2 Cases of Endoscopic Ligation Therapy of a Dieulafoy Ulcer / 대한소화기내시경학회지

A dieulafoy ulcer is rarely recognized but is not an uncommon cause of massive, recurrent and frequently fatal gastrointestinal bleeding resulting from the erosion of an unusually large submucosal artery. Although the lesion has been predominantly found in the proximal stomach, it has also been detected throughout the gastrointestinal tract. Diagnosis can be made by observation of protruding and eroded arteries with pulsatile bleeding, or through detection of an adherent thrombus using an endoscopy. In the past, surgical intervention was believed to be the best treatment, but currently, therapeutic endoscopy is more favored, due to its recent success in achieving permanent hemostasis. We experienced 2 cases of Dieulafoy's ulcer of the stomach. Endoscopic ligations using an O ring were performed successfully.

A case of esophageal bezoar consisted with candidiasis / 대한내과학회지

Bezoars are persistent concretions of indigestible matter, usually seen in the stomach. But very rarely have bezoars been reported in the esophagus.. Most esophageal bezoars are either phytobezoars or medication bezoars occuring usually in the middle aged & elderly associated with underlying anatomical or functional abnormalities of esophagus. A variety of techniques has been developed recently in diagnostic and therapeutic endoscopy. So endoscopic management is safe and successful in most cases those required surgical management. We experienced an esophageal bezoar consisted with esophageal candidiasis in a patient who underwent esophago-gastric anastomosis and proximal gastrectomy due to early gastric cancer. The bezoar was removed by endoscopy and the esophago-gastric stenosis was treated with balloon dilator without any significant complication.

Observation of 35 Cases of Mallory: Weiss Syndrome Diagnosed by Endoscopy / 대한소화기내시경학회지

35 cases of Mallory-Weiss syndrome among 277 cases of upper gastrointestinal bleeding were ascertained by endoscopy at department of internal medicine St. Columban's hospital. The mean age was 41.6 years. All of 35 cases were found in male. Combined disease were gastritis(15 cases), peptic ulcer(7 cases) and esophageal varix(3 cases). The most common precipitating factor was vomiting, 22 cases among the 28 cases of vomiting(80%) developed after drinking. Endoscopic finding revealed active bleeding in 5 cases, blood clot without active bleeding in 22 cases, and scar change without bleeding evidence in 8 cases. Most cases had had hematemesis after active bleeding but 5 cases had had only melena without hematemesis. The Mallory-Weiss lacerations were located at stomach in 16 cases(46%), at esophagogastric junction in 11 cases(31%) and at esophagus in 8 cases. On the view of gastric direction, 14 cases were on anterior wall side, 9 cases were on posterior wall side, 11 cases were on lesser curvature side and one case was on great curvature side. Single lacerations were more common than multiple lacerations.

A Case of Esophageal Perforation by an Endoscopic Biopsy / 대한소화기내시경학회지

The esophagus or stomach can be perforated during diagnostic upper endoscopy in 0.03 to 0.1 percent. Instrumentation injury, as a whole, is probably the most common single cause of all cases of esophageal perforation. Most of the esophageal perforation result from either therapeutic maneuvers(dilation, sclerotherapy, foreign-body removal etc.) or underlying esophageal lesion(such as strictures or diverticular or neoplasm). Endoscopic perforation of the esophagus may be obvious immediately or within a few hours. Cervical pain, subcutaneous emphysema, fever, tachycardia, and characteristic radiographic appearances make the diagnosis easy, but some distal esophageal injuries are subtler, An immediate esophagogram should be obtained if peirforation is suspected. To select an appropriate course of management, precise delineation of location and the extent of perforation is necessary. The esophageal perforation can be managed conservatively by close observation, esophageal rest, and antibiotic coverage, but the mortality rate of medical treatment is near 12%. Causes of death are sepsis and multisystem organ failure. So we report a case of esophageal perforation by an endoscopic biopsy.