The Prevalence of Barrett's Esophagus and the Comparison of Barrett's Esophagus with Cardiac Intestinal Metaplasia in the Health Screening at a Secondary Care Hospital / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to estimate the prevalence of Barrett's esophagus (BE) and its association with reflux esophagitis (RE) and peptic ulcer disease detected by free charge endoscopy which was covered by the National Health Insurance at a secondary care hospital, and to compare the results of the biopsy of BE with that of cardiac intestinal metaplasia (CIM). METHODS: A total of 4,002 patients underwent endoscopy from March 2010 to December 2012. BE was diagnosed if there was histologically proven specialized intestinal metaplasia, and CIM was diagnosed if intestinal metaplasia was accompanied with chronic gastritis. RESULTS: Four hundred twenty four patients underwent endoscopic biopsy, and the prevalence of BE was 1.0% (42/4,002). The mean age and the proportion of males in BE were significantly higher than those of the rest of study population, and BE had slight tendency related to RE than the rest of study population. CIM was observed in 34 patients and BE and CIM showed similar results, regarding age, sex and association with RE. The mean length of endoscopic Barrett's mucosa of BE group was 9.2+/-5.1 mm, and it was similar to that of CIM. CONCLUSIONS: The prevalence of BE in the secondary care hospital was not low, and old age and male sex were significantly associated with BE. Because BE was observed in about 10% of biopsied patients and CIM was observed in a similar percentage with BE, the precise targeted biopsy is warranted and the biopsy method should be reestablished through the large prospective study of multiple secondary care hospitals.

A case of jejuno-jejunal intussusception caused by a small intestinal lipoma / 대한내과학회지

Intussusception is a prolapse of a segment of the intestine into the lumen of the adjacent intestine. The majority of intussusceptions occur in infancy and early childhood. Intussusception arising in adulthood represents only about 5% of all intussusceptions and is usually caused by a malignant small bowel lesion acting as an apex for intussusception. Lipoma is not a common tumor in the gastrointestinal tract, and gastrointestinal lipomas may be submucosal or subserosal. Most of them are asymptomatic, although they may cause abdominal pain, bowel obstruction, and gastrointestinal bleeding. Intestinal intussusception caused by lipoma is uncommon and is particularly rare when the lipoma is located in the small intestine. We report an unusual case of intussusception in an adult male patient, which was caused by a lipomatous lesion located in the proximal jejunum acting as a lead point.

An Ampulla of Vater Carcinoid Tumor that Presented with Upper Gastrointestinal Bleeding / 대한소화기내시경학회지

A Carcinoid tumor of the ampulla of Vater is extremely rare, accounting for less than 0.3% of all gastrointestinal carcinoids. Most reported cases have arisen from the gallbladder. An ampullary carcinoid most commonly presents with jaundice or upper abdominal discomfort, and bleeding from the tumor is exceedingly rare. A diagnosis is most frequently made postoperatively due to submucosal spread of the tumor. As the metastatic potential cannot be predicted by tumor size, a Whipple pancreaticoduodenectomy rather than local excision is considered the treatment of choice. We herein report a case of a primary carcinoid tumor located at the ampulla of Vater that presented as gastrointestinal bleeding; the tumor was diagnosed by an endoscopic biopsy after a papillary sphinterotomy.