The Efficacy of Intraluminal Radiotherapy after Metallie Stent Insertion in Malignant Biliary Tract Obstruction / 대한소화기내시경학회지

BACKGROUND/AIMS: Inoperable malignant biliary tract obstructions (MBTO) are best palliated by drainage procedures followed by radiation therapy. In order to administer high doses in a short time to the central part of the tumor, internal radiotherapy has been proposed for a palliative goa1. The aim of this study is to investigate the effect of intraluminal radiotherapy (ILRT) to the stent patency and patients survival time after expandable metallic stent insertion in MBTO. METHODS: Between August 1996 and July 1998, 28 patients (17 females, 11 males, average age 61.4 years) with inoperable MBTO were provided with percutaneous transhepatic biliary drainage (12 patients; bile duct cancer, 8 patients; pancreatic head cancer, 4 patients; gallbladder cancer; 4 patients; lymph node metastasis from stomach cancer). The 14 patients were treated by only metallic stent. The other 14 patients were treated by metallic stent insertion and followed by ILRT. The ILRT was done by iridium-192 (mean dosage 23.3 Gray, 5 fractions). RESULTS: There were no significant differences in the two groups regarding age, sex, type of disease, and location of the obstruction. The patients tolerated ILRT well. CONCLUSIONS: The ILRT after expandable metallic stent was safe and effective in stent patency and the patient's surviva1 time in inopcrable MBTO.

Duodenal Variceal Bleeding Treated with a Transjugular Intrahepatic Portosystemic Shunt / 대한소화기내시경학회지

Most cases of upper gastrointestinal bleeding in patients with portal hypertension are caused by esophagogastric varices. Less often, bleeding originates in varices located elsewhere. If ectopic varices are found, the same hemostatic technique tend to be used. However, there is no evidence that such techniques are useful in these cases. Duodenal varices are quite common, although they rarely bleed due to their location deep in the duodenal wall. Consequently, if emergency endoscopy is not conducted, hemorrhage may be wrongfully attributed to coexisting esophagogastric varices in a patient with portal hypertension without active bleeding. Hemorrhage from duodenal varices may be severe and life threatening. We report a patient with portal hypertension and bleeding duodenal varices caused by cirrhosis of the liver. Hemorrhage was subsequently controlled by placement of a transjugular intrahepatic portosystemic shunt. We recommend that in patients with life-threatening hemorrhage from duodenal varices caused by cirrhosis of the liver, transjugular intrahepatic portosystemic shunt (TIPS) be considered in the man-agement.

A Case of Hydrogen Peroxide Enema Induced Chemical Colitis

Hydrogen peroxide solution is commonly used for irrigating and cleaning wounds. When it is applied to tissues, catalase causes its rapid molecular degeneration with the release of oxygen bubbles. We present case report illustrating two hazards ; chemical colitis and oxygen embolus. A 29-year-old previously healthy woman presented to the bloody diarrhea and anal pain after hydrogen peroxide enema. In the colonoscopic examination, severe mucosal edema and ulceration with bleeding was noted from anus to sigmoid colon. With use of anal endosonography, multiple high level echo were noted in the internal and external anal sphincter of the upper anal canal. Microscopically, mononuclear cells were infiltrated in lamina propria and congestion. She had treatment with IV fluid, IV antibiotics and NPO. At 3rd hospital day, anal pain was disappeared. Bloody stool was disappeared next day. At 8th hospital day, mucosal edema and ulceration were disappeared on colonoscopic examination. Recovery was full and the patient was discharged at nine days after the episode.