Endoscopic Treatment of Bile Duct Calculi in Patients with Gallbladder in Situ / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic sphincterotomy (EST) is a safe and effective method of managing CBD calculi. But whether EST of CBD calculi in patients with gallbladder in situ should be followed by routine post-EST cholecystectomy, is still a subject of controversy. The aims of this study was to identify the recurrence rate and predictive factors of biliary symptoms after EST of CBD calculi in patients with gallbladder in situ. METHODS: 90 patients of CBD calculi with intact gallbladder treated with endoscopic sphincterotomy from 1992 to 1998 were reviewed. Follow up on the patients consisted of phone calls or personal interviews and the length of the follow up ranged from 6 to 77 months. RESULTS: Cholecystectomy was required in 12 patients (13.3%) due to recurrent biliary symptoms and the remaining 78 patients (86.6%) were symptom free. Of the recurrence, 67.7% occurred within 12 months after EST and only one occurred after 5 years of follow-up. The risk of recurrence was higher in those patients with periampullary diverticulum in ERCP. CONCLUSIONS: The low recurrence rate of 13.3% after EST of CBD stones in patients with gallbladder in situ hardly justifies routine post-EST cholecystectomy and rather suggests selective post-EST cholecystectomy especially in high operative risk patients.

Three Cases of Polymyositis Developed Associated with Chronic Liver Disease / 대한내과학회지

Polymyositis is characterized by symmetrical proximal muscle weakness, nonsuppurative inflammation of striated skeletal muscle, elevation of muscle enzyme, and abnormality of electromyographical change, but its pathogenesis is not clear. The incidence of polymyositis is low, and that associated with chronic liver disease is rare. Clinical importance of polymyositis associated with chronic liver disease is that it is a reversible disease which can be treated with glucocorticoid. We experienced three cases of polymyositis associated with chronic liver disease which was treated with prednisolone. And we report these cases with a brief review of literature. So, the further study about the influence of chronic liver disease on the polymyositis is warranted.

The Risk Factors of Re-bleeding in Peptic Ulcer Patients and the Efficacy of Ethanol Injection Therapy / 대한소화기내시경학회지

BACKGROUND/AIMS: Acute peptic ulcer bleeding is the most common cause of upper gastrointestinal bleeding, and needs urgent management in cases including large amounts of blood loss. Ernergency endoscopy was performed and evaluation was made on the risk factors of rebleeding in peptic ulcer patients and the efficacy of ethanol injection therapy. METHODS: The clinical and endoscopic variables were evaluated according to the rebleeding rates and the efficacy of ethanol injection therapy for hemostasis and prevention of rebleeding in 161 cases including gastric ulcers (GU) with bleeding (M: F 134: 27, mean age 56.5 years) and 136 cases including duodenal ulcers (DU) with bleeding (M: F 111: 25, mean age 40.7 years).

Efficacy and Need of Sclerotherapy with Ethanol Injection on the Bleeding Peptic Ulcer / 대한소화기내시경학회지

The peptic ulcer is the most common cause of the upper gastrointestinal bleeding. We evaluated the efficacy of the sclerotherapy by endoscopic injection of ethanol for the bleeding peptic ulcer patients. We also evaluated the need of the sclerotherapy on the bleeding peptic ulcer according to the bleeding stigmata on the ulcer base. We classified the bleeding stigmata on the ulcer base with 4 group: active bleeding(21/345, 6%), visible vessel(122/345, 35%), red spot(97/345, 28%), no stigmata(105/345, 31%). The patients who manifested hernatemesis, melena, or both initially, were diagnosed as benign gastric ulcer(BGU, 179 patients) and duodenal ulcer(BDU, 166 patients). The median age was 57 year-old in the BGU patients and 37 year-old in the BDU patients. The sclerotherapy was performed to the 109 patients(58 BGU and 51 BDU patients), 96 patients(96/109, 89%) show permanent hemostasis. The hemostasis rate was 77% with active bleeding in the BGU patients, 75% with active bleeding in the BDU patients. There was no significant difference between sclerotherapy and observation group with visible vessel and red spot on the ulcer base of the bleeding peptic ulcer patients. Conclusively, the endoscopic sclerotherapy was very useful and effective treatment method for the bleeding peptic ulcer, but we suggested that all the bleeding peptic ulcer patients should not have done the sclerotherapy.

Endoscopic Foreign Body Extraction of Upper Gastrointestinal Tract / 대한소화기내시경학회지

This is a retrospective review of our experience with endoscopic extraction of 20 cases of foreign body on the upper gastrointestinal tract at sanggye paik hospital from Oct. 1989 to Nov. 1993. Among 20 cases, 3 cases were under 5years of age and 17 cases were over 27years of age. 9 cases (45%) were located in the esophagus, 8 cases (40%) were in the stomach and 3 cases (15%) were in the duodenum. All children (100%) have true foreign body, almost of all adults (82%) have food-related foreign body. Dysphagia with chest pain or vomiting was the most common symptom in the esophageal foreign body. Epigastric pain and vomiting or hematemesis were common symptoms in the stomach or duodenal foreign body, All of the esophageal foreign body (100%) were extracted within 72 hours, most of all (91%) stomach and duodenal foreign body were extracted after 72 hours.

The influence of helicobacter pylori on the development of gastric cancer / 대한내과학회지

No abstract available.

Arterial oxygen desaturation during esophagogastroduodenoscopy

This prospective study evaluated the incidence and severity of arterial oxygen desaturation during esophagogastroduodenoscopy (EGD) and assessed clinical factors in relation to arterial oxygen desaturation. Following pulmonary function testing, 192 patients underwent elective EGD with continuous recording of arterial oxygen saturation (SaO2). 62 patients (32.3%) showed arterial oxygen desaturation (SaO2 decrease greater than 4% from baseline SaO2); severe arterial oxygen desaturation (SaO2 less than or equal to 85%) reflecting hypoxemia (arterial oxygen tension less than or equal to 50 mmHg) was found in 17 patients (8.9%). These changes were most frequent at the esophageal stage of EGD but most marked at the gastroduodenal stage of EGD. The incidence of arterial oxygen desaturation was not related to age, sex, preendoscopic pulmonary function tests, smoking, or duration of endoscopy. These data support that continuous monitoring of SaO2 should be standard procedure during endoscopy because there was no identifiable preendoscopic risk factor for arterial oxygen desaturation during EGD. But there was no persistent drop in SaO2 longer than 2 minute. We suppose that oxygen supplement may not be required during EGD even in patients with modestly impaired pulmonary function tests.