A Benign Ulcer of the Gastric Fundus Reminiscent of a Malignant Submucosal Tumor / 대한소화기내시경학회지

The gastric fundus is a rare site for benign ulcer occurrence as it consists of parietal cells, which secret gastric acid. It is resistant to gastric acid and pepsin, and has an abundant blood supply. Varices or other vascular lesions, such as polyps and submucosal tumors, are more frequently found in the gastric fundus. When an ulcer is found in the gastric fundus, it is important to consider underlying conditions such as a malignancy. In this case, a benign gastric ulcer in the gastric fundus dome formed a protruding mass-like lesion with central necrosis, which was reminiscent of a malignant submucosal tumor. Proper follow-up gastroscopy with endoscopic ultrasonography helped to differentiate these similar lesions. We report here a case of a benign gastric ulcer in the fundus dome that was reminiscent of a malignant submucosal tumor, with a review of the literature.

Immunohistochemical Expression of the p53 and Ki-67 Proteins in Barrett's Esophagus in Korea / 대한소화기학회지

BACKGROUND/AIMS: Barrett's esophagus is a premalignant lesion of the esophagus in which normal squamous epithelium is replaced by intestinalized columnar epithelium. In Korea, adenocarcinoma associated with Barrett's esophagus is rare compared with that of Western country. The purpose of this study was to investigate the immunohistochemical expression of p53 and Ki-67 in Barrett's esophagus which had predictive value for cancer risk in Korea. METHODS: Ninety five patients (43 male and 52 female, median age 44, range 21-75) who have been suspected to have Barrett's esophagus by endoscopic assessment were enrolled in this study. Alcian blue (pH 2.5) and high ion diamine stain for the evaluation of specialized intestinal metaplasia (SIM) and immunohistochemical stain for p53 and Ki-67 were done. RESULTS: 57.9% (55/95) of biopsies from the columnar lined esophagus showed SIM, but no dyspalsia. 56.4% (31/55) of Barrett's esophagus showed sulfomucin positive colonic metaplasia. The p53 expression was observed in 10.9% (6/55) of the patients of Barrett's esophagus and all of them showed colonic metaplasia. Ki-67 labeling index showed no difference significantly. CONCLUSIONS: In Korea, 10.9% of Barrett's esophagus had p53 mutation and moreover all of them had colonic metaplasia. Consequently, we expect that these patients have high risk of developing dysplasia and adenocarcinoma and need careful follow-up.

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 Gastric Injury by Acute Iron Intoxication / 대한소화기내시경학회지

Iron is a kind of corrosive agent. Iron overdose causes gastrointestinal complication such as mucosal ulceration, bleeding, intestinal perforation and may occur metabolic acidosis, hepatic dysfunction, hepatic failure, renal failure and cardiomyopathy. Delayed sequalae including gastric outlet obstruction develops 4 to 6 weeks after ingestion. The determination of serum iron and TIBC is an important factor in ascertaining the toxic potential in acute iron ingestion and more is the amount of ingested elemental iron, greater is a patient's toxicity. Supportive care is most important and patients who have severe symptom and abnormal vital sign should be treated with deferoxamine. We report the case that a 20-year-old pregnant female (33 weeks gestation) who had visited complaining of gastrointestinal symptom with iron overdose state was administrated with deferoxamine, therefore we removed iron loads within stomach with endoscopic suction and observed multiple gastric erosion with much old iron in endoscopic findings.

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 Pneumatosis Cystoides Intestinalis Presented with Nonspecific Symptom / 대한소화기내시경학회지

Pneumatosis cystoides intestinalis is a relatively rare condition, characterized by multiple gas-filled cysts of varying size in the wall of gastrointestinal tract. Although the etiology of pneumatosis intestinalis remains uncertain, the possibility that both the gas-forming bacteria and mechanical theories develop pneumocysts has recently been advocated. We experienced a case of pneumotosis cystoides intestinalis found by colonoscopy in a 31-year old woman with intermittent abdominal pain.

A Case of Bleeding from Rectal Dieulafoy-like Lesion Treated by Endoscopy / 대한소화기내시경학회지

Dieulafoy-like lesion is a relatively uncommon disease which is a potential source of life-threatening gastrointestinal bleeding. The lesion comprises mainly of an abnormally large submucosal artery that protrudes through a small mucosal defect. The lesion is frequently found at distal portion of gastroesophageal junction but may occur anywhere in gastrointestinal tract including small bowel, colon and rectum. Moreover bleeding from dieulafoy-like lesion of rectum is very reae. It has been reported that rectal Dieulafoy-like lesion is very rare source of lower gastrointestinal bleeding and its pathogenesis may be associated with constipation. Recently, endoscopy has an important role in the diagnosis and treatment (including injection and coagulation therapy) of bleeding from Dieulafoy-like lesion. We herein report a case of a patient who presented wih massive hemorrhage from a small rectal ulcer with adherent blood clots. Bleeding was controlled with endoscopic treatment by utilizing bipolar electrocoagulation without complication and recurrence.

A Small Rectal Carcinoid Tumor with Liver Metastasis / 대한소화기내시경학회지

Carcinoid tumors are originated from the enterochromaffin cells in the gastrointestinal mucosa. The incidence of rectal carcinoid tumors is more than 10 percent of gastrointestinal tract carcinoid. The tumor has naturally the benign character that does not develop symptoms and it is found incidentally. The tumor may infrequently have a malignant behavior such as invasion to muscle wall, obstruction of bowel lumen and metastasis to distant organ (especially, liver) almost when its size is larger than 2 cm. We have experienced a case of rectal carcinoid tumor smaller than 1 cm in its size with huge metastatic mass of liver.

A Case of Tuberculous Bronchoesophageal Fistula / 대한소화기내시경학회지

Tuberculous bronchoesophageal fistula is a rare disease. We experienced a case of the tuberculous bronchoesophageal fistula, which was found by endoscopy and surgically confirmed. A sixty seven years old female patient complained of foreign body sensation in the throat and frequent aspiration, especially after liquid meal. Esophagoscopic ex- aminatian showed the orifice of the fistula in the midesophagus at the level of 28 cm from the incisors. Esophagogram showed bronchoesophageal fistula between midesophagus and the right intermediate bronchus. A bronchoscopy visualized fistulous tract with granulation in the right intermediate bronchus. Biopsy specimens obtained from the bronchus revealed the esophageal tissue with granulation and multinucleated giant cells. Fistulectomy with wrapping procedure was performed successfully. Surgical pathologic findings confirmed a small focal granuloma and chronic inflammations, compatible with tuberculosis. There was no evidence of malignancy at the specimens. She was treated with anti-tuberculous agents and became well.