Although endoscopic biliary drainage(ERBD) is the preferred palliative treatment for unresectable malignant obstructive jaundice, the failure of endoprosthesis insertion occurs in 15% of the cases. In most cases, technical failure results from the inability to pass either a guide wire or a stent beyond the bile duct stricture due to high grade biliary stenosis or tumorous extending down to involve the papilia so that no normal orifice can be identified. In instances of technical failure, percutaneous transhepatic biliary drainage (PTBD) can be achieved, but compared to ERBD, prolonged external decompression has important disadvantages, and the placement of large-bore endoprothetic stent is painful, requires a bougination, and has fairly high complication rate. Recently, percutaneous endoscopic biliary stent (PEBS) is more commonly used in these patients because of higher successfulness than ERBD and higher safety than PTBD. So we report a case that was performed PEBS successfully, previously failed ERBD due to high grade stenosis of extrahepatic bile duct resulting from cholangiocarcinoma.
Bile Ducts ; Bile Ducts, Extrahepatic ; Cholangiocarcinoma ; Constriction, Pathologic ; Decompression ; Drainage ; Humans ; Jaundice, Obstructive ; Palliative Care ; Stents*

Although our present knowledge of the etiology of peptic ulcer is incomplete, the presence or absence of peptic ulcer is determined by the delicate interplay between aggressive factors (secreted gastric acid and pepsin) and defensive factors (mucosal resistance). Peptic ulcer is produced when the aggressive effects of acid-pepsin dominate the protective effects of gastric or duodenal mucosal resistance by predominance of aggressive factors or interruption of defensive factors. KU-54 enhances mucosal resistance to tissue injury by the increase of gastric mucosal blood flow, the stimulation of gastric mucosal metabolism, the increase of glycoprotein of gastric mucus, and the increase of ATP of gastric mucosa. We have treated 38 cases of gastric ulcers with KU-54 300 mg daily for 4-12 weeks for the evaluation of the therapeutic efficacy. Endoscopic, clinical, and laboratory assessments were undergone before and after 4 ~ 12 weeks of the treatment. Major symptoms of gastric ulcer have been improved in 83.3% after the medication with KU-54. The healing rate of gastric ulcer evaluated by endoscopy was observed in 33.3% after 4 weeks, 73.3% after 8 weeks, 76.6% after 12 weeks of the medication with KU-54. The utility rate of KU-54 was 86.7%. We could conclude that KU-54 is the utilizable drug for gastric ulcer.
Adenosine Triphosphate ; Endoscopy ; Gastric Acid ; Gastric Mucosa ; Glycoproteins ; Metabolism ; Mucus ; Peptic Ulcer ; Stomach Ulcer*

Acid ingestion causes a coagulative necrosis of the surface epithelium of the upper gastromtestinal tract. Its late sequence is luminal stenosis which frequently requires surgical repair. Nevertherless, in many cases, non-operative dilatation of luminal stenosis have been applicated, such as bouginations, balloon dilatations, endoscopic laser therapy, endoscopic electrocoagulation, endescopic microwave coagulation. These methods may give some considerable benefits in unoperable cases. Recently, we experienced a case of a 60-year-old man who had severe corrosive esophageal and gastric angular strictures by accidentally ingested hydrochloric acid and after many tiems of application of non-operative dilatation was able to have normal diet without dysphagia. So, we report this case with a review of literatures.
Constriction, Pathologic* ; Deglutition Disorders ; Diet ; Dilatation* ; Eating ; Electrocoagulation ; Epithelium ; Humans ; Hydrochloric Acid ; Laser Therapy ; Microwaves ; Middle Aged ; Necrosis ; Phenobarbital

To determine the most effective and tolerable method of preparation with Golytely for colonoscopy, 141 consecutive cases were randomly allocated to drink either 2,000cc(74 cases, Group I) or 4,000cc(67 cases, Group 2), with infusion rate of 1,000cc/h. The reaults were as follows. 1) The rates of effective colonic clearance in group 1 and group 2 was 94.6% and 94.0%, respectively. There is no significance difference between two groups. 2) There was no significant difference in the ingested volume until the first bowel movement and the time required for rectal efflunt to be clear between two groups. 3) Patient acceptance was higher in group 1 than in group 2. 4) Side effects were less noticed in group 1 than group 2, and incraased in body weight (average 0.8 kg) after ingestion of Golytely was observed only in group 2.
Body Weight ; Colon ; Colonoscopy* ; Eating ; Humans ; Therapeutic Irrigation*

Non-operative palliative treatment for malignant colonic obstruction can sometimes be accomplished by the insertion of anorectal tube, endoscopic balloon dilation or endoscopic laser therapy. But these methods have some disadvantages, such as limitaation of activity, need of repetitive treatment and high-risk of perforation. Endoscopic prosthesis is generally accepted as a safe, effective palliative treatment for malignant esophageal stricture, because this method has no above disadvantages. Neverthless, there is only a few experence with endoecopic prosthesis in malignant colorectal stricture over the world. We report two cases which were safely, effectively performed endoscopic prosthesis in palliative treatment for their malignant rectal strictures.
Colon ; Constriction, Pathologic* ; Esophageal Stenosis ; Laser Therapy ; Palliative Care ; Prostheses and Implants*

A clinical review was performed in 52 cases with the foreign body in the gastrointestinal tract who underwent the endoscopic extraction of fereign body at our hospital from June 1985 to October 1989. The results are as following. 1) The most prevalent age was under 10 years of age (21 cases, 40.4%), and male was more prevalent than female (M:F=1.6:1). 2) The most common site of foreign bodies was esophagus (35 cases, 67.3%), next stomach (15 cases, 28.9%). 3) The foreign bodies in esophagus were coins (18 cases, 51.4%), meats (7 cases, 20.0%), bones (5 cases, 14.3%), other food materials or metals (5 cases, 14.3%)in order of frequency, and those in the stomach wer bezoars (7 cases, 50.0%), coins (2 cases, 14.3%), suture materials (2 cases, 14.3%), others (baduk stone, pin, tack, cross). 4) The combined diseases with upper gastrointestinal foreign bodies were the passage disturbances (11 cases, 21.2%) due to stenosis, and schizophrenia (1 case), aleoholism (1 case). 5) Complications by foreign bodies were 8 cases (15.4%), such as eisophageal laceration or ulceration (4 cases), esophaigeal perforation (1 case), aspiration pneumonia(1 case), duodenal obstruction (2 cases). 6) Successful rate of the endoscopic extraction was 88.5%(46 in 52 cases). And 6 unsuccessful cases were 4 cases who have gastric bezoars too hard and large to extract, a case with esophageal perforation, and a case with bezoar in the third portion of duodenum.
Bezoars ; Constriction, Pathologic ; Duodenal Obstruction ; Duodenum ; Esophageal Perforation ; Esophagus ; Female ; Foreign Bodies* ; Gastrointestinal Tract ; Humans ; Lacerations ; Male ; Meat ; Metals ; Numismatics ; Schizophrenia ; Stomach ; Sutures ; Ulcer

Gastric lipomas are rare benign submucosal tumors which can present the diagnostic and therapeutic problems. The preferred treattment is observation or local excision. Since preoperative diagnosis and differentation from malignant tumors can be difficult by use of the conventional diagnostic modalities such as X-ray or endoscopic examination, patients are sometimes subjected to more extensive surgical procedures than warranted. As to the diagnosis of submucosal tumors of the upper digestive tract, a newly developed diagnostic modality of endoscopic ultrasonography(EUS) allows us to visuialize the structures underlying the gastrointestinal wall in a noninvasive maneuver, and can contribute to make differential diagnosis and decision of management. Strip biopsy is an endascopic tissue resection technique which permits resection of both mucosal and submucosal tissue regardless of the morphological type of the lesion, because the submucosal saline injections during the procedures make the flat or depressed lesions to be elevated. Now, we report a 56-yr-old female which had a Yamada type I polypoid gastric submucosal lipoma in the antrum, which could be performed the different diagnosis and successful endoscopic removal by endoscopic ultrasonography and strip biopsy.
Biopsy* ; Diagnosis ; Diagnosis, Differential ; Endosonography ; Female ; Gastrointestinal Tract ; Humans ; Lipoma*

A new method for combining ultrasonography snd endoscopy, endoscopic ultrasonography (EUS), was developed to improve the diagnostic accuracy of ultrasound by direct image of the target lesion via the gastrointestinal lumen. EUS has the unique ability to provide clear sonographic images of the wall structure of the stomach. This capability can be ultilized in assessing the depth of cancer invasion of the stomach by identifying which layer the ultrasonographic change extends to. However, the depressed types of early gastric cancer(EGC) are often accompanied by ulcerative change in the tumor foci. And the ultrasonographic picture is also influenced by the ulcerative change. (continue...)
Endoscopy ; Endosonography* ; Stomach ; Stomach Neoplasms* ; Ulcer ; Ultrasonography

Endoscopic nasobiliary drainage(ENBD) has been developed as a safe and effective noninvasive biliary drainage method for initial decompression in the benign or malignant biliary obstruction, dissolution of biliary stones by injection of litholytic agents through the tube, and proper causative diagnosis of biliary obstruction by cytologic, bacteriologic and parasite investigation of drained bile. Generally, endoscopic sphicterotomy (EST) is performed before the insertion of an ENBD tube in order to make the procedure easy and to prevent acute pancreatitis that may develop by compression of the pancreatic orifice of the inserted tube. Nevertheless, in some cases EST is difficult to perform or should not be performed due to their coagulopathy. In such cases, ENBD without EST may be necessary. To evaluate the safety, successfullness and effectiveness of ENBD without EST, ENBD without EST using 5, 6 or 7 Fr pigtail tubes were performed in 81 cases(49 malignant, 32 benign). ENBD without EST was successfully performed in 78 out of 81 cases(96.3%). This effectiveness for decompression of bile duct, evaluated by decreasing total bilirubin values, was good in 66 out of 73 casee (90. 2%). The complications of this procedure were noted in 6 out of 78 cases(7. 7%). e. g. cholangitis in 3, migration of ENBD tube in 2, acute pancreatitis in 1 case. Particularly, regardless of our concern that ENBD without EST may develop acute pancreatitis acute panereatitis was noted in only one case. In conclusion, ENBD without EST is a safe and effective method which can be applied to the cases who have benign or malignant obstructive jaundice.
Bile ; Bile Ducts ; Bilirubin ; Cholangitis ; Decompression ; Diagnosis ; Drainage* ; Jaundice, Obstructive ; Pancreatitis ; Parasites

Endoscopic injection sclerotherapy(EIS) is currently the most widely practiced method for treating and eradicating acutely bleeding esophageal varices in repeated sessions, but may be associated with some uadesirable local and systemic complications. Endoscopic variceal ligation(EVL), which consists of mechanical ligation and thrombosis of varices using elastic "0"- rings, has been recently developed as a non-operative alternative to EIS. We performed EVL in 16 patients who had recently bled from esophageal varices. Total 249 variceal ligations were performed during 71 separate EVL sessions. Three patients were actively bleeding at initial EVL; all of them were successfully controlled by emergency EVL. During the study period two patients died after initial EVL; one who refused te return for repeated EVL died from rebleeding, the other died from hepatic failure without any rebleeding. Rebleeding, following initiation of EVL, occured in 3 patients(l8.8%); two patients had bled from varices except previousiy ligated site and were successfully controlled by emergency EVL, remained one who refused any repeat endoscopy could not be confirmed the bleeding site. Varices were eradicated or reduced to grade I in 10(71.4%) of the 14 survivors by 14-28 ligations(mean, 19.5 ligations) in 3 -7 EVL sessions(mean, 5.4 sessions), During or after EVL, there were no complications, except transient mild dysphagia in 3 patients of 16 patients. These results indicated that EVL is a safe and effective method for treatmet of bleeding esophageal varices.
Deglutition Disorders ; Emergencies ; Endoscopy ; Esophageal and Gastric Varices* ; Hemorrhage* ; Humans ; Ligation* ; Liver Failure ; Survivors ; Thrombosis ; Varicose Veins