N-utyl--yanoacrylate (Histoacryl) in the Treatment of Esophageal Variceal Bleeding: Comparison with Band Ligation / 대한간학회지

BACKGROUND/AIMS: Endoscopic sclerotherapy and band ligation have been well documented beneficial therapeutic options of esophageal variceal bleeding. But acute variceal bleeding is refractory to sclerotherapy in upto one-hird of patients, and rebleeding occurs in 30% to 50%. Recently alternative endoscopic modality, N-utyl--yanoacrylate (Histoacryl) injection is performed in intravariceal sclerotherapy but its efficacy and safty are not clearly established. We evaluated the efficacy of Histoacryl on esophageal variceal bleeding and compared with that of endoscopic band ligation in the present study. MATERIALS/METHODS: From March 1994 to March 1998, ninety seven patients with endoscopically documented esophageal variceal bleeding were enrolled. Histoacryl injection (Histoacryl group, n=33) or endoscopic band ligation (EVL group, n=64) was done for esophageal variceal bleeding. We evaluated the rebleeding rate and in-ospital mortality in both groups. RESULTS: Baseline characteristics were similar but active bleeding on first endoscopic session was significantly higher in Histoacryl group (Histoacryl group; 90.7%, EVL group; 26.6%, p=0.002). Successful hemostasis was done at 87.9% in Histoacryl group, 95.3% in EVL group (not significant). There were no significant differences on early rebleeding rate (18.2% vs 23.4%), late rebleeding rate (39.4% vs 37.5%) and in-ospital mortality (24.2% vs 15.6%) between Histoacryl group and EVL group. There were no technique-elated fatal complications at Histoacryl injection group. CONCLUSION: Therapeutic efficacy of Histoacryl injection was similar to the endoscopic band ligation in patients with esophageal varix bleeding in terms of hemostasis and rebleeding. Histoacryl is effective therapeutic option for esophageal variceal bleeding as well as gastric variceal bleeding.

Two Cases of Villous Adenoma of the Common Bile Duct: Endoscopic Diagnosis and Treatment / 대한소화기내시경학회지

Villous adenomas of the common bile duct are rare and accordingly it is difficult to render a firm preoperative diagnosis. They are the unusual cause of bile duct obstruction and can mimic malignant extrahepatic biliary tumors or stones. Until recently, only a few cases had been reported in the medical literature. Although some authors advocate open surgical excision, especially with recurrence or carcinomatous change, an endoscopic resection of a distal common bile duct adenoma is a viable alternative for those patients considered poor surgical risks. We present two cases of villous adenoma of the common bile duct diagnosed by an endoscopic biopsy and endoscopically resected, with review of the relevant literature on the subject.

Two Cases of CMV Esophagitis and Proctitis / 대한소화기내시경학회지

Gastrointestinal cytomegalovirus (CMV) disease most frequently occurs in adults with immune deficiency due to acquired immune deficiency syndrome (AIDS), organ trans- plantation, cancer chemotherapy, and steroid therapy. Because the number of patients with immune deficiency has increased in recent years in Korea and CMV is one of the most common infecting complications in these settings, the number of patients with CMV disease is also increasing. Most cases of CMV disease are due to reactivation of a latent virus. The pathogenesis of this intestinal disease is vascular endothelial involvement with subsequent ischemic mucosal injury. An endoscopy usually reveals large, well defined ulcers greater than 3 cm. Deep longitudinal serpiginous ulcers represent a coalescence of adjoining smaller ulcers. CMV infection produces a characteristic cytomegalic cell containing a intranuclear inclusion, which is sometimes surrounded by a clear halo ("owl's eye"). The presence of cytomegalic cells on mucosal biopsy specimens stained with hematoxylin and eosin has been considered the golden standard for establishing the diagnosis of CMV gastrointestinal disease. Immunohistochemistry with monoclonal antibody to CMV antigens and in situ hybridization for CMV DNA are useful in the diagnosis. We report 2 cases of CMV esophagitis and proctitis which showed characteristic endoscopic and histologic findings of the CMV infection.