A Case of Primary Sclerosing Cholangitis Localized at Intrahepatic Bile Duct / 대한소화기내시경학회지

Primary sclerosing cholangitis is a cholestatic liver disease characterized by fibroobliterative inflammation of the entire biliary tree. It is a slowly progressive disease with an undulating course, resulting in biliary cirrhosis. The gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricturing and beading. We exprienced a case of primary sclerosing cholangitis by Endoscopic retrograde cholangiopancreatography (ERCP) demonstration. ERCP findings revealed multiple luminal narrowing, stricture and beaded dilatation of the intrahepatic duct. We report a case of primary sclerosing cholangitis localizing at intrahepatic bile duct, which is confused with cholangiocarcinoma.

A Case of Intramural Pancreatic Pseudocyst of the Duodenum / 대한소화기내시경학회지

Pancreatic pseudocysts are a well-recognized complication of pancreatitis. Most occur in or adjacent to the pancreas. Occasionally, duodenal involvement may occur due to the nonperitonealized posterior surface of the duodenum is in direct contact with the head of the pancreas. But there is little awareness of the intramural and major extrinsic involvement of the duodenum with also occurs. A case was recently experienced involving an intramural pancreatic pseudocyst of the duodenum.

A Case of a Congenital Web of the Common Bile Duct Treated with Balloon Dilatation / 대한소화기내시경학회지

The web of the common bile duct is an extremely rare anomaly and the cause of the obstructive jaundice. We experienced a case of the congenital web of common bile duct in a 42 years old male who complained of jaundice for 10 days prior to admission without choledocholithiasis and cholangitis. An endoscopic retrograde cholangiopancreatography revealed a common bile duct web (transverse, diaphragmatic type) and the diagnosis was confirmed by an endoscopic forcep biopsy. We reported a case of the congenita1 web of the common bile duct which was treated with a stent insertion and balloon dilatation.

A Case of Esophageal and Gastroduodenal Candidiasis / 대한소화기내시경학회지

Candidiasis of the gastrointestinal tract typically occurs in a setting of decreased re- sistance to opportunistic infection, but also occurs in apparently normal individuals. Mucosal lesions in the gastrointestinal tract predominantly involve the esophagus, and gastroduodenal and enteric candidial lesions, which are less frequent, have only infrequently been detected antemortem. A case was experienced involving esophageal and gastroduodenal candidiasis in the patient of hepatocellular carcinoma and spinal metastasis treated with emergent radiotherapy and corticosteroid. He complained of anorexia and dyaphagia in the 4th day of radiotherapy. Endoscopy revealed multiple, large raised, white plaques and patches covering the mid- and distal esophageal mucosa, and several superficial aphthous ulcerations covered with white plaques in the entire stomach, and two deep excavating ulcers at the angle and antrum. The duodenal mucosa was covered with multiple small, white plaques, and a huge penetraing ulcer was seen in the duodenal bulb. Endoscopic biopsy showed budding yeast and pseudohyphae infiltrating through the ulcerated mucosa. Cultures of the same material canfirmed the organism to be Candida albicans. The patient was treated with fluconazole for 2 weeks. The case of esophgeal and gastroduodenal candidiasis is reported with reviiew of relevant literature.

A Clinical Usefulness of Premedication with Hyoscine-N-butyl bromide (Buscopan(R)) in Colonoscopy: A Randomized, Double Blinded, Prospective Study / 대한소화기내시경학회지

BACKGROUND: Use of antispasmodic medication prior to colonoscopy is controversial but someone believes antispasmodic may improve visualization of colonic mucosa and ease colonoscope insertion. So, we designed a study to assess the effect of premedication with the antispasmodic, hyoscine-N-butyl bromide(Buscopan(R)) on the performance of colonoscopy. METHODS: This study was prospective, double blinded, randomized, controlled study, One hundred three consecutive patients were randomized to receive intravenous buscopan lml(n=52) or placebo(n=51) combined with our standard initial medication(me-peridine 50 mg and midazolam 2 mg). Insertion of colonoscopy was timed, and 100 mm visual analogue scales (VAS) were used for asscssing difficulty of procedure, colonic motility, frequency of positional change, frequency of external compression, difficulty of assistance and degree of discomfort experienced by the patients. RESULTS: There were no significant differences of intubation time between buscopan group(mean time, 7.23 min., range 2~15) and placebo group(7.07 min., range 3~25), (p=0.83) and withdrawal time between buscopan group (6.46 min., range 2-22) and placebo group(6.76 min., range 2 25), (p=0.69). Also, there was no significant differences in intubation time between males and females(buscopan; males 7.00 min., females 7.60 min., p=0.34, placebo; males 7.0~5 min., females 7.08 min., p 0.44). The VAS scores checked by endoscopist(p=0.29), assistant(p=0.32) and patient (p=0.15) were not significantly different in both groups. There were no significant differences in intubation time, VAS scores nf endoscopist, assistant, and patients. CONCLUSION: Premedication with intravenous bu.opan has no advantage on colonoscopy procedure. Use of antispasmodic medication prior to colonoscopy was not considered as recommendable agent.

A Case of the Multiple Intussusceptions of Small Bowel by Metastatic Malignant Melanoma / 대한소화기내시경학회지

We present herein the case of 31-year-old man with disseminated malignant melanoma in whom a multiple metastasis into jejunum causing multiple intussusceptian. At laparotomy, multiple variable sized metastatic melanoma were noted on proximal and distal jejunum. To our knowledge, there was no report about multiple intussusceptions by malignant melanoma in Korea.

A Case of the Multiple Intussusceptions of Small Bowel by Metastatic Malignant Melanoma / 대한소화기내시경학회지

We present herein the case of 31-year-old man with disseminated malignant melanoma in whom a multiple metastasis into jejunum causing multiple intussusceptian. At laparotomy, multiple variable sized metastatic melanoma were noted on proximal and distal jejunum. To our knowledge, there was no report about multiple intussusceptions by malignant melanoma in Korea.