Analysis of the Factors that Affect the Diagnostic Yield of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding / 대한소화기학회지

BACKGROUND/AIMS: Capsule endoscopy (CE) has become a valuable modality for the detection of small bowel lesions. The usefulness of CE for obscure gastrointestinal (GI) bleeding has been established with an overall diagnostic yield of 60%. It is unknown whether CE is of equal value in all the patients or of greater benefit in selected groups in Korea. We evaluated the factors that affect the diagnostic yields of CE in patients with obscure GI bleeding. METHODS: CE was performed in 126 consecutive patients [74 men and 52 women mean age : 52.5 years (25-75 yrs), 23 with active bleeding] with obscure GI bleeding between September 2002 and July 2004. Patients were divided into two groups: those with documented bleeding lesions and those with non specific CE findings. We analyzed the clinical characteristics and other parameters that influenced the diagnostic yields of CE. RESULTS: A definite or probable cause for obscure GI bleeding was found in 69% (80/116) of the patients. NSAID induced ulcer (16.4%) and angiodysplasia (12.1%) were the most common diagnoses. In patients with active bleeding, the diagnostic yield was significantly greater than that of the patients with occult bleeding (80% vs. 68.3%, p<0.05). However, there was no significant difference in parameters between patients with abnormal CE and those with normal CE in respect to gender, age, previous bleeding history, need for transfusion, cecum imaging, and bowel preparation. CONCLUSIONS: The diagnostic yield of CE in patients with obscure GI bleeding is 69%. It is significantly higher in patients with active bleeding.

A Case of Congenital Esophageal Stenosis Due to Tracheobronchial Remnants in Adult / 대한소화기내시경학회지

Congenital stenosis of the esophagus is a rare form of esophageal stenosis in adults. The main causes of congenital esophageal stenosis are the esophageal web, esophageal stricture due to tracheobronchial remnants, and idiopathic esophageal muscular hypertrophy. Recently we have experienced a 32-year-old male with dysphagia, indigestion, postprandial chest discomfort who was diagnosed as congenital esophageal stenosis due to tracheobronchial remnant. The esophagogram showed stricture of the distal esophagus with secondary proximal dilatation and endoscopic finding revealed marked stenosis on the distal esophagus with normal surrounding mucosa. The esophageal manometric finding showed decreased body peristalsis and incomplete relaxation of the lower esophageal sphincter. The patient was treated by surgical resection of the stenotic segment with end to end anastomosis. We report this rare case of adult type tracheobronchial remnant with analysis of various worldwide report and with brief review of literature.

A Case of Acute Lower Gastrointestinal Bleeding from the Appendix / 대한소화기내시경학회지

In spite of the recent advances in diagnostic technology in clinical gastroenterology, identifying the cause of acute lower gastrointestinal bleeding is still a challenging task. Hematochezia from the appendiceal bleeding is rare and associated diseases are appendiceal endometriosis, angiodysplasia, arteriovenous malformation, Crohn's disease, appendicitis, carcinoid, lymphoma, diverticulosis, and intussusception of the appendix. We experienced a 31-year-old male with acute lower gastrointestinal bleeding from the appendix. Colonoscopy could demonstrate an active hemorrhage from the orifice of the appendix. Mesenteric arteriography revealed active bleeding from the appendix, which was managed with gelfoam embolization. Next day, appendectomy was done because of recurrent bleeding. Surgically removed appendix could not dislose any abnormal lesion except a small mucosal break.

Neurofibroma of the Esophagus / 대한소화기내시경학회지

Neurofibroma in gastrointestinal tract are presented as localized forms or in associated with neurofibromatosis. Previous reported cases were presented as relatively large sized esophageal mass and treated by surgical resection. However, a neurofibroma was found incidentally during endoscopy in this case. It was presented as palisade like solitary nodules with or without connecting mucosal bridges in lower esophagus. It was treated by mucosectomy and followed up without recurrence.

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.