The Usefulness of Endoscopic Subtumoral Dissection for En-bloc Resection of Upper Gastrointestinal Submucosal Tumor / 대한소화기내시경학회지

BACKGROUND/AIMS: The removal of esophageal and gastric submucosal tumors is difficult using conventional endoscopic mucosal resection methods. This study examined the usefulness of an endoscopic subtumoral dissection for an en-bloc resection of submucosal tumors. METHODS: An endoscopic subtumoral dissection was attempted for an en-bloc resection in 15 submucosal tumors (M: F=10 : 5, 13 stomach, 2 esophagus). Before the procedures, endoscopic ultrasonography was performed in all cases. The procedure was carried out using various electrosurgical knives, such as an endoscopic submucosal dissection. RESULTS: Pathological and immunohistochemical studies confirmed a gastrointestinal stromal tumor in 6 cases. Other pathological diagnoses were made in 9 patients with submucosal lesions: leiomyoma (4), ectopic pancreas (3), lipoma (1), and hemangioma (1). An en-bloc resection was performed in 13 of the 15 tumors (86.7%). The mean specimen size was 29.5x21.1 mm. The mean procedure time was 49.4 minutes (range: 8~103 minutes). Gastric perforation was a complication in 2 cases with GIST. However, the two perforated cases were treated with endoscopic closure using endoclips and recovered without the need for surgery. CONCLUSIONS: An endoscopic subtumoral dissection technique is useful for an en-bloc resection of esophageal and gastric submucosal tumors. However, sufficient attention should be paid to the detection of perforations in the case of tumors with a proper muscle origin.

Safety and efficacy of propofol for sedative endoscopy in patients with compensated liver cirrhosis / 대한내과학회지

BACKGROUND/AIMS: Propofol is widely used for sedation during endoscopy. Because propofol may cause hepatic encephalopathy, hemodynamic compromise, and respiratory depression, cautious use is required in patients with liver cirrhosis. We evaluated the safety and efficacy of propofol in compensated cirrhosis during endoscopic examination. METHODS: Thirty-nine cirrhotic patients (19 and 20 cases of Child Pugh classes A and B, respectively) and 56 control subjects were included. The initial dose of propofol (40 mg) was increased by 20-mg increments until moderate sedation was achieved. The number connection test, flapping tremor test, blood pressure, heart rate, oxygen saturation, liver enzymes, and prothrombin time were evaluated before and after endoscopy. RESULTS: No significant change was observed in any parameter compared to baseline in either group. The mean dose of propofol was significantly lower in cirrhotic versus control subjects (49.7+/-15.8 versus 65.0+/-17.9 mg, respectively; p<0.001). Scores based on a visual analog scale evaluating patient satisfaction did not differ between groups (72+/-27 versus 64+/-26, respectively; p=0.196), nor did mean recovery time (16.4+/-9.8 versus 14.2+/-6.7 min, respectively; p=0.186). CONCLUSION: Propofol is safe and effective for moderate sedation in compensated liver cirrhosis.

Effectiveness and Tolerance of Duodenoscopic Bowel Preparation for Colonoscopy / 대한소화기학회지

BACKGROUND/AIMS: Bowel preparation for colonoscopy remains an unpleasant experience because oral solutions have unpleasant tastes and may provoke abdominal pain, nausea, vomiting, and sleep disturbance. Duodenoscopic bowel preparation is an alternative method for patients who are unwilling to take oral preparation solution or for those who are supposed to have both gastroscopic and colonoscopic examination on the same day. We assessed the effectiveness and tolerance of duodenoscopic bowel preparation. METHODS: Patients in group OA (orally administered) ingested 45 mL of sodium phosphate (NaP) in the evening before the day of procedure and in the morning on the day of colonoscopy, whereas patients in group EA (endoscopically administered) were prepared for the procedure by duodenoscopic infusion of 90 mL of NaP diluted with 180 mL of water into the second portion of the duodenum. After 4 hours, we assessed the overall quality of colonic cleansing, using a range of excellent to inadequate. The patients completed a questionnaire on their preparation-associated symptoms, tolerance, and preference. RESULTS: In group EA, sleep disturbance (p<0.05) and nausea (p<0.05) occurred less frequently than in group OA. Overall, the tolerance rating for preparation was higher in group EA. However, the quality of colonic cleansing and cecum intubation time was not different between the two groups. Patients in group EA who had ingested NaP in the past preferred duodenoscopic bowel preparation. CONCLUSIONS: Duodenoscopic bowel preparation may play a role in colonic cleansing especially for patients who are scheduled to undergo gastroscopic and colonoscopic examination on the same day and for those who are unwilling to ingest NaP.

Effectiveness and Tolerance of Duodenoscopic Bowel Preparation for Colonoscopy / 대한소화기학회지

BACKGROUND/AIMS: Bowel preparation for colonoscopy remains an unpleasant experience because oral solutions have unpleasant tastes and may provoke abdominal pain, nausea, vomiting, and sleep disturbance. Duodenoscopic bowel preparation is an alternative method for patients who are unwilling to take oral preparation solution or for those who are supposed to have both gastroscopic and colonoscopic examination on the same day. We assessed the effectiveness and tolerance of duodenoscopic bowel preparation. METHODS: Patients in group OA (orally administered) ingested 45 mL of sodium phosphate (NaP) in the evening before the day of procedure and in the morning on the day of colonoscopy, whereas patients in group EA (endoscopically administered) were prepared for the procedure by duodenoscopic infusion of 90 mL of NaP diluted with 180 mL of water into the second portion of the duodenum. After 4 hours, we assessed the overall quality of colonic cleansing, using a range of excellent to inadequate. The patients completed a questionnaire on their preparation-associated symptoms, tolerance, and preference. RESULTS: In group EA, sleep disturbance (p<0.05) and nausea (p<0.05) occurred less frequently than in group OA. Overall, the tolerance rating for preparation was higher in group EA. However, the quality of colonic cleansing and cecum intubation time was not different between the two groups. Patients in group EA who had ingested NaP in the past preferred duodenoscopic bowel preparation. CONCLUSIONS: Duodenoscopic bowel preparation may play a role in colonic cleansing especially for patients who are scheduled to undergo gastroscopic and colonoscopic examination on the same day and for those who are unwilling to ingest NaP.

Survival Analysis of Elderly Hemodialysis Patients in a Single Center / 대한신장학회잡지

PURPOSE: The increased prevalence and incidence of end-stage renal disease (ESRD) in the elderly has become a worldwide phenomenon. New cases of ESRD are growing faster among people aged older than 70 years. We studied in order to investigate the survival rate, technical survival rate, causes of death and the predictors of death in patient starting hemodialysis aged over 70 years. METHODS: We analyze 34 patients who started hemodialysis as an initial replacement therapy for chronic renal failure in Kangnung Asan Hospital between July 1996 and July 2001. Demographic and clinical characteristics, including diabetes mellitus and laboratory findings at the beginning of hemodialysis were retrospectively analyzed. All subjects were followed up until the point of assessment, the time of death or withdrawal from dialysis. The survival rate was calculated by Kaplan-Meier method. In order to determine independent predictors of death, we used Cox proportional hazard model. RESULTS: The median age of the patients was 74.5 years and sex ratio was 2.4:1 (M:F). The most common cause of ESRD was diabetes (35.5%) and obstructive uropathy was second. The mean follow-up period was 18.6+/-2.5 months and cardiac problems were major causes of death (37.5%). The survival rate of 34 patients was 84.9% at 1 year, 72.8% at 2 year and 56.6% at 5 years. The technical survival rate of 34 patients was 54.7% at 1 year, 48.6% at 2 year and 30.1% at 4 years. The predictors of death were found to be (i) age starting hemodialysis (RR=1.685, p=0.018) (ii) female (RR=18.5, p=0.028) (iii) low initial hemoglobin level (RR 0.233, p=0.009). CONCLUSION: Very elderly ESRD patients on dialysis have a relatively good outcome and age is not barrier to dialysis. Measures to improve quality of life of elderly hemodialysis patients may favorably influence their survival.

Epidemiological Comparison of viral hepatitis-hepatocellular carcinoma(HCC) and non viral hepatitis-hepatocellular carcinoma(HCC) / 한국역학회지

BACKGROUND: Korea is one of high incidence areas of Hepatocellular carcinoma (HCC) and major etiologic factor is hepatitis B virus (HBV). In future incidence of HBV related HCC may decrease and non viral hepatitis HCC (Non-B,C HCC) relatively increase because of widely used vaccination for HBV. To evaluate epidemiological characters of Non-B,C HCC, We divided HCC by viral or non-viral feature and compared each others. METHODS: 185 patients firstly diagnosed HCC and 455 normal subjects included from January 1997 to December 2000 and divided into 3 groups, HBV group (positive HBsAg), HCV group (positive anti-HCV Ab) and Non-B,C group (both negative HBsAg and anti-HCV Ab). RESULTS: 136 cases were HBV group (73.5%), 19 cases were HCV group (10.3%) and 27 cases were Non-B,C group (14.6%). Mean age of Non-B,C group at diagnosis was higher than HBV group (64.1+/-7.1 vs 55.6+/-7.7). Non-B,C HCC were more associated with alcohol abuse and rural residence (p<0.01). There was no difference of family history of liver disease, coexistence rate of liver cirrhosis and occupation. CONCLUSION: Non-B,C HCC tended to be older in mean age than HBV HCC and more associated with alcohol abuse and rural residence. This characteristics of Non-B,C HCC supposed to be from difference in alcohol consumption and environment.

Acute Gastric Volvulus due to Diaphragmatic Hernia / 대한소화기학회지

Gastric volvulus is an uncommon condition which is difficult to diagnose and treat. It designates abnormal rotation of the stomach along its longitudinal (organoaxial) or transverse (mesenteroaxial) axis. When the rotation exceeds 180 degrees, gastric obstruction or strangulation may occur. The classical presentation of acute gastric volvulus is the triad of severe epigastric pain, vomiting followed by retching without the ability to vomit, and difficulty or inability to pass a nasogastric tube. Delay in diagnosis and treatment of gastric volvulus can lead to fatal complications such as gastric ischemia, perforation, and hemorrhage. Gastric volvulus is a true emergency which should be treated immediately either surgically or by upper endoscopy. We report a case of an acute incarcerated gastric volvulus due to a left-sided diaphragmatic hernia in an adult male patient, which was treated successfully by operation.