Journal of Yeungnam Medical Science

Original article

Comparison of small bowel findings using capsule endoscopy between Crohn’s disease and intestinal tuberculosis in Korea: Yong Gil Kim, Kyung-Jo Kim, Young-Ki Min; Yeungnam Univ J Med. 2020;37(2):98-105. Published online November 22, 2019; DOI: https://doi.org/10.12701/yujm.2019.00374

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Background
Little is known about capsule endoscopy (CE) findings in patients with intestinal tuberculosis who exhibit small bowel lesions. The aim of the present study was to distinguish between Crohn’s disease (CD) and intestinal tuberculosis based on CE findings.
Methods
Findings from 55 patients, who underwent CE using PillCam SB CE (Given Imaging, Yoqneam, Israel) between February 2003 and June 2015, were retrospectively analyzed.
Results
CE revealed small bowel lesions in 35 of the 55 patients: 19 with CD and 16 with intestinal tuberculosis. The median age at diagnosis for patients with CD was 26 years and 36 years for those with intestinal tuberculosis. On CE, three parameters, ≥10 ulcers, >3 involved segments and aphthous ulcers, were more common in patients with CD than in those intestinal tuberculosis. Cobblestoning was observed in five patients with CD and in none with intestinal tuberculosis. The authors hypothesized that a diagnosis of small bowel CD could be made when the number of parameters in CD patients was higher than that for intestinal tuberculosis. The authors calculated that the diagnosis of either CD or intestinal tuberculosis would have been made in 34 of the 35 patients (97%).
Conclusion
The number of ulcers and involved segments, and the presence of aphthous ulcers, were significantly higher and more common, respectively, in patients with CD than in those with intestinal tuberculosis. Cobblestoning in the small bowel may highly favor a diagnosis of CD on CE.

Citations

Citations to this article as recorded by

Deep Learning Radiomics Analysis of CT Imaging for Differentiating Between Crohn’s Disease and Intestinal Tuberculosis
Ming Cheng, Hanyue Zhang, Wenpeng Huang, Fei Li, Jianbo Gao
Journal of Imaging Informatics in Medicine.2024; 37(4): 1516. CrossRef
Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review
Arup Choudhury, Jasdeep Dhillon, Aravind Sekar, Pankaj Gupta, Harjeet Singh, Vishal Sharma
BMC Gastroenterology.2023;[Epub] CrossRef
Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease
M. N. Reshetnikov, D. V. Plotkin, Yu. R. Zyuzya, A. A. Volkov, O. N. Zuban, E. M. Bogorodskaya
Acta Biomedica Scientifica.2021; 6(5): 196. CrossRef
Differentiating intestinal tuberculosis and Crohn disease: Quo Vadis
Vishal Sharma
Expert Review of Gastroenterology & Hepatology.2020; 14(8): 647. CrossRef

Review article

Endoscopic features aiding the diagnosis of gastric mucosa-associated lymphoid tissue lymphoma: Byung Sam Park, Si Hyung Lee; Yeungnam Univ J Med. 2019;36(2):85-91. Published online February 26, 2019; DOI: https://doi.org/10.12701/yujm.2019.00136

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Abstract PDF

The incidence of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is increasing worldwide, but the diagnosis is difficult. Most patients are asymptomatic or complain of nonspecific gastrointestinal symptoms. As the endoscopic features of gastric MALT lymphoma are variable and nonspecific, the possibility of this condition may be overlooked during esophagogastroduodenoscopy, and it remain undiagnosed. Therefore, this condition needs to be considered when an abnormal mucosa is observed during this procedure. Biopsy performed during endoscopy is the primary diagnostic test, but false negative results are possible; large numbers of samples should be collected from both normal and abnormal mucosae. Endoscopic ultrasonography is useful to assess the depth of invasion and to predict the treatment response. After treatment, follow-up tests are required every 3 months until complete remission is achieved, and annually thereafter. Early diagnosis of gastric MALT lymphoma is difficult, and its diagnosis and follow-up require wide experience and competent endoscopic technique.

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Mohamed Zayati, Mohamed Ali Chaouch, Ahmed Hadj Taieb, Besma Gafsi, Mehdi Ben Abdelwahed, Faouzi Noomen
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Development and evaluation of a double-check support system using artificial intelligence in endoscopic screening for gastric cancer
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Case Reports

A Case of Huge Gastric Bezoar Removed by Endoscopic Combination Therapy with Coca-Cola Injection.: Min Suk Jung, Jang Won Lee, Seung Hyun Lee, Dong Hyun Kim, Sang Hwan Byun, Yeong Muk Kim; Yeungnam Univ J Med. 2013;30(1):62-65. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.62

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Abstract PDF

Gastric bezoars are concretion of undigested material in the gastrointestinal tract. In the past, gastric bezoars were generally treated with surgical management. Recently, the efficacy of oral intake or endoscopic injection therapy with Coca-Cola has been reported. We report a case of a 47-year-old-man with huge gastric bezoar (4x2.5 cm) that was successfully removed by endoscopic fragmentation with Coca-Cola injection. Compared with a single endoscopic fragmentation therapy, the combination therapy with Coca-Cola injection shortened the procedure time and reduced the complication associated with fragmented bezoar.

Citations

Citations to this article as recorded by

Successful removal of a foreign body by endoscopic balloon dilatation at the colonic stricture
Chang Jo Im, Ji Hoon Na, Hyun Sik Kim, Sung Sam Ha, Yoo Li Lim, Ji Hyeon Lee, Hee Kyoung Choi, Hee Man Kim
Yeungnam University Journal of Medicine.2016; 33(1): 29. CrossRef

A Case of Duodenal Brunner's Gland Adenoma Treated by Endoscopic Rescetion.: Sung Joon Kim, Min Geun Gu, Jun Suk Park, Kyeong Ok Kim, Si Hyung Lee, Tae Nyeun Kim, Jun Hyuk Choi; Yeungnam Univ J Med. 2011;28(1):84-89. Published online June 30, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.1.84

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Abstract PDF

Brunneroma, also known as Brunner's gland adenoma or harmatoma, is a very rare benign tumor of the duodenum, which is usually asymptomatic, and is discovered incidentally during endoscopic exam. These lesions are most commonly located in the duodenal bulb and clinical manifestations are variable. We report on a case of a large Brunner's gland adenoma in a 54-year-old man, which was successfully removed by endoscopic resection without complications, such as bleeding or perforation. Microscopically, it was composed entirely of variable Brunner's gland.

Citations

Citations to this article as recorded by

Solitary schwannoma of the ascending colon
Myeong Su Chu, Hyun Mo Kang, Hyeong Ju Sun, Dong Min Kim, Hyong Jong Kwak
Yeungnam University Journal of Medicine.2016; 33(1): 37. CrossRef

Original Article

A Case of Gastric Bezoar Causing Ileal Obstruction During Treatment with Coca-Cola: Jun Young Lee, Sung Bum Kim, Sang Hoon Lee, Hee Jung Moon, Jong Ryul Eun, Tae Nyeun Kim, Byung Ik Jang; Yeungnam Univ J Med. 2007;24(2 Suppl):S683-688. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S683

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Abstract PDF

Gastric bezoars are usually occur in patients who have undergone gastric surgery and have delayed gastric emptying. Recently, the efficacy of nasogastric lavage or endoscopic injection therapy with Coca-Cola has been reported. But the complication like intestinal obstruction has poorly been reported. We report a case of gastric bezoar causing ileal obstruction during treatment with oral administration and endoscopic injection of Coca-Cola. A 53-year-old man was referred because of epigastric pain for a day. He had a history of subtotal gastrectomy with gastroduodenostomy since 8 years ago. On upper gastrointestinal endoscopy, about 6cm sized, dark-greenish hard bezoar was impacted at gastric antrum and about 3-5cm sized three bezoars were found at body. We injected Coca-Cola into the bezoar through the endoscopy and the patient was instructed to drink four liters of Coca-Cola per day. On the 12^th day of admission, the patient complained severe abdominal pain. On plain abdominal X-ray and CT scan, small bowel obstruction at proximal ileum with bezoar was suspected and exploration was performed. About 4cm sized two bezoars were impacted at proximal ileum, and small bowel resection with primary closure after removal of bezoar was performed. The patient was discharged on the 10th postoperative day without any complication.

Citations

Citations to this article as recorded by

A Case of Huge Gastric Bezoar Removed by Endoscopic Combination Therapy with Coca-Cola Injection
Min Suk Jung, Jang Won Lee, Seung Hyun Lee, Dong Hyun Kim, Sang Hwan Byun, Yeong Muk Kim
Yeungnam University Journal of Medicine.2013; 30(1): 62. CrossRef

Case Report

Gastric Phytobezoar Treated by Oral Intake and Endoscopic Injection of Coca-Cola.: Hee Jung Moon, Sang Hoon Lee, Jun Young Lee, Dong Hee Kim, Ji Eun Lee, Chang Hun Yang, Jong Ryul Eun, Tae Nyeun Kim, Heon Ju Lee, Byung Ik Jang; Yeungnam Univ J Med. 2006;23(2):247-251. Published online December 31, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.2.247

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Abstract PDF

Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract; they usually occur in patients who have undergone gastric surgery and have delayed gastric emptying. Treatment options include dissolution with enzymes, endoscopic fragmentation with removal or aspiration, and surgery. Recently, the efficacy of nasogastric lavage or endoscopic infusion of Coca-Cola for the dissolution of phytobezoar have been reported. We report a case of phytobezoar successfully treated by oral administration and endoscopic injection of Coca-Cola. A 62-year-old woman was referred to Yeungnam University Hospital for epigastric pain. Upper gastrointestinal endoscopy revealed one very large, dark-greenish, solid bezoar in the stomach with gastric ulcer and duodenal bulb deformity. We performed endoscopic injection of Coca-Cola into the bezoar. The patient was instructed to drink four liters of Coca-Cola per day. At endoscopy two days later, the phytobezoar was easily broken into pieces. At endoscopy on the 11th day of admission, the phytobezoar was decreased in size and removed by endoscopic fragmentation with a polypectomy snare. At follow up endoscopy after 13 days, the bezoar was completely dissolved.

Citations

Citations to this article as recorded by

Systematic review: Coca‐Cola can effectively dissolve gastric phytobezoars as a first‐line treatment
S. D. Ladas, D. Kamberoglou, G. Karamanolis, J. Vlachogiannakos, I. Zouboulis‐Vafiadis
Alimentary Pharmacology & Therapeutics.2013; 37(2): 169. CrossRef

Original Article

The Usefulness of Capsule Endoscopy in Diagnosis of Small Bowel Diseases.: Jong Ryul Eun, Byung Ik Jang; Yeungnam Univ J Med. 2006;23(1):45-51. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.45

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Abstract PDF: BACKGROUND
This study was conducted to evaluate the usefulness of capsule endoscopy (CE) for the diagnosis of small bowel diseases. MATERILAS AND METHODS: We reviewed the medical records of 66 patients (mean age: 52.1 years, male/female: 39/27), who underwent CE at Yeungnam University Hospital from August 2003 to March 2006. RESULTS: Suspicious gastrointestinal (GI) bleeding presenting as anemia or history of gross bleeding was the most common reason to perform CE (71.2%). Other indications included GI symptoms (21.2%) such as abdominal pain/discomfort, nausea, diarrhea, and others (7.6%). In studies performed for GI bleeding (n=47), ulcer/erosion was the most common finding (n=22, 46.8%) followed by tumor (n=5, 10.6%), angiodysplasia (n=3, 6.4%), polyp (n=3, 6.4%), active bleeding (n=1, 2.1 %), ulcer with stenosis (n=1, 2.1%), and normal findings (n=12, 25.5%). Of these, a bleeding focus was detected in 32 cases (68.1%) undergoing CE studies. Among 14 patients with GI symptoms, only two patients had typical findings related with symptoms. Surgical resection was performed in five cases with tumor. Of these, four were diagnosed as gastrointestinal stromal tumor and the other one was a lymphangioma. There were no complications associated with the CE procedure. CONCLUSION: Capsule endoscopy is a safe, noninvasive diagnostic tool for small bowel diseases and may be useful for the diagnosis of small bowel hemorrhage including obscure bleeding. However, further studies are needed to confirm its utility for abdominal symptoms other than hemorrhage because of the low diagnostic yield.

Case Report

Two Cases of Jejunal Gastrointestinal Stromal Tumor Diagnosed by Capsule Endoscope.: Jae Won Choi, Ji Eun Lee, Byung Ik Jang, Tae Nyeun Kim, Sun Kyo Song, Young Kyong Bae; Yeungnam Univ J Med. 2006;23(1):131-137. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.131

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Abstract PDF: Small bowel tumors have been difficult to diagnose because of low incidence and absence of specific symptoms. There are no efficient and accurate tests available for diagnosis. Capsule endoscopy is an efficient diagnostic tool for small bowel disease and obscure gastrointestinal bleeding. We diagnosed two cases of small bowel gastrointestinal stromal tumor (GIST) diagnosed by capsule endoscopy that were treated by surgery. A 68 year old male presented with abdominal pain. The capsule endoscopy showed fungating ulcer mass at the jejunum. A 55 year female presented with melena. The capsule endoscopy showed an intraluminal protruding mass with a superficial ulcer at the jejunum. Two cases were diagnosed with GIST after surgery. We report these two case diagnosed by capsule endoscopy and review the medical literature.

Original Article

Foreign Body in the Gastrointestinal Tract in Children.: Bo Hyeong Lee, Hyun Kyung Lee, Mi Jung Kim, Kwang Hae Choi; Yeungnam Univ J Med. 2001;18(1):75-84. Published online June 30, 2001; DOI: https://doi.org/10.12701/yujm.2001.18.1.75

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Abstract PDF: BACKGROUND
The accidental swallowing of foreign body is a common problem in the children. Ingested foreign bodies may be managed by endoscopy, observation, or surgery. So we analyzed the methods of removal, type, location and complications of foreign bodies. MATERIALS AND METHODS: This report reviewed 37 cases of ingested foreign body in the gastrointestinal tract at the Department of Pediatrics, Yeungnam University Hospital between January 1997 and April 2001. RESULTS: The age ranged from 8 months to 8 years. The most prevalent age group was between 1 year and 2 years of age(19%). The male to female ratio was 2.1:1 with 25 male and 12 female patients. The type of foreign bodies were coins in 20 cases(54%), nail in 4 cases(11%), key in 4 cases(11%), pin in 2 cases(5.5%), necklace in 2 cases(5.5%) and others. The locations of foreign bodies were upper esophagus in 12 cases(32.5%), lower esophagus in 4 cases(10.8%), stomach in 16 cases(43.2%), small bowel in 5 cases(13.5%). 4. Presenting symptoms were variable with asymptomatic (59. 4%) , vomiting (19. 0%) , epigastric pain (8.1%), dysphagia (5. 4%) and others. The methods for removal of foreign bodies included 20 cases of endoscopic removal(54.0%), 3 cases of spontaneous removal(8.1%) and there was no surgical removal. 14 cases(37.9%) did not confirmed removal of foreign body because of no revisit of our hospital. Endoscopic finding of patients were normal(15 cases), ulceration(2 cases), erosion(1 case), inflammation(l case), mucosal scratch(l case). CONCLUSION: It appears that the endoscopic approach is the preferable method for the removal of upper gastrointestinal foreign bodies in the children.

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