Duodenal leiomyomas are rare benign tumors of mesenchymal origin. Generally, Fluorodeoxyglucose (FDG)-PET would have a negative finding in leiomyomas. A 52-year-old man was referred to our hospital with melena. Gastroendoscopy revealed the presence of a huge submucosal tumor with ulceration at the duodenum bulb. Subsequent CT demonstrated a poorly enhanced oval mass adjoining the duodenal bulb. FDG-PET scan demonstrated an excessive accumulation of FDG in the lesion. A definitive diagnosis of duodenal leiomyoma was made on the basis of the pathologic finding of his surgical specimen. We report in this first case that duodenal leiomyma may show a potential pitfall of giving a positive FDG-PET result. Through this case, we would like to caution clinicians against PET-dependent evaluations of malignant potential of duodenal submucosal tumors.
Duodenum ; False Positive Reactions ; Fluorodeoxyglucose F18 ; Humans ; Leiomyoma ; Melena ; Middle Aged ; Positron-Emission Tomography ; Ulcer

Gastroduodenal fistula or double pylorus is a very rare condition. It is a fistulous communication between gastric antrum and duodenal bulb. It can be either congenital or acquired. In most cases it is thought to be a complication of gastric ulcer. We recently experienced a case of gastroduodenal fistula in 70 year-old man presenting as epigastric pain. He was diagnosed with non ST elevation myocardial infarction previously, and was taking aspirin. Gastroduodenal communication was revealed by endoscopy. We report a case of gastroduodenal fistula that developed in man who was taking aspirin, with review of the literature.
Aspirin ; Endoscopy ; Fistula ; Myocardial Infarction ; Pyloric Antrum ; Pylorus ; Stomach Ulcer

Visceral artery pseudoaneurysms are uncommon. The splenic artery is the most commonly affected visceral artery. They usually develop secondary to chronic pancreatitis. Only 20 cases of giant pseudoaneurysms, defined as psedoaneurysms equal to, or greater than, 5 cm in sized, have been reported until now. Pseudoaneurysmal rupture can manifest as gastrointestinal bleeding. In this case, hemosuccus pancreaticus which means fistula to pancreatic duct, and hemorrhage in stomach, duodenum, or adjacent gastrointestinal track which result from fistula to gastrointestinal track are two main symptoms that develop. Both of them require immediate operation or transcatheter embolization. We herein describe the case of a giant splenic pseudoanerysmal rupture with gastric fistula in a patient who presented with hematemesis.
Aneurysm, False ; Arteries ; Duodenum ; Fistula ; Gastric Fistula ; Hematemesis ; Hemorrhage ; Humans ; Pancreatic Ducts ; Pancreatitis, Chronic ; Rupture ; Splenic Artery ; Stomach ; Track and Field

The Sengstaken-Blakemore tube (SB tube) is used to control esophageal or gastric variceal bleeding in emergencies, and various complications have been reported following its use. Tracheoesophageal fistula (TEF) is an extremely rare complication after SB tube insertion. We herein present a case of an 80-year-old female patient who experienced TEF after repeated insertion of the SB tube to control recurrent gastric variceal hemorrhage.
Aged, 80 and over ; Emergencies ; Female ; Hemorrhage ; Humans ; Tracheoesophageal Fistula

Cronkhite-Cadana syndrome is a rare non-familial disease. This syndrome is characterized by multiple hamartomatous polyps on the entire gastrointestinal tract except esophagus, nail dystrophy, alopecia and hyperpigmentation. Taste disturbance, abdominal pain, diarrhea and weight loss are common symptoms of it. The pathogenesis and causes of Cronkhite-Canada syndrome remain unknown until now. Although various treatment strategies including steroid therapy have been tried, their prognosis is poor. We report a 68 years old man who were diagnosed Cronkhite-Canada syndrome with esophageal candidiasis. After using combination of steroids and anti-fungal drugs, both Cronkhite-Canada syndrome and esophageal candidiasis were cured.
Abdominal Pain ; Alopecia ; Candidiasis ; Diarrhea ; Esophagus ; Gastrointestinal Tract ; Hyperpigmentation ; Intestinal Polyposis ; Nails ; Polyps ; Prognosis ; Steroids ; Weight Loss

BACKGROUND/AIMS: This study verifies whether endoscopic findings differ according to the infection of Helicobacter pylori in patients with chronic gastritis. MATERIALS AND METHODS: The study surveyed upper gastrointestinal symptoms of 382 patients with chronic gastritis and conducted esophagogastroduodenoscopy. The endoscopic findings were classified according to the Sydney classification, as edema, erythema, friability, exudates, flat erosion, raised erosion, rugal hyperplasia, atrophy, visibility of vascular pattern, intramural bleeding spot, nodularity, respectively in antrum, body, fundus. RESULTS: 1) The average age of 382 patients was 52.3 years and there were 176 males and 206 females. 2) Among 382 patients, 167 (43.7%) had epigastric pain syndrome and 215 (56.3%) had postprandial distress syndrome. 3) Among 167 patients with epigastric pain syndrome, 85 (51.1%) patients were infected with H. pylori, while 82 (48.9%) patients were uninfected. Among 215 patients with postprandial distress syndrome, patients infected with H. pylori were 102 (47.6%), while those uninfected with H. pylori were 113 (52.4%). This shows no difference between patients with and without H. pylori infection (P>0.05). 4) Compared to patients uninfected with H. pylori, those infected with H. pylori had more erythema (70.2% vs. 66.4%, P>0.05) in antrum, (48.5% vs. 45.2%, P>0.05) in body, and (36.4% vs. 32.7%, P>0.05) in fundus, which shows no difference (P>0.05). CONCLUSIONS: Patients infected with H. pylori tend to show more erythema, while those uninfected with H. pylori showed more atrophy. However, such difference between two groups was statistically insignificant, leading to a conclusion that endoscopic findings do not differ according to H. pylori infection.
Atrophy ; Edema ; Endoscopy ; Endoscopy, Digestive System ; Erythema ; Exudates and Transudates ; Female ; Gastritis ; Helicobacter ; Helicobacter pylori ; Hemorrhage ; Humans ; Hyperplasia ; Male

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

Gastrointestinal disease can be diagnosed by observing the lesion through endoscopic examination. The location, size, and shape of the lesion can be determined by direct observation, and the final endoscopic diagnosis is made based on the knowledge and experience of the examiner. However, such diagnosis based on direct observation and examiner's judgment can be inaccurate, suggesting the need to perform biopsy. Since most gastrointestinal disease involve lesion forming from the mucosa level, biopsy is more useful if done by endoscopy. Biopsy is especially crucial in diagnosing a case vague to determine with naked eyes, distinguishing the lesion as benign or malignant, determining the boundary of the lesion, and assessing the effectiveness of the treatment. Enough tissue should be collected in order to make an accurate diagnosis. In order to make an accurate diagnosis, one should collect the tissue as much as possible. Shifting the lesion towards the bottom of the endoscope field, changing the posture of the patient to make the lesion perpendicular, improves the accuracy of the biopsy. Cutting edge equipments such as transparent cap, side-view endoscopy, two channel endoscopy, and double bend endoscopy also enable precise biopsy. In addition, it is crucial to provide the pathologist with enough information. Using the clinical information of the patient, diagnosis made by endoscopy and that made by biopsy should be attempted to be in agreement. Biopsy is an invasive diagnosing method, so it should always be done carefully to minimize any complication.
Biopsy ; Endoscopes ; Endoscopes, Gastrointestinal ; Endoscopy ; Endoscopy, Gastrointestinal ; Eye ; Gastrointestinal Diseases ; Humans ; Judgment ; Mucous Membrane ; Posture

Gastrointestinal tract is the most common location of extranodal lymphoma and 95.4% of gastrointestinal lymphoma is non-Hodgkin type. Although gastrointestinal lymphoma is usually secondary to nodal lymphoma, it can present as a primary gastrointestinal lymphoma with the majority being in the stomach (74.8%). In South Korea, the most frequent histological subtype of gastric lymphoma is extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), followed by diffuse large B-cell lymphoma. Gastrointestinal lymphoma typically presents with nonspecific symptoms, and endoscopic findings are quite variable. So, the diagnosis is mainly dependent on the histopathological evaluation. Treatment of gastrointestinal lymphoma is dictated primarily by the histopathological type and the stage of the disease. This review will discuss the histopathological classification, staging systems, clinical features and treatment of gastrointestinal lymphoma.
Gastrointestinal Neoplasms ; Gastrointestinal Tract ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Non-Hodgkin ; Republic of Korea ; Stomach ; Stomach Neoplasms

In recent years, the incidence of adenocarcinoma of the esophagogastric junction (AEJ) is increasing in the western world, despite of decreasing trend of distal gastric cancer, and the prognosis of AEJ remains poor. The appropriate classification of AEJ is important for selecting the optimal surgical approach and making better prognosis. According to Siewert's classification, distal esophageal cancers (type I) are distinguished from true cardia cancers (type II) and subcardiac gastric cancers (type III). Until now, surgical resection with lymphadenectomy based on Siewert's classification has been the mainstay of treatment for all resectable AEJ. Except surgical approach, therapy strategies for AEJ include endoscopic ablation or endoscopic mucosal resection, endoscopic submucosal dissection, neoadjuvant or adjuvant therapy in combination with surgery, and palliative procedures such as stent, laser, photodynamic therapy. A multidisciplinary approach is necessary for optimal management of AEJ. In this article, we review the treatment options for AEJ including a tailored surgical approach.
Adenocarcinoma ; Cardia ; Esophageal Neoplasms ; Esophagogastric Junction ; Incidence ; Lymph Node Excision ; Photochemotherapy ; Prognosis ; Stents ; Stomach Neoplasms ; Western World