Uncovered Self-expandable Metal Stents (SEMS) for Gastric Outlet Obstruction Caused by Stomach Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: The use of self-expandable metal stents (SEMS) is a safe and efficacious method for palliating malignant gastric outlet obstruction. However, few reports have assessed clinical outcome after the insertion of SEMS for malignant gastric outlet obstruction caused by stomach cancer. The aim of this study was to assess the usefulness of uncovered SEMS in patients with malignant gastric outlet obstruction caused by stomach cancer. METHODS: We evaluated 62 patients with gastric outlet obstruction caused by stomach cancer treated by the implantation of uncovered SEMS. A total of 62 patients (43 males, 19 females) were treated between August 2000 and March 2007. A scoring system was used to grade the ability to eat. RESULTS: Stent implantation was successful in 61 (98.4%) patients. Relief of obstructive symptoms was achieved in 49 (80.3%) patients. The mean survival duration was 143 days. The mean stent patency time was 103.5 days. An improvement in the ability to eat using the scoring system was statistically significant (p<0.05). CONCLUSIONS: Endoscopic placement of uncovered SEMS is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.

Catheter Probe Endoscopic Ultrasonography Using the Jelly-Filled Method for Esophageal Subepithelial Lesions / 대한소화기내시경학회지

BACKGROUND/AIMS: The catheter probe endoscopic ultrasonography (EUS) system is widely used to evaluate upper gastrointestinal tract lesions. The depiction of the esophageal wall by probe EUS remains problematic due to the difficulty of the filling of water in the esophageal lumen. In addition, filling the esophagus with water can be associated with an increased risk of aspiration. To resolve such problems, we recently applied the use of probe EUS with the jelly-filled method for the evaluation of subepithelial lesions. The procedure is characterized by filling the esophageal lumen with jelly. In this study, we evaluated the efficacy of probe EUS by using the jelly-filled method for esophageal subepithelial lesions. METHODS: We analyzed the records of the patients with suspected subepithelial lesions at the time of endoscopy that was performed from November 2005 to June 2007. Esophageal subepithelial lesions with both EUS findings and pathological reports were retrospectively compared. RESULTS: The study included 181 patients (96 males, 85 females), with an average age of 55.5 years (age range, 29~78 years). Sixty-eight patients had lesions in the upper esophagus, 60 patients had lesions in the middle esophagus and 53 patients had lesions in the lower esophagus. Secondary layers of esophageal lesions were predominant (91/181) in the cases. Pathological findings were available for 34 patients. Compared with the pathological findings, the diagnostic accuracy of EUS was 91.1%. CONCLUSIONS: Probe EUS by using the jelly-filled method is convenient and safe to perform and provides clear and full-circumferential imaging of a lesion. It is an alternative method to use in place of previously used probe-EUS procedures for the assessment of esophageal subepithelial lesions.

Detection of Celiac Ganglia with Radial Scanning Endoscopic Ultrasonography

BACKGROUND/AIMS: It has been recently reported that celiac ganglia can be identified by linear-array endoscopic ultrasonography (EUS). Still, there has been no report on the detection rate of celiac ganglia with radial scanning EUS. The aim of this study was to evaluate the detection rate of celiac ganglia by radial scanning echoendoscopy during a routine examination. METHODS: We prospectively enrolled 57 consecutive patients (23 men, 34 women; mean age 54 years, range 21-78 years) who were referred for EUS examination from September 2006 to December 2006. EUS was performed using a radial scanning echoendoscope. The size, location and EUS appearance of the celiac ganglia were recorded for each patient. RESULTS: Celiac ganglia were identified in 51 out of 57 patients (89.4%). They were identified at the left side of the celiac trunk and aorta and between the celiac artery and the left adrenal gland. They appeared as hypoechoic, oblong or lobulated structures, often with an irregular edge, and they often contained a hyperechoic focus or strand. The mean size was 18 mm by 4 mm. Structures corresponding to the visualized celiac ganglia were retrospectively identified on CT scans in 33 among the 37 patients (89.2%). CONCLUSIONS: The results of this study showed that celiac ganglia could be identified, with radial scanning EUS, in the majority of subjects.

Aneurysm of the inferobasal wall and ventricular septal rupture complicated with inferior myocardial infarction / 대한내과학회지

The incidence of left ventricular aneurysm following acute myocardial infarction is 5 to 10 percent. Eighty % of aneurysms involve the anteroapical wall of the left ventricle: They are four times more frequent in this wall than in the inferior or posterior wall. Anterior myocardial infarction causes aneurysm in the anteroapical wall of the left ventricle, while inferior myocardial infarction causes aneurysm in the posterobasal wall of the left ventricle. Yet the aneurysmal complications in the interventricular septum after myocardial infarction are very rare. A 74-year-old woman with inferior myocardial infarction presented with both an aneurysm of the inferobasal wall and a ventricular septal rupture, and these were detected by two-dimensional and Doppler echocardiography. The aneurysm originated from the inferobasal portion of the left ventricular wall. The short-axis view of the two-dimensional echocardiography revealed an abrupt discontinuity of the junctional area of the inferoseptum and the inferior segment, and a large aneurysm at the inferior portion of the left ventricular cavity. The communication orifice was 4 cm wide. Color Doppler echocardiography showed a left-to-right shunt flow from the aneurysm to the right ventricle. We report here on a case of an aneurysm of the inferobasal wall and a ventricular septal rupture, and these lesions were detected by two-dimensional and Doppler echocardiography.

A Case of Adult Idiopathic Ileocecal Intussusception Reduced by Colonoscopy / 대한소화기내시경학회지

Intussusception frequently occurs in children as the main causes of intestinal obstruction in childhood but relatively rare in adult. A 65-year-old male visited our hospital because of abrupt onset right lower quadrant pain with tenderness for three days. He had a previous history of appendectomy and alcoholic liver cirrhosis. On physical exam, bowel sound was decreased. Abdomen ultrasonography showed a kidney like mass and abdominal computed tomography revealed the typical target lesion in the ileocecal area. Colonoscopy was performed which failed to find any lesion leading to intussusception. After the colonoscopy, the abdminal pain had disappeared, and we would not find any intussusception sign by abdominal ultrasonography. Colonocopy was done two weeks later. No pathologic lesion was found, then. We report a case of adult idiopathic ileocecal intussusception reduced by colonoscopy.