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Volume 36(2); February 2008
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Uncovered Self-expandable Metal Stents (SEMS) for Gastric Outlet Obstruction Caused by Stomach Cancer
Hyoung Yoel Park, M.D., Dae Hwan Kang, M.D., Jae Sup Eum, M.D., Tae In Ha, M.D., Chan Ho Park, M.D., Kyung Yeob Kim, M.D., Cheol Woong Choi, M.D., Do Hoon Kim, M.D., Ji Young Kim, M.D., Hye Jeong Lee, M.D., Gwang Ha Kim, M.D. and Geun Am Song, M.D.
Korean J Gastrointest Endosc 2008;36(2):57-63.   Published online February 27, 2008
AbstractAbstract PDF
/Aims: The use of self-expandable metal stents (SEMS) is a safe and efficacious method for palliating malignant gastric outlet obstruction. However, few reports have assessed clinical outcome after the insertion of SEMS for malignant gastric outlet obstruction caused by stomach cancer. The aim of this study was to assess the usefulness of uncovered SEMS in patients with malignant gastric outlet obstruction caused by stomach cancer. Methods: We evaluated 62 patients with gastric outlet obstruction caused by stomach cancer treated by the implantation of uncovered SEMS. A total of 62 patients (43 males, 19 females) were treated between August 2000 and March 2007. A scoring system was used to grade the ability to eat. Results: Stent implantation was successful in 61 (98.4%) patients. Relief of obstructive symptoms was achieved in 49 (80.3%) patients. The mean survival duration was 143 days. The mean stent patency time was 103.5 days. An improvement in the ability to eat using the scoring system was statistically significant (p<0.05). Conclusions: Endoscopic placement of uncovered SEMS is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer. (Korean J Gastrointest Endosc 2008;36:57-63)
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Diagnostic and Therapeutic Usefulness of Double Balloon Enteroscopy: Single Center Experience
Soo Hoon Eun, M.D., Jin-Oh Kim, M.D., Bong Min Ko, M.D., Keun Hyok Cho, M.D., Kyu Sung Chung, M.D., Joo Young Cho, 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 2008;36(2):64-70.   Published online February 27, 2008
AbstractAbstract PDF
/Aims: Until recently, only indirect procedures were available to provide images of the small bowel. Double-balloon enteroscopy (DBE) has the ability to obtain tissue for diagnosis and endoscopic interventions. This study was designed to determine the usefulness of DBE in patients with small bowel diseases by evaluating diagnostic yields and the impact on treatment. Methods: From November, 2004 to November, 2006 a total 81 patients with suspected small bowel disease were investigated by DBE. We analyzed the diagnostics and therapeutics rates according to the indications of DBE. Results: A total of 114 DBE procedures were performed. Gastrointestinal bleeding (64.2%) was the most common indication, followed by chronic abdominal pain/diarrhea (29.6%). A diagnosis was obtained in 44 of 52 patients with gastrointestinal bleeding and 17 of 24 patients with chronic abdominal pain/diarrhea. DBE resulted in therapeutic intervention in 17 patients with gastrointestinal bleeding and 13 patients with chronic abdominal pain/ diarrhea. DBE was diagnostic in 75.3% of the patients and played a role in the subsequent treatment of 37.0% of the patients. Conclusions: DBE was a useful and safe method for diagnosis and treatments in patients with small bowel diseases. (Korean J Gastrointest Endosc 2008;36: 64-70)
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A Case of a Primary Esophageal Bezoar after a Total Gastrectomy
Hwa Mock Lee, M.D., Won Il Park, M.D., Hyun Ju Kim, M.D., Sung Han Yun, M.D., Nam Sik Kim, M.D., Seung Eun Lee, M.D., Jin Kwang An, M.D., Kwang Jin Kim, M.D., Joon Seok Oh, M.D., Jong Yun Cheong, M.D., Won Ook Ko, M.D. and Ung Suk Yang, M.D.
Korean J Gastrointest Endosc 2008;36(2):71-73.   Published online February 27, 2008
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An esophageal bezoar, although uncommon, is now recognized as a distinct clinical entity. An esophageal bezoar is rare but can form due to regurgitation of a gastric bezoar, motor disorder or anatomical abnormality, or following a gastrectomy. In general, bezoars are most often found in the stomach, and are formed by the accumulation of foreign ingested materials, including vegetable material and hair. In Korea, no case of a primary esophageal bezoar has been reported after a total gastrectomy. We report a case of an endoscopically treated primary esophageal bezoar that occurred after a total gastrectomy, without complications. (Korean J Gastrointest Endosc 2008;36:71-73)
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Trial of Argon Plasma Coagulation in Patients with Heterotopic Gastric Mucosa Presenting with Laryngopharyngeal Symptoms
Chan Ik Park, M.D., Jung Ar Shin, M.D., In Su Jung, M.D. and Hyojin Park, M.D.
Korean J Gastrointest Endosc 2008;36(2):74-77.   Published online February 27, 2008
AbstractAbstract PDF
Heterotopic gastric mucosa in the upper esophagus, in which the inlet patch is a salmon-colored valvet patch, is located mainly below the upper esophageal sphincter. The acid secretion and inflammation from heterotopic gastric mucosa causes laryngopharyngeal symptoms. Generally, the management of heterotopic gastric mucosa depends on the symptoms, and the condition is generally treated by proton pump inhibitor. Recently, it was reported that argon plasma coagulation (APC) is effective when medical treatment fails. A 49-year-old man and a 44-year-old woman with symptoms of globus sensation and hoarseness visited this clinic. An upper gastrointestinal endoscopy showed a flat salmon-colored patch located at the upper esophagus. The former patient failed medical treatment and the latter did not require long term medical treatment. Therefore, the patients were treated with APC, which resulted in an improvement in symptoms. APC treatment may improve the symptoms of patients with heterotopic gastric mucosa of the cervical esophagus. (Korean J Gastrointest Endosc 2008;36:74-77)
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A Case of Esophageal Compression by a Right-sided Aortic Arch and Kommerell's Diverticulum Mimicking an Esophageal Submucosal Tumor
Young Jig Cho, M.D., Bora Keum, M.D., Youn Ho Kim, M.D., Hwi Kong, M.D., Jin Nam Kim, M.D., Yong Sik Kim, M.D., Yoon Tae Jeen, M.D., Hoon Jai Chun, M.D., Soon Ho Um, M.D., Chang Duck Kim, M.D., Ho Sang Rhu, M.D. and Jin Hai Hyun, M.D.
Korean J Gastrointest Endosc 2008;36(2):78-82.   Published online February 27, 2008
AbstractAbstract PDF
A right-sided aortic arch and Kommerell's diverticulum, remnants of the left dorsal aortic arch in the circulation of the embryo, are uncommon congenital defects of the aorta. They may be asymptomatic in most cases, but symptoms are manifested by compressing mediastinal structures or are related to congenital heart anomalies. If aneurismal dilatation of the diverticulum presents with rupture, it is lethal. We report a case of esophageal compression by a right-sided aortic arch and Kommerell's diverticulum that mimicked an esophageal submucosal tumor in a patient who complained of symptoms during the past ten years of food retention in the upper thorax when a bolus of food was ingested. (Korean J Gastrointest Endosc 2008;36: 78-82)
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A Case of Rapidly Improved Menetrier's Disease after Short-term Treatment with Proton Pump Inhibitor
Hyun Jeong Lim, M.D., Seun Ja Park, M.D., Jeong Ah Seo, M.D., Won Moon, M.D., Kyu Jong Kim, M.D. and Moo In Park, M.D.
Korean J Gastrointest Endosc 2008;36(2):83-86.   Published online February 27, 2008
AbstractAbstract PDF
Menetrier's disease is a rare illness that is characterized by diffuse tremendous thickening of the gastric wall caused by excessive proliferation of the mucosa of unknown cause. An exact diagnosis is crucial due to the excellent prognosis as compared to other malignant lesions such as a gastric lymphoma and infiltrative gastric carcinoma. A 23-year-old woman presented with epigastric discomfort and dyspepsia. A rapid urease test, a test for H. pylori using serum IgG antibody, and a 13C-urea breath test were all negative. A gastroscopic examination revealed a wide lesion encircling the lumen, which showed diffusely hard and thickened folds from an angle to the upper body near the cardia. Endoscopic ultrasonography showed diffusely hypoechoic thickness of the second wall layer, but the other wall layers were well preserved. The patient was diagnosed with Menetrier's disease without H. pylori infection, and the patient rapidly improved after short-term treatment with a proton pump inhibitor. (Korean J Gastrointest Endosc 2008;36:83-86)
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A Case of Submucosal Tumor-like Gastric Mucinous Adenocarcinoma Showing Mucin Waterfall
Hyung Ha Jang, M.D., Sang Hyun Lee, M.D., Gwang Ha Kim, M.D., Chul Woong Choi, M.D., Chan Ho Park, M.D., Jae Sup Eum, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Dae Hwan Kim, M.D.*, Suk Kim, M.D. and Kyung Un Choi, M.D.
Korean J Gastrointest Endosc 2008;36(2):87-91.   Published online February 27, 2008
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Muinous gastric carcinoma (MGC) is a rare histological type that accounts for approximately 3∼7% of all gastric carcinomas. The results of clinicopathological studies suggest that the overall survival rate for patients with MGC is worse than that for patients with non-mucinous tumors as MGC is more frequently diagnosed in the advanced stage. In this report, we preoperatively predicted the type of a tumor from its endoscopic finding. An endoscopic ultrasonographic examination showed a submucosal tumor like mass showing mucin waterfall on the gastric cardia. A total gastrectomy with splenectomy was performed. The pathology of the tumor identified the lesion as a mucinous adenocarcinoma. (Korean J Gastrointest Endosc 2008;36:87-91)
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A Case of Capsule Endoscopy in a 42-month-old Girl
Kyung-Jo Kim, M.D., Kyung Mo Kim, M.D.*, Sung Chul Kim, M.D., Young Mi Cho, M.D. and Eun Jin Rho, M.D.§
Korean J Gastrointest Endosc 2008;36(2):92-96.   Published online February 27, 2008
AbstractAbstract PDF
Capsule endoscopy (CE) provides a minimally invasive examination of the entire small intestine, and is the preferred procedure for evaluation of patients with GI bleeding of unknown origin. Even though the FDA approved its use for pediatric patients between 10 and 18 years old in January 2004, little information is available regarding the effectiveness of CE in the younger pediatric population (below 6 years old) because of safety issues. A 42-month child with recurrent melena was referred to evaluate the cause of gastrointestinal bleeding. Despite extensive evaluation, including EGD, colonoscopy, a small bowel series, and Meckel's scan, the bleeding source was not identified. Finally, wireless CE demonstrated angiodysplasia on the mucosa of proximal jejunum. This is the first pediatric case of endoscopy-assisted CE under intravenous sedation without endotracheal intubation in Korea. (Korean J Gastrointest Endosc 2008;36:92-96)
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A Case of Inflammatory Myofibroblastic Tumor Diagnosed with Double-balloon Enteroscopy
Hyun Gun Kim, M.D., Jin Oh Kim, M.D., Ik Sung Choi, M.D., Soo Hoon Eun, M.D., Bong Min Ko, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., So Young Jin, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.
Korean J Gastrointest Endosc 2008;36(2):97-101.   Published online February 27, 2008
AbstractAbstract PDF
Gastrointestinal bleeding from an unknown origin occurs in 2∼10% of patients with a small bowel lesion. The recent developments in capsule endoscopy and double- balloon enteroscopy have helped improve the accuracy of a diagnosis of small bowel bleeding. Inflammatory myofibroblastic tumors are most often observed in the lungs of young adults but have rarely been reported in conjunction with a small bowel bleeding episode. We report a case of a bleeding inflammatory myofibroblastic tumor in the jejunum that had been diagnosed as non specific jejunal bleeding by capsule endoscopy and confirmed by double- balloon enteroscopy. (Korean J Gastrointest Endosc 2008;36:97-101)
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A Case of Primary B Cell Mucosa-associated Lymphoid Tissue Lymphoma Presenting as a Solitary Rectal Mass
Jong Hoon Kim, M.D., Young-Soo Moon, M.D., Seuk Hyun Lee, M.D., Jun Sup Park, M.D.*, Won Ki Bae, M.D., Nam-Hoon Kim, M.D., Sunhee Chang, M.D., Kyung-Ah Kim, M.D., Hye Ran Lee, M.D. and June Sung Lee, M.D.
Korean J Gastrointest Endosc 2008;36(2):102-106.   Published online February 27, 2008
AbstractAbstract PDF
Primary extranodal B cell lymphoma of mucosa- associated lymphoid tissue (MALT) can develop in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, and breast. Its distribution in the GI tract is as follows: 50∼60% in the stomach, 20∼30% in the small intestine and ileocecal area and 10% in the colorectal area. Although autoimmune and infectious diseases are known as the main etiologies, H. pylori infection has been clearly shown to play a causative role in lymphomagenesis, especially in the stomach. H. pylori eradication therapy only can induce disease remission nearly in 80% of the cases of gastric MALT lymphoma. However, there is lack of evidence for the extragastric area. In this case, a 71-year-old woman with low abdominal pain was diagnosed as having a rectal MALT lymphoma that was noted as a solitary rectal mass in a colonoscopic examination. Remission induction was commenced by H. pylori eradication and radiation therapy. (Korean J Gastrointest Endosc 2008;36:102-106)
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Two Cases of a Solitary Peutz-Jeghers Polyp in the Rectum
Il Young You, M.D., Sei Jin Youn, M.D., Won Joong Jeon, M.D., Byeongseong Ko, M.D., Hee Bok Chae, M.D., Seon Mee Park, M.D. and Ho-chang Lee, M.D.*
Korean J Gastrointest Endosc 2008;36(2):107-111.   Published online February 27, 2008
AbstractAbstract PDF
Peutz-Jeghers syndrome is a rare autosomal dominant disorder in which multiple hamartomatous polyps are present in the gastrointestinal tract in association with distinctive mucocutaneous pigmentation. A single hamartomatous polyp arising in a patient without pigmentation or familial history of Peutz-Jeghers syndrome is termed a solitary Peutz-Jeghers polyp; such a case is rare and would result in a case report being presented even in other countries. We experienced two cases of a solitary Peutz-Jeghers polyp that developed in the rectum, and report the cases with a review of the literature. (Korean J Gastrointest Endosc 2008;36:107-111)
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A Case of Toxic Megacolon Associated with Fulminant Pseudomembranous Colitis
Dong Hee Koh, M.D., Hang Lak Lee, M.D., Jung Mi Kim, M.D., Won Moon, M.D., Oh Young Lee, M.D., Byung Chul Yoon, M.D., Ho Soon Choi, M.D., Joon Soo Hahm, M.D. and Chan Kum Park, M.D.*
Korean J Gastrointest Endosc 2008;36(2):112-116.   Published online February 27, 2008
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The clinical presentation of Clostridium difficile infection ranges from asymptomatic carriage, colitis with or without pseudomembranes, to fulminant colitis. Although not common, fulminant Clostridium difficile colitis can result in bowel perforation and peritonitis with a high mortality rate. We report a case of toxic megacolon associated with fulminant pseudomembranous colitis. We experienced a case of a 65-year-old male patient who presented with abdominal distension and pain for three days during treatment of pneumonia. We were able to diagnose the case as a toxic megacolon associated with fulminant pseudomembranous colitis. In spite of oral metronidazole treatment and conservative treatment, the clinical course worsened and the patient went into septic shock. The patient underwent a total colectomy but the clinical situation did not improve and the patient died. (Korean J Gastrointest Endosc 2008;36:112-116)
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Carcinoid Tumor of the Extrahepatic Bile Duct: A Case Report and Review of the Literature
Jae Seung Yun, M.D., Woo Chul Chung, M.D., Yong Sung Won, M.D.*, Ju Won Chyung, M.D., Jin Dong Kim, M.D., Jung Rok Lee, M.D., Chang Nyol Paik, M.D. and Kang Moon Lee, M.D.
Korean J Gastrointest Endosc 2008;36(2):117-121.   Published online February 27, 2008
AbstractAbstract PDF
A carcinoid tumor of the bile duct represents between 0.2 and 2% of all gastrointestinal carcinoids, most of which are located in the gallbladder or in the ampulla of Vater. A carcinoid tumor of the extrahepatic bile duct is extremely rare. A 43-year-old man presented with epigastric discomfort for several months. An abdominal ultrasound revealed a mass of the common bile duct. An endoscopic retrograde cholangiopancreatographic (ERCP) examination showed a 1.5 cm sized filling defect in the distal common bile duct and marked dilatation of the common bile duct and intrahepatic bile ducts. A 7 F endoprosthesis was put in place during the examination. The histological finding following an intralesional biopsy was a carcinoid tumor. We performed a pylorus preserving pancreaticoduodenectomy. The final pathological diagnosis was a well-differentiated carcinoid tumor of a malignant nature. (Korean J Gastrointest Endosc 2008; 36:117-121)
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[Retraction] A Comparison of Covered Expandable Metal Stent and Uncovered Expandable Metal Stent for the Management of Distal Malignant Biliary Obstruction
Korean J Gastrointest Endosc 2008;36(2):124-124.   Published online February 27, 2008
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