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A Case of Esophageal Tuberculosis as the Cause of a Fever of an Unknown Origin.

Jae Myung CHA ; Joung Il LEE ; Jae Won CHOE ; Kwang Ro JOO ; Sung Won JUNG ; Hyun Phil SHIN ; Woo Young HEW

Korean Journal of Gastrointestinal Endoscopy.2008;37(5):335-338.

Fever of an unknown origin (FUO) means a fever that does not resolve spontaneously, and the cause remains elusive after an extensive diagnostic workup. The most common cause of FUO is infectious disease, and the most common infectious cause documented in Korea is tuberculosis, and particularly extrapulmonary or miliary tuberculosis. Among the extrapulmonary tuberculosis, esophageal tuberculosis is a very rare form of adult tuberculosis, and even in Korea with its high prevalence of tuberculosis. Esophageal tuberculosis can present as systemic symptoms such as weight loss, fever, chills and general weakness, or as local symptoms such as chest pain, dysphagia, cough and hematemesis. However, it can present as a prolonged fever of an unknown origin without any other symptoms. In this report, we describe a patient with esophageal tuberculosis, and the patient presented with a fever of unknown origin for 1 month. The patient was diagnosed by esophagogastroduodenoscopy with biopsy and he responded well to antituberculosis therapy.
Adult ; Biopsy ; Chest Pain ; Chills ; Communicable Diseases ; Cough ; Deglutition Disorders ; Endoscopy, Digestive System ; Esophagus ; Fever ; Fever of Unknown Origin ; Hematemesis ; Humans ; Korea ; Prevalence ; Tuberculosis ; Tuberculosis, Miliary ; Weight Loss

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Endoscopic Ultrasonography-guided Tru-Cut Biopsy for Differential Diagnosis in the Gastrointestinal Mesenchymal Neoplasm.

Hyoun Woo KANG ; Joo Sung KIM ; Sang Gyun KIM ; Hae Yeon KANG ; Hyun Chae JUNG ; In Sung SONG

Korean Journal of Gastrointestinal Endoscopy.2008;37(5):328-334.

BACKGROUND/AIMS: Risk assessment by mitotic count in the gastrointestinal stromal tumor (GIST), the most common mesenchymal neoplasm, is important. EUS-guided fine- needle aspiration cannot obtain sufficient tissue for determination of mitotic count, but An EUS-guided Tru-Cut biopsy (EUS-TCB) can. The aim of this study was to evaluate clinical role of EUS-TCB in differential diagnosis of mesenchymal neoplasm and risk assessment of GIST. METHODS: We prospectively enrolled 18 patients who were diagnosed with submucosal hypoechoic tumors, 2~5 cm, in the muscular layer by EUS in Seoul National University Hospital from November, 2005, to July, 2007. The rates of adequate biopsy and possibility of risk assessment were evaluated. RESULTS: EUS-TCB was performed in 16 patients. The median tumor size was 2.7 cm, and adequate diagnosis was possible in 8 patients. Tumor size in the adequate specimen group was larger than in the inadequate group (p=0.021). The number of needle passes was higher in the adequate specimen group (p=0.012). Risk assessment by mitotic count was possible in only one case. CONCLUSIONS: EUS-TCB in the diagnosis and risk assessment of GIST was inadequate, in part because of insufficient operator experience and small tumors. Development of a new instrument is needed to obtain sufficient tissue.
Biopsy ; Diagnosis, Differential ; Gastrointestinal Stromal Tumors ; Humans ; Needles ; Prospective Studies ; Risk Assessment

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A Clinical Analysis of Patients with Active Small Bowel Bleeding as Detected on Double Balloon Enteroscopy.

Tae Hee LEE ; Jin Oh KIM ; Soo Hoon EUN ; Bong Min KO ; Joo Young CHO ; Joon Seong LEE ; So Young JIN ; Moon Sung LEE ; Chan Sup SHIM ; Boo Sung KIM

Korean Journal of Gastrointestinal Endoscopy.2008;37(5):321-327.

BACKGROUND/AIMS: There are few studies that have evaluated active small bowel bleeding. The aim of this study was to evaluate patients with active small bowel bleeding that had been considered as obscure gastrointestinal bleeding an was confirmed by the use of double balloon enteroscopy (DBE). METHODS: We retrospectively reviewed the medical records of 12 patients with active small bowel bleeding as detected on DBE from January 2005 to September 2007. RESULTS: The mean patient age was 63 years (age range, 45~80 years) and the patients consisted of seven men and five women. The mean hemoglobin level at admission was 7.6 g/dL (range, 5.8~9.0 g/dL). The mean transfusion volume was 4.4 pints (range, 0~7 pints). Angiodysplasia was the most common cause of bleeding (n=6, 50%), followed by small bowel tumors (n=4, 33%). Other causes included diverticula and a nonspecific ulcer. The most common location of bleeding was the jejunum. Diagnostic yields of capsule endoscopy, a 99mTc RBC scan, an abdomen CT scan, angiography and a small bowel series were 40%, 33%, 25%, 0% and 0%, respectively. Endoscopic treatment was performed successfully in eight patients (67%). CONCLUSIONS: The most common etiology for active small bowel bleeding is angiodysplasia followed by a small bowel tumor. Other diagnostic methods for the small bowel showed low diagnostic yields. Further investigation of active small bowel bleeding is needed to confirm our results.
Abdomen ; Angiodysplasia ; Angiography ; Capsule Endoscopy ; Diverticulum ; Double-Balloon Enteroscopy ; Female ; Gastrointestinal Stromal Tumors ; Hemoglobins ; Hemorrhage ; Humans ; Jejunum ; Male ; Medical Records ; Retrospective Studies ; Ulcer

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The Current Status of Endoscopic Submucosal Dissection.

Joo Young CHO ; Won Young CHO

Korean Journal of Gastrointestinal Endoscopy.2008;37(5):317-320.

Endoscopic Submucosal Dissection (ESD) is curative treatment for early gastrointestinal neoplasia, and this procedure does not involve open surgery. Significant advances of the techniques and instruments for ESD have been made and many medical institutes have the facilities to perform ESD. This article reviews the current status of ESD in Korea.
Academies and Institutes ; Korea

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Two Cases of Direct Peroral Cholangioscopy Using an Ultra-Slim Upper Endoscope after Endoscopic correction of Endoscopic after Stone Removal.

Jong Chan LEE ; Jong Ho MOON ; Bong Min GO ; Hyun Jong CHOI ; Hyun Cheol KOO ; Young Koog CHEON ; Young Deok CHO ; Joon Seong LEE ; Moon Sung LEE ; Chan Sup SHIM ; Boo Sung KIM

Korean Journal of Gastrointestinal Endoscopy.2007;35(5):373-377.

Peroral cholagioscopy is a good procedure that permits direct visualization of the biliary tree and target biopsies of lesions. However, peroral cholangioscopy with a mother-baby system requires two experienced endoscopists, and the procedure remains time consuming and expensive and the apparatus is easily broken. Therefore, an easier technique to get direct visual examination of the biliary tree is needed. Direct peroral cholangioscopy (direct POC) with using an ultra-slim upper endoscope was performed in two patients after endoscopic stone removal for diagnosing their biliary stricture. One patient had wire-guided direct POC performed and the patient was diagnosed benign biliary stricture on the proximal CBD after forcep biopsy. Another patient had overtube-assisted direct POC performed and that patient was found to have a polypoid lesion at the bifurcation. Future advances in endoscope development, as well as specifically designed accessories, are expected to increase its clinical utility.
Biliary Tract ; Biopsy ; Constriction, Pathologic ; Endoscopes* ; Humans ; Surgical Instruments

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A Case of a Double Gallbladder with Common Bile Duct Stones.

Nark Soon PARK ; Hong Sik LEE ; Ji Hoon KIM ; Dong Hun LEE ; Eun Sun KIM ; Young Jin KIM ; Eun Bum PARK ; Jin Nam KIM ; Ja Seol KOO ; Sang Woo LEE ; Jae Hyun CHOI ; Chang Duck KIM ; Ho Sang RYU

Korean Journal of Gastrointestinal Endoscopy.2007;35(5):369-372.

A double or bilobed gallbladder is a rare congenital anomaly, occurring at a rate of 1/4,000~5,000. We encountered a case of a double gallbladder that was diagnosed by an endoscopic retrograde cholangiogram. In view of the paucity of this anomaly, we report the case of a patient with a double gallbladder (Y duplication) accompanied by a common bile duct (CBD) stone. We also discuss the characteristics, classification, embryology and treatment of the double gallbladder.
Cholangiopancreatography, Endoscopic Retrograde ; Classification ; Common Bile Duct* ; Embryology ; Gallbladder* ; Humans

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A Case of Choledochocele Associated with Papillary Adenocarcinoma.

Dong Hun LEE ; Jae Seon KIM ; Ji Hoon KIM ; Eun Sun KIM ; Young Jin KIM ; Nark Soon PARK ; Sun Jae LEE ; Beom Jae LEE ; Young Tae BAK

Korean Journal of Gastrointestinal Endoscopy.2007;35(5):364-368.

Choledochocele is a rare abnormality that's defined as cystic or diverticular dilatation of the common bile duct, and this protrudes into the duodenal lumen. It may cause abdominal pain, recurrent pancreatitis, obstructive jaundice etc. Although its anatomic form does not meet the criteria of pancreaticobiliary malunion, malignant changes of the choledochocele in relation to pancreaticobiliary reflux may occur. It still is regarded as having a lower malignant potential than any other type of choledochal cyst. Only one case has been currently been reported in Korea. We experienced a case of a 71 year-old woman with upper abdominal pain that was caused by a choledochocele with duodenal ampullary adenocarcinoma. She was successfully treated by surgical excison without severe complications. We report here on this case along with a review of the literature.
Abdominal Pain ; Adenocarcinoma ; Adenocarcinoma, Papillary* ; Aged ; Choledochal Cyst* ; Common Bile Duct ; Dilatation ; Female ; Humans ; Jaundice, Obstructive ; Korea ; Pancreatitis

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A Case of Pancreatic Arteriovenous Malformation Presenting Upper Gastrointestinal Bleeding.

Su Hee PARK ; Mi Jeong KIM ; You Sang KO ; You Jin LIM ; Seung Yong HAN ; Hyun Woo BYUN ; Min Ho CHOI ; Hyun Joo JANG ; Sea Hyub KYE ; Jin LEE

Korean Journal of Gastrointestinal Endoscopy.2007;35(5):359-363.

A pancreatic arteriovenous malformation (AVM) is a very rare disease entity that is usually asymptomatic; however, it may present with a massive gastrointestinal hemorrhage. Recent advances in cross-sectional imaging and the widespread availability of angiography have contributed to the diagnosis of this condition. A patient was transferred to our clinic due to unknown origin gastrointestinal bleeding and upper abdominal pain. Double balloon enteroscopy and duodenoscopy revealed a bleeding pancreatico-cholangio-duodenal fistula. We were able to diagnose an arteriovnous malformation with a pancreatico-cholangio-duodenal fistula by the use of angiography and from the post-operative pathological findings.
Abdominal Pain ; Angiography ; Arteriovenous Malformations* ; Diagnosis ; Double-Balloon Enteroscopy ; Duodenoscopy ; Fistula ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Pancreas ; Rare Diseases

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A Case of a Colonic Giant Lipoma Removed by Endoscopic Resection.

Hyun Chul WHANG ; Dong Han IM ; Joon Seok OH ; Hyun Ju KIM ; Hwa Mock LEE ; Youn Uk KO ; Won Il PARK ; Kwang Jin KIM ; Jin Kwang AN ; Ung Suk YANG

Korean Journal of Gastrointestinal Endoscopy.2007;35(5):355-358.

A gastrointestinal lipoma, though rare, is a mesencymal tumor of the large bowel, and the second most common benign colonic tumor detected after an adenomatous polyp. The lesion may be asymoptomatic when small and may be detected incidentally, usually during a colonoscopic examination for another purpose. Lipomas of the large bowel that are not causing symptoms probably need no treatment, as malignant transformation has not been documented. If the mass is large, it can cause pain, anal bleeding due to intussusception, bowel obstruction and diarrhea, and thus resection should be considered. Due to the risk of perforation, endoscopic resection of large colonic lipomas has been discouraged. However, large colonic lipomas can be removed safely by endoscopic resection with the use of an endoscopic ultrasonogram and submucosal injection to elevate the lesion.
Adenomatous Polyps ; Colon* ; Diarrhea ; Hemorrhage ; Intussusception ; Lipoma* ; Ultrasonography

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A Case of Arteriovenous Malformation of the Descending Colon Presenting with Massive Bleeding.

Young Kook SHIN ; Jin Tae JUNG ; Jung Seok KWON ; Myung Jun SEONG ; Han Il LEE ; Chang Ho CHO

Korean Journal of Gastrointestinal Endoscopy.2007;35(5):351-354.

Arteriovenous malformation is a rare cause of lower gastrointestinal bleeding in patients younger than 50 years of age and is characterized by recurrent, painless, massive bleeding and chronic anemia without a remarkable prior or family history. The most commonly sites involved are the ascending colon and small bowel. This condition rarely involves the stomach and descending colon. Until recently, there has been only one case report on arteriovenous malformation of the descending colon in Korea. We report a case of a 32 year old male patient who presented with massive lower gastrointestinal bleeding and had been diagnosed with arteriovenous malformation of the descending colon after undergoing colonoscopy and abdomen CT with contrast enhancement. The patient underwent left hemicolectomy because of persistent bleeding despite conservative management.
Abdomen ; Adult ; Anemia ; Arteriovenous Malformations* ; Colon, Ascending ; Colon, Descending* ; Colonoscopy ; Hemorrhage* ; Humans ; Korea ; Male ; Stomach

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