The Korean Association of Internal Medicine
252 32nd World Congress of Internal Medicine (October 24-28, 2014) PS 1048 Gastroenterology (Gastrointestinal Tract) Comparison of the Self Expanding Metal Stent in En- doscopic and Fluoroscopic Control in Malignant Esoph- ageal Stricture
Hong Kyu Lim1, Jung Boom Hong1, Cheol Woong Choi1, Dae Hwan Kang1, Hyung Wook Kim1, Ja Jun Goo1, Peel Jung1, Sook Kyoung Oh1
Pusan National University YangSan Hospital, Korea1
Background: This study compares the effi cacy and safety between the endoscopic direct vision technique self expanding metal stent (endoscopy group) and fl uoroscopy guided self expanding metal stent (fl uoroscopy group) in malignant stricture.
Methods: A total of 118 patients, 94 from the fl uoroscopy group and 24 from the endoscopy group, who underwent self expanding metal stent (SEMS) between January 2009 and December 2013, were reviewed retrospectively on single center experience.
Each procedure time and fluoroscopic guided time were measured. Early and late complications, such as tumor, tissue overgrowth, migration, retrosternal pain and per- foration, were recorded. Dysphagia before and after stent placement was scored on a 5-point scale.
Results: We analyzed 118 patients (18 women: mean age 69±10.7) with dysphagia due to inoperable esophageal stricture of which 58 for squamous cell carcinoma, 58 for adenocarcinoma and 2 for extrinsic compression. The mean procedure time of en- doscopy and fl uoroscopy group were 6.0±1.2 min and 15.0±4.8 min (p
Conclusions: It is safe to perform SEMS under endoscopic control without fl uorosco- py. This confi rms the endoscopic direct vision technique SEMS as an effective method for palliative treatment of malignant esophageal dysphagia.
PS 1049 Gastroenterology (Gastrointestinal Tract) A Case of Esophageal Foreign Body Mimicking Acute Coronary Syndrome
Kwang Hoon Oh1, Jong Kyu Park1, Sang Jin Lee1, Woo Jin Jeong1, Jong Sam Hong1, Yang Hee Han1, Hyun Joong Kim1, Gab Jin Cheon1
Gangneung Asan Hospital, Korea1
We report the case of a 56-year-old man with acute pericarditis and mediastinitis due to esophageal perforation by fi sh bone with ST elevation mimicking acute coronary syndrome. He was in Jeju Island trip, 13 hours prior to admission, he had a substernal chest pain. So, he returned to places connected and transferred to the our emergency room. While waiting at the emergency room, he had diaphoresis with decreased blood pressure. at that time, ECG showed ST segment elevation in leads II, III ,and aVF. Car- diac evaluations including transthoracic echocardiography, emergency coronary angi- ography was performed with the clinical suspicion of acute coronary syndrome. CAG revealed no signifi cant stenosis in both coronary arteries to explain the chest pain. He admitted to the ICU, during the 3 days follow-up, there was no improvement in chest pain. So, an upper gastrointestinal endoscopy was performed for the differential diag- nosis of atypical and prolonged chest pain. the embedded fi sh bone in the esophageal wall was observed above gastroesophageal junction. The fi sh bone was immediately removed using endoscopic forcep. Follow-up chest CT revealed pneumomediastinum and pericardial effusion with air. He was hemodynamically stable and had been a dra- matic improvement after removal the fi sh bone. Therefore, he underwent conservative medical treatment including total parenteral nutrition and intravenous antibiotics. He has improved and was discharged without other complications.
PS 1050 Gastroenterology (Gastrointestinal Tract) A Case of Clinistomum Complanatum Endoscopically Removed from Human Larynx
Shin Hyoung Jo1, Seung won Jung1, Dong cheol Lee1, Susie Rah1, Geum soo Lee1, Sang wook Park1, Gun young Hong1
Kwangju Christian Hospital, Korea1
Introduction: Clinostomum complanatum species are fluke mainly found a bird’s throat or esophagus which eats freshwater fi sh. Rarely the fl uke is attachced on the throat of human who eat raw fi sh and causes the symptom such as pharyngitis. A few cases of Clinostonum complanatum in human have been reported in Korea. We describe a case of human infection with Clinostomum complanatum which was ex- tracted from the larynx endoscopically.
Case report: A 46-year-old female patient presented at our clinic with a 2day history of throat discomfort. Throat discomfort developed after a week from eating sliced raw gray mullet. Endoscopic fi nding revealed about 0.5cm long, fl at and transparent mov- able fl uke with inner black lines was found on the mucosa of left arytenoid cartilage.
The fl uke was endoscopically removed successfully. Histopathological examination of the specimen revealed a parasite known as Clinostomum Complanatum.
Conclusion: Clinostomum is usually attached to the membrane of the throat in human and causes acute pharyngitis, or laryngitis called halzoun. Though C. Complanatum rapidly grows after human infection, most case are not serious. Thus endoscopic removal of parasite is the fi rst choice of treatment in human infection with Clinosto- mum. This case emphasize the importance that pharyx and laryx should be carefully examined especially in patient showing throat discomfort.
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 253
Poster Session
PS 1051 Gastroenterology (Gastrointestinal Tract) A Case of Aortoesophageal Fistula Treated with End- ovascular Stent-Grafting in a Patient with Esophageal Cancer and History of Esophageal Stenting
Shin Ju Oh1, Jae Young Jang1
Department of Internal Medicine, Kyung Hee University School of Medicine, Korea1
Hemorrhage into the esophagus due to aortoesophageal communication is very rare but is life-threatening with high morbidity and mortality. Most cases have been associated with aortic aneurysm. The next common cause is ingestion of foreign bodies followed by esophageal malignancy. Due to high mortality, most cases of aortoesophageal fi stula is confi rmed by autopsy. However we reported a case of aortoesophageal fi stula suc- cessfully treated with endovascular stent-grafting in a patient with esophageal cancer, who had received an esophageal stent insertion before.A 62-year-old male with a history of esophageal cancer was presented at the hospital with hematemesis. The pa- tient was diagnosed with cancer in September 2009. During chemotherapy the patient complained of swallowing diffi culty and showed luminal narrowing of the esophagus on endoscopy. Therefore covered esophageal stent was inserted. Subsequently he was admitted due to hemodynamic shock with massive hematemesis that was caused by an aortoesophageal fi stula 7 months after implantation of an esophageal stent. Emergency endoscopy was performed to evaluate and treat under suspicious upper GI bleed- ing. However endoscopy did not show a defi nite bleeding focus because of massive bleeding. After endoscopy, computed tomography (CT) was performed and it showed focal psedoaneurysm at descending aorta and diffuse thinning of esophageal wall(Fig.
1). After being diagnosed with aortoesophageal fistula, he underwent endovascular stent-grafting. The patient recovered and was discharged 2 weeks after implantation without complications such as re-bleeding.This is the case in which the sequence of events of esophageal cancer with aortoesophageal fi stula occurred. Although aortoe- sophageal fistula is usually a fatal disorder because of acute and massive bleeding, previously implanted covered stent in esophagus took an important role in preventing massive bleeding and therefore made an opportunity to treat the patient.
PS 1052 Gastroenterology (Gastrointestinal Tract) A Case of Esophago-Mediastinal Fistula Due to Tuber- culous Mediastinal Lymphadenitis
Jwa Hoon Kim1, Do Hoon Kim2, Hee Young Yoon1, Ji Wan Lee1, Hyungwoo Cho1, Soomin Jeung1, EunJeong Gong2, Hwoon-Yong Jung2, Jin-Ho Kim2
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Korea1, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Korea2
Tuberculosis rarely involves the esophagus, and the most esophageal tuberculosis occurs secondary to adjacent tuberculous lymphadenitis. Esophago-mediastinal fi s- tula is very rare complication of tuberculous lymphadenitis. A 28-year-old, previously healthy female visited the outside hospital due to nausea, vomiting, and fever. Chest CT(Computed tomography) showed enlargement of multiple, mediastinal lymph nodes with air density in the mediastinum, and thus suggesting an esophago-mediastinal fi s- tula. Esophagogram showed the extraluminal contrast leakage in cervical esophagus.
Esophagogastroduodenoscopy(EGD) showed the deep ulcer with the fi stula opening at 24cm from the upper incisor teeth. Tuberculosis(Tb) polymerase chain reaction(PCR) on the sputum was positive. A biopsy of the right subclavian lymph node revealed necrotizing granuloma with Tb PCR positive. We diagnosed as tuberculous mediastinal lymphadenitis with esophago-mediastinal fi stula. The referring doctor failed to close the fi stula by endoscopic clipping. Therefore, we decided to use anti-Tb medications to treat fi stula via gastrostomy, because of severe nausea and vomiting. After four weeks, EGD and esophagogram showed that the fi stula opening was closed. The present case highlights the importance of anti-Tb medications in treatment of esophago-mediasti- nal fi stula due to tuberculous mediastinal lymphadenitis.n
