Clinical Endoscopy

A Case Report of Primary Duodenal Tuberculosis Mimicking a Malignant Tumor: Ji Hye Jung, Seong Hwan Kim, Min Jeong Kim, Young Kwan Cho, Sang Bong Ahn, Byoung Kwan Son, Yun Ju Jo, Young Sook Park; Clin Endosc 2014;47(4):346-349. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.346

Tuberculosis remains a serious infectious disease with primary features of pulmonary manifestation in Korea. However, duodenal tuberculosis is rare in gastrointestinal cases of extrapulmonary tuberculosis. Here, we report a case of primary duodenal tuberculosis mistaken as a malignant tumor and diagnosed with QuantiFERON-TB GOLD (Cellestis Ltd.) in an immunocompetent male patient.

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Rare case of duodenal tuberculosis causing gastric outlet obstruction, a case report
Yohannis Derbew Molla, Samrawit Andargie Kassa, Amanuel Kassa Tadesse
International Journal of Surgery Case Reports.2023; 105: 108080. CrossRef
Primary Extraskeletal Ewing Sarcoma of the Duodenum Revealed by 18F-FDG PET/CT
Hao Liu, Yan Deng, Nan Liu, Jing Huang, Wei Zhang
Clinical Nuclear Medicine.2023; 48(8): e398. CrossRef
Infections in the gastrointestinal tract that can mimic malignancy
David W. Dodington, Klaudia M. Nowak, Runjan Chetty
Diagnostic Histopathology.2022; 28(10): 435. CrossRef
Disseminated tuberculosis mimicking abdominal metastatic carcinoma
Qi Zhou, MiaoXin Zhang
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Primary duodenal tuberculosis misdiagnosed as tumor by imaging examination: A case report
Yang Zhang, Xiao-Jun Shi, Xian-Cui Zhang, Xing-Jie Zhao, Jun-Xiang Li, Lin-Heng Wang, Chun-E Xie, Yu-Yue Liu, Yun-Liang Wang
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Ri Sa, Hong-Guang Zhao, Yu-Yin Dai, Feng Guan
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Rui-Lin Ding, Hong-Ying Cao, Yue Hu, Chang-Ling Shang, Fang Xie, Zhen-Hua Zhang, Qing-Lian Wen
Experimental and Therapeutic Medicine.2017; 13(6): 3369. CrossRef

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The Clinical Meaning of Benign Colon Uptake in ¹⁸F-FDG PET: Comparison with Colonoscopic Findings: Sun Hee Roh, Sung-Ae Jung, Seong-Eun Kim, Hye-In Kim, Min Jin Lee, Chung Hyun Tae, Ju Young Choi, Ki-Nam Shim, Hye-Kyung Jung, Tae Hun Kim, Kwon Yoo, Il Hwan Moon, Bom Sahn Kim; Clin Endosc 2012;45(2):145-150. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.145

Abstract PDF PubReader ePub

Background/Aims

Benign colon ¹⁸F-fluorodeoxyglucose (FDG) uptake is frequently observed in asymptomatic individuals. Aims of this study were to investigate the benign colon uptake by whole body FDG-positron emission tomography (PET) in asymptomatic adults and to correlate those results with colonoscopic and histologic findings.

Methods

Among 3,540 subjects who had undergone FDG-PET, 43 subjects who were diagnosed to have benign colon uptake in FDG-PET and underwent colonoscopy were retrospectively reviewed. Subjects were classified as diffuse or focal groups based on their FDG uptake patterns. PET results were analyzed together with colonoscopic and histologic findings.

Results

Forty-three subjects showed benign colon uptake in FDG-PET; 28 of them were shown as the diffuse group, while other 15 subjects were classified as the focal group. Five subjects among those showed diffuse uptake were diagnosed as adenoma. Seven among 15 subjects who showed focal uptake were diagnosed as adenocarcinoma (n=2), adenoma (n=3), or non-neoplastic polyp (n=2). Positive predictive values were 25% in the diffuse group and 47% in the focal group.

Conclusions

We recommend that patients showing benign FDG uptake in the colon should be further evaluated by colonoscopy, especially for patients with focal FDG uptake.

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Citations to this article as recorded by

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Rajit A. Gilhotra, Lisa Song, Matthew Remedios, Eva Malacova, Mark Appleyard, Kimberley Ryan, Florian Grimpen
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Assessment of incidental focal colorectal uptake by analysis of fluorine-18 fluorodeoxyglucose positron emission tomography parameters
Haejun Lee, Kyung-Hoon Hwang, Kwang An Kwon
World Journal of Clinical Cases.2022; 10(17): 5634. CrossRef
Combined SUVmax and localized colonic wall thickening parameters to identify high-risk lesions from incidental focal colorectal 18F-FDG uptake foci
Wenmin Xu, Hansen Li, Ziqian Guo, Linqi Zhang, Rusen Zhang, Long Zhang
Frontiers in Oncology.2022;[Epub] CrossRef
Interim [18F]FDG PET/CT can predict response to anti-PD-1 treatment in metastatic melanoma
Christos Sachpekidis, Annette Kopp-Schneider, Leyun Pan, Dimitrios Papamichail, Uwe Haberkorn, Jessica C. Hassel, Antonia Dimitrakopoulou-Strauss
European Journal of Nuclear Medicine and Molecular Imaging.2021; 48(6): 1932. CrossRef
Clinical impact of FDG PET/CT in alimentary tract malignancies: an updated review
Esma A. Akin, Zain N. Qazi, Murat Osman, Robert K. Zeman
Abdominal Radiology.2020; 45(4): 1018. CrossRef
Diffuse Intense Intestinal FDG Activity in a Patient With Familial Adenomatous Polyposis
Liang Cai, Fuqiang Shao, Jie Zhang, Yue Chen
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Incidental colorectal FDG uptake on PET/CT scan and lesions observed during subsequent colonoscopy: a systematic review
S. J. Kousgaard, O. Thorlacius-Ussing
Techniques in Coloproctology.2017; 21(7): 521. CrossRef
Prevalence and clinical significance of focal incidental 18F-FDG uptake in different organs: an evidence-based summary
Adriana Tamburello, Giorgio Treglia, Domenico Albano, Francesco Bertagna, Luca Giovanella
Clinical and Translational Imaging.2017; 5(6): 525. CrossRef
Fixations colorectales focales en TEP/TDM 18FDG : importance de la coloscopie et apport du SUVmax pour orienter sur la gravité anatomopathologique des lésions
T. Cassou-Mounat, M. Terroir, F. Adam-Tariel, R. Perdrisot, I. Biancheri-Mounicq
Médecine Nucléaire.2015; 39(2): 154. CrossRef
Incidental gastrointestinal 18F-Fluorodeoxyglucose uptake associated with lung cancer
Juliette Vella-Boucaud, Dimitri Papathanassiou, Olivier Bouche, Alain Prevost, Thibault Lestra, Sandra Dury, Hervé Vallerand, Jeanne-Marie Perotin, Claire Launois, Louis Boissiere, Mathilde Brasseur, François Lebargy, Gaëtan Deslee
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PET incelemede insidental saptanan fokal kolon tutulumu olgularımız
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Rifaximin suppresses background intestinal 18F-FDG uptake on PET/CT scans
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Lesion Location in Clinical Significance of Incidental Colorectal FDG Uptake
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Efficacy and Safety of Albis^Ⓡ in Acute and Chronic Patients with Gastritis: A Double-blind, Placebo-controlled, Randomized Multi-center Study: Hae Won Han, M.D., Myung-Gyu Choi, M.D., Sang Young Seol, M.D.*, Dong Ho Lee, M.D.^†, Hwoon-Yong Jung, M.D.^‡, Tae Nyeun Kim, M.D.^§, Suck Chei Choi, M.D.^∥ and Hyen Soo Kim, M.D.^¶; Korean J Gastrointest Endosc 2011;42(4):215-221. Published online April 28, 2011

Abstract PDF: Background
/Aims: Albis^Ⱂ is a newly developed drug comprised of ranitidine, bismuth and sucralfate. The aim of the study was to prove non-inferiority of Albis^Ⱂ compared to Stillen^Ⱂ for treating erosive gastritis.
Methods
This study was a randomized, double-blind, multi-center trial. The primary endpoint was 2 weeks of treatment.
Results
Of the 229 patients in the intention-to-treat (ITT) population, 87 from the Albis^Ⱂ, and 96 from the Stillen^Ⱂ group were included in the per protocol (PP) analysis. The endoscopic improvement rate was not different between the Albis^Ⱂ group and the control in both the PP (42.5%, 39.6%) and ITT (35.3%, 34.5%) populations. The endoscopic cure of erosion was also not different in the Albis^Ⱂ group than that in the control group in both the PP (32.3%, 31.3%) and ITT (27.6%, 27.4%) populations. The endoscopic improvement rate for hemorrhage, edema, and erythema were also not different between the two groups in both the PP and ITT populations. No statistically significant differences were observed for adverse events between the two groups.
Conclusions
Half of the approved dose of Albis^Ⱂ for peptic ulcers has non-inferiority compared to Stillen^Ⱂ for treating erosive gastritis. A low dosage of Albis^Ⱂ is cost efficient and safe. (Korean J Gastrointest Endosc 2011;42:215-221)

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Expression of Mutant p⁵³ Protein, p21^waf1/cip1 and Cyclin D1 in Dysplasia and Adenocarcinoma of Stomach: Ki Jung Yun, M.D., Hun Soo Kim, M.D., Hyang Jeong Jo, M.D. and Suck Chei Choi, M.D.*; Korean J Gastrointest Endosc 2007;34(1):9-13. Published online January 30, 2007

Abstract PDF: Background
/Aims: Gastric carcinoma is a major cause of morbidity and mortality in Korea. It evolves through dysplasia to an invasive adenocarcinoma. The carcinogenesis of dysplasia and adenocarcinoma in the stomach was investigated by examining the levels of mutant p53 protein, p21waf1/cip1, and cyclin D1 expression in gastric dysplasia and invasive adenocarcinoma. Methods: Formalin- fixed paraffin-embedded tumors were examined immunohistochemically using the monoclonal antibodies to the 53 protein, p21waf1/cip1 and cyclin D1. Results: Mutant p53 protein, p21waf1/cip1 and cyclin D1 expression were found in 66.6% (12/18), 72.2% (13/18) and 33.8% (6/18) of dysplasia, and 45.0% (9/20), 15.0% (3/20) and 30.0% (6/20) of invasive adenocarcinoma, respectively. Conclusions: These results suggest that p21waf1/cip1, which is controlled by the p53 protein, plays a more important role in the carcinogenesis of the stomach than cyclin D1.

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A Case of Protein Losing Enteropathy Caused by Primary Intestinal Lymphangiectasia: Se Young Lee, M.D., Ju Chun Yeo, M.D., Young Deuk Youn, M.D., Sae Rom Kim, M.D., Young Lan Kwon, M.D., Hyon Uk Ryu, M.D., Jun Chul Kim, M.D., Myung Kwon Lee, M.D., Chang Keun Park, M.D. and Sang Mun Lee, M.D.; Korean J Gastrointest Endosc 2006;33(5):307-312. Published online November 30, 2006

Abstract PDF: Primary intestinal lymphangiectasia is a rare congenital cause of protein losing enteropathy that is characterized by chronic diarrhea, generalized edema, ascites, hypoproteinemia, hypoalbuminemia, and lymphopenia. We encountered an 18-year-old woman who suffered from longstanding diarrhea and progressive leg edema. The laboratory findings showed the typical features of this disorder. The presence of enteric protein loss was documented with the 24 hour fecal clearance of α₁-antitrypsin and ^99mTc human serum albumin scintigraphy. A duodenoscopy and biopsy showed scattered white spots and markedly dilated lymphatics in the tips of the villi, respectively. The patient's clinical symptoms improved after placing her on a high protein and low fat diet with medium chain triglyceride supplements. (Korean J Gastrointest Endosc 2006;33:307⁣312)

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A Case of Boerhaave's Syndrome after Bowel Preparation with Polyethylene Glycol: Chi Hoon Kim, M.D., Jong Hwan Park, M.D., Min Woong Kim, M.D., Hwa Mi Kang, M.D., Ji Hoon Yoon, M.D., Suk Hun Kim, M.D., Jae Hoon Jeong, M.D., Hyung Wook Kim, M.D., Seung Keun Park, M.D. and Hee Ug Park, M.D.; Korean J Gastrointest Endosc 2005;31(5):315-319. Published online November 30, 2005

Abstract PDF: Polyethylene glycol (Colyte^Ⱂ) electrolyte lavage solution is widely used for bowel preparataion before colonoscopy and surgery. The minor complications associated with PEG solution, i.e., nausea and bloating have been reported on. However, major complications such as PEG electrolyte lavage solution-induced Mallory-Weiss tear, esophageal rupture, asystole and aspiration have rarely been reported on. Spontaneous rupture of the esophagus (Boerhaave's syndrome) is a very rare disease and it is often diagnosed late or it is misdiagnosed because of the atypical clinical symptoms. Its mortality increases proportionally to the time between esophageal rupture and treatment. It can cause a fatal outcome unless it is treated early. We authors report here on a case of spontaneous esophageal rupture after bowel preparation with polyethylene glycol. (Korean J Gastrointest Endosc 2005;31:315⁣319)

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A Case of Broncho-esophageal Fistula Treated by Histoacryl^Ⓡ Injection Therapy: Kun Hyung Cho, M.D., Jee Hyun Park, M.D., In Du Jeong, M.D., Byeong Mahn Lee, M.D., Dong In Kim, M.D., Jin Woo Lee, M.D., Young Chul Jo, M.D., Jae Cheol Hwang, M.D.*, Dae-Hyun Kim, M.D.^† and Do Ha Kim, M.D.; Korean J Gastrointest Endosc 2005;31(3):161-165. Published online September 30, 2005

Abstract PDF: Broncho-esophageal fistula is a disease of varying etiologies. Spontaneous fistula occurs as a result of malignancy, radiotherapy or inflammatory disease. The majority of fistulas are caused by iatrogenic causes. Treatment of fistula usually consists of surgery and conservative management. Recently, it has been reported that broncho-esophageal fistula can be treated endoscopically using tissue adhesive agent such as Histoacryl^Ⱂ and fibrin glue. We report a case of broncho-esophageal fistula as a complication of tuberculosis that was successfully treated by radiological Histoacryl^Ⱂ injection therapy with a review of literatures. (Korean J Gastrointest Endosc 2005;31:161⁣165)

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A Case of Broncho-esophageal Fistula Treated by Histoacryl^Ⓡ Injection Therapy: Kun Hyung Cho, M.D., Jee Hyun Park, M.D., In Du Jeong, M.D., Byeong Mahn Lee, M.D., Dong In Kim, M.D., Jin Woo Lee, M.D., Young Chul Jo, M.D., Jae Cheol Hwang, M.D.*, Dae-Hyun Kim, M.D.^† and Do Ha Kim, M.D.; Korean J Gastrointest Endosc 2005;31(3):161-165. Published online September 30, 2005

Abstract PDF: Broncho-esophageal fistula is a disease of varying etiologies. Spontaneous fistula occurs as a result of malignancy, radiotherapy or inflammatory disease. The majority of fistulas are caused by iatrogenic causes. Treatment of fistula usually consists of surgery and conservative management. Recently, it has been reported that broncho-esophageal fistula can be treated endoscopically using tissue adhesive agent such as Histoacryl^Ⱂ and fibrin glue. We report a case of broncho-esophageal fistula as a complication of tuberculosis that was successfully treated by radiological Histoacryl^Ⱂ injection therapy with a review of literatures. (Korean J Gastrointest Endosc 2005;31:161⁣165)

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The Efficacy of 38 mg Low Dose Capsule-Based ¹³C-urea Breath Test for the Diagnosis of Helicobacter pylori Infection: Yong Sik Kim, M.D., Hoon Jai Chun, M.D., Yoon Tae Jeen, M.D., Han Kyum Kim, M.D., Jin Hai Hyun, M.D., In Sik Chung, M.D.*, Myung Gyu Choi, M.D.*, Sang Woo Kim, M.D.*, In Seok Lee, M.D.*, Gyeong Sin Park, M.D.*, Chan Sup Shim, M.D.^†, Joo Young C; Korean J Gastrointest Endosc 2005;30(3):126-132. Published online March 31, 2005

Abstract PDF: Background
/Aims: Urea breath test (UBT), the noninvasive test for diagnosing Helicobacter pylori infection, was developed in 1987 and had advanced in accuracy and convenience by improvement of analytic device, ¹³C or ¹⁴C urea regimen, expiration sampling protocol and test meal. However, conventional UBT using 75 mg or 100 mg of ¹³C-urea is expensive and time consuming. The objective of this study was to evaluate the diagnostic performance of UBT using capsulated 38 mg low dose ¹³C-urea (HeliFinder^Ⱂ) developed by Medichems Co., Ltd. Methods: A total of one hundred forty seven volunteers were enrolled and examined at Catholic University, Korea University, and Soon Chun Hyang University hospital. UBT was performed using 38 mg ¹³C urea capsule and compared with the gold standard methods (rapid urease test and histology). Baseline and 20 min breath samples were collected. We used ∆¹³C 2.0‰ as the cut-off value suggested by the manufacturer. Results: Of the 147 subjects, 142 cases were available for analysis. The sensitivity and specificity of UBT using the 38 mg ¹³C urea capsule at 20 min were 98.7% and 100% respectively. Conclusions: A 20 min, 38 mg capsule based ¹³C urea breath test protocol is more efficient, cost effective, and convenient than conventional protocol. (Korean J Gastrointest Endosc 2005;30:126⁣132)

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The Effects of Endoscopic Sodium Alginate Powder (Alto Shooter^TM) in Peptic Ulcer Bleeding: Ilhyun Baek, M.D., Heung Young Oh, M.D., Gwang Ho Baik, M.D., Taeho Hahn, M.D., Jin Bae Kim, M.D., Jin Lee, M.D. and Myung Seok Lee, M.D.; Korean J Gastrointest Endosc 2004;29(6):489-494. Published online December 30, 2004

Abstract PDF: Background
/Aims: Peptic ulcer bleeding can be treated by endoscopic laser, argon plasma coagulation, heater probe, or electrocoagulation. However, techinical difficulties and significant rebleeding rate after such endoscopic hemostasis, offer some beneficial effect of Alto Shooter^TM as an adjuvant therapy in active peptic ulcer bleeding. Methods: Twenty-three patients with active peptic ulcer bleeding were randomized to Alto Shooter^TM & argon plasma coagulation therapy (ALTO⁢APC) or argon plasma coagulation therapy alone (APC). Forrest classifications were used to compare the effect of bleeding control. Results: The Forrest classifications in two groups before treatment were Ib (6 patients), IIa (11 patients) in "ALTO⁢APC", Ib (2 patients) and IIa (4 patients) in "APC". The Forrest classifications of two groups at follow-up endoscopy were Ia (1 patient), Ib (1 patient), IIc (14 patients), III (1 patient) in "ALTO⁢APC" and IIc (6 patients) in "APC". There was no significant difference in hemostatic effect between "ALTO⁢APC" (p=0.001) and "APC" (p=0.001) groups. Conclusions: Alto Shooter^TM offers no advantage over conventional endoscopic argon plasma coagulation therapy in controlling active peptic ulcer bleeding. Therefore routine addition of Alto Shooter^TM treatment may not be recommended after initial successful endoscopic argon plasma coagulation therapy in active peptic ulcer bleeding. (Korean J Gastrointest Endosc 2004;29:489⁣494)

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A Phase III Clinical Trial of Stillen^TM for Erosive Gastritis: Sang Yong Seol, M.D.*, Myung Hwan Kim, M.D.^†, Jong Sun Rew, M.D.^‡ and Myung Gyu Choi, M.D.^§; Korean J Gastrointest Endosc 2004;28(5):230-236. Published online May 30, 2004

Abstract PDF: Background
/Aims: Phase IIb clinical study of Stillen^TM, a novel cytoprotectant, for gastritis showed 180 mg of Stillen, t.i.d. for 2 weeks results in a significant increase of cure rate when compared with a placebo group. It is reported that antioxidative effect and strengthening the endogenous cytoprotective molecules of the gastric mucosa play a pivotal role for cytoprotective action of Stillen^TM. The aim of this phase III multicenter, double-blind comparative study was to assess the efficacy of Stillen^TM for the treatment of erosive gastritis. Methods: Five hundred and twelve patients with erosive gastritis were enrolled and divided into three groups. Each group received 180 mg or 360 mg of Stillen^TM or 600 mg of cetraxate (Neuer^TM) t.i.d. for 2 weeks, respectively and a follow-up endoscopic examination for evaluation. Results: Patients treated with 180 mg and 360 mg of Stillen^TM had a significantly improved endoscopic cure rate of gastritis (55.6% and 57.5%, respectively) compared with patients treated with 600 mg of cetraxate (35.5%, p＜0.001). Endoscopic improvement rate was also significantly higher in 180 mg group (67.3%) and 360 mg group (65.0%) of Stillen^TM treated patients than cetraxate treated group (46.4%, p＜0.001). During the study, both Stillen^TM and cetraxate were well tolerated. Conclusions: These results clearly demonstrate that Stillen^TM is an efficacious, safe, and well-tolerated treatment for gastritis. (Korean J Gastrointest Endosc 2004;28:230⁣236)

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위 정맥류 출혈에 대한 Histoacryl^Ⓡ 치료 효과: Korean J Gastrointest Endosc 2003;27(5):450-450. Published online November 20, 2003

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