A Case of Primary Systemic Amyloidosis Presenting Submucosal Hematoma and Bleeding in the Lower Gastrointestinal Tract / 대한소화기내시경학회지

A case of systemic amyloidosis involving the upper and lower gastrointestinal tract is presented. The initial manifestation of this case was bloody diarrhea. On colonoscopy, multiple submucosal hematomas and irregular ulcerations of the sigmoid and descending colon were found. The pathologic diagnosis was confirmed by an endoscopic mucosal biopsy of the gastrointestinal tract and the specimen revealed massive amyloid deposits in the wall of the upper and lower intestinal tract. With intensive medical treatment, the submucosal hematoma disappeared and the ulcerations decreased in size. However, on the 29th day, the patient was expired due to unexpected sepsis.

Combined Endoscopic Transpapillary Biopsy and Exfoliative Cytology for the Diagnosis of Bile Duct Cancer / 대한소화기내시경학회지

BACKGROUND AND AIMS: In the management of patients with extrahepatic bile duct carcinoma, histologic diagnosis is crucial to determine therapeutic modalities, to predict their outcomes, and to avoid an unnecessary operation. Though various methods were developed, none of them yielded satisfactory results. A combination of those methods was reported to yield superior sensitivity and specificity to a single method. To evaluate the diagnostic efficacy, endoscopic transpapillary biopsy (ETPB) and exfoliative bile aspiration cytology (BAC) was performed in 40 patients with extrahepatic bile duct carcinoma. METHODS: After visualization of the biliary tree and the lesion by endoscopic retrograde cholangiopancreatography (ERCP), ETPB (n=40) and BAC (n=28) was done in one session with or without endoscopic sphincterotomy (EST) and the results of two methods were analyzed. RESULTS: The final diagnoses were made by surgical pathology and by clinical follow-ups of more than a year. The locations of the 40 bile duct carcinomas were in the upper area in 25, the middle in 14 and the lower in 1. ETPB was performed in all patients and BAC in 28 patients. The overall sensitivity of the ETPB was 65.0% (26/40). According to the morphology and location, the sensitivity of ETPB was 65.6% (11/32) for sclerotic, 60.0% (3/5) for papillary, and 66.7% (2/3) for the protruding type, and 68.0% (17/25) for the upper bile duct lesion, 64.3% (9/14) for the middle, and 0% (0/1) for the lower. The overall sensitivity of the BAC was 71.4% (20/28). According to the morphology and location, the sensitivity of BAC was 80.0% (16/20) for sclerotic, 20% (1/5) for papillary, and 100% (3/3) for the protruding type, and 82.4% (14/17) for the upper bile duct lesion and 54.5% (6/11) for the middle bile duct lesion. When the two tests were combined, the sensitivity rose to 96.4% (27/28). CONCLUSIONS: A combination of ETPB and BAC is useful in making a histologic diagnosis in patients with bile duct carcinoma.

Factor Influencing the Recurrence of CBD Stones after an Endoscopic Sphincteromy / 대한소화기내시경학회지

BACKGROUND AND AIMS: Long term results of an endoscopic sphincterotomy (EST) have still been poorly estimated. The aim of this study was to assess late complications of EST. METHODS: The rate of late complications were retrospectively evaluated in with 91 patients (mean age, 59.1 years; range, 28~86 years; M:F, 44:47), who underwent EST for choledocholithiasis. RESULTS: Forty six patients (50.5%) had their gallbladder in situ, and 45 patients (49.5%) underwent cholecystectomy. Early complications (<30 days) such as hemorrhage, pancreatitis, and perforation occurred in 7 patients (7.7%). During a mean period of 53.4 months (range, 24~134 months), 26 patients (28.0%) developed late complications, including a recurrence of CBD stones in 20 patients (22.0%) (8-gallbladder in situ, 12-cholecystectomized). An univariate analysis of risk factors for stone recurrence revealed dilated ducts, stone sizes, and stone numbers which were not related with stone recurrence. The history of choledocholithotomy with cholecystectomy was significantly related to stone recurrence. CONCLUSIONS: After EST for bile duct stones, late complications occurred in a significant proportion of patients and it was determined that a history of choledocholithotomy with cholecystectomy was significantly correlated with stone recurrence.