Endoscopic Hemoclipping Using a Transparent Cap in Technically Difficult Cases / 대한소화기내시경학회지

BACKGROUND/AIMS: There was some technical difficulty in applying the hemoclip on the posterior wall of the body, cardia of the stomach and posterior wall of duodenum because the angle of approach was tangential. Use of transparent cap on the tip of the endoscope could reduce some of these problems. The purpose of this study was to examine the efficacy of endoscopic hemoclipping using a transparent cap. METHODS: From August 1997 to July 2000, 74 patients with bleeding peptic ulcer and stigmata of recent hemorrhage were treated with endoscopic hemoclipping. There was technical difficulty in applying the hemoclip in 18 patients and the transparent cap was used. RESULTS: There was no statistically significant difference between the patients treated with cap and the patients treated without cap in initial hemostasis rate (91.1% vs 94.4%), rebleeding rate (11.8% vs 11.7%), and permanent hemostasis rate (92.9% vs 94.4%). CONCLUSIONS: Use of transparent cap on the tip of the endoscope was an efficient method when the angle of approach was tangential.

Endoscopic Aspiration Mucosectomy of Gastric Adenoma and Early Gastric Cancer: Two Year Experience with Assessment of Results / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic aspiration mucosectomy (EAM) can always lift up the lesion by suction regardless of its location and does not injure the mucosal surface. The clinical usefulness of this method was evaluated as follows. METHODS: Thirty two patients with gastric adenoma (35 lesions) and 6 patients with early gastric carcinoma were treated by EAM from March 1997 to February 1999. Their characteristics (diameter, macroscopic appearance, and histologic diagnosis) were verified at endoscopy with a biopsy specimen. The complete resection was defined as the presence of normal mucosa at the resected margin. RESULTS: The average size of the resected specimens was 17.8 mm in antrum and 16.5 mm in body. The ratio of complete resection by location was 67% in anterior wall, 88% in posterior wall, 86% in lesser curvature and 92% in greater curvature. The complete resection rate for smaller lesions (15 mm). No serious complication was encountered. CONCLUSIONS: EAM is suitable for the treatment of gastric tumors. Lesions 15 mm or less in diameter can be resected easily by single procedure regardless of its location.

Hepatic Septal Fibrosis Induced by Long-term Use of Ketoconazole / 대한간학회지

Ketoconazole, an imidazole derivative, is a broad spectrum antifungal agent which has been used widely in the treatment of systemic or local fungal infections. Mild asymptomatic elevation of plasma transaminase activities occurs in approximately 6% to 17.5% of patients who have used ketoconazole. However, the incidence of symptomatic hepatic injury is low and overt hepatitis develops in about 5% of the patients. Nausea and vomiting are the most frequent side reactions. Histopathological features of the reported ketoconazole induced hepatotoxicity are massive or submassive hepatocellular necrosis involving the acinar zone 3, destroyed lobular architecture with bridging necrosis and inflammatory cell infiltration on portal tracts. However, hepatic septal fibrosis with liver cirrhosis has not been reported yet. We experienced a case of hepatic septal fibrosis that developed after 9 months of ketoconazole administration.

Hepatocellular Carcinoma Incidentally Discovered by Liver Abscess Associated with CBD Stone and Cholangitis / 대한간학회지

Hepatocellular carcinoma (HCC) is one of the most common fatal malignancies worldwide, especially in Korea. The recent advances in diagnostic techniques, such as serum tumor marker assay, ultrasonography, computerized tomography (CT), magnetic resonance imaging (MRI), and angiography, allow us to detect HCC at early stage. Even though, it remains difficult to distinguish malignant nodules from benign space-ccupying lesions of liver. Distinction of HCC from benign entities such as liver abscess is important because failure of prompt diagnosis could result in a missed opportunity for curative treatment. The differential diagnosis of HCC and liver abscess, especially HCC presenting as abscess, is sometimes very difficult. We report a case of HCC with liver abscess caused by secondary infection of CBD stone and cholangitis, that mimicked the dynamic CT findings of liver abscess, in an elderly patient with chronic hepatitis C virus infection.