Icteric Type Hepatocelluar Carcinoma for Which Cholangioscopic Ethanol Injection Was Effective / 대한소화기내시경학회지

Hepatocellular carcinoma often invades the portal or hepatic veins, but rarely proliferates in the bile duct. Since curative resection is rarely possible in these cases, conservative therapy has been the sole modality. Herein, we report a case of icteric type hepatocellular carcinoma for which cholangioscopic ethanol injection was effective. By only transcatheter arterial chemoembolization in this patient, obstructive jaundice and intermittent cholangitis were not relieved. Therefore, we performed ethanol injection into the intraductal hepatoma mass under percutaneous transhepatic cholangioscopic guidance. As a result of therapy, he had been well without jaundice and cholangitis for 9 months until die.

The diagnostic course of ulcerative colitis in Korea / 대한내과학회지

BACKGROUND: In Korea, the incidence of ulcerative colitis has been very low, but there are few epidemiologic studies about ulcerative colitis. The aim of the present study is to obtain basic epidemiologic information about the diagnostic course of ulcerative colitis in Korea. METHODS: The diagnostic course and methods of 150 patients with ulcerative coltis were analyzed by standard questionnaire and interview. RESULTS: The median time between the onset of symptoms and diagnosis was 5 months (2 weeks-10 years). The initial diagnosis made at the institution first visited was ulcerative colitis in 31.3%, hemorrhoid in 16.7%, dysentery in 8.7%, irritable bowel syndrome in 9.3%, enteritis in 12.0%, and others in 22.0%. The diagnostic rate of ulcerative colitis among institutions was 13.0% in clinics (14/108), 28.6% in hospitals (8/28), 47.9% in general hospitals (23/48), and 83.3% in academic medical centers (105/126). Among 39 patients who have received both barium study and endoscopic evaluation at the time of diagnosis at Asan Medical Center, the overall sensitivity of barium study was 76.9% (30/39) (p=0.001). Depending on the extent of the disease, the diagnostic sensitivity of barium study was 50.0% in proctitis (5/10), 69.2% in left-sided colitis (9/13), and 100% in extensive colitis (16/16). CONCLUSION: For early detection of ulcerative colitis, it should always be considered in the differential diagnosis of rectal bleeding, and sigmoidoscopy or colonoscopy is preferred to barium study for evaluation of patients with mild symptoms. We suggest that endoscopic procedures are necessary to get more accurate epidemiologic data.

A Case of a Pancreaticobiliary Fistula Accompanied by Pancreatic Duct Stones / 대한소화기내시경학회지

A Pancreaticobiliary fistula is a rare complication of acute necrotizing pancreatitis or pancreatic abscess. One case is herein reported of pancreaticobiliary fistula that was found following removal of pancreatic duct stones by extracorporeal shock-wave lithotripsy and endoscopic sphincterotomy. The patient was a 53-year old woman who was admitted with epigastric pain and fever. Endoscopic retrograde pancreatography revealed multiple stones in the main pancreatic duct. Pus from the pancreatic duct was drained through the major papilla during cannulation. On balloon cholangiogram obtained after removal of the stones, a direct fistulous connection between the main pancreatic duct and distal common bile duct was noted. It is speculated that pancreatic abscess or mechanical compression of pancreatic duct stones may contribute to the destruction of the intrapancreatic bile duct, which leads to the formation of a pancreaticobiliary fistula.