A Prospective Endoscopic Blind Trial Comparing Precolonoscopy Bowel Cleansing Methods / 대한소화기내시경학회지

BACKGROUND AND AIMS: Although some authors have suggested that sodium phosphate (NaP) is more effective than polyethylene glycol (PEG) in bowel cleansing, there has been no crossover study proving the superiority of NaP over PEG in bowel cleansing and patients' compliance. The aim of this study was to compare the two solutions for colonoscopy, PEG and NaP, through crossover design with regard to patients' compliance, cleansing ability and side effects. METHODS: Thirty patients underwent two separate colonoscopies for colonic polyp(s) with PEG and NaP, respectively. Before and after bowel preparation, blood pressure, body weight, and serum biochemical parameters were measured in all patients. In addition, a detailed questionnaire was used to assess side effects and the patients' preference. The presence of bubbles, types of residual stool, and overall quality of colon cleansing were assessed by one endoscopist blinded to the type of preparation used. In each colonoscopy, two biopsy specimens were taken at rectum. RESULTS: In the NaP group, but not in the PEG group, there were significant changes in several biochemical parameters including sodium ( +3.0 +/- 3.0 mEq/L), potassium ( -0.3 +/- 0.3mEq/L), calcium ( -0.5 +/- 0.5 mg/dL), phosphorus ( +3.9 +/- 2.2 mg/dL) and osmolarity ( +10.1 +/- 9.3 mOsm/kg) after bowel preparation. In addition, the degree of body weight change was greater with NaP ( -2.2 +/- 2.3 kg) than with PEG ( -1.2 +/- 2.0 kg) (p=0.06) and the formation of bubbles that disturb luminal observation was more frequently found in the NaP group (p<0.01). There was no difference, however, in the type of residual stool and the overall quality of bowel preparation between the two groups and no significant mucosal change was noted after bowel preparation in both groups. Moreover, PEG was found to be more difficult to take than NaP (p<0.05) and among the 30 patients, 26 (87%) preferred NaP, while only two favored PEG (p<0.01). CONCLUSIONS: We conclude that NaP can replace PEG at least in patients with good general condition. Further studies to decrease the incidence of bubbles and to establish subgroups suitable for NaP are needed.

A Case of Intraabdominal Sparganosis Presenting as Submucosal Tumor on Gastroscopy / 대한소화기내시경학회지

Sparganosis in humans is caused by migrating larvae of the cestode Spirometra. Humans are considered the second intermediate host that are incidentally infected. Sparganosis usually infestates the subcutaneous tissues and visceral organs have rarely been reported to be involved. A case is herein reported however, a 67-year old female patient with sparganosis in the gastric wall and perigastric region, presented as a submucosal tumor upon gastrofiberscopy. The diagnosis was made after surgery by the pathologic findings determining a characteristic degenerated Sparganum and multiple tunnel-shape cavities surrounded by many inflammatory cells and necrotic materials.

The Frequency of Phasic Wave Confraction is Variable during Long - Term Sphincter of Oddi (SO) Manometry / 대한소화기내시경학회지

Objectives: The sphincter of Oddi(SO) manometry via transpapillary route is performed usually for a period of several minutes. To investigate whether there is a considerable variation in the manometric measurements of SO over a longer period of time, we have performed long-term manometry of SO via transpapillary(n=5) as well as percutaneous(n=7) route. Methods: Transpapillary manometry of SO was carried out by conventional low- compliant continuously perfused techni~que. The location of the manometric catheter was maintained at the same level by observing the video monitor. SO manometry and the duodenal migrating motor complex(MMC) was simuitaneously measured with specially designed catheter via pereutaneous route. Results: The mean recording time was 41 minutes(range 11-72 minutes). The frequency of phasic contractions of SO varied from 0 to 12/min. Throughout the whole recording period, high-frequency contractians(over 8/min) were noted in 14.9 % of the time. In the eases of percutaneous transductal SO manometry, the periods of high-frequency contractions coincided with the phase III of duodenal MMC. The interval between the first high-frequency contractions and the second was 47 minutes. The mean duration of high-frequency contractions was 6 minutes and 4~2 seconds. There as no significant change in the amplitude, basal pressure and contraction sequence among the various periods of frequencies. Conclusions: Long-term continuous recording of SO manometry via transpapillary and percutaneous route showed that the contraction frequency of SO was not constant and tachyoddia appearde periodically. In the interpretation of tachyoddia, it is necessary to consider the period of phase III of the duodenal MMC.

Application of Peroral Cholangioscopy in Biliary Diseases / 대한소화기내시경학회지

Retrograde transpapillary cholangioscopy can be safely performed by use of a mother-baby-scope system after endoscopic sphincterotomy. Improved endoscopes are now available and may lead to a better acceptance of this technique. Cholangioscopy is complementary to cholangiography for differential diagnosis of various types of bile duct lesions. From march 1992 to September 1994, we performed 15 cases of peroral cholangioscopy for evaluation of bile duct lesions. Indications of peroral cholangioscopy were 6 cases of benign biliary diseases and 9 cases of malignant biliary diseases. In benign diseases, two cases of extrahepatic bile duct stones, 1 case of intrahepatic duct stone with stricture, 2 cases of benign elevated lesions of bile duct and 1 case of occluded expandable metallic stent were involved. In malignant diseases, 7 cases of primary bile duct cancer, 2 cases of hepatocellular carcinoma with bile duct invasion were involved. By use of peroral cholangioscopy with biopsy, differential diagnosis of bile duct lesion was possible. As a complication, severe abdominal pain and hypotension was developed in one case during the procedure and in another case, cholangitis was developed after the procedure. In conclusion, peroral cholangioscopy is a safe and useful procedure in various types of biliary diseases especially in the differential diagnosis of malignancy.