Safe Endoscopic Removal of a Sharp Foreign Body Using Latex Glove / 대한소화기내시경학회지

Most of swallowed foreign bodies pass spontaneously. However, sharp objects are usually lodged in the proximal esophagus and cause aspiration, bleeding, obstruction, and perforation. Therefore, prompt retrieval of lodged foreign bodies are necessary. The safe extraction of sharp foreign bodies using endoscopic technique is difficult because sharp objects carry a significant risk of mucosal injury and perforation. Endoscopic techniques for retrieval of foreign body include methods using protector hood and overtube. The former is not available, the later is uncomfortable and its diameter is the limiting factor. Method using a latex glove is available, comfortable, and its diameter is not limited. The thickness of the glove is thinner than protector hood, but we think that a latex glove would seem to be a effective alternative. We report a case in which a sharp foreign body was endoscopically removed using a latex glove without complication.

Endoscopic Band Ligation for Non-variceal, Non-ulcer Gastrointestinal Hemorrhage and Post-polypectomy Hemorrhage / 대한소화기내시경학회지

BACKGROUND/AIMS: There is no consensus as to the best treatment for non-variceal, non-ulcer gastrointestinal hemorrhage. Endoscopic band ligation is an inexpensive, readily available, and easily learned technique in contrast to conventional thermal methods of endoscopic hemostasis. The purpose of this study is to define the effectiveness of endoscopic band ligation for non-variceal, non-ulcer gastrointestinal hemorrhage and post-polypectomy hemorrhage. METHODS: Twenty eight patients were treated by band ligation between July 1996 and October 2000. The lesions treated were: Dieulafoy's lesion in 13, Mallory-Weiss tear in 7, angiodysplasia in 1, post-polypectomy bleeding in 4, post-endoscopic mucosal resection bleeding in 2, post-endoscopic biopsy bleeding in 1. RESULTS: Endoscopic band ligation was successful in 25 of 28 cases. Additional sclerotherapy was necessary in two cases of Dieulafoy's lesion. The remaining case was early band detachment. CONCLUSIONS: Endoscopic band ligation is effective for non-variceal, non-ulcer bleeding. It has the advantage of ease of use and is relatively inexpensive.

A Case of Diverticulitis of Sigmoid Colon Mimicking Carcinoma / 대한소화기내시경학회지

Diverticular disease of the colon in Korea is different from developed Western countries. Diverticulosis leads to the complications in about 20% of cases. The diverticulitis of the right colon is difficult to be differentiated from acute appendicitis. According as increase of elderly populations, incidence of the diverticulitis of the left colon increase. Therefore we should be differenciated from other diseases. In very rare case, frequent recurrence and recovery of the diverticulitis leads to a chronic state with complications such perforation, microabscess, fistula, adhesion and fibrous hypertrophy. These findings may be misdiagnosed as malignancy because of protruding mass and stricture on colonoscopy. We present a case of an pseudotumor that looks like a malignancy in the sigmoid on colonoscopy. After surgical resection, the lesion turned out to be a complicated diverticulitis.

Survival and Prognostic Factors in Patients with Hepatocellular Carcinoma Who Showed Initial Good-Response to Transarterial Chemoembolization / 대한간학회지

Focal nodular hyperplasia (FNH) is a benig nepithelial tumor of the liver. The etiology of FNH is unknown, but recent evidence suggests that FNH may represent a localized, hyperplastic response to a pre-existing vascular malformat ion. There is a high probability of as sociat edlesions , most commonly hepatic hemangiomas, meningioma, as trocytoma, and arterial dysplasia in various organs . In the present report we describe a FNH with aberrant lymphatics in a 24-year-old woman. In operation field, lymphatics were located on the site of falciform ligament. Histologically, aberrant lymphatics were composed of well vas cularized complex lymphatic channels and the mass were typical FNH. In this case, the role of aberrant lymphatics in the development of FNH was unclear . But as the FNH frequently as sociated with ot her anomalies , we think the aberrant lymphatic as such anomaly that have not been reported.

Endoscopic Alkaline Reflux Gasitritis and Esophagitis in Gastroresected Patients: Clinical significance and difference according to the types of surgery / 대한소화기내시경학회지

BACKGROUND/AIMS: The reflux alkaline gastritis and esophagitis are important late complications after gastric surgery. Endoscopy is primary diagnostic tool for them. But, the clinical significance of gastritis and esophagitis diagnosed by endoscopy is not well known. We evaluated the correlation between the alkaline reflux gastritis and esophagitis and their symptoms and we also examined their prevalence according to types of surgery. METHODS: The 111 gastroresected patients who had had upper endoscopy by one endoscopist were evaluated. We reviewed all their medical records, and interviewed 54 patients by telephone to evaluate symptoms. RESULTS: Endoscopic reflux alkaline gastritis was observed in 38 patients(45%) with Billroth-II gastrectomy and in 4 patients(33%) with Bil]roth-I gastrectomy. But, there was no symptomatic difference between group with and without endoscopic reflux gastritis. Moreover, none of them had typical reflux gastritis symptom complex including billous vomiting. In all patients with total gastrectomy and loop esophagojejunostomy, endoscopic reflux esophagitis was observed. But, there was no case af endoscopic reflux esophagitis in the patients with total gastrectomy and Roux-en-Y anastomosis. There was significant symptomatic correlation between group with and without endoscopic reflux esophagitis. T'he incidence of reflux esophagitis had no difference between Billroth-II gastrectomy and Billroth-I gastrectomy. CONCLUSION: The endoscopic alkaline reflux gastritis had poor symptematic correlation. In the case of total gastrectomy, for the prevention of reflux esophagitis, Roux-en-Y anastomosis is better than loop esophagojejunostomy.

A Case of Brunner's Gland Hamartoma with Severe Anemia and Intussusception / 대한소화기내시경학회지

Brunner's gland hamartomas are rare duodenal tumors with characteristic pathologic featmes. The usual clinical presentation is nonspecific symptoms, obstructive symptoms, or intestinal bleeding. The majority of these tumors are less than 3 cm in diameter. In cases of larger size, the manifestations are usually intestinal obstruction or intestinal bleeding. The cases with massive gastrointestinal bleeding and severe anemia, requiring transfusion are rare. The diagnosis is made by radiologic studies and gastroduodenoscopy. The treatment of Brunner's gland hamartomas should be conservative, since they are not premalignant, However, the lesions originate in the submucosa, so the confimative diagnosis usually cannot be made by endoscopie biopey. For definitive diagnosis and relief of symptoms, the lesions must be removed surgically or endoscopically. Endoscopic excision is indicated if the tumar is pedunculated. We recently experienced a case of Brunner's gland hamartoma of about 5.5 cm in diameter with intestinal bleeding, requiring transfusion and intussusception. Preoperative diagnosis was submucosal tumor, such as lymphoma, with duodeno-duodenal intussusception. After surgical removal, the resected specimen showed the histologic features of Bruaner's gland hamartoma.

Survival and Prognostic Factors in Patients with Small Hepatocellular Carcinoma after Curative Resection / 대한내과학회지

BACKGROUND: The survival in patients with hepatocellular carcinoma (HCC) has recently been improved by the advancement in the early detection of HCC. Among the various treatment modalities, the surgical resection has been considered as the most effective for small HCC, and the clinical course of patients with small HCC who underwent curative resection is known to be dependent on the etiology of HCC. Since the differences in the etiology of HCC depend on the different geographical area, it is necessary to verify the clinical outcomes and their affecting factors in patients with small HCC after curative resection in Korea, one of the hepatitis- B-virus(HBU)-endemic areas. METHODS: A total of 89 patients with small HCC (or=50 years old), Child's classification and vascular invasion were factors affecting the rate of recurrence. CONCLUSION: These results verify that the clinical outcomes of patients with small HCC after curative resection in Korea are similar to those of patients with different etiology of HCC in other geographic areas. To improve the prognosis of patients with small HCC after curative resection, strict preoperative evaluation of the presence of vascular invasion and postoperative preservation of liver function are necessary as well as the close postoperative follow-up for the early detection of recurrence.