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.

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.

A Case of Esophageal Submucosal Dissection that Developed during Conscious Sedation Endoscopy / 대한소화기내시경학회지

Esophageal submucosal dissection is a rare condition, resulting in the separation of the submucosa and muscle layer by mucosal laceration and bleeding. Possible causes are external trauma, foreign body entrapment, endoscopic instrumentation and even spontaneous dissection. Typical endoscopic findings show a false lumen from the torn mucosa and a muscle layer in the false lumen. Esophagography shows a "double barrelled" appearance. A dissection can be resolved with conservative management. We experienced a case of a submucosal dissection of the esophagus with perforation, an unusual complication of conscious sedation endoscopy.

Transluminal Removal of a Fractured and Embolized Indwelling Central Venous Catheter in the Pulmonary Artery

Vascular catheters are associated with complications such as infection, thrombosis and stenosis. The embolization of a venous catheter fragment is a rare complication. A 39-year-old woman underwent placement of a totally implantable venous access device for chemotherapy to treat a recurrent liposarcoma of the left thigh. The "pinch-off sign" was noted on a routine chest X-ray but that was ignored. Three-months after implantation of the intravenous access device, the indwelling central catheter was fractured and embolized to the pulmonary trunk. The catheter in the pulmonary trunk was successfully removed through a percutaneous femoral vein approach using a pigtail catheter and goose neck snare.

Mitral-aortic Intervalvular Fibrosa Pseudoaneurysm with Dual Fistula and Complete AV Block after Aortic Valve Replacement in a Patients with Infective Endocarditis of Aortic Valve

The involvement of subaortic structures in the aortic valve endocarditis appears more common than previously recognized. The most common location of the subaortic complications is mitral-aortic intervalvular fibrosa(MAIVF) and the complications may be presented as abscess or pseudoaneurysm. We describe a case of infectious pseudoaneurysm of mitral-aortic intervalvular fibrosa mimicking abscess. In our case, complete AV block was revealed on ECG after aortic valve replacement (AVR). Several days after the first operation, re-do AVR and reconstruction of the MAIVF was performed because of complete AV block and dual fistula complicated by pseudoaneurysm in MAIVF.