Clinical Endoscopy

Prophylactic Antibiotics, Anticoagulants and Antiplatelets for GI Endoscopy: Seon Mee Park, M.D.; Korean J Gastrointest Endosc 2010;40(4):221-228. Published online April 30, 2010

Abstract PDF: This review provides general recommendations, based on the literature, on antibiotic prophylaxis, anticoagulants and antiplatelets for GI endoscopy. Antibiotic prophylaxis is recommended for patients at high risk of infection - ERCP with incomplete drainage, ERCP with sterile pancreatic fluid collection (which communicates with the pancreatic duct), pancreatic pseudocyst drainage, EUS-FNA of cystic lesions, percutaneous endoscopic feeding tube placement and cirrhosis with acute GI bleeding. Prophylactic antibiotics are no longer recommended for GI endoscopy to prevent infectious endocarditis. To decide how to manage anticoagulants and antiplatelets during endoscopic procedures, the risk of an adverse ischemic event or a thromboembolic complication and the risk of bleeding must be weighed. For a low-risk procedure, no adjustments in anticoagulation and antiplatelets need to be made. For a high risk procedure, it is recommended to discontinue warfarin 3 to 5 days before the procedure and clopidogrel 7 to 10 days before. Low molecular weight heparin may be used as a bridge before endoscopy in patients with a high risk of a thromboembolism. In the absence of a pre-existing bleeding disorder, endoscopic procedures may be done in patients taking aspirin or other NSAIDs. Further controlled clinical studies are needed to clarify aspects of these recommendations. (Korean J Gastrointest Endosc 2010;40:221-228)

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The Benefit of Percutaneous Endoscopic Gastrostomy Is Low in Patients with Dementia: YuJin Suh, M.D., Jae Myung Cha, M.D., Joung Il Lee, M.D., Kwang Ro Joo, M.D., Sung Won Jung, M.D., Hyun Phil Shin, M.D. and Soo Woong Kim, M.D.; Korean J Gastrointest Endosc 2010;40(4):229-235. Published online April 30, 2010

Abstract PDF: Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) is beneficial in treatment of stroke or head and neck cancer. The situation for dementia is unknown. Presently, results, complications, and survival of PEG patients with or without dementia were assessed.
Methods
In a retrospective analysis of 67 patients, gender, age, diagnosis, laboratory results, complications, tube change, early death and death were compared in dementia (n=5) and non-dementia (n=62) patients (average age 68.7 years).
Results
Patient clinical characteristics were not different, except for the proportion of gender. Complications occurred in 11 cases (16.4%). Wound infection was the most common complication followed by Mallory-Weiss tear, tube leakage, fever and pneumonia. Twenty six patients (38.8%) died during the follow-up period, and the 30 day mortality rate was 2.7%. Average survival of dementia and non- dementia patients was 12 months and 25 months, respectively. Dementia patients showed a tendency for shorter survival, although it was insignificant (p=0.068). Dementia was the only predictor of mortality that showed significance (p=0.006).
Conclusion
In this study there was a tendency for shorter survival in dementia patients and dementia was the only significant predictor of mortality. (Korean J Gastrointest Endosc 2010;40:229-235)

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Diagnostic Agreement between Capsule Endoscopy and Double-balloon Enteroscopy of Small Bowel Disease: Hyun Gun Kim, M.D., Jin-Oh Kim, M.D., Tae Hee Lee, M.D., Wan Jung Kim, M.D., Hyun Sook Chol, M.D., Young Kwan Cho, M.D., Won Young Cho, M.D., Bong Min Ko, M.D., Joo Young Cho, M.D., Moon Sung Lee, M.D. and Joon Seong Lee, M.D.; Korean J Gastrointest Endosc 2010;40(4):236-243. Published online April 30, 2010

Abstract PDF: Background
/Aims: To evaluate the diagnostic agreement between capsule endoscopy (CE) and double-balloon enteroscopy (DBE) in patients with suspected small bowel disease.
Methods
We retrospectively analyzed and compared the diagnostic yield and the diagnostic agreement between CE and DBE, in patients who initially underwent CE followed by DBE at a single tertiary referral center.Results: Thirty patients (17 males, mean age 45±17) underwent both CE and DBE. Total small bowel examination was possible in 80% (24/30) with CE, and 20% (6/30) with DBE. Diagnostic yield was 56.7% (17/30) with CE, and 73.3% (22/30) with DBE. Overall diagnostic yield was 93.3% (28/30) after both examinations. The overall degree of concordance between CE and DBE for lesion description was a moderate agreement, with a calculated kappa index of 0.48 (95% CI 0.44∼0.52, p＜0.05). Both CE and DBE detected identical lesions relevant to the clinical presentation in 56.6% (17/30) of cases. A total of 36.7% (11/30) of cases changed diagnosis because different lesions were detected by each method.
Conclusions
The overall degree of concordance between CE and DBE showed moderate agreement. Additional DBE examinations can improve the diagnostic yield of small bowel lesions in patients with no relevant findings or failed detection on CE, who are, however, clinically suspicious. (Korean J Gastrointest Endosc 2010;40:236-243)

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A Case of Esophageal Hemangioma Treated by Endoscopic Mucosal Resection: Sun Wook Park, M.D., Jeong Seop Moon, M.D., Sang Ryul Lee, M.D., Su-Yeon Lee, M.D., Jong Hyeok Park, M.D., Soo Hyung Ryu, M.D., Jung Hwan Lee, M.D. and You Sun Kim, M.D.; Korean J Gastrointest Endosc 2010;40(4):244-248. Published online April 30, 2010

Abstract PDF: Esophageal hemangioma occurs in fewer than three percent of all benign esophageal neoplasm. To treat symptomatic esophageal hemangioma, surgical resection can be performed. A case of esophageal hemangioma was successfully treated by endoscopic mucosal resection (EMR). The patient was a 50-year-old man who presented with dysphagia and epigastric discomfort. An endoscopic ultrasonography examination revealed an esophageal submucosal mass confined to the submucosal layer, with no continuity with adjacent vessels without regional lymphadenopathy. For diagnosis and symptomatic relief, EMR was performed. The final diagnosis was benign esophageal cavernous hemangioma. No complications have been evident during a 3-year follow-up. (Korean J Gastrointest Endosc 2010;40:244-248)

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A Case of Endoscopic Removal of a Broken off Gastric Balloon from a Sengstaken-Blakemore Tube: Dong Hoon Ko, M.D., Chang-Whan Kim, M.D., Chang Hoon Lim, M.D., Seok Ju Lee, M.D., Jung Ah Kim, M.D., Tae Ho Kim, M.D. and Sok Won Han, M.D.; Korean J Gastrointest Endosc 2010;40(4):249-251. Published online April 30, 2010

Abstract PDF: A Sengstaken-Blakemore (S-B) tube, when used approximately, still has a place in the management of acute variceal bleeding, and controls bleeding in 40∼90% of the cases. However its use is accompanied by number of complications such as esophageal ulcer, pulmonary aspiration, and malfunction of the tube, which requires replacement. We recently observed a very unusual complication: the remaining gastric balloon of a S-B tube was broken off in the fundus of stomach by the patient's traction. The gastric balloon was easily and safely removed using an endoscopic snare after deflating the gastric balloon with a needle puncture. (Korean J Gastrointest Endosc 2010;40:249-251)

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A Case of Gastric Non-Hodgkin's Lymphoma That Developed in a Patient with Behçet's Disease: Jong Min Kim, M.D., Seok Won Jung, M.D., Young Arm Yi, M.D., Shi Jung Sung, M.D., Se Jin Hwang, M.D., Se Jin Kim, M.D., Hee Jeong Cha, M.D.* and Young Min Kim, M.D.*; Korean J Gastrointest Endosc 2010;40(4):252-255. Published online April 30, 2010

Abstract PDF: Behçet's disease is chronic, relapsing, multi-systemic inflammatory vasculitis. Unlikely the other autoimmune diseases, gastric non-Hodgkin's lymphoma has rarely been reported in a patient with Behçet's disease. We report here on a 40-year-old man who had Behçet's disease for several years and who suffered recurrent oral ulcer, genital ulcer and skin lesion. The patient was treated with azathioprine and intermittent oral steroid. He complained of epigastric pain for 1 month, and he had a large ulcerative lesion seen on endoscopic evaluation. We confirmed the lesion was a gastric, diffuse, large B cell lymphoma by endoscopic biopsy. The patient was treated with the rituximab-CHOP regimen, and he has achieved a complete remission for 3 years. We report here on a case of gastric non-Hodgkin's lymphoma in a patient with Behçet's disease and who also had an ileocecal valve ulcer. (Korean J Gastrointest Endosc 2010;40:252-255)

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Gastric Lymphoepithelioma-like Carcinoma Diagnosed and Treated by Endoscopic Submucosal Dissection: Review of the Literature: Jun Ho Cho, M.D., Wan Sik Lee, M.D., Kyoung Rok Lee, M.D., Hye Kyong Jeong, M.D., Sung Bum Cho, M.D., Young Eun Joo, M.D., Sung Kyu Choi, M.D. and Jong Sun Rew, M.D.; Korean J Gastrointest Endosc 2010;40(4):256-260. Published online April 30, 2010

Abstract PDF: Gastric lymphoepithelioma-like carcinoma (LELC) is a rare neoplasm of the stomach that features undifferentiated carcinoma mixed with lymphoid stroma, and it invariably has a good prognosis. Most gastric LELCs have been linked to Epstein-Barr virus (EBV) infection. We experienced a case of a patient with gastric LELC. A 57 years old female patient was found to have shallow irregular ulcerative lesion on the gastric antrum. Although repetitive endoscopic biopsy didn't yield any cancer, early gastric cancer (EGC) was strongly suspected. Endoscopic submucosal dissection (ESD) was performed for establishing the correct diagnosis and curatively resecting the lesion. The pathology revealed gastric LELC with vertical invasion to the submucosa. No remnant cancer and no lymph node metastasis were noted after surgery following ESD. Here, we are reporting on a case of gastric ELEC along with reviewing the relevant literature. We believe this is the first case of gastric ELEC that was successfully diagnosed and managed by ESD. (Korean J Gastrointest Endosc 2010;40:256-260)

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Two Cases of Pyloric Stenosis Caused by Endoscopic Submucosal Dissection: Sang Hoon Park, M.D., Jin Woong Cho, M.D., Yong Keun Cho, M.D., Ji Woong Kim, M.D.,Gum Mo Jung, M.D. and Young Jae Lee, M.D.; Korean J Gastrointest Endosc 2010;40(4):261-265. Published online April 30, 2010

Abstract PDF: Endoscopic Submucosal Dissection (ESD) has recently become a widely accepted treatment for premalignent lesions of the stomach and early gastric cancer. Post-ESD stenosis is a rare complication of ESD, but this can be caused by the removal of a large lesion when lesions are located near the cardia or pylorus. We experienced two cases of post-ESD stenosis. One developed in a high risk patient and this was treated by repeated balloon dilation. The other occurred in a patient who was without risk factors, but the stenosis improved spontaneously. It is important that we should perform early follow-up endoscopy in patients who are at a high risk for post-ESD stenosis, and administer effective treatment. (Korean J Gastrointest Endosc 2010;40:261-265)

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Recurrent Gastric Cancer at the Duodenal Stump after Billroth II Subtotal Gastrectomy: Jeong Guil Lee, M.D., Hwa Young Lee, M.D., Seon Mi Jin, M.D., Il Park, M.D., Sang Jong Lee, M.D., Woo Joong Kim, M.D. and Yoon Hee Lee, M.D.*; Korean J Gastrointest Endosc 2010;40(4):266-269. Published online April 30, 2010

Abstract PDF: Many studies have shown that gastric stump cancer develops after distal gastrectomy, particularly after Billroth II reconstruction. But, recurrent cancer at the duodenal stump following Billroth II type distal gastrectomy for gastric cancer is extremely rare. We report a case of duodenal stump cancer in a 64-year-old man underwent Billroth II distal gastrectomy. (Korean J Gastrointest Endosc 2010;40: 266-269)

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A Case of Leiomyosarcoma of the Sigmoid Colon Presenting as Intussusception: Su Hyun Cho, M.D., Jong Hoon Lee, M.D., Seok Reyol Choi, M.D., Yang Hyun Baek, M.D., Hyun Ah Yoon, M.D., Chang Jae Lee, M.D., Se Woong Choi, M.D. and Jin Han, M.D.; Korean J Gastrointest Endosc 2010;40(4):270-274. Published online April 30, 2010

Abstract PDF: Leiomyosarcomas are malignant tumors of smooth muscle. Leiomyosarcomas of the large intestine are rare, with an incidence of less than 0.1% of all colorectal malignancies. A 70-year-old woman was admitted to the hospital with lower abdominal pain and hematochezia. The abdominal CT scan revealed a solid mass in the sigmoid colon and intussusception with a lead point. Surgical excision of the sigmoid colon mass was performed. The patient was diagnosed with a leiomyosarcoma originating from the sigmoid colon. Few cases of primary sigmoid colon leiomyosarcoma presenting as an intussusception have been reported in the medical literature. We report here on a case of complete surgical resection for a leiomyosarcoma of the sigmoid colon and this presented as intussusception. (Korean J Gastrointest Endosc 2010;40:270-274)

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A Case of Crohn's Disease Associated with Turner Syndrome: Yong Eun Cho, M.D., Chang Hun Yang, M.D., Joong Hyun Lee, M.D., Jung Bae Park, M.D., Jae Hak Kim, M.D.* and Yun Jeong Lim, M.D.*; Korean J Gastrointest Endosc 2010;40(4):275-279. Published online April 30, 2010

Abstract PDF: Turner syndrome is a chromosomal disorder in which of all or part one of the X chromosomes is absent, and this syndrome affects females. The syndrome leads to a constellation of physical findings that often includes congenital lymphedema, a short stature and gonadal dysgenesis. The prevalence of inflammatory bowel diseases in the general population is estimated to be 150∼250 per 100,000 population. A 2-fold increase in the risk of developing inflammatory bowel diseases has been reported in women with Turner syndrome. We describe here a case of Turner syndrome with Crohn's disease. (Korean J Gastrointest Endosc 2010; 40:275-279)

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Two Granular Cell Tumors of the Colon with the Endosonographic Features: Du San Baik, M.D., Jeong Eun Shin, M.D., Sang Soo Lim, M.D., Se Young Yun, M.D., Suk Bae Kim, M.D., Hong Ja Kim, M.D., Il Han Song, M.D. and Na-Hye Myong, M.D.*; Korean J Gastrointest Endosc 2010;40(4):280-284. Published online April 30, 2010

Abstract PDF: Granular cell tumor is relatively uncommon, it is usually benign and it can be located anywhere throughout the body. It is uncommon in the digestive tract, and especially in the colon and rectum. The endosonographic features of granular cell tumor are usually a relatively hypoechoic, heterogenous lesion in the submucosa, but this tumor has rarely been reported in the colon. We report here on two cases of granular cell tumors of the colon that were observed by using endoscopic ultrasonograpy for making the differential diagnosis of a submucosal tumor and these tumors were confirmed by microscopic examinations after endoscopic mucosal resection. (Korean J Gastrointest Endosc 2010;40:280-284)

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Primary Squamous Cell Carcinoma of the Gallbladder Forming a Cholecystogastric Fistula: Chang Jae Lee, M.D. and Jinsook Jung, M.D.*; Korean J Gastrointest Endosc 2010;40(4):285-289. Published online April 30, 2010

Abstract PDF: The most common type of gallbladder cancer is adenocarcinoma. Primary squamous cell carcinoma of the gallbladder is a rare and aggressive disease. It is responsible for up to 1.7% of the malignant neoplasms of the gallbladder. It characteristically presents with invasive growth, a low tendency towards lymph node metastasis and a high incidence of local infiltration and hepatic metastasis, presenting a worse prognosis than adenocarcinoma of the gallbladder. Cases of gallbladder cancer forming a fistula to the stomach are also rare. We experienced a case of primary squamous cell carcinoma of the gallbladder which formed a fistula to the stomach. (Korean J Gastrointest Endosc 2010;40:285-289)

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