BACKGROUNDS/AIMS: The prevalence of reflux esophagitis has been considered to be low in Korea, but recent studies suggested that it has been increasing. The prevalence also is generally thought to be less in Korea compared to that in western countries. METHODS: Data was collected from the leading medical journals published in Korea dealing with the prevalence of reflux esophagitis for last 10 years between 1990 and 1999 and annual reports of Health Promotion Center in Asan Medical Center of 1997 to 1999. RESULTS: The prevalence was occupied 1.3% in the early period of 1990's, 5.3% in the middle and 7.2% in the late period in symptomatic group and 2.7%, 3.2% and 5.8% in asymptomatic group. The prevalence was reported 5.4% in 1997, 5.3% in 1998 and 7.0% in 1999 in asymptomatic group of annual report of Health Promotion Center in Asan Medical Center. Associated conditions in reflux esophagitis were hiatal hernia, alcohol consumption, smoking and obesity suggesting as risk factors. CONCLUSIONS: The prevalence of reflux esophagitis in Korea has increased in last 10 years of 1990's but is still lower than that in the western countries. Continuous increase in the prevalence of reflux esophagitis in Korea is predictable and it leads to a greater concern for accurate diagnosis and rapid treatment of symptoms.
Adult* ; Alcohol Drinking ; Chungcheongnam-do ; Diagnosis ; Esophagitis, Peptic* ; Health Promotion ; Hernia, Hiatal ; Humans ; Korea ; Obesity ; Prevalence* ; Risk Factors ; Smoke ; Smoking

Most patients with bile duct carcinoma are diagnosed at an advanced stage, commonly after the appearance of jaundice. The prognosis is generally poor when the diagnosis is made at this stage. Early diagnosis of cholangiocarcinoma at a nonicteric stage may more likely allow curative resection. Initial workup of suspected biliary tract obstruction begins with noninvasive radiologic examinations including US and CT, but these and with even ERCP have a limitation in the diagnosis of early bile duct carcinoma. A case of intrahepatic early bile duct carcinoma without jaundice in a 53-year-old man, is herein reported. The lesion could be early diagnosed, especially with the use of MR cholagiography and percutaneous transhepatic cholangioscopic examination, and eventually could be completely resected.
Bile Ducts* ; Bile* ; Biliary Tract ; Cholangiocarcinoma ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis* ; Early Diagnosis ; Humans ; Jaundice ; Middle Aged ; Prognosis

Villous adenomas of the ampulla of Vater are rare premalignant tumors that have been reported to occur in 0.04% to 0.12% of postmortem series. Traditionally surgical treatment has been used but it might result in significant morbidity and mortality. This case is a villous adenoma of ampulla of Vater found incidentally, but successfully removed by endoscopic method. After endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS), we resected the tumor of ampulla of Vater endoscopically using endoscopic mucosal resection (EMR) method. The post-procedure course was uneventful. Here we report an ampullary adenoma resected by endoscopic method in a 42-year-old man with villous adenoma of the ampulla of Vater.
Adenoma* ; Adenoma, Villous ; Adult ; Ampulla of Vater ; Cholangiopancreatography, Endoscopic Retrograde ; Endosonography ; Humans ; Mortality

OBJECTIVE: We analysed various surgical approaches and surgical results of 28 middle cranial base tumors for the purpose of selecting optimal surgical approach to the middle cranial base tumor. METHODS: In this retrospective review, 28 patients, including 16 meningioma, 6 trigeminal neurinoma, 2 pituitary adenoma, 2 craniopharyngioma, 1 facial neurinoma, and 1 metastatic tumor, underwent surgical treatment using skull base technique. Of theses, 16 tumors were mainly confined to middle cranial fossae, 5 tumors with extension into both anterior and middle fossa, and 7 tumors with extension into both middle and posterior fossa. Tumors that confined to the middle cranial fossa or extended into the anterior cranial fossa were operated with modified pterional, orbitozygomatic or Dolen'c approach, and tumors that extended into the posterior cranial fossa were operated with anterior, posterior or combined transpetrosal approach. Completeness of tumor resection, surgical outcome, postoperative complication, and follow up result were studied. RESULTS: Total tumor removal was achieved in 9 tumors of 10 tumors that did not extended to the cavernous sinus, and was achieved in 7 tumors of 8 tumors that extended to the lateral wall of the cavernous sinus. Of 10 tumors that extended to the venous channel of the cavernous sinus, only 2 were removed totally. Surgical outcome was excellent in 14 patients, good in 10, fair in 2 and poor in 2. There were no death in this series. Dumbell type tumor which extended into both middle and posterior fossae showed tendency of poor prognosis as compared with tumors that confined middle cranial fossa and extended into both anterior and middle cranial fossa. Postoperative dysfunctions were trieminal hypesthesia in 3, oculomotor nerve palsy in 2, abducens nerve palsy in 2, hemiparesis in 2, cerebellar sign in 1, facial palsy in 1 and hearing impairment in 1. CONCLUSION: Based on our findings and a review of the literature, we conclude that, when selecting the surgical approach to the middle cranial fossa tumors, the most important factors to be considered were exact location of the tumor mass and existence of the cavernous sinus invasion by tumor mass. We recommend modified pterional or orbitozygomatic approach in cases with tumors located anterior and middle cranial base, without cavernous sinus invasion. In cases with tumors invading into cavernous sinus, we recommend Dolen'c or orbitozygomatic approach. And in lateral wall mass and the cavernous sinus, it is preferred to approach the tumor extradurally. For the tumor involing with middle fossa and posterior fossa(dumbell type) a combined petrosal approach is necessary. In cases with cavernous sinus invasion and internal carotid artery encasement, we recommend subtotal resection of the tumor and radiation therapy to prevent permanent postoperative sequele.
Abducens Nerve Diseases ; Carotid Artery, Internal ; Cavernous Sinus ; Cranial Fossa, Anterior ; Cranial Fossa, Middle ; Cranial Fossa, Posterior ; Craniopharyngioma ; Facial Paralysis ; Follow-Up Studies ; Hearing Loss ; Humans ; Hypesthesia ; Meningioma ; Neurilemmoma ; Oculomotor Nerve Diseases ; Paresis ; Pituitary Neoplasms ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Skull Base*

BACKGROUND: In Korea, the incidence of ulcerative colitis has been very low, but there are few epidemiologic studies about ulcerative colitis. The aim of the present study is to obtain basic epidemiologic information about the diagnostic course of ulcerative colitis in Korea. METHODS: The diagnostic course and methods of 150 patients with ulcerative coltis were analyzed by standard questionnaire and interview. RESULTS: The median time between the onset of symptoms and diagnosis was 5 months (2 weeks-10 years). The initial diagnosis made at the institution first visited was ulcerative colitis in 31.3%, hemorrhoid in 16.7%, dysentery in 8.7%, irritable bowel syndrome in 9.3%, enteritis in 12.0%, and others in 22.0%. The diagnostic rate of ulcerative colitis among institutions was 13.0% in clinics (14/108), 28.6% in hospitals (8/28), 47.9% in general hospitals (23/48), and 83.3% in academic medical centers (105/126). Among 39 patients who have received both barium study and endoscopic evaluation at the time of diagnosis at Asan Medical Center, the overall sensitivity of barium study was 76.9% (30/39) (p=0.001). Depending on the extent of the disease, the diagnostic sensitivity of barium study was 50.0% in proctitis (5/10), 69.2% in left-sided colitis (9/13), and 100% in extensive colitis (16/16). CONCLUSION: For early detection of ulcerative colitis, it should always be considered in the differential diagnosis of rectal bleeding, and sigmoidoscopy or colonoscopy is preferred to barium study for evaluation of patients with mild symptoms. We suggest that endoscopic procedures are necessary to get more accurate epidemiologic data.
Academic Medical Centers ; Barium ; Chungcheongnam-do ; Colitis ; Colitis, Ulcerative* ; Colonoscopy ; Diagnosis ; Diagnosis, Differential ; Dysentery ; Enteritis ; Epidemiologic Studies ; Hemorrhage ; Hemorrhoids ; Hospitals, General ; Humans ; Incidence ; Irritable Bowel Syndrome ; Korea* ; Proctitis ; Sigmoidoscopy ; Ulcer* ; Surveys and Questionnaires

When the common bile duct (CBD) cannulation is attempted for the visualization and therapeutic intervention of biliary tree, difficulties can arise in the selective bile duct cannulation due to the deviation of the duodenal ampulla, a mobile ampulla or an acute angle between the CBD and the papillary orifice. During an attempt at a deep biliary cannulation for the endoscopic therapy, pancreatic sliding often occurs, which means a catheter or a sphincterotome inadvertently enter the pancreatic duct instead of the CBD. From our experience, we have learned that an acute angle between the CBD axis and ampullary orifice could cause pancreatic sliding. We could succeed in the deep cannulation of sphincterotome into the CBD after fixing the ampulla and blunting the acute angle of the CBD with a guidewire inserted into the pancreatic duct. No complications had occurred. This method may be a simple and useful tool in cases of recurrent pancreatic sliding and can avoid the post-ERCP pancreatitis subsequent to repeated cannulation of the pancreatic duct.
Axis, Cervical Vertebra ; Bile Ducts ; Biliary Tract ; Catheterization* ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Pancreatic Ducts* ; Pancreatitis

An ampulla within a diverticulum is not rare especially in elderly patients with duct stones, but may pose a problem in identifying the papilla and properly orienting this structure for cannulation during endoscopic retrograde cholangiopancreatography. We therefore have used a new technique using the application of an additional catheter to keep the ampulla outside the diverticulum. When we pushed the duodenal fold downward and laterally with the first catheter, the ampulla was everted from the diverticulum and the hidden papilla was brought into view. Once the papilla was visible, the second catheter which was identical to the first, was advanced alongside it and inserted into the papillary orifice without difficulty. Eventually a successful cholangiogram was obtained. With the insertion of a guidewire through the second catheter, sphincterotomy and insertion of endoscopic nasobiliary drainage tube were also performed successfully.
Aged ; Catheterization* ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Diverticulum* ; Drainage ; Humans

The vast majority of ampullary tumors are epithelial in nature and are either adenoma or adenocarcinoma. Rarely lymphoma or mucinous and squamous elements may be found. Primary lymphoma of pancreaticobiliary region are exceedingly rare, and mostly nodal. Recently, we have experienced a 29-year-old woman with primary malignant lymphoma of the ampulla of Vater with recurrent acute pancreatitis and jaundice. On duodenoscopy, bulging ampulla with normal overlying duodenal mucosa was observed. Endoscopic sphincterotomy was done and tumor inside the ampulla was exposed. ERCP showed high grade biliary and pancreatic ductal strictures extending from the papillary orifice, with upstream ductal dilatation, respectively. With endoscopic biopsy alone, the tumor was confirmed as B-cell lymphoma histologically.
Adenocarcinoma ; Adenoma ; Adult ; Ampulla of Vater* ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Dilatation ; Duodenoscopy ; Female ; Humans ; Jaundice ; Lymphoma* ; Lymphoma, B-Cell ; Mucins ; Mucous Membrane ; Pancreatic Ducts ; Pancreatitis ; Sphincterotomy, Endoscopic

Hepatocellular carcinoma often invades the portal or hepatic veins, but rarely proliferates in the bile duct. Since curative resection is rarely possible in these cases, conservative therapy has been the sole modality. Herein, we report a case of icteric type hepatocellular carcinoma for which cholangioscopic ethanol injection was effective. By only transcatheter arterial chemoembolization in this patient, obstructive jaundice and intermittent cholangitis were not relieved. Therefore, we performed ethanol injection into the intraductal hepatoma mass under percutaneous transhepatic cholangioscopic guidance. As a result of therapy, he had been well without jaundice and cholangitis for 9 months until die.
Bile Ducts ; Carcinoma, Hepatocellular ; Cholangitis ; Ethanol* ; Hepatic Veins ; Humans ; Jaundice ; Jaundice, Obstructive