rectal carcinoid tumors are smaller than 1 cm and rarely metastasis. However, malignant behavior, such as invasion to the muscle wall, and metastasis to a distant organ, may be seen infrequently with tumors greater than 2 cm in size. The liver is the most common site of a metastasis. We experienced a case of a 1 cm sized small rectal carcinoid tumor with multiple liver metastases. (Korean J Gastrointest Endosc 2007;34:233⁣238)

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