Gastritis cystica polyposa(GCP) is a polypoid cystic lesion showing all the histological features of the hyperplastic polyps and the cysts penetrating through the mucularis mucosae. Most reported GCP lesions were developed at gastraenterostomy stomas. It is rare that GCP develops without history of previous gastroenterostomy. In 1990, however, Kim et al reported a GCP presenting as a submucosal tume-like lesion in a 69-year-old man. Recently, we had experienced two consecutive cases of GCP diagnosed by endoscopic polypectomy. The first case was 49-year-old housewife without history of previous gastric surgery. Esophagogastroduodenoscopy(EGD) showed a 2.0x1.5x1.5cm sized lobulated polypoid lesion with a broad stalk on the anterior wall of the distal antrum. The second case was 45-year-old woman without history of previous gastric surgery. EGD revealed a 1.0 x 1.0 x l.0 cm sized polypoid lesion with a pedicle on the greater curvature aspect of the upper body and two duodenal ulcers with pseudodiverticulum formation. These lesions were endoscopically polypectomized and diagnosed as GCP by the histologic examination.
Aged ; Duodenal Ulcer ; Female ; Gastritis* ; Gastroenterostomy ; Humans ; Middle Aged ; Mucous Membrane ; Polyps

The majority of cystic lesions of the pancreas are psudocysts and a small fraction neoplastic. Failure to recognize the true nature of neoplastic cyst will lead to an incorrct treatment strategy. Ultrasonography, computerized tomography and angiography were used to distingish these lesions, but diagnostic value of ERCP is in controversy. To evaluate the diagnostic value of ERCP in cystic lesions of the pancreas, we analysed 33 cases of pancreatic cystic lesions (pseudocyst 18 cases, retention cyst 3 cases and cystic, neoplasm l2 cases) between Apr. 1985 and June 1993. In 18 cases of pseudocysts, ERP findings were communication with cyst in 8 cases (44.4%), chronic pancreatitis in 8 cases (44.4%), obstruction in 4 cases (22.2%) and displscement of pancreatic duct in 2 cases (11.1%), and ERC findings, which were perfomed in 8 cases, showed cholangitis in 3 cases (37.5%), CBD stone in 2 cases (25%), mass effect in 1 case (12.5%) and normal in 2 cases (25%). There was no communication with the cyst and pancreatic duct, except two mucinous ductal ectasia, in 12 cases of cystic neoplasms, and the other findings were displacement of pancreatic duct in 4 cases (33.3%), obstruction in 2 cases (16.7%) and normal in 4 cases (33.3%). ERC findings of cystic neoplasm were almost normal (85.7%) except 1 case of cholangitis. In conclusion, ERCP findings of pseudocysts were communication with pancreatic duct, chronic pancreatitis and biliary tract abnormality. In contrast, ERCP findings of cystic neoplasms were displacement or obstruction of pancreatic duct without communication and chronic pancreatitis, and biliary tract abnormality were rare.
Angiography ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Dilatation, Pathologic ; Mucins ; Pancreas ; Pancreatic Cyst* ; Pancreatic Ducts ; Pancreatitis, Chronic ; Ultrasonography

The orifice of duodenal papilla is only about 1 mm in diameter. As much as 2,000 ml of bile and pancreatic juice pass through its sphincter zone into the duodenum each day. Since the sphincter of Oddi regulates the flow of bile and pancreatic juice, a disorder of the sphincter can disturb the smooth outflow of bile and pancreatic juice and produce secondary abnormalities in the biliary tract or the exocrine pancreas. (continue...)
Bile ; Biliary Tract ; Duodenum ; Humans ; Manometry* ; Pancreas, Exocrine ; Pancreatic Ducts* ; Pancreatic Juice ; Pancreatitis, Chronic* ; Sphincter of Oddi

The orifice of duodenal papilla is only about 1 mm in diameter. As much as 2,000 ml of bile and pancreatic juice pass through its sphincter zone into the duodenum each day. Since the sphincter of Oddi regulates the flow of bile and pancreatic juice, a disorder of the sphincter can disturb the smooth outflow of bile and pancreatic juice and produce secondary abnormalities in the biliary tract or the exocrine pancreas. (continue...)
Bile ; Biliary Tract ; Duodenum ; Humans ; Manometry* ; Pancreas, Exocrine ; Pancreatic Ducts* ; Pancreatic Juice ; Pancreatitis, Chronic* ; Sphincter of Oddi

A 56-year-old man who had suffered from intermittent right upper quadrant abdominal pain for 6 months and jaundice for 2 months was admitted for evaluation. Endoscopic retrograde cholangio-pancreatography showed filling defect which suggested tumor. Peroral choledo-choscopy was performed which showed polypoid tumor of the common hepatic duct and biopsy reported as papiilary adenocarcinoma. So segmental resection of the bile duct including removal of tumor with Roux-en Y hepaticojejunostomy was performed successfully.
Abdominal Pain ; Adenocarcinoma ; Adenocarcinoma, Papillary* ; Bile Ducts ; Biopsy ; Hepatic Duct, Common* ; Humans ; Jaundice ; Middle Aged

A 56-year-old man who had suffered from intermittent right upper quadrant abdominal pain for 6 months and jaundice for 2 months was admitted for evaluation. Endoscopic retrograde cholangio-pancreatography showed filling defect which suggested tumor. Peroral choledo-choscopy was performed which showed polypoid tumor of the common hepatic duct and biopsy reported as papiilary adenocarcinoma. So segmental resection of the bile duct including removal of tumor with Roux-en Y hepaticojejunostomy was performed successfully.
Abdominal Pain ; Adenocarcinoma ; Adenocarcinoma, Papillary* ; Bile Ducts ; Biopsy ; Hepatic Duct, Common* ; Humans ; Jaundice ; Middle Aged

Although variation is the rule with pancreatic duct morphology, certain variants occur as a result of altered embroological development. These ductal configurations, most striking deviations from the normal configuration, may be classfied according to alterations of embryological development. These congenital variants of pancreatic duct may be important for several reasons. First, the pseudomass effect of ductal anomalies can be mistaken for carcinoma by the inexperienced radiologists. Second, whether or not the anomaly is important, it is present in many patients with recurrent pacreatitis. Original descriptions were based on small sampling of postmortem studies and surgical specimen, but more recently the advent of endoscopic retrograde cholangiopancreatography(ERCP) has confirmed of the work of early anastomists and increased awareness of these variants. To evalute of frequency, characteristics of associated disease and clinical significance of pancreatic anomalies, we have reviewed of 5330 case of ERCP filmes which were undertaken between July, 1973 and August, 1993. Having reviewed of ERCP filmes, we found out 9 case of pancreatic duct variants. Among them, 7 cases were classified as ductal duplication anomalies, 4 cases of number variation, most, bifuricaiton and 3 cases of form variation, which were composed of loop, spiral and terminal N. Three cases of fusion anomalies were also noted, which were 2 cases of panceratic divisum and 1 case of incomplete pancreatic divisum. The associated diseases were 6 cases of bile duct and galbladder stones and 3 cases of pancreatic cancer. We could not find out the case of congenital anomalies as cause of obstructive pain and pseudomass effect.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Humans ; Pancreatic Ducts* ; Pancreatic Neoplasms ; Pancrelipase ; Strikes, Employee

The bleeding duodenal varices are a rare complication in patients with portal hypertension, but present a difficult diagnostic problem. If there is no bleeding esophageal, gastric fundal varices or ulcer in a patient with upper gastrointestinal bleeding and portal hypertension, the possibility of bleeding duodenal varices should be kept in mind. Thorough endoscopic examination of the entire duodenal mucosa is essential to document bleeding from duodenal varices. As an initial treatment, endoscopic sclerotherapy has had limited success in controlling active duodenal variceal bleeding. However, rebleeding rate is high, surgical treatment including shunt operation may be required for permanent control of bleeding and portal decompression. We report three cases of duodenal varices causing massive hemorrhage. All the patients had portal hypertension caused by liver cirrhosis of various etiologies and had varices in their esophagus. The second portion of the duodenum was the site of duodenal varices in all cases. The management was tailored to the condition of each patient, but only one patient among three survived.
Decompression ; Duodenum ; Esophageal and Gastric Varices ; Esophagus ; Gastrointestinal Hemorrhage* ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Mucous Membrane ; Sclerotherapy ; Ulcer ; Varicose Veins*

The safety of endoscopic retrograde cholangiopancreatography(ERCP) in patients with acute pancreatitis(AP) was confirmed in the past decade. Especially in ease of acute gallstone panereatitis, early ERCP/EST(endoscopic sphincterotomy) may reduce the incidence of complications by removing gallstone which causes acute attack of pancreatitis. To assess clinical usefulness of ERCP/EST in the setting of AP, we reviewed clinical records of 58 patients with AP who had undergone ERCP /EST during the same period of admission.(continue...)
Cholangiopancreatography, Endoscopic Retrograde* ; Gallstones ; Humans ; Incidence ; Pancreatitis*

Endoscopic retrograde biliary drainge is a useful method of palliative treatment of malignant biliary obstruction with respect to safety, rapidity in decompression of obstruction. However, despite of efforts to prolong patency of the stents, the main long term complication of current-widely used plastic endoprosthesis is to tendency for the stents to become clogged by sludge leading to recurrent jaundice and cholangitis, finally, obstruction of stents. Recently, in an effort to improve the patency of stent, variety of self-expandable metallic endoprosthesis have developed and which can be compressed into and inserted through small lumen catheter with large-bored lumen in expandable state. However, most of these open mesh of self-expandable stents allows tumor in growth which causes reobstruction, and additionally it is nearly impossible to retrieve the inserted prosthesis. Recently developed coil metal stent(Endocoil, Intent Co.), which, unlikely other previous metallic stent, has possibility of retrieving prosthesis and prevention of tumor ingrowth. We experienced a case of 52-year old male sufferd from malignant biliary obstruction due to recurrence of cancer at peripancreatic lymph nodes and combined with common bile duct stones on both proximal and distal side of the stricture, in whom Endocoil was implanted with sucessful decompression of obstruction and simultaneous removal of biliary stones located at both side of stricture.
Catheters ; Cholangitis ; Common Bile Duct ; Constriction, Pathologic* ; Decompression ; Humans ; Jaundice ; Jaundice, Obstructive* ; Lymph Nodes ; Male ; Middle Aged ; Palliative Care ; Plastics ; Prostheses and Implants ; Recurrence ; Sewage ; Stents*