Successful Endoscopic Resection of Tubulovillous Adenoma Arising in Choledochocele / 대한췌담도학회지

Choledochocele is the least common type of choledochal cyst. Choledochocele has a potential for carcinogenesis, but only a handful of cases with concurrent ampullary carcinoma have been reported. We recently experienced a case of choledochocele with tubulovillous adenoma with focal high-grade dysplasia, which was successfully and completely resected en bloc via endoscopic papillectomy. Prior to endoscopic papillectomy, the endoscopic ultrasonography was able to accurately diagnose the ampullary tumor arising in choledochocele. Herein, we would like to report this case and discuss the potential of malignant transformation and the usefulness of endoscopic ultrasonography in choledochocele.

Effectiveness of cholangioscopy using narrow band imaging for hepatobiliary malignancies

PURPOSE: Recently, cholangioscopy using narrow band imaging (NBI) has been used as a diagnostic modality for better visualization in hepatobiliary malignancies; however, there are few reports on it. Our aim is to evaluate the effectiveness of cholangioscopy using NBI in hepatobiliary malignancies. METHODS: Between January 2007 and December 2016, 152 cholangioscopies using percutaneous approach were conducted in total 123 patients. Among these, 36 patients were suspicious of hepatobiliary malignancies. Thirteen patients with an ambiguous margin on endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP), for whom NBI tipped the balance in diagnosis of lesion and decision of lesion extent by adding NBI, were involved in our study. RESULTS: Underlying diseases were all malignant in 13 patients (11 bile duct cancers, 1 liver cancer, 1 pancreas cancer with common bile duct invasion). In 7 cases with papillary type tumor, minute superficial spreading tumor was detected by NBI more easily, and NBI provided a better visualization of tumor vessel and margin evaluation in 4 cases with infiltrative tumor. In 2 cases with mucin-hypersecreting tumor, NBI showed better penetration through the mucin and gave us a much clearer image. Nine patients ultimately underwent surgical resection. The margins predicted by NBI cholangioscopy were consistent with the pathological margins on the resected specimens. CONCLUSION: In conclusion, cholangioscopy using NBI is very useful for evaluation of suspected hepatobiliary malignancies with an ambiguous margin on ERCP or MRCP. It can give us an accurate pathologic mapping, and this information seems to be essential before deciding on a treatment strategy.

Histological Changes of Gastric Mucosa after Helicobacter pylori Eradication

BACKGROUND/AIMS: The aim of this study was to evaluate whether Helicobacter pylori eradication could improve histologic findings of gastric mucosa. MATERIALS AND METHODS: One hundred thirty two H. pylori infected patients were evaluated for histologic findings. Biopsy specimens from antrum and corpus were taken before and 7 weeks after H. pylori eradication therapy. Before and after eradication, H. pylori status was determined by biopsy, rapid urease test and urea breath test. Histologic findings were classified as mild, moderate, or severe according to the updated Sydney classification. RESULTS: The scoring of H. pylori density, activity and gastric atrophy was found significantly decreased in H. pylori eradicated groups after 7 weeks, while no significant change was found in H. pylori non-eradicated groups. Intestinal metaplasia wasn't improved in neither H. pylori eradicated group or H. pylori non-eradicated group. CONCLUSIONS: It can be suggested that improvement of H. pylori density, activity and gastric atrophy may occur after eradication of H. pylori. To see the positive effects of eradication therapy, a longer follow-up duration might be needed.

Histological Changes of Gastric Mucosa after Helicobacter pylori Eradication

BACKGROUND/AIMS: The aim of this study was to evaluate whether Helicobacter pylori eradication could improve histologic findings of gastric mucosa. MATERIALS AND METHODS: One hundred thirty two H. pylori infected patients were evaluated for histologic findings. Biopsy specimens from antrum and corpus were taken before and 7 weeks after H. pylori eradication therapy. Before and after eradication, H. pylori status was determined by biopsy, rapid urease test and urea breath test. Histologic findings were classified as mild, moderate, or severe according to the updated Sydney classification. RESULTS: The scoring of H. pylori density, activity and gastric atrophy was found significantly decreased in H. pylori eradicated groups after 7 weeks, while no significant change was found in H. pylori non-eradicated groups. Intestinal metaplasia wasn't improved in neither H. pylori eradicated group or H. pylori non-eradicated group. CONCLUSIONS: It can be suggested that improvement of H. pylori density, activity and gastric atrophy may occur after eradication of H. pylori. To see the positive effects of eradication therapy, a longer follow-up duration might be needed.

Necrotizing Myositis as an Extraintestinal Manifestation of Crohn's Disease

Inflammatory bowel disease is associated with extraintestinal manifestations involving almost every organ system in the body. Crohn's disease (CD) appears to be more commonly associated with an inflammatory myopathy than ulcerative colitis. However, myopathy of the thigh in patients with CD is rare. We report an unusual site of necrotizing myositis in a patient with CD. A 23-year-old woman presented with swelling and pain at the left popliteal area that had lasted for 1 week. Twenty-two months before admission, she had presented with pyoderma gangrenosum on the left upper chest and was diagnosed with CD. A magnetic resonance imaging scan of her leg revealed diffuse swelling in the left semimembranous muscle and biceps femoris muscle that was compatible with myositis, and a cystic lesion in the distal portion of the semimembranous muscle. The findings from semimembranous muscle biopsy were also consistent with necrotizing myositis. In conclusion, myositis, although rare, can be an extraintestinal manifestation of CD.