Comparison between the Effectiveness of Oral Phloroglucin and Cimetropium Bromide as Premedication for Diagnostic Esophagogastroduodenoscopy: An Open-Label, Randomized, Comparative Study

BACKGROUND/AIMS: Suppression of gastrointestinal (GI) peristalsis during GI endoscopy commonly requires antispasmodic agents such as hyoscine butylbromide, atropine, glucagon, and cimetropium bromide. This study examined the efficacy of oral phloroglucin for the suppression of peristalsis, its impact on patient compliance, and any associated complications, and compared it with intravenous or intramuscular cimetropium bromide administration. METHODS: This was a randomized, investigator-blind, prospective comparative study. A total of 172 patients were randomized into two groups according to the following medications administered prior to upper endoscopy: oral phloroglucin (group A, n=86), and cimetropium bromide (group B, n=86). The numbers and the degrees of peristalsis events at the antrum and second duodenal portion were assessed for 30 seconds. RESULTS: A significantly higher number of gastric peristalsis events was observed in group A (0.49 vs. 0.08, p<0.001), but the difference was not clinically significant. No significant difference between both groups was found in the occurrence of duodenal peristalsis events (1.79 vs. 1.63, p=0.569). The incidence of dry mouth was significantly higher with cimetropium bromide than with phloroglucin (50% vs. 15.1%, p<0.001). CONCLUSIONS: Oral phloroglucin can be used as an antispasmodic agent during upper endoscopy, and shows antispasmodic efficacy and adverse effects similar to those of cimetropium bromide.

Diffuse Intense 18F-FDG Uptake at PET in Unilateral Breast Related to Breastfeeding Practice

We present an interesting case of incidental diffuse fluorodeoxyglucose (FDG) uptake at PET in her left breast, related to atypical breastfeeding practice. Clinically, differential diagnoses of diffuse intense FDG uptake in unilateral breast include advanced breast cancer, breast lymphoma and inflammatory condition. However, normal physiologic lactation may also show increased FDG uptake in the breasts. Therefore, if we encounter that finding in daily practice, we should question the patient regarding unilateral breastfeeding. In addition, mammography and ultrasound would be helpful to confirm the diagnosis.

Incidence and Significance of Periampullary divertucula at Endoscopic retrograde cholangiopancreatography / 대한내과학회지

OBJECTIVES: Diverticula on the second part of the duodenum have a 1-5% incidence in barium studies reports. They have been associated to : choledocholithiasis, biliary dysfunction, acute pancreatitis, diverticulitis, duodencolic fistula, bleeding, malabsorption, and bowel obstruction. With forward viewing endoscope diverticula are not easy to see but with side viewing scope are commonly seen and widely accepted as a cause of difficult cannulation and/or sphinterotomy. The purpose of this study is to determine the incidence of periampullary diverticula and to see whether our results are in accordance wtih above statements included in difficult cannulation and/or sphincterotomy at endoscopic retropgrade cholangiography (ERCP) in retrospectively examine our own series. Also to examine their association with biliary and pancreatic diease. PATIENTS AND METHODS: Three hundred and thirty one consecutive ERCP reports were reviewed with special reference to the following : sex, age, presence of duodenal diverticula, difficulty of cannulation and/or sphinterotomy. RESULTS: Seventy-nine patients (24%) had one or more periampullary diverticula. Age and sex made no difference. Thirty-two (10.3%) had a difficult or unsuccessful cannulation and only five of those patients (1.6%) had periampullary diverticulum (p<0.001). But the failure rate of large sphincterotomy was more common in patient with periampullary diverticum (73.5%) than without diverticulum (24.6%) (p<0.001). The disease of the patients who had diverticulum, gallstone is the most frequent incidence (77.2%). Diverticulum was more frequently found in choledocholithiasis patients (45.3%) than studied patients (24%). CONCLUSION: Periampullary diverticula are a common finding during ERCP and less likely to cause a unsuccessful cannulation, but the cause of unsuccessful sphincteromy.