A Case of Gangliocytic Paraganglioma of the Ampulla of Vater Presenting as Jaundice / 대한소화기내시경학회지

Gangliocytic paraganglioma is a rare and benign gastrointestinal tumor that usually arises in the second portion of the duodenum. Histogenesis of this tumor is yet unclear. It is incidentally found during radiographic examinations or during endoscopy looking for the cause of gastrointestinal hemorrhage, which usually manifests as mucosal ulcerations. To our knowledge, there was only one case of duodenal gangliocytic paraganglioma presenting with melena in Korea. We experienced a case of gangliocytic paraganglioma arising from the ampulla of Vater, presenting as obstructive jaundice, which was subsequently removed surgically. Thus, we report this case with a review of literatures.

A Case of Idiopathic Duodenal Intramural Hematoma / 대한소화기내시경학회지

Duodenal intramural hematoma is mostly caused by blunt abdominal trauma. Spontaneous duodenal intramural hematoma has been reported in the literature in patients with over-anticoagulation and coagulation disorders. The presentation of patients can vary from mild and vague abdominal pain to intestinal tract obstruction and an acute abdomen. The diagnosis is evident by gastroduodenal endoscopy, EUS and abdominal CT scan. We report a case of spontaneous duodenal intramural hematoma without the history of abdominal trauma and coagulation disorders in 54-year-old male patient. After conservative treatment, the patient was discharged without any complications.

A Case of Cap Polyposis Successfully Managed with Infliximab / 대한소화기내시경학회지

Cap polyposis is a rare disorder characterized by bloody, mucoid diarrhea with rectosigmoid polyps covered by a cap of fibrinopurulent exudate. The etiology and pathogenesis of cap polyposis is unknown, and no specific treatment has been established. Drug therapies are usually unsuccessful. Patients with a solitary cap polyp respond well to endoscopic polypectomy, while patients with multiple polyps and concurrent anorectal pathology require surgical resection. However, rapid recurrence has been described after a limited surgical resection, and this necessitates panproctocolectomy. We report a case of a 58-year-old female diagnosed as cap polyposis on rectum with similar clinical and endoscopic features of pseudomenbranous colitis successfully treated with infliximab (murine chimeric monoclonal antibody to TNF-alpha).

Successive Suture Device for Gastrointestinal Endoscopes / 대한소화기내시경학회지

BACKGROUND/AIMS: Recently, treatment using an endoscopic device is actively being developed. Techniques for incision and bleeding control have been developed, but endoscopic suturing remains to be perfected. Using an endoscopic suturing technique, a variety of diseases could be managed noninvasively. We have attempted to use a new endoscopic suturing device which enables a continuous suture using a flexible upper endoscope. METHODS: A suturing device was designed where a semicircular needle could sew through tissue by rotation making a continuous suture possible. RESULTS: We successfully sutured the stomach tissue of a dog using an optimized suturing device model. CONCLUSIONS: The initial model was found to have some problems. However, we hope to develop a continuous suturing device for flexible upper endoscope procedures in Korea.

A Case of Refractory Pediatric Crohn's Disease with a Successful Treatment by Infliximab Therapy / 대한소화기학회지

Crohn's disease is a chronic inflammatory bowel disease which affects mainly children and young adults, and its cause remains unknown so far. Infliximab, a monoclonal antibody to the pivotal cytokine tumor necrosis factor-alpha, has been approved as a drug for both induction and maintenance therapy for moderately to severely active, or fistula-complicated Crohn's disease. The authors report a 12-year-old male patient diagnosed as Crohn's disease complicated with a perianal fistula, which was refractory to the conventional therapy. After the 0, 2, and 6 week scheduled intravenous infusion of infliximab, the patient reached to clinical remission in both subjective symptoms and objective manifestations. For children or young adults who develop Crohn's disease in a refractory course, infliximab may serve as a drug which leads to a clinical improvement or even to an extent of remission.