A Case of Percutaneous Endoscopic Gastrostomy in a Patient with Liver Cirrhosis Accompanied by Both Esophageal and Gastric Varices / 대한소화기학회지

Malnutrition in patients with liver disease is common. Consequently, percutaneous endoscopic gastrostomy may be needed for the correction of malnutrition. Percutaneous endoscopic gastrostomy is rarely performed in patients with liver cirrhosis because of the presence of varices and coagulation abnormalities. However, if careful insertion technique along with thorough clinical assessment is undertaken, percutaneous endoscopic gastrostomy may be successfully performed in patients with liver cirrhosis. Here, we report successful application of percutaneous endoscopic gastrostomy in a patient with liver cirrhosis accompanied by both gastric and esophageal varices.

Efficacy of Percutaneous Treatment of CBD Stones Which Could Not be Removed by Per-oral Endoscopic Method / 대한소화기내시경학회지

BACKGROUND/AIMS: Common bile duct (CBD) stones can be removed by endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) in most cases. In addition, surgery or stenting as well as percutaneous transhepatic cholangioscopy (PTCS) with lithotripsy can be used to remove CBD stones also. In this study we evaluated the efficacy of percutaneous removal of CBD stones which could not be removed by per-oral endoscopic method. METHODS: From Jan. 1998 to Sep. 2001, ERCP were tried to remove CBD stones in 395 patients. We reviewed causes of treatment failure through the peroral method and PTCS-results by the medical records and cholangiograms in 15 patients. RESULTS: We successfully removed stones with PTCS in all 15 patients. The reasons for percutaneous approach were previous operation history in 8 (53.3%) and old age in 10 (66.7%). Mean number and size of stone were 4.4 and 17.4 x 13.1 mm, respectively. Complete fragmentation and removal of stones were achieved in a single session in 40%. Mean time to complete removal was 19 days. In 1 patient, bile peritonitis was developed but cured by conservative management alone. CONCLUSIONS: PTCS with or without lithoptripsy is an effective and safe method for the treatment of CBD stones which can not be removed by peroral endoscopic approach.

A Case of Anisakiasis Diagnosed after Partial Resection of Ileum Due to Eosinophilic Ascites and Ileal Abscess / 대한소화기내시경학회지

Eosinophilic enteritis is characterized by massive infiltration of eosinophil throughout the entire or each layer of intestinal wall with marked submucosal edema. The etiology of this disease is not clear until now, and parasite infestation should be considered as a cause of eosinophilic enteritis like this case. We experienced a case of eosinophilic enteritis manifested by intermittent periumbilical pain and bloody ascites. After partial resection of ileum, we confirmed the eosinophilic abscess from Anisakis infestation and successfully treated this patient without sequalae and report it with literatures review.

A Case of Rectal Cap Polyposis Cured by Segmental Resection / 대한소화기내시경학회지

Cap polyposis is a rare condition, which is characterized by inflammatory polyp located mainly from the rectum to the sigmoid colon with a "cap"-coverage of granulation tissue. A 60-year-old woman with tenesmus, constipation, and abdominal pain visited our hospital. Colonoscopy showed variable sized multiple polypoid lesions limited in high rectum, mainly 10 cm distance from anal verge. No other abnormalities of colonic mucosa were seen beyond this area. Medical treatments including stool softner and oral steroid had a little symptomatic improvement. Because symptoms had been frequently recurred after withdrawal of these medications, surgical resection was intended for diagnosis and curative treatment. Resected specimen showed multiple inflammatory polyps with granulation cap. After the resection, the patient has been good at daily activity without evidence of symptomatic or endoscopic aggravation.

Comparison of Doppler Ultrasonography and Hepatic Venous Pressure Gradient in Assessing Portal Hypertension in Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: This prospective study aimed to determine if Doppler ultrasonography can be representative of hepatic venous pressure gradient (HVPG) in assessing the severity of portal hypertension and response to drug reducing portal pressure. METHODS: The HVPG and the parameters of Doppler ultrasonography including portal venous velocity (PVV) and splenic venous velocity, the pulsatility and resistive index of hepatic, splenic and renal arteries were measured in 105 patients with liver cirrhosis. In 31 patients the changes of hepatic venous pressure gradient and portal venous velocity after administration of terlipressin were evaluated. The patients who showed a reduction in HVPG of more than 20% of the baseline were defined as responders to terlipressin. RESULTS: Any Doppler ultrasonographc parameters did not correlate with HVPG. Both HVPG and PVV showed a highly significant reduction after the administration of terlipressin(-28.3 +/- 3.9%, -31.2 +/- 2.2% respectively). However, PVV decreased significantly not only in responders(31.7 +/- 2.4%) but also in nonresponders(29.5 +/- 6.1%). CONCLUSION: Doppler ultrasonography can not be representative of HVPG in assessing the severity of portal hypertension and response to drug reducing portal pressure in liver cirrhosis.