BACKGROUND/AIMS: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. METHODS: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. RESULTS: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group's compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. CONCLUSIONS: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method.
Administration, Oral ; Adult ; Aged ; Colonic Diseases/diagnosis ; Colonoscopy/*methods ; Humans ; Male ; Middle Aged ; Patient Compliance ; Phosphates/*administration & dosage ; Polyethylene Glycols/*administration & dosage ; Questionnaires ; Solutions ; Therapeutic Irrigation

Carcinoma of the cystic duct remnant is a rare disease. We report a case of a remnant cystic duct carcinoma in a male patient who had undergone cholecystectomy for cholecystolithiasis 20 years previously. A 53-yr-old man visited our hospital for the evaluation of a submucosal tumor on the duodenum. During the evaluation, we detected a mass in the cystic duct remnant by the use of endoscopic ultrasonography. Based on the pathology, the mass was confirmed as a carcinoma of the cystic duct remnant by intraductal ultrasonography and an intraductal biopsy.
Biopsy ; Cholecystectomy ; Cholecystolithiasis ; Cystic Duct ; Duodenum ; Endosonography ; Humans ; Male ; Rare Diseases

BACKGOUND/AIMS: Pancreatitis is the most common and important complication of an endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to identify risk factors for post ERCP-pancreatitis in patients pretreated with nafamostat mesilate, a synthetic protease inhibitor. METHODS: A total of 247 patients who underwent an ERCP were evaluated prospectively. Potential risk factors of post-ERCP pancreatitis in patients pretreated with nafamostat mesilate were evaluated. RESULTS: Twenty-four patients (9.7%) and nine patients (3.6%) developed post-ERCP hyperamylasemia and pancreatitis, respectively. As determined by univariate analysis among the potential risk factors, we found a procedure time over 20 minutes, pancreatic duct cannulation over four times, prior post-ERCP pancreatitis and the absence of a common bile duct (CBD) stone as risk factors for post-ERCP hyperamylasemia. We also found a patient age under 60 years, a procedure time over 20 minutes, pancreatic duct cannulation over four times and the absence of a CBD stone as risk factors for post-ERCP pancreatitis (p<0.05). As determined by multivariate analysis, pancreatic cannulation over four times is independently associated with post-ERCP hyperamylasemia (p=0.038; OR, 5.165; 95% CI, 1.093~24.412) and post-ERCP pancreatitis (p=0.002; OR, 33.122; 95% CI, 3.526~311.138). CONCLUSIONS: A repeated pancreatic duct cannulation is the most important risk factor for post-ERCP pancreatitis in patients pretreated with nafamostat mesilate.
Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Guanidines ; Humans ; Hyperamylasemia ; Mesylates ; Multivariate Analysis ; Pancreatic Ducts ; Pancreatitis ; Prospective Studies ; Protease Inhibitors ; Risk Factors

Dieulafoy's lesion is an uncommon source of massive gastrointestinal hemorrhage. The lesion predominantly occurs in the proximal stomach, but may occur in all parts of the gastrointestinal tract including small bowel, colon and rectum. We herein report a case of a patient who presented with hematochezia from Dieulafoy's lesion of the terminal ileum with adherent blood clots. Bleeding was successfully controlled with endoscopic treatment by utilizing hemoclipping.
Colon ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileum ; Rectum ; Stomach

Hydrogen peroxide is a safe and useful disinfectant that has achieved widespread utility in various clinical settings. However, hydrogen peroxide may cause mucosal damage and contact injury when applied to the surface of the gut wall. Endoscopically, hydrogen peroxide colitis and proctitis can mimic acute ulcerative colitis, ischemic colitis, or pseudomembranous colitis such as mucosal whitening, erythema, frothy bubbles, granularity and ulceration. We have experienced a case of hydrogen peroxide proctitis in a 37- year-old female patient. She visited our hospital due to symptoms such as hematochezia, anal pain and pelvic pain after insertion of 15 mL of 3% hydogen peroxide. Colonscopy revealed rectal mucosal whitening, severe erythema and scattered small ulcerations up to 12 cm from the anal verge. Pathologic finding revealed neutrophil infiltration in the lamina propria and intact colonic crypt. Herein we report a case of hydrogen peroxide proctitis with reviewed literatures.
Colitis ; Colitis, Ischemic ; Colitis, Ulcerative ; Colon ; Enterocolitis, Pseudomembranous ; Erythema ; Female ; Gastrointestinal Hemorrhage ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Mucous Membrane ; Neutrophil Infiltration ; Pelvic Pain ; Proctitis* ; Ulcer

Dieulafoy's lesions are often unrecognized cause of obscure, massive gastrointestinal bleeding, reported to be 0.3~1.5% of cases of major gastrointestinal bleeding. It is characterized by severe bleeding from rupture of an exposed submucosal artery. Dieulafoy's lesion is usually occured in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been described in the esophagus, duodenum, small intestine, colon, and rectum. The diagnosis is made by endoscopy, angiography, laparoscopy, or laparotomy. Endoscopy showed protruding and eroded artery with pulsatile bleeding or adherent thrombus. Currently, various therapeutic options are available to the endoscopist for the treatment of Dieulafoy's lesions. Therapeutic endoscopy should now become first-line therapy for Dieulafoy's lesions. We experienced a rare case of bleeding from the duodenal Dieulafoy's lesion. Endoscopic hemoclipping was performed successfully. We report this case with a review of the literature.
Angiography ; Arteries ; Colon ; Cytochrome P-450 CYP1A1 ; Diagnosis ; Duodenum ; Endoscopy ; Esophagogastric Junction ; Esophagus ; Hemorrhage* ; Intestine, Small ; Laparoscopy ; Laparotomy ; Rectum ; Rupture ; Stomach ; Thrombosis

Primary venous thrombosis caused by deficiency or qualitative abnormality of antithrombin III, protein C and protein S is usually inherited as an autosomal dominant trait. Usually, deep vein thrombosis or pulmonary thromboembolism is developed by such abnormalities, however, mesenteric vein thrombosis is rarely reported. A 27-year-old man with previous history of deep vein thrombosis underwent segmental resection of jejunum due to mesenteric vein thrombosis complicated by necrosis of jejunum. Postoperative investigation disclosed combined deficiency of antithrombin III and protein C. His son also showed deficiency of antithrombin III. Postoperatively, he is on life-long warfarin therapy without experiencing recurrence of venous thrombosis.
Adult ; Antithrombin III* ; Humans ; Jejunum ; Mesenteric Veins ; Necrosis ; Protein C* ; Protein S ; Pulmonary Embolism ; Recurrence ; Thrombosis ; Venous Thrombosis* ; Warfarin

Carcinoid tumors of the rectum are relatively uncommon and comprise only about one percent of all rectal neoplasms. Typically, rectal carcinoids present as small, solitary submucosal nodules and have benign course. But, multicentricity is rare. The frequency of an associated second malignancy is about 13%. The explanation of the high frequency of other neoplasms associated with carcinoid tumors is still unclear. We have experienced two cases of multiple carcinoid tumors of the rectum, one was coexisted with adenocarcinoma of the sigmoid colon. They presented with mass on the right inguinal area and hematochezia. Carcnoids was found incidentally. Because the tumors measured 15 mm or less in diameter, did not infiltrate beyond the submucosal layer and had no histological atypia, carcinoids was treated by endoscopic polypectomy and mucosal resection. Thereafter, one underwent surgery for adenocarcinoma of the sigmoid colon. Herein we present our experience with reviewed literatures.
Adenocarcinoma ; Carcinoid Tumor* ; Colon, Sigmoid ; Gastrointestinal Hemorrhage ; Neoplasms, Second Primary ; Rectal Neoplasms ; Rectum*

BACKGROUND: The criteria established by Light et al in 1972 have been used widely for the differential diagnosis of the pleural effusions in transudates and exsudates. However, in recent years, several reports have agreed that these criteria misclassified an important number of effusions. For this reason, different parameters have been proposed for differentiation the transudates from exudates. Nevertheless, all these alternative parameters have not been better than the past criteria of Light et al. In response the usefulness of two parameters for differentiation pleural transudate from exudates were evaluated : pleural fluid cholinesterase level and pleural fluid to serum cholinesterase ratio. METHODS: A total of forty-three patient with know causes of the pleura effusion by diagnostic thoracentesis were studied. The following criteria for differentiating the pleural effusions in transudates and exsudates were analyzed : Light's criteria, the pleural fluid cholesterol level, the pleural fluid to serum cholesterol ratio. the pleural fluid cholinesterase level, and the pleural fluid to serum cholinesterase ratio. RESULTS: The conditions of forty-three patients were diagnosed. Ten were classified as having transudates and thirty-three as exudates. The percentage of effusions misclassified by each parameter was as follows : Light's criteria, 9.3% ; pleural fluid cholesterol, 2.3% ; pleural fluid to serum cholesterol ratio, 2.3% ; pleural fluid cholinesterase, 4.7% ; and pleural fluid to serum cholinesterase ratio, 2.3%. CONCLUSIONS: The pleural fluid to serum cholinesterase ratio is one of the accurate criteria for differentiating pleural transudates from exudates. If further studies confirm these results, the cholinesterase ratio could be used as the first step in the evaluation of pleural effusion and if evaluated together with the other criteria, the differentiation of pleural transudate from exsudates will become more accurate.
Cholesterol ; Cholinesterases* ; Diagnosis, Differential* ; Exudates and Transudates* ; Humans ; Pleura ; Pleural Effusion

Morning glory syndrome is a rare congenital clinical entity that results from abnormal optic nerve development. In 1970, Kindler reported on ten patients having this anomaly and coined the term "morning glory syndrome" because of its similarity to the flower. The ophthalmoscopic picture is characterized by an enlarged pink excavated optic disk containing a mass of white tissue at its center, surrounding the disk is a wide, grey, elevated annulus of chorioretinal pigment disturbance. The retinal vessels appear as multiple radially oriented branches near the edge of the disk. Vision is usually markedly reduced. We experienced four cases of morning glory syndrome demonstrating various ophthalmoscopic and fluorescein angiographic features.
Flowers ; Fluorescein ; Humans ; Numismatics ; Optic Disk ; Optic Nerve ; Retinal Vessels