소화성궤양 환자에서 Helicobacter pylori의 DNA지문 분석

홍수진(Su Jin Hong),박용순(Yong Soon Park),이영홍(Young Hong Lee),조영덕(Young Deok Cho),김진오(Jin Oh Kim),봉형근(Hyung Keun Bong),조주영(Joo Young Cho),이준성(Joon Seong Lee),이문성(Moon Sung Lee),김연수(Yun Soo Kim),황성규(Seong G 대한소화기학회 1997 대한소화기학회지 Vol.29 No.3

N/A Background/Aims: The gastric pathogen Helicobacter pylori establishes long-term chronic infection that can lead to gastritis, peptic ulcers, and gastric cancer. However, little is known about the source and route of infection of this organism, and the mechanism of pathogenicity is only now beginning to be unravelled. Urease might allow the survival of the bacteria in an acidic environment, a prerequisite for colonization. H. pylori is cytotoxic to cultured human gastric epithelial cells and this toxicity is due in part to ammonia produced by hydrolysis of urea. We performed this study to evalute the usefulness of DNA fingerprinting of urease genes as a sensitive epidemiological tool for the typing of H. pylori clinical isolates. Methods: Clinical isolates of H. pylori were obtained by biopsy from 18 patients with peptic ulcer at the time of endoscopic examination. Biopsy tissues were cultured under microaerophilic conditions. DNA of H. pylori were extracted for PCR amplification. This study used the polymerase chain reaction(PCR) to amplify the urease structural subunit genes, ureA and ureB, which, when digested with restriction endonucleases, allow the differentiation of patterns on 1.5% agarose gels. Results: The 2.4 kb PCR products amplified and subjected to Hae III restriction endonuclease digestion produced 11 distinct patterns on agarose gels, with five patterns occurring within two or three isolates. Conclusions: The urease genes of H. pylori had genetic heterogeneity, but it could be of considerable tool for epidemiological studies. Moreover the method is useful for studies of relation between H. pylori induced diseases and different strains because unique pattems were shown in two or three isolates. In conclusion, DNA fingerprinting of H. pylori could be available for epidemiological studies of H. pylori infections and for clinical applications. (Korean J Gastroenterol 1997; 29:317 - 325)

악성 폐쇄성황달에 대한 각종 내시경적 역행성담관배액법 ( ERBD ) 비교 평가

심찬섭(Chan Sup Shim),조영덕(Young Deok Cho),문종호(Jong Ho Moon),이영홍(Young Hong Lee),김진오(Jin Oh Lee),봉형근(Hyung Keun Bong),조주영(Joo Young Cho),김연수(Yun Soo Kim),이준성(Joon Seong Lee),이문성(Moon Sung Lee) 대한내과학회 1998 대한내과학회지 Vol.54 No.4

N/A Objectives : Endoscopic biliary drainage has been established as the palliative treatment of choice for malignant obstructive jaundice. At present, the major drawback of endoscopic biliary stenting is occlusion of the endoprosthesis with sludge, resulting in recurrence of jaundice or cholangitis. Recently, there are variable stents that have different materials, sizes, and designs have been used in efforts to overcome this problem To determine the success rate of stent insertion, successful drainage rate, duration of patency, complications related to stent insertion, and cause of stent malfunction, plastic endoprosthesis compared to metal stents in palliative treatment of malignant biliary obstruction. Method: We retrospectively evaluated 157 patients (total number of stent insertion: 308 cases) with unresectable malignant biliary obstruction to receive either a plastic stent(group I, 261 cases) or metal stent(group II, 47 cases). The patients who were recieved plastic stent were subdivided to general plastic stents(group Ia, polyethylene, polyurethane, polyvinylchloride, 225 cases) and Tannenbaum stent(group 1b, Teflon, 36 times) group. And the patients who were received metal stent were subdivided to uncovered metal stents(group IIa, Gianturco- Rosch, Wall, Strecker, EndoCoil stent, 26 times) and membrane covered self-expandable metal stent(group Ilb, 21 cases) group. Results 1) There were no statistical difference in successful rate of stent insertion and drainage effect of stent according to the types of stent(p>0.05). 2) Median patency of the stent was significantly prolonged in patients with a metal stent(group II) compared with those with a plastic stent(group I) (249 vs 123 days; p < 0.05). Median patency of the gorup Ib was significantly prolonged than those of group Ia(137 vs 109 days ; P < 0.05), but there was no statistical difference in median patency between group IIa and Ilb(233 vs 267 days; p > 0.05). 3) The rate of early complication related to stent insertion showed no significant difference in plastic and metal stent groups(P > 0.05). 4) Major causes of stent malfunction in plastic and metal stent were sludge(90% vs 21,4%), tumor ingrowth (4.4% vs 71.4%), and dislocation(5.6% vs 7.2%), respectively. Conclusion : Metal stents have a longer patency than plastic stent in patients with malignant biliary obstruction. In plastic stents, Tannenbaum stents have a slighlty longer patency than other plastic stents, but there were no differences in the success rates, drainage effect and complication rates according to types of stents.

급성 담낭염의 비수술적 담낭배액술 - 내시경적 경비 담낭배액술 및 경피경간 담낭배액술을 중심으로

봉형근(Hyung Keun Bong),문종호(Jong Ho Moon),이영홍(Young Hong Lee),조영덕(Young Deok Cho),김진오(Jin Oh Kim),조주영(Joo Young Cho),김연수(Yun Soo Kim),이준성(Joon Seong Lee),이문성(Moon Sung Lee),황성규(Seong Gyu Hwang),심찬섭(Chan 대한소화기학회 1998 대한소화기학회지 Vol.30 No.1

N/A Background/Aims: Acute cholecystitis is the most common biliary emergency and until now, the choice of the treatment of this disease is surgical operation. But, the. Mortality and morbidity associated with surgical cholecystostomy in those patients are relatively high. Recently, PTCCD and ENGBD were developed as a useful method of nonsurgical cholecystic drainage in high surgical risk group of acute cholecystitis. The purpose of this study was tn assess the usefulness of nonsurgical cholecystic drainage such as PTCCD and ENCrBD in the patients with acute cholecystitis. Methods: Of 59 patients with acute cholecystitis treated with nonsurgical cholecystic drainage, 47 were calculous cholecystitis and 12 were acalculous cholecystitis. Nonsurgical chole- cystic drainages were successful in all 59 cases: PTCCD in 45 patients, ENGBD in rernaining 14 patients. 39 patients were treated with nonsurgical cholecystic drainages due to high surgical risk. In remaining 20 patients there were cholangiocarcinoma in 5 patients, netastatic heptna in 2, gallstone pancreatitis in 1, advanced gastric cancer in 2, refusal of surgery in 10. Results: The prompt clinical recovery were achieved in 42 patients(93.3%) with PTCCD and cornpletely in all 2 cases with ENGBD. In the group with 35 calculous cholecystitis performed PTCCD, 28 under- went PTCCS-L, 4 elective surgery and 3 died because of the underlying condition, In the group with 10 acalculous cholecystitis performed PTC(D, 8 patients need nr further treatment except drainage and remaining 2 patients underwent elective surgery. Jn the group with 12 calculous cholecystitis treated by ENGBD, 10 underwent elective surgery, l F.SWI. And I gallstone dissolu- tion with MTBE. In 2 acalculous cholecystitis treated by ENGBD, the one patient took no further treatment and the other underwent elective surgery. Complications related to PT( CD occurred in 10 of 45 patients, but there was no mortality re]ated to this procedure. No complications were noted related to ENGBD. Conclusions: We conclude that nonsurgical cholecystic drainage witli ENGBD and PTCCD were safe, effective and useful procedures for the management of acute cholecystitis, especially in high surgical risk group, (Korean J Gastroenterol 1997; 30:81 - 89)

대장편평선종의 임상적 고찰

박용순(Yong Soon Park),최우봉(Woo Bong Choi),함정식(Jung Sik Ham),장재영(Jae Young Jang),이영홍(Young Hong Lee),김진오(Jin Oh Kim),조영덕(Young Deok Cho),봉형근(Hyung Keun Bong),김연수(Yun Soo Kim),조주영(Joo Young Cho),이준성(Joon S 대한내과학회 1997 대한내과학회지 Vol.53 No.2

N/A Objectives: To determine accurate diagnosis and proper treatment, we reviewed colonoscopic and histologic findings of flat adenoma of colon, Methods: We studied retrospectively 2148 cases of colonoscopic findings performed in our hospital from March of 1993 to September of 1995. Results: 1) The incidence of adenoma is 9.5%(203 cases), and that of flat adenoma is 1.6%(34 cases). 2) The location of flat adenoma is 3 cases in rectum(8.8%), 15 cases in sigmoid colon(44.1%), 9 cases in descending colon(26.5%), 3 cases in transverse colon(8.8%) and 4 cases in ascending colon and cecum(11.8%). 3) The diameter of flat adenoma was smaller than 5mm in 17 cases(50.0%), between 5-10mm in 8 cases(23.5%) and larger than 10mm in 9 cases (26.5%). Mean size was 9.2mm. 4) In colonoscopic features, type IIa was 25 cases (73.5%), type IIa + IIc was 5 cases(14.7%) and lateral spreading tumor was 4 cases(11.8%). 5) In histologic findings, tubular adenoma was 26 cases(76.5%), tubulovillous adenoma was 6 cases (17.6%) and serrated adenoma was 2 cases(5.9%). 6) The incidence of severe dysplasia or carcinoma was zero in smaller than 5mm, 25.0%(2 case) in 5-10mm and 55.6%(5 cases) in larger than 10mm. 7) The incidence of severe dysplasia or carcinoma was 11.5%(3 cases) in tubular adenoma and 66.7%(6 cases) in tubulovillous adenoma. 8) It was confirmed by abdominal CT scan or operation that lesions were limited to intraepithelium in 4 cases, mucosa in 2 cases submucosa in 1 case and no lymph node metastasis in any case. Conclusion: Even though flat adenoma of colon was smaller than polypoid adenoma, the incidence of malignant change was higher. When it was smaller than 10mm, the incidence of submucosal invasion or lymph node invasion was rare. Therefore endoscopic mucosal resection(EMR) can be the treatment of choice in flat adenoma smaller than 10mm, and after EMR, it is desirable to decide the treatment modality depending on the histologic findings.

췌장질환의 진단에 있어 초미세 췌관경 검사 (Ultrathin-caliber Pancreatoscopy) 의 유용성

조주영,이준성,이문성,황성규,김연수,심찬섭,조영덕,이영홍,김진오,봉형근 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.5

Although ERCP has been widely used to diagnose and occasionally treat chronic pancreatitis, it is not always easy to differentiate between malignancy and benign disease by ERCP alone. So peroral pancreatoscopy(PPS) using mother and baby type scopes was developed and several types of peroral pancreatoscopes with various diameters have been used at several institutes. To assess the clinical usefulness of ultrathin-caliber pancreatoscopy on diagnosis of various pancreatic diseases, we performed peroral pancreatoscopy with PF 8P (Olympus, external diameter: 0.8 mm) in 12 cases(6 cases of chronic pancreatitis, 5 cases of pancreatic tumor, and 1 case of mucinous ductal ectasia) of pancreatic diseases. The pancreatoscope was successfully inserted into main pancreatic duct in 11 cases and permitted satisfactory endoscopic observation. The endoscopic findings of chronic pancreatitis were smooth stenosis, protein plug, and stones in pancreatic duct. Peroral pancreatoscopic findings of pancreatic cancer were characteristically seen as stenosis with irregular mucosal protrusion. In the mucin-producing tumor cases, the lesions were generally not clearly visualized due to the presence of copious amount of mucin. We conclude that pancreatoscopy is a valuable alternative or supplementary procedure to diagnostic imaging method of arriving at a more definite diagnosis in difficult cases. But several limitations, such as poor visual field, absence of biopsy channel and controllable tip, and poor durability of endoscope will be overcomed to serve as essential diagnosic tool for pancratic diseases.

대장종양 선구 형태 (Pit Pattern) 와 확대 대장내시경의 유용성

조주영,이준성,김진오,이문성,황성규,김연수,심찬섭,조영덕,이영홍,봉형근 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.3

Background/Aims: To investigate the usefulness of pit patterns of colorectal tumors and magnifying colonoscopy, Methods: The surface mucosal pits of seventy five colorectal lesions were observed using a magnifying colonoscopy with a zoom 1 to 100 magnification after indigo carmine or methylene blue spray. The lesions were removed by hot biopsy, palypectomy, or endoscopic mucosal resection. Histologic diagnoses were determined by light microscopy. Results: The pit patterns were classified into six types; I, Ⅱ, Ⅲs, Ⅲ_L, Ⅳ, V. The histologic findings according to the pit patterns were 4 chronic nanspecific inflammations, 1 chronic nonspecific inflammation with focal adienomatous change, and 1 submucosal tumor in 6 cases with type I pit pattern; 21 hyperplastic polyps, 3 tubular adenomas, 2 chronic nonspecific inflammations with focal adenomatous change in 26 cases with type Ⅱ; 1 tubular adenoma, 1 chronic nonspecific inflammation, 4 chronic nonspecific inflammations with focal adenomatous change, and 5 hyperplastic polyps with adenornatous change in 11 cases with type Ⅱ+Ⅲ_L; 21 tubular adenomas; 1 tubular adenoma with focal carcinomatous change in 22 cases with type Ⅲ_L.; 2 tubular adenomas, 1 tubulovillous adenoma, and 1 tubular adenoma with focal carcinomatous change in 4 cases with Ⅲ_L.+Ⅳ; 3 tubulovillous adenomas, 1 vinous adenoma with focal carcinomatous change in 4 cases with type Ⅳ; 1 villous adenoma with focal carcinomatous change in 1 case with type Ⅳ+Ⅲs; 1 chronic nonspecific inflammation in 1 case with type V. In assessing the histologic findings according to pit pattern, positiv predictive value was 83% (5/6) in type I (inflammatory change and submucosal tumor), 81% (21/26) in type Ⅱ (hyperplastic polyp), 45 % (5/ 11) in type Ⅱ + Ⅲ (serrated adenoma), 95 % (21/22) type Ⅲ (tubular adenoma), 75% (3/4) in type Ⅲ_L+Ⅳ (tubular or tubulovillous adenoma), 75% (3/4) im type Ⅳ (tubulovillous or villous adenoma), 104% (1/1) in type Ⅳ + Ⅲs (vinous adenoma with focal carcinomatous change), and the overall diagnostic predictive value was 79% (59/75), and the diagnostic accuracy in differential diagnosis between neoplastic and ncnmtWoplastic lesions was 89% (67/75). Conclusions: There was a gc~d correlation between pit pattern and the histologic findings of colorectal tumors, and observation of pit patterns of calore~tal lesions using the magnifying endoscope with dye-contrast techniques has clinical value in assessment of the histologic diagnosis of colorectal neoplasm. Futhermare, we can perform tote differential diagnosis between neoplastic and nonneoplastic lesions, and decide on treatment by observing the pit patterns using the magnifying colonoscopy in vivo.

Mallory-Weiss 증후군 출혈의 내시경적 금속 Clip 지혈술의 유용성

조주영,이준성,김진오,이문성,황성규,김연수,박용순,심찬섭,조영덕,이영홍,봉형근 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.4

Mallory-Weiss syndrome is a laceration in the region of the gastroesophageal junction due to vomiting, retching, coughing preceding hematemesis in alcoholic patient. Bleeding from Mallory-Weiss tears stop spontaneously without specific therapy in 80-90 percent of patient, but rebleeding is uncommonly occurring in 2 to 5 percent of patients. Thus most patients require only supportive care. Rarely endoscopic therapy or operative therapy may be required. We conducted an uncontrolled study to evaluate an improved metallic clip(Olympus hemoclip) for the endoscopic treatment of Mallory-Weiss syndrome. Initial hemostasis was achieved in all patients with active bleeding. No complications resulted from this treatment. Clips did not impair healing of teared mucosa. We conclude that endoscopic hemoclip placement is a highly effective and safe method for treating uncontrolled Mallory-Weis syndrome.

식도정맥류 출혈에 있어서 내시경적 다연발 정맥류 결찰요법의 임상적 의의

조주영,이준성,김진오,이문성,황성규,김연수,심찬섭,조영덕,이영홍,봉형근 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.4

Endoscopic esophageal variceal ligation (EVL) was first introduced by Stiegmann and colleagues in 1986, and it has since grown to he became an extremely popular modality throughout the world as well as Korea. Endoseopic variceal ligation(EVL), which consists of mechanical ligation and thrombosis of varices using elastic O-rings, has been recently developed as a non-operative alternative to endapic injection sclerotherapy (EIS). EVL is minimally operator-dependent and is also associated with fewer local and systemic complications than sclerotherapy. However, the conventional device has only one O ring, and thus the inner cylinder has to be exchanged after each ligation, So, it is a time-consurning procedure that requires the use of an overtube which has somtimes caused tearing of the esophageal mucosa. To save time and control variceal bleeding, multi-band ligation (MBL) was developed. These ligators have five or six O rings, and serial ligation is now possible without exchanging the cylinder or withdrawing the endoscope.Our purposes were ① to evlauate a new custom-made MBL and ② to compare the efficacy and safety of MBL with those of conventional EVL. We performed conventional EVL in 15 patients and MBL in 15 patients who had recently bled from esophageal varices. Six patients were actively bleeding at initial conventional EVL and MBL; all of them were successfully controlled by emergency conventional EVL and MBL. Rebleeding, following initiation of conventional EVL and MBL, did not occur in all patients. Mean time during 5 or 6 bands ligation by conventional EVL and MBL were 6'02$quot; vs 3'23$quot;, 8'17$quot; vs 4'35$quot;. So time-consuming procedure showed statistically significant difference between conventional EVL and MBL(p$lt;0:05): Artifical ulcer size after the first week with band ligatian by conventional EVL and MBL were 8 mm vs 8 mm. So artfical ulcer size showed not significant difference in conventional EVL and MBL by size-marker measurement. Complicatians were not significant difference in conventional EVL and MBL except transient dysphagia in conventional EVL group using overtube. In conclusions, The MBL was significantly faster and easier for endoscopic treatment of variceal bleeding than conventional EVL. The need for an overtube was obviated by multshot mechanism. We conclude that MBL allowed faster and mare successful multiple ligation of esophageal varices, without any major complication and without requiring the placement of an overtube, and the procedure of MBL was much more easy for the endoscopist, and much more comfortable for the patient.

담낭-십이지장-대장루 1예

조주영,이준성,황주호,김진오,이문성,황성규,김연수,심찬섭,조영덕,이영홍,봉형근 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.5

Biliary-enteric fistula is in 0.5% to 5% of patients undergoing biliary tract surgery. The most common cause of biliary-enteric fistula is gallstones and their complications, Much less common causes are complieation of peptic ulcer, malignancy, trauma, and rarely, Crohns, disease. The most common type of biliary-enteric fistula is cholecysto-duadenal. Cholecysto-colic, cholecysto-gastric, and choledocho-duodenal fistula are reported much less frequently. The combination of cholecysto-duodenal fistula with cholecysto-colic fistula is a very rare. Symptoms are generally nonspecific, so diagnosis has depended on plain film of abdomen and barium studies. Recently, endoscopic examination and cannulation of the fistula for precise radiographic delineation will help to make a diagnosis. A 78-year-old man was admitted our hospital because of epigastric discomfort, indigestion, nausea and vomiting for 10 days. He was confirmed as cholecysto-duodeno-colic fistula by gastroduodenoscopy, colonoscopy, and endoscopic cholangio-graphic techniques. So, we report a case of cholecysto-duodeno-colic fistula of the patient with a review of relevant literatures.

십이지장구부에 발생한 용종양 위상피화생 1예

조주영,이준성,장재영,김진오,이문성,황성규,김연수,심찬섭,조영덕,이영홍,봉형근 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.4

Gastric metaplasia of the duodenum, defined as the presence of groups of gastric mucosal cell within normal duodenal epithelium, is an almost constant feature of duodenal ulcer. The pathogenesis of gastric metaplasia is unclear, but acid and Helicobacter pylori infection are contributory factors to the development of gastric metaplasia. Generally, endoscopic finding of gastric metaplasia in duodenum is typically patchy distribution in duodenal bulb, but polypoid gastric metaplasia in duodenum is very rare. We report that the patient who complaints of abdominal pain has a villous, polypoid gastric metaplasia in duodenal bulb without duodenal ulcer.