Jung Whan Lee

3482 Endoscopic removal of impacted sharp foreign body in esophagus.

Background/Aims: Sharp impacted esophageal foreign bodies can be very difficult to manage. When attempting to remove such objects inappropriately, life threatening complications, such as perforation can occur. Therefore, surgical intervention generally affords a safer approach. The aim of this study is to evaluate the safety and efficacy of endoscopic removal of impacted sharp esophageal foreign bodies using dilation method with oral side balloon. Methods: Total of 17 patients(Male 6, Female 11) with impacted sharp esophageal foreign bodies underwent endoscopic extraction. The following technique was successfully performed at our hospital(Figure A,B). Oral side balloon(Top Co. Japan) for esophageal variceal sclerotherapy was attached on the distal part of endoscope. Under local anesthesia, endoscope was inserted near the proximal part of the esophageal foreign body. Then, oral side balloon was gradually dilated. Dilataion of proximal part of esophagus made it possible to release the impacted sharp foreign body from the esophageal wall. Results: The types of foreign bodies were fish bones(10 case), and press-through packages(7 cases). Endoscopic removal was successful in all 17 cases without complications such as perforation. Conclusion: This method using oral side balloon is safe and effective in removing impacted sharp esophageal foreign bodies avoiding surgery and possible perforation.

6966 Histopathologic analysis and clinical significance of small colorectal adenomas.

Background & aim : Most colorectal cancers are believed to arise from adenoma, and it is believed that the colorectal cancer can be prevented by colonoscopic removal of the adenoma. The risk of a adenoma becoming cancerous increases with its size, but the histopathologic analysis and clinical significance of dysplasia and malignant change in small colorectal adenomas have been wide variations amomg populations. This study aimed to evaluate the clinicopathologic characteristics of the small colorectal adenomas in the Koreans. Methods : From 1215 patients, who had colonoscopy at our center between 1991 through 1999, 1742 polyps were obtained and analyzed. All enrolled patients were confirmed to have adenomatous polyps histologically and with available medical records. Small adenomas were defined as adenomas measured less than 10mm in diameter. These were categorized into two groups ; less than 5mm and 6-10mm. Results : The number of patients with small colorectal adenomas were 1100(770 men and 330 women, mean age 52.2 ± 11.7 years) and total of 1280 small colorectal adenomas were analyzed. 68% was solitary small adenomas, and 32% was multiple ; the number of small adenomas sized less than 5mm was 941(61%), that of 6 to 10mm was 592(39%), and 55% of small adenomas were located in rectosigmoid. Moderate to severe dysplasia of small adenomas were found in 233(15%) and carcinoma in situ in 30(2%)(Table). Conclusion : Moderate to severe dysplasia of small colorectal adenomas were found in 15% and carcinoma in situ in 2%.

3407 Analysis of advanced proximal colonic neoplasia without index polyp in the rectosigmoid.

Background & aim : Colorectal adenoma is known as a precursor of colon cancer. Current recommendation is to perform total colonoscopy whenever any adenoma is detected during screening sigmoidoscopy. Most previous studies which did focus their interest on proximal advanced lesions only used total colonoscopy in case with index polyp in the rectosigmoid. The aim of this study was to evaluate the frequency of the colonic neoplasia above the rectosigmoid without an index polyp in our colonoscopy population. Methods : Colonoscopic and histologic data were analyzed from all patients on whom total colonoscopy was performed between 1995 and 1999 in Anam hospital of Korea university medical center. Advanced neoplasia was defined as cancer or adenoma>10mm in diameter, adenoma with villous component, or high grade dysplasia. Patients with polyposis syndrome, inflammatory bowel disease, previous colorectal neoplasia were excluded. Results : Total colonoscopy was performed on 6672 patients. 573 patients(Male 392 Female 181, Mean age 54.3 years) had at least one colorectal neoplasm of which 48 percent had neoplasm above rectosigmoid. The analysis of patients with proximal colonic neoplasia without an rectosigmoidal adenoma were summerized in table. Conclusion : Thirty-five percent of all patients with neoplasia had no index polyp in the rectosigmoid and 12 percent of these had at least one advanced proximal neoplasm without index polyp.

Dose the Gabexate mesilate (FOY) protect against ERCP-related pancreatic damage?

Backgrou nds and Aim: Recent studies have been reported that prophylact ic treatment with 19 of Gabexate mesi late (GM) is effective in preventing ERCP-related pancreatic damage. However, there are some debates for its low cost-effectiveness in application of Ig of GM in all patients undergoing ERCP. Furthermore, it has not been established whether the effect of GM in preventing ERCPrelated pancreatic damage is dosedependent. The aim of this study was to evaluate the effectiveness of low dose of GM for preventing ERCP-related pancreatic damage. Methods: Th is study was performed prospectively with consec utive 102 patients (68 for GM group, 34 for placebo group) who were sched uled for ERCP due to various reasons . Infusion of GM (500 mg) was started 30 minutes before ERCP and continued for 12 hours afterward. The control group was given normal saline alone as same methods. The serum amylase and lipase were measured before ERCP and 4, 8, and 24 hours after ERCP . Hyperenz ymemi a was defined as elevation of serum amylase and/or lipase above upper norma l limit within 24 hours after ERCP. The ERCP-related pancreatiti s was defined as abdominal pain with elevation of serum amylase and/or lipase more than 3 times the upper norma l limit. Incidence of hypcren zymemia and pancreatitis, and mean changes of serum amylase and lipase levels were analyzed between two groups according to the various parameters, such as difficulty of duct cannulation, visualization of pancreatic duct, performance of therapeut ic procedures and total procedure time. Resu lts: The overall incidence of ERCP-related hyperenzymemia was not statis tically reduced by GM treatment (45.6% in GM group, 55.9% in con trol group) . Overall incidence of acute pancreatitis was low (1.0%) in our series. and did not affect by GM treatment. Difficulty of duct cannulation, visualization of pancreatic duct, performa nce of therapeutic procedures and total procedure time were associated with increased incidence of hyperenzyme mia. However, GM treatment did not reduce hyperenzymemia under the various conditio ns. Concl usion: Prophylactic treatment with 500 mg of GM has no advantage for the prevention of ERCP-related pancreatic damage. This suggests that the effec t of prophylactic treatment with GM is dose-dependent. Conside ring cost-effectiveness. further randomized studies are needed in determining the selective indications for prophylactic treatment with expensive high dose of GM.