Significance of Non-erosive Minimal Esophageal Lesions in Gastro-esophageal Reflux Disorder

BACKGROUND: Non-erosive reflux disorder, which represents more than 60% of gastro-esophageal reflux disorders, lacks objective parameters for diagnosis. The purpose of this study was to evaluate the correlation between non-erosive minimal lesions at the lower esophagus and gastro-esophageal reflux disorder. METHODS: Patients were asked to answer a symptom questionnaire. The endoscopic findings were either graded by LA classification or recorded as non-erosive minimal lesions. Patients with minimal lesions were treated with rabeprazole or a placebo and responses were evaluated at weeks 1 and 4. RESULTS: In 8 centers, 3454 patients were screened. In patients with heartburn or acid regurgitation as the most bothersome symptom, 23.7% had endoscopy negative reflux disorder, 40.1% showed minimal lesions, and 36.2% had mucosal break esophagitis. Thirty-four percent of patients with minimal lesions and 39.1% of patients with LA 'grade A' mild esophagitis reported typical reflux symptoms as their main symptom. In patients with minimal lesions, medication with rabeprazole reduced symptoms significantly at weeks 1 and 4, but not with the placebo. CONCLUSION: Patients with non-erosive minimal esophageal lesions had similar reflux symptoms comparable to those with mild erosive reflux esophagitis, and reflux symptoms were improved with a short-term proton pump inhibitor. Thus, non-erosive minimal esophageal lesion constitutes a great part of gastro-esophageal reflux disorder.

Significance of rectosigmoid polyp as a predictor of proximal colonic polyp

The association between rectosigmoid polyps and polyps in the more proximal colon is still a matter of debate, and the need for colonoscopy in patients with rectosigmoid polyps that are detected by flexible sigmoidoscopy is controversial. The aim of this study was to determine whether or not certain characteristics of rectosigmoid polyps are associated with the presence and characteristics of proximal colonic polyps. Seven hundred and twenty-eight patients who underwent total colonoscopy between October 1995 and June 1998 and who had colorectal polyps were retrospectively analyzed. Patients with inflammatory bowel diseases, familial adenomatous polyposis, or any advanced cancer were excluded. The odds ratio (OR) and 95% confidence interval (CI) of prevalence of proximal colonic polyps according to the patients age and sex, as well as the characteristics of rectosigmoid polyps, were calculated. Advanced adenoma was defined as an adenoma larger than 10 mm or an adenoma of any size with villous component, high-grade dysplasia or invasive carcinoma. Among 728 patients with colorectal polyps, 356 patients (48.9%) had polyps only in the rectosigmoid region, 193 patients (26.5%) had polyps only in the proximal colon, and 179 patients (24.6%) had polyps in both the rectosigmoid and proximal colon. In 535 patients with rectosigmoid polyps, the prevalence of proximal colonic polyps, neoplastic polyps and advanced adenomas were 33.4%, 27.3% and 2.9%, respectively. The prevalence of proximal colonic polyps in patients with rectosigmoid polyps was found to be significantly related to the male gender and elderly patients, in addition to the neoplastic histology of the rectosigmoid polyps. However, the prevalence of the proximal colonic polyps was not related to the size, number and shape of rectosigmoid polyps. In 179 patients with both rectosigmoid and proximal colonic polyps, the characteristics of proximal colonic polyps such as size, number and shape were similar to those of rectosigmoid polyps. We recommend total colonoscopic examination in all patients with rectosigmoid adenomas, regardless of the size, number, and shape, especially in elderly males.

A Comparison of Endoscopic Ultrasonography with Transabdominal Ultrasonography of Water-Filled Stomach in the Accuracy of Staging of Gastric Cancer / 대한소화기내시경학회지

BACKGROUND AND AIMS: There was no single method satisfying accuracy, patient compliance and cost in preoperative staging of gastric cancer. A transabdominal ultrasonography of water-filled stomach (TUS) was compared with endoscopic ultrasonography (EUS) for TN staging in operated gastric cancer. METHODS: We performed EUS conventionally and TUS immediately after 600 mL deaerated water ingested in 40 patients with gastric cancer prior to operation. All the cases were operated and the histological findings were compared with the results of preoperative TN staging. RESULTS: The overall T-staging accuracy rate of TUS was 62.5% and 55.0% for EUS. Both TUS and EUS could differentiate EGC from AGC in 85.0%. There was no statistical difference in the accuracy for the depth of cancer invasion between EUS and TUS. Differentiation of the cancer defined within the gastric wall (T3) from the cancer invading adjacent organs (T4) was possible in 92.5% for TUS and 87.5% for EUS. The accuracy of determining the depth of invasion was tent to be lower in fundus than in antrum and body. Lymph node metastasis was correctly diagnosed in 67.5% for TUS and in 70.0% for EUS. CONCLUSIONS: TUS may be a considered to be a relatively accurate and simple method for preoperative staging of gastric cancer in the absence of available EUS.

Factors Affecting Insertion Time during Colonoscopy / 대한소화기내시경학회지

BACKGROUND AND AIMS: The goal of this study was to examine whether certain variables are associated with insertion time during colonoscopy. METHODS: A total of 703 consecutive subjects underwent colonoscopy by a single endoscopist from April of 1998 to August of 1998. The insertion time during colonoscopy was checked and the factors that may affect insertion time were analyzed. RESULTS: The indications for colonoscopy were bowel habit change (34.8%), the diagnosis of and follow up for colonic neoplastic disease (31.6%), abdominal pain (22.8%), thin stool caliber (19.2%), hematochezia (16.1%), routine examination (10.7%), inflammatory bowel disease (9.4%), tenesmus (8.8%) and a family history of colonic disease (3.1%). Of 703 subjects, complete colonoscopy was possible in 678 (96.4%). Reasons for incomplete insertion included inadequate bowel cleaning (n=11), pain (n=6), a history of operations (n=3), and others (n=5). Therefore, the adjusted completion rate was 97.9% (678/692). The mean insertion time in complete colonoscopy was 7.07 4.26 min (range; 2~35 min). Multivariable analysis revealed that inadequacy of bowel preparation was significantly associated with prolonged (>10 min) insertion time (p=0.005), whereas the history of colorectal resection was inversely associated with prolonged insertion time (p=0.010). CONCLUSIONS: Among the factors affecting insertion time during colonoscopy, cleanness of the bowels is the only correctable factor.

A Case of Primary Systemic Amyloidosis Presenting Submucosal Hematoma and Bleeding in the Lower Gastrointestinal Tract / 대한소화기내시경학회지

A case of systemic amyloidosis involving the upper and lower gastrointestinal tract is presented. The initial manifestation of this case was bloody diarrhea. On colonoscopy, multiple submucosal hematomas and irregular ulcerations of the sigmoid and descending colon were found. The pathologic diagnosis was confirmed by an endoscopic mucosal biopsy of the gastrointestinal tract and the specimen revealed massive amyloid deposits in the wall of the upper and lower intestinal tract. With intensive medical treatment, the submucosal hematoma disappeared and the ulcerations decreased in size. However, on the 29th day, the patient was expired due to unexpected sepsis.

Dieulafoy's Disease of Upper Gastrointestinal Tract: Clinical Features and Endoscopic Treatment / 대한소화기내시경학회지

BACKGROUND AND AIMS: Dieulafoy' s disease is an uncommon cause of recurrent massive gastrointestinal bleeding. The bleeding results from abnormally large submucosal artery , usually located on proximal stomach. Endoscopic examination reveals a small mucosal defect with an isolated protruding vessel without associated ulcer. Endoscopic treatment had recently been attempted to control the bleeding from these lesions. METHODS: The clinical and endoscopic characteristics of 51 patients with gastrointestinal bleeding due to Dieulafoy' s disease were retrospectively analysed from January 1991 to July 1997 and the efficacy of endoscopic therapy of Dieulafoy' s disease was evaluated. RESULTS: The mean age was 51.2 +/-16.2 (Mean +/-SD, range: 19-80) years and male predominance (4.7 : 1) was observed. Symptoms included: melena (45.1%); hematochezia (31.4%); melena and hematochezia (23.5%). The mean hemoglobin value was 7.5 +/-2.1 g/dL. The mean transfusion requirement was 12.4 +/-13.2 blood units. The diagnosis was made at initial endoscopy in 72.5%. The lesion located in proximal stomach (49.0%), in mid/distal stomach (25.5%) and in duodenum (25.5%) in order. Endoscopic therapies included fibrin glue injection (FG) in 16 patients, hypertonic saline-epinephrine (1 : 1,000) injection (HSE) in 15 patients, HSE+FG in 14 patients and others in 6 patients. Overall, endo-scopic trreatment was successful in achieving hemostasis in 38 (74.5%) patients; FG in 14/16 (87.6%), HSE in 12/15 (80.0%), FG HSE in 9/14 (64.3%). There was no significant difference in success rate among the endoscopic treatment modalities. Nine patients had to be operated despite the endoscopic treatments, and four patients died due to the causes other than gastrointestinal bleeding. CONCLUSIONS: Endoscopic therapy of upper gastrointestinal Dieulafoy' s disease is effective and should be employed before the surgical intervention.

A Case of Multiple Biliary Papillomatosis with Focal Adenocarcinoma / 대한소화기내시경학회지

Multiple biliary papillomatosis are extremely rare, fifty one cases have been reported in the literature. Clinical symptoms are associated with obsructive jaundice and cholangitis. Malignant transformation into adenocarcinoma had been described. We report a case of multiple papillomatosis in the entire biliary ductal system with malignant transformation, in which endoscopic retrograde cholangiopancreatography and peroral choledochoscopy showed multiple polypoid lesicons. The endoscopic sphincterotomy and the intraductal biopsy confirmed the histologic diagnosis of multiple papillomatosis and adenocarcinoma.

Diversion Colitis: Diversion Colitis A case report

Pseudomyxoma peritonei may result from implantation of benign or malignant tumor in peritoneal cavity and is filled with gelatinous material (termed "Jelly Belly") in abdominal cavity. Its origin is usually an appendiceal or ovarian mucinous adenoma or cystadenocarcinoma, but other primary origin such as uterus, intestine, pancreas and stomach umor have been reported. Generally, pseudomyxoma peritonei is slowly progressive and has low grade malignant potential. This report presents a unusual long term survival after evacuation of 15,000 cc of gelatinous material from abdominal cavity which was the low grade mucinous adenocarcinoma and a review of the current literature, management and new its concept. The origin of pseudomyxoma peritonei of this case was most likely from appendiceal mvcinous adenocarcinoma.

Clinical Significance of Anomalous Pancreaticobiliary Ductal Union Diagnosed by Endoscopic Retrograde Cholangiopancreatography / 대한소화기내시경학회지

To evaluate the clinical significance of anomalous pancreaticobiliary ductal union(PBDU), we analysed 11 cases(0.19%) of anomalous PBDU among 5675 cases performed ERCP from Jan. 1973 to Aug. 1992. According to the classification of Kimura et al., 4 cases were type 1(P-C union) and 7 cases type 2(C-P union). The length of common channel ranged from 1.5 cm to 3.1 cm(mean 1.9 cm). The common associated disease were choledochal cyst(7 cases), carcinoma of the gallbladder(5 cases) and biliary stone(3 cases). Four cases of carcinoma of the gallbladder were type 1. The incidence of anomalous PBDU was significantly higher in cases with carcinoma of the gallbladder(5 cases among 49 cases) than in case without carcinoma of the gallbladder(6 cases among 5626 cases). And the incidence of gallbladder carcinoma(45%) among the 11 cases of anomalous PBDU was significantly higher than that(0.78%) among those who did not have anomalous PBDU. In conclusion, the common associated diseases with the anomalous PBDU were choledochal cyst, carcinoma of the gallbladder and stone, and the anomalous PBDU may be risk factor in the development of carcinoma of the gllbladder.

The changing patterns of liver abscess during the past 20 years: a study of 482 cases

The diagnostic and treatment modalities of liver abscess have developed rapidly over the past few years but morbidity and mortality has not been markedly reduced. A total of 482 cases of liver abscess admitted to the Yonsei Medical Center over the past 20 years (Jan. 1971-Dec. 1990) were divided into 261 cases from the 1970s and 221 cases from the 1980s and the clinical and laboratory parameters were analyzed comparatively to determine if the clinical features, therapies and prognosis of liver abscess had changed. The proportion of amebic relative to pyogenic liver abscess decreased. Transbiliary infections increased in pyogenic liver abscess of the 1980s. Clinical signs such as jaundice and hepatomegaly and symptom duration before admission decreased. Abnormal laboratory features including hypoalbuminemia and elevation of alkaline phosphatase decreased and increased, respectively, in the 1980s. Ultrasonically guided percutaneous aspiration was the choice of treatment instead of surgical drainage in the 1980s. Despite diagnostic and therapeutic advances in the management of liver abscess, the prognosis has not improved in the 1980s as compared to the 1970s. This may reflect an increase in the incidence of liver abscess in old aged patients and patients with diabetes mellitus or underlying malignancy in the 1980s.

A Case of Lymphangioma of the Large Intestine Removed by Colonoscopic Polypectomy / 대한소화기내시경학회지

Lymphangioma occuring in the gastrointestinal tract is a rare benign tumor, which is composed of lymphatic vessels of various size. A sharply demarcated smooth, soft, cystic submucosal tumor which is easily compressible and covered with normal mucosa is a characteristic eadoscapic feature. Recently, we experienced a case of lymphangioma in ascendmg colon and removed it successfully by colonoscopic snare polypectomy.

Obstructive Jaundice Caused by the Fragment of Hepatocellular Carcinoma in the Common Hepatic Duct Confirmed by Peroral Choledochoscopy / 대한소화기내시경학회지

The causes of jaundice in patients with hepatocellular carcinoma are usually attributed to the underlying liver diseases or extensive hepatic destruction by tumor. Obstructive jaundice by the intraluminal tumor fragment of intrahepatic and/or extrahepatic bile duct in hepatocellular carcinoma is exceedingly rare and usually diagnosed by operation or autopsy. Recently, we observed a patient in whom the fragment of tumor from the primary hepatocellular carclnoma obstructed the common hepatic duct, which was confirmed by peroral choledochoscopy. Using peroral choledochoscopy. we could see the mass located at the common hepatic duct and diagnose histologically by cytologic examination of aspirated material of common bile duct. We describe here this rare case with review the literature on primary hepatocellular carcinoma with jaundice caused by biliary obstruction.

Treatment of refractory exit-site infection with externalization of external cuff of CAPD catheter / 대한신장학회잡지

No abstract available.