The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 261
Poster Session
PS 1080 Gastroenterology (Gastrointestinal Tract) Mucosal-Incision Assisted Biopsy for Suspicious Gastro- intestinal Stromal Tumors
Young Soo Lee1, Yoonchul SEOK1, Hye Jae CHO2, Jaeil Chung1
Internal Medicine, Sahmyook Medical Center, Korea1, Pathology, Sahmyook Medical Center, Korea2 Background: Tissue sampling is necessary for defi nitive diagnosis of GIST. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been developed for tissue sampling of suspected GIST and is generally accepted to be a very useful for the diagnosis of this lesion, but the success rate for histology does not seem to be satis- factory(62%).Recently Eikichi at al has published of retrospective review of mucosal incision assisted biopsy(MIAB) of suspected GISTs. So we performed prospective study of MIAB associated with suspicious GISTs.
Methods: To evaluate the diagnostic yield of the procedure, mucosal-incision assisted biopsy (MIAB), for the histological diagnosis of gastric gastrointestinal stromal tumor (GIST),and to know the complications of MIAB, we performed prospective study of the 14 patients with suspected gastric GIST who underwent MIAB in our hospitals.
Results: Tissue samples obtained by MIAB were suffi cient to make a histological diag- nosis (diagnostic MIAB) in 12 out of the 14 patients(86%), where the lesions had in- traluminal growth patterns. Histologic diagnosis were GIST(9, 64 %), Leiomyoma(2, 14
%) and infl ammatory change(1,7 %). Locations were fundus( 3 , 21 %), cardia (3 ,21 %), body(5 , 36% ) and antrum(3 , 21 %). Mean size 15.3 ± 0.8.1patient had signifi cant bleeding after MIAB but well controlled by endoscopic hemostasis.
Conclusions: Although it is generally accepted that EUS-FNA is the gold standard for obtaining biopsies for histological and cytological analysis of suspected gastric GIST, MIAB may be chosen as an alternative diagnostic modality only when the lesion has an intraluminal growth pattern. Further studies will be required to further assess MIAB, including randomized controlled trials to compare MIAB with EUS-FNA.
PS 1081 Gastroenterology (Gastrointestinal Tract) A Case of Endoscopic Hemostasis of Gastric Ulcer Bleeding through the Percutaneous Gastrostomy Site
Jong Min Kim1, Jae Kwon Jung1, Hyun Soo Kim1, Chang Keun Park1, Yun Jin Jung1, Dong Wook Lee1
Daegu Fatima Hospital, Korea1
Introduction: Although successful endoscopic hemostasis can be achieved in most case of gastric ulcer bleeding, endoscopic hemostasis can`t be tried in some limited cases including esophageal stricture. We report a case of gastric ulcer bleeding that achieved successful endoscopic hemostasis through the percutaneous gastrostomy site in the patient with esophageal stricture.
Case: A 46-year-old man was in a bed-ridden state for 7 years due to cervical spine injury caused by traffi c accident. After operation (C-spine discectomy and interbody fusion), percutaneous endoscopic gastrostomy (PEG) tube insertion was performed.
He underwent fi rst PEG tube insertion in other hospital under endoscopic visualization (in medical records). But upper esophageal stricture had progressed after operation, whenever inadvertent tube removal was occurred, tube replacement was performed using balloon replacement tube (PEG-24-BRT-S; Wilson-COOK Medical, USA). After last replacement of the PEG tube 1 year ago, he was referred to our hospital with a 1-day history of hematemesis. Because of upper esophageal stricture, endoscopic examination was not available through trans-esophageal route. Thus endoscopy was performed through trans-abdominal route after the PEG tube removal. Active ulcer lesion with exposed vessel was observed in greater curvature of the stomach body and successful hemostasis was achieved by epinephrine injection. After the procedure, PEG tube was re-inserted and neither complications nor re-bleeding was developed.
Conclusion: In patients with PEG tube, trans-abdominal approach of endoscopy is possible option for endoscopic hemostasis when non variceal upper gastrointestinal bleeding is occurred.
PS 1082 Gastroenterology (Gastrointestinal Tract) Comparison of the Effi cacy of Closure Techniques for Large Colon Perforation in an Established Experimental Simulation Model
Dong Hyun In1, Yun Ho Jung1, Ho Sung Rhee1, Baek Gyu Jun1, Il Kwun Chung1, Young Sin Cho1, Tae Hoon Lee1, Sang Heum Park1, Sun Joo Kim1
Soon Chun Hyang University Hospital Cheonan, Korea1
Background/Aims: Early recognition of perforation and rapid closure of mucosal defect can prevent peritonitis and surgery by mineralization of the egress of luminal contents. Therefore, the aim of this study was to evaluate the efficacy of closure techniques for large colon perforation.
Methods: This study was designed as a prospective, controlled, and ex-vivo study.
A total of 30 standardized defects measuring 3 cm were created approximately 10 cm from anal verge in fresh ex vivo porcine colorectal specimens using the simulator platform. An experienced endoscopist performed the three closure techniques such as endoclip closure technique (Endoclip group), loop and clip technique (Endoloop group) and OTSC closure technique (OTSC group).
Results: In Endoclip group, the mean total procedure time was 14.2 ± 6.9 minutes and mean number of spending endoclips (90 degree, long, Olympus Optical Co., Tokyo, Japan) were 7.0 ± 2.1. Complete closure rate was 50% (5/10, three for leak detection and two for closure failure). In Endoloop group, the mean total procedure time was 12.5 ± 5.9 minutes and mean number of spending endoclips with an endoloop (Olympus Optical Co., Tokyo, Japan) were 6.4 ± 1.5. Complete closure rate was 40% (4/10, fi ve for leak detection and one for closure failure). In OTSC group, the mean procedure time was 2.8 ± 1.8 minutes and mean number of spending endoclips with an OTSC clip were 0.7 ± 0.8. Complete closure rate was 70% (7/10, three for leak detection). The mean total procedure time of OTSC group was signifi cantly shorter than Endoclip and Endoloop group (p<0.001).
Conclusion: OTSC with enclipping method seems to be safe and faster for large colon perforation in ex-vivo setting. Further large and clinical trial needed for proving this result.
PS 1083 Gastroenterology (Gastrointestinal Tract) The Case of Intestinal Tuberculosis Mimicking Crohn’s or Intestinal Behcet’s Disease
Wang Yong Choi1, Kyung Sik Park1, Eun Soo Kim1, Kwang Bum Cho1 Keimyung University Dongsan Medical Center, Korea1
According to the World Health Organization in 2013, South Korea is classifi ed as the country having intermediate burden of tuberculosis (TB) infection. It is a great chal- lenge for the clinicians to differentiate correctly intestinal TB from Crohn’s disease or intestinal Behcet’s disease since clinical manifestations and endoscopic appearances are very similar among these diseases. We recently experienced an interesting case, fi nally confi rmed as intestinal TB, whose endoscopic features were very typical for those of intestinal Behcet’s disease or Crohn’s disease. A 43 year-old male visited our hospital for recurrent abdominal pain for 3 months. He complained of diarrhea 5 times a day and 4 kg body weight loss. His colonoscopic findings showed a single huge round-shaped deep ulcer with discrete margin located at IC valve. Abdominal CT scan revealed that the lesions were extended up to the proximal ileum, which suggested Crohn’s disease more likely. He denied systemic characteristics of Behcet’s disease such as oral/genital ulcers, uveitis, and erythema nodosum. There was no evidence of TB in forceps biopsy specimen with TB PCR and culture. We prescribed oral steroid for induction, then 5-ASA and azathiopurine were administered as a maintenance therapy. Although there was a clinical response to oral steroid initially, patient’s symp- toms went wax and wane. He sustained of dyspnea during follow up period and his chest X-ray and CT scan showed right side pleural effusion. Fluid analysis revealed TB pleurisy. After 6 months of anti-TB medication, his abdominal symptoms were found to improve signifi cantly. Colonoscopy conducted in 3 months after complete anti-TB treatment also showed a clear resolution of intestinal ulcer lesions. Here, we report an intestinal TB case mimicking intestinal Behcet’s disease or Crohn’s disease.
The Korean Association of Internal Medicine
262 32nd World Congress of Internal Medicine (October 24-28, 2014) PS 1084 Gastroenterology (Gastrointestinal Tract) Risk Factors for Colonoscopic Polypectomy Bleeding
Kyungmo Yoo1, Dongil Park1 Kangbuk Samsung Hospital, Korea1
Background: Post polypectomy bleeding is the most frequent complication after co- lonoscopic polypectomy. The aim of this study was to investigate the incidence of PPB and its associated risk factors.
Methods: This study included 7,944 colonoscopic polypectomies conducted on 2,401 patients between May 2013 and March 2014. Patient condition, polyp characteristics, and procedure techniques were evaluated as potential risk factors for PPB. PPB was classifi ed as overall or signifi cant bleeding. Immediate-type (24h – 30days) bleeding were also assessed.
Results: Of the 2,401 patients, 98 developed PPB overall, and 41 patients developed signifi cant PPB. Multivariate logistic regression analysis revealed risk factors for both overall and signifi cant PPB to be the number of resected polyps (overall: OR 1.08, 95%
C.I 1.02 – 1.14; signifi cant: OR 1.11, 95% C.I 1.03 – 1.20), intraprocedural bleeding (overall: OR 2.80, 95% C.I 1.62– 4.84; signifi cant: OR 2.49, 95% C.I 1.03 – 5.99), and the use of antiplatelet agents (overall: OR 2.53, 95% C.I 1.33 – 4.82; signifi cant: OR 2.72, 95% C.I 1.04– 7.17). Polyp size was associated with overall PPB (OR 1.03, 95%
C.I 1.00 – 1.05) but was not associated with signifi cant PPB (OR 1.02, C.I 0.98 – 1.05).
Immediate-type PPB showed a similar association, but delayed-type PPB was not as- sociated with any of the studied risk factors.
Conclusions: Polyp size, number of resected polyps, intraprocedural bleeding and the use of antiplatelet agents were found to be independent risk factors for PPB.
PS 1085 Gastroenterology (Gastrointestinal Tract) A Case of Intestinal Amyloidosis in Multiple Myeloma Appeared as Ischemic Colitis
Jaehyuck Jun1, Hyunil Seo1, Yanghee Han1, Junsung Kwon1, JongKyu Park1, Sangjin Lee1, Koonhee Han1
Gangneung Asan Hospital, Korea1
Introduction: Amyloidosis is a group of diseases caused by abnormal deposition of insoluble amyloid fi brils in various tissues of the body. Diagnosis of gastrointestinal amyloidosis is difficult by reason of various symptoms and nonspecific endoscopic fi ndings. Here, we report a case of small and large intestine amyloidosis in multiple myeloma appeared as ischemic colitis.
Case Report: A 67-year-old female was admitted due to hematochezia with ab- dominal pain. Immediate lower gastrointestinal endoscopy was done and showed necrotic colonic mucosa on transverse colon (Fig.1 A). Contrast-enhanced computed tomography revealed ischemic colitis with intramural hematoma (Fig.1 B). Thus,she had emergency right hemicolectomy for necrotizing ischemic colitis. After operation, she took ordinary postoperative care and discharged.After 1 month, she was admitted again due to abdominal pain and melena. There was no evidence of bleeding on upper gastrointestinal endoscopy. Lower gastrointestinal endoscopy revealed multiple ulcer of various size and shape in distal ileum and biopsy was done (Fig.1 C). Histopatho- logic exam exhibited green birefringence under polarized light microscopy (Fig.1 D).
Therefore we could diagnose ileal amyloidosis. We reviewed surgically resected colonic tissue and had same result. Additional test, serum and urine protein electrophoresis, provided clues to multiple myeloma. Subseqent bone marrow biopsy confi rmed multi- ple myeloma. Finally, we diagnosed intestinal amyloidosis in multiple myeloma which presented as necrotizing ischemic colitis. She took chemotherapy for multiple myelo- ma in oncology and has improved gradually until now 18 month after diagnosis.
Conclusion: We report a case of a small and large intestinal amyloidosis fi rst pre- sented with hematochezia and abdominal pain as typical ischemic colitis and showed necrotizing ischemic colitis in endoscopy. Gastroenterologist and endoscopist have to be aware of possibility of intestinal amyloidosis in case of ischemic colitis.
Key word: Amyloidosis, Ischemic colitis, Hematochezia, Endoscopy.
