Eradication Rates of Bismuth-based Quadruple Therapy as a Second-line Treatment for Helicobacter pylori Infection / 대한소화기내시경학회지

BACKGROUND/AIMS: There has been a substantial decline in Helicobacter pylori (H. pylori) cure rates with standard triple therapy in recent years. Therefore, great emphasis has been placed on second line treatment for its successful eradication. The aim of this study was to evaluate the efficacy of bismuth based quadruple therapy as a second line treatment for H. pylori infection. METHODS: From January 2001 to December 2007, the hospital records of 215 patients who failed to the standard triple therapy were reviewed retrospectively. The patients were treated with bismuth based quadruple therapy (PPI, bismuth 120 mg qid, metronidazole 500 mg tid, and tetracycline 500 mg qid). The successful eradication of H. pylori was defined as negative result from histology, CLO test or (13)C-urea breath test. RESULTS: Eradication rates by intention-to-treat (ITT) and per-protocol (PP) analyses with quadruple therapy were 64% (137/215) and, 91% (137/151) respectively. The eradication rates were not significantly different according to diseases, duration of treatment, area and proton pump inhibitors. The PP eradication rates for the years from 2001 to 2007 were not significantly different. CONCLUSIONS: The bismuth based quadruple therapy is still effective as the second line treatment for the eradication of H. pylori.

A Case of Synchronous Quintuple Early Gastric Cancer / 대한소화기내시경학회지

The frequency of multiple gastric cancers has recently been on the increase due to the development of improved diagnostic methods, such as endoscopy, chromoscopy, and pathological methods. To prevent relapse by a remnant cancer, it is critical to determine the surgical area after evaluating the entire synchronous multiple gastric cancer area using closed endoscopy and a radiological evaluation prior to surgery. There have been no prior reports of a diagnosis of quintuple gastric cancer before surgery, although; a diagnosis of quadruple gastric cancer has been previously reported. Here we describe a 65-year-old male patient who received a diagnosis of early quintuple gastric cancer by endoscopy before surgery.

Usefulness of Medium Incision Endoscopic Sphincterotomy with Endoscopic Papillary Balloon Dilatation for the Removal of Common Bile Duct Stones / 대한소화기내시경학회지

BACKGROUND/AIMS: Recent meta-analysis data has shown that there was no significant difference in the rate of overall successful stone removal between endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilatation (EPBD). However, bleeding occurred more frequently in the EST group, and post-ERCP pancreatitis more commonly occurred in the EPBD group. Thus, we hypothesized that medium incision EST modestly combined with EPBD (m-EST+EPBD) could overcome the drawbacks of both techniques. METHODS: Fifty eight patients who underwent m-EST+EPBD for removal of common bile duct stones were compared with sixty patients who underwent EST only. Medium incision EST was performed with a pure cut mode and then a 12 mm diameter balloon was used for the EPBD. RESULTS: Complete bile duct stone clearance was achieved in 96.7% of the patients in the EST group and in 96.5% of the patients who underwent m-EST+EPBD (p > 0.05). There was no significant difference between the two groups for procedure-related pancreatitis. The rate for procedure- related hemorrhage was 0% in the both groups. CONCLUSIONS: m-EST+EPBD showed the possibility of being alternative to EST for the removal of common bile duct stone. To establish effectiveness and safety of m-EST+EPBD, further randomized large scaled clinical studies for comparing EST and m-EST+EPBD are needed.

An Outbreak of Glutaraldehyde Colitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Disinfecting solutions of endoscope, including glutaraldehyde cause colonic damage if allowed to contact mucosa. Glutaraldehyde colitis occurs due to inadvertent contact during colonoscopy and sigmoidoscopy. We experienced unexpectedly glutaraldehyde colitis. We describe symptoms, signs and clinical courses of glutaraldehyde colitis. METHODS: Colonoscopy and sigmoidoscopy were performed at one session after bowel cleaning with polyethylene glycol ingestion 2~3 liters. Within 24 hours, all of them visited emergency room because of bloody diarrhea, vomiting and colicky abdominal pain. We performed sigmoidoscopy again in one patient. RESULTS: Sigmoidoscopic findings was diffuse edematous, hyperemic mucosa and shallow ulcerations similar to the findings of ischemic colitis. But, un-contacted mucosa was normal findings which can be completely distinguished from contacted mucosa. Microscopically, colonic mucosa showed edema, polymorphonuclear leukocytes infiltration and fibroprulent exudates with surface erosions. Laboratory findings were non-specific except leukocytosis of peripheral blood. Both bacterial cultures of blood and stool were negative in all patients. Symptoms subsided within 7 days and duration of admission is almost within 9 days. All of patients recovered completely without any complication. CONCLUSIONS: The clinical features of glutaraldehyde colitis resembled colonic ischemia in symptoms and endoscopic findings. This complication should be suspected in patients who develop hemorrhagic colitis suddenly after undergoing colonoscopy.

Urticaria Reaction by Oral Polyethylene Glycol Ingestion / 대한소화기내시경학회지

Administration of oral PEG electrolyte lavage solution for colonoscopy preparation has been well tolerated by patients and physicians. Overall incidence of adverse reactions of PEG is low. Nausea, vomiting, and abdominal pain are relatively common side effects and serious adverse reactions are rare. PEG is absorbed by intestinal mucosa in very small amount but this minimal absorption could be sufficient to provoke the appearance of systemic reaction in susceptible patients. Allergic reaction manifested as the contact dermatitis in patient treated with the local preparation containing PEG is rarely reported and the case of hypersensitivity response followed oral PEG lavage is more rare. We report a patient who had experienced the urticaria reaction mainly at the trunk after oral PEG intake for colonoscopy preparation.

A Case of Large Bowel Herniation Through a Diaphragmatic Defect during Colonoscopy / 대한소화기내시경학회지

Colonoscopy is a safe procedure and life-threatening complications occur rarely during diagnostic colonoscopy. There have been several reports of complications of colonoscopy, including bleeding, bowel perforation, bacteremia, vasovagal reactions and side effects of preparation and other more minor problems. The development of diaphragmatic hernia during diagnostic colonoscopy is extremely rare complication. We report a case of herniation and entrapment of the colon into the left thorax, via a small diaphragmatic defect caused by previous trauma, during diagnostic colonoscopy.

A Case of Idiopathic Colorectal Varices: Case report / 대한소화기내시경학회지

Colorectal varix (CRV) is a rare cause of lower gastrointestinal bleeding and usually associated with portal hypertension from liver cirrhosis or portal venous obstruction. Idiopathic CRV have no identifiable underlying cause and can only be diagnosed after the cause of portal or mesenteric vein circulation have been excluded. We report a case of idioipathic CRV presented with rectal bleeding for a week. Colonoscopy revealed markedly dilatated tortuous, and bluish veins in the rectum as well as coexistent adenomatous polyp and internal hemorrhoid. Despite extensive investigation, there was no evidence of portal hypertension or any other cause. Family history was also negative. Although blood transfusions were required, the patient remained asymptomatic without further rectal bleeding.

A Case of Buried Bumper Syndrome Replaced by Endoscopic Management / 대한소화기내시경학회지

Percutaneous endoscopic gastrostomy (PEG) is used for nutritional support to the patients who cannot maintain the adequate oral intake. Compared with operative gastrostomy, PEG is a safe, rapid, and less expensive technique. Among several complications, buried bumper syndrome is a late complication in which internal bumper erodes into the gastric wall or migrates into the abdominal wall due to improper compression to the gastric wall. We here report a patient with peritubular leakage, resistance of tube feeding, and abdominal pain which were developed 13 months after percutaneous endoscopic gastrostomy. On endoscopic examination, the gastrostomy lumen could not be found. The gastrostomy tube was replaced successfully to new one with single procedure endoscopic technique. No complication was occurred and the function of tube has been well preserved.

A Case of Rectal Bleeding Treated by Endoscopic Band Ligation / 대한소화기내시경학회지

Endoscopic band ligation has been a standard therapy in esophageal varix bleeding since it was first introduced in 1980s. However, technical problems have interrupted as a therapeutic management of lower gastrointestinal bleeding. We report a case of successful management of rectal bleeding with endoscopic band ligation in patient with chronic renal failure, who had been managed by hemodialysis since eight months before. Successful control of rectal bleeding was achieved by endoscopic band ligation. Three days later, round and shallow ulcer developed at the ligated site, which was improved at follow-up sigmoidoscopy and bleeding was not observed any more. He was discharged without complications. Herein, we report the band ligation as a useful method in treatment of rectal bleeding.

Influence of Helicobacter pylori Infection on Gastric Motor and Sensory Function in Asymptomatic Healthy Volunteers / 대한소화관운동학회지

BACKGROUND/AIMS: The influence of Helicobacter pylori infection on gastric motility and sensation is unclear. Our hypothesis is that H. pylori infection increases gastric sensation and reduces gastric accommodation. METHODS: Seventeen healthy volunteers were recruited by public advertisement. Gastrointestinal symptoms were assessed by a questionnaire. All subjects underwent gastrofiberoscopy for assessment of organic diseases and for diagnosis of H. pylori infection. We evaluated for (1) proximal gastric compliance, (2) gastric sensation for three symptoms (nausea, abdominal fullness, and abdominal discomfort/pain) during balloon inflation and (3) fasting and postprandial proximal gastric tone using a barostat. RESULTS: The H. pylori negative (HP-) volunteers were eight (M:F=7:1, mean age 28+/-4 years) and the H. pylori positive (HP+) volunteers were nine (M:F=5:4, mean age 31+/-11 years). There was no difference in the fasting and the postprandial proximal gastric tone between the two groups. The minimal distending pressure was similar between the two groups [5.50+/-1.69(HP-) vs. 5.78+/-1.72 (HP+)]. No differences were detected on aggregate perception scores during the three levels of phasic distension. CONCLUSIONS: Our study suggests that H. pylori infection in asymptomatic subjects may not significantly alter gastric sensitivity or gastric accommodation.

A Case of Hemorrhagic Angiodysplasia of the Duodenal Bulb in a Patient under Chronic Hemodialysis / 대한소화기내시경학회지

Upper gastrointestinal tract angiodysplasia is rare, but it is an important cause of upper gastrointestinal bleeding. We experienced a case of hemorrhagic angiodysplasia of duodenal bulb in a patient under chronic hemodialysis due to chronic renal failure. Repeated upper GI endoscopy revealed an angiodysplasia at the posterior wall of the duodenal bulb. It was successfully treated by bipolar electrocoagulation. We report a case of angiodysplasia in chronic renal failure patient with the review of the literatures.

Drug - Induced Esophageal Ulcers / 대한소화기내시경학회지

Over 26 kinds of tablets and capsules, such as Tetracycline, Quinidine and Potassium preparations were reported to cause esopbageal ulcerations, eharacterized in various size, shape and number, ind sually in mid-esophagus, Recently authors experienced 10 cases of drug-induced esophageal ulcerations due to antibiotics and antiinflammatory agents such as Tetracycline, Aspirin, etc. Four cases were men and six were women. Four cases were in third dades, three in fourth cleeades, two in fifth decades and one in sixth decades. Presenting symptoras were odynophagia(4/10), dysphagia(3/10), substernal pain(7/10) and epigastric pain(3/10). Endoscopic examination of the esophgus showed single or multiple, small and shallow ulcers on the mid-esophgeal mucosa at the level of 30cm from the ineisor in eight cases, one Iarge and deep ulcer at the level of 40cm from incisor in one patient and one amall, shallow and one large, deep ulcers at the same time. in one patient The shape of alcers were various from a round to a large horseshoe shaped one. The clinical course was mild without complications. It was suggested that drug-induced esophsgeal ulcers with antibiotics and antiinflammatory agents could be found frequently and they had benign and mild clinicalc ourse,