Comparison of Endoscopic Ligation and Propranolol for the Primary Prevention of Variceal Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: Although there were many studies to prevent recurrent variceal bleeding, studies about primary prophylaxis of variceal bleeding have been relatively few. We retrospectively evaluated the efficacy of endoscopic variceal ligation (EVL) and propranolol therapy for primary prevention. METHODS: 64 patients who underwent EVL or received propranolol for primary prophylaxis were enrolled and these patients were in the state of Child A or B with large varices and/or red markings on varices. We compared the cumulative bleeding-free rate and the survival rate between EVL group (n=40) and propranolol group (n=24) for primary prophylaxis. RESULTS: The Child classification, the size of varices, and the presence of red color sign were not different statistically between both groups. The mean duration of follow-up in each group was 44 18 and 22 12 months, respectively (p=0.023). The cumulative bleeding- free rate was high in EVL group than in propranolol group (p=0.03). The cumulative survival rate was not different statistically between both groups. CONCLUSIONS: In patients with high-risk varices, EVL therapy prolonged bleeding-free interval compared with propranolol therapy for the primary prophylaxis of variceal bleeding.

A Case of Low Grade MALT Lymphoma Presented as Submucosal Tumor without Mucosal Lesion / 대한소화기내시경학회지

Low grade mucosa-associated lymphoid tissue (MALT) lymphoma is a very indolent disease and can achieve complete remission with only localized treatment unlike the low grade B-cell lymphoma originating from peripheral lymph nodes. The endoscopic finding of the low grade gastric MALT lymphoma is usually presented as multiple and superficial erosions or ulceration. We recently experienced one case of low grade gastric MALT lymphoma without any mucosal lesion. The patient was initially considered as a submucosal tumor originating from the proper muscle layer of stomach and underwent the subtotal gastrectomy. But the submucosal tumor was confirmed to the low grade gastric MALT lymphoma without H. pylori infection.

A Case of Successful Colonoscopic Drainage of Peri-appendiceal Abscess Complicating Acute Appendicitis / 대한소화기내시경학회지

Traditionally, early appendectomy has been the cornerstone of therapy for acute appendicitis. However, once appendiceal perforation and abscess formation occurs, the optimal means of treatment and the timing of operation is controversial. Recently, it was reported that radiologically guided percutaneous abscess drainage and antibiotic therapy, as an initial nonoperative management, was effective and safe. Recent experience with endoscopic transmural drainage of pancreatic pseudocysts or even pancreatic abscesses prompted us to use the similar technique for the primary treatment of peri-appendiceal abscess. We report a case of peri-appendiceal abscess complicating acute appendicitis which was successfully treated by colonoscopic transmural internal drainage.

Clinical Outcome in Cases of Viral Breakthrough During Lamivudine Therapy in Chronic Hepatitis B Patients / 대한간학회지

BACKGROUND/AIMS: Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy. METHODS: A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months. RESULTS: After viral breakthrough, only 8 patients (11%) maintained normal ALT levels and 66 patients (89%) showed elevation of ALT. 30 patients (41%) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63%). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable. CONCLUSIONS: Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.

Two Difficultly Diagnosed Cases with Pseudoaneurysm in Chronic Pancreatitis Pseudoaneurysms Identified Inadvertently during Percutaneous Drainage and Hemosuccus Pancreaticus / 대한소화기내시경학회지

Pseudoaneurysm is a rare life-threatening complication of chronic pancreatitis. It can be diagnosed by various imaging modalities including computerized tomography (CT), ultrasound, and angiography. Early diagnosis and radiologic or surgical treatment can promise better outcomes. However, pseudoaneurysm is not easily diagnosed. It can be misdiagnosed as a pseudocyst with secondary infection. Rarely, the correct diagnosis is made by an inadvertent trial with percutaneous drainage. The endoscopically identified hemosuccus pancreaticus is also a rare finding. Recently, we experienced two cases of pseudoaneurysm in patients with chronic pancreatitis. They did not have any evidence of bleeding in the initial endoscopy or evidence of pseudoaneurysms in the initial ultrasound and CT scan. In one case, the pseudoaneurysm was identified during a percutaneous drainage procedure, performed to diagnose and manage a cystic lesion which appeared to be an infected cyst. In the other case, the pseudoaneurysm was suspected after the hemosuccus pancreaticus was found during endoscopy performed due to recurrent hematemesis. Both cases were successfully treated with arterial embolization of the pseudoaneurysms.

A Case of Synchronous Quadruple Early Gastric Cancer Which was Detected Preoperatively / 대한소화기내시경학회지

Early diagnosis of gastric cancer is very important since gastric cancer is one of the leading causes of cancer-mortality in Korea. The incidence of early gastric cancer has increased recently with much advances in diagnostic modalities and increasing concerns about individual health status. The incidence of multiple gastric cancer is also increasing. The number of lesions in cases with multiple gastric cancer is usually 2 or 3, and lesions over 4 sites are rare. The problem in the diagnosis of multiple gastric cancer is the low preoperative detection rate in spite of the recent advances of diagnostic techniques, especially in cases with small flat or elevated lesions. We report a case of a synchronous quadruple early gastric cancer which was preoperatively diagnosed with endoscopy. Of the four lesions, one was depressed (IIc) and the other three were superficial elevated (IIa). All four lesions were well differentiated adenocarcinomas confined to the mucosa.

A Case of Hepatic Biloma Following Endoscopic Retrograde Cholangiography / 대한소화기내시경학회지

Endoscopic retrograde cholangiography has now evolved into a highly sophisticated diagnostic and therapeutic tool in patients with hepatobiliary-pancreatic disorders. However, this procedure is associated with risks of significant complications such as cholangitis, pancreatitis, hemorrhage, and perforation which have been widely recognized. Hepatic subcapsular biloma is a very rare and less recognized complication of this procedure. Recently, we experienced a case of hepatic subcapsular biloma, developed after endoscopic removal of choledocholithiasis, managed with percutaneous drainage procedure and endoscopic stenting, and report with a review of literature.