The Usefulness of Applying an Additional Clip When Using a Double-layered Pyloric Stent to Treat Gastric Outlet Obstruction / 대한소화기내시경학회지

BACKGROUND/AIMS: It has been reported the placement of a double-layered pyloric combination stent can overcome the disadvantage of the increased ingrowth observed for an uncovered stent and the increased migration for a covered stent. But this did not satisfactorily prevent stent migration and it caused stent migration more frequently than with using the uncovered stent. This study evaluated the usefulness of applying a clip in an effort to reduce stent migration. METHODS: Fifteen patients with malignant gastric outlet obstruction were treated with endoscopic placement of a double-layered combination pyloric stent. Three endoscopic clips were then applied to fix the proximal end of the enteral stent to the gastric or duodenal mucosa. The clinical efficacy and especially the rate of migration were analyzed. RESULTS: The technical and clinical success rate was 100% (15/15) and 93.3% (14/15), respectively. No stent migration was observed in any of the patients. Three patients (20%) experienced complications such as stent collapse. The median stent patency period was 83.4 days. CONCLUSIONS: Endoscopic clipping for enteral stent placement is effective for preventing stent migration in patients with malignant gastric outlet obstruction.

The Clinical Significance of Extraluminal Compressions According to the Site of the Stomach / 대한소화기내시경학회지

BACKGROUND/AIMS: It can be difficult to differentiate an extraluminal compression from a true submucosal tumor (SMT) in the stomach. The best method for differentiating an extraluminal compression from a true SMT is endoscopic ultrasonography (EUS). Extragastric compression is frequently observed, but its clinical significance has rarely been reported on. We evaluated the clinical findings of extraluminal compression according to the site of the stomach. METHODS: Ninety-one patients were diagnosed by EUS as having extragastric compressions from January 2006 to July 2008. Abdominal sonography or computed tomography was performed in some cases. RESULTS: The causes of normal structures (64 cases) were the vessels, spleen, intestine, gallbladder, liver, mesentery, pancreas and kidney. The causes of pathologic lesions (27 cases) were hepatic cyst, distended gallbladder with sludge, splenic cyst, hepatic hemangioma, polycystic hepatic and renal disease, pancreatic cyst, renal cyst, calcified lymph node and hepatocelluar carcinoma. The great curvature of the fundus was the most frequent site of extraluminal compressions. The lesions in the anterior wall of the body showed a higher frequency of pathologic lesions than did those lesions in other sites. CONCLUSIONS: EUS is useful for finding the causes of extragastric compression. Careful evaluation is needed because many lesions in the anterior wall of the body of the stomach were due to pathologic causes.

The Balloon Occluded Method for Selective Cannulation of the Intrahepatic Duct: A Case Report / 대한소화기내시경학회지

Selective cannulation into the intrahepatic duct during ERCP can occasionally be difficult and time-consuming depending on the GI tract anatomy and the presence of biliary tree anomalies or pathology. A variety of techniques or devices have been used to enhance the success rate of selective cannulation in these situations. The balloon occluded method for selective cannulation of the LHD (left hepatic duct) with using an inflated balloon catheter to occlude the RHD (right hepatic duct) has also been reported. We report here a case of successful selective cannulation of the RHD with using an inflated balloon catheter to occlude the LHD in a patient who had a GB cancer with liver metastasis. After this maneuver, a guidewire is advanced; it deflects off the inflated balloon and then proceeds to the RHD.

Four Cases of Trichuris Trichiura Infection in the Colon / 대한소화기내시경학회지

Trichuris trichiura (whipworm) is a ubiquitous parasite that resides in the human intestinal tract, and it is known as whipworm because of its whip-like appearance. Trichuriasis is rare in developed countries, but it is more prevalent in tropical countries and areas with suboptimal sanitation. In most patient, whipworm infection is asymtomatic but patient with heavy infection present with anemia, diarrhea, trichuris dysentery syndrome, abdominal pain, weight loss, appendicitis and rectal prolapse. It is characterized by the invasion of the colonic mucosa by the adult Trichuris and produces minor inflammatory changes at the sites of localization. Its diagnosis is usually made by identification of football-shaped eggs in the stool or by confirming adult whipworm during colonoscopy. We report four cases of whipworm infection that were incidentally diagnosed on colonoscopy.

A case of strongyloidiasis with severe malnutrition / 대한내과학회지

Strongyloides stercoralis, which has two different generations: the free living and parasitic generation, is primarily adapted to warm climates, but strongyloidiasis has been reported sporadically in temperate and cold regions. Strongyloidiasis may be asymptomatic in almost 50 percent of the cases, rarely, infestation presents with severe clinical pictures. The reason for this exacerbation of illness is probably a rapid increase in the number of infecting larvas through the development or acceleration of a cycle of autoinfection. A breakdown of the host-parasite equilibrium due to decreased host resistance may occur in malnutrition, debilitating diseases or therapy with immunosuppressive drugs. Corticosteroid treatment may have an important role in the sudden occurrence of severe stongyloidiasis. We experienced a case of strongyloidiasis with severe malnutrition, accompanied with bronchial asthma and diabetes mellitus. This patient has been treated with corticosteroid for several years. So, we report this rare case with the literature review.

A Case of Duodenal Involvement in Waldenstrom's Macroglobulinemia / 대한소화기내시경학회지

Waldenstrom's macroglobulinemia is a disorder of malignant proliferation of plasmacytoid lymphocytes and monoclonal immunoglobulin M. However, the patients occasionally present with malabsorption and diarrhea due to deposition of extracellular periodic acid-Schiff positive homogenous eosinophilic, amorphorous, and proteinaceous materials in the villi and/or lamina propria of the duodenum. We report a 62-year-old man who, despite involvement of the duodenal mucosa, presented only with fatigue, dypnea on exertion, and anemia. Characteristic duodenoscopic and pathologic findings of this patient are described.