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Volume 40(5); May 2010
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Endoscopic Treatment of Chronic Pancreatitis
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Hong Sik Lee, M.D., Ph.D.
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Korean J Gastrointest Endosc 2010;40(5):291-296. Published online May 30, 2010
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Abstract
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- Endoscopic treatments are being increasingly used for chronic pancreatitis. Themost common indications for endoscopic treatment are pancreatic duct stones (requiring removal) and pancreatic duct stricture (requiring stenting). Endoscopic treatment is also widely indicated for drainage of pseudocyst and ceiliac plexus block/neurolysis. In this review, I discuss techniques, efficacy and complications of various endoscopic treatments for chronic pancreatitis. (Korean J Gastrointest Endosc 2010;40:291-296)
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Clinical Characteristics of Large Brunner's Gland Tumors in Korea
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Ji Hun Kang, M.D., Yun Jeong Lim, M.D., Suk Jae Hahn, M.D., Jong Sun Choi, M.D.*, Moon Soo Koh, M.D. and Jin Ho Lee, M.D
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Korean J Gastrointest Endosc 2010;40(5):297-302. Published online May 30, 2010
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Abstract
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- Background
/Aims: Brunner's gland tumor is a common benign tumor noted in duodenum and might be designated as Brunner's gland hamartoma, adenoma or hyperplasia. But, a large duodenal polyp (over 1 cm in diameter) pathologically proven as a tumor of Brunner's gland origin is rare.
Methods
We analyzed a total of 39 cases including our direct experience of two cases and reports of 37 cases to clarify the clinical features of large Brunner's gland tumors.
Results
This tumor tends to present predominantly after the fourth decade: Median age is 52.6 years. Neither gender showed predominance. The size of the tumor ranged from 1 to 8 cm and the mean diameter was 2.9 cm. The most common location was the bulb. A pedunculated polyp was the common appearance. Epigastric pain was the most common symptom. Brunner's gland tumor can cause gastrointestinal hemorrhage or obstruction. Most of the polyps had non-diagnostic pathologic yield at pinch biopsy and only one case was diagnosed as focal adenocarcinoma. Endoscopic or surgical removal was undertaken for treatment. Most cases had no recurrence after removal. Snare polypectomy or submucosal dissection very safe and useful treatment modalities.
Conclusions
Large Brunner's gland tumors are mostly found during a check up or epigastric pain. Anemia, melena and obstruction often develop. Endoscopic polypectomy is recommended as a first line treatment. (Korean J Gastrointest Endosc 2010;40:297-302)
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Characteristics of Laterally Spreading Colorectal Tumors according to Morphologic Classifications
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Su Bum Park, M.D., Geun Am Song, M.D., Bong Eun Lee, M.D., Dong Yup Ryu, M.D., Dong Uk Kim, M.D., Tae Oh Kim, M.D. and Gwang Ha Kim, M.D.
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Korean J Gastrointest Endosc 2010;40(5):303-308. Published online May 30, 2010
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Abstract
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- Background
/Aims: Laterally spreading tumors (LSTs) are similar in color to the adjacent mucosa, so they are difficult to recognize. This study aimed to investigate the features of LSTs by morphologic classification and find effective diagnoses and treatments.
Methods
This retrospective study was done between March 2006 and August 2008. We reviewed patients' medical records, endoscopic findings, and histological findings.
Results
A total of 151 patients met criteria for LSTs. Eighty-seven lesions (57.6%) were of the granular type. The most frequent location was ascending colon (37.1%), followed by rectum and sigmoid colon (36.4%). The cecum is a common site in the granular type, but the transverse colon is common in the nongranular type. The overall malignancy rate was 21.2%, and the malignant rate increased in proportion to size. Malignant rates were higher for the mixed nodular type (25.9%) and pseudo-depressed type (41.2%) than for the homogeneous granular type (3.0%) or flat elevated type (10.0%).
Conclusions
LSTs showed different clinicopathologic characteristics according to their morphologic classification. The homogenous type has a lower malignant potential. Piecemeal resection for those with a large diameter is possible, while the pseudo-depressed and mixed nodular types have a higher malignant potential and should receive en-bloc resection as soon as possible. (Korean J Gastrointest Endosc 2010;40:303-308)
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A Case of Spontaneous Intramural Hematoma of the Esophagus
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Chang Hun Lee, M.D., Hyun Gwang Jung, M.D. and Do Hyeong Kim, M.D.
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Korean J Gastrointest Endosc 2010;40(5):309-311. Published online May 30, 2010
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Abstract
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- Spontaneous intramural hematoma of the esophagus is a very rare disease. Varying degrees of submucosal rupture of the esophagus are caused by intramural hematoma of the esophagus. The causative factors include vomiting, an esophageal foreign body, endoscopic sclerotherapy for esophageal varices, equipment manipulation, drugs (e.g., warfarin and aspirin) and full-body disease (e.g., chronic renal failure, hemophilia and leukemia), and idiopathic causes have also been described. A 68-year-old male taking aspirin, clopidogrel and cilostazol was admitted to our hospital complaining of hematemesis. Spontaneous intramural hematoma of the esophagus was diagnosed by endoscopy. We report here on a case of spontaneous intramural hematoma of the esophagus that occurred after vomiting and the patient showed spontaneous improvement. We also review the relevant literature. (Korean J Gastrointest Endosc 2010;40:309-311)
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Endoscopic Ultrasonographic Findings of Esophageal Tuberculosis: Case Report
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Kyu Hyun Cho, M.D., Jin Tae Jung, M.D., Chang Jae Hur, M.D., Joong Goo Kwon, M.D., Eun Young Kim, M.D. and Hoon Kyu Oh, M.D.*
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Korean J Gastrointest Endosc 2010;40(5):312-315. Published online May 30, 2010
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Abstract
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- Esophageal tuberculosis is a rare disease that is difficult to diagnose with esophagogastroduodenoscopy (EGD), endoscopic ultrasonography (EUS), and computerized tomography. The patients with esophageal tuberculosis show diverse endoscopic findings, but ulcerative lesion in the middle esophagus is usually found. In Korea, the endoscopic ultrasonographic findings of esophageal tuberculosis have not been described. The main endoscopic ultrasonographic findings of esophageal tuberculosis include heterogeneous or homogeneous hypoechoic masses in the esophageal wall with hyperechoic spots inside, interruption of the esophageal adventitia, and mediastinal lymphadenopathy. In this report, we describe two patients with esophageal tuberculosis, and they presented with submucosal tumor. In these patients, esophageal tuberculosis was diagnosed by EGD, EUS, and performing tuberculosis phase chain reaction on the endoscopic biopsies. (Korean J Gastrointest Endosc 2010;40:312-315)
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Two Cases of Foreign Body-induced Esophageal Perforation That Were Treated by Endoscopic Clipping and Non-surgical Management
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Jung Bok Park, M.D., Won Ki Bae, M.D., Hyoung Don Lee, M.D., Jung Hoon Kim, M.D., Nam-Hoon Kim, M.D., Kyung-Ah Kim, M.D., June Sung Lee, M.D. and Young Soo Moon, M.D.
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Korean J Gastrointest Endosc 2010;40(5):316-320. Published online May 30, 2010
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Abstract
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- Perforation of the esophagus is a deadly injury that requires careful management if the patient is to survive. Prompt recognition and proper treatment of esophageal perforation may avert death or minimize complications. Esophageal perforation might be followed by mediastinitis, broncho-esophageal fistula, pneumomediastinum, peritonitis and empyema. Although primary surgical repair is the mainstay of treatment, non-surgical management can be attempted in selected patients. Endoscopic closure of an esophageal perforation with metallic clips and conservative therapy has recently been reported. We describe here two patients with esophageal perforation and pneumomediastinum that were caused by fish bones. One was completely closed by endoscopic clipping and the other was not. Non-surgical management that was made up of parenteral nutrition and antibiotic therapy produced the same successful outcomes in these two cases. (Korean J Gastrointest Endosc 2010;40:316-320)
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Extensive Gastric Mucosal Laceration During Endoscopic Examination
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Han Byul Chun, M.D., Il Hyun Baek, M.D., Su Rin Shin, M.D., Hyo Jung Kim, M.D., Jin Bae Kim, M.D. and Myung Seok Lee, M.D.
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Korean J Gastrointest Endosc 2010;40(5):321-324. Published online May 30, 2010
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Abstract
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- Gastric mucosal lacerations occurring during the course of upper gastroduodenal endoscopy are apparently rare. The location and extent of the lesion are little different from the usual one found in the Mallory-Weiss tear. But the pathogenesis of the gastric mucosal tear is similar to that of Mallory-Weiss tear. Hiatal hernia, atrophic gastritis, and old age are predisposing factors for Mallory-Weiss tear. There is currently only one report about extensive gastric mucosal laceration during performance of endoscopy in an elderly patient. During a standard diagnostic endoscopic procedure, we experienced extensive gastric mucosal laceration that ranged from the gastroesophageal junction to the gastric angle in an elderly woman Furthermore, her body surface area and stomach size were very small. The patient was treated successfully with hemoclip application for the laceration. We report on the case along with a review of the relevant literature. (Korean J Gastrointest Endosc 2010;40:321-324)
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A Case of Signet Ring Cell Carcinoma with Hyperplastic Polyp in the Remnant Stomach after Subtotal Gastrectomy
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Myung Hyun Lee, M.D., Woo Chul Chung, M.D., Sung Hoon Jung, M.D., Jae Wuk Kwak, M.D., Sung Jun Kim, M.D., Chang Nyol Paik, M.D. and Kang-Moon Lee, M.D.
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Korean J Gastrointest Endosc 2010;40(5):325-328. Published online May 30, 2010
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Abstract
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- Hyperplastic polyps are usually found in the stomach and they account for 50 to 90% of all gastric epithelial polyps. In contrast to the adenomatous polyps, it has been reported that most hyperplastic polyps are benign. However, in rare cases hyperplastic polyps have revealed carcinoma, and the incidence of malignant changes is generally recognized to be about 1 to 3%. Most of the reported cases of a hyperplastic gastric polyp with a transformation to adenocarcinoma were well differentiated histopathologically. Herein we report on an extremely rare case that involved the association of a hyperplastic polyp and focal signet ring cell carcinoma in the remnant stomach after subtotoal gastrectomy. (Korean J Gastrointest Endosc 2010;40:325-328)
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A Case of Early-stage Squamous Cell Carcinoma of the Anal Canal Diagnosed by Endoscopic Mucosal Resection
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Soo Woong Kim, 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., Yu Jin Suh, M.D. and Jun Uk Lim, M.D.
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Korean J Gastrointest Endosc 2010;40(5):329-333. Published online May 30, 2010
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Abstract
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- In the past, abdominoperineal resection was routinely performed for anal canal cancer, yet it is now known that squamous cell carcinoma of the anal canal has a favorable prognosis and it rarely requires radical surgery. Furthermore, T1 anal cancer, which represents about 10% of all anal canal cancers, has an excellent prognosis. Endoscopic mucosal resection (EMR), which has been used for removal of early-stage adenocarcinoma of the rectum, has not been reported as a treatment option for squamous cell carcinoma of the anal canal because making the endoscopic diagnosis of early-stage anal canal cancer is very difficult. We have experienced a case of early-stage squamous cell carcinoma of the anal canal that was identified without symptoms during routine screening colonoscopy and it was removed by EMR. As far as we know, it is the first case of early-stage anal canal cancer that was diagnosed and treated by endoscopic mucosal resection. (Korean J Gastrointest Endosc 2010;40:329-333)
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A Case of Meckel's Diverticulum Diagnosed for Recurrent Hematochezia in Old Age
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Dong Kyun Kim, M.D., Jin Oh Kim, M.D., Hyun Gun Kim, M.D., Tae Hee Lee, M.D., Yoon Ho Jung, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D. and So Young Jin, M.D.*
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Korean J Gastrointest Endosc 2010;40(5):334-337. Published online May 30, 2010
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Abstract
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- The small bowel is the most common site of an unknown origin of gastrointestinal bleeding. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract in children. The complications from Meckel's diverticulum such as bleeding decrease with age, and so Meckel's diverticular bleeding is very rare in old age patients. The diagnosis of Meckel's diverticulum may be very difficult and especially in old age patients. Capsule endoscopy and double balloon enteroscopy have recently become useful diagnostic tools for assessing diverticular bleeding and small bowel lesions as these techniques can examine the entire small intestine. We report here on a case of Meckel's diverticulum that was detected by capsule endoscopy and double balloon enteroscopy and this was confirmed by surgery in a 76-year-old man with recurrent hematochezia. (Korean J Gastrointest Endosc 2010;40:334-337)
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