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Volume 38(1); January 2009
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Linear Array Endoscopic Ultrasonography
Eun Young Kim, M.D.
Korean J Gastrointest Endosc 2009;38(1):1-8.   Published online January 30, 2009
AbstractAbstract PDF
Endoscopic ultrasonography (EUS) was first developed to observe the pancreas more clearly without interference from the air and the abdominal wall. EUS is currently being used as an important diagnostic and therapeutic tool for various gastrointestinal diseases. Until recently, a radial echoendoscope with a vertical scanning plane has been mainly used, but a linear echoendoscope (linear EUS) with a parallel scanning plane has been recently developed. With the introduction of linear EUS, it is possible to perform many interventional procedures, including fine needle aspiration, and the field of EUS has been greatly expanded. This article briefly reviews the accepted procedures and the new trials using linear EUS. (Korean J Gastrointest Endosc 2009;38:1-8)
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Colonoscopic Perforations: 4 Years' Experience
Jung Hyuk Suh, M.D., Chin Seung Kim, M.D., Kwang Chan Lee, M.D. and Jin Chul Ko, M.D.
Korean J Gastrointest Endosc 2009;38(1):9-13.   Published online January 30, 2009
AbstractAbstract PDF
Background/Aims: Many physicians agree that colonoscopy is the best modality for either the diagnostic evaluation or use in therapy for colorectal disease. Although the incidence of perforations that occur after colonoscopy is low, the increasing number of performed colonoscopies may pose a relevant health problem with including the often lethal consequences. This study aimed to determine the frequency of perforation and the management of colonoscopic perforation. Modern Korean society has adopted westernized dietary habits, and this has led to an increased incidence of colorectal disease such as colorectal cancer, polyps and diverticulosis.

Methods: We conducted a retrospective review of the medical records of all the patients who underwent colonoscopy complicated by colon perforation between January 2004 and December 2007. The patients' demographics, the purpose of colonoscopy, the location of the perforation, the management and the outcome were compared.

Results: A total of 5254 patients underwent either a diagnostic or therapeutic colonoscopy procedure during four consecutive years at a single institution. Iatrogenic colonoscopic perforations (0.2%) were diagnosed in 11 patients (seven males and four females). Perforations occurred in six patients during a diagnostic colonoscopy and these occurred in five patients during a therapeutic colonoscopy. Free air in the peritoneum or retroperitoneum was seen in all the patients, as depicted on plain X-rays. Seven patients were treated with surgical intervention and four patients were treated with conservative management. One of the 11 patients with a perforation expired on postoperative day 47 due to infective endocarditis.

Conclusions: The rate of iatrogenic colonoscopic perforation is still very low. Although perforation is a very serious complication and it can be a lethal malady, early recognition and treatment are very critical factors to optimize the patient outcome. Although a gold standard therapeutic modality has not been established, the patients who present with the signs and symptoms of generalized peritonitis are recommended to undergo early surgical intervention. (Korean J Gastrointest Endosc 2009;38:9-13)

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Recent Trends in the Eradication Rates of Second-Line Quadruple Therapy for Helicobacter Pylori and the Clinical Factors that Potentially Affect the Treatment Outcome
Eun Ju Cho, M.D., Dong Ho Lee, M.D.*, Jae Young Chun, M.D., Jong Kyung Choi, M.D., Sung Wook Hwang, M.D., Sang Hyub Lee, M.D.*, Young Soo Park, M.D.*, Jin Hyeok Hwang, M.D.*, Jin Wook Kim, M.D.*, Sook Hyang Jung, M.D.*, Nayoung Kim, M.D.*, Hyun Chae Jung,
Korean J Gastrointest Endosc 2009;38(1):14-19.   Published online January 30, 2009
AbstractAbstract PDF
Background/Aims: The present study aimed to evaluate the efficacy of second-line quadruple therapy for treating patients with Helicobacter Pylori, and these patients were treated at our hospitals for September, 2003 through April, 2008 in Seongnam, Korea.

Methods: One hundred and thirty-three patients who failed to respond to the initial PPI-based triple therapy received quadruple therapy, whcih consisted of PPI, bismuth, tetracycline and metronidazole. The patients were divided into two groups. One group was treated for 7 days and the other group was treated for 14 days. Four to six weeks after completing the schedule, a 13C-urea breath test was performed to detect the presence of H. pylori.

Results: The overall intention-to-treat and per-protocol (PP) eradication rates were 75.2% and 81.1%, respectively. The PP eradication rates for the years 2003∼2004, 2005, 2006 and 2007∼2008 were 76.5%, 82.5%, 91.3% and 75%, respectively. There was no significant difference of the eradication rates according to gender, age and the duration of treatment. Yet the eradication rate of the chronic gastritis group (66.7%) was significantly lower than that of the peptic ulcer group (84.7%) (p=0.030).

Conclusions: There was no definite downward trend for the eradication rates of second-line quadruple therapy during the 6 year study period. However, the eradication rate in the recent 2 years guaranteed only a 75% cure rate and the quadruple therapy was less effective for the patients with chronic gastritis. Therefore, a novel, more potent novel second-line regimen may be needed for the eradication of H. pylori. (Korean J Gastrointest Endosc 2009;38:14-19)

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A Case of Esophageal Anthracosis with Polypoid Features
Jong Yul Lee, M.D., Seok Hui Kang, M.D., Jae Hyuck Chang, M.D., Myung Gyu Choi, M.D., In Sik Chung, M.D., Yeong Jin Choe, M.D.*, Kyo Young Lee, M.D.* and Eun Sun Jung, M.D.*
Korean J Gastrointest Endosc 2009;38(1):20-23.   Published online January 30, 2009
AbstractAbstract PDF
Anthracosis mostly occurs at the lung and esophageal anthracosis has rarely been reported. As a result, the pathogenesis and prognosis of esophageal anthracosis is currently unclear. In previous reports, esophageal anthracosis has been mostly observed as relatively flat lesions that require differentiation from malignant melanoma. We report here on a case of esophageal anthracosis with polypoid features in a seventy year old male patient with hepatocellular carcinoma. The patient had undergone endoscopic examination and a 1 cm sized black polypoid lesion was observed. Pathology revealed macrophages phagocyting black carbon pigments beneath the mucosal epithelium and the diagnosis of esophageal anthracosis was made. (Korean J Gastrointest Endosc 2009;38:20-23)
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A Case of Double Primary Cancer in the Esophagus
Jeong Yo Min, M.D., Hyun Jeong Lee, M.D., Hye Suk Son, M.D., Jin Su Kim, M.D., Hyung Keun Kim, M.D., Young Seok Cho, M.D. and Hiun Suk Chae, M.D.
Korean J Gastrointest Endosc 2009;38(1):24-27.   Published online January 30, 2009
AbstractAbstract PDF
Double primary cancer is usually accompanied by gastrointestinal cancer. The incidence of histologically different cancers in the same organ is less than that of double cancers arising from different organs. The cancers accompanied by esophageal squamous cell carcinoma are laryngopharyngeal cancer, gastric adenocarcinoma and primary hepatocarcinoma. Esophageal cancer is supposed to be frequently accompanied by squamous cell carcinoma of the head and neck or the upper respiratory tract because of such common carcinogens as smoking and alcohol ingestion. On the other hand, it is vary rare that a synchronous double primary cancer is diagnosed at the esophagus. We present here a case of double esophageal cancer in a 77 year-old patient who visited our hospital because of progressive dysphagia that she'd experienced for 3 weeks. (Korean J Gastrointest Endosc 2009;38:24-27)
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Three Cases of Double Primary Cancer in the Esophagus and Stomach
Hye Suk Son, M.D., Jin Soo Kim, M.D., Young Seok Cho, M.D., Hyung Keun Kim, M.D., Jeong Yo Min, M.D., Myong Ki Baeg, M.D., Yun Ji Kim, M.D. and Hiun Suk Chae, M.D.
Korean J Gastrointest Endosc 2009;38(1):28-33.   Published online January 30, 2009
AbstractAbstract PDF
Double primary cancer means that more than 2 cancers occur independently in an individual. There have been many reports on double primary cancer since Billroth reported it for the first time in 1889 and Warren and Gates established it. The incidence of esophageal cancer is low, about 1~2% of all cancer and, 7% of all gastrointestinal cancer, but double cancer with including esophageal cancer is 9.5~27% of all double primary cancer. Double primary cancer of the esophagus and stomach has occasionally been reported. We have experienced three cases of double primary cancer of squamous carcinoma in the esophagus and adenocarcinoma in the stomach. In this study we reviewed the clinical characteristics of the reported cases of double primary esophageal and gastric cancer that have been reported in Korea and these three cases we experienced at our hospital. (Korean J Gastrointest Endosc 2009;38:28-33)
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A Case of Synchronous Triple Early Gastric Cancer
Dong Han Im, M.D., Pyoung Rak Choi, M.D., Eun Ho Park, M.D., Jee Suk Lee, M.D., Seun Ja Park, M.D., Moo In Park, M.D., Won Moon, M.D. and Kyu Jong Kim, M.D.
Korean J Gastrointest Endosc 2009;38(1):34-37.   Published online January 30, 2009
AbstractAbstract PDF
Multiple gastric cancers have several clinicopathologic characteristics that are different from those of solitary cancer and the incidence of multiple gastric cancers has recently been on the increase due to the development of diagnostic endoscopy, chromoscopy, and radiological examination. It is important to determine the proper surgical area after evaluating the synchronous multiple gastric cancer by performing closed endoscopy and radiological evaluation prior to surgery. Generally, elderly men have a relatively high incidence of multiple gastric cancers and the well differentiated type is most common. There have been reports on the diagnoses of multiple gastric cancers of elderly men and the well differentiated type, but there are no prior reports concerned with multiple gastric cancers of younger patients and the different pathologic differentiation. We experienced a case of synchronous multiple early gastric cancer of a younger man and this showed different pathologic differentiation. (Korean J Gastrointest Endosc 2009;38:34-37)
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A Case of Malignant Duodenocolic Fistula
Sei Won Kim, M.D., Hiun Suk Chae, M.D., Jeong Yo Min, M.D., Hye Suk Son, M.D., Jin Su Kim, M.D., Hyung Keun Kim, M.D., Young Seok Cho, M.D. and Chang Hyuk Ahn, M.D.*
Korean J Gastrointest Endosc 2009;38(1):38-42.   Published online January 30, 2009
AbstractAbstract PDF
Malignant duodenocolic fistula is a rare complication of colon cancer, and this usually develops as the right-side colon cancer or colonic hepatic flexure cancer infiltrates into the second portion of the duodenum. Six Korean cases of this malignancy have been previously reported on. The patients usually complain of watery diarrhea, feculant vomiting and weight loss that can be attributed to the altered normal flora. Barium enema has been the diagnostic procedure of choice to demonstrate the fistulous tract, but with the technical development of gastroendoscopy, the primary procedure is also changing. Curative resection is not possible in many cases. Palliative ileotransverse colostomy with gastrodjejunostomy is performed to relieve symptoms, but it cannot completely prevent the vomiting or diarrhea. We herein present a case of malignant duodenocolic fistula in a patient who had been suffering from indigestion, loose stool and feculant vomiting for one year. This case was diagnosed by endoscopy and the patient underwent a palliative operation. (Korean J Gastrointest Endosc 2009;38:38-42)
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A Case of Juvenile Polyposis Syndrome with Whole Gastrointestinal Tract Involvement
Key Hyeon Kim, M.D., Yoon Tae Jeen, M.D., Bora Keum, M.D., Seung Joo Nam, M.D., Jin Yong Park, M.D., Jong Gyu Song, M.D., Cho Rong Oh, M.D. and Woo Seok Choi, M.D.
Korean J Gastrointest Endosc 2009;38(1):43-46.   Published online January 30, 2009
AbstractAbstract PDF
Juvenile Polyposis Syndrome is a rare condition that is characterized by the development of multiple polyps in the gastrointestinal tract. It is a hamartomatous disorder that was first described in families in 1964. Both sporadic and familial cases with autosomal dominant inheritance have been reported on. Juvenile Polyposis Syndrome is regarded as a distinct from the solitary juvenile polyps that develop in 2% of children and adolescents, and the latter have no malignant potential. We report here on a case of Juvenile Polyposis Syndrome in an 18 year old male along with a review of the relevant literature. The patient had various numbers of different sized pedunculated polyps that were observed throughout the entire gastrointestinal tract. (Korean J Gastrointest Endosc 2009;38:43-46)
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Anti-Tuberculosis Agents Induced Pseudomembranous Colitis Treated with Maintaining Anti-Tuberculosis Drugs
Myoung Lyeol Woo, M.D., Jae Hee Cho, M.D., Jeong Hun Kim, M.D., Myoung Hwan Kim, M.D., Hyuk Jin Kwon, M.D., Kil Sang Wang, M.D., Sang Yeop Yi, M.D.* and Hyeon Geun Cho, M.D.
Korean J Gastrointest Endosc 2009;38(1):47-51.   Published online January 30, 2009
AbstractAbstract PDF
Tuberculosis is one of the main infectious health problems in Korea, and a combination of antibiotics is required to treat this illness. The combination therapy with rifampicin, isoniazid, ethambutol and pyrazinamide has many adverse reactions and there have been several case reports about pseudomembranous colitis (PMC) after anti- tuberculosis treatment. Rifampicin is regarded as a main cause of anti-tuberculosis induced PMC because of its bacteriocidal effect, and interruption of the offending drug, such as rifampicin, is usually necessary to treat the PMC. However, in patents with uncompensated tuberculosis, the discontinuance of anti-tuberculosis medication accentuates the disease severity, and continuance of the anti-tuberculosis medication is necessary to overcome the tuberculosis. We report here on a case in which the anti- tuberculosis agents induced PMC in 32 year old female who was diagnosed with active pulmonary tuberculosis. She was treated with maintenance of the anti-tuberculosis medication and also the addition of both oral metronidazole and probiotics. (Korean J Gastrointest Endosc 2009;38:47-51)
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A Case of Small Rectal Carcinoid Tumor with Local Lymph Node Metastases
Jong Beom Park, M.D., Jae Myung Cha, M.D.*, Joung Il Lee, M.D.*, Jae Won Choe, M.D.*, Kwang Ro Joo, M.D.*, Sung Won Jung, M.D.*, Hyun Phil Shin, M.D.* and Suk Hwan Lee, M.D.
Korean J Gastrointest Endosc 2009;38(1):52-56.   Published online January 30, 2009
AbstractAbstract PDF
Carcinoid tumors are rare and they arise from the enterochromaffin cells of the gastrointestinal tract. The rectum is the most common site for gastrointestinal carcinoids, and the majority of rectal carcinoids are found incidentally during colonoscopy. As the use of diagnostic colonoscopy has recently become more common, the number of cases with small rectal carcinoids resected by endoscopic resection has increased. However, distinguishing benign from malignant carcinoids is usually imposible based solely on the histology; therefore, evaluation for the local and distant metastases of rectal carcinoids is necessary even after complete endoscopic resection. We have experienced a case of small rectal carcinoid tumor that was endoscopically completely resected and surgical resection was done for the associated lymph node metastases. (Korean J Gastrointest Endosc 2009;38:52-56)
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The Balloon Occluded Method for Selective Cannulation of the Intrahepatic Duct: A Case Report
Yong Wuk Kim, M.D., Dae Han Kang, M.D., Dong Uk Kim, M.D., Cheol Woong Choi, M.D., Pyo Jun Kim, M.D., Kyung Sik Jung, M.D. and Woo Jin Jung, M.D.
Korean J Gastrointest Endosc 2009;38(1):57-59.   Published online January 30, 2009
AbstractAbstract PDF
Selective cannulation into the intrahepatic duct during ERCP can occasionally be difficult and time-consuming depending on the GI tract anatomy and the presence of biliary tree anomalies or pathology. A variety of techniques or devices have been used to enhance the success rate of selective cannulation in these situations. The balloon occluded method for selective cannulation of the LHD (left hepatic duct) with using an inflated balloon catheter to occlude the RHD (right hepatic duct) has also been reported. We report here a case of successful selective cannulation of the RHD with using an inflated balloon catheter to occlude the LHD in a patient who had a GB cancer with liver metastasis. After this maneuver, a guidewire is advanced; it deflects off the inflated balloon and then proceeds to the RHD. (Korean J Gastrointest Endosc 2009;38:57-60)
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