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Endoscopic Management for Colocutaneous Fistula as a Complication of Percutaneous Endoscopic Gastrostomy.

Tae Young JUNG ; Jeong Rok LEE ; Dong Keun SEOK ; Sae Yoon KEE ; Soon Young KO ; Joon Ho WANG ; Jae Dong LEE

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2013;13(2):128-131. doi:10.7704/kjhugr.2013.13.2.128

Percutaneous endoscopic gastrostomy (PEG) has become a safe and effective technique for enteral feeding. Colocutaneous fistula, which is a rare complication of PEG, is thought to be formed during insertion of the original PEG tube when the colon becomes interposed between the stomach and the abdominal wall. We present a patient who developed colocutaneous fistula after PEG tube exchange. Three years ago, a PEG tube for enteral feeding was placed in a 27-year-old male with cerebral palsy and severe scoliosis. Two months after PEG tube exchange, he was admitted to our hospital because fecal material was observed in the tube and exit site. The diagnosis of colocutaneous fistula was made after injection of gastrografin in the fistula opening of the abdominal wall. Endoscopic management for the fistula opening of the colon was successfully performed using metal-clips and we were able to avoid surgical therapy for the fistula.
Abdominal Wall ; Cerebral Palsy ; Colon ; Diatrizoate Meglumine ; Enteral Nutrition ; Fistula ; Gastrostomy ; Humans ; Male ; Scoliosis ; Stomach

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Pill-induced Intramural Hematoma of the Esophagus.

Hyung Seok YOON ; Jeong Rok LEE ; Dong Keun SEOK ; Woong Gil CHOI ; Soon Young KO ; Joon Ho WANG ; Jae Dong LEE

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2013;13(2):124-127. doi:10.7704/kjhugr.2013.13.2.124

Intramural hematoma of the esophagus is a rare cause of chest pain. Varying degrees of submucosal dissection and rupture of the esophagus can induce intramural hematoma of the esophagus. It is viewed as a complication of endoscopic sclerotherapy of esophageal varices, and is likely caused by an elevation in intraesophageal pressure due to factors such as blood coagulation abnormality, drugs, trauma or vomiting. We describe one case of pill-induced spontaneous intramural hematoma that was successfully managed by conservative treatment and discuss the case with a review of the literature.
Blood Coagulation ; Chest Pain ; Esophageal and Gastric Varices ; Esophagus ; Hematoma ; Rupture ; Sclerotherapy ; Vomiting

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Penumomediastinum and Subcutaneous Emphysema Developed Following Gastric Endoscopic Submucosal Dissection: Two Cases.

Hye Won JANG ; Beom Hee KIM ; Sun Hyung KANG ; Hee Seok MOON ; Jae Kyu SEONG ; Hyun Yong JEONG

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2013;13(2):119-123. doi:10.7704/kjhugr.2013.13.2.119

Endoscopic submucosal dissection (ESD) is extensively used for the management of early gastric cancer. But many possible complications can occur. We report here two cases where subcutaneous empysema and pneumomediasinum occurred after ESD of early gastric cancers without perforation. The lesions were close to the esophagogastro-junction. The reason subcutaneous empysema and pneumomediasinum developed is lack of serosa of esophagus. Insufflated air may leak when the muscular layer is exposed during ESD. After intravenous antibiotics and total parenteral nutirition were administered, the patients improved without any other complications.
Anti-Bacterial Agents ; Esophagus ; Humans ; Mediastinal Emphysema ; Serous Membrane ; Stomach Neoplasms ; Subcutaneous Emphysema

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A Case of Gastric Undifferentiated Carcinoma with Focal Yolk Sac Tumor and Hepatoid Carcinoma Differentiation.

Dae Hwa PARK ; Hee Seok MOON ; Dae Hyun TAK ; Suk Hyun KIM ; Jae Gyu SUNG ; Hyun Yong JEONG ; Gyu Sang SONG

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2013;13(2):114-118. doi:10.7704/kjhugr.2013.13.2.114

We report herein a case of gastric undifferentiated carcinoma with focal yolk sac tumor and hepatoid carcinoma differentiation. A 57-year-old man was referred after a gastroscopy for anemia evaluation. Gastroscopy revealed an approximately 3 cm ulcerofungating mass occupying the greater curvature of stomach body. Biopsy results revealed a poorly differentiated adenocarcinoma. Left gastric lymph node was enlarged, but there were no evidence of distant metastasis on the abdominal CT. He underwent a radical subtotal gastrectomy and gastroduodenostomy with dissection of the enlarged lymph nodes. Postsurgical histological examination revealed an undifferentiated carcinoma with focal yolk sac tumor and hepatoid carcinoma differentiation. Immunohistochemical staining revealed that the tumor cells were focal positive for AFP, anti-hepatocyte antibody.
Adenocarcinoma ; Anemia ; Biopsy ; Carcinoma ; Endodermal Sinus Tumor ; Gastrectomy ; Gastroscopy ; Lymph Nodes ; Neoplasm Metastasis ; Stomach ; Yolk Sac

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Unusual Treatment of Gastric Mucosa Associated Lymphoid Tissue Lymphoma Unresponsive to Helicobacter pylori Eradication.

Woo Tae KIM ; Won Seok PARK ; Sang Bum KANG ; Soon Woo NAM ; Dong Soo LEE ; Seung Woo LEE ; Yeon Soo KIM ; Jong Ok KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2013;13(2):109-113. doi:10.7704/kjhugr.2013.13.2.109

The connection between Helicobacter pylori and mucosa-associated lymphoid tissue (MALT) lymphoma is well established. H. pylori eradication is the initial treatment for MALT lymphoma. However, in H. pylori negative cases or unresponsive patients after successful eradication, radiation, systemic therapies, and surgical resection should be considered. Also local treatment modalities such as endoscopic mucosal resection (EMR) may be a therapeutic option in cases of low grade, localized MALT lymphoma. Herein, we report a case of a 53-year-old man who had a persistent endoscopic mass and tumor cells on histology for 5 months despite H. pylori eradication. Because of no early response to H. pylori eradication, the possibility of the presence of a high-grade lymphoma component, the proximal location of the tumor, and the exophytic nature of the tumor, we decided to perform EMR for complete resection. After EMR, the patient remained in complete remission throughout the 15-month follow up. In our case, endoscopic resection could lead to a more rapid complete remission. Therefore, we suggest that endoscopic resection may be a useful option for low-grade exophytic-type gastric MALT lymphoma treatment with no response to H. pylori eradication.
Endoscopy ; Follow-Up Studies ; Gastric Mucosa ; Helicobacter ; Helicobacter pylori ; Humans ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Non-Hodgkin

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Prevalence and Predictive Factors of Malignant Potential in Resected Gastric Subepithelial Tumors.

Seung Kak SHIN ; Jun Won CHUNG ; Jung Hyun LEE ; Yoon Jae KIM ; Kwang Ahn KWON ; Dong Kyun PARK ; Woon Kee LEE

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2013;13(2):104-108. doi:10.7704/kjhugr.2013.13.2.104

BACKGROUND/AIMS: EUS is a useful method to differentiate malignant from benign gastric subepithelial tumors (SETs) and to determine resection. However, this results in unnecessary resections of benign gastric SETs. The aim of our study is 1. to investigate clinical factors that may predict malignancy in gastric SET and 2. to determine how many of them have malignant potential in resected gastric SETs. MATERIALS AND METHODS: We retrospectively identified 111 patients who underwent pathologic confirmation for gastric SETs by surgical (104/111, 93.6%) and endoscopic resection between February 2003 and April 2012 and analyzed the clinical, EUS findings and final pathologic diagnosis for these patients. RESULTS: The diagnostic accuracy of EUS for SETs was 58.6% (51/87) and the rate of resection for benign SETs was 31.5% (35/111). In multivariate analysis, old age (> or =65), as well as tumor size (> or =2 cm) and location (upper or middle) were significant predictive factors for malignant potential of gastric SETs. CONCLUSIONS: One-third of endoscopic and surgical resections are performed for benign SETs. Patient's age, tumor size, and location should be considered before resection of gastric SETs. In addition, more accurate tools for histologic confirmation should be developed in order to avoid unnecessary resection.
Endosonography ; Humans ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Stomach

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A Study of Esophageal Cancer Detected by Screening Upper Endoscopy for a Routine Health Check-up.

Jong In YANG

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2013;13(2):99-103. doi:10.7704/kjhugr.2013.13.2.99

BACKGROUND/AIMS: This study was performed to evaluate the extent, diagnostic and therapeutic results of esophageal cancer found by screening upper endoscopy during a routine health check-up. MATERIALS AND METHODS: Among 88,575 subjects presenting for screening upper endoscopy between 2003 and 2011, those with esophageal cancer were extracted using the pathologic results of upper endoscopic biopsy from the esophagus as the final subjects for this study. Wilcoxon rank sum test or Fisher's exact test were used to test statistical differences. RESULTS: A total of 9 patients with esophageal cancer were detected. Seven patients had squamous cell carcinoma and 2 had adenocarcinoma. A depressed mucosal lesion about 1.0 cm size was the most common endoscopic finding of squamous cell carcinoma, however, a polypoid lesion in association with reflux esophagitis was the major finding of adenocarcinoma. Therapeutic data were available in 7 patients. Five squamous cell carcinoma patients were at stage IA, 3 were treated by endoscopic submucosal dissection and 2 by laparoscopic total esophagectomy. Two adenocarcinoma patients, of stage IIB and IIIA respectively, were treated by Ivor Lewis operation. CONCLUSIONS: Our data suggest that screening upper endoscopy during a routine health check-up may enable early detection of esophageal cancer. However, more effort should be given to detect esophageal adenocarcinoma in an earlier stage.
Adenocarcinoma ; Biopsy ; Carcinoma, Squamous Cell ; Endoscopy ; Esophageal Neoplasms ; Esophagectomy ; Esophagitis, Peptic ; Esophagus ; Humans ; Mass Screening

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Outcomes and Efficiency of National Gastric Cancer Screening Program in Korea.

Sang Wook LEE ; Beom Jin KIM ; Jung Duck PARK ; Jae Gyu KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2013;13(2):95-98. doi:10.7704/kjhugr.2013.13.2.95

BACKGROUND/AIMS: The National Cancer Screening Program (NCSP) for Medicaid recipients has contributed to reduction of cancer-related mortality in Korea. Although biennial gastric cancer screening by endoscopy has been increasing in Korea as part of the NCSP, few studies have evaluated its efficiency. Therefore, we analyzed the outcomes and efficiency of the NCSP for gastric cancer using endoscopy in Korea. MATERIALS AND METHODS: We reviewed results from the NCSP for gastric cancer at Chung-Ang University Yong-San Hospital in Korea from March 2003 to March 2008. The study population comprised of Medicaid recipients more than 40 years old, who were taken from the National Health Insurance Corporation. RESULTS: A total of 7,278 asymptomatic subjects underwent endoscopy for gastric cancer screening. The mean age of the screened subjects was 51.3 years for men and 48.9 years for women. The male to female ratio of the screened subjects was 1.2:1. Gastric cancer was diagnosed in 32 (0.44%) of 7,278 subjects (22 men and 10 women). Their mean age was 54.4 years. Of these, 21 subjects (0.29%) were diagnosed as early gastric cancer (EGC) and 11 subjects (0.15%) were diagnosed as advanced gastric cancer. The proportion of EGCs among total gastric cancers was 65.6%. CONCLUSIONS: Despite accomplishments of the NCSP for gastric cancer in Korea, its effectiveness remains an issue. Efficiency and cost-effectiveness analysis will be needed for successful progression.
Early Detection of Cancer ; Endoscopy ; Female ; Humans ; Korea ; Male ; Mass Screening ; Medicaid ; National Health Programs ; Stomach Neoplasms

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Intestinal Metaplasia: Reversible after Treatment?.

Si Hyung LEE ; Byung Ik JANG

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2013;13(2):91-94. doi:10.7704/kjhugr.2013.13.2.91

Intestinal metaplasia is often found in the clinical situation in Korea and was reported as a pre-cancerous lesion by several previous studies. Intestinal metaplasia is mainly caused by infection of Helicobacter pylori, but whether intestinal metaplasia improves or reverses after eradication of H. pylori has not been agreed upon. Most randomized clinical studies reported that intestinal metaplasia improved or did not progress after H. pylori eradication therapy. But, infection rates and antibiotic resistance rates of H. pylori infection and the prevalence of intestinal metaplasia varies according to the region and race, therefore large prospective randomized studies are needed before we can reach any conclusions.
Continental Population Groups ; Drug Resistance, Microbial ; Helicobacter pylori ; Humans ; Korea ; Metaplasia ; Prevalence

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Pathologic Diagnosis of Gastric Intestinal Metaplasia.

Nari SHIN ; Do Youn PARK

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2013;13(2):84-90. doi:10.7704/kjhugr.2013.13.2.84

Gastric intestinal metaplasia (IM) is one of the precursors of gastric adenocarcinoma and is clinically important regarding issue for recommendation of further endoscopic evaluation. Herein we review the histologic characteristics, molecular features and pathological diagnosis of IM. Histologically, IM has been classified as 3 types: type I complete IM, type 2 incomplete IM and type 3 incomplete IM. This classification is important to clinicians as well as pathologists. We emphasize that careful follow up should be recommended in patient with extensive IM or incomplete IM.
Adenocarcinoma ; Humans ; Metaplasia ; Stomach

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