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1.
Article in English | WPRIM | ID: wpr-918973

ABSTRACT

Background/Aims@#Several conditions may cause difficulties with oral feeding. Percutaneous endoscopic gastrostomy (PEG) is commonly performed on patients who require enteral feeding for >2-3 weeks. This study examined the nutritional state of patients who required enteral feeding and underwent PEG to quantify the benefits of the procedure. @*Methods@#This retrospective study included patients who underwent PEG at the Chungnam National University Hospital between January 2013 and December 2018. A gastroenterologist performed all PEG procedures using the pull technique, and all patients were followed up for >3 weeks postoperatively. The BMI and lymphocyte count, along with the levels of hemoglobin, total protein, albumin, total cholesterol, BUN, and creatinine pre-PEG and between 3 weeks and 6 months post-PEG were evaluated. @*Results@#Overall, 151 patients (116 males; mean age 64.92 years) were evaluated. Of these patients, 112 (74.2%), 34 (22.5%), and five (3.3%) underwent PEG tube insertion because of neurological diseases, malignancy, and other conditions, respectively. The BMI and the hemoglobin, total protein, albumin, and total cholesterol levels were significantly higher post-PEG than pre-PEG. @*Conclusions@#These findings highlight the usefulness of PEG in the management of nutritionally poor patients with difficulties in feeding orally.

2.
Annals of Coloproctology ; : S18-S23, 2021.
Article in English | WPRIM | ID: wpr-896759

ABSTRACT

Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular and provides a brief literature review.

3.
Article in English | WPRIM | ID: wpr-892738

ABSTRACT

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

4.
Annals of Coloproctology ; : S18-S23, 2021.
Article in English | WPRIM | ID: wpr-889055

ABSTRACT

Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular and provides a brief literature review.

5.
Article in English | WPRIM | ID: wpr-900442

ABSTRACT

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

6.
Article in Korean | WPRIM | ID: wpr-786618

ABSTRACT

Gastric schwannoma, a rare mesenchymal tumor originating from the schwann cells of peripheral nerves, rarely occurs in the gastrointestinal tract. It accounts for only 0.2% of all gastric tumors and 2~6% of gastric mesenchymal tumors. Gastric schwannoma is observed as a subepithelial tumor on endoscopy; it is covered with normal mucosa, rendering its preoperative differential diagnosis difficult. An asymptomatic 43-year-old woman visited our hospital after a 7-cm ulcerofungating mass was detected in the lesser curvature of the gastric body on gastroscopy. Abdominal CT revealed multiple enlarged lymph nodes, and ¹⁸F-fluorodeoxyglucose (FDG) PET demonstrated a subtle uptake of FDG, suggestive of advanced gastric cancer. After three failed attempts of endoscopic biopsy, the patient underwent total gastrectomy with lymphadenectomy and was subsequently diagnosed with gastric schwannoma. Herein, we report this case with a literature review.


Subject(s)
Adult , Biopsy , Diagnosis, Differential , Endoscopy , Female , Gastrectomy , Gastrointestinal Tract , Gastroscopy , Humans , Lymph Node Excision , Lymph Nodes , Mucous Membrane , Neurilemmoma , Peripheral Nerves , Schwann Cells , Stomach Neoplasms , Tomography, X-Ray Computed
7.
Article in English | WPRIM | ID: wpr-718629

ABSTRACT

Percutaneous endoscopic gastrostomy (PEG) is widely used to provide nutritional support for patients with dysphagia and/or disturbed consciousness preventing oral ingestion, and PEG tube placement is a relatively safe and convenient non-surgical procedure performed under local anesthesia. However, the prevention of PEG-insertion-related complications is important. A 64-year-old man with recurrent pneumonia underwent tracheostomy and nasogastric tube placement for nutritional support and opted for PEG tube insertion for long-term nutrition. However, during the insertion procedure, needle puncture had to be attempted twice before successful PEG tube placement was achieved, and a day after the procedure his hemoglobin had fallen and he developed hypotension. Abdominal computed tomography revealed injury to a pancreatic branch of the superior mesenteric artery (SMA) associated with bleeding, hemoperitoneum, and pancreatitis. Transarterial embolization was performed using a microcatheter to treat hemorrhage from the injured branch of the SMA, and the acute pancreatitis was treated using antibiotics and supportive care. The patient was discharged after an uneventful recovery. Clinicians should be mindful of possible pancreatic injury and bleeding after PEG tube insertion. Possible complications, such as visceral injuries or bleeding, should be considered in patients requiring multiple puncture attempts during a PEG procedure.


Subject(s)
Anesthesia, Local , Angiography , Anti-Bacterial Agents , Consciousness , Deglutition Disorders , Eating , Endoscopy , Gastrostomy , Hemoperitoneum , Hemorrhage , Humans , Hypotension , Mesenteric Artery, Superior , Middle Aged , Needles , Nutritional Support , Pancreatitis , Pneumonia , Punctures , Tracheostomy
8.
Article in Korean | WPRIM | ID: wpr-718628

ABSTRACT

During laparoscopic cholecystectomy, a surgical clip is used to control the cystic duct and cystic artery. In the past, metallic clips were usually used, but over recent years, interest in the use of Hem-o-lok clips has increased. Surgical clip migration into the common bile duct (CBD) after laparoscopic cholecystectomy has rarely been reported and the majority of reported cases involved metallic clips. In this report, we describe the case of a 53-year-old woman who presented with abdominal pain caused by migration of a Hem-o-lok clip into the CBD. The patient had undergone laparoscopic cholecystectomy 10 months previously. Abdominal CT revealed an indistinct, minute, radiation-impermeable object in the distal CBD. The object was successfully removed by sphincterotomy via ERCP using a stone basket and was identified as a Hem-o-lok clip.


Subject(s)
Abdominal Pain , Arteries , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy , Cholecystectomy, Laparoscopic , Common Bile Duct , Cystic Duct , Female , Foreign-Body Migration , Humans , Middle Aged , Surgical Instruments , Tomography, X-Ray Computed
9.
Clinical Endoscopy ; : 334-343, 2018.
Article in English | WPRIM | ID: wpr-715793

ABSTRACT

Colon capsule endoscopy (CCE) is a relatively new diagnostic procedure for patients with suspected colonic diseases. This convenient, noninvasive method enables the physician to explore the entire colon without significant discomfort to the patient. However, while CCE can be performed painlessly without bowel air insufflation, the need for vigorous bowel preparation and other technical limitations exist. Due to such limitations, CCE has not replaced conventional colonoscopy. In this review, we discuss historical and recent advances in CCE including technical issues, ideal bowel preparation, indications and contraindications and highlight further technical advancements and clinical studies which are needed to develop CCE as a potential diagnostic tool.


Subject(s)
Capsule Endoscopy , Colon , Colonic Diseases , Colonoscopy , Humans , Insufflation , Methods
10.
Clinical Endoscopy ; : 289-293, 2018.
Article in English | WPRIM | ID: wpr-714591

ABSTRACT

Gastric remnant necrosis after a subtotal gastrectomy is an extremely uncommon complication due to the rich vascular supply of the stomach. Despite its rareness, it must be carefully addressed considering the significant mortality rate associated with this condition. Patients vulnerable to ischemic vascular disease in particular need closer attention and should be treated more cautiously. When gastric remnant necrosis is suspected, an urgent endoscopic examination must be performed. We report a case of gastric remnant necrosis following a subtotal gastrectomy and discuss possible risk factors associated with this complication.


Subject(s)
Endoscopy , Gastrectomy , Gastric Stump , Humans , Ischemia , Mortality , Necrosis , Risk Factors , Splenic Infarction , Stomach , Vascular Diseases
11.
Article in English | WPRIM | ID: wpr-33735

ABSTRACT

For inflammatory bowel disease (IBD), antitumor necrosis factor treatment offers a new direction for both patients and medical doctors. This treatment has dramatically improved the quality of life for patients with ulcerative colitis and Crohn disease (CD). However, with increasing usage and longer follow-up periods, a wider range of possible adverse effects may be encountered. We report an unusual case of pulmonary sarcoidosis developed during the treatment of a patient with CD by using infliximab. A 30-year-old male who had been treated for CD with infliximab for 18 months was admitted due to abnormal opacities on chest radiography. Chest computed tomography displayed clustered small nodules in both lobes and enlarged multiple lymph nodes. The patient was diagnosed with sarcoidosis from the results of a biopsy of the subcarinal lymph node. Lung lesions were improved five months after infliximab was stopped.


Subject(s)
Adult , Biopsy , Colitis, Ulcerative , Crohn Disease , Follow-Up Studies , Humans , Inflammatory Bowel Diseases , Infliximab , Lung , Lymph Nodes , Male , Necrosis , Quality of Life , Radiography , Sarcoidosis , Sarcoidosis, Pulmonary , Thorax , Tumor Necrosis Factor-alpha
12.
Article in English | WPRIM | ID: wpr-21597

ABSTRACT

Colonoscopy is a commonly performed endoscopic procedure. Although it is generally considered to be safe, serious complications, such as colorectal perforation, can occur. Most colonic perforations are intraperitoneal and cause pneumoperitoneum with acute abdominal pain as the initial symptom. However, extraperitoneal perforations with pneumoretroperitoneum may happen, albeit rarely, with atypical initial symptoms. We report a rare case of rectosigmoid perforation occurring after diagnostic colonoscopy that developed into pneumoretroperitoneum, pneumomediastinum, pneumothorax, and subcutaneous emphysema, with a change in voice and neck swelling as the initial symptoms. The patient was successfully treated with endoscopic closure of the perforation and conservative management.


Subject(s)
Abdominal Pain , Colon , Colonoscopy , Humans , Mediastinal Emphysema , Neck , Pneumoperitoneum , Pneumothorax , Retropneumoperitoneum , Subcutaneous Emphysema , Voice
13.
Article in Korean | WPRIM | ID: wpr-76275

ABSTRACT

Many neoplasms, including lung cancer, breast cancer, melanoma, and gastrointestinal tract malignancy, possess potential for skin metastasis. Skin metastases can represent the first presentation of such malignancies and may be observed incidentally during routine exam. Skin metastases from gastric adenocarcinoma are uncommon, with a prevalence rate of 0.04-0.8%. Cutaneous metastases from gastric cancer are generally observed as the initial symptom of advanced gastric cancer. Early detection and treatment can increase patient survival. A 42-year-old woman visited our department with nodule about 1 cm in size on the right frontal scalp noticed incidentally after laparoscopy-assisted distal gastrectomy and adjuvant systemic chemotherapy for early gastric cancer about 16 months prior. The patient was diagnosed with skin metastasis from gastric adenocarcinoma. Complete excision of the skin lesion and additional chemotherapy were performed. Herein, we report a case of nodular tumor-like scalp metastasis from early gastric cancer with a brief review of the literature.


Subject(s)
Adenocarcinoma , Adult , Breast Neoplasms , Drug Therapy , Female , Gastrectomy , Gastrointestinal Tract , Humans , Lung Neoplasms , Melanoma , Neoplasm Metastasis , Prevalence , Scalp , Skin , Stomach Neoplasms
14.
Korean Journal of Medicine ; : 217-223, 2016.
Article in Korean | WPRIM | ID: wpr-75766

ABSTRACT

Gastric adenoma is a precancerous lesion. While some adenomas regress spontaneously, others progress as invasive carcinomas. Simple follow-up of gastric adenoma may be possible considering the possibility of spontaneous regression. However, several studies have reported discrepancies between the results of endoscopic forceps biopsies and post-resection biopsies. These studies showed that the pathological findings are more severe in biopsies performed after endoscopic resections. We suggest that endoscopic resections should be planned for cases of gastric adenoma. After endoscopic resection, regular endoscopic surveillance and Helicobacter pylori eradication may reduce the occurrence of gastric cancer.


Subject(s)
Adenoma , Biopsy , Follow-Up Studies , Helicobacter pylori , Stomach , Stomach Neoplasms , Surgical Instruments
15.
Clinical Endoscopy ; : 294-297, 2016.
Article in English | WPRIM | ID: wpr-94066

ABSTRACT

The incidence of gastric band erosion has decreased to 1%. Gastric band erosion can manifest with various clinical symptoms, although some patients remain asymptomatic. We present a case of a mostly asymptomatic patient who was diagnosed with gastric band erosion during a routine health check-up. A 32-year-old man without any underlying diseases except for non-alcoholic fatty liver underwent laparoscopic adjustable gastric band surgery in 2010. He had no significant complications postoperatively. He underwent routine health check-ups with near-normal gastroduodenoscopic findings through 2014. However, in 2015, routine gastroduodenoscopy showed that the gastric band had eroded into the stomach. His gastric band was removed laparoscopically, and the remaining gastric ulcer perforation was repaired using an omental patch. Due to the early diagnosis, the infection was not serious. The patient was discharged on postoperative day 3 with oral antibiotics. This patient was fortunately diagnosed early by virtue of a routine health check-up; thus, eliminating the possibility of serious complications.


Subject(s)
Adult , Anti-Bacterial Agents , Bariatric Surgery , Cytochrome P-450 CYP1A1 , Early Diagnosis , Fatty Liver , Humans , Incidence , Obesity, Morbid , Stomach , Stomach Ulcer , Virtues
16.
Article in English | WPRIM | ID: wpr-149532

ABSTRACT

BACKGROUND/AIMS: In gastric cancer, the rate of recurrence and metastasis following radical resection is high, necessitating improvement in survival and cure rates. Neoadjuvant chemotherapy (NAC) has potential benefits for locally advanced gastric cancer; however, the surgical benefits and effects on survival are unclear. This study evaluates the effectiveness of NAC in locally advanced gastric cancer and compares clinical outcomes of doublet and triplet regimens. METHODS: We reviewed patient medical records of 383 patients who underwent NAC (n=41) or surgery only (n=342) for treatment of locally advanced gastric cancer. The baseline characteristics and clinical outcomes were compared between the groups. Chemotherapy patients were classified according to regimen, doublet (n=28) and triplet (n=13), and NAC-related clinical response, safety, and toxicity were analyzed. RESULTS: The baseline characteristics did not differ significantly between groups. After NAC, the tumor downstage rate was 51.2% (21/41); however, overall survival (p=0.205) and disease-free survival (p=0.415) were not significantly different between the groups. On subgroup analysis, no significant differences in drug toxicity (p=0.604) or clinical response (p=0.374) were found between outcomes of doublet and triplet chemotherapy regimens. CONCLUSIONS: In patients with locally advanced gastric cancer, NAC showed tolerable drug toxicity and increased tumor downstage, but NAC failed to increase the survival rate, which may be caused by a high D2-lymphadenectomy rate. Therefore, NAC was found to be a therapeutic option for select gastric cancer patients.


Subject(s)
Adenocarcinoma , Disease-Free Survival , Drug Therapy , Drug-Related Side Effects and Adverse Reactions , Humans , Medical Records , Neoadjuvant Therapy , Neoplasm Metastasis , Recurrence , Stomach , Stomach Neoplasms , Survival Rate , Triplets
17.
Article in English | WPRIM | ID: wpr-149529

ABSTRACT

Neuroendocrine tumors (NETs) of the esophagus are extremely rare, aggressive and have a poor prognosis. Combined therapy using chemotherapy, radiotherapy and/or surgery appear effective. Here, we present a patient with a complaint of dysphagia who was diagnosed with this rare tumor. Upper gastrointestinal endoscope of a 46-year-old female revealed a localized ulcerative lesion in the middle esophagus. Histologic exam of biopsy specimens indicated a neuroendocrine carcinoma. The tumor cells were arranged in microtubular structures, with small and round cells containing scanty cytoplasm. They were positive for synaptophysin and chromogranin A on immunohistochemical staining. A computed tomography scan showed an esophageal tumor with enlarged superior mediastinal lymph nodes and about 1.2 cm sized liver metastasis, similar to findings in PET-CT scanning. The patient was prescribed chemotherapy consisting of etoposide and cisplatin, which led to regression of disease on follow-up imaging study. She continues under clinical observation. We seek to increase awareness of this exceedingly rare but hazardous disease by sharing our unexpected finding.


Subject(s)
Biopsy , Carcinoma, Neuroendocrine , Chromogranin A , Cisplatin , Cytoplasm , Deglutition Disorders , Drug Therapy , Endoscopes, Gastrointestinal , Endoscopy , Esophageal Neoplasms , Esophagus , Etoposide , Female , Follow-Up Studies , Humans , Liver , Lymph Nodes , Middle Aged , Neoplasm Metastasis , Neuroendocrine Tumors , Prognosis , Radiotherapy , Synaptophysin , Ulcer
18.
Clinical Endoscopy ; : 522-527, 2015.
Article in English | WPRIM | ID: wpr-55037

ABSTRACT

BACKGROUND/AIMS: To validate the AIMS65 score for predicting mortality of patients with nonvariceal upper gastrointestinal bleeding and to evaluate the effectiveness of urgent ( or =2) were allocated to either the urgent or non-urgent endoscopic procedure group. In-hospital mortality, success of endoscopic procedure, recurrence of bleeding, admission period, and dose of transfusion were compared between groups. RESULTS: A total of 634 patients were analyzed. The AIMS65 score successfully predicted mortality (AUROC=0.943; 95% confidence interval [CI], 0.876 to 0.99) and was superior to the Rockall score (AUROC=0.856; 95% CI, 0.743 to 0.969) in predicting mortality. The group with high AIMS65 score included 200 patients. The urgent endoscopic procedure group had reduced hospitalization periods (p<0.05) CONCLUSIONS: AIMS65 score may be useful in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding. Urgent endoscopic procedures in patients with high scores may be related to reduced hospitalization periods.


Subject(s)
Endoscopy , Gastrointestinal Hemorrhage , Hemorrhage , Hospital Mortality , Hospitalization , Humans , Mortality , Recurrence , Retrospective Studies , Risk Assessment
19.
Article in Korean | WPRIM | ID: wpr-88233

ABSTRACT

Cytomegaloviurs (CMV) usually causes severe infection only in immunocompromised patients. However, in rare cases, gastrointestinal infection can occur in patients with normal immunity. Though most such patients recover spontaneously, major complications such as massive hemorrhage have also been reported. We report a case of massive hemorrhage in an immunocompetent elderly patient which was successfully treated with angiographic embolization.


Subject(s)
Aged , Angiography , Colitis , Cytomegalovirus , Hemorrhage , Humans , Immunocompetence , Immunocompromised Host
20.
Article in Korean | WPRIM | ID: wpr-179125

ABSTRACT

Small cell neuroendocrine carcinoma in the ampulla of Vater is a rare disease and there have only been three cases reported in Korea. In these three cases, the patients had symptoms of abdominal pain and jaundice. A biopsy via endoscopic retrograde cholangiopancreatography confirmed a small cell neuroendocrine carcinoma; thus, each patient underwent surgical treatment. Recently, we experienced a case of small cell neuroendocrine carcinoma in an asymptomatic patient. An ulcerative lesion was identified during screening gastroduodenoscopy. Here, we report this case and review the relevant literature.


Subject(s)
Abdominal Pain , Ampulla of Vater , Biopsy , Carcinoma, Neuroendocrine , Cholangiopancreatography, Endoscopic Retrograde , Duodenoscopy , Humans , Jaundice , Korea , Mass Screening , Rare Diseases , Ulcer
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