Clinical Endoscopy

Endoscopic Treatment of Primary Esophageal Motility Disorders: Joon Seong Lee, M.D., Ph.D.; Korean J Gastrointest Endosc 2011;42(6):341-348. Published online June 21, 2011

Abstract PDF: Treatment of primary esophageal motility disorders, particularly achalasia, has developed enormously. The proven treatments for these patients include mostly endoscopic methods. Currently, pneumatic dilatation and laparoscopic myotomy with partial fundoplication are both useful for treating achalasia. A young man with high lower esophageal sphincter pressure might be best indicated for a laparoscopic myotomy with fundoplication, whereas an older patient with a high risk for surgery or vigorous achalasia may for a candidate for an endoscopic botulinum toxin injection. Pneumatic balloon dilatation is the choice of treatment for other
case
s of achalasia. The best treatment option for a nonachalasia spastic motor disorder of the esophagus may be endoscopic injection of botulinum toxin. In the future, endoscopic injection of neuronal stem cells could be the best treatment option for achalasia.

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Effect of Additional Ecabet Sodium on Conventional Triple Therapy for Helicobacter pylori Eradication in Korea: Ji Yeon Kim, M.D., Dong Ho Lee, M.D.^*, Jun Hyuk Son, M.D., Jae Yeon Kim, M.D., Ji Eun Kwon, M.D., Young Soo Park, M.D.^*, Nayoung Kim, M.D.^*, Cheol Min Shin, M.D.^*, Hyun Chae Jung, M.D. and In Sung Song, M.D.; Korean J Gastrointest Endosc 2011;42(6):349-355. Published online May 25, 2011

Abstract PDF: Background/Aims: Ecabet sodium is known for its bactericidal effect against H. pylori. It was reported that a supplement of ecabet sodium to conventional triple therapy showed good results in Asia. The Aim of this study was to ascertain the efficacy of additional ecabet sodium on conventional triple therapy for eradication of H. pylori. Methods: We reviewed the cases of 111 patients (Group A) with H. pylori infection who received ecabet sodium with triple therapy (20 mg of rabeprazole, 1 g of amoxicillin, 500 mg of clarithromycin and 1 g of ecabet sodium, twice daily for 7 days). Another 186 patients (Group B) received PPI-based triple therapy (same as the above, except without the ecabet sodium). Eradication was evaluated 4 weeks later after completion of treatment by ¹³C-UBT. Results: Eradication rates were 74.8% (83/111) in group A and 70.4% (131/186) in group B by intention-to-treat analysis (p=0.420), and 75.2% (82/109) in group A and 70.7% (128/181) in group B by per protocol analysis (p=0.405). Conclusions: The addition of ecabet sodium to conventional triple therapy did not increase the eradication rate of H. pylori in this study. These findings imply that ecabet sodium as an additional agent cannot overcome antibiotic resistance, which is the most important cause of failure of triple therapy.

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Usefulness of Real-time Measurement of Colonoscopy Withdrawal Time during Fellow Training: Chung Hyun Tae, M.D., Sung-Ae Jung, M.D., Seung-Jung Jun, M.D., Sun-Hee Roh, M.D., Ju Young Choi, M.D., Min Jung Kang, M.D., Ji Min Jung, M.D., Seong-Eun Kim, M.D., Ki-Nam Shim, M.D., Hey-Kyung Jung, M.D., Tae Hun Kim, M.D., Kwon Yoo, M.D. and Il-Hwan M; Korean J Gastrointest Endosc 2011;42(6):356-360. Published online April 16, 2011

Abstract PDF: Background/Aims: Attempts to increase colonoscopy withdrawal time have been the topic of several recent publications. We assessed whether the real-time measurement of withdrawal time affected the withdrawal time and polyp detection rate. Methods: Real-time colonoscopy withdrawal time was measured in 197 subjects in a study group and 184 subjects comprised a control group without real-time measurements. Colonoscopies were performed by four endoscopy specialists and three fellows during their first year of training. Withdrawal time, clinical features, bowel preparation, and polyp detection rates were comparatively analyzed. Results: No significant differences in age, gender, bowel preparation, or polyp history were found in the two groups. Withdrawal time was significantly higher in the study group than that in the control group when a fellow performed the withdrawal. However, polyp detection rate did not significantly increase in the study group, regardless of physician. Conclusions: Real-time measurement of colonoscopy withdrawal time did not increase polyp detection rate, but the withdrawal time was significantly higher when a fellow performed the withdrawal phase than when a specialist performed withdrawal. Therefore, the real-time measurement of colonoscopy withdrawal time seems to be a useful tool for fellow training.

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A Case of Eosinophilic Gastroenteritis presenting with Fever and Multiple Lymphadenopathy: Borami Kang, M.D., Woo Chul Chung, M.D., Kang-Moon Lee, M.D., Chang Nyol Paik, M.D., Ji Min Lee, M.D., Hyo Sin Jeon, M.D.^*, Kyong-Hwa Jun, M.D.^* and Hyung Min Chin, M.D.^*; Korean J Gastrointest Endosc 2011;42(6):361-365. Published online May 25, 2011

Abstract PDF: Eosinophilic gastroenteritis is an unusual disease that is associated with various clinical gastrointestinal manifestations. and its severity depends on the area involved as well as the wall layer involved. Eosinophilic gastroenteritis often causes abdominal pain, nausea, vomiting and diarrhea. To date, there has been an extremely rare case of eosinophilic gastroenteritis with systemic symptoms, such as fever or lymphadenopathy (LAP). We experienced a case of a 68-year-old-woman with fever and abdominal pain. Abdominal computed tomography revealed diffuse wall thickening of the gastric antrum as linitis plastica. Multiple hot uptakes of lymph nodes were visualized on fludeoxyglucose-positron emission tomography. The gastric biopsy pathological report demonstrated eosinophilic infiltration without malignant cells. We could not exclude malignancy and performed an exploratory laparoscopy. A lymph node specimen showed reactive hyperplasia, and her illness was finally diagnosed as eosinophilic gastroenteritis. Herein, we report the case with a brief review.

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A Case of Corrosive Gastritis Caused by Salt-Fermented Northern Sand Lance: In Sung Jung, M.D., In Sung Jung, M.D. and Jae Su Kim, M.D.; Korean J Gastrointest Endosc 2011;42(6):366-368. Published online June 12, 2011

Abstract PDF: We experienced a case of an 18-year-old woman who ingested salt-fermented northern sand lance and developed corrosive gastritis. The patient underwent a esophagogastroscopy and had developed a deep ulceration in the antrum. This
case
s shows that salt-fermented northern sand lance, which is very acidic and includes various biogenic amines, has the possibility of inducing a corrosive injury to the stomach.

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Endoscopic Foley Balloon Extraction of an Esophageal Foreign Body: Jinou Kim, M.D., Jung Hoon Song, M.D., Hee Bae Wang, M.D., Eun Ho Jeong, M.D., Soo Hyung Ryu, M.D.^*, Jung Hwan Lee, M.D.^*, You Sun Kim, M.D.^* and Jeong Seop Moon, M.D.^*; Korean J Gastrointest Endosc 2011;42(6):369-372. Published online June 21, 2011

Abstract PDF: Esophageal foreign bodies should be retrieved as soon as possible, as they may cause complications such as bleeding, perforation, and respiratory distress. Flexible endoscopy is the preferred method, because it is effective and safe, but rigid esophagoscopy or a surgical procedure should be considered if flexible endoscopy fails. Extraction with a Foley balloon is an effective method for removing blunt foreign bodies from the esophagus. The general technique used is to insert the catheter into the esophagus through the nose or mouth, place it in the distal part of the foreign body, balloon the catheter, and remove the foreign body by pulling the catheter out. This procedure is generally performed under fluoroscopy, but a few reports have used Foley balloon extraction during endoscopy. We report a case of an elderly woman with a blunt foreign body in the upper esophagus. After failing to remove the object by endoscopy, we removed it with a Foley balloon under endoscopy.

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A Case of Gastric Adenocarcinoma Arising from Ectopic Pancreas showing Gastric Outlet Obstruction: Suk Hyun Jung, M.D., Hang Lak Lee, M.D., Seung Sam Paik, M.D.^*, Hulin Han, M.D.^*, Tae Kyung Ha, M.D.^†, Byeong Bae Park, M.D., Chang Ryeol Choi, M.D. and Soon Young Song, M.D.^‡; Korean J Gastrointest Endosc 2011;42(6):373-377. Published online June 17, 2011

Abstract PDF: An ectopic pancreas in the gastrointestinal tract is mostly found incidentally and its malignant transformation is extremely rare. We report herein a rare case of malignant transformation of ectopic pancreas in the stomach, associated with gastric outlet obstruction. A 69-year-old woman was admitted to our hospital, complaining of vomiting. Esophagogastroduodenoscopy revealed an encircling submucosal tumor-like lesion on the prepyloric antrum showing outlet obstruction. Abdominal CT showed an enhancing mass on the antrum and PET CT showed hypermetabolic wall thickening. So we performed a subtotal gastrectomy. Surgical specimens showed a moderately differentiated ductal adenocarcinoma, and the tumor cells were strongly positive for cytokeratin 7. The tumor was located close to the ectopic pancreas tissue. The tumor showed subserosal and omental invasion. There was one lymph node metastasis and no distant metastasis. The patient is being followed up in the outpatient department.

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A Case of Multiple Gastric Duplication Cysts Presented with Melena: Seok Hyung Kang, M.D., Ki-Nam Shim, M.D., Chung Hyun Tae, M.D., Hye-Kyung Jung, M.D., Sung-Ae Jung, M.D., Sun Wha Lee, M.D.^*, Joo-Ho Lee, M.D.^† and Sun Hee Sung, M.D.^‡; Korean J Gastrointest Endosc 2011;42(6):378-382. Published online May 25, 2011

Abstract PDF: A gastric duplication cyst is a rare congenital anomaly. Among gastrointestinal duplication cysts, gastric duplication cyst account for only 3.8%. They tend to be symptomatic in early childhood, but asymptomatic during adulthood. So its diagnosis is incidental. Abdominal pain is the most common complaint in adults, and most cases are discovered incidentally by radiological examination or endoscopic gastroduodenoscopy. Preoperative diagnosis of gastric duplication cyst is difficult, and definitive diagnosis requires pathological examination of the lesion. So far, about 8 cases of gastric duplication cyst have been reported in adults in the Korean literature. We report here a case of multiple gastric duplication cysts presenting with melena in a 14-year-old man, which were detected by endoscopic gastroduodenoscopy, abdominal computed tomography and endoscopic ultrasonography. They were treated by complete excision of the multiple gastric duplication cysts by laparoscopic wedge resection.

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A Case of Duodenal Wall Abscess Caused by a Foreign Body: Byoung Hoon Ji, M.D., Ji Hoon Yoon, M.D., Jin Ho Lee, M.D., Hee Ryong Lee, M.D., Seong Min Yu, M.D., Min Dae Kim, M.D., Young Il Choi, M.D.^* and Il Seon Lee, M.D.^†; Korean J Gastrointest Endosc 2011;42(6):383-387. Published online June 12, 2011

Abstract PDF: Duodenal abscess is a form of phlegmonous enterocolitis and is a rarely reported disease throughout the entire world. Duodenal abscess mostly develops from complications of duodenal ulcer perforation, and may result in a clinically fatal course because it is difficult to differentiate from some diseases such as gastric ulcer, gastric cancer, hepatobiliary disorders etc.. The therapeutic gold standard is surgical intervention including abscess removal and drainage. We experienced a
case
of duodenal abscess that expressed non-specific symptoms, weight loss and epigastric pain, and diagnosed by gastrointestinal endoscopy, abdominal computed tomography. We successfully treated it through surgical intervention with intravenous antibiotics.

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A Case of Whole Body Metastatic Malignant Melanoma: Kook Hyun Kim, M.D.; Korean J Gastrointest Endosc 2011;42(6):388-391. Published online June 6, 2011

Abstract PDF: Malignant melanomas have the potential to metastasize to any site in the body. They commonly invade the gastrointestinal tract. The small bowel is most commonly involved, followed by the stomach, large bowel, and esophagus. The vast majority of gastrointestinal melanomas are metastatic from a cutaneous lesion. An abdominal CT scan revealed multiple and variable sized low density lesions throughout the whole liver. Endoscopy revealed multiple black pigmentations at the distal esophagus, stomach, duodenum and rectum. The brain CT showed multiple hemorrhagic metastases in the brain. This 72-year-old man had malignant melanoma in his right thumb one year ago. It had metastasized to the liver, lung, gastrointestinal tract and brain. Here we report this case of whole body metastatic malignant melanoma and review the literature.

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Cytomegalovirus Infectious Mononucleosis in a Patient with a Gastric Ulcer: Se Yoon Park, M.D., Eun Jung Lee, M.D., Tae Hee Lee, M.D., So My Koo, M.D., Jin Nyoung Kim, M.D., Min Huok Jeon, M.D., Eun Ju Choo, M.D. and Tae Hyong Kim, M.D.; Korean J Gastrointest Endosc 2011;42(6):392-396. Published online June 4, 2011

Abstract PDF: Cytomegalovirus (CMV) is a prevalent pathogen, with 98∼100% of Korean adults showing prior exposure by serology. A primary infection, such as CMV infectious mononucleosis, is very rare. CMV infectious mononucleosis often presents an initial diagnostic problem. Patients are often hospitalized with a wide variety of clinical diagnoses including fever of unknown origin without pharyngitis and lymphadenopathy. CMV gastrointestinal infections are rare in previously immunocompetent individuals. The most common sites involved are the colon and rectum, although lesions of the stomach have also been described. It is unusual to see CMV infectious mononucleosis and CMV gastrointestinal infection in the same patient. Our patient received symptomatic treatment and fully recovered. We present a case of CMV infectious mononucleosis with gastric ulcers in a previously healthy adult.

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Spontaneous Intramural Hematoma of the Sigmoid Colon Caused by Anti-platelet Agents: Gwang Il Kim, M.D., Yong Seok Kim, M.D., Jung Kyung Yang, M.D., Hoon Sup Koo, M.D., Sun Moon Kim, M.D., Tae Hee Lee, M.D., Euyi Hyeog Im, M.D. and Kyu Chan Huh, M.D.; Korean J Gastrointest Endosc 2011;42(6):397-400. Published online June 4, 2011

Abstract PDF: A 71-year-old man presented at the emergency department with an acute onset of hematochezia and abdominal pain that had developed 1 day previously. He had no history of surgery and was taking aspirin (100 mg) and clopidogrel (75 mg). CT revealed a short segmental concentric lower density bowel wall thickening at the proximal sigmoid colon. Sigmoidoscopy showed blue-colored elevated lesions and ruptured intramural hematomas with submucosal bleeding in the sigmoid colon. These findings correspond to intramural hematomas of the sigmoid colon. His symptoms were reduced with conservative treatment stopping aspirin and clopidogrel for 20 days. Here we report a case of non-traumatic intramural hematoma of the colon in a patient receiving dual antiplatelet agents. This had never been reported.

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A Case of Gastrointestinal Amyloidosis as a Complication of Crohn’s Disease: Kee Tae Park, M.D., Dae Hwan Kang, M.D., Cheol Woong Choi, M.D., Su Bum Park, M.D., Jae Hyung Lee, M.D., Bong Gap Kim, M.D., Suk Hun Kim, M.D. and Hyung Wook Kim, M.D.; Korean J Gastrointest Endosc 2011;42(6):401-405. Published online May 22, 2011

Abstract PDF: Amyloidosis is a disorder resulting from extracellular deposition of insoluble fibrils and causes dysfunction in many organs. Secondary amyloidosis, caused by chronic infectious and inflammatory disease, may involve the kidneys, liver, bone marrow and gastrointestinal tract. Involvement of the gastrointestinal tract is common and presents various symptoms according to location. Amyloidosis as a complication of Crohn’s disease is a rare but serious complication that may worsen the prognosis. We report a case of gastrointestinal amyloidosis in a 59-year-old male patient with Crohn’s disease that was diagnosed with an endoscopic forceps biopsy of the stomach, terminal ileum and colon.

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A Bowel Perforation That Developed during the Transanal Extraction of a Large Rectal Foreign Body: Keun-Suk Yang, M.D., Joung-Ho Han, M.D.^*, Sunyoung Kim, M.D., Woo Hyung Choi, M.D., Hong-Soon Jung, M.D., Eun Chung, M.D., HyenJeong Jeon, M.D.^* and Seijin Youn, M.D.^*; Korean J Gastrointest Endosc 2011;42(6):406-409. Published online May 25, 2011

Abstract PDF: Rectal foreign bodies are rare clinical problem in South Korea. Although many foreign bodies can be extracted safely using endoscopic procedures, some patients require surgery. Here we describe the case of a 35-year-old male who presented with a rectosigmoid foreign body, a large carrot measuring 28×7 cm. Sigmoidoscopy revealed a carrot in the upper rectum extending to the sigmoid colon. Endoscopic removal failed. The surgeon unsuccessfully attempted to extract the carrot using various tools without spinal anesthesia. During the extraction attempt, the patient complained of sudden abdominal pain, and a simple x-ray revealed pneumoperitoneum. An emergency colotomy and removal of the foreign body was performed, followed by primary repair of the perforation and a colostomy. Three months later, the colostomy was repaired.

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Three Cases of Pseudomembranous Colitis with Hematochezia: Hyun Jun Kang, M.D., Dong Hyup Kwak, M.D., Min Ho Choi, M.D., Ho Tae Kim, M.D., Tae Yeung Kwak, M.D., Hyun Chaol Lee, M.D., Yeung Sung Kim, M.D. and Jung Hee Kim, M.D.^*; Korean J Gastrointest Endosc 2011;42(6):410-414. Published online June 20, 2011

Abstract PDF: Clostridium difficile is the most common nosocomial pathogen of the gastrointestinal tract. Pseudomembranous colitis occurs as a result of a severe inflammatory response to Clostridium difficile toxins. Pseudomembranous colitis is an increasingly frequent cause of morbidity and mortality among elderly hospitalized patients. Diarrhea is the most common manifestation. According to the literature, stools are almost never grossly bloody, and range from soft and unformed to watery or mucoid in consistency. We now report the cases of three patients with pseudomembranous colitis whose main clinical manifestation was hematochezia.

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A Case of Adenosquamous Carcinoma of the ampulla of Vater: Hong Jun Kim, M.D., Sung Koo Lee, M.D., Ji Woong Jang, M.D., Choong Heon Ryu, M.D., Do Hyun Park, M.D., Sang Soo Lee, M.D., Dong Wan Seo, M.D. and Myung-Hwan Kim, M.D.; Korean J Gastrointest Endosc 2011;42(6):415-418. Published online May 25, 2011

Abstract PDF: Primary adenosquamous carcinoma arising from the papilla of Vater is an extremely rare tumor. Here we report a case of adenosquamous carcinoma of the duodenal major papilla. The patient was a 56-year-old man presenting with abdominal discomfort and anorexia. A computed tomography (CT) scan showed dilatation of the common bile duct (CBD) and both intrahepatic ducts with a suspicious mass in the distal CBD. Duodenoscopy revealed a mass with an irregular surface at the papilla. The patient underwent Whipple's operation. He was diagnosed as having adenosquamous carcinoma of the papilla of Vater. Eighteen months after pancreaticoduodenectomy, metastatic lymph nodes were noted in a follow-up CT scan.

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A Case of Biliary Cast Syndrome in a Non-liver Transplant Patient: Sung Gon Jun, M.D., Seong Ran Jeon, M.D., Jong Ho Moon, M.D. and Young Deok Cho, M.D.; Korean J Gastrointest Endosc 2011;42(6):419-423. Published online June 17, 2011

Abstract PDF: Biliary casts are uncommon but are typically seen in post-liver transplant patients, whereas very few cases have been reported in non-liver transplant patients. A 65- year-old man, who had not undergone a liver transplantation or other hepatobiliary surgery, presented with jaundice and fever. Radiological imaging studies showed diffuse thickening and enhancement of the intrahepatic duct with mild ductal dilatation and multiple linear filling defects. A percutaneous transhepatic cholangioscopy revealed severe bile duct inflammation and multiple biliary casts, which were removed with multiple percutaneous choledocoscopic procedures. The pathogenesis of the biliary casts in this patient was uncertain. However, we presumed that biliary tract infection with subsequent extensive cholangitis was an important predisposing factor in the cast formation. We report a case of biliary cast syndrome with no preexisting morbidity that was managed favorably with endoscopic removal.

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A Case of Neuroendocrine Carcinoma of the Gallbladder That Was Diagnosed by Endoscopy: Hyon A Lee, M.D., Hong Joo Kim, M.D., Mi Yeon Jung, M.D. and Dong Seok Shin, M.D.; Korean J Gastrointest Endosc 2011;42(6):424-427. Published online June 6, 2011

Abstract PDF: A neuroendocrine carcinoma mostly occurs in gastrointestinal tract, lung and pancreas. The gallbladder is an uncommon organ occurring a neuroendocrine carcinoma and it is difficult to diagnose before operation of gallbladder. It is not definitely established to natural course and treatment owing to its rare occurrence. A 71-year-old woman was hospitalized with intermittent abdominal pain and nausea. Abdominal computed tomography showed multiple masses of gallbladder obstructing biliary tract, and she was suspected of carcinoma of gallbladder infiltrating a common bile duct in endoscopic ultrasonography. She took a biopsy through endoscopic retrograde cholangiopancreatography (ERCP) and was diagnosed with a neuroendocrine carcinoma of gallbladder. We report a case of a neuroendocrine carcinoma of gallbladder confirmed by endoscopic biopsy, with a review of literature.

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Two Cases of Xanthogranulomatous Cholecystitis and Gallbladder Cancer with Hemobilia: Jong Kyu Kwon, M.D., Dae Jin Kim, M.D., Hyun Uk Ryu, M.D., Soo Hwan Seol, M.D., Byung Sik Hwang, M.D., Jong Hun Park, M.D.^* and Kyung Rak Son, M.D.^†; Korean J Gastrointest Endosc 2011;42(6):428-432. Published online June 4, 2011

Abstract PDF: Hemobilia is a rare upper gastrointestinal (GI) bleeding phenomenon usually caused by trauma but may occur due to various liver and pancreatobiliary diseases. Causes related to gallbladder disease include vascular disorders, malignancy, polyps, heterotopic GI mucosa, acalculous inflammation, and most commonly gallstones. Most cases are treated with a cholecystectomy. If hemobilia is detected, efforts must be made to exclude malignancy because hemobilia develops from both benign and malignant disease. Particularly in gallbladder disease with hemobilia, the possibility of gallbladder carcinoma should be considered. We report two cases of hemoblia by endoscopic retrograde cholangiopancreatography and duodenoscopy, with a review of the literature. The first case was xanthoglanulomatous cholesystitis and the second case was gallbladder cancer disclosed by cholecystectomy.

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Adenosquamous Carcinoma of the Pancreas: A Case Report: Jun Hyuk Son, M.D., Sang Hyub Lee, M.D., Byung Hyo Cha, M.D.^§, Jin Hyeok Hwang, M.D., Yun Bin Lee, M.D., Yoo Seok Yoon, M.D^*, So Yeon Kim, M.D.^† and Hae Ryoung Kim, M.D.^‡; Korean J Gastrointest Endosc 2011;42(6):433-436. Published online May 25, 2011

Abstract PDF: Adenosquamous carcinoma of the pancreas is a rare tumor, which is difficult to diagnose. A 65-year-old man was admitted complaining of abdominal pain. Abdominal computed tomography (CT) demonstrated a cystic mass in the pancreatic body. Endoscopic ultrasound (EUS) showed an approximate 1.0 cm-sized hypoechoic cystic mass with a solid portion in the pancreatic body and narrowing of the main pancreatic duct. Under the impression of acute pancreatitis with a pseudocyst diagnosis, medical therapy including pancreatic stent insertion was administered to the patient for 4 weeks. A distal pancreatectomy was performed with the suspicion of pancreatic cancer due to the remaining mass on a follow-up CT scan, and the tumor was histopathologically diagnosed as stage I (TNM classification) adenosquamous carcinoma of the pancreatic body. The patient was discharged without any problems and has been on follow-up without recurrence. We report a case of adenosquamous carcinoma of the pancreas that was diagnosed relatively early with the help of EUS.

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A Primary Repair with Hemoclips and Fibrin Glue Injection in Biliary Stent Induced Duodenal Perforation: Ki Won Kim, M.D., Tae Hoon Lee, M.D., Sang-Heum Park, M.D., Bum Suk Son, M.D., Sae Hwan Lee, M.D., Suck-Ho Lee, M.D., Il-Kwun Chung, M.D. and Sun-Joo Kim, M.D.; Korean J Gastrointest Endosc 2011;42(6):437-441. Published online May 25, 2011

Abstract PDF: Duodenal perforations caused by biliary prostheses are uncommon, but they are potentially life threatening and require immediate treatment. Here we describe an unusual case of duodenal perforation induced by a plastic biliary stent. It masqueraded as a case of cholecystitis and combined systemic upset with a localized peritonitis and fever. Primary endoscopic closure by hemoclips was difficult due to the position of the lateral wall and the complexity of aligning the perforation with the endoscope. To approximate the perforated hole and adherent hemoclips, glue injection and sprayings were successfully performed under cap-fitted endoscopy. The patient recovered without additional complications.

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A Case of Biliary Ascariasis with Duodenal Stenosis: Kang Jin Park, M.D., Cho Yun Chung, M.D., Young A Song, M.D., Sang Hun Kim, M.D., Chung Su Park, M.D., Sung Bum Cho, M.D., Wan Sik Lee, M.D. and Young Eun Joo, M.D.; Korean J Gastrointest Endosc 2011;42(6):442-445. Published online May 25, 2011

Abstract PDF: Infestation with Ascaris lumbricoides is one of the most common helminthic diseases in humans. The highly motile mature worm can cause intestinal obstructions, pancreaticobiliary diseases, appendicitis, and peritonitis. However, biliary ascariasis associated with duodenal stenosis is extremely rare. We report a case of biliary ascariasis with duodenal stenosis in a 70-year-old man. The patient was admitted to our hospital with a 2 month history of epigastric pain and vomiting. An esophagogastroduodenoscopy showed stenosis of the second portion of the duodenum and an impacted living round worm in the ampulla of Vater. The round worm was extracted with a snare without any complications, and the patient received albendazole treatment. A pathological examination of the stenotic portion of the biopsy specimen revealed chronic inflammation with eosinophilic infiltration throughout the mucosa. The patient remained asymptomatic at a follow-up examination. Duodenal stenosis should be considered in the complications of ascariasis, particularly in areas where this parasitic infestation is endemic.

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A Case of Solid Pseudopapillary Tumor of the Pancreas Presenting as a Submucosal Tumor with Hemorrhage: Jong Han Kim, M.D., Sang Heon Lee, M.D., Ji Hyun Kim, M.D., Byoung Jin Choi, M.D., Young Jin Song, M.D., Sang Bun Choi, M.D., Jae Ik Lee, M.D. and Su Jin Jung, M.D.^*; Korean J Gastrointest Endosc 2011;42(6):446-449. Published online May 25, 2011

Abstract PDF: A solid pseudopapillary tumor is a rare pancreatic tumor with a low malignant potential that occurs commonly in young females. We report a case of 12-year-old girl with a solid pseudopapillary tumor of the pancreas associated with symptoms of anemia. She was suspected to have a 7×4.5 cm mass growing from the head of the pancreas based on an esophagogastroduodenoscopy, a radiological imaging study, and an immunohistochemical stain examination. She was finally diagnosed with a solid pseudopapillary tumor after a pancreaticoduodenectomy as the definitive treatment.

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