Clinical course of subepithelial lesions detected on upper gastrointestinal endoscopy

AIM:To evaluate the natural history of subepithelial lesions.METHODS:We reviewed the medical records of 104 159 patients who underwent upper gastrointestinal endoscopy at the Center for Health Promotion of Samsung Medical Center between 1996 and 2003.Subepithelial lesions were detected in 795 patients(0.76%);252 patients were followed using upper gastrointestinal endoscopy for 82.5 ± 29.2 mo(range,12-160 mo;median,84 mo;1st quartile,60 mo;3rd quartile,105 mo).The median interval of follow-up endoscopy was 12 mo(range,6-105 mo;1st quartile,12 mo;3rd quartile,24 mo).RESULTS:The mean patient age was 53 years(range,22-80 years),and the male-to-female ratio was 2.36:1(177/75).The lesion size at initial measurement averaged 8.9 mm(range,2-25 mm;median,8 mm;1st quartile,5 mm;3rd quartile,10 mm).Of the 252 lesions,244(96.8%) were unchanged and 8(3.2%) were significantly increased in size(from 12.9 ± 6.0 to 21.2 ± 12.2 mm) after a mean interval of 59.1 ± 27.5 mo(range,12-86 mo).Surgical resection of lesions was performed when the lesions were ≥ 3 cm in diameter.Two lesions were diagnosed as gastrointestinal stromal tumors with an intermediate or high risk of malignancy and one lesion was classified as a schwannoma.CONCLUSION:Most small subepithelial lesions do not change as shown by endoscopic examination,and regular follow-up with endoscopy may be considered in small,subepithelial lesions,especially lesions < 1 cm in size.

Procedure-related musculoskeletal symptoms in gastrointestinal endoscopists in Korea

AIM: To determine the prevalence and risk factors of work-related musculoskeletal disorders in gastrointestinal endoscopists in Korea. METHODS: A survey of musculoskeletal symptoms, using a self-administered questionnaire, was conducted on 55 endoscopists practicing in general hospitals or health promotion centers. RESULTS: Forty-nine (89.1%) endoscopists reported musculoskeletal pain on at least one anatomic location and 37 (67.3%) endoscopists complained of pain at rest. Twenty-six (47.3%) endoscopists had severe musculoskeletal pain defined as a visual analogue score greater than 5.5. Factors related to the development of severe pain were (1) standing position during upper endoscopy, (2) specific posture/ habit during endoscopic procedures, and (3) multiple symptomatic areas. Finger pain was more common in beginners, whereas shoulder pain was more common in experienced endoscopists. Sixteen percent of symptomatic endoscopists have modified their practice or reduced the number of endoscopic examinations. Only a few symptomatic endoscopists had sought professional consultation with related specialists. CONCLUSION: The prevalence of musculoskeletal pain in endoscopists is very high. The location of pain was different between beginners and experienced endoscopists. Measures for the prevention and adequate management of endoscopy-related musculoskeletal symptoms are necessary.

Seroprevalence of anti-HAV among patients with chronic viral liver disease

AIM:To investigate the current seroprevalence of hepatitis A virus(HAV) antibodies in patients with chronic viral liver disease in Korea.We also tried to identify the factors affecting the prevalence of HAV antibodies. METHODS:We performed an analysis of the clinical records of 986 patients(mean age:49±9 years,714 males/272 females) with chronic hepatitis B virus(HBV) or hepatitis C virus(HCV) infection who had undergone HAV antibody testing between January 2008 and December 2009.RESULTS:The overall prevalence of IgG anti-HAV was 86.61%(854/986) in patients with chronic liver disease and was 88.13%(869/986) in age-and gendermatched patients from the Center for Health Promotion.The anti-HAV prevalence was 80.04%(405/506) in patients with chronic hepatitis B,86.96%(20/23) in patients with chronic hepatitis C,93.78%(422/450) in patients with HBV related liver cirrhosis,and 100%(7/7) in patients with HCV related liver cirrhosis.The anti-HAV prevalence according to the decade of age was as follows:20s(6.67%) ,30s(50.86%) ,40s(92.29%) ,50s(97.77%) ,and 60s(100%) .The antiHAV prevalence was significantly higher in patients older than 40 years compared with that in patients younger than 40 years of age.Multivariable analysis showed that age≥40 years,female gender and metropolitan cities as the place of residence were independent risk factors for IgG anti-HAV seropositivity. CONCLUSION:Most Korean patients with chronic liver disease and who are above 40 years of age have already been exposed to hepatitis A virus.

Unexpected anterograde amnesia associated with Buscopan used as a predmedication for endocscopy

It has been known that peripheral adverse event is caused by peripheral antimuscarinic action, from hyoscine butylbromide (Buscopan; Boehringer Ingelheim, Germany) used as a premedication for endoscopy. However, symptoms or signs associated with the central nervous system are rarely reported in the field of anesthesiology and peripartum labor. This central anticholinergic syndrome is likely caused by blockade of muscarinic cholinergic receptors in the central nervous system. There is no report on Buscopan-induced central anticholinergic syndrome in endoscopy room so far. Three middle-aged females unexpectedly suffered from anterograde amnesia after intramuscular injection of hyoscine butylbromide as an antispasmodic premedication for endoscopy at our endoscopy unit in the Health Promotion Center.