Clinical Endoscopy

The Endoscopic Report for Endoscopic Electronic Medical Records: Yu Kyung Cho, M.D.; Korean J Gastrointest Endosc 2010;41(4):189-195. Published online October 30, 2010

Abstract PDF: Electronic medical record systems for endoscopic data have evolved from simple endoscopy report generators to endoscopy unit managers. These systems may improve patient care and enhance endoscopy unit efficiency and productivity. Regarding endoscopists, the introduction of automated endoscopic reporting using endoscopic electronic medical records should permit database establishment. The systematic development of the structure and content of endoscopic reports is mandatory before it is possible to create large, clinically useful databases of endoscopic reports. An accurate endoscopic report is based on the use of standard terminology, a standard classification method, and image and video recordings. The minimal standard terminology was developed as a minimum list of terms that could be included in a computer system for endoscopic reporting. A standard framework of endoscopic reports using standard terminology and a minimal checklist of endoscopic images are also needed for quality assurance. (Korean J Gastrointest Endosc 2010;41:189-195)

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Clinicopathologic Features of the Duodenum Related to the Genesis of Duodenal Gastric Metaplasia: Tae Jung Jang, M.D.; Korean J Gastrointest Endosc 2010;41(4):196-200. Published online October 30, 2010

Abstract PDF: Background
/Aims: It has been suggested that gastric metaplasia in the duodenum is prerequisite for duodenal ulcer. The aim of this study was to investigate the role of clinicopathologic parameters of the duodenum such as endoscopic diagnosis, pathologic findings and Helicobacter pylori (H. pylori) infection on the development of gastric metaplasia.
Methods
Endoscopic records as well as pathologic findings of 390 patients were reviewed. The degree of gastric metaplasia in duodenum was evaluated. H. pylori infection was determined by immunohistochemical staining.
Results
The degree of gastric metaplasia was higher in duodenal ulcers and hyperplastic duodenal polyps than in chronic duodenitis. The degree of gastric metaplasia was closely related to severe acute inflammation, mild chronic inflammation and H. pylori infection in duodenum. Duodenal ulcers showed higher acute inflammation and a higher incidence of H. pylori infection than hyperplastic polyps and chronic duodenitis.
Conclusions
Gastric metaplasia in duodenal ulcers may be related to duodenal inflammation and H. pylori infection, whereas in hyperplastic polyps gastric metaplasia may occur by another mechanism. (Korean J Gastrointest Endosc 2010;41:196-200)

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Associations between Nonalcoholic Fatty Liver Disease and Colorectal Adenoma in Health Screen Examinees: Won Gyu Choi, M.D., Sang-Jung Kim, M.D., Seok Jin Myung, M.D., Seung Oh Choi, M.D., Jung Hee Kim, M.D., Sang Woon Park, M.D., Sang Jong Park, M.D., Eun Jeong Jang, M.D., Ju Sang Park, M.D., Hyun W. Baik, M.D., Eun Ran Kim, M.D.* and Beom Jin Kim, M.D.^†; Korean J Gastrointest Endosc 2010;41(4):201-207. Published online October 30, 2010

Abstract PDF: Background
/Aims: Nonalcoholic fatty liver disease (NAFLD) and colorectal cancer share several risk factors. However the relationship between NAFLD and colorectal adenoma is unclear. Therefore, we investigated the possibility of an association between NAFLD and colorectal adenoma.
Methods
We reviewed the records of 3,106 subjects who had undergone colonoscopy and abdominal ultrasonography between April 2007 and August 2009.
Results
The sex ratio (male/female) was 4.94:1 and the mean age was 50.6±9.7 years in patients with colorectal adenoma; the corresponding numbers were 2.23: 1 and 45.0±9.2 years in patients without colorectal adenoma (p＜0.001). The prevalence of NAFLD was 26.0% in the adenoma group and 21.4% in the control group (p=0.013). Additionally, there were positive associations between colorectal adenoma and BMI and lipid profile. Among the risk factors selected by univariate analysis, older age (OR 2.592; 95% CI 2.087∼3.219), and being male (OR 2.470; 95% CI 1.878∼3.247) were independent risk factors for colorectal adenoma. Patients with NAFLD had more colorectal adenomas (p=0.005) and their adenomas were located more in the proximal colon (p=0.009).
Conclusions
NAFLD is not associated with increased risk for colorectal adenoma. However, among patients with NAFLD, colorectal adenomas were likely to be increased in number and they were likely to be located in the proximal colon. (Korean J Gastrointest Endosc 2010;41:201-207)

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Primary NK-/T- Cell Lymphoma of the Esophagus: a Case Presentation and Literature Review: Tae Hyung Kim, M.D., Ho Sang Ryu, M.D., Chang Ha Kim, M.D., Hocheol Hong, M.D., Jin-Sung Koh, M.D., Hoon Jai Chun, M.D., Chang Duck Kim, M.D. and Insun Kim, M.D.*; Korean J Gastrointest Endosc 2010;41(4):208-213. Published online October 30, 2010

Abstract PDF: Extranodal natural killer/T-cell lymphoma (ENKL) is an uncommon neoplasm, and it is a subtype of non-Hodgkin's lymphoma. It most commonly presents in the nasal cavity and nasopharynx. But only 10% of ENKL may present on the skin or the gastrointestinal tract and this has a poor prognosis. We report here on a case of CD56＋ NK/T-cell lymphoma that limited to the esophagus. A 55-year-old male patient presented with epigastric soreness. Esophagogastroduodenoscopy (EGD) showed well demarcated, longitudinal ulcerative lesions with an irregular base and a discrete margin on the lower esophagus. We performed EGDs and endoscopic biopsies 2 times, but these were insufficient to make a diagnosis. The 3^rd time, we finally took a big piece of tissue using endoscopic mucosal resection with a cap-fitted panendoscope (EMR-C). The biopsies showed surface ulceration and a heavy lymphoid infiltration and a positive pattern for CD3, CD56 and granzyme B. The pathologic diagnosis was NK/T-cell lymphoma. The patient was treated with concurrent chemoradiation followed by additional chemotherapy and he achieved a complete response. (Korean J Gastrointest Endosc 2010;41:208-213)

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A Case of Esophageal Carcinoma after an Esophageal Reconstruction Operation for Sulfuric Acid Injury: Eun Seo Park, M.D., Suck-Ho Lee, M.D., Chang Kyun Lee, M.D., Bo Yong Jung, M.D., Il-Kwun Chung, M.D., Sun-Joo Kim, M.D., Sang Byung Bae, M.D. and Ji-Hye Lee, M.D.*; Korean J Gastrointest Endosc 2010;41(4):214-218. Published online October 30, 2010

Abstract PDF: Patients with corrosive esophageal strictures have a high risk of developing carcinoma of the esophagus. For this reason, it is often recommended that resection of the esophagus should be considered for chronic caustic strictures in order to prevent the development of carcinoma. A 49-year-old woman who had undergone an esophagogastrectomy due to esophageal caustic stricture at the age of 23 was admitted with a 2-month history of dysphagia. Esophagoscopy showed a benign postoperative stricture in the remnant esophagus. After endoscopic balloon dilation of the stricture, which was about 5 cm in length, an ulcerative mass was noted distal to the stricture. This mass was diagnosed as squamous cell carcionoma. Nearly all the patients with corrosive carcinomas in the published literature had consumed an alkali drink, but our patient had a history of sulfuric acid ingestion. (Korean J Gastrointest Endosc 2010;41:214-218)

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A Case of High-grade Endometrial Stromal Sarcoma with Metastasis to the Stomach: Si Young You, M.D., In Sook Woo, M.D., Yun Ji Kim, M.D., Si Eun Kong, M.D., Hyung Woo Kim, M.D., Jin Il Kim, M.D., Chi Hwa Han, M.D. and Youn Soo Lee, M.D.*; Korean J Gastrointest Endosc 2010;41(4):219-223. Published online October 30, 2010

Abstract PDF: To our knowledge, this is the first report of case of high-grade endometrial stromal sarcoma metastasized to the stomach. Endometrial stromal sarcoma is very rare, accounting for 0.2% of female genital tract malignancies. High-grade endometrial stromal sarcoma demonstrates more frequent infiltration into the muscle layer of the uterus or metastasis to other organs, having a poorer prognosis than low grade disease. During its clinical course, endometrial stromal sarcoma may involve ovary, fallopian tube and pelvic cavity. Distant metastasis to lung, liver, bladder, breast, heart, brain and bones have been reported. However, to the best of our knowledge, high-grade endometrial stromal sarcoma presenting with gastric metastasis has never been reported. We now report a case of a 52-year-old woman with previously diagnosed lung metastasis having stomach metastasis from endometrial stromal sarcoma of the uterus. (Korean J Gastrointest Endosc 2010;41:219-223)

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Acute Gastric Mucosal Injury Induced by Lugol's Solution During Chromoendoscopy: Hee Kyong Na, M.D., Do Hoon Kim, M.D., Hyun Lim, M.D., O Sung Kwon, M.D., Kee Don Choi, M.D., Gin Hyug Lee, M.D., Hwoon-Yong Jung, M.D. and Jin Ho Kim, M.D.; Korean J Gastrointest Endosc 2010;41(4):224-227. Published online October 30, 2010

Abstract PDF: Chromoendoscopy using Lugol's iodine solution is widely used to improve the detection of esophageal dysplasia or early squamous carcinoma. Although the solution helps to notice esophageal lesions and to delineate the lesions more clearly, it can cause mucosal irritation leading to retrosternal pain and epigastric discomfort infrequently. We report a case of acute gastric mucosal injury after application of Lugol's solution during chromoendoscopy in a 63-year-old woman. (Korean J Gastrointest Endosc 2010;41:224-227)

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Partial Duodenal Obstruction Caused by an Impacted Gastritis Cystica Polyposa: Ju Hwan Kim, M.D., Chang Il Kwon, M.D., Seung Won Koo, M.D., Kwang Ho Yoo, M.D., Gwang Il Kim, M.D.*, So Young Chong, M.D., Kwang Hyun Ko, M.D. and Sung Pyo Hong, M.D.; Korean J Gastrointest Endosc 2010;41(4):228-231. Published online October 30, 2010

Abstract PDF: Gastritis cystica polyposa is an uncommon lesion that usually occurs at the gastroenterostomy site, but it may also develop in the non-operated stomach. This malady is characterized by polypoid mucosal changes with hyperplasia and cystic dilatation of glands that infiltrate into the submucosal layer. We report here on a case of gastritis cystica polyposa that presented as a mass impacted in the duodenum in a 63-year-old male, and this patient had been admitted for evaluation of progressive epigastric fullness and dyspepsia. Esophagogastroduodenoscopy revealed that the partial duodenal obstruction was caused by impaction of a huge polypoid mass with a stalk that originated from the lower body of the stomach. We fished out the impacted mass with a forceps catheter while holding the neck with a snare catheter. Thereafter, an endoloop was applied to the stalk of mass, and this was followed by polypectomy using a snare catheter. (Korean J Gastrointest Endosc 2010;41:228-231)

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A Case of a Patient Presenting with Upper Gastrointestinal Bleeding Due to Direct Stomach Invasion by Hepatocellular Carcinoma: Joon Mo Park, M.D. and Dong Hee Kim, M.D.; Korean J Gastrointest Endosc 2010;41(4):232-235. Published online October 30, 2010

Abstract PDF: Gastrointestinal bleeding is a common complication of hepatocellular carcinoma, and the most common causes are esophageal varix, gastric varix and a bleeding ulcer. Hepatocellular carcinoma rarely invades the gastrointestinal tract, and this has been shown to occur in 0.7∼2% of the clinical hepatocellular carcinoma cases. A 52-year old male who had a history of a huge hepatocellular carcinoma on the left lobe of the liver and this had been by chemoembolization was admitted due to hematemesis and melena. Esophagogastroduodenoscopy showed a huge fungating mass with easy contact bleeding in the lesser curvature of the gastric body. The histology was consistent with the diagnosis of metastatic hepatocellular carcinoma and results of the CT scan supported this finding. This case illustrates a rare event of direct invasion of hepatocellular carcinoma into the stomach and this was followed by gastrointestinal hemorrhage. (Korean J Gastrointest Endosc 2010;41:232-235)

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A Case of Postpolypectomy Coagulation Syndrome Had a Hemicolectomy: Song Yi Song, M.D., Young Kyung Sung, M.D., Hye Jeong Kim, M.D., Soyoung Bae, M.D., Silvia Park, M.D., Yong Beom Cho, M.D.*, Jin Yong Kim, M.D. and Seung Min Chung, M.D.; Korean J Gastrointest Endosc 2010;41(4):236-239. Published online October 30, 2010

Abstract PDF: Colonoscopy is commonly used as a screening tool for colorectal polyps and cancer. It also offers a chance to remove polyps via the polypectomy technique. Colonoscopic polypectomy is a relatively safe procedure, yet there is the possibility of serious complications such as perforation and bleeding. Postpolypectomy coagulation syndrome presents with pain, fever, an elevated white blood cell count and signs of peritoneal irritation, and usually within 12 hours of the procedure. No free air is seen on plain films or a CT scan, which is different from frank bowel perforation. The management of postpolypectomy coagulation syndrome includes fasting, antibiotics and intravenous hydration. We report here on a case of a 53-year-old woman who underwent right hemicolectomy because she presented with fever, signs of peritoneal irritation and shock after colonoscopic polypectomy. The final diagnosis was postpolypectomy coagulation syndrome as there was no perforation in the resected specimen. (Korean J Gastrointest Endosc 2010;41:236-239)

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A Case of a Cytomegalovirus Colitis Related Rectal Stricture Treated by Endoscopic Balloon Dilation: Kwonoh Park, M.D., Kyung Ho Kim, M.D., Jong Won Park, M.D., Sangho Lee, M.D., Hyunjung Jo, M.D., Seungyun Chun, M.D., Hyewon Park, M.D. and Hak Yang Kim, M.D.; Korean J Gastrointest Endosc 2010;41(4):240-244. Published online October 30, 2010

Abstract PDF: Cytomegalovirus (CMV) colitis is a common opportunistic infection in immunocompromised patients. Affected individuals present with abdominal pain, diarrhea, or hematochezia. Complications of CMV colitis can include massive bleeding, toxic megacolon, bowel perforation and, rarely, colon stricture. A 69-year-old woman who had no specific past history was admitted to the orthopedic department for pelvic bone fracture with right iliac artery rupture caused by a traffic accident. She was successfully managed with emergency transarterial coil embolization. After 2 weeks, she developed hematochezia and recurrent abdominal pain. Colonoscopy showed a huge, deep ulcer in the rectosigmoid colon. Biopsy and immunohistochemical staining revealed giant cells with intracellular inclusion bodies that were positive for CMV antigen. She received antiviral treatment after which her symptoms improved. On follow-up colonoscopy 3 months later, we found a tight luminal narrowing in the rectum. We did a repeat endoscopic balloon dilation in this patient and she experienced improvement. (Korean J Gastrointest Endosc 2010;41:240-244)

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A Case of Jejunal Extranodal MALT Lymphoma Diagnosed by Single-balloon Enteroscopy: Son Ook Choi, M.D., Jung Sun Bag, M.D., Sok Won Han, M.D., Chang Whan Kim, M.D., Tae Ho Kim, M.D., Min Kuk Kim, M.D. and Hwang Choi, M.D.; Korean J Gastrointest Endosc 2010;41(4):245-250. Published online October 30, 2010

Abstract PDF: Small bowel lesions located in long and multiple complex loop configurations were difficult to diagnose early because of vague clinical manifestations and because of the poor diagnostic yield of conventional examination methods. In this setting, double-balloon enteroscopy (DBE) was an epoch-making diagnostic and therapeutic tool for the management of patients with small bowel disease. Single-balloon enteroscopy (SBE), lacking a balloon at the endoscopic tip, is also a useful method for investigating and managing suspected small bowel lesions. Mucosa associated lymphoid tissue (MALT) lymphoma of the small bowel is relatively uncommon and remains a localized disease for long periods in most patients. Recently, we experienced a case of advanced-stage MALT lymphoma in the jejunum. A 60-year old female, with a history of anemia of unknown etiology and who was suspected of having a small bowel lesion, presented with complaints of vague abdominal pain and dizziness. She had undergone SBE via the oral route. She was diagnosed with MALT lymphoma of the jejunum and treated with medical management. (Korean J Gastrointest Endosc 2010;41:245-250)

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A Case of Signet-ring Cell Carcinoma of the Ampulla of Vater: Dong Ik Kim, M.D., Sang Wook Park, M.D., Geum Soo Lee, M.D., Geyong Yun Jung, M.D., Hyun Jin Jung, M.D., Hyeung Cheol Moon, M.D., Gun Young Hong, M.D. and Yeun Keun Lim, M.D.; Korean J Gastrointest Endosc 2010;41(4):251-254. Published online October 30, 2010

Abstract PDF: Signet-ring cell carcinoma of the ampulla of Vater is so rare that only 16 cases have been reported. Here we report a case of a 47-year-old man with signet-ring cell carcinoma in the ampulla of Vater. The patient was hospitalized for right upper quadrant abdominal pain and jaundice which had developed 10 days prior. Computed tomography (CT) and ultrasonography (US) revealed dilatation of the common bile duct and the intrahepatic bile duct. On duodenoscopy, a bulging mass with an irregular margin in the major papilla was noted. Histologic findings showed a signet-ring cell carcinoma. Surgical resection was not done because lymph node metastasis was noted during the operation. Hence, conservative treatment including chemotherapy and bile drainage was done. (Korean J Gastrointest Endosc 2010;41:251-254)

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