ABSTRACT
Gastric MALT lymphoma usually presents with various endoscopic morphologic characteristics. The majority of gross findings reveal multiple and superficial erosions or ulcerations. However gastric MALT lymphoma, presenting as a submucosal tumor, is very rare. We recently experienced a case of low-grade gastric MALT lymphoma, presenting as a submucosal tumor-like lesion without definite mucosal lesion, confirmed by endoscopic mucosal resection. So we report this case with a review of the related literatures.
Subject(s)
Lymphoma, B-Cell, Marginal Zone , UlcerABSTRACT
BACKGROUND AND AIMS: Nowadays, common bile duct stones are predominantly extracted endoscopically, after endoscopic papillotomy. Nearly 90% of stones can be removed with a Dormia basket or mechanical lithotripter. In the remaining patients several nonoperative procedures serve as alternatives to surgery. Once extracorporeal lithotripsy had been successfully used for gallbladder stones, this technique was extended to bile duct stones. An experience of endoscopic removal of difficult bile duct stones combined with extracorporeal shock wave lithotripsy (ESWL) is reported. METHODS: 82 patients were selected for this treatment because conventional stone extraction had failed. The Biolithos Mark III was used for extracorporeal spark-gap lithotripsy and the shock wave number was 2,000 waves (average) at one session. The stones were detected through a fluoroscopy with dye injection through an endoscopic naso-biliary drainage tube. After the fragmentation of bile duct stones, endoscopic removal of stones was performed for the facilitation of the complete removal of the stones, and to decrease the discomfort of the patients for the duration of their stay. RESULTS: Visualization of the stones using a fluoroscopy with dye injection was possible in all patients. On average, these patients had 3.1 (1-7) sessions of treatment with ESWL. Fragmentation was achieved in 74 (90.2%) patients and complete stone removal occurred in 71 (86.5%) patients. Complete stone clearance was achieved without further intervention in 8 (11.3%) patients, and in 63 (88.7%) patients after endoscopic extraction of the fragments. Thirty-seven (58.7%) patients underwent one endoscopic intervention to extract the remaining fragments. In 54 (81.8%) patients, a balloon catheter or Dormia basket was sufficient to extract the remaining fragments and an additional mechanical lithotripsy was necessary to break down larger fragments in 12 (18.2%) patients. There were no serious adverse effects from ESWL. CONCLUSIONS: Endoscopic removal combined with ESWL is also a useful method for the treatment of difficult bile duct stones to facilitate the complete removal of the stones and to decrease the discomfort of the patients, as well as the duration of their hospitalization.
Subject(s)
Humans , Bile Ducts , Bile , Catheters , Common Bile Duct , Drainage , Fluoroscopy , Gallbladder , Hospitalization , Lithotripsy , Shock , Sphincterotomy, EndoscopicABSTRACT
BACKGROUND/AIMS: To investigate the usefulness of pit patterns of colorectal tumors and magnifying colonoscopy. METHODS: The surface mucosal pits of seventy five colorectal lesions were observed using a magnifying colonoscopy with a zoom 1 to 100 magnification after indigo carmine or methylene blue spray. The lesions were removed by hot biopsy, palypectomy, or endoscopic mucosal resection. Histologic diagnoses were determined by light microscopy.
Subject(s)
Biopsy , Colonoscopy , Colorectal Neoplasms , Diagnosis , Indigo Carmine , Methylene Blue , MicroscopyABSTRACT
OBJECTIVES: Endoscopic biliary drainage has been established as the palliative treatment of choice for malignant obstructive jaundice. At present, the major drawback of endoscopic biliary stenting is occlusion of the endoprosthesis with sludge, resulting in recurrence of jaundice or cholangitis. Recently, there are variable stents that have different materials, sizes, and designs have been used in efforts to overcome this problem. To determine the success rate of stent insertion, successful drainage rate, duration of patency, complications related to stent insertion, and cause of stent malfunction, plastic endoprosthesis compared to metal stents in palliative treatment of malignant biliary obstruction. METHOD: We retrospectively evaluated 157 patients (total number of stent insertion: 308 cases) with unresec table malignant biliary obstruction to receive either a plastic stent(group I, 261 cases) or metal stent(group II, 47 cases). The patients who were recieved plastic stent were subdivided to general plastic stents(group Ia, polyethylene, polyurethane, polyvinylchloride, 225 cases) and Tannenbaum stent(group Ib, Teflon, 36 times) group. And the patients who were received metal stent were subdivided to uncovered metal stents(group IIa, Gianturco R sch, Wall, Strecker, EndoCoil stent, 26 times) and membrane covered self-expandable metal stent(group IIb, 21 cases) group. RESULTS: 1) There were no statistical difference in successful rate of stent insertion and drainage effect of stent accord ing to the types of stent(p>0.05). 2) Median patency of the stent was significantly prolonged in patients with a metal stent(group II) com pared with those with a plastic stent(group I) (249 vs 123 days; p 0.05). 3) The rate of early complication related to stent insertion showed no significant difference in plastic and metal stent groups(P > 0.05). 4) Major causes of stent malfunction in plastic and metal stent were sludge(90% vs 21.4%), tumor ingrowth (4.4% vs 71.4%), and dislocation(5.6% vs 7.2%), respec tively. CONCLUSION: Metal stents have a longer patency than plastic stent in patients with malignant biliary obstruc tion. In plastic stents, Tannenbaum stents have a slighlty longer patency than other plastic stents, but there were no differences in the success rates, drainage effect and complication rates according to types of stents.
Subject(s)
Humans , Cholangitis , Drainage , Jaundice , Jaundice, Obstructive , Membranes , Palliative Care , Plastics , Polyethylene , Polytetrafluoroethylene , Polyurethanes , Recurrence , Retrospective Studies , Sewage , StentsABSTRACT
Granular cell tumors (GCT), previously termed granular cell myoblastorna, was first described as a myoblastic myoma of the tongue in 1926 by Abrikossoff and has been reported in many different locations throughout the body. In 1931, Abrikossaff described the first granular cell tumor of the esophagus. The gastrointestinal tract is one of the more uncommon locations for granular cell tumors. Until recently, granular cell tumors had been considered rare but, the incidence of granular cell tumors has been slowly raising since endoscopy has been used more commonly as a diagnostic tool. In this study, we report three cases of esophageal granular cell tumors which were successfully diaganosed by an esophagoscopy and an endoscopic ultrasonography and confirmed using an endoscopic esophageal mucosal resection (EEMR).
Subject(s)
Endoscopy , Endosonography , Esophagoscopy , Esophagus , Gastrointestinal Tract , Granular Cell Tumor , Incidence , Myoblasts , Myoma , TongueABSTRACT
OBJECTIVES: To determine accurate diagnosis and proper treatment, we reviewed colonoscopic and histologic findings of flat adenoma of colon, METHODS: We studied retrospectively 2148 cases of colonoscopic findings performed in our hospital from March of 1993 to September of 1995. RESULTS: 1) The incidence of adenoma is 9.5%(203 cases), and that of flat adenoma is 1.6%(34 cases). 2) The location of flat adenoma is 3 cases in rectum(8.8%), 15 cases in sigmoid colon(44.1%), 9 cases in descending colon(26.5%), 3 cases in transverse colon(8.8%) and 4 cases in ascending colon and cecum(11.8%). 3) The diameter of flat adenoma was smaller than 5mm in 17 cases(50.0%), between 5-10mm in 8 cases(23.5%) and larger than 10mm in 9 cases (26.5%). Mean size was 9.2mm. 4) In colonoscopic features, type IIa was 25 cases (73.5%), type IIa + IIc was 5 cases(14.7%) and lateral spreading tumor was 4 cases(11.8%). 5) In histologic findings, tubular adenoma was 26 cases(76.5%), tubulovillous adenoma was 6 cases (17.6%) and serrated adenoma was 2 cases(5.9%). 6) The incidence of severe dysplasia or carcinoma was zero in smaller than 5mm, 25.0%(2 case) in 5-10mm and 55.6%(5 cases) in larger than 10mm. 7) The incidence of severe dysplasia or carcinoma was 11.5%(3 cases) in tubular adenoma and 66.7%(6 cases) in tubulovillous adenoma. 8) It was confirmed by abdominal CT scan or operation that lesions were limited to intraepithelium in 4 cases, mucosa in 2 cases submucosa in 1 case and no lymph node metastasis in any case. CONCLUSION: Even though flat adenoma of colon was smaller than polypoid adenoma, the incidence of malignant change was higher. When it was smaller than 10mm, the incidence of submucosal invasion or lymph node invasion was rare. Therefore endoscopic mucosal resection(EMR) can be the treatment of choice in flat adenoma smaller than 10mm, and after EMR, it is desirable to decide the treatment modality depending on the histologic findings.
Subject(s)
Adenoma , Colon , Colon, Ascending , Colon, Sigmoid , Diagnosis , Incidence , Lymph Nodes , Mucous Membrane , Neoplasm Metastasis , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Biliary-enteric fistula is in 0.5% to 5% of patients undergoing biliary tract surgery. The most common cause of biliary-enteric fistula is gallstones and their complications, Much less common causes are complieation of peptic ulcer, malignancy, trauma, and rarely, Crohns, disease. The most common type of biliary-enteric fistula is cholecysto-duadenal. Cholecysto-colic, cholecysto-gastric, and choledocho-duodenal fistula are reported much less frequently. The combination of cholecysto-duodenal fistula with cholecysto-colic fistula is a very rare. Symptoms are generally nonspecific, so diagnosis has depended on plain film of abdomen and barium studies. Recently, endoscopic examination and cannulation of the fistula for precise radiographic delineation will help to make a diagnosis. A 78-year-old man was admitted our hospital because of epigastric discomfort, indigestion, nausea and vomiting for 10 days. He was confirmed as cholecysto-duodeno-colic fistula by gastroduodenoscopy, colonoscopy, and endoscopic cholangio-graphic techniques. So, we report a case of cholecysto-duodeno-colic fistula of the patient with a review of relevant literatures.
Subject(s)
Aged , Humans , Abdomen , Barium , Biliary Tract , Catheterization , Colic , Colonoscopy , Diagnosis , Dyspepsia , Fistula , Gallstones , Nausea , Peptic Ulcer , VomitingABSTRACT
Although ERCP has been widely used to diagnose and occasionally treat chronic pancreatitis, it is not always easy to differentiate between malignancy and benign disease by ERCP alone. So peroral pancreatoscopy(PPS) using mother and baby type scopes was developed and several types of peroral pancreatoscopes with various diameters have been used at several institutes. To assess the clinical usefulness of ultrathin-caliber pancreatoscopy on diagnosis of various pancreatic diseases, we performed peroral pancreatoscopy with PF 8P (Olympus, external diameter: 0.8 mm) in 12 cases(6 cases of chronic pancreatitis, 5 cases of pancreatic tumor, and 1 case of mucinous ductal ectasia) of pancreatic diseases. The pancreatoscope was successfully inserted into main pancreatic duct in 11 cases and permitted satisfactory endoscopic observation. The endoscopic findings of chronic pancreatitis were smooth stenosis, protein plug, and stones in pancreatic duct. Peroral pancreatoscopic findings of pancreatic cancer were characteristically seen as stenosis with irregular mucosal protrusion. In the mucin-producing tumor cases, the lesions were generally not clearly visualized due to the presence of copious amount of mucin. We conclude that pancreatoscopy is a valuable alternative or supplementary procedure to diagnostic imaging method of arriving at a more definite diagnosis in difficult cases. But several limitations, such as poor visual field, absence of biopsy channel and controllable tip, and poor durability of endoscope will be overcomed to serve as essential diagnosic tool for pancratic diseases.
Subject(s)
Humans , Academies and Institutes , Biopsy , Cholangiopancreatography, Endoscopic Retrograde , Constriction, Pathologic , Diagnosis , Diagnostic Imaging , Endoscopes , Mothers , Mucins , Pancreatic Diseases , Pancreatic Ducts , Pancreatic Neoplasms , Pancreatitis, Chronic , Visual FieldsABSTRACT
Endoscopic esophageal variceal ligation(EVL) was first introduced by Stiegmann and colleagues in 1986, and it has since grown to he became an extremely popular modality throughout the world as well as Korea. Endoseopic variceal ligation(EVL), which consists of mechanical ligation and thrombosis of varices using elastic O-rings, has been recently developed as a non-operative alternative to endapic injection sclerotherapy(EIS). EVL is minimally operator-dependent and is also associated with fewer local and systemic complications than sclerotherapy. However, the conventional device has only one O ring, and thus the inner cylinder has to be exchanged after each ligation, So, it is a time-consurning procedure that requires the use of an overtube which has somtimes caused tearing of the esophageal mucosa. To save time and control variceal bleeding, multi-band ligation(MBL) was developed. These ligators have five or six O rings, and serial ligation is now possible without exchanging the cylinder or withdrawing the endoscope.(continue...)
Subject(s)
Esophageal and Gastric Varices , Korea , Ligation , Mucous Membrane , Sclerotherapy , Thrombosis , Varicose VeinsABSTRACT
Mallory-Weiss syndrome is a laceration in the region of the gastroesophageal junction due to vomiting, retching, coughing preceding hematemesis in alcoholic patient. Bleeding from Mallory-Weiss tears stop spontaneously without specific therapy in 80-90 percent of patient, but rebleeding is uncommonly occurring in 2 to 5 percent of patients. Thus most patients require only supportive care. Rarely endoscopic therapy or operative therapy may be required. We conducted an uncontrolled study to evaluate an improved metallic clip(Olympus hemoclip) for the endoscopic treatment of Mallory-Weiss syndrome. Initial hemostasis was achieved in all patients with active bleeding. No complications resulted from this treatment. Clips did not impair healing of teared mucosa. We conclude that endoscopic hemoclip placement is a highly effective and safe method for treating uncontrolled Mallory-Weis syndrome.
Subject(s)
Humans , Alcoholics , Cough , Esophagogastric Junction , Hematemesis , Hemorrhage , Hemostasis , Lacerations , Mallory-Weiss Syndrome , Mucous Membrane , VomitingABSTRACT
Mallory-Weiss syndrome is a laceration in the region of the gastroesophageal junction due to vomiting, retching, coughing preceding hematemesis in alcoholic patient. Bleeding from Malloly-Weise tears stop spontaneously without specific therapy in 80-90% of patient, but rebleeding occurs in 2 to 5% of patients. Thus most patients require only supportive care. Rarely endoscopic therapy or operative therapy may be required. We performed endoscopic mucosal ligation using intraluminal negative pressure with band ligation for uncontrolled Mallory-Weiss syndrome. In conclusion, Endoscopic O-ring band ligation in uncontrolled intractable Mallory-Weiss syndrome is safe and effective method, but its important that accurate endoscopic O-ring band ligation an bleeding site in laceration area. We experienced endoscopic O-ring band ligation in 6 cases of Mallory-Weiss syndrome.
Subject(s)
Humans , Alcoholics , Cough , Esophagogastric Junction , Hematemesis , Hemorrhage , Lacerations , Ligation , Mallory-Weiss Syndrome , VomitingABSTRACT
Gastric metaplasia of the duodenum, defined as the presence of groups of gastric mucosal cell within normal duodenal epithelium, is an almost constant feature of duodenal ulcer. The pathogenesis of gastric metaplasia is unclear, but acid and Helicobacter pylori infection are contributory factors to the development of gastric metaplasia. Generally, endoscopic finding of gastric metaplasia in duodenum is typically patchy distribution in duodenal bulb, but polypoid gastric metaplasia in duodenum is very rare. We report that the patient who complaints of abdominal pain has a villous, polypoid gastric metaplasia in duodenal bulb without duodenal ulcer.
Subject(s)
Humans , Abdominal Pain , Duodenal Ulcer , Duodenum , Epithelium , Helicobacter pylori , MetaplasiaABSTRACT
Endoscopic biliary drainage has been established as the palliative treatment of choice for malignant obstructive jaundice. But the clogging of biliary endoprosthesis has been a persistent problem faced by endoscopists over many years. Different materials, sizes, and designs have been used in efforts to overcome this problem. Recently, there are some reports that incorporating sideholes increases the risk of stent clogging, and prostheses without sideholes had significantly lower clogging compared to those with sideholes. And then Soehendra and his colleagues introduced a new design Teflon straight stent without sideholes, designated "Tan-nenbaum" (TB) stents, and reported that TB stent had significantly longer patency than Teflon pigtail stent with sideholes. When placing the TB stent, we used OASIS (One Action Stent Introduction System). This introducer enables the stent to be pre-loaded onto the distal tip of the guiding catheter and placed endoscopically in one step. By using OASIS, we reduced the duration of placing the stent in narrowed bile duct and the patients were more tolerable. Now, we report our experience of endoscopic retrograde biliary drainage by use of TB stent and OASIS" in 12 patients with obstructive jaundice due to malignancy.
Subject(s)
Humans , Bile Ducts , Catheters , Drainage , Jaundice, Obstructive , Palliative Care , Polytetrafluoroethylene , Prostheses and Implants , StentsABSTRACT
We report our experience in five patients with malignant obstructive jaundice with a new self expandable metallic stent, a coil spring made from nickel-titanium alloy. Endoscopic biliary drainage(EBD) is a safe and effective noninvasive biliary drainage method and is indicated with malignant obstructive jaundice. In order to avoid being limited by the size of the instrumentation channel of the endoscope, expandable stents have been developed. The main problems with these expandable metal stents are tumor ingrowth leading to reobstruction, migration of the stent from its original position, and epithelial trauma by the distal hard edges of the stent. The new super-elastic metallic coil stent which has a very strong radial force (EndoCoil'" stent, Instent Co.) was developed to solve the above mentioned problems. The stent which is constricted over an introducing catheter is inserted by transduodenal approach. It expands spontaneously after release to its original 8 mm diameter. During the last 6.5 rnonths, 5 stents were inserted in patients with cholangiocarcinoma, pancreatic carcinoma and cancer of the ampulla of Vater to releave jaundice. Clinical improvement was achieved in all the patients except in one who died from multiple organ metastasis. After a mean follow-up of 6 month., patients had no evidence of biliary reobstruction. Although follow-up is short, these results are encouraging, and this new metallic stent seems to have several advantages over the current commercially available ones.
Subject(s)
Humans , Alloys , Ampulla of Vater , Catheters , Cholangiocarcinoma , Drainage , Endoscopes , Follow-Up Studies , Jaundice , Jaundice, Obstructive , Neoplasm Metastasis , StentsABSTRACT
Trichuriasis is an intestinal infection of human beings caused by Trichuris trichiura, more commonly known as whipworm because of its whip-like appearance. It is characterized by the invasion of the colonic mucosa by the adult trichuris. It is prevalent throughout the world, especially in tropical areas. Diagnosis is made typically by the identification of characteristic barrel-shaped eggs in the feces, although adult worms may be seen rarely at sigmoidoscopy or colonoscopy. We report five cases of whipworm infection that was diagnosed on colonoscopic examination.