Docetaxel, Cisplatin, 5-FU Combination Chemotherapy as a First-Line Treatment in Patients with Advanced Gastric Cancer / 대한내과학회지

BACKGROUND/AIMS: This study investigated the efficacy and safety of docetaxel/cisplatin/5-fluorouracil (DCF) combination chemotherapy as a first-line treatment in patients with advanced gastric cancer. METHODS: The study enrolled 48 patients diagnosed with unresectable pathologically proven gastric cancer who received DCF combination chemotherapy between April 2006 and August 2009. The dose administered was docetaxel 75 mg/m2 for 1 h and cisplatin 75 mg/m2 for 90 min on day 2, and 5-FU 750 mg/m2 for 24 h on days 1-5, every 3 weeks. The response was assessed every three cycles. The toxicity was evaluated for every chemotherapy course according to the National Cancer Institute (NCI) toxicity criteria ver. 2.0. RESULTS: The median age of the patients was 58 years (range 31-78 years). The median overall survival was 11.5 months (2.3-28.2 months) and the median time to progression was 5.5 months (0.3-18.9 months). No complete remission occurred. Of the patients, 56% achieved a partial response, 21% stable disease, and 10% progressive disease. The overall response rate was 56%. During a total 292 cycles, anemia worse than NCI toxicity grade 3 occurred in 2%, leukopenia in 33.1%, neutropenia in 67.1%, and thrombocytopenia in 4.4%. Neutropenic fever occurred in 33 cycles (11.3%), dose reduction due to side effects in 165 cycles (56.5%), and a regimen change due to side effect in five cycles (1.7%). CONCLUSIONS: Combination chemotherapy with docetaxel, cisplatin, and 5-FU is efficacious, but has relatively high toxicity. A DCF protocol that maximizes its efficiency, while minimizing toxicity, would be more useful as a first-line treatment in patients with advanced gastric cancer.

Crohn's Disease Presenting with Erythema Nodosum as an Early Sign: A Case Report / 대한소화기학회지

Erythema nodosum is the most common form of septal panniculitis and the most frequent skin manifestation associated with inflammatory bowel disease, affecting up to 15% of Crohn's disease patients. Since the development of erythema nodosum is closely related with a variety of disorders and condition, it can serve as an important early sign of systemic disease. Here, we present the occurrence of erythema nodosum as an early sign of Cronh's disease in a 16-year-old woman.

A Case of Chronic Intestinal Pseudo-Obstruction with Esophageal and Gastric Dysfunction / 대한내과학회지

Chronic intestinal pseudo-obstruction (CIPO) is a rare digestive syndrome characterized by symptoms and signs of intestinal obstruction in the absence of mechanical obstruction. A 48-year-old female presented at our facility with severe abdominal pain and vomiting. Simple abdominal radiography revealed small bowel gas and ileus. Computed tomography also revealed a dilated small bowel, but there was no evidence of mechanical obstruction. Esophageal function was decreased based on high-resolution manometry and the gastric emptying time was prolonged on a gastric emptying scan. The patient recovered with conservative treatment. We report a case of chronic intestinal pseudo-obstruction with esophageal and gastric dysfunction.

Effect of Combination Pretreatment of Polyethylene Glycol Solution and Magnesium Hydroxide for Colonoscopy / 대한소화기학회지

BACKGROUND/AIMS: This study was designed to compare the efficacy and patient tolerance between standard bowel preparation using 4 liters of polyethylene glycol (PEG) solution and 4 liters of PEG preceded by the osmotic laxative, magnesium hydroxide in constipation and non-constipation group. METHODS: 173 outpatient colonoscopy, except for three patients who were not taking magnesium, were divided into constipation and non-constipation group. Then, the patients were randomly assigned to receive 4-liter of PEG solution or 4-liter of PEG plus magnesium hydroxide. The quality of bowel preparation was assessed using Ottawa scale, and satisfaction score was assessed using questionnaires. Solid stool, cecal intubation time, compliance, and side effects were assessed. RESULTS: Non-constipation group showed no significant differences between two groups. In constipation group, 4-liter PEG solution plus magnesium hydroxide induced the more effective colonic preparation (Ottawa scale 2.47+/-0.99 vs. 5.92+/-2.39, p<0.05), and less solid stool (0.67+/-0.72 vs. 1.38+/-0.65, p<0.05) compared with 4-liter PEG solution. CONCLUSIONS: Bowel preparation with magnesium hydroxide and 4 liters of PEG solution might reduce solid stool in constipation group, but could not improve preparation quality.

A case of colonoscopy-induced right-sided ischemic colitis in a patient with no risk factor / 대한내과학회지

Ischemic colitis is the most common form of intestinal ischemia. Although there are a variety of causes, the most common mechanism is acute, self-limited compromise in intestinal blood flow. Most cases of ischemic colitis are transient and resolve spontaneously, but right colon involvement is associated with poor outcome. Colonoscopy is the gold standard for the identification of colonic ischemia; however, very rarely, colonoscopy itself may induce ischemic colitis in patients with underlying predisposing factors, such as connective tissue disorders. We experienced a case of ischemic colitis of the right colon, following colonoscopy in a patient without risk factors.

A 48-Year-Old Male With Dysphagia: What Is Your Diagnosis by High-Resolution Manometry Finding?

No abstract available.

A 43-Year-Old Female with Dysphagia: What Is Your Diagnosis by High-Resolution Manometric Finding?

No abstract available.

A Case of Idiopathic Pancreatitis in a Patient with Crohn's Disease / 대한소화기학회지

Pancreatitis has been occasionally associated with Crohn's disease (CD). A definite etiology of pancreatitis can be identified in most patients, but a very small proportion remain idiopathic. We report a case of idiopathic pancreatitis resolved along with the clinical improvement of CD in a 25-year-old man. He presented with abdominal pain and diarrhea for 8 years. Ileocolonoscopy and enteroclysis showed multiple, longitudinal ulcers and strictures at the ileojejunum. The laboratory findings showed elevated serum amylase (951 IU/L) and lipase (326 IU/L) without positive autoantibodies. Esophagogastroduodenoscopy, enhanced pancreatic CT, and MRCP showed no abnormalities at ampulla of Vater, pancrease, and pancreaticobiliary duct. With the treatment with antibiotics, 5-aminosalicylic acid, steroid, and azathioprine, as a whole, decreasing pattern and intermittent fine coordinated fluctuation of the levels of amylase and lipase along with the decrease of Crohn's disease activity index (CDAI) and the CRP levels were observed. Then, three months after the start of the treatment, normalization of the pancreatic enzymes was observed, and there was recurrent elevation of pancreatic engyme during 12 months maintenance therapy. This report supports the concept of an association between idiopathic pancreatitis and CD, based on a significant and close relation between the levels of serum amylase and lipase, and CDAI.

A case of sparganosis mimicking a skin metastasis in a patient with stomach cancer / 대한내과학회지

Sparganosis is a rare parasitic disease caused by the migrating plerocercoid larva of tapeworms in the genus Spirometra. The most frequent clinical manifestation of human sparganosis is a subcutaneous nodule resembling neoplastic disease. Since the disease is relatively uncommon, even in endemic areas, sparganosis is rarely considered in the differential diagnosis of skin lesions. We experienced a case of sparganosis mimicking a skin metastasis in a patient with metastatic stomach cancer and made the diagnosis after an excisional tissue biopsy.

A case of sparganosis mimicking a skin metastasis in a patient with stomach cancer / 대한내과학회지

Sparganosis is a rare parasitic disease caused by the migrating plerocercoid larva of tapeworms in the genus Spirometra. The most frequent clinical manifestation of human sparganosis is a subcutaneous nodule resembling neoplastic disease. Since the disease is relatively uncommon, even in endemic areas, sparganosis is rarely considered in the differential diagnosis of skin lesions. We experienced a case of sparganosis mimicking a skin metastasis in a patient with metastatic stomach cancer and made the diagnosis after an excisional tissue biopsy.

A Case of Removing an Esophageal Sharp Foreign Body Using a Surgical Glove / 대한소화기내시경학회지

Foreign bodies with a sharp margin in the esophagus are often associated with serious complications, such as bleeding, perforation and mediastinitis in the middle of endoscopic removal, as well as impaction in the esophagus wall. Therefore, safe extraction for such patients is essential. The techniques that are performed with an endoscope have been designed with using a protector hood and overtube. Yet the former is not available in Korea, and the later is uncomfortable and limited in diameter. Press-through-packs (PTPs) are commonly used as a package for drugs and they also usually cause esophageal impaction because they have sharp edges. We report here on a case of an impacted PTP in the upper esophagus, and this was successfully extracted endoscopically with using a surgical glove, which is a better safe alternative to above mentioned removal items.

A Case of a Small Rectal Carcinoid Tumor with Multiple Liver Metastasis / 대한소화기내시경학회지

Carcinoid tumors originate from the enterochromaffin cells. Rectal carcinoid tumors comprise 12.6% of all carcinoid tumors and they represent the third largest group of the gut carcinoids. However, a recent report showed that the number of reported cases has increases rapidly, which is probably due to the increased number of colonoscopic examinations. The aggressiveness of rectal carcinoid tumors is determined by the depth of invasion and the presence of metastasis. The clinical course of rectal carcinoid is benign, but these tumors may have a malignant character when the lesion is larger than 2 cm in diameter. We have experienced a case of rectal carcinoid tumor smaller than 2 cm in diameter and the patient had multiple liver metastasis.

A Gigantic Gastric Mucosal Rupture When Performing Endoscopy under Conscious Sedation in a Patient with Hiatal Hernia / 대한소화기내시경학회지

Mallory-Weiss syndrome is a tear in the gastro-esophageal junction or its adjacent mucosa, and this occurs due to nausea or vomiting that is caused by various etiologic factors. It may occur in patients with excessive retching and struggling when undergoing upper gastrointestinal endoscopy, and its underlying factors are esophageal hiatal hernia, atrophic gastritis and old age. There are currently only rare reports about gigantic gastric mucosal rupture during performance of upper gastrointestinal endoscopy in patients with esophageal hiatal hernia. We recently experienced a 76-year-old woman who developed a gigantic gastric mucosal rupture that ranged from the gastro-esophageal junction to the gastric angle. This occurred during performance of standard upper gastrointestinal endoscopy with the patient under sedation and the patient had a concurrent esophageal hiatal hernia. The patient was treated conservatively for the rupture. Herein we report on our case along with a review of the relevant literature.

A Case of Synchronous Triple Early Gastric Cancer / 대한소화기내시경학회지

Multiple gastric cancers have several clinicopathologic characteristics that are different from those of solitary cancer and the incidence of multiple gastric cancers has recently been on the increase due to the development of diagnostic endoscopy, chromoscopy, and radiological examination. It is important to determine the proper surgical area after evaluating the synchronous multiple gastric cancer by performing closed endoscopy and radiological evaluation prior to surgery. Generally, elderly men have a relatively high incidence of multiple gastric cancers and the well differentiated type is most common. There have been reports on the diagnoses of multiple gastric cancers of elderly men and the well differentiated type, but there are no prior reports concerned with multiple gastric cancers of younger patients and the different pathologic differentiation. We experienced a case of synchronous multiple early gastric cancer of a younger man and this showed different pathologic differentiation.

Normal 24-hour Ambulatory Esophageal pH Values in Koreans

BACKGROUND/AIMS: Twenty-four-hour ambulatory esophageal pH monitoring is considered the gold standard for diagnosing gastroesophageal reflux disease. The aim of this study was to quantify normal distal esophageal acid parameters in healthy Koreans. METHODS: Thirty healthy adults who were not on medication and were free from gastrointestinal symptoms were analyzed. Ambulatory esophageal acid (pH 5 minutes, 5.3; and the longest single acid-exposure episode, 21.3 minutes. CONCLUSIONS: Physiological gastroesophageal reflux occurs frequently in healthy Koreans. These data provide a reference range that could be utilized in studies involving Korean subjects.

A Case of Rapidly Improved Menetrier's Disease after Short-term Treatment with Proton Pump Inhibitor / 대한소화기내시경학회지

Menetrier's disease is a rare illness that is characterized by diffuse tremendous thickening of the gastric wall caused by excessive proliferation of the mucosa of unknown cause. An exact diagnosis is crucial due to the excellent prognosis as compared to other malignant lesions such as a gastric lymphoma and infiltrative gastric carcinoma. A 23-year-old woman presented with epigastric discomfort and dyspepsia. A rapid urease test, a test for H. pylori using serum IgG antibody, and a (13)C-urea breath test were all negative. A gastroscopic examination revealed a wide lesion encircling the lumen, which showed diffusely hard and thickened folds from an angle to the upper body near the cardia. Endoscopic ultrasonography showed diffusely hypoechoic thickness of the second wall layer, but the other wall layers were well preserved. The patient was diagnosed with Menetrier's disease without H. pylori infection, and the patient rapidly improved after short-term treatment with a proton pump inhibitor.

The Colonoscopic Miss Rates of Colorectal Polyps as Determined by a Polypectomy / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonoscopy is the most effective method to detect and remove colonic polyps and for colorectal cancer screening and prevention. However, polyps are frequently missed during colonoscopy. The aim of this study was to determine the miss rates of polyps by colonoscopy and to evaluate the factors that affect the miss rates. METHODS: Within sixty days after a first-time colonoscopy, consecutive polypectomies were performed in 317 patients who had one or more colon polyps. RESULTS: The overall miss rate for polyps was 26.6%. As the withdrawal time increased, the number of polyps detected on the first colonoscopy decreased, and the miss rate decreased significantly (respectively p=0.000, p=0.028). The withdrawal time for an expert operator was shorter than the withdrawal time for a beginner operator (p=0.001). The miss rate for a beginner operator and expert operator was not different (p=0.271) due to interference with withdrawal time. The most frequent location of a polyp was the ascending colon and the most frequent size of a polyp was < or =5 mm. CONCLUSIONS: Although colonoscopy is the gold standard for colorectal polyp detection, it is imperfect even when meticulously performed. To reduce the miss rates of polyps, it is important that a careful examination with sufficient withdrawal time is performed, the colonoscopy is complete to the cecum, and that the bowel preparation is adequate.

Endoscope-guide Infusion of Sodium Phosphate: A Novel Bowel Cleansing Method, Efficacy and Safety Comparisons with Polyethylene Glycol / 대한소화기내시경학회지

BACKGROUND/AIMS: Single full-dose oral sodium phosphate (NaP) on the examination day instead of a conventional divided-dose has been used in some patients to reduce burdens and sleep disturbance caused by bowel movement. However, this treatment may be inconvenient to some patients who are adversely affected by the full dose or its-related symptoms. This study compared the quality of bowel preparation, side effects, and patient's acceptance after a full-dose of NaP into the duodenum under an endoscopic examination and with those from conventional polyethylene glycol (PEG). METHODS: A total of 60 admitted patients receiving both endoscopy and colonoscopy each day were divided randomly into two groups and given either PEG 4 L (n=33) or an endoscopic infusion of NaP 90 mL (n=27). Before and after the bowel preparation and 1 day later, the blood pressure, body weight, and serum biochemical parameters were measured. In addition, a detailed questionnaire was used to assess the patient's side effects. The quality of bowel cleansing was assessed by a single endoscopist who was blinded to the type of preparation used. RESULTS: Although changes in the serum biochemical parameters (phosphate: increase, potassium: decrease) were observed in the NaP group, all were normalized after 1 day without side effects. There were significant difference in symptoms after the preparation, such as vomiting, but this was not serious. The suction volume was significantly lower in the NaP group. CONCLUSIONS: A duodenal infusion of NaP might be used as a new bowel cleansing method in patients having trouble with other procedures.

A Case of Synchronous Double Primary Cancer: Gastric Carcinoid and Early Gastric Cancer / 대한소화기내시경학회지

An association of carcinoid tumors with another primary neoplasm has been reported in 17~53% of cases, with an especially high incidence of adenocarcinomas. However, simultaneous association of a gastric carcinoid tumor with a gastric adenocarcinoma as a synchronous double primary cancer is extremely rare. We report a case of a synchronous double primary cancer associated with a gastric carcinoid and early gastric cancer in a 63-year-old male patient.

A Case of Double Pylorus Caused by Peptic Ulcer in a Diabetic Patient / 대한소화기내시경학회지

A double pylorus, a fistulous communication between the gastric antrum and duodenal bulb, is a very rare anomaly. It appears as an acquired lesion in the majority of cases and mainly occurs in males with chronic obstructive pulmonary disease, chronic renal failure, chronic rheumatism, systemic lupus erythematosus, or diabetes. However, there are no previous reports of a double pylorus combined with diabetes mellitus in Korea. Recently we experienced a case of double pylorus caused by a peptic ulcer in 74-year-old man who had diabetes mellitus with complications. We report this case with a review of the literature.