Usefulness of double balloon enteroscopy in obscure gastrointestinal bleeding / 대한내과학회지

BACKGROUND: Double balloon enteroscopy was developed to improve access to the small intestine. The aim of this study was to evaluate the efficacy of double balloon enteroscopy in patients with obscure gastrointestinal bleeding. METHODS: From November 2004 through August 2005, 24 consecutuve patients (14 males, 10 females; mean age 48+/-15.1 years, range 2181 years) with gastrointestinal bleeding of an obscure origin were enrolled in this study. The patients underwent enteroscopy using the double balloon technique for the following indications: (1) clinical evidence of gastrointestinal bleeding such as melena and hematochezia (the Hb levels ranged from 5.9 g/dL to 11.9 g/dL, mean 9.0+/-2.3 g/dL) (2) no site and cause of blood loss detected by upper endoscopy and colonoscopy. RESULTS: Of 24 patients that underwent a double balloon enteroscopy, bleeding points were identified in 22 patients. The causes of bleeding were nine small bowel ulcera, six angiodysplasiaa, three cases of Crohn's disease, two gastrointestinal stromal tumors, one Meckel's diverticulum and one cecal diverticular ulcer. However, two cases showed negative findings. No patient suffered from procedure related complication. CONCLUSIONS: Double balloon enteroscopy is a safe and useful diagnostic tool for obscure gastrointestinal bleeding.

The Clinical Significance of the Absolute and Relative Classification of the Depth of Invasion for Submucosal Invasive Carcinomas of the Colon / 대한소화기내시경학회지

BACKGROUND/AIMS: We investigated the clinical significance of the criteria of the absolute and relative depth of invasion for submucosal invasive colorectal carcinomas. METHODS: We analyzed retrospectively the clinicopathological features of 29 submucosal invasive colorectal cancers. The relative depth of submucosal invasion was evaluated by a relative (sm1, 2, 3) classification and the absolute depth of submucosal invasion was measured in micrometers from the lower border of the muscularis mucosa to the deepest cancer gland. RESULTS: All sm1 cancers showed a submucosal layer invasion of less than 1,000micronm; invasion was seen between 500micronm and 1,000micronm. The rate of lymphovascular invasion was higher for sm1c, sm2 and sm3 than for sm1a and sm1b, and the rate of invasion was higher for a level of 500micronm or more than for a level of 500micronm or less for the depth of submucosal invasion. One of sixteen patients that underwent surgery showed lymph node involvement. For this patient, the relative depth of invasion was sm1c and the absolute depth was 900micronm. CONCLUSIONS: Endoscopically treated submucosal colorectal cancer needs to be evaluated by the absolute depth in addition to the relative depth. It seems that a submucosal invasive cancer less than 500micronm in submucosal depth probably can be treated by endoscopic resection.

The Clinical Significance of the Absolute and Relative Classification of the Depth of Invasion for Submucosal Invasive Carcinomas of the Colon / 대한소화기내시경학회지

BACKGROUND/AIMS: We investigated the clinical significance of the criteria of the absolute and relative depth of invasion for submucosal invasive colorectal carcinomas. METHODS: We analyzed retrospectively the clinicopathological features of 29 submucosal invasive colorectal cancers. The relative depth of submucosal invasion was evaluated by a relative (sm1, 2, 3) classification and the absolute depth of submucosal invasion was measured in micrometers from the lower border of the muscularis mucosa to the deepest cancer gland. RESULTS: All sm1 cancers showed a submucosal layer invasion of less than 1,000micronm; invasion was seen between 500micronm and 1,000micronm. The rate of lymphovascular invasion was higher for sm1c, sm2 and sm3 than for sm1a and sm1b, and the rate of invasion was higher for a level of 500micronm or more than for a level of 500micronm or less for the depth of submucosal invasion. One of sixteen patients that underwent surgery showed lymph node involvement. For this patient, the relative depth of invasion was sm1c and the absolute depth was 900micronm. CONCLUSIONS: Endoscopically treated submucosal colorectal cancer needs to be evaluated by the absolute depth in addition to the relative depth. It seems that a submucosal invasive cancer less than 500micronm in submucosal depth probably can be treated by endoscopic resection.

A Case of Atypical Fundic Gland Hyperplasia Confirmed by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Fundic gland hyperplasia is a hyperplasia of glandular portion on epithelium of gastric fundus or body. The incidence of fundic gland hyperplasia is 1.4% in the general population. Fundic gland hyperplasia is the most common cause of multiple polyposis. Probably the most cause of fundic gland hyperplasia is a hamartomatous origin but some hyperplastic origin because of spontaneous remission. We have experienced and reported a case of atypical fundic gland hyperplasia confirmed by endoscopic mucosal resection.

A Case of Successful Endoscopic Therapy in Delayed Diagnosed Perforation after Endoscopic Colon Polypectomy / 대한소화기내시경학회지

With the wide use of colonoscopy and development of technology, colon tumors and colon polyps are being found frequently and for the treatment of colon polyp, endoscopic polypectomy is used at present. The most common complications of endoscopic colon polypectomy are hemorrhage and perforation. Colon perforation is an abdominal emergency with high mortality. When colon perforation happens, surgical resection was being used at past. But when colon perforations are resulted from therapeutic colonoscopy, devoid of down stream obstacles with a perfectly prepared colon, and the patient's general condition is satisfactory, colon porforation is successfully treated by conservative measures. But, in delayed diagnosed perforation endoscopic treatment is controversial yet. We report here a case which sustained iatrogenic delayed diagnosed perforation of the sigmoid colon caused by polypectomy that was successfully treated by endoscopic clip therapy.

The Study of Pathologic Difference between Endoscopic Biopsy before EMR and Histology of Specimen after Endoscopic Mucosal Resection (EMR) on Gastric Flat Adenoma or Early Gastric Cancer (EGC) / 대한소화기내시경학회지

BACKGROUND/AIMS: It is not uncommon to show discrepancy between the histology of the endoscopic biopsy and that of the resected specimen obtained from the same lesion by EMR. The aim of this study was to ascertain whether routine endoscopic biopsy specimens are sufficient to qualify the representative enough to reliable indication of EMR. METHODS: We retrospectively reviewed 36 cases that could be compared the histologic results from the resected specimens by EMR to the tissue obtained by endoscopic biopsy. The histologic slides were reviewed by one pathologist. RESULTS: Of the 36 cases, 13 cases of EGC and 23 cases of gastric flat adenomas were included. Among 13 cases of EGC, 2 case (15.4%) revealed discrepancy between the histology of the endoscopic biopsy and that of a resected specimen by EMR. The histology of a resected specimen by EMR revealed moderate differentiated adenocarcinoma, while that of endoscopic biopsy was a well differentiated adenocarcinoma. Gastric flat adenoma revealed 47.8% (11/23) of discrepancy. CONCLUSIONS: The histologic discrepancy between the result of endoscopic biopsy and that of the resected specimen obtained by EMR was about 8% in EGC and 47.8% in gastric flat adenoma.

A Case of Gastric Lipomatosis / 대한소화기내시경학회지

Gastric lipomas are rare benign submucosal tumor, usually solitary, and comprise about 3% of gastric benign tumors. The occurrence of gastric lipomatosis is extremely rare. Although most gastric lipomas are usually detected incidentally, they can cause severe symptoms such as obstruction, invagination, and life-threatening hemorrhage. The diagnosis and differentation from malignant tumors and other submucosal tumors are difficult with conventional diagnostic modalities such as X-ray or endoscopic examination. But endoscopic ultrasonography allows us to visualize the structures underlying the gastrointestinal wall in a noninvasive maneuver, and can contribute to make differential diagnosis and decision of management. The treatment of lipoma is still controversial. We reported a 70-year-old male who had gastric lipomatosis in entire stomach, which could be diagnosed with endoscopic ultrasonography and was proven by endoscopic lumpectomy, pathologically.