Colon Polyp Detection in Primary Health Care Institutions of Korea: Detection Rate and Issues with Following the Guidelines / 대한소화기학회지

Background/Aims@#There have been few multicenter studies on colonic polyps conducted by primary medical institutions. This study examined the detection rate of colonic polyps in primary health care institutions and the related factors while following the guidelines. @*Methods@#The medical records of 14,029 patients who underwent colonoscopy between January-June 2020 at 40 primary medical institutions in Korea were analyzed. High-risk adenoma was defined as advanced adenoma, carcinoma, or ≥3 adenomas. @*Results@#Most patients (71.2%) aged ≥50 years underwent re-colonoscopy within 5 years (51.3%) for diagnostic purposes (61.3%) in Korean primary medical institutions. The detection rates of colon polyps, adenoma, advanced adenoma, high-risk adenoma, and carcinoma was 59.9%, 38.9%, 5.9%, 11.4%, and 0.3% in all subjects and 59.8%, 37.5%, 8.5%, 12.9%, and 0.3% in average-risk patients, respectively. The incidences of adenoma in average-risk patients increased significantly with age (30s/40s/50s: 20.1%/29.4%/43% for adenoma, 4.4%/6.7%/10.3% for advanced adenoma, and 5.6%/9.5%/14.6% for high-risk adenoma; p<0.05). Before 50 years of age, high-risk adenoma was detected in 9.1% of patients in the first-time screening group, and the significant risk factors were being male and ≥40 years of age. The detection rate of high-risk adenoma in the normal index colonoscopy group within 5 years was 9.0%. The significant risk factors included older age, male sex, positive fecal occult blood test, stool form changes, and nonspecific symptoms (gas and indigestion). @*Conclusions@#More colonic adenoma studies targeting real-world clinical practice will be needed to revise the Korean guidelines for colorectal cancer screening and surveillance.

A Case of Massive Bleeding from Jejunal Stromal Tumor Diagnosed by Intraoperative Enteroscopy: A Case of Jejunal Stromal Tumor Bleeding / 대한소화기내시경학회지

Gastrointestinal stromal tumors (GISTs) are uncommon tumors that originate from primitive mesenchymal cells. Because GISTs develop throughout the gastrointestinal tract, they present variable heterogenous clinical manifestations such as gastrointestinal bleeding. We report a case of massive gastrointestinal bleeding from jejunal stromal tumor mimicking arteriovenous malformation.

A case of hepatobronchial fistula in liver abscess / 대한내과학회지

We report an uncommon case of pyogenic hepatic abscess with hepatobronchial fistula. A 59 year-old male was admitted because of purulent sputum and cough. Ultrasonography and abdominal computed tomography showed an abscess on the superior segment of right hepatic lobe. Diagnostic and therapeutic percutaneous trans-hepatic abscessography disclosed hepatobronchial fistula. Liver abscess with hepatobronchial fistula was managed with percutaneous abscess drainage and antibiotics. The abscess was resolved and he is being on the follow-up with symptom free status.

A case of hepatobronchial fistula in liver abscess / 대한내과학회지

We report an uncommon case of pyogenic hepatic abscess with hepatobronchial fistula. A 59 year-old male was admitted because of purulent sputum and cough. Ultrasonography and abdominal computed tomography showed an abscess on the superior segment of right hepatic lobe. Diagnostic and therapeutic percutaneous trans-hepatic abscessography disclosed hepatobronchial fistula. Liver abscess with hepatobronchial fistula was managed with percutaneous abscess drainage and antibiotics. The abscess was resolved and he is being on the follow-up with symptom free status.

The effects of propranolol on portal pressure in cirrhotic patients with portal hypertension / 대한내과학회지

BACKGROUND: Propranolol is only known drug effective in preventing variceal bleeding by ameliorating portal hypertension. The optimal dose of propranolol is variable due to racial differences of cardiovascular receptor sensitivity. In this prospective study, we tried to evaluate the effect of propranolol on portal hypertension, required optimal dose and to find out factors that influence drug responses in Korean cirrhotic patients with portal hypertension. METHODS: This study included 25 patients with liver cirrhosis who had variceal bleeding episode. Propranolol was given orally at an initial dose of 20 mg twice daily. The dose was subsequently adjusted over a period of 2 days until the resting heart rate had been reduced by 25% or less than 55 beats per minute. The hemodynamic studies including measurements of heart rate (HR), mean blood pressure (MBP), hepatic venous pressure gradient (HVPG), portal venous flow (PVF) were evaluated both prior to and 3 months after commencing treatment. Patients who showed a reduction in HPVG of more than 20% of baseline or absolute value under 12 mmHg were defined as being responders. RESULTS: The mean required dose of propranolol to reach target heart rate was 165 mg (80~280 mg). Propranolol induced significant reduction in HVPG (-29.0+/-21.4%, p<0.01), PVF (-19.6+/-17.8%, p<0.01) and HR (-29.3+/-9.1%, p<0.01). Drug responders were 15 (60%) and non-responders were 10 (40%). There was no significant factor for drug responders in multivariate analysis. The main complication of propranolol was dizziness with incidence of 24%, but was not serious enough to stop the administration of the drug. CONCLUSION: Propranolol is effective in reducing portal pressure in Korean cirrhotic patient and considered as relatively safe, and might be useful in preventing variceal bleeding. To obtain effective improvement of portal hypertension, it is necessary to increase the dosage until the targeted heart rate is reached when the measurement of HVPG is not be available.

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.

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 Arteriovenous Malformation Presented as a Submucosal Tumor / 대한소화기내시경학회지

Arteriovenous malformations (AVM) are an unusual cause of gastrointestinal (GI) bleeding. But most GI AVM can occur with GI bleeding. When conventional diagnostic studies have failed to reveal the source of GI bleeding, AVM have been one of the most common causes. But the incidence of AVM presented as bleeding of a gastric submucosal tumor is very low. A case of gastric submucosal tumor was experienced and reported as an AVM. This case is herein discussed with review of corresponding literature.

Frequency and Predictive Factors of Recurrent Spontaneous Bacterial Peritonitis in Cirrhosis / 대한내과학회지

OBJECTIVES: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of cirrhosis. In the most recently published studies, the prevalence of SBP among hospitalized cirrhotics with ascites has been estimated to be around 10-15%, the mortality rate related to this complication being more than 50%. SBP is thought to appear as a consequence of the impaired defensive mechanisms against infection present in cirrhotic patients, such as depressed reticuloendothelial system phagocytic activity, impaired leukocyte function, reduced serum compliment levels, and low antibacterial activity of ascitic fluid. It has proposed that ascitic fluid opsonin capacity is directly correlated to ascitic protein concentration and that this explains an observed predisposition to infection in patients with low ascitic fluid protein concentration. This present study aims to investigate the frequency of the recurrence of SBP in a large series of cirrhotic patient who recovered from the first episode of SBP and to identify any possible predictors of recurrent SBP. METHOD: We reviewed records of chart in 312 consecutive cirrhotics with ascites patients treated in our hospital between January, 1988 and August, 1995. RESULTS: The incidence of SBP was 21.8%(68 cases) and showed 80.9% in male, 19.1% in female. Seventeen(25%) of the 68 patients included in the study after the resolution of their first episode of SBP developed one or more episodes of SBP during follow-up. SBP recurred once in 16 of these patients, twice in 1 patients. The cumulative probability of SBP recurrence was 47.1% at 6 months, 64.7% at 12 months, and 82% at 18 months of follow-up. This study reveals that neither ascitic fluid total protein nor the severity of liver disease(Child's class) predicts the occurence of recurrent SBP. CONCLUSON: We conclude that the occurrence of recurrent SBP is unrelated to the type of liver disease, and severity of liver disease did not predict the presence of recurrent SBP. Also, ascitic fluid total protein < or =1.0 g/dl, prothrombin time < or =45% may not be a sensitive predictor of recurrent SBP.

A Case of Glomerulonephritis Associated with Staphylococcal Retroperitoneal Abscess / 대한신장학회잡지

The development of renal glomerular lesions secondary to severe visceral infection (pulmonary, pleural, retroperitoneal or hepatic abscess) is not generally appreciated. Such patients resemble those with infective endocarditis. The suggested pathogenetic mechanisms by which infection can cause glomerular damage are immunologic interaction, direct toxicity of a bacterial products, and some other triggering factors; However, direct correlation between the infectious and immunologic events has not been demonstrated. The histopathologic findings of infectious glomerulonephritis are variable, and these findings, as well as the clinical abnormalities, may resolve with effective antimicrobial therapy or abscess drainage. We experienced a case of glomerulonephritis and acute renal failure due to staphylococcal retroperitoneal abscess. The patient was a 58-year-old man who presented with abdominal and back pain. We performed an abdominal CT scan which showed a retroperitoneal abscess which was proven to be a staphylococcal infection upon percutaneous abscess drainage. Furthermore, we performed a renal biopsy in order to investigate hematuria, RBC casts, and proteinuria. Pathologic findings revealed postinfectious glomerulonephritis. Abscess drainage and sensitive antibiotics were administered, after which his symptoms and urinary abnormalities disappeared, and the retroperitoneal abscess subsided. Here, we report a case of a staphylococcal retroperitoneal abscess which led to postinfectious glomerulonephritis and acute renal failure along with a brief review of the literatures.

Endoscopic Mucosal Resection for Premalignant Lesions and Early Gastric Cancer / 대한내과학회지

OBJECTIVES: Gastrectomy with lymph node dissec tion is the standard treatment for early gastric can cer(EGC). However, patients who have high risks demand modifications in surgical treatment for EGC. Recently, endoscopic mucosal resection(EMR) has become accepted in many institutions as a treatment for cancerous mucosal lesions of the stomach. Thus we investigated the efficacy and safety of EMR prospectively in the patients with EGC who have high risks in surgery and those with premalignant lesions. METHOD: Twenty-five patients were treated with EMR, thirteen were EGC and twelve were premalignant lesions such as tubular adenoma, severe dysplasia. We used standard snare method and endoscopic mucosal resection using a band ligation kits(EMRL). RESULTS: The complete resection rate at the first step of EMR was 100%(12/12) in premalignant lesions, 76.9%(10/13) in EGC. Of three EGC resected incomple tely at the first step, one patient was treated by surgery and two patients underwent the third step of EMR. The final complete resection rate was 92%(23/25) and it was 100%(12/12) in the premalignant lesions, 84.6%(11/13) in EGC. The final complete resection rate in according to the methods was 100%(5/5) by standard snare method, 75%(6/8) by EMRL. As pathologic results, all cases of EGC were limited to the mucosa. No serious complications such as perforation, major bleeding were encountered. CONCLUSION: We consider that EMR is effective and safe in treatment of the patients with EGC who have high risks in surgery and those with premalignant lesions.

A Case of Systemic Lupus Erythematosus with Ascites as the Initial Presenting Manifestation / 대한류마티스학회지

The major presenting manifestations of systemic lupus erythematosus (SLE) in Korea are known to be cutaneous manifestations, arthritis, nephritis, and fever. The ascites due to peritoneal involvement in SLE is quite common. However, it is unusual for massive ascites to be major presenting manifestations of SLE. In this report, we describe a case of SLE patient whose disease manifested as intractable ascites. This illustrates an unusual presentation and natural history of a complex autoimmune disease.

Two Cases of Graves Disease Associated The Empty Sella Syndrome / 대한내분비학회지

The empty sella syndrome is characterized by obesity, frequent pregnancy, headache and high blood pressure, but its exact cause remains unknown. Usually the incomplete diaphragmatic sella has been considered as the cause of the empty sella syndrome, but some authors recently have suggested that the antipituitary antibody way be related to development of pituitary atrophy and the pituitary empty sella syndrome, and thus it may be clinically useful as screening test for the empty sella syndrome. We experienced two empty sella syndromes associated Graves disease and applied the antipituitary antibody as the diagnostic tool of the empty sella syndrome. But none of this two patients had antipituitary antibody and we report these cases with reviews of literatures.