Magnifying Endoscopy with Narrow Band Imaging of Early Gastric Cancer: Correlation with Histopathology and Mucin Phenotype

BACKGROUND/AIMS: Magnifying endoscopy with narrow band imaging (ME-NBI) is a useful modality for the detailed visualization of microsurface (MS) and microvascular (MV) structures in the gastrointestinal tract. This study aimed to determine whether the MS and MV patterns in ME-NBI differ according to the histologic type, invasion depth, and mucin phenotype of early gastric cancers (EGCs). METHODS: The MS and MV patterns of 160 lesions in 160 patients with EGC who underwent ME-NBI before endoscopic or surgical resection were prospectively collected and analyzed. EGCs were categorized as either differentiated or undifferentiated and as either mucosal or submucosal, and their mucin phenotypes were determined via immunohistochemistry of the tumor specimens. RESULTS: Differentiated tumors mainly displayed an oval and/or tubular MS pattern and a fine network or loop MV pattern, whereas undifferentiated tumors mainly displayed an absent MS pattern and a corkscrew MV pattern. The destructive MS pattern was associated with submucosal invasion, and this association was more prominent in the differentiated tumors than in the undifferentiated tumors. MUC5AC expression was increased in lesions with either a papillary or absent MS pattern and a corkscrew MV pattern, whereas MUC6 expression was increased in lesions with a papillary MS pattern and a loop MV pattern. CD10 expression was more frequent in lesions with a fine network MV pattern. CONCLUSIONS: ME-NBI can be useful for predicting the histopathology and mucin phenotype of EGCs.

Retraction Notice to "Endoscopic Resection for Rectal Carcinoid Tumors: Comparision of Polypectomy and Endoscopic Submucosal Resection with Band Ligation"

This retracts the below mentioned article upon the authors' request.

Endoscopic Resection for Rectal Carcinoid Tumors: Comparision of Polypectomy and Endoscopic Submucosal Resection with Band Ligation

BACKGROUND/AIMS: Rectal carcinoid tumors, at diagnosis, are as small as 10 mm or less in about 80% of patients. These tumors are generally removed by endoscopic resection. The aim of this study was to compare treatment efficacy and safety between endoscopic submucosal resection with band ligation (ESMR-L) and conventional polypectomy. METHODS: Between January 2005 and September 2010, a total of 88 patients, who visited at Busan Paik Hospital and Kosin University Gospel Hospital for endoscopic resection of rectal carcinoid, were reviewed, retrospectively. RESULTS: Thirty-three cases were treated by ESMR-L, and 55 cases by conventional polypectomy. There were no significant difference in the size of tumor between ESMR-L group and polypectomy group (6.02+/-2.36 vs. 6.49+/-3.24 mm, p=0.474). The rate of positive resection margin was significantly lower in ESMR-L group (2/33, 6.1%) than in polypectomy group (19/55, 34.5%; p=0.002). The rate of positive vertical resection margin, among others, was markedly lower in ESMR-L group (1/33, 3.0%) compared to polypectomy group (19/55, 34.5%; p<0.001). CONCLUSIONS: ESMR-L, rather than conventional polypectomy, is a useful treatment option for removal of rectal carcinoid tumors less than 10 mm in diameter.

Involvement of Splenic Hemangioma and Rectal Varices in a Patient with Klippel - Trenaunay Syndrome / 대한소화기학회지

Klippel - Trenaunay syndrome (KTS) is characterized by a cutaneous vascular nevus of the involved extremity, bone and soft tissue hypertrophy of the extremity and venous malformations. We present a case of KTS with splenic hemangiomas and rectal varices. A 29-year-old woman was referred for intermittent hematochezia for several years. She had history with a number of operations for cutaneous and soft tissue hamangiomas since the age of one year old and for increased circumference of her left thigh during the last few months. Abdominal CT revealed multiple hemangiomas in the spleen, fusiform aneurysmal dilatation of the deep veins and soft tissue hemangiomas. There was no evidence of hepatosplenomegaly or liver cirrhosis. Colonoscopy revealed hemangiomatous involvement in the rectum. There were rectal varices without evidence of active bleeding. Upon venography of the left leg, we also found infiltrative dilated superficial veins in the subcutaneous tissue and aneurysmal dilatation of the deep veins. The patient was finally diagnosed with KTS, and treated with oral iron supplementation only, which has been tolerable to date. Intervention or surgery is not required. When gastrointestinal varices or hemangiomatous mucosal changes are detected in a young patient without definite underlying cause, KTS should be considered.

Diagnostic Use of Endoscopic Ultrasound-guided Trucut Biopsy in Various Diseases / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic ultrasound-guided trucut biopsy (EUS-TCB) is a relatively new method, which facilitates obtaining a core biopsy through the gut wall. We evaluated the diagnostic accuracy of EUS-TCB based on the types of lesions. METHODS: We retrospectively reviewed the database of 37 cases in 35 patients (mean age, 57.2+/-2.3 years; 23 men) with thoracic and abdominal masses who got EUS-TCB between January 2007 and June 2008. Final diagnoses were determined by malignant positive EUS specimens, surgical pathology, or the clinical course. RESULTS: Adequate samples were obtained by EUS-TCB in 78.4% (29/37) of the cases. The overall diagnostic accuracies of the EUS-TCB were 73.0%. The mean size of the masses was 3.7+/-2.6 cm. The diagnostic accuracies of EUS-TCB according to the lesions were as follows: lymph node, 85.7% (18/21); subepithelial lesion, 60.0% (6/10); and solid tumor, 50% (3/6). With respect to accuracy, lymph nodes were significantly superior to non-lymph node lesions (p=0.046). There was a minor bleeding controlled by hemoclipping (2.7%). CONCLUSIONS: EUS-TCB is a useful technique for the diagnosis of lymph nodes, subepithelial tumors, and solid tumors that were not able to be diagnosed by other methods. In addition, EUS-TCB is a safe and minimally invasive method.

Chronic Non-granulomatous Ulcerative Jejunoileitis Assessed by Wireless Capsule Endoscopy / 대한소화기학회지

Chronic non-granulomatous jejunoileitis is a rare disease characterized by malabsorption, abdominal pain, and diarrhea that causes shallow ulcers in the small bowel. The etiology of chronic non-granulomatous jejunolieitis remains unknown. A 69-year-old man complained of abdominal pain and lower extremity edema. A 99m-Tc albumin scan showed increased radioactivity at the left upper quadrant, suggesting protein-losing enteropathy. A small bowel follow-through did not disclose any lesions. Wireless capsule endoscopy revealed several small bowel ulcers and strictures. A jejunoileal segmentectomy with end-to-end anastomosis was performed, and the histologic examination revealed non-granulomatous ulcers with focal villous atrophy. Ruling out all other possible diagnoses, we diagnosed our patient with chronic non-granulomatous ulcerative jejunoileitis. Postoperatively, the patient's abdominal pain and lower extremity edema improved, and the serum albumin normalized. This is the first case of chronic non-granulomatous ulcerative jejunoileitis localized by wireless capsule endoscopy and treated successfully with segment resection.

Clinical Characteristics of Colonic Diverticulosis in Korea: A Prospective Study

BACKGROUND/AIMS: The prevalence of colonic diverticulosis has been reported to be lower in Korea than in Western countries. This disease also shows markedly different characteristics in the Korean population. We describe herein a prospective investigation, based on colonoscopic examination, of the prevalence, clinical characteristics, and factors associated with colonic diverticulosis in Korea. METHODS: The prevalence of colonic diverticulosis has been reported to be lower in Korea than in Western countries. This disease also shows markedly different characteristics in the Korean population. We describe herein a prospective investigation, based on colonoscopic examination, of the prevalence, clinical characteristics, and factors associated with colonic diverticulosis in Korea. RESULTS: The overall prevalence of colonic diverticulosis was 12.1% (103 / 848). The right side of the colon was involved in 84.5% of patients (87 / 103); patients with right side diverticula were, on average, younger than those with left side diverticulosis (p = 0.014). Multiple diverticula were observed in 60.2% (62 / 103) of patients. Age greater than 60 years, a high-fat diet, and alcohol consumption were significantly associated with the presence of colonic diverticulosis (p < 0.05). CONCLUSIONS: The prevalence of colonic diverticulosis in Korea is increasing and is most commonly located in the right side of the colon. Further, old age and diet may affect the risk of development of this disease.

The Difference of Clinicopathologic Features according to Leptin Expression in Colorectal Adenoma / 대한소화기학회지

BACKGROUND/AIMS: Colorectal adenoma and cancer are known to be associated with obesity. Leptin, an adipocyte-derived hormone that plays a crucial role in obesity has been suggested as a growth factor in colon cancer. However, the association between adenoma and leptin remains controversial. We evaluated the leptin expression in human colorectal adenoma and its correlation to clinicopathologic factors. METHODS: Leptin expression was assessed by immunohistochemistry in 91 samples of colorectal adenoma larger than 5 mm, which were removed by endoscopic polypectomy. All patients underwent colonoscopy for cancer screening at Seoul Paik Hospital from 2007 to 2008 and we only included the patients less than 50 years of age. Leptin expression and its relationship with clinicopathologic features were analyzed. RESULTS: Eighty samples were available for the interpretation of leptin expression and showed positive in 42 (52.5%) cases and negative in 38 (47.5%) cases. As body mass index (BMI) increased based on World Health Organization (WHO) classification the positivity of leptin expression also increased (p(trend)=0.02). In leptin positive group, the correlation of leptin expression with adenoma size and histological showed positive tendency without statistical significance. CONCLUSIONS: Leptin expression of colorectal adenoma was associated with BMI. The question of whether leptin contributes to colorectal adenoma development is unresolved and will require additional studies.

Trichuris trichiura Infection Diagnosed by Colonoscopy: Case Reports and Review of Literature

Trichuris trichiura, commonly referred to as a whipworm, has a worldwide distribution, particularly among countries with warm, humid climates. In Korea, trichuriasis was a highly prevalent soil-transmitted helminthiasis until the 1970s. However, the nationwide prevalence decreased to 0.02% in 2004 as a result of national control activities and improvement in the socioeconomic status of Koreans. Most infected individuals have no distinct symptoms, if lightly infected. The diagnosis is typically confirmed by detection of T. trichiura eggs on examination of a stool sample; few reports have described detection of the parasite during colonoscopy. Recently, we managed 4 patients with trichuriasis who were diagnosed by detection of the parasite on colonoscopy, and we reviewed the literature on the colonoscopic diagnosis of T. trichiura in Korea. We suggest that colonoscopy might be a useful diagnostic tool, especially when infected by only a few male worms with no eggs in the stool.

A Prospective Comparison of Sulfate Free Polyethylene Glycol versus Sodium Phosphate Solution for Precolonoscopic Bowel Preparation / 대한소화기내시경학회지

BACKGROUND/AIMS: Polyethylene glycol (PEG) solution is commonly used for precolonoscopic preparation because of its safety and effectiveness. Sulfate free PEG (SF-PEG) solution was developed to reduce the salty taste by removing the sodium sulfate. The aim of this study was to compare the efficacy and patient compliance of SF-PEG and sodium phosphate (NaP) solutions for preparing the bowel before colonoscopy. METHODS: From February through April in 2007, 534 patients who underwent colonoscopy were prospectively enrolled. The efficacy of bowel cleansing was assessed by a doctor's questionnaire and the patient's compliance was assessed by a patient's questionnaire. RESULTS: There was no significant difference between the groups for the "stools and fluids" assessment of bowel cleansing (2.07 vs. 2.14, respectively, p=0.149). However, SF-PEG was more effective on the "air bubbles" assessment (1.34 vs. 1.71, respectively, p<0.001) and the overall assessment (0.72 vs. 0.91, respectively, p=0.010) than NaP. The patients preferred SF-PEG rather than NaP for "Taste" (1.34 vs. 2.25, respectively, p=0.148). However, the patients significantly preferred NaP rather than SF-PEG for "Quantity" (2.46 vs. 1.18, respectively, p<0.001). CONCLUSIONS: The SF-PEG solution showed more effectiveness for bowel cleansing as compared to the NaP solution. SF-PEG tastes better than NaP, but patients are still required to consume 4 liters for the standard preparing regimen.

Clinical Characteristics of Colonic Diverticular Disease Diagnosed with Colonoscopy

BACKGROUND/AIMS: Although colonic diverticular disease is less common in Koreans than in Western people, its incidence has been on the increase in Korea. We investigated the clinical characteristics and related complications of colonic diverticular disease in Koreans. METHODS: We retrospectively reviewed the medical records of 9,006 patients who underwent colonoscopy at the Seoul Paik hospital between July 2002 and January 2008. RESULTS: Of the 9,006 patients, there were 654 cases (7.3%) of colonic diverticulosis (472 men, 182 women). The mean age of the patients was 54.6+/-12.0 years. The right colon was involved in 535 cases, the left colon was involved in 86 cases and both the left and right colon was involved in 33 cases. Among the patients, a single diverticulum was seen in 253 cases and two or more diverticuli were seen in 401 cases. Related complications were diverticulitis (11 cases, 1.7%) and diverticular bleeding (3 cases, 0.5%). CONCLUSIONS: The incidence of colonic diverticular disease in Korea shows an increasing trend. Colonic diverticular lesions are frequently found in the right colon.

Hyponatremic Encephalopathy Following a Sulfate Free Polyethylene Glycol-based Bowel Preparation for Colonoscopy / 대한소화기내시경학회지

Hyponatremia associated with the use of both a sodium phosphate (NaP) and polyethylene glycol (PEG) solution for colonoscopy preparation has been reported in patients with impaired renal handling of water. A PEG solution is believed to affect serum electrolytes less than NaP, but the use of a PEG solution can lead to nausea, vomiting, intestinal hyperactivity and dehydration, often resulting in a raised plasma antidiuretic hormone (ADH) concentration. Non-osmolar stimuli such as pain, stress, nausea, and vomiting can stimulate ADH release. We report a case of severe hyponatremic encephalopathy after sulfate-free PEG ingestion for a colonoscopy in a healthy middle-aged woman. We think that physicians should be familiar with the medical history and current medication schedule of patients prior to bowel preparation. The levels of serum electrolytes should be checked in patients with impaired ability to excrete free water and any mental aberrations before undertaking colonoscopy procedures.

A Case of Peutz-Jeghers Polyp that was Diagnosed using Capsule Endoscoy and the Polyp was Removed by Means of Double Balloon Enteroscopy / 대한소화기내시경학회지

Peutz-Jeghers syndrome is an autosomal dominant hereditary disease that's characterized by hamartomatous polyps of the gastrointestinal tract and mucocutaneous melanin pigmentation. Hamartomatous polyps can arise anywhere in the gastrointestinal tract, but they are most common in the small intestine. The major symptoms of Peutz-Jeghers syndrome are abdominal pain, intussusception and anemia due to gastrointestinal bleeding, which are all caused by harmatomatous polyp. Capsule endoscopy has been reported to have a higher diagnostic yield than small bowel barium radiography for patients with Peutz-Jeghers syndrome and who have small bowel polyp. Small bowel polyp in patients with Peutz-Jeghers syndrome can be resected by double balloon enteroscopy without laparotomy. We report here on a patient with melena that was caused by small bowel polyps, and this was found by using capsule endoscopy. Polyp in the distal ileum was resected by using colonoscopy and the patient was diagnosed as suffering with Peutz-Jeghers syndrome. The other proximal ileum polyp was resected by using double balloon enteroscopy without complication.

A Case of Endoscopic Unroofing after Detachable Snare Ligation of a Duodenal Duplication Cyst / 대한소화기내시경학회지

A duodenal duplication cyst is rare congenital anomaly, which accounts for 5% of all gastrointestinal duplication cysts. Most of the duodenal duplication cysts are usually found during infancy or early childhood, and present with obstructive symptoms. The most common clinical manifestations are an intestinal obstruction or, less commonly, hemorrhage, perforation, biliary obstruction or pancreatitis. The traditional treatment of a duodenal duplication cyst has been complete surgical resection, but very few cases of endoscopic treatment of a duodenal duplication cyst have been previously reported recently in the literature. Moreover, endoscopic treatment of a duodenal duplication cyst has not been reported in Korea. We report our first experience of a duodenal duplication cyst, including diagnosis and endoscopic management with a detachable snare.

Lymphocytic Interstitial Pneumonitis Associated with Epstein-Barr virus in Systemic Lupus Erythematosus and Sjgren's Syndrome: Complete remission with corticosteroid and cyclophosphamide

Lymphocytic interstitial pneumonitis (LIP) is characterized by diffuse bilateral pulmonary infiltrations in both lower lobes. Pleomorphic lymphohistiocytes including mature lymphocytes, variable admixture of plasma cells and other mononuclear cells infiltrate within the pulmonary interstitium, ranging from widened septa to confluent masses. We report a case of LIP associated with Epstein-Barr virus in a patient with SLE and Sj gren's syndrome. A 50-year-old woman was admitted with insidious onset of progressive dyspnea for 20 days. She suffered from arthritis 10 years earlier without specific diagnosis. A radiography of chest has showed bilateral consolidative infiltrations with pleural effusion in both lower lung fields. Open lung biopsy documented lymphocytic interstitial pneumonitis which expressed Epstein-Barr virus genome in situ hybridization study. Following corticosteroid and cyclophosphamide therapy, clinical symptoms and radiologic infiltrations gradually remitted.

A Case of Bronchial Artery Aneurysm Presenting with Massive Hemoptysis / 결핵

A bronchial artery aneurysm(BAA) is rare, and has an unclear etiology. However, it may be caused by conenital abnormalities and acquired diseases like as bronchiectasis, tuberculosis, and other infections. The pathogenesi s of a bronchial artery dilatation and the formation of an aneurysm results in an increase in the systemic blood flow to the chronic inflammatory pathologic lungs such as bronchiectasis or tuberculosis. It can be divided into the mediastinal and intrapulmonary BAA according to their location. The most common symptom is hemoptysis. Chest computed tomography and bronchial artery angiography may be used for a diagnosis. Treatment is mainly by a surgical resection of the aneurysmal artery. However, when patient is unstable due to massive hemoptysis or recurrent hemoptysis, bronchial artery embolization is useful. Here, we experienced a case of a bronchial artery aneurysm presenting as a massive hemoptysis.

A Case of Polyarteritis Nodosa Preceded by Otitis Media / 대한류마티스학회지

Polyarteritis nodosa (PAN) is a disease of small and medium sized muscular arteries, typically involving the skin, kidney, peripheral nerves, muscle and gut. Although its etiology has not been known clearly yet, an immune complex is believed to initiate a vasculitis. Infections, such as hepatitis B virus, hepatitis C virus, and streptococcal infection, may be related with the development of PAN. We experienced a case of PAN preceded by Methicillin resistant staphylococcus aureus-associated otitis media in a 50-year-old woman. This is the first case reported in Korea.