Clinical Endoscopy

Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage in hypervascular hepatocellular carcinoma: a retrospective study from Japan: Kenneth Tachi, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Ahmed Mohammed Sadek, Hossam El-Din Shaaban Mahmoud Ibrahim, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto; Received April 2, 2024 Accepted July 29, 2024 Published online November 11, 2024; DOI: https://doi.org/10.5946/ce.2024.079 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC.
Methods
This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023.
Results
A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours.
Conclusions
EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.

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Safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis compared to non-cirrhosis and effect of Child-Pugh score on post-ERCP complications: a systematic review and meta-analysis: Zahid Ijaz Tarar, Umer Farooq, Mustafa Gandhi, Saad Saleem, Ebubekir Daglilar; Clin Endosc 2023;56(5):578-589. Published online May 2, 2023; DOI: https://doi.org/10.5946/ce.2023.027

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: The safety of endoscopic retrograde cholangiopancreatography (ERCP) in hepatic cirrhosis and the impact of Child-Pugh class on post-ERCP complications need to be better studied. We investigated the post-ERCP complication rates in patients with cirrhosis compared with those without cirrhosis.
Methods
We conducted a literature search of relevant databases to identify studies that reported post-ERCP complications in patients with hepatic cirrhosis.
Results
Twenty-four studies comprising 28,201 patients were included. The pooled incidence of post-ERCP complications in cirrhosis was 15.5% (95% confidence interval [CI], 11.8%–19.2%; I2=96.2%), with an individual pooled incidence of pancreatitis 5.1% (95% CI, 3.1%–7.2%; I2=91.5%), bleeding 3.6% (95% CI, 2.8%–4.5%; I2=67.5%), cholangitis 2.9% (95% CI, 1.9%–3.8%; I2=83.4%), and perforation 0.3% (95% CI, 0.1%–0.5%; I2=3.7%). Patients with cirrhosis had a greater risk of post-ERCP complications (risk ratio [RR], 1.41; 95% CI, 1.16–1.71; I2=56.3%). The risk of individual odds of adverse events between cirrhosis and non-cirrhosis was as follows: pancreatitis (RR, 1.25; 95% CI, 1.06–1.48; I2=24.8%), bleeding (RR, 1.94; 95% CI, 1.59–2.37; I2=0%), cholangitis (RR, 1.15; 95% CI, 0.77–1.70; I2=12%), and perforation (RR, 1.20; 95% CI, 0.59–2.43; I2=0%).
Conclusions
Cirrhosis is associated with an increased risk of post-ERCP pancreatitis, bleeding, and cholangitis.

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The Impact of Frailty on ERCP-Related Adverse Events: Findings From a National Cohort
Umer Farooq, Zahid Ijaz Tarar, Abdallah El Alayli, Faisal Kamal, Alexander Schlachterman, Anand Kumar, David E. Loren, Thomas E. Kowalski
Techniques and Innovations in Gastrointestinal Endoscopy.2024; 26(2): 138. CrossRef
Applicability of Child-Turcotte-Pugh Score in Anticipating Post-ERCP Adverse Events in Patients With Cirrhosis
Saqr Alsakarneh, Fouad Jaber, Willie Mohammed, Mohammad Almeqdadi, Abdallah Al-Ani, Yassine Kilani, Saeed Abughazaleh, Laith Momani, Muhammad Shah Miran, Hassan Ghoz, John Helzberg, Wendell Clarkston, Mohamed Othman
Journal of Clinical Gastroenterology.2024;[Epub] CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Hyung Ku Chon, Ki-Hyun Kim, Tae Jun Song, Dong-Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyun Chung, Jin Lee, Miyoung Choi
Gut and Liver.2024; 18(4): 564. CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Ki-Hyun Kim, Hyung Ku Chon, Tae Jun Song, Dong Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyung Chung, Jin Lee, Miyoung Choi
The Korean Journal of Gastroenterology.2024; 84(3): 111. CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Ki-Hyun Kim, Hyung Ku Chon, Tae Jun Song, Dong Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyung Chung, Jin Lee, Miyoung Choi
The Korean Journal of Pancreas and Biliary Tract.2024; 29(4): 144. CrossRef
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY FOR THE MANAGEMENT OF CHOLEDOCHOLITHIASIS IN OLDER PATIENTS
Júlia Gardenyes, Pere Roura, Helena Vallverdú-Cartie, Judit Hermoso-Bosch, Cl�udia Roca, Mariona Espaulella, Antoni Casals, Héctor Ivo Marani, Joan Saló, Martín Galdín, Marta Gallach, Carles Leal
Revista Española de Enfermedades Digestivas.2023;[Epub] CrossRef

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Outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms in patients with liver cirrhosis: Young Kwon Choi, Jin Hee Noh, Do Hoon Kim, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung; Clin Endosc 2022;55(3):381-389. Published online April 20, 2022; DOI: https://doi.org/10.5946/ce.2021.242

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: The treatment of superficial esophageal neoplasms (SENs) in cirrhotic patients is challenging and rarely investigated. We evaluated the outcomes of endoscopic submucosal dissection (ESD) to determine the efficacy and safety of treating SENs in patients with liver cirrhosis.
Methods
The baseline characteristics and treatment outcomes of patients who underwent ESD for SENs between November 2005 and December 2017 were retrospectively reviewed.
Results
ESD was performed in 437 patients with 481 SENs, including 15 cirrhotic patients with 17 SENs. En bloc resection (88.2% vs. 97.0%) and curative resection (64.7% vs. 78.9%) rates were not different between the cirrhosis and non-cirrhosis groups (p=0.105 and p=0.224, respectively). Bleeding was more common in cirrhotic patients (p=0.054), and all cases were successfully controlled endoscopically. The median procedure and hospitalization duration did not differ between the groups. Overall survival was lower in cirrhotic patients (p=0.003), while disease-specific survival did not differ between the groups (p=0.85).
Conclusions
ESD could be a safe and effective treatment option for SENs in patients with cirrhosis. Detailed preprocedural assessments are needed, including determination of liver function, esophageal varix status, and remaining life expectancy, to identify patients who will obtain the greatest benefit.

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Endoscopic resection of early esophageal neoplasia in patients with esophageal varices: a systematic review
Charlotte N. Frederiks, Laura S. Boer, Bas Gloudemans, Lorenza Alvarez Herrero, Jacques J.G.H.M. Bergman, Roos E. Pouw, Bas L.A.M. Weusten
Endoscopy.2025;[Epub] CrossRef
Clinical outcomes of endoscopic submucosal dissection for esophageal squamous cell carcinoma with esophageal varices: Multicenter retrospective study
Yosuke Toya, Waku Hatta, Tomohiro Shimada, Tamotsu Matsuhashi, Takeharu Shiroki, Yu Sasaki, Tetsuya Tatsuta, Jun Nakamura, Norihiro Hanabata, Yohei Horikawa, Ko Nagino, Tomoyuki Koike, Atsushi Masamune, Yoshihiro Harada, Tetsuya Ohira, Katsunori Iijima, Y
Digestive Endoscopy.2024; 36(3): 314. CrossRef
Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasia in close proximity to esophageal varices: a multicenter international experience
Shruti Mony, Bing Hu, Abel Joseph, Hiroyuki Aihara, Lorenzo Ferri, Amit Bhatt, Amit Mehta, Peng-Sheng Ting, Alex Chen, Andrew Kalra, Jad Farha, Manabu Onimaru, Long He, Qi Luo, Andrew Y. Wang, Haruhiro Inoue, Saowanee Ngamruengphong
Endoscopy.2024; 56(02): 119. CrossRef
Risk associated with endoscopic treatment of early upper gastrointestinal cancer in patients with liver cirrhosis and management strategies
Yu-Yong Tan, Yu-Min Qing, Jian Gong, De-Liang Liu
World Chinese Journal of Digestology.2024; 32(2): 102. CrossRef
Radical chemoradiotherapy for superficial esophageal cancer complicated with liver cirrhosis
Hejing Bao, Hehong Bao, Liping Lin, Yuhuan Wang, Longbin Zhang, Li Zhang, Han Zhang, Lingxiang Liu, Xiaolong Cao
PeerJ.2024; 12: e18065. CrossRef
Endoscopic management of early esophageal cancer in patients with concomitant cirrhosis
Linlin Zhu, Zhenming Zhang
Chinese Medical Journal.2024; 137(24): 3142. CrossRef
Endoscopic submucosal dissection for early cancers or precancerous lesions of the upper GI tract in cirrhotic patients with esophagogastric varices: 10-year experience from a large tertiary center in China
Shuai Zhang, Ying-Di Liu, Ning-Li Chai, Yi Yao, Fei Gao, Bo Liu, Zhan-Di He, Lu Bai, Xin Huang, Chao Gao, En-Qiang Linghu, Lian-Yong Li
Gastrointestinal Endoscopy.2023; 97(6): 1031. CrossRef
Endoscopic Submucosal Dissection for Treatment of Early-Stage Cancer or Precancerous Lesion in the Upper Gastrointestinal Tract in Patients with Liver Cirrhosis
Yuyong Tan, Yumin Qing, Deliang Liu, Jian Gong
Journal of Clinical Medicine.2023; 12(20): 6509. CrossRef

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Evaluation of Non-invasive Fibrosis Markers in Predicting Esophageal Variceal Bleeding: Sami Cifci, Nergiz Ekmen; Clin Endosc 2021;54(6):857-863. Published online May 26, 2021; DOI: https://doi.org/10.5946/ce.2021.028

Abstract PDF PubReader ePub

Background
/Aims: Esophageal variceal bleeding (EVB) is an important cause of mortality and morbidity in liver cirrhosis. In this study, we aimed to predict the possibility of EVB in patients with cirrhosis using a non-invasive score.
Methods
A total of 359 patients with cirrhosis were divided into two groups based on the presence or absence of EVB. ChildTurcotte-Pugh (CTP) score, a model for end-stage liver disease, aspartate aminotransferase to alanine aminotransferase ratio, aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4-index (FIB-4), aspartate aminotransferase to alanine aminotransferase ratio/platelet ratio index (AARPRI), and S-index were measured for all participants. Receiver operating characteristic curves were obtained for all parameters, and the optimal cut-off value was determined in predicting EVB.
Results
In patients with EVB, the number of platelets (PLT) were low (p<0.001) and APRI, AARPRI, FIB-4, and S-index were significantly higher than those in patients without EBV. APRI, AARPRI, FIB-4, PLT, and S-index were statistically significant predictors of EVB (p<0.05).
Conclusions
FIB-4 and AARPRI, which are non-invasive markers of fibrosis, can be used to predict EVB. In addition, the 66.5 10⁹/L cut-off value for PLT is important for EVB.

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Prognostic model for esophagogastric variceal rebleeding after endoscopic treatment in liver cirrhosis: A Chinese multicenter study
Jun-Yi Zhan, Jie Chen, Jin-Zhong Yu, Fei-Peng Xu, Fei-Fei Xing, De-Xin Wang, Ming-Yan Yang, Feng Xing, Jian Wang, Yong-Ping Mu
World Journal of Gastroenterology.2025;[Epub] CrossRef
Improving radiomics-based models for esophagogastric variceal bleeding risk prediction in cirrhotic patients
Arunkumar Krishnan
World Journal of Gastroenterology.2025;[Epub] CrossRef
Non-invasive Fibrosis Markers for Predicting Esophageal Varices: A Potential Alternative to Endoscopic Screening
Kunza Ali, Saad Slah-Ud-Din, Mishal Afzal, Mah R Tariq, Tallha Waheed, Haroon Yousuf
Cureus.2024;[Epub] CrossRef
Diagnostic accuracy of shear wave elastography versus laboratory parameters as non-invasive screening tool for esophageal varices
Khaled Mohamed Ali Shehata, Abdul-Allah Ismael Kelany, Salma Mokhtar Osman Hassan, Ramy Mohamed Ahmed, Peter Atef Mounir, Amira Hassan AbdelAziz
The Egyptian Journal of Internal Medicine.2024;[Epub] CrossRef
Assessment of nomogram model for the prediction of esophageal variceal hemorrhage in hepatitis B-induced hepatic cirrhosis
Jing Xu, Lin Tan, Ning Jiang, Fengcheng Li, Jinling Wang, Beibei Wang, Shasha Li
European Journal of Gastroenterology & Hepatology.2024; 36(6): 758. CrossRef
Predicting High-Risk Esophageal Varices in Cirrhosis: A Multi-Parameter Splenic CT Study
Cheng Yan, Chunhua Xia, Qiuting Cao, Jingwen Zhang, Mingzi Gao, Jing Han, Xiaohong Liang, Mingxin Zhang, Lin Wang, Liqin Zhao
Academic Radiology.2024; 31(12): 4866. CrossRef
Progress in Noninvasive Assessment of Esophageal Varices
Yuki Arita
Academic Radiology.2024; 31(12): 4875. CrossRef
Non-invasive predictors of the first episode of bleeding from esophageal varices in patients with liver cirrhosis awaiting transplantation
V. L. Korobka, Yu. V. Khoronko, V. D. Pasechnikov, R. V. Korobka, M. V. Malevanny, E. S. Pak, D. V. Pasechnikov
Transplantologiya. The Russian Journal of Transplantation.2024; 16(4): 507. CrossRef
Diagnosis of esophageal varices by liver stiffness and serum biomarkers in virus-related compensated advanced chronic liver disease
Amine Zoughlami, Jordana Serero, Stephen Congly, Irene Zhao, Julie Zhu, Alnoor Ramji, Curtis Cooper, Philip Wong, Robert Bailey, Carla S Coffin, Giada Sebastiani
Canadian Liver Journal.2023; 6(3): 332. CrossRef
Albumin‑bilirubin grade and INR for the prediction of esophagogastric variceal rebleeding after endoscopic treatment in cirrhosis
Fenghui Li, Tao Wang, Jing Liang, Baoxin Qian, Fei Tang, Yanying Gao, Jiayu Lv
Experimental and Therapeutic Medicine.2023;[Epub] CrossRef
Biochemical markers to predict the development of gastrointestinal bleeding and esophageal varices after portoenterostomy in biliary atresia
Wataru Sumida, Takahisa Tainaka, Chiyoe Shirota, Kazuki Yokota, Satoshi Makita, Masamune Okamoto, Aitaro Takimoto, Akihiro Yasui, Shunya Takada, Yoichi Nakagawa, Daiki Kato, Shinya Yokoyama, Yoji Ishizu, Hizuru Amano, Yaohui Guo, Akinari Hinoki, Hiroo Uch
Pediatric Surgery International.2022; 38(12): 1799. CrossRef
Liver Fibrosis Indices Predict the Severity of SARS-CoV-2 Infection
Lucilla Crudele, Fabio Novielli, Stefano Petruzzelli, Stefano Battaglia, Antonio Francesco Maria Giuliano, Rosa Melodia, Chiara Maria Morano, Paola Dell’Aquila, Renata Moretti, Luigi Castorani, Roberto Salvia, Gianfranco Inglese, Nicola Susca, Lucrezia de
Journal of Clinical Medicine.2022; 11(18): 5369. CrossRef

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Mucosal Changes in the Small Intestines in Portal Hypertension: First Study Using the Pillcam SB3 Capsule Endoscopy System: Mahesh Kumar Goenka, Bhavik Bharat Shah, Vijay Kumar Rai, Surabhi Jajodia, Usha Goenka; Clin Endosc 2018;51(6):563-569. Published online October 5, 2018; DOI: https://doi.org/10.5946/ce.2018.041

Abstract PDF PubReader ePub

Background
/Aims: To evaluate patients with portal hypertension (PH) of varied etiologies for portal hypertensive enteropathy (PHE) using the PillCam SB3 capsule endoscopy (CE) system.
Methods
Consecutive patients with PH presenting with unexplained anemia and/or occult gastrointestinal bleeding were evaluated using the PillCam SB3 CE system. Abnormal findings were categorized as vascular or non-vascular. The patients with ongoing bleeding caused by PHE were treated. The correlation of the CE scores of PHE with the clinical, laboratory, and endoscopic features was determined.
Results
Of the 43 patients included in the study, 41 (95.3%) showed PHE findings. These included varices (67.4%), red spots (60.5%), erythema (44.2%), villous edema (46.5%), telangiectasia (16.3%), and polyps (16.3%). The CE scores varied from 0 to 8 (mean±standard deviation, 4.09±1.8). Five patients (11.6%) showed evidence of ongoing or recent bleeding due to PHE. Three of these five patients underwent endotherapy, and one patient underwent radiological coil placement.
Conclusions
The PillCam SB3 CE system revealed a high prevalence of PHE in the patients with PH. Using this system, evidence of bleeding due to PHE was found in a small but definite proportion of the patients.

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Capsule endoscopy for small bowel bleed: Current update
Uday C. Ghoshal, Akash Roy, Mahesh K. Goenka
Indian Journal of Gastroenterology.2024; 43(5): 896. CrossRef
Diagnosis and management of ectopic varices in portal hypertension
Thomas H Tranah, Jeremy S Nayagam, Stephen Gregory, Sarah Hughes, David Patch, Dhiraj Tripathi, Debbie L Shawcross, Deepak Joshi
The Lancet Gastroenterology & Hepatology.2023; 8(11): 1046. CrossRef
The Role of Video Capsule Endoscopy in Liver Disease
Alexander Ross Robertson, Anastasios Koulaouzidis, Emanuele Rondonotti, Mauro Bruno, Marco Pennazio
Gastrointestinal Endoscopy Clinics of North America.2021; 31(2): 363. CrossRef
Role of Video Capsule in Small Bowel Bleeding
Richard M. Wu, Laurel R. Fisher
Gastrointestinal Endoscopy Clinics of North America.2021; 31(2): 277. CrossRef
The Usefulness of New-Generation Capsule Endoscopy in Patients with Portal Hypertensive Enteropathy
Seung-Joo Nam, Ji Hyun Kim, Sung Chul Park
Clinical Endoscopy.2018; 51(6): 505. CrossRef

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Removal of Esophageal Variceal Bands to Salvage Complete Esophageal Obstruction: Ala’ A Abdel Jalil, Ghassan Hammoud, Jamal A Ibdah, Sami Samiullah; Clin Endosc 2018;51(5):491-494. Published online August 21, 2018; DOI: https://doi.org/10.5946/ce.2018.011

Abstract PDF PubReader ePub

Esophageal varices develop in almost half of the patients with cirrhosis, and variceal hemorrhage constitutes an ominous sign with an increased risk of mortality. Variceal banding is considered an effective and mostly safe measure for primary and secondary prophylaxis. Although adverse events related to banding including dysphagia, stricture formation, bleeding, and ligation-induced ulcers have been described, complete esophageal obstruction is rare, with only 10 reported cases in the literature. Among those cases, 6 were managed conservatively; 1 patient had esophageal intraluminal dissection from an attempt to remove the bands using biopsy forceps but ultimately recovered with conservative management. Three patients developed strictures following removal of the bands, requiring repeated sessions of dilation therapy. We report on a patient who developed absolute dysphagia and complete esophageal obstruction after variceal banding. We successfully used the endoloop cutter hook to release the bands intact and restore luminal integrity.

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Esophageal necrosis and obstruction after esophageal variceal banding
Simran Gupta, Emily Zhou, Jason Ferreira, Arkadiy Finn
Journal of Brown Hospital Medicine.2022;[Epub] CrossRef

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A Case of Early Esophageal Cancer Treated by Photodynamic Therapy in a Patient with Liver Cirrhosis Accompanied by Esophageal Varix: Yoon Yung Chung, M.D., Woo Chul Chung, M.D., U-Im Chang, M.D., Ju Hyun Oak, M.D., Yeon Oh Jeong, M.D., Min Ju Kim, M.D., Chang Nyol Paik, M.D. and Kang-Moon Lee, M.D.; Korean J Gastrointest Endosc 2010;41(5):298-302. Published online November 30, 2010

Abstract PDF: Photodynamic therapy (PDT) is a non-invasive treatment for cancer that works through a photochemical effect after the administration of a photosensitizer. At first, PDT had been used for the relief of obstructive symptoms caused by exophytic esophageal cancer or for control of tumor overgrowth. Recently, several investigators have reported the use of PDT in early esophageal cancer with encouraging results. This report describes a case of a 52-year-old man with early esophageal cancer, who had a long history of liver cirrhosis with esophageal varix. The patient was treated successfully with PDT using porfimer sodium as the photosensitizer. PDT is an alternative to surgical treatment of early esophageal cancer, especially in patients with liver cirrhosis. (Korean J Gastrointest Endosc 2010;41:298-302)

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An Intramural Gastric Hematoma after Epinephrine Injection for Gastric Ulcer Bleeding in Patient with Liver Cirrhosis: Hyeong Cheol Cheong, M.D., Tae Hyeon Kim, M.D., Jin Soo Chung, M.D., Tae Hyun Kim, M.D., Bong Jun Yang, M.D., Hyo Jung Oh, M.D. and Yong Woo Sohn, M.D.; Korean J Gastrointest Endosc 2010;40(6):366-369. Published online June 30, 2010

Abstract PDF: Intramural hematoma of the gastrointestinal tract is an uncommon occurrence with the majority being localized to the esophagus or duodenum. Hematoma of the gastric wall is very rare, and has been reported most commonly in association with coagulopathy, trauma, hematologic disease, and therapeutic endoscopy. Here we describe a case of intramural gastric hematoma after epinephrine injection therapy for a gastric ulcer with underlying liver cirrhosis that was successfully managed with conservative therapy. (Korean J Gastrointest Endosc 2010;40:366-369)

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Two Cases of Rectal Vascular Ectasia in Patients with Liver Cirrhosis and Who Were Treated by Argon Plasma Coagulation: Woong Park, M.D., Chang Il Kwon, M.D., Young Jun Song, M.D., Han Ul Song, M.D., Ju Hee Oh, M.D., Kwang Hyun Ko, M.D. and Kyu Sung Rim, M.D.; Korean J Gastrointest Endosc 2009;38(3):171-175. Published online March 30, 2009

Abstract PDF: The term "vascular ectasia" is defined to include angiodysplasia, gastric antral vascular ectasia (GAVE) and telangiectasis, and these are the leading causes of acute or chronic gastrointestinal bleeding. We describe here the first 2 Korean cases of GAVE with rectal vascular ectasia in patients with liver cirrhosis. A 70-year-old woman was admitted to the hospital with hematochezia. The finding on endoscopy showed diffuse nonconfluent spots with oozing bleeding on the antrum and several vascular spots with oozing bleeding on the rectum. The lesions were successfully treated by argon plasma coagulation (APC). We report on another case of rectal vascular ectasia in a patient with liver cirrhosis. A 77-year-old man was admitted to the hospital with hematochezia. The findings on colonoscopy showed diffuse vascular spots with oozing bleeding on the rectum. The lesions were successfully treated by APC. These two patients have had no bleeding since their treatment, and they are currently being evaluated by follow-up studies at the outpatient department. (Korean J Gastrointest Endosc 2009;38:171-175)

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Clinical Features of Duodenopathy Associated with Liver Cirrhosis: Jin Bae Kim, M.D., Dong Soo Han, M.D., Hang Lak Lee, M.D., Jong Pyo Kim, M.D., Joon Yong Park, M.D.,Oh Young Lee, M.D., Joo Hyun Sohn, M.D., Ho Soon Choi, M.D. and Joon Soo Hahm, M.D.; Korean J Gastrointest Endosc 2004;28(6):277-283. Published online June 30, 2004

Abstract PDF: Background
/Aims: Congestive duodenopathy could be associated with liver cirrhosis with portal hypertension. The aims of this study were to assess the incidence of duodenopathy and to evaluate the relationship between duodenopathy and the presence of esophageal varices and portal hypertensive gastropathy in cirrhotic patients. Methods: A total of 56 patients with liver cirrhosis and 481 controls were taken upper endoscopic examination. Results: Prevalence of duodenopathy was significantly higher in the liver cirrhosis group (26.8%) compared to the control group (6.9%), although positive rate of Helicobacter pylori was significantly lower in the liver cirrhosis group. Duodenal erosions in cirrhotic patients were predominately located in 2^nd portion of duodenum compared to contol group and tended to be circular or linear along the Kerck's ring. Vascular congestion was evident in 5 of the 10 cases. Presence of duodenal lesions had no relationship with the size and extent of esophageal varices and congestive gastropathy. Conclusions: Although histology of duodenopathy tends to show vascular congestion in patients with liver cirrhosis, few clinical markers of portal hypertension support them. Therefore, further studies including endoscopic ultrasonogram are needed to demonstrate the pathogenesis of the duodenal lesions in patients with liver cirrhosis. (Korean J Gastrointest Endosc 2004;28:277⁣283)

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A Case of Spurting Duodenal Variceal Bleeding Treated with an Endoscopic Sclerotherapy in a Patient with Biliary Cirrhosis: Chan Sik Weon, M.D., Soon Goo Baik, M.D., Sang Ha Kim, M.D., Jung Koun Kim, M.D., Houn Soo Joo, M.D., Mi Young Lee, M.D., Hyun Soo Kim, M.D., Dong Ki Lee, M.D. and Sang Ok Koun, M.D.; Korean J Gastrointest Endosc 2004;28(3):127-130. Published online March 31, 2004

Abstract PDF: Duodenal varices can result from portal hypertension regardless of the etiologies of liver cirrhosis. Bleeding from duodenal varices is rare but often severe and life threatening. Treatment modalities of duodenal varices include endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and surgery. As an initial treatment, endoscopic sclerotherapy is recommended due to easy accessibility but has limited success in controlling active duodenal variceal bleeding. In this case, we report a spurting duodenal varix treated with Histoacryl^Ⱂ injection in a 48-year-old woman with secondary biliary cirrhosis. Endoscopic sclerotherapy with Histoacryl^Ⱂ is a useful therapeutic measure in the treatment of bleeding duodenal varix. (Korean J Gastrointest Endosc 2004;28:127⁣130)

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A Case of Lower GI Bleeding from Portal Hypertensive Colopathy Successfully Treated: Ji Song Ko, M.D., Ju Sang Kim, M.D., Chee Ho Noh, M.D., Do Young Kim, M.D., Jong; Korean J Gastrointest Endosc 2004;28(2):97-101. Published online March 1, 2004

Abstract PDF: Cirrhotic patients with portal hypertension are often found to have changes in their colonic mucosa. Such mucosal changes are termed portal hypertensive colopathy. Most patients with portal hypertension remained asymptomatic but some may show massive bleeding. The mainstay of treatment for portal hypertensive gastropathy include non-surgical methods such as octreotide injection, endoscopic hemostasis, and interventional methods such as TIPS. However, treatment for portal hypertensive colopathy remained unresolved. The authors here report a case of a 41 year old male with liver cirrhosis admitted for fever and abdominal pain, who reported an episode of hematochezia in the course of admisssion period. Subsequent colonoscopy revealed angiodysplasia-like lesions throughout the entire colon. We observed that such lesions were the source of hematochezia and that direct clipping with octreotide injection was successful in controlling the bleeding. (Korean J Gastrointest Endosc 2004;28:97⁣101)

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간경변증 환자의 총담관 결석 제거에 있어서 EST와 EPBD의 합병증 비교: Korean J Gastrointest Endosc 2003;27(5):416-416. Published online November 20, 2003

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구연 / 상부 : 56 세 남자 , 토혈 및 흑변: Korean J Gastrointest Endosc 2001;22(5):295-296. Published online November 30, 2000

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간경변증 환자의 소화성궤양 발병에 있어 Helicobacter pylori의 역할 ( The Role of Helicobacter pylori in Cirrhotic Patients with Peptic Ulcers ): Korean J Gastrointest Endosc 1999;19(6):918-924. Published online November 30, 1998

Abstract PDF: Background
/Aims: The overall age-matched incidence of gastroduodenal ulcers was considerably higher in cirrhotic patients compared to the general population. There are several possible underlying mechanisms which may explain the ulcerogenic factors in cirrhotic patients. Recently, Helicobacter pylori (H. pylori) was proven as the cause of peptic ulcer disease in the general population. But the role of H. pylori infection in the pathogenesis of peptic ulcers of cirrhotic patients has not been clearly elucidated. The purpose of this study was to determine the role of H. pylori infection in cirrhotic patients with peptic ulcers. Methods: From 1995 to 1997, 105 patients with histologically or radiologically proven liver cirrhosis (LC) who received panendoscopic examination due to presence of any upper gastrointestinal symptoms were studied. During endoscopic examination, a CLO (campylobacter like organism) test or gastric antral mucosal biopsy was performed in all patients. The severity of LC assessed by Child's criteria revealed that 31 patients had Child's A, 26 patients Child's B, and the remain 48 patients, Child's C. Child B or C was classified as decompensated LC. An esophageal varix was present in 73 patients or absent in 32. Results: There was no statistical difference in the H. pylori prevalance between the ulcer group and non-ulcer group (67% vs 52%). In Child A group, the H. pylori prevalence was significantly higher in the ulcer group when compared with the non-ulcer group (87% vs 50%, p＜0.05). In contrast, in the Child B or C group, there was no statistical difference between the ulcer group and non-ulcer group. In the abscence of esophageal varix, the ulcer group showed significantly higher prevalence of H. pylori than the non-ulcer group (87% vs 59%, p＜0.05). But in the esophageal variceal group, there was no significant difference in the H. pylori prevalence between the ulcer and non-ulcer group (60% vs 40%). Conclusions: These observations suggest that H. pylori infection may play a role in the pathogenesis of peptic ulcer in compensated cirrhotic patients. However, in cirrhotic patients with decompensation or an esophageal varix, the association between H. pylori infection and peptic ulcers was weak, so other factors (portal hypertension etc.) should be considered as more potent etiology of peptic ulcers in cases of decompensated cirrhosis. (Korean J Gastrointest Endosc 19: 918∼924, 1999)

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증례 : 식도 위장관 ; 양측 폐농양을 동반한 Boerhaave Syndrome 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Boerhaave Syndrome with Empyema in both Lungs in Alcoholic Liver Cirrhosis ): Korean J Gastrointest Endosc 1998;18(6):879-883. Published online November 30, 1997

Abstract PDF: Spontaneous esophageal perforation (Boerhaave Syndrome) is an unusual condition that frequently leads to fatal complications. It typically occurs with rigorous emesis after an unduly large meal or heavy drinking. Its diagnosis is often delayed in almost all cases due to nonspecific symptoms and signs, resulting in increased morbidity and mortality. Therefore early diagnosis and appropriate treatment are very important. Recently we experienced a case of esophagogastric junctional perforation accompanied by bilateral empyema and mediastinitis after heavy alcohol drinking in a 56-year-old male patient. He was presented with hematemesis and abdominal pain. We diagnosed him using esophagography and chest CT. Thus, we report a case with a brief review of related literatures. (Korean J Gastrointest Endosc 18: 879-883, 1998)

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원저 : 식도 위장관 ; 소화성 궤양을 갖는 간경변증 환자에서 H. pylori 의 역할에 관한 연구 ( Original Articles : Esophagus , Stomach & Intestine ; Helicobacter pylori in Cirrhotic Patients with Peptic Ulcer Disease : a Prospective , Controlled Case Study ): Korean J Gastrointest Endosc 1998;18(2):169-175. Published online November 30, 1997

Abstract PDF: Rackground: There is an increased prevalence of peptic ulcer disease in patients with liver cirrhosis, but the role of Helicobacter pylori is unclear. Method: IgG antibodies against H. pylori were measured in 30 patients with compensated liver cirrhosis, in 30 sex- and age-matched patients with decompensated liver cirrhosis, and 30 normal controls. All patients underwent a panendosocpic examination in order to search for the evidence of esophageal varices, congestive gastropathy, and peptic ulcers. Results: Duodenal ulcers were more common in compensated and decompensated cirrhotic patients (13.3% and 13.3%, respectively) than in the normal controlled group (6.7%, p <0.05). The prevalence of H. pylori was not statistically different among the three groups (normal 63.3%, compenstated 63.3%, and decompensated, 70.0%; p > 0,05). The prevalence of H. pylori also showed no statistical differences in respect to duodenal ulcers (100%, 75%, and 75%, repectively, p>0.05) or gastric ulcers (100%, 100%, and 60%, respectively, p >0.05). The prevalence of an H. pylori infection did not differ significantly in relation to the presence or absence of esophageal varices or of congestive gastropathy. In cirrhotic patients with peptic ulcers, the prevalence of H. pylori was lower in the presence of esopahgeal varices (60.0% vs 100% if without varices, p=0.04) and in the presence of congestive gastropathy (50.0% vs 88.9% p=0.03). Conclusions: The prevalence of peptic ulcer was increased in cirrhotic patients, but the prevalence of H. pylori was similar in compensated cirrhotic patients, decompensated cirrhotic patinets, and in the normal controlled group. The frequency of non-H. pylori associated with peptic ulccrs in cirrhotic patients was increased in the presence of an esophageal varix or a congestive gastropathy. (Korean J Gastrointest Endosc 18: 169-175, 1998)

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원저 : 간 ; 바이러스간염 환자에서 복강경소견과 조직학적 소견의 비교관찰 ( Original Articles : Liver ; Comparative Study between Laparoscopic and Histologic Findings in Patients with Viral Hepatitis ): Korean J Gastrointest Endosc 1997;17(2):143-150. Published online November 30, 1996

Abstract PDF: Background
/Aims: The authors compared laparoscopic changes of the diseased liver surface according to Shimadas classification with laparoscopic needle biopsy in order to clarify whether the two diagnostic criteria have consistency or discrepancy in each other. By serologicai tests the patients with chronic hepatitis B were 179 cases, chronic hepatitis C 22 cases and NBNC hepatitis 54 cases. Histologically the patients with non-specific reactive hepatitis were 35 cases, chronic lobular hepatitis 20 cases, chronic persistent hepatitis 18 cases, chronic active hepatitis 8~5 cases, subacute hepatic necrosis 32 cases, circumscribed hepatic necrosis 9 cases and liver cirrhosis 56 cases. Methods: We performed laparoscopy on 255 patients with chronic hepatitis and laparoscopic guided liver needle biopsy was done in all cases. Results: 1) Age incidence of chronic viral hepatitis was peak in chronic hepatitis C, and then that in chronic hepatitis B and NBNC heatitis in decreasing order. 2) Code numbers of liver surfaces were mainly numbers between 200 and 300 in chronic hepatitis B and NBNC hepatitis, but those of chronic hepatitis C were numbers between 300 and 400 which meant advanced patterns. 3) Comparing macroscopic fmdings of liver surfaces with histologic diagnosis by guided liver biopsy, the consistency of two criteria was 83.9% in all cases and the discrepancy was 16.1%. 4) Among the cases with diagnostic discrepancy, the patients showing macroscopically chronic hepatitis but histologically liver cirrhosis were predominant in chronic hepatitis B under the age of 40. In contrast to this, the cases showing surface changes of liver cirrhosis but histologically chronic hepatitis was mainly in chronic hepatitis C over the age of 40. Conclusions: The above results suggest that laparoscopy and guided liver biopsy may be very useful diagnostic tools to determine correct diagnosis, adequate treatment and prognosis. (Korean J Gastrointest Endosc 17: 143-150, 1997)

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원저 : 간경변증 환자에서 상부소화관 출혈에 대한 임상적 고찰 ( Original Articles : Upper Gastrointestinal Bleeding in Liver Cirrhosis : clinical and endoscopic findings ): Korean J Gastrointest Endosc 1995;15(1):33-39. Published online November 30, 1994

Abstract PDF: It is well known that the main source of upper gastrointestinal(UGI) bleeding in patients with liver cirrhosis is the variceal rupture of esophagus. But, peptic ulcer disease, congestive gastrophathy, and gastric varices are frequently found by endoscopic examination in patients with liver cirrhosis. These lesions are related to UGI bleeding. It is necessary to verify the causes of bleeding in liver cirrhosis, and evaluate the influencing factors related with UGI bleeding, and define the endoscopic findings of bleeding in liver cirrhosis. We reviewed the records of 145 episodes of UGI bleeding in cirrhosis, with endoscopy performed within 24 hours of entry, and report here the bleeding sites, influencing factors related with UGI bleeding, and endoscopic findings. The most common bleeding site was the esophageal varices(66.9%). Other bleeding lesions included gastric ulcer(8.3%), congestive gastrophathy(6.9%), undetermined origin(6.9%), duodenal ulcer(6.2%), gastric varices(2.1%), esophageal varices+gastric ulcer(1.4%), and esophageal varices+duodenal ulcer(1.4%). Endoscopic features of bleeding esophageal varices were identified as Spurting(2.1%), Oozing(11.3%), Red plugh(10,3 %), White plugh(14.4%), and Red-color sign(61.9%). In bleeding esophageal varices, gradeIV varices(41.2%) had a significantly higher association with bleeding than gradeI varices(2.1%), gradeII varices(22.7%), and gradeIII varices(34.0%). Endoscopic features of bleeding gastric ulcer were identified as Spurting(8.3%), Oozing(25.0%), Blood clots(58.3%), and Exposed blood vessels on ulcer base(41.7%). Endoscopic features of bleeding duodenal ulcer were identified as Oozing(44.4%), Blood clots(55.6 %), and Exposed blood vessels on ulcer base(55.6%). We found no difference in the bleeding sources according to etiology of cirrhosis(P>0.05). Bleedings due to the variceal rupture of esophagus were more frequently found in Child class B(71.2%) and C(75.0%) than A(34.8%)(P<0.05).

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원저 : 간경변증 환자에서 급성 식도정맥류 출혈의 내시경적 정맥류 결찰요법후 추적 관찰 성적 ( Original Articles : Follow-up Results after Endoscopic Variceal Ligation for Treatment of Acute Bleeding Esophageal Varices in Liver Cirrhosis ): Korean J Gastrointest Endosc 1994;14(2):151-160. Published online November 30, 1993

Abstract PDF: Endoscopic injection sclerotherapy(EIS) is currently the most widely practiced method for treating and eradicating bleeding esophageal varices in repeated sessions, but may be associated with some undesirable local and systemic complications. (continue...)

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