It is very important to be aware of occurrence and distinctive histologic features of gastric glomus tumor because its clinical presentation and endoscopic ficdings are indistinguishable from other gastric tumors. A 58-year-old man was admitted because of intermittent epigastric pain and indigestion for 2 months. Physical examination and laboratory findings revealed within normal limits. Upper gastroendoscopy demonstrated a submucosal mass near the antrum with central mucosal depressionand peripheral multiple erosions. Endoscopic ultrasonography revealed a circumscribed mass that continued to the third and fourth layers which demonstrated a heterogeneous low echo pattern mixed with internal high echo spots. Histologically, the tumor cells have uniform small nuclei with inconspicuous nucleoli. Immunochemical analysis on the tumor cells expressed alpha 1 smooth muscle actin and the tumor cells are enveloped by reticulin fiber, individually or grouped. A case of glomus tumor of the stomach is herein reported with a review of literature.
Actins ; Dyspepsia ; Endosonography ; Glomus Tumor* ; Humans ; Middle Aged ; Muscle, Smooth ; Physical Examination ; Reticulin ; Stomach*

The terms "gastrointestinal stromal tumor" (GIST) have been applied to mesenchymal tumos that represent neither typical leiomyoma nor schwannoma. The majority of GISTs are Located in the stomach and small intestine, and only 4% of GISTs are found in duodenum. The most important characteristic is their indolent, slow-growing nature, rendering the most common definitions of malignancy invalid and inapplicable. Clinical and pathological criteria to differentiate benign from malignant GISTs are not well established. Tumor size and mitoic activity are commonly considered as important features, allowing for the prediction of biological behaviour and outcome. The case of a 87-year-old male patient who was presented with melena and acute anemia is herein reported. Esophagogastroduodenoscopy and computed tomography of the abdomen revealed two submucosal tumors in the stomach and duodenum. Histological and immunohistochemical studies on the surgical resection specimen revealed a gastrointestinal stromal tumor of an uncommiteed type, with no evidence of increased mitotic activity. The patient was treated with local excision of the tumors and is now in a favorable state.
Abdomen ; Aged, 80 and over ; Anemia ; Duodenum ; Endoscopy, Digestive System ; Gastrointestinal Stromal Tumors* ; Hemorrhage* ; Humans ; Intestine, Small ; Leiomyoma ; Male ; Melena ; Neurilemmoma ; Stomach

Idiopathic Myelofibrosis (IMF), a clonal disorder of a multipotent hemtopoietic progenitor cell of unknown etiology, is characterized by massive splenomegaly, leukoerythroblastic blood changes, and bone marrow fibrosis. Portal hypertension occurs in approximately 10% of patients with IMF. Alsom there mey be bleeding from esophageal varices. A 59-year-old woman was admitted with intermittent abdominal distension and melena. An esophagogastroduodenoscopy revealed extensive esophageal varices with red colored signs, and subsequently esophageal variceal ligation was performed. Marked splenomegaly and ascites was observed through abdominal US and MRI scan. Bone marrow biopsy revealed an increase in reticulin and fibrosis. Extramedullary hematopoiesis and sinusoidal change were observed in the liver biopsy specimen. This case of IMF causing an esophageal variceal hemorrhage is herein reported.
Ascites ; Biopsy ; Bone Marrow ; Endoscopy, Digestive System ; Esophageal and Gastric Varices ; Female ; Fibrosis ; Hematopoiesis, Extramedullary ; Hemorrhage* ; Humans ; Hypertension, Portal ; Ligation ; Liver ; Magnetic Resonance Imaging ; Melena ; Middle Aged ; Primary Myelofibrosis* ; Reticulin ; Splenomegaly ; Stem Cells

The Cronkhite-Canada Syndrome (CCS) is a monfamilial disorder of adults characterized by diffuse gastro-intestinal polyposis, ectodermal changes consisting of alopecia, dystrophy of nails and cutaneous hyper-pigmentation. The pathogenesis and the causes of CCS remain unknwon but the symptoms such as diarrhea and malnutrition are generally progressive, and the prognosis is knwon to be poor. Though the definitive treatment is not well known, it has been reported that the conservative management is the most important treatment, and that the clinical sourse can be reversible. One case was experienced involving Cronkhite-Canada Syndromen in a patient who was managed by conservative treatment and an other who was treated by corticosteroid. These two cases are reported herein with a review of corresponding literature.
Adult ; Alopecia ; Canada* ; Diarrhea ; Ectoderm ; Humans ; Intestinal Polyposis ; Malnutrition ; Prognosis

BACKGROUND/AIMS: Recent studies reported that 1g of gabexate mesilate (GM) was effective in preventing endoscopic retrograde cholangiopancreatography (ERCP)-related pancreatic damage. The aim of this study was to evaluate the effectiveness of low dose GM for the prevention of ERCP-related pancreatic damage. METHODS: This study was performed prospectively with 102 consecutive patients (68 for the GM group, 34 for the placebo group) who were scheduled for ERCP. Infusion of GM (500 mg) was started 30 minutes before ERCP and continued for 12 hours afterward. The serum amylase and lipase were measured before ERCP and 4, 8, and 24 houps after ERCP. RESULTS: The incidence of hyperenzymemia was 45.6% in the GM group and 55.9% in the control group (p=0.40). Acute pancreatitis was developed in only one patient who was given the placebo. Although difficult cannulation, visualization of the pancreatic duct, performance of therapeutic procedures, and longer total procedure time were associated with an increased incidence of hyperenzymemia, the incidence of pancreatic damage was not affected by the GM treatment in these conditions. CONCLUSIONS: Prophylactic treatment with 500 mg of GM has no advantage for the prevention of ERCP-related pancreatic damage. Considering the cost effectiveness, further studies are necessary to identify the patients at greatest risk fot acute pancreatitis.
Amylases ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde* ; Cost-Benefit Analysis ; Gabexate* ; Humans ; Incidence ; Lipase ; Pancreatic Ducts ; Pancreatitis ; Prospective Studies

BACKGORUND/AIMS: Endoscopic choledochoduodenal fistulotomy(fistulotomy), using a needle-knife sphin-cterotome as an alternative to failed duct cannulation and subsequent endoscopic drainage in patients with ampullary cancer, can be performed in patients with a suprapapillary bulged or distorted papilla. The purpose of this prospective sutdy was to evaluate the safety and clinical usefulness of endoscopic fistulotomy in patients with ampullary cancer. METHODS: Of the 29 patients with ampullary cancer requiring biliary drainage, 13 patients with a suprapapillary bulged papilla underwent fistulotomy either alone or followed by an upward extension of the fistulous orifice using a standard sphincterotome (fistulotomy group). Of the remaing 16 patients, transpapillary biliary stenting was successful in 13 patients (biliary stenting group). In both group, the rate of successful bile duct cannulation and effective biliary drainage were assessed and compared. RESULTS: Bile duct cannulation was successful in 92.3% of the patients in the fistulotomy group and 81.3% of patients in the biliary stenting group, and the only complications were mild bleeding in 1 patient (7.7%) and cholangitis in 1 patient(6.3%). The success rate for initial biliary drainage with the fistulotomy or transpapillary stenting were 100% and 84.6%, respectively. Of the 12 patients in whom biliary drainage was used as the definite treatment, the symptom-free duration was 3.2 months in 6 patients of the fistulotomy group and 3.9 months in 6 patients in the biliary stenting group. CONCLUSIONS: Endoscopic fistulotomy is safe and effective for both preoperative and palliative biliary decompression in patients with ampullary cancer and it is suggested that the procedure can be applied primarily to increase the success rate of biliary access and subsequent biliary drainage especially in patients with a bulged papilla.
Bile Ducts ; Catheterization ; Cholangitis ; Decompression ; Drainage ; Hemorrhage ; Humans ; Prospective Studies ; Stents

BACKGROUND/AIMS: Midazolam is utilized as a premedication for uppoer gastrointestinal endoscopy. Midazolam has a more rapid onset of reaction than that of diazepam and its duration is shorter. But the Consciousness of premedicated patients has not been regained sooner. The Purpose of this study was to examine the effectiveness of flumazenil against midazolam as premedication for upper gastrointesinal endoscopy. METHODS: Sixty patients underwent upper gastrointestinal endoscopy. These patients were divided to three groups: Group I included twenty patients without premedication; Group II Included twenty patients with premedication of midazolam and then were not given an antisedative agent excluign of normal saline; and Group III included the others with midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam and flumazenil as an antisedative agent. RESULTS: There was no change in vital signs after midazolam injection, compared with presedation value. Modified Steward Coma Scale showed a significant increase after flumazenil injection as an antagonist of midazolam. The assessment of the endoscopist and the comfort of patients were satisfactory. When the 40 patients were asked about their willingness to undergo the same procedure in the future, thirty-four patients responded favorably. CONCLUSION: Midazolam was safe and effective for sedation for upper gastrointestinal endoscopy. There was rapid regaining of consciousness with flumazenil indection after midazolam, so the use of flumazenil against midazolam injection also appeared to be effective.
Coma ; Consciousness ; Diazepam ; Endoscopy ; Endoscopy, Gastrointestinal* ; Flumazenil* ; Humans ; Midazolam* ; Premedication* ; Vital Signs

BACKGROUND/AIMS: Placement of stents in cases of inoperable malignant gastric outlet obstruction is difficult due to anatomical and technical problems. The aim of this study was to assess the feasibility, effectiveness, safety, and long-term outcome of a self-expandable metal stent (SEMS) as a means of providing palliative care for patients with an inoperable malignant gastric outlet obstruction, METHODS: Fifty-one consecutive patients (53 cases of stent insertion) with onoperable gastric outlet obstruction were treated palliatively with EsophaCoil, Choo's stent, or through-the-scope (TTS) stent. RESULTS: Technical Success was achieved in 46 cases (86.8%). Six cases of stent insertion failure were caused by acute angulation of the stenotic area and sereve distal luminal narrowing. The other failed case was due to the inappropriate location of the stent. In 41 cases, the patients (89.1%) could ingest soft or solid foods after successful insertion of the stents. All the remaining 16 cases of TTS SEMS had technical and clinical successes. During the follow-up (mean; 3.3+/-1.1 months, range; 1~11 months), there was 1case of aspiration pneumonia, 1 case of bowel perforation, 2 cases of stent migration, and 2 cases of stent occlusion by tumor ingrowth. CONCLUSIONS: Placement of a SEMS, especially TTS SEMS in patients with malignant gastric outlet obstruction is a feasible, effective, and safe palliative therapy.
Follow-Up Studies ; Gastric Outlet Obstruction* ; Humans ; Palliative Care ; Phenobarbital ; Pneumonia, Aspiration ; Stents*

BACKGROUND/AIMS: Sharp impacted esophageal foreign bodies can be very difficult to manage. When attempting to remove such objects inappropriately, life threatening complications, such as perforation can occur. Terefore, surgical intervention generally affords a safer approach. The aim of this study was to evaluate the safety and efficacy of endoscopic remval of sharp impacted esophageal foreign bodies using a dilatation method with an oral side balloon. METHODS: A total of 17 patients (7 Male, 10 Female)with sharp impacted esophageal foreign bodies underwent endoscopic Extraction. The following technique was successfully performed; an oral side balloon (Top Co., Japan) for esophageal variceal sclerotherapy was attached on the distal part of the endoscope. Under local anesthesia, the endoscope was inserted near the proximal part of the esophageal foreign body. Then, the oral side balloon was gradually dilated. Dilataion of the proximal part of the esophagus made it possible to release the sharp impacted foreign body from the esophageal wall. RESULTS: The types of foreign bodies were fish bones (6 cases), press-through packages (6 ases), chichen bones (3 cases), dentures (1 case), and a watch (1case). Endoscopic removal was successful in all 17 cases without complications such as perforation. CONCLUSIONS: This method of using an oral side balloon is safe and effective in removing sharp impacted esophageal foreign bodies, preventing, surgery and possible perforation.
Anesthesia, Local ; Dentures ; Dilatation ; Endoscopes ; Esophagus* ; Foreign Bodies* ; Humans ; Male ; Sclerotherapy

BACKGROUND/AIMS: Choledochal cyst is an unusual but serious condition which most commonly affects Oriental people. And it is an unusual entity that has increasingly been encountered by ultrasonography and computed tomography scan, even if the symptoms are variable. METHODS: We reviewed 23 patients with choledochal cyst who were treated at the Department of Internal Medicine, Pusan Paik Hospital from April, 1986 to April 1995. RESULTS: 1) Age ranged from 14 years to 73 years, and sex ratio was 1:1.4 in male vs female. 2) The durations of symptoms varied from 4 days to several years. 3) The major clinical symptoms were right upper quardrant pain in 19 cases, jaundice in 4 cases, abdominal mass in 2 cases. One case had all of above three symptoms. 4) The diagnostic tools were ultrasonography(USG) in l7 cases, ERCP in 11 cases, abdominal CT in 11 cases, PTC in 6 cases and oral GB in 1 case. The eight cases(61.5%) were confirmed as anomalous junction of the pancreaticobiliary ductal system(AJPBS) among the 13 cases who had performed ERCP. 5) The choledochal cysts were classified into type I to V according to the classification of Todani; Fifteen cases were type I, six cases type IVa, one case was type II and one case was type V, respectively. 6) Excision of choledochal cyst and Roux-en-Y hepaticojejunostomy was performed in 10 cases, and choledocho-jejunostomy in 4 cases, and Whipple's operation in 2 cases. 7) The associated diseases were CBD stone in 8 cases, cholecystitis in 6 cases, intrahepatic stone in 2 cases, GB cancer in 1 case, and colon cancer in 1 case. CONCLUSIONS: ERCP should be used when choledochal cyst is suspected by USG, aiming at demonstrating both AJPBS and enabling the morphologic classification. In addition, Surgical procedures including the excision of choledochal cyst and Roux-en-Y hepaticojejunostomy may be effective to reduce mortality and morbidity related to complication of choleclochal cyst.
Busan ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystitis ; Choledochal Cyst* ; Classification ; Colonic Neoplasms ; Female ; Humans ; Internal Medicine ; Jaundice ; Male ; Mortality ; Sex Ratio ; Tomography, X-Ray Computed ; Ultrasonography