Background /Aims: Peptic ulcer bleeding is the most common cause of upper gastrointestinal tract bleeding. Platelet-rich plasma (PRP) enhances tissue repair, and is therefore used in various medical treatments. A combination of mechanical or electrothermal hemostasis has been recommended for upper gastrointestinal tract bleeding treatment. This study evaluated the additive efficacy of PRP in bleeding peptic ulcer hemostasis and recovery.
Methods Eighty patients with peptic ulcer bleeding were initially treated by hemoclipping, and were randomly chosen for either additional PRP (n=40) or additional epinephrine (n=40) injections. Both groups were compared with regard to achieving hemostasis and the frequency of complications.
Results Hemostasis was immediately achieved in both groups. Two patients (5%) in the PRP group and 8 (20%) patients in the epinephrine group experienced rebleeding after 15.9±2.8 and 12.3±3.7 days, respectively. They were managed by PRP injection in addition to proton pump inhibitor infusion. Hemoglobin was substantially increased in the PRP-treated group with full recovery occurring in 60.5% compared to 31.3% of patients in the epinephrine group (p=0.001). There was no recurrent bleeding in the PRP group, but 4/32 (12.5%) patients in the epinephrine group exhibited rebleeding.
Conclusions PRP showed additional benefit in reducing peptic ulcer bleeding with no reported significant complications. Clinical trial (NCT03733171).
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Korean J Gastrointest Endosc 2011;43(1):21-24. Published online July 28, 2011
Cytomegalovirus (CMV) is a potentially important pathogen in an immunocompromised host. CMV infection usually occurs in patients with severe immune deficiency, such as acquired immunodeficiency syndrome, organ transplantation, malignant disease, or immunosuppressive therapy. CMV can cause ulcerations anywhere in the GI tract ranging from the esophagus to the rectum, but the colon is the most susceptible organ in the GI tract. CMV infection rarely occurs but generally causes an asymptomatic or mildly symptomatic acute illness in immunocompetent patients. Some patients with gastrointestinal CMV disease do not require antiviral treatment such as ganciclovir and frequently recover with supportive therapy. Although in immunocompetent patients, antiviral therapy may be needed based on age, chronic illness, or treatment response. We experienced a case of CMV-induced multiple gastric ulcers with severe epigastric pain in an immunocompetent patient who fully recovered with supportive therapy including a proton pump inhibitor. (Korean J Gastrointest Endosc 2011;43:21-24)
Chang Jung Lee, M.D., Suk Joon Park, M.D., Seong Yong Woo, M.D., Hyun Jong Oh, M.D., Mi Kyung Sung, M.D., Byeong Ho Lee, M.D., Sung Bae An, M.D. and Hyun Ju Yoo, M.D.*
Korean J Gastrointest Endosc 2011;43(1):33-37. Published online July 28, 2011
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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
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.
Yong Wan Sung, M.D., Ji Hun Roh, M.D., Young Hwa Jo, M.D., Dong Young Gu, M.D., Jae Hoon Yoo, M.D., Jun Mo Youn, M.D., Sung Hoon Kim, M.D. and Young Min Shin, M.D.
Korean J Gastrointest Endosc 2009;38(4):218-223. Published online April 30, 2009
Upper gastrointestinal bleeding is a primary and emergency complication of peptic ulcer. Injection of Histoacryl (N-butyl-2-cyanoacrylate) is an effective endoscopic hemostasis procedure to treat peptic ulcer bleeding. However, Histoacryl injection is not a widely used method because of its various and sometimes severe complications. Therefore, the use of Histocaryl should be considered as a second line treatment modality to achieve therapeutic endoscopic hemostasis when the conventional treatment modalities fail or the patient has a high risk of needing operative therapy. Three patients, who had gastric ulcer bleeding from an exposed blood vessel, were each treated by an injection of Histoacryl diluted with Lipiodol at a dilution ratio of 1:1. All 3 procedures were successfully accomplished without any complications. (Korean J Gastrointest Endosc 2009;38:218-223)
Therapeutic radiation therapy has developed new technologies that use a high dose of radiation with three- dimensional targeting for a few days instead of conventional radiation therapy that uses small doses of radiation for a longer period of time. A Cyberknife is an image- guided robotic system for stereotactic radiosurgery. The Cyberknife was first developed for the treatment of intracranial lesions, and recently has been used for tumors in the chest and abdomen. A Cyberknife can use a high dose of radiation for treatment of a hepatocellular carcinoma and can be employed to minimize radiation injury around the tumor. However, in a large tumor, the therapeutic efficacy is reduced and injury can occur around the organs. We report a case of acute injury in the stomach and duodenum after Cyberknife treatment of a hepatocellular carcinoma near the hepatic portal area. (Korean J Gastrointest Endosc 2007;35:262-266)
Rin Chang, M.D.*, In Sik Chung, M.D.†, Soo-Heon Park, M.D.†, Sung-Kook Kim, M.D.‡, Seok-Reyol Choi, M.D.§, Geun-Am Song, M.D.∥, Ki-Baik Hahm, M.D.¶, Yong-Chan Lee, M.D.**, Hyun-Soo Kim, M.D
Korean J Gastrointest Endosc 2007;34(6):312-319. Published online June 30, 2007
Background/Aims: This randomized, double-blind, phase III, multicenter trial was carried out to compare the efficacy and safety of revaprazan, a novel acid pump antagonist, with that of omeprazole in patients with more than one of gastric ulcers. Methods: Two hundred and ninety two subjects were randomized to 4∼8 weeks of treatment with either revaprazan 200 mg or omeprazole 20 mg. The primary efficacy parameter was the cumulative healing rate determined by endoscopy after 4 and 8 weeks of treatment, and the secondary efficacy parameter was an improvement rate of pain. Results: The intention-to-treat analysis revealed revaprazan and omeprazole to have similar cumulative healing rates (93.0% and 89.6%, respectively; p=0.3038). The per-protocol analysis revealed revaprazan and omeprazole to also have similar cumulative healing rates (99.1% and 100%, respectively; p= 0.3229). In both analyses, there were no significant differences in an improvement rate of pain between the two groups. Both drugs were well tolerated. Conclusions: Revaprazan has similar efficacy to omeprazole in the treatment of patients with gastric ulcer with a once a day application of revaprazan 200 mg or omeprazole 20 mg over a 4 to 8-week period. In terms of safety, revaprazan was well tolerated.
Eun Jung Kim, M.D., Woo-Chul Chung, M.D., Kang Moon Lee, M.D., Jin Sun Lee, M.D., U-Im Chang, M.D., Hyun Mi Cho, M.D., Jin Mo Yang, M.D., Sung Kyoung Kim, M.D.,Jong Myoung Nah, M.D. and In Sik Chung, M.D.
Korean J Gastrointest Endosc 2004;29(4):199-203. Published online October 30, 2004
Henoch-Schönlein purpura is a systemic leukoclastic vasculitis that predominantly affects small vessels. This results in purpura, abdominal pain, arthralgia and occasional sometimes nephritis. Gastrointestinal involvement occurs in 50∼75% of the patients. The small bowel and colon are relatively commonly affected, but the gastric involvement is rare. Endoscopic findings include mucosal edema, hemorrhagic changes, erosions and superficial ulcers. However, deep gastric ulcers are rarely observed in Henoch-Schönlein purpura and have not been reported yet. We report a patient with typical Henoch-Schönlein purpura who presented with melena due to bleeding from multiple deep gastric ulcers and got improved with administration of high dose corticosteroid. (Korean J Gastrointest Endosc 2004;29:199203)
Behcet's disease is characterized by mucocutaneousocular symptoms, namely recurrent stomatitis aphthosis, genital ulcer and ocular symptoms. Gastrointestinal tract involvement is common in Behcet's disease. In Korea, incidence of gastrointestinal tract involvement is 4.0~7.3% and the most common manifestation is ulceration of the bowel, localized to the terminal ileum, ileocecal vlave, and cecum, but gastric involvement is very rare. We experienced a case of Behcet's disease with gastric ulcer perforation and recurrent gastric ulcer after primary suture, selective vagotomy and pyloroplasty. We failed to improve the recurrent active gastric ulcers with Helicobacter pylori eradication and antiulcer medication. So we tried steroid and azathioprine therapy for 3 months and active ulcers were healed to multiple scarring ulcers. We would like to suggest this case as a Behcet's disease with gastric involvement. (Korean J Gastrointest Endosc 2001;23:184-187)
It is known that multiple ulcers of the gastric antrum are often accompanied by marked submucosal fibrosis during the healing process, and that this may result in a deformity of the gastric wall. Thus, benign antral ulcers may be misinterpreted as intramural tumors, or even malignant ulcers when the surrounding edema is pronounced and sharply defined. It is possible for an endoscopic ultrasonography (EUS) to detect which layer has a submucosal tumor (SMT) in the five-layer structures of the digestive tract wall. In the diagnosis of SMT of the upper digestive tract, EUS allows for the visualization of the structures underlying the gastrointestinal wall in a noninvasive manner and has a great advantage over conventional modalities such as endoscopy and X-ray examination. The EUS findings of 2 cases of submucosal tumor-like gastric lesion caused by fibrotic ulcer healing are herein reported with a brief review of relevant literature. (Korean J Gastrointest Endosc 2000;20:460-463)
Mucormycosis is an uncommon, frequently fatal opportunistic infection. Mucormycosis of the gastrointestinal tract is usually found in patients suffering from chronic illness and is thought to arise from fungi entering the body through food. When gastric mucormycosis is presented as an invasive fungal infection, the prognosis is extremely poor. But when the fungus colonizes on the gastric mucosa or on necrotic debris without invasion of the blood vessels, the prognosis is good. A case is herein reported of a colonization type of gastric mucormycosis in a 46 year old male alcoholic. On histologic examination, characteristic findings of nonseptate hyphae with right angle branchings were observed in the ulcer debris without tissue or vessel invasion. Also, the broad and ribbon-like aseptate hyphae was noted on the fungus culture. The patient was treated with nystatin syrup and a proton pump inhibitor without systemic antifungal therapy. (Korean J Gastrointest Endosc 2000;20:49~52)
Helicobacter pylori infection causes chronic gastritis and its well documented con- sequences are peptic ulcer disease and gastric neoplasia. As duodenal ulcer is often associated with gastroesophageal reflux disease and antral gastritis is a frequent finding in patients with reflux disease, H. pylori infection may be a common cause of both conditions. Recent studies reveal that H. pylori has no role in the pathogenesis of reflux esophagitis. Furthermore, there are some arguments on whether H. pylori infection may have a protective role in reflux esophagitis. We have experienced two cases of reflux esophagitis after cure of H. pylori infection. H. pylori eradication therapy was performed in two patients who have gastric and/or duodenal ulcer with omeprazole and two anti-biotics (clarithromycin and amoxicillin). After cure of H. pylori infection, reflux esophagitis was demonstrated in these patients by endoscopy. (Korean J Gastrointest Endosc 18: 707-712, 1998)
Gastrocolic fistula is a rare lesion which is caused most commonly by carcinoma of colon or stomach. The less common causes of gastrocolic fistula are follows: trauma, faulty gastrocolic anastomosis during gastrectomy, benign gastric ulcer, syphilis, carcinoid tumor, tuberculosis, intraperitoneal abscess, lymphoma, perforated diverticulum of colon, and ulcerative colitis. The locations of fistulae are mostly between greater curvature of stomach and distal half of the transverse colon. In the case of penetrating benign gastric ulcer and gastrcolic fistula, it is usually associated either with asipirin or with prolonged steroid administration. A 36-year-old male who had an unusual gastrocolic fistula secondary to non-surgically treated benign gastric ulcer is presented. The exitence of a gastrocolic fistula was dernonstrated by radiological examination of the colon and the stomach. In this patient, the colonoscope passde through the fistula and the stomach could be examined. Careful preparation was carried out preoperatively with intravenous fluids and blood transfusions. Resection of the distal stomch, fistulous tract, and segment of the transverse colon was then accamplished. (Korean J Gastrointest Endosc 16: 615-619, 1996)
To examine the relationship between gastric ulcer and gastric cancer, we investigated petients with gastric ulcer diagnosed from 1986 to l993. We reviewed the endoscopic reports and films of patients with gastric ulcer retrospective1y. We excluded the patients who was diagnosed as gastric cancer in two years follow-up. The results were as follaws; 1) During follow-up of the original cohort, there were 5 patients(0.5~%) in whom gastric cancer developed at the same site initially diagnosed as gastric ulcer. The gross type of the lesion was early gastric cancer in two and advanced gastric cancer in three patients 2) The time interval between the initia1 diagnosis of gastric ulcer and cancer development was from 31 months to 70 months (average 51 months). 3) At the initial examination of 5 gastric cancer patients, the diagnosis was active gastric ulcer in four, multiple gastric ulcer in one, and linear gastrie ulcer in one patient. Characteristic endoscopic findjngs were gastric ulcer with clubbing mucosal folds in three and gastric ulcer with bleeding in one patient. 4) During the follow-up period, endoscopicailly and histologically healing of gastric uleer was observed in one patient and histologic finding showed chronic superficial gastritits with intestinal metaplasia. These results suggest that gastric ulcers rarely progress to gastric cancer. However if the endoscopic findings are suspicious for malignancy, then follow-up endoscopy until complete healing should be done, (Korean J Gastrointest Endosc l6: 169 ~177, 1996)
The double pylorus is a rare condition consisting of a double communication between gastric antrum and duodenal bulb. Some investigators postulate that the doubling of the pyloric channel is a congenital phenornenon, but others believe that it is an acquired lesion. A 72 year-old-man was admitted to this hospital because of epigastric pain for 1 month. Upper G-I series revealed thickened rnucosal folds of pylorus and duodenal bulb and dilated, deformed duodenal bulb filled with barium materials. Endoscopic findings also showed two ovoid large openings of the pyloric channel divided by smooth thickened septum and multiple gastroduodenal ulcers. We thought that this case was an acquired lesion. The relevant literatures on the subject were reviewed. (Kor J Gastrointest Endosc 15: 741-746, 1995)
PEG is a simple, safe and rapid method for the placement of feeding gastrostomy tube because of its low morbidity and mortality. Also, exchange of gastrostomy tube can be easily performed because several types of exchange tube, suich as replacement balloon gastrostomy tube are available. But, less has been known about complications of exchange tube. The authors experienced a case of severe gastric ulcer bleeding in seventy one years old male patient who had been suffered from melena after exchange of old PEG tube for replacement balloon gastrostomy tube. Gastroscopy showed bleeding from acute, large and deep ulcer on the body of stomach, and replacement tube tip directed to the center of ulcer. Bleeding was thought to be caused by gastric ulcer due to replacement balloon gastrostomy tube, After removal of tube and conservative management with H2 receptor antagonist, bleeding ceased
In gastrointestinal tract CMV has been implicated in inducing mucosal inflammatory and ulcerative lesions. More recently, increasing number of patients with CMV-associated gut lesions have been reported primarily in immunocompromised patients or occasionally in normal hosts. The colon is the most common site of the infection, although it might occur in other gastrointestinal tract such as esophagus, stomach, duodenum and terminal ileum. The diagnosis of CMV infection can often be difficult and must await serological conversian or viral cultures. (continue...)
I tried the endoscopic laser therapy for the malignant and benign disease of the alimentary tract to evaluate efficacy in rejection of surgical treatment or inoperable state. I have experienced 16 cases of the laser therapy in my hospital from July 1990 to June 1991. The apparatus I used is the SLT contact Nd-YAG laser with the ceramic endoprobe of rounded or chisel or hollow type in each case. The irradiation was made at an output of 15-20 Watts within 1.5 seconds. Between the 2-4 weeks laser therapy, the treatment response was observed by rebiopsy, I treated 7 cases of early gastric cancer and post-laser follow-up study showed 70% negative for cancer cells by endoscopic biopsy. Failure of laser treatment was found in case of IIc type, Two cases of advanced gastric and I case of rectal cancer with severe obstruction were relieved by laser therapy. I also experienced 3 cases of esophageal or gastric polyp which were completely. resolved after irradiation. Besides, I could get hemostasis in 1 case of gastric ulcer bleeding with exposed vessels and 1 case of Mallory-Weiss syndrome. And a case of gastric bezoar was completely fragmentated after irradiation. As mentioned above, I achieved satisfactory results of 13 cases in 16 cases. Contact Nd - YAG laser treatment ean be applicated with excellent efficacy in any age, sex and severity of disease with or without complications and any site of lesions which can be reached within the endoscope. I suggest it is maybe highly promising medical technique in the future.