Prevalence and risk factors of gallstones in a general health screened population / 대한내과학회지

BACKGROUND: Gallstone is the most common disease of the biliary system. Most cases of gallstone are asymptomatic and we incidentally found gallstones during a community health survey. Our study was designed to determine the prevalence and risk factors for gallstone in a population who underwent health screening. METHODS: We enrolled a total of 36,314 persons who visited the health promotion center in Kyungpook National University Hospital in Korea from 1998 to 2004. They had their gallbladder or biliary system examined with using ultrasonography. The body mass index and biochemical parameters from liver function tests, the lipid profiles and the fasting blood sugar were all measured. All the subjects were divided into several groups and the particular prevalence for gallstone disease for each group was calculated. Chi-square tests and logistic regression analysis assessed the risk factors for gallstone disease. RESULTS: Among 36,314 persons, (19,345 males (53.3%) and 16,969 females (46.7%)), gallstone was found in 735 persons (2.0%). On univariate analysis, the risk factors for gallstone disease were age, body mass index, fasting blood sugar, total cholesterol, LDL-cholesterol, triglyceride and serum aspartate aminotransferase. On multivariate logistic regression analysis, the the risk factors were high body mass index, older age and high fasting blood sugar. CONCLUSIONS: The risk factors seem to show a common pathogenesis for gallstone disease. Although the relation between gallstone disease and metabolic syndrome has not been established, it appears to be associated with metabolic syndrome, but further study on a general population is required.

A Case of Pseudomembraneous Colitis Associated with Ascites / 대한소화기내시경학회지

Antibiotics associated colitis due to Clostridium difficile is a common nosocomial infection associated with significant morbidity. In severe cases, pseudomembraneous colitis may be associated with intraperitoneal fluid accumulation. However, the characteristics of the fluid are seldom described. This case report describes pseudomembraneous colitis patient who was presented with low serum-ascites albumin gradients and lymphocytic ascites, without the evidence of infection, malignancy, or inflammatory peritoneal disease.

The Usefullness of Percutaneous Transluminal Balloon Angioplasty in the Management of Budd-Chiari Syndrome / 대한간학회지

BACKGROUND/AIMS: Membranous obstruction is the most common cause of Budd-Chiari syndrome in Orientals. Recently, percutaneous transluminal balloon angioplasty (PTBA) has been successfully applied as a treatment of membranous obstruction. We evaluated etiologies and clinical manifestations in our cases and the usefulness of PTBA. METHODS: Twelve cases of Budd-Chiari syndrome were analyzed. RESULTS: 50.3 years was the average age of the cases (ranging from 37 to 67 years). Major symptoms or signs were superficial collateral vessels on the chest or the abdomen in 6 cases, ascites in 3, abdominal pain in 4, hepatomegaly in 4, splenomegaly in 3, melena or hematemesis in 2, and leg edema in 2. Upper gastrointestinal endoscopy showed esophageal varices in 6 cases and two of these 6 cases had gastric varices. Of 8 cases with liver cirrhosis, 4 were classified as Child-Pugh class A and 4 as B. Four patients with cirrhosis had concurrent hepatocellular carcinoma including 1 patient who was HBs Ag positive. Etiologies were membranous obstruction in 11 cases and protein C deficiency in 1 case. The main site of obstruction was IVC in 8 and hepatic vein in 4. PTBA was successfully performed in 8 cases of membranous obstruction. During the mean follow-up period of 27.6 months (12-40 months), there were no reobstructions except in 2 cases. CONCLUSIONS: The most common cause of Budd-Chiari syndrome in our cases was membranous obstruction of IVC. Percutaneous transluminal balloon angioplasty is a very useful treatment method.

Laparoscopic and Percutaneous Ultrasound Guided Radiofrequency Ablation for Hepatocellular Carcinoma: a Preliminary Study / 대한간학회지

BACKGROUND/AIMS: Radiofrequency ablation (RFA) is emerging as a new therapeutic method in the management of hepatocellular carcinoma (HCC). We report the results of 64 patients with a follow-up interval of 3 to 19 months. METHOD: Sixty-four patients with 82 nodules underwent ultrasound guided RFA. The mean tumor diameter was 2.5+/-1.0 cm. Laparoscopic ultrasound guided RFA was performed in 38 cases, and percutaneous ultrasound guided RFA in 26 cases. The therapeutic efficacy was evaluated by means of three-phase dynamic abdominal computed tomography (CT) performed within at least one week after ablating. The recurrence was evaluated after treatment by means of abdominal CT and alpha fetoprotein every 3 months. We calculated cumulative recurrence rates, survival rates of patients, and found out complication of RFA. RESULTS: Cumulative recurrence rates in 3, 6, 12 months after RFA was 8.8%, 15.8%, 25.9%. 12 cases were recurred during follow-up. Among them, intrahepatic recurrences were noted in 11 cases, local recurrences in 3 cases. Cumulative survival curves indicated that survival rate was 95% at the third month, 94% at the sixth month, 81% at the twelfth month. After RFA, the alpha fetoprotein level was decreased significantly after 1 month (p<0.05), and serum transaminase levels were transiently elevated (p<0.01) but returned to normal within one week. Complications of RFA were not serious, and resolved spontaneously. CONCLUSION: RFA can be considered a useful new treatment for HCC. Laparoscopic RFA is a useful procedure for the treatment of HCC regardless of its location.

Prognostic Factors of the Long-Term Survival after Transjugular Intrahepatic Portosystemic Shunt in the Treatment of Gastric and Esophageal Variceal Bleeding

Transjugular intrahepatic portosystemic shunt (TIPSS) is a promising method of treatment for gastric or esophageal variceal bleeding. This study was performed to determine the prognostic factors contributing to the survival of patients after TIPSS for gastric or esophageal variceal bleeding. One hundred and fifty-five patients who underwent TIPSS between September 1991 and March 2001 were followed up by clinical examination, upper gastrointestinal endoscopy, and Duplex sonography. The mean portohepatic pressure gradient prior to TIPSS was 20.5 +/-9.93 mmHg and dropped to 10.7 +/-6.62 mmHg after TIPSS (p<0.001). The cumulative survival rate was 75.1% at 6 months, 66.6% at 1 yr, 58.4% at 2 yr, and 38.1% at 5 yr. Survival after TIPSS was inversely related to the Child-Pugh classification (p<0.05). The rebleeding rate was 18.3% at 6 months, 21.0% at 1 yr, 32.8% at 2 yr, and 53.1% at 5 yr. The causes of deaths were hepatic failure (53.5%), recurrent variceal bleeding (11.6%), pneumonia (4.6%), sepsis (3.5%), hepatic encephalopathy (2.3%), and unknown (17.4%). Multivariate analysis (Cox proportional hazard model) revealed that the Child-Pugh classification and age were statistically significant independent prognostic factors. In conclusion, TIPSS is an effective method of treatment for variceal bleeding in cases where other treatment modalities including endoscopic therapy are unsuccessful and the most important prognostic factors are preprocedural hepatic reserve (Child-Pugh class) and age.

Gastric lymphangioma

Gastric lymphangioma is a rare benign gastric tumor composed of unilocular or multilocular lymphatic spaces. On gastrofiberscopy a submucosal tumor covered with smooth transparent normal mucosa is revealed in the stomach with or without a stalk. Endoscopic ultrasonography has become an indispensable tool for differentiating these gastric tumors. Treatment of lymphangioma depends on its size, location, and presence of complications. Endoscopic resection is safe and easy and plays an important role in confirming the diagnosis and treatment of the tumors especially of small-sized ones. We report a case of gastric lymphangioma in a 68-yr-old woman who presented with nausea and vague epigastric discomfort for two months. She was diagnosed by gastrofiberscopy with endoscopic ultrasonography and treated successfully with endoscopic resection by strip biopsy method.

Clinical Significance of Autonomic Neuropathy in Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: Autonomic neuropathy is not rare in patients with liver cirrhosis but little is known about the mechanisms and clinical characteristics of it. We evaluated the relationship between the severity of liver disease and that of autonomic neuropathy. METHODS: Sixty patients with liver cirrhosis (age 53+/-8.4, mean+/-SD) were studied. Liver function and prothrombin time were tested and an ultrasonography or CT scan was performed. Liver function reservoir was classified according to Child-Pugh score for all patients. Heart rate variations in response to deep breathing, to Valsalva maneuver, and to orthostatism were also measured and were expressed by E/I index, Valsalva index, and Posture index, respectively. The prevalence was estimated and divided into early involvement and definite involvement using each index. The correlation between the severity of the liver disease and that of autonomic neuropathy was also studied. RESULTS: Evidence of autonomic neuropathy was found in 68.3% (41); early involvement 46.7% (28), and definite involvement 21.7% (13), respectively. The prevalence of autonomic neuropathy was similar in alcohol induced, and virus induced, liver disease (84.6% vs 63.8%). Child-Pugh score showed inverse correlation with E/I index (r=-0.38, p<0.01) and Valsalva index (r=-0.34, p<0.05). On multiple logistic regression analysis, cardiovascular autonomic neuropathy was related to the serum albumin level (odds ratio 0.063, 95% CI). CONCLUSION: In liver cirrhosis the prevalence and the severity of cardiovascular autonomic dysfunction are related to the severity of hepatic dysfunction (Child-Pugh score). It is possible that this complication may be of prognostic significance in patients with liver cirrhosis.

Comparison of Magnetic Resonance Cholangiopancreatography with Endoscopic Retrograde Cholangiopancreatography in the Evaluation of the Biliary Tract Diseases / 대한소화기내시경학회지

BACKGROUND/AIMS: This study was performed to evaluate the diagnostic accuracy and clinical applications of magnetic resonance cholangiopancreatography (MRCP) compared with endoscopic retrograde cholangiopan creatography (ERCP). METHODS: Prior to carrying out ERCP, MRCP was performed on 71 patients and the two examinations were compared using a double blank test. RESULTS: The results revealed that 15 patients had choledocholithiasis, 4 gall bladder stones, 28 cholangiocarcinomas, 12 pancreatic head cancers, 2 ampulla of Vater cancers, 1 gall bladder cancer with ductal invasion, 4 other benign diseases and 5 normal conditions. For the patients with choledocholithiasis, the values of MRCP's sensitivity, specificity and accuracy were 100%, 98.2% and 98.6%, respectively, and those of ERCP's were all 100%. For the patients with malignant obstructions, the values of MRCP's sensitivity, specificity and accuracy were 90.7%, 100% and 94.4%, respectively, and the values of ERCP's were 95.3%, 92.9% and 94.4%. CONCLUSIONS: These data show that MRCP has a rather high sensitivity, specificity and accuracy in the diagnosis of the biliary tract system, and therefore MRCP can be substituted for ERCP in the aspect of diagnosis.

A Case of Mantle Cell Lymphoma of Small Bowel Presenting Recurrent Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

Lower gastrointestinal bleeding is difficult to localize despite advanced diagnostic procedures such as colonoscopy, small bowel series, mesenteric angiography and radionuclide scan. We had experienced a case of mantle cell lymphoma of small bowel. In this case, the cause of recurrent lower gastrointestinal bleeding and abdominal pain was not defined despite extensive preoperative evaluation. We diagnosed this case as mantle cell lymphoma after exploratory laparotomy.

Analysis of Recurrence and Prognostic Factors after Transarterial Chemoembolization in Patients with Hepatocelular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is a malignant tumor with very poor prognosis if left untreated after diagnosis. However, recent advances in digital subtraction imaging techniques and superselective catheterization seem to have somewhat increased the survival rate in patients with HCC after transarterial chemoembolization (TACE). This study analyzed the relationship between prognostic factors and recurrence after TACE, an aspect which has not attracted much attention. METHODS: This investigation included 258 cases of HCC with 100% lipiodol uptake who received TACE for a duration of 13 years from 1985 to 1997. Clinical characteristics, biochemical factors, tumoral factors, angiographic characteristics, embolization technique, degree of lipiodol uptake, response, and recurrence factors were analyzed retrospectively. RESULTS: Significant differences in survival were noted among 3 groups according to cancer-free interval (p<0.01). The different factors between early recurrence group (within 6 months) and late recurrence group (after 18 months) were initial tumor size (8.8+/-4.1/6.1+/-3.7cm, p<0.01), tumor type (multinodular,massive/single nodule, p<0.01), ill-defined margin (51.4/22.0%, p<0.01), response after TACE (NC/CR,PR, p<0.01), ALP level (196.1+/-124.5/144.4+/-72.0 IU/L, p<0.05), absence of encapsulation (42.3/25.0%, p<0.05), portal vein thrombosis (64.3/14.3%, p<0.05), nonsegmental embolization (46.6/25.0%, p<0.05), post-TACE AFP level (180.5+/-252.1/76.6+/-329.8 ng/mL, p<0.05), and recurrence pattern (revascularization of initial lesion/single nodule, p<0.05). CONCLUSIONS: Recurrence factors were significant in the survival of patients with HCC after TACE. Therefore, an understanding of the relationship between prognostic factors and recurrence is very important for early detection of recurrence and the timely provision of further TACE treatment.

Diagnostic Accuracy of Ultrasonography-guided Needle Biopsy of the Liver as determined by Postsurgical Sampling / 대한간학회지

BACKGROUND/AIMS: It is questionable whether the needle biopsy of the liver can represent the whole pathology of the liver. This study evaluates the diagnostic accuracy of ultrasonography-guided needle biopsy of the liver as determined by surgically resected liver. METHOD: The histopathologic findings of preoperative ultrasonography-guided needle biopsy for confirming the background liver disease and surgically resected liver were compared in the 40 patients with primary hepatocellular carcinoma. RESULTS: 1) Of the 40 cases, 30 (75.0%) cases showed the same histopathological diagnosis between the two methods. Their histopathological results were: 20 cases of cirhosis, 6 cases of chronic hepatitis and 4 cases of normal tissue. 2) There was a direct proportion between histologic concordance, the number of portal areas, and the size of the needle biopsy specimen. The histologic concordance rate was 79.2% in the cases with 4 portal areas in their biopsy sample and 100% in the cases with more than 5 areas. 3) Of the 10 cases in which diagnostic discrepancy was found between the two methods, 8 cases of chronic hepatitis and 1 case of normal tissue, all diagnosed by needle biopsy, proved to be cirrhosis by surgically resected liver. One case of normal tissue proved to be chronic hepatitis. The causes of diagnostic error were fragmentations of tissue and inadequate specimens. CONCLUSION: The diagnostic accuracy of the ultrasonography-guided needle biopsy of the liver was 75.0% in our study. To lessen the diagnostic error, at least 4 or more portal areas should be contained in the biopsy sample and the fragmentation of tissue should be minimized.

A Case of Focal Nodular Hyperplasia of the Liver / 대한간학회지

Focal nodular hyperplasia (FNH) is a rare benign hepatic tumor occurring predominantly in women of childbearing age. Generally oral contraceptive is not associated with FNH but might accentuate the vascular abnormalities which may cause the lesion to enlarge and, very rarely, to rupture. FNH is typically asymptomatic and seldom bleeds. Often it is incidentally observed during imaging procedures performed for some other reasons. The histologic feature of FNH is characterized by areas of localized growth of mature hepatocytes and septal fibrosis. Surgical resection is seldom required because of the benign nature of the lesion and its lack of significant complication. We experienced a case of focal nodular hyperplasia without liver cirrhosis confirmed by surgical resection and histologic examination. in a 47-year-old man.

Factors Associated with the Development of Gastroduodenal Lesions after Transcatheter Arterial Embolization in a Hepatocellular Carcinoma / 대한소화기내시경학회지

BACKGROUND/AIMS: Gastroduodenal lesions such as erosions and ulcers are less infrequent complications after transcatheter arterial embolization (TAE) procedures. This study was conducted to clarify the incidence and associated factors of post-TAE gastroduodenal lesions. METHODS: Cases involving 142 patients with unresectable hepatocellular carcinoma (HCC) who underwent TAE during 70 months were retrospectively analyzed. Endoscopic examinations were performed before and after TAE. Patients were classified into two groups depending upon whether gastroduodenal lesions developed or not. RESULTS: New gastroduodenal lesions developed in 32 of 142 patients (22.5%) within 3 months of TAE. Of these, 14 patients (9.9%) developed upper gastrointestinal bleeding. There were no significant differences in clinical and biochemical characteristics between the two groups (p>0.05). There was also no significant difference in catheter selection level, tumor type, number of TAE, use of gelform between the two groups (p>0.05). However, the cases involving large tumor size (>8 cm) and angiographical abnormalities of hepatic arteries including atypical branching, vascular tortuosity, spasms or intimal dissection during the procedure, infusion of embolizing materials adjacent to vessels supplying the stomach or duodenum, had more post-TAE gastroduodenal lesions. These two factors were found to significantly affect the development of post-TAE gastroduodenal lesions by multivariate analysis (p<0.05). CONCLUSIONS: The major factors associated with the development of post-TAE gastroduodenal lesions are large tumor sizes and angiographical abnormalities of hepatic arteries. Upper gastrointestinal endoscopy should be performed as follow-up examinations in these patients.

A Case of Transcatheter Arterial Embolization-nduced Hepatobronchial Fistula in a Patient with Hepatocellular Carcinoma / 대한간학회지

Transcatheter arterial embolization (TAE) is widely used in the treatment of unresectable hepatocellular carcinoma. Its common complications are right upper quadrant pain, nausea, vomiting, and rare complications include focal pancreatic necrosis, gastric ulcer, renal failure, DIC, biliary tree necrosis and splenic infarction and so on. It has been reported that hepatobronchial fistula could develop as a pleuropulmonary complication of liver abscess. We report a case of hepatobronchial fistula caused by complicating liver abscess in a patient with hepatocellular carcinoma who was treated with TAE.

Treatment of Esophagorespiratory Fistulas with Silicone-Coated Self-Expanding Metal Stents / 대한내과학회지

BACKGROUND: Implantation of esophageal stents is nowadays considered as the method of choice for the management of esophagorespiratory fistula. However, implantation of conventional plastic prosthesis is inconvenient for the patient and associated with relativelty high mortality and complications. Silicone coated self expandable metal stents have been developed to overcome these limitations of plastic tubes. And then, the efficacy of silicone-coated self expandable metal stents in esophagorespiratory fistulas was investigated. METHODS: Six patients with esophagorespiratory fistulas were treated with silicone-coated self expandable metal stents(Song's esophageal stents). All six patients were unable to swallow food or water before treatment due to aspiration via esophagorespiratory fistula. The stents were inserted under endoscopic and fluoroscopic guidence. Clinical improvement was determined by grading food intake capacity on five-point scale : none, liquid, soft food, solid food, or all food. RESULTS: The stents were successfully inserted in all patients. All stents spontaneously showed sufficient expansion without further endoscopic control. After procedure, all fistulas were sealed and symptoms due to branchial aspiration were disappeared. Dysphagia improved by at least two grades in 5 of the 6 patients(83.3%). One patient died due to massive hemoptysis 11 days after stent placement, which could be regarded as a complication. Retrosternal and epigastric pain were observed in three patients. In the follow-up, tumor overgrowth at the end of the stent was found in one patient, who was retreated with implantation of another stent. CONCLUSION: These results suggest that implantation of silicone-coated self expandable metal stents is a rapid, and effective procedure for the palliative treatment of malignant esophagorespiratory fistulas and other cause of esophagorespiratory fistula.

Hepatic Asialoglycoprotein Receptor Scintigraphy Using 99mTc - Galactosylated Serum Albumin ( GSA ): Biodistribution Study in Mice with Thioacetamide - induced Hepatic Injury / 대한간학회지

BACKGROUND/AIMS: Tc-DTPA-galactosylated serum albumin (GSA) is a new liver imaging agent that specifically binds to asialoglycoprotein receptor, which resides exclusively on the plasma membrane of mammalian hepatocytes. To evaluate the usefulness of hepatic scintigraphy with Tc-GSA in the assessment of hepatic function, we have investigated serial changes in organ uptakes of Tc-GSA in mice with thioacetamide-induced hepatic injury and compared to changes in histology or levels of hepatic enzymes. MATERIALS AND METHODS: Acute hepatic injuries were induced by intraperitoneal injection of thioacetamide in ICR (Institute of Cancer Research) mice. Hepatic injuries were serially assessed by either light microscopic examination of liver slices or measurement of hepatic enzymes. The biodistribution of Tc-GSA was measured in liver and each excised organs using gamma counter. RESULTS: Hepatic injuries in light microscopic examination were not evident at 12 hours after injection of thioacetamide but resulted in maximal centrilobular necrosis and inflammation at 24 hours. These histologic changes were progressively improved upto 72 hours. Studied hepatic enzymes were elevated at 6 hours and reached to maximal level at 24 hours after administration of thioacetamide and declined progressively after then. Hepatic uptake of Tc-GSA was lowest at 6 hours after administration of thioacetamide and serially recovered until 72 hours. CONCLUSION: The degree in the decrease of hepatic uptake of Tc-GSA was precedent to either histologic changes or elevation of hepatic enzymes and correlated with the degree of hepatic daneges in acute hepatic injury. These findings suggest that hepatic scintigraphy using Tc-GSA can be used to detect early changes and serial assessment of hepatic function in acute hepatic injury.

Hepatic Asialoglycoprotein Receptor Scintigraphy Using 99mTc - Galactosylated Serum Albumin ( GSA ): Biodistribution Study in Mice with Thioacetamide - induced Hepatic Injury / 대한간학회지

BACKGROUND/AIMS: Tc-DTPA-galactosylated serum albumin (GSA) is a new liver imaging agent that specifically binds to asialoglycoprotein receptor, which resides exclusively on the plasma membrane of mammalian hepatocytes. To evaluate the usefulness of hepatic scintigraphy with Tc-GSA in the assessment of hepatic function, we have investigated serial changes in organ uptakes of Tc-GSA in mice with thioacetamide-induced hepatic injury and compared to changes in histology or levels of hepatic enzymes. MATERIALS AND METHODS: Acute hepatic injuries were induced by intraperitoneal injection of thioacetamide in ICR (Institute of Cancer Research) mice. Hepatic injuries were serially assessed by either light microscopic examination of liver slices or measurement of hepatic enzymes. The biodistribution of Tc-GSA was measured in liver and each excised organs using gamma counter. RESULTS: Hepatic injuries in light microscopic examination were not evident at 12 hours after injection of thioacetamide but resulted in maximal centrilobular necrosis and inflammation at 24 hours. These histologic changes were progressively improved upto 72 hours. Studied hepatic enzymes were elevated at 6 hours and reached to maximal level at 24 hours after administration of thioacetamide and declined progressively after then. Hepatic uptake of Tc-GSA was lowest at 6 hours after administration of thioacetamide and serially recovered until 72 hours. CONCLUSION: The degree in the decrease of hepatic uptake of Tc-GSA was precedent to either histologic changes or elevation of hepatic enzymes and correlated with the degree of hepatic daneges in acute hepatic injury. These findings suggest that hepatic scintigraphy using Tc-GSA can be used to detect early changes and serial assessment of hepatic function in acute hepatic injury.

Silicone - Covered Self - Expandable Metal Stents for the Palliation of Malignant Esophageal Obstruction and Esophagorespiratory Fistulas / 대한소화기내시경학회지

BACKGROUND: Esophageal cancer can induce progressive dysphagia and occasionally develop esophagorespiratory fistulas. Surgically incurable disease is present in over 60% of patients at the time of presentation and in such a means, relief of dysphagia is one of the important treatment modes in the majority of these patients. Implantation of stents is widely used for improvement of dysphagia and sealing of esophagorespiratary fistulas. METHODS: Silicone-covered self-expandable metal stents were used in 19 consecutive patients with malignant esophageal obstruction (n=14) or esophageal obstruction with esophagorespiratory fistulas (n=5). RESULTS: The stents were successfully inserted in all patients. Dysphagia improved in 18 of 19 patients (95%). All fistulas were sealed and symptoms due to bronchial aspiration disappeared. Complications occurred during follow-up including chest pain (11 patients), aspiration pneumonia (4 patients), reflux esophagitis (2 patients), stent migration (2 patients), tumor overgrowth (2 patients) and hemorrhage (1 patient). Three of the 4 patients with aspirtion pneumonias and a patient with hemorrhage suffered from dysfunction of upper esophageal sphincter after implantation of stents in upper esophageal carcinoma. But, Tumor ingrowth and perforation did not occur. Two patients died of massive hemorrhage and respiratory failure caused by aspiration pneumonia. CONCLUSION: These results suggest that implantation of silicone-covered self-expandable metal stents is a rapid and effective procedure for the palliative treatment of malignant esophageal obstruction and esophagorespiratory fistulas.

A Case of Tuberculous Esophagorespiratory Fistula Managed by Silicone - Covered Self - Expendable Metal Stent / 대한소화기내시경학회지

Esophagorespiratory fistulas resulting from Mycobacterium tuberculosis infection are rare. Whereas most esophagorespiratory fistulas are absolute indication for direct surgical closure, this may not be necessary in the case of those of tuberculous origin. If diagnosed early, the infection and the complicating fistula could be treated effectively with anti- tuberculous chemotherapy without the need for surgical intervention. Despite the sugges- tion of a trend away from direct surgical closure in recent years, it seems that anti tuberculous chemotherapy may not result in healing of the fistula in all patients. So we report a case of tuberculous esophagorespiratory fistula that has severe aspiration pneumorua and effectively treated with implantation of silicone-covered self-expandable metal stent and antituberculous chemotherapy.

Weiss Syndrome by 0-ring Band Ligation / 대한소화기내시경학회지

BACKGROUND/AIMS: Mallory-Weiss syndrome refers to a laceration or lacerations in the region of the gastroesophageal junction due to vomiting, retching, or coughing induced by several causes, and preceding hematemesis. In the last several years, endoscopic therapies have dramatically changed the need for emergency surgery in patients with upper gastrointestinal bleeding. There is only little information however, regarding the indication criteria and the efficacy of endoscopic therapies in severe upper gastrointestinal bleeding, due to Mallory-Weiss syndrome. This study was designed to assess the usefulness and the indications of endoscopic O-ring band ligation. METHODS: Thirty patients with Mallory- Weiss syndrome who were experiencing a related hemorrhage were studied. Among these, 5 patients with active bleeding or a visible vessel revealed during an endoscopic examination were treated with O-ring band ligation. Patients with blood clots or linear tears received only conservative treatment.