Study of portal vein diameter by ultrasound and its association with endoscopic findings in patients with liver cirrhosis

Background: The major cause of morbidity and mortality in patients with portal hypertension is due to oesophageal varices. Upper gastrointestinal endoscopy is considered best to detect varices earlier. It’s an invasive tool which is expensive and increased financial burden among patients. Hence this study is undertaken to find non-invasive indicators of oesophageal varices in cirrhosis patients with portal hypertension and to establish the role of portal vein diameter determined by ultrasonography in predicting the oesophageal varices. Aim and objectives: To detect non-invasive indicators of oesophageal varices in chronic liver disease, to determine the relation between oesophageal varices on upper gastrointestinal endoscopy and portal vein diameter, to determine other non-invasive parameters to identify oesophageal varices. Materials and methods: A cross sectional study on 45 patients, who were diagnosed to have chronic liver disease and are being presented to outpatient department and were admitted in Malla Reddy Institute of Medical Sciences, Suraram over a period of one year under department of general medicine. All the patients with chronic liver disease who underwent upper gastrointestinal endoscopy are included in the study. Results: 45 patients with cirrhosis of liver were included in the study, among which 32 were males and 13 were females with a mean age group of 46 years. On upper gastrointestinal endoscopy 87% of patients had oesophageal varices while other 13% of patients were normal. Mean portal vein diameterwas 13.8 mm and has a positive linear correlation with p<0.01 and positive predictive value of 95.25%. Majority of patients belonged to the platelet count group of 50,000 to 1lakh and its inversely co related to the severity of varices. Majority of patients with oesophageal varices had moderate splenomegaly. Conclusion: Ultrasonography of portal vein diameter and spleen size along with thrombocytopenia are reliable, inexpensive and easily reproducible non-invasive tool in predicting the presence of oesophageal varices and hence can identify the patients who require endoscopy on a prophylactic basis.

Etiology and current treatment status of 277 patients with chronic atrophic gastritis and erosion in Beijing area / 中华消化杂志

Objective:To preliminarily understand the living habits, medication taking and treatment status including the therapeutic regimen, compliance and short-term efficacy of patients with chronic atrophic gastritis and erosion in Beijing area.Methods:From April to September in 2019 at Peking Union Medical College Hospital, Peking University Third Hospital and Peking University Shougang Hospital, the outpatients with chronic atrophic gastritis and erosion diagnosed with endoscopy within two weeks before visiting were prospectively included in this non-interventional observation study. Chi square test was used for statistical analysis.Results:A total of 277 patients with chronic atrophic gastritis and erosion had complete follow-up data, of which male patients accounted for 49.8% (138/277). The common initial symptoms of patients with chronic atrophic gastritis and erosion included acid reflux, abdominal distension, epigastric pain and postprandial distension, which accounted for 60.3% (167/277), 59.6% (165/277) , 58.8% (163/277) and 52.3% (145/277), respectively. For treatment, 36.8% (102/277) of the patients only received lifestyle instruction without medication. Among the patients with medication treatment, the short-term efficacy of gastric mucosal protectants+ proton pump inhibitor+ gastro-kinetic agent for abnominal distension, postprandial distention, acid reflux and nausea was highest as compared with other therapeutic regimen, and the differences were statistically significant ( χ2=25.18, 19.49, 13.75, 8.84, all P<0.05). Conclusions:Chronic gastritis with erosion may be caused by a combination of multiple factors, and the symptoms of which lack specific. If necessary, gastroscopy may help the diagnosis. Individualized treatment strategies based on the symptoms of patients is needed for treatment.

Histopathological Changes in Stomach Wall at Sites Other than the Ulcer Site in Peptic Ulcer Disease and its Association with Helicobacter pylori

Introduction: A peptic ulcer (PU) is a break in the lining of the gastrointestinal tract, extending through to the muscular layer(muscularis mucosae) of the bowel wall. It is an endoscopic diagnosis. While they may technically appear anywhere in thegastrointestinal tract, they are most often located on the lesser curvature of the proximal stomach or the first part of the duodenum.Aim: This study aims to study the changes in stomach wall at sites other than the ulcer site in PU disease and to correlate theassociation of stomach wall changes with Helicobacter pylori infection.Materials and Methods: In this study, patients with duodenal ulcers diagnosed in endoscopy were included in the study. Duringan endoscopy, the stomach wall is examined and any changes in the stomach wall are noted. Endoscopically and biopsy fromtwo areas in the stomach are taken from antrum and body and sent to histopathological examination. Rapid urease test toconfirm the presence of H. pylori was done.Results: Sixty patients were included, 67% of patients were male, 82% of patients were positive in rapid urease test, 84%antrum was affected, and 50% in the body of the stomach was affected. The overall incidence of chronic atrophic gastritis isnearly 84.1% when compared to other types of lesions.Conclusion: Gastric antrum was the most common site for H. pylori than the body of the stomach. The presence of H. pyloriin the stomach wall is associated with active on chronic gastritis.

Evaluation of upper gastro intestinal endoscopy among HIV positive and negative patients at a tertiary care hospital: a comparative study

Background: Endoscopy is the diagnostic test of choice for most HIV-associated GI diseases, as endoscopic and histopathologic evaluation can render diagnoses in patients with non-specific symptoms. The objective of the present research was to study the gastrointestinal endoscopic findings among HIV positive patients and compare them with HIV negative patients.Methods: A comparative study was carried out in the department of General Medicine to study the gastrointestinal endoscopic findings among HIV positive patients and compare them with HIV negative patients for a period of two years. 101 cases who were HIV positive were compared with equal number of HIV negative subjects. The subjects in the case group as well as control group were chosen randomly.Results: There was a significant lower incidence of Helicobacter pylori positivity (38.6%) among HIV positive patients when compared to controls (73.6%). There were overall 63 patients with abnormal biopsy findings in HIV group and 75 patients with abnormal biopsy findings in the control group. Among HIV positive patients who were also RUT positive approximately 80% had abnormal histopathological findings. Similarly, among the RUT positive control 81% of the patients had abnormal biopsy findings. Incidence of normal biopsy findings was more in the control group (57.1%) compared to the study group (48.4%). But this difference was not found to be statistically significant.Conclusions: The histology of gastric mucosa was no different in Helicobacter pylori positive or negative subjects with HIV. But Helicobacter pylori incidence was significantly less in HIV positive persons compared to HIV negative.

5-Aminosalicylic acid aggravates colitis mimicking exacerbation of ulcerative colitis

Ulcerative colitis (UC) is one of the major clinical phenotypes of inflammatory bowel diseases. Although 5-aminosalicylic acid (5-ASA) is widely used for UC and its efficacy and safety have been demonstrated, a few patients paradoxically develop a severe exacerbation of colitis by 5-ASA administration. It is crucial to know clinical features including endoscopic findings in this condition for making a correct diagnosis and a prompt decision to withdraw the medication. Here, we report case series with UC exacerbated by 5-ASA. Medical records of 8 UC patients experiencing an exacerbation of colitis after induction of 5-ASA that was improved by the withdrawal of 5-ASA but also re-aggravated by dose increase or re-administration of 5-ASA were reviewed. The patients were newly diagnosed with UC, started 5-ASA and developed an exacerbation in approximately 2 to 3 weeks. They did not appear to have systemic allergic reactions. Seven of the 8 patients had a high fever. Three of 5 patients who undertook total colonoscopy showed right-side-dominant colitis. These findings suggest clinical characteristics in this condition. Further assessment of clinical and endoscopic features in more cases is necessary for establishing diagnostic criteria and understanding underlying mechanisms in those cases where 5-ASA aggravates the colitis.

Clinical and endoscopic features of 49 cases of gastric inflammatory fibroid polyp / 中华消化杂志

Objective To summarize the endoscopic appearance,endoscopic ultrasound findings and histopathological characteristics of gastric inflammatory fibroid polyp (IFP) in order to improve diagnosis of IFP.Methods From September 2011 to November 2016,49 patients with pathologically comfirmed gastric IFP,who underwent endoscopy in Taizhou Hospital of Zhejiang Province,were enrolled.The medical history,endoscopic examination,treatment and follow-up were retrospectively enalyzed.Results Among 49 patients with gastric IFP (16 males and 33 females;average age 54 years) the maximum diameter of 33 cases (67.3％) was between 1.0 cm and 2.0 cm.Forty-eight cases had single lesion and one case had multiple lesions.The lesions of 17 cases (34.7％) were located at the anterior wall of gastric antrum,the lesions of seven cases (14.3％) were at the posterior wall of gastric antrum,the lesions of seven cases (14.3％) were at the lesser curvature of gastric antrum and the lesions of seven cases (14.3％) were at the great curvature of gastric antrum.Among the lesions of 41 patients who received endoscopic ultrasonography,28 lesions were located in the submucosa of stomach,13 lesions were located in mucosa and muscularis mucosa.The rate of misdiagnosis of endoscopic ultrasonography was 29.3％ (12/41).The endoscopic ultrasound findings of the lesions included 26 hypoechoic structures,11 hyperechoic structures and four slightly hypoechoic structures.The lesions of all the patients were successfully removed by endoscopic polypectomy without any complication.Thirty-seven lesions were treated by endoscopic submucosal dissection (ESD) and 12 lesions by endoscopic mucosal resection (EMR).All the patients were not clearly diagnosed before operation and were finally diagnosed by pathological examination.Postoperative pathological examination showed that in the suhmucosa and mucosa lamina propria,spindle-shaped cells proliferated and arranged in an interwoven pattern or cells around vessels or mucosal glands formed vortex-like or onion skin like pattern.Forty-seven patients were followed up and the median follow-up time was 31 months.All patients survived withont recurrence or metastasis until the submission of this paper.Conclusions The rate of misdiagnosis of gastric IFP is high before operation,and the diagnosis is depended on histopathological examination.Endoscopic resection is the first choice because the diameter of most lesions are less than 5 cm.

Caracterización clínico-endoscópica de pacientes con hemorragia digestiva alta, Hospital General Pedro Betancourt de Jovellanos / Clinic-endoscopic characterization of patients with upper gastrointestinal bleeding in the General Hospital Pedro Betancourt, Jovellanos

Introducción: la hemorragia digestiva alta es una de las emergencias más frecuentes en los servicios de urgencias. Su mortalidad promedio es del 10 por ciento. La etiología más común continúa siendo la úlcera péptica y es más frecuente en hombres y adultos mayores. Objetivo: caracterizar clínica y endoscópicamente a los pacientes con hemorragia digestiva alta atendidos en el departamento de Gastroenterología del Hospital General Pedro Betancourt en el período comprendido entre Enero del 2012 a Enero del 2013. Métodos: se realizó un estudio descriptivo prospectivo, se tuvieron en cuenta diferentes variables clínicas y endoscópicas como: edad, sexo, presentación clínica, tipo de lesión y clasificación de la hemorragia por úlcera; estas fueron representadas en tablas y gráficos por frecuencias absolutas y relativas. Resultados: de los 40 pacientes estudiados con una edad promedio de 57,3 años más o menos 13,5 años; predominó del sexo masculino (72,5 por ciento). La presentación clínica más frecuente fue la melena (65 por ciento). El principal hallazgo endoscópico fue la úlcera duodenal (45 por ciento) y la clasificación de la complicación hemorrágica de la úlcera más frecuente fue el sangrado reciente. Conclusión: la hemorragia digestiva alta continúa siendo una urgencia que se presenta con mayor frecuencia en pacientes mayores de 60 años, fue la úlcera gastroduodenal con estigmas de sangrado reciente el hallazgo endoscópico más común

Introduction: the upper gastrointestinal bleeding is one of the most common emergencies treated at the emergency services. Its average mortality rate reaches 10 per cent. The most common etiology is still the peptic ulcer, and it is more frequent in men and elder people.Objective: to characterize, clinically and endoscopically, the patients with upper gastrointestinal bleeding attended at the Department of Gastroenterology of the General Hospital Pedro Betancourt in the period from January 2012 to January 2013. Methods: it was carried out a descriptive- prospective study, taking into account clinical and endoscopic variables like age, gender, clinical presentation, endoscopic findings, kind of lesion and classification of the ulcer hemorrhage complication. The variables were represented in charts and pictures per absolute and relative frequencies. Results: a sample of 40 patients were enrolled with an average age of 57,3 plus or less 13,5 years. The predominant gender was the male one with 72,5 per cent. The most common clinical presentation was the melena (65 per cent). The main endoscopic finding was the duodenal ulcer (45 per cent) and the most frequent ulcer hemorrhagic complication was the recent bleeding. Conclusion: the upper gastrointestinal bleeding still remains as an urgency more frequently in male patients older than 60 years. The gastroduodenal ulcer with recent bled stigmas was the most common endoscopic finding

Hallazgos endoscópicos en pacientes con hemorragia digestiva inferior en el Hospital General del Oeste durante los años 2003-2008 / Endoscopic findings in patients with lower gastrointestinal bleeding in the Hospital General del Oeste during the years 2003-2008

La hemorragia digestiva inferior ocupa aproximadamente el 0.5% de todas las admisiones de corta estancia en los hospitales de lo estados Unidos. La incidencia de sangrado digestivo inferior es estimada en 20 a 27 casos por cada 100 mil adultos en la población de riesgos. Es más común en hombres que en mujeres. La mortalidad global oscila al 5 % según la causa. El objetivo de nuestro trabajo fue determinar los hallazgos endoscópicos más frecuentes en pacientes con hemorragia digestiva inferior en el servicio de gastroenterología del hospital General del Oeste. Se realizo una revisión retrospectiva de los hallazgos endoscópicos en pacientes mayores de 18 años que acudieron al servicio de Gastroenterología del Hospital General del Oeste entre diciembre del 2003 y diciembre del 2008 con el diagnostico de hemorragia digestiva inferior. Un total de 389 pacientes. De los cuales el55.7 %fueron del sexo femenino y 44.3 % del sexo masculino. Con una edad promedio de 53.2 años. El principal hallazgo endoscópico fue enfermedad diverticular con un 26. 9%, seguido de hemorroides internas y externas con un 26.4% y 12.8 % respectivamente. El 15.4 % de las endoscopias digestivas inferiores fueron normales. La hemorragia digestiva inferior en nuestro centro es más frecuente en mujeres, siendo el hallazgo endoscópico más común la enfermedad diverticular y la enfermedad hemorroidal en ambos sexo...

Lower gastrointestinal bleeding represents approximately 0.5% of all short-stay admissions in United States hospitals. The incidence of lower gastrointestinal bleeding is estimated at 20-27 cases per 100.000 adults in the risk population. It is more common in men than in women. The overall mortality ranges at 5% depending on the cause. The aim of our study was to determine the endoscopic findings in patients with lower gastrointestinal bleeding in Hospital General del Oeste. Methods: We conducted a retrospective review of endoscopic findings in patients older than 18 years-old who attended the Gastroenterology Service of Hospital General del Oeste between December 2003 and December 2008, with lower gastrointestinal bleeding diagnosis. A total of 389 patients. Of which, 55.7% were female and 44.3% male; with an average age of 53.2 years-old. Diverticulitis was the main endoscopic finding with 26.9%, followed by internal and external hemorrhoids with 26.4% and 12.8% respectively. 15.4% of lower gastrointestinal endoscopies were normal. The lower gastrointestinal bleeding in our hospital is more common in women, being diverticulitis and hemorrhoids the most common endoscopic finding, in either sex...

Hallazgos clínicos, endoscópicos e histológicos asociados a la infección por Helicobacter pylori considerando los genotipos CAG A y VAC A en pacientes con dispepsia: Servicio de Gastroenterología Hospital Central Universitario “Antonio María Pineda” Barquisimeto Estado Lara / Clinical, endoscopic and histological findings associated with helicobacter pylori infection considering genotypes CAG A and VAC A in patients with dyspepsia: Gastroenterology Department Hospital Central Universitario

La dispepsia afecta la calidad de vida de muchos pacientes y en muchos casos está asociada a la infección por Helicobacter pylori. Esta bacteria es reconocida como el agente causal de la gastritis crónica, se asocia al desarrollo de úlceras gástrica y duodenal y está relacionada con el desarrollo de cáncer gástrico. Como objetivo primario se planteó establecer los hallazgos clínicos, endoscópicos e histológicos asociados a la infección por Helicobacter pylori considerando los genotipos cag A y vac A en pacientes con dispepsia que acudieron al Servicio de Gastroenterología del Hospital Central Universitario “Antonio María Pineda”. Se trata de un estudio epidemiológico descriptivo de corte transversal. La población estuvo conformada por los pacientes con dispepsia que acudieron al servicio y el muestreo fue de tipo no probabilístico intencional, puesto que se tomó a la población que consultó con síntomas dispépticos y que cumplieron con los criterios de inclusión y exclusión establecidos. Dichos pacientes se interrogaron sobre síntomas dispépticos, se les realizó endoscopia digestiva superior, se describieron los hallazgos endoscópicos y se les tomó muestra para estudio histológico y de genotipificación. Se encontró una incidencia de infección por H. pylori de 98,5%, la infección predominó en el sexo femenino, los genotipos cag A positivos y las formas alélicas m1/s1 son los más frecuentes en la población estudiada y, los mismos se asocian con gastritis crónica, úlceras gástricas y metaplasia intestinal incompleta...

Dyspepsia affects quality of life for many patients and often is associated with Helicobacter pylori infection. This bacterium is recognized as the causative agent of chronic gastritis, is associated with development of gastric and duodenal ulcers and, with the development of gastric cancer. Primary objective was raised to establish the clinical, endoscopic and histological findings associated with Helicobacter pylori infection considering genotypes cag A and vac A in patients with dyspepsia who attended the Gastroenterology Service of Hospital Central Universitario “Antonio María Pineda”. This is a cross-sectional descriptive epidemiological study. The population consisted of patients with dyspepsia who attended the gastroenterology service. The sampling was intentionally non-probabilistic, since we only took the people who consulted with dyspeptic symptoms and met the established criteria of inclusion and exclusion. These patients were questioned about dyspeptic symptoms, underwent upper gastrointestinal endoscopy, endoscopic findings were described and samples were taken for histology and genotyping. We found an incidence of H. pylori of 98.5%, infection prevailed in females, the genotypes cag A positive and m1/s1 allelic forms are most frequent in the population studied and, the same is associated with chronic gastritis, gastric ulcers and intestinal metaplasia incomplete...

Hallazgos endoscópicos en poblaciones chilenas aisladas: Isla de Pascua y Chile Chico / Endoscopic findings in isolated chilean populations: Isla de Pascua (easter island) and Chile Chico

Chile is a country with high incidence of gastrointestinal diseases, but there are Chilean populations without access to an expeditious endoscopic diagnosis. Easter Island (3.791 inhabitants) and Chile Chico (3.042 inhabitants). Objective: To describe and compare the endoscopic findings in two subgroups of Chilean population of Easter Island (Isla de Pascua) and Chile Chico. Methods: Endoscopic procedures were performed on selected subgroups from Isla de Pascua and Chile Chico during October 2008 and March 2009, in the context of health operations conducted by our hospital. Results: Seventy two patients were evaluated in Isla de Pascua and 52 in Chile Chico. The most frequent endoscopic indications in Isla de Pascua were epigastric pain (22%), heartburn (18.2%), and gastroesophageal reflux (16.2%) and in Chile Chico: gastroesophageal reflux and pirosis (36,5%), epigastric pain (19,3%), and previous gastric ulcer (5.7%). Endoscopic findings in Isla de Pascua and Chile Chico were: gastritis, 26 patients (36.1%) and 5 (9.6%); peptic ulcer 2 (2.7%) and 9 (17.2%); esophagitis 10 (13.8%) and 6 (11.5%); hiatal hernia, 9 (12.5%) and 11 (21%); and endoscopy without lesions 20 (27%) and 13 (25%), respectively. Comparing the findings in both groups the occurrence of two advanced cancers stands out (gastric and esophageal) in the population of Chile Chico; no neoplastic diseases were found in Isla de Pascua. Conclusion: The endoscopic findings in a subgroup of Chileans belonging to isolated populations are described. Differences in the type of digestive diseases suggest that these are different populations despite sharing the same nationality. Future operations will provide a better understanding of these conditions.

Introducción: Chile es un país con alta incidencia de patología digestiva, sin embargo, existen poblaciones chilenas que por situación geográfica no cuentan con acceso expedito a un diagnóstico endoscópico. Objetivo: Describir los hallazgos endoscópicos en dos subgrupos de población chilena de Isla de Pascua y Chile Chico y compararlos entre sí. Métodos: Se realizaron procedimientos endoscópicos a subgrupos seleccionados en Isla de Pascua y Chile Chico en los meses de octubre de 2008 y marzo de 2009, en el marco de los operativos de salud realizados por nuestro Hospital. Resultados: Se evaluaron 72 pacientes en Isla de Pascua y 52 en Chile Chico. Las indicaciones endoscópicas más frecuentes en Isla de Pascua son epigastralgia (22%), pirosis (18,2%) y control de reflujo gastroesofágico (16,2%) y en Chile Chico: reflujo gastroesofágico y pirosis (36,5%), epigastralgia (19,3%) y antecedente de úlcera gástrica (5,7%). Los hallazgos endoscópicos en Isla de Pascua y Chile Chico respectivamente son: gastritis 26 pacientes (36,1%) y 5 (9,6%), úlcera péptica 2 (2,7%) y 9 (17,2%), esofagitis 10 (13,8%) y 6 (11,5%), hernia hiatal 9 (12,5%) y 11 (21%), sin lesiones 20 (27%) y 13 (25%). Al comparar los hallazgos en ambos grupos destaca la presencia de dos cánceres avanzados (gástrico y esofágico) en la población de Chile Chico, sin encontrarse patología neoplásica en Isla de Pascua. Conclusión: Se describen los hallazgos endoscópicos en un subgrupo de chilenos pertenecientes a poblaciones más aisladas. Las diferencias en el tipo de patologías pesquisadas sugiere que se trata de poblaciones diferentes pese a compartir una misma nacionalidad. La realización de futuros operativos permitirá obtener un mayor conocimiento de las patologías más prevalentes en dichas poblaciones y evaluar la influencia de las...

Infestación de mucosa gástrica por Strongyloides Stercoralis y su correlación con hallazgos endoscópicos: presentación de un caso clínico y revisión

La Estrongiloidiasis es una parasitosis intestinal de distribución mundial, generalmente paucisintomática que puede producir ocasionalmente cuadros intestinales severos, así como enteritis invasiva e hiperinfección en pacientes inmunosuprimidos e inmunocompetentes. La biopsia gástrica y duodenal es poco empleada, su sensibilidad aumenta en la hiperinfección (hasta un 90%), aún si se compara con los métodos coprológicos convencionales, por lo que la endoscopia puede ser considerada como un marcador de severidad, permitiendo establecer el diagnóstico y las características endoscópicas de las lesiones en el tracto gastrointestinal. El presente caso trata de paciente masculino de 52 años, quien consultó por dolor epigástrico, concomitantemente flatulencias y eructos fétidos, nauseas, vómitos y diarreas líquidas autolimitadas. Examen físico: dolor en marco colónico izquierdo y epigastrio. Hallazgos paraclínicos de eosinofilia, se realiza endoscopia que reporta: Gastropatía Antral Nodular y biopsia con diagnóstico de infestación gástrica por Ss. Se indica tratamiento con Albendazol 400mg/d por 3 días, mejorando la sintomatología. La infestación por Ss en mucosa gástrica es un hallazgo infrecuente.

Strongyloidiasis(Ss) is an intestinal parasitosys of global distribution, usually causing few symptoms although can occasionally cause severe intestinal manifestations, as well as invasive enteritis and hyperinfection in immunosuppressed and immunocompetent patients. Gastric and duodenal biopsies are rarely used, their sensitivity increases in the presence of hyperinfection (up 90%), even when compared with the conventional coprologic methods, so endoscopy can be seen as a marker of severity, allowing to establish the diagnosis and characteristics of lesions in the gastrointestinal tract. The following case is about a 52-year-old male with epigastric pain, flatulence and belching, nausea, vomiting and acute watery diarrhea. At physical examination there was pain at the epigastrium and left hemiabdomen. Para - clinical findings revealed eosinophilia; endoscopy report: Antral Nodular gastropathy with the biopsy reporting Ss gastric infestation. Treatment with Albendazole 400mg / d for 3 days was indicated, improving the symptoms. Gastric mucosal infestation by Ss is a rare finding.

The Usefulness of the Endoscopic Findings for Predicting Depth of Invasion in Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) has been used as a treatment for early gastric cancer (EGC). This study was performed to evaluate the usefulness of the endoscopic findings for diagnosing the depth of invasion in EGC patients. METHODS: We retrospectively analyzed the endoscopic findings of 558 EGC patients who were diagnosed after gastrectomy, EMR or ESD at Dong-A University Hospital between 2000 and 2006, and we divided them into two groups (the mucosa group versus the submucosa group). Nine factors were assessed (Type I or IIa: surface color, surface irregularity, the Yamada type and pitting on the apex; Type IIb: surface color, surface irregularity and marginal definiteness: Type IIc or III: ulcer base irregularity, shape of the converging folds, center of the converging folds and marginal elevation). The tumor size and histologic type were assessed for all the EGCs. RESULTS: Ulcer base irregularity (p=0.005), marginal elevation (p=0.001), and the shape of the converging folds (p=0.018) showed significant correlation with the depth of invasion in type IIc or III EGCs. Tumor size ( <2 cm) showed a significant correlation with mucosal invasion for all the EGCs. CONCLUSIONS: These results support the usefulness of the endoscopic findings for making the therapeutic decision for performing EMR or ESD through predicting the depth of invasion of EGCs.

Clinical Characteristics and Endoscopic Findings of Impacted Papillary Stone / 대한소화기내시경학회지

BACKGROUND/AIMS: Impacted papillary stone (IPS) may lead to complete biliary obstruction and acute cholangitis. We evaluated clinical characteristics and endoscopic findings of IPS. METHODS: Data were obtained from patient recordings, radiologic and endoscopic reports in 14 patients. RESULTS: All patients had severe epigastric pain, but only 3 patients showed typical presentation of acute cholangitis. Radiologically, IPS was not found in 6 patients, but subsequently found as be a single IPS (n=5) and sandy stones filled in the bile duct and gallbladder (n=1). All patients showed a bulging and swollen papilla. Patients (n=9) without peripapillary diverticulum, or with extradiverticular papilla showed more posteriorly displaced papillary orifice and more frequent mucosal changes compared with patients (n=5) with intradiverticular papilla or juxtapapillary diverticulum. The stones were completely removed in 11 patients endoscopically, and the remainders, who had intradiverticular papilla, underwent surgical treatment. CONCLUSIONS: To predict IPS, clinical assessment is very important because the only characteristic manifestation is severe epigastric pain and radiological studies seem to be occasionally insufficient for detecting IPS. The characteristic endoscopic findings of IPS are bulging and swollen papillae with posterioriy displaced orifice and frequent mucosal changes, which may be influenced by presence or absence, and types of peripapillary diverticulum.

Relationship between Esophageal Lesions Observed by Endoscopy and Nasogastric Intubation: A Study of 185 Cases of Percutaneous Endoscopic Gastrostomy / 대한소화기학회지

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a method widely used for long-term enteral nutrition in dysphagia. Mostly, it is preceded by nasogastric intubation (NI) for short-term enteral nutrition; endoscopic findings associated with NI are encountered during PEG. The purpose of this study was to discuss such findings and to delineate a relationship between these findings, especially esophageal lesions and the duration of NI. METHODS: This study involved 185 individuals who had undergone PEG at Kyung Hee Medical Center from January 1999 to May 2002. The medical records were examined retrospectively. RESULTS: The dysfunction of the CNS comprised 98.4% of the causes of dysphagia. The duration of NI was 15.2 weeks on average, with median value of 8.7 weeks, indicating that PEG was performed relatively soon. Endoscopic findings revealed esophagitis in 63 cases, esophageal ulcers in 27 and active bleedings in another 10. The incidence of esophageal lesions was shown to be higher in subjects with duration of NI under 12 weeks than in those with duration over 12 weeks (p=0.032). CONCLUSIONS: PEG was carried out in many cases during the early stages of dysphagia, and NI-associated esophageal lesions appeared to be more prevalent within 12 weeks of NI duration. These results may be of help in deciding the timing of PEG.

Two Cases of Extended Endoscopic Sphincterotomy in Patients with Periampullary Diverticulum -How do we estimate the upper margin of intramural ampulla in patients with periampullary diverticulum?- / 대한소화기내시경학회지

Periampullary diverticulum (PAD), which was frequently noticed during endocopic retrograde cholangiopancreatography (ERCP) for examination on patients with pancreaticobiliary diseases, made difficult to cannulate the duct and to perform the endoscopic sphincterotomy (EST). EST was very useful therapeutic modality for pancreaticobiliary disease, but endoscopists are always careful about EST-related complication, especially in patients with PAD. The general principle of EST was not to incise extendedly above the papillary roof, but the following endoscopic findings help to try the extended EST safely above the papillary roof. On the endoscopic examination there was reducible protrusion above papilla by contrast injection or air deflation, which had bile-colored transparency and arborescent capillary network in the usual direction of the bile duct. We have recently experienced 2 cases of extended EST in patients with PAD, who showed the endoscopic findings mentioned above and recovered without bleeding or perforation.

Endoscopic Findings of Acute Gastric Anisakiasis: Thirty-nine cases in Inchon City / 대한소화기내시경학회지

BACKGROUND AND AIMS: When acute gastric anisakiasis is clinically suspected, endoscopic removal of larva is the only definite treatment method. However, there has been little known for endoscopic findings of gastric anisakiasis. METHODS: In 39 patients with gastric anisakiasis, the ingested species of marine products and clinical findings were investigated. The form of larvae, the mucosal changes of the insertion site, close and distant area were also analysed during endoscopic examination. RESULTS: Twelve patients (30.8%) ate raw Astroconger myriaster solely, and the most frequent mucosal insertion site of larvae was around the greater curvature of the body (59.5%). Endoscopic findings of erosion (33.3%), hemorrhagic erosion (33.3%) and redness of the mucosa (11.9%) were observed at the insertion site. The adjacent mucosal changes were edema and fold enlargement. All patients were treated medically. CONCLUSIONS: When acute gastric anisakiasis is suspected, the careful endoscopic examination of larva was necessary for confirmatory diagnosis and definite treatment of the disease.

The Endoscopie Findings of Superficial Flat Type Early Gastric Cancer (EGC IIb) / 대한소화기내시경학회지

Early gastric cancer(EGC) has been proved to be a malignant tumor with favorable prognosis in contrast to the advanced one, thus early diagnosis has always been the emphasis regardless its type. In particular, diagnosis of superficial flat type EGC(IIb) is extremely difficult on gross inspection. The aim of this study is to review the clinical features of the patients with EGC type IIb, with special reference to the endoscopic appearance of tumor. We reviewed the medical records and endoscopic findings of 13 patients which were thereafter surgically resected and pathologically proven EGC type IIb at SNUH from 1989 to 1993. The depressed lesion was observed most frequently in EGC type IIb. The endoscopic suggestion of EGC type IIb were given initially with mucosal bleeding and discoloration. In 3 cases (20%), tumor extended to the submucosa and in only 1 case, lymph node metastasis was found. Four patients(30.9%) had another coincidental EGC or peptic ulcer. Every possible effort is needed not to omit the resectable cancer when the mucosal bleeding and discoloration is observed. Careful observation is recommended not to overlook coincidental lesions.