Endoscopic retrograde cholangiopancreatography(ERCP) has become the mainstay of treatment in hepato-pancreato-biliary disease. However, ERCP requires a high level of technical skills and experience in therapeutic endo...Endoscopic retrograde cholangiopancreatography(ERCP) has become the mainstay of treatment in hepato-pancreato-biliary disease. However, ERCP requires a high level of technical skills and experience in therapeutic endoscopy, there is always a risk of complications. Especially, the perforation per se affects the patient adversely, and the clinical course may lead to a poor prognosis, even with appropriate management. The treatments for ERCPrelated perforation are diverse, depending on the location and mechanism of the bowel perforation and the time of diagnosis. Thus, we reviewed the appropriate surgical and non-surgical management options for therapeutic ERCP-related perforations, especially, evaluating metallic stenting as a treatment modality in perivaterian perforation.展开更多
The high incidence of gastric cancer has led to the initiation of cancer screening programs.As a result,the number of early gastric cancer cases has increased and consequentially,the cancer mortality rate has decrease...The high incidence of gastric cancer has led to the initiation of cancer screening programs.As a result,the number of early gastric cancer cases has increased and consequentially,the cancer mortality rate has decreased.Moreover,the development of minimally invasive endoscopic treatment has been introduced for these early lesions.Endoscopic submucosal dissection(ESD) is now recognized as one of the preferred treatment modalities for premalignant gastrointestinal epithelial lesions and early gastric cancer without lymph node metastasis.We review the results of ESD including experiences in Japan and Korea,as well as western countries.展开更多
AIM To investigate histologic abnormalities in the gastric smooth muscle of patients with diabetes mellitus(DM).METHODS Full-thickness gastric specimens were obtained from patients undergoing surgery for gastric cance...AIM To investigate histologic abnormalities in the gastric smooth muscle of patients with diabetes mellitus(DM).METHODS Full-thickness gastric specimens were obtained from patients undergoing surgery for gastric cancer. H&E stain and Masson's Trichrome stain were performed to assess the degree of fibrosis. Immunohistochemical staining using various antibodies was also performed [antibodies against protein gene product 9.5(PGP9.5), neuronal nitric oxide synthase(n NOS), vasoactive intestinal peptide(VIP), neurokinin-1(NK1) receptor, c-Kit, and platelet-derived growth factor receptor-alpha,(PDGFRα)]. Immunofluorescent staining and evaluation with confocal microscopy were also conducted.RESULTS Twenty-six controls and 35 diabetic patients(21 shortduration patients and 14 long-duration patients) were included. There were no significant differences in basic demographics between the two groups except in mean body mass index(BMI)(higher in the DM group). Proportions of moderate-to-severe intercellular fibrosis in the muscle layer were significantly higher in the DM group than in the control group(P < 0.01). On immunohistochemical staining, c-Kit- and PDGFRα-positive immunoreactivity were significantly decreased in the DM group compared with the control group(P < 0.05). There were no statistically significant differences in PGP9.5, n NOS, VIP, and neurokinin 1 expression. On immunofluorescent staining, cellularity of interstitial cells of Cajal(ICC) was observed to decrease with increasing duration of DM.CONCLUSION Our study suggests that increased intercellular fibrosis, loss of ICC, and loss of fibroblast-like cells are found in the smooth muscle of DM patients. These abnormalities may contribute to changes in gastric motor activity in patients with DM.展开更多
AIM: To investigate factors related to recurrence following en bloc resection using endoscopic submucosal dissection(ESD) in patients with early gastric cancer(EGC). METHODS: A total of 1121 patients(1215 lesions) who...AIM: To investigate factors related to recurrence following en bloc resection using endoscopic submucosal dissection(ESD) in patients with early gastric cancer(EGC). METHODS: A total of 1121 patients(1215 lesions) who had undergone ESD for gastric neoplasia between April 2003 and May 2010 were retrospectively reviewed. Data from 401 patients(415 lesions) were analyzed, following the exclusion of those who underwent piecemeal resection, with deep resection margin invasion or lateral margin infiltration, and diagnosed with benign lesions. RESULTS: Local recurrence after en bloc ESD was found in 36 cases(8.7%). Unclear resection margins, long procedure times, and narrow safety margins were identified as risk factors for recurrence. Lesions located in the upper third of the stomach showed a higher rate of recurrence than those located in the lower third of the stomach(OR = 2.9, P = 0.03). The probability of no recurrence for up to 24 mo was 79.9% in those with a safety resection margin ≤ 1 mm and 89.5% in those with a margin > 1 mm(log-rank test, P = 0.03). CONCLUSION: Even in cases in which en bloc ESD is performed for EGC, local recurrence still occurs. To reduce local recurrences, more careful assessment will be needed prior to the implementation of ESD in casesin which the tumor is located in the upper third of the stomach. In addition, clear identification of tumor boundaries as well as the securing of sufficient safety resection margins will be important.展开更多
AIM:To evaluate the incidence and risk factors of Korean tuberculosis(TB) infection in patients with inflammatory bowel disease(IBD) undergoing anti-TNF treatment.METHODS:The data of IBD patients treated with anti-TNF...AIM:To evaluate the incidence and risk factors of Korean tuberculosis(TB) infection in patients with inflammatory bowel disease(IBD) undergoing anti-TNF treatment.METHODS:The data of IBD patients treated with anti-TNFs in 13 tertiary referral hospitals located in the southeastern region of Korea were collected retrospectively.They failed to show response or were intolerant to conventional treatments,including steroids or immunomodulators.Screening measures for latent TB infection(LTBI)and the incidence and risk factors ofactive TB infection after treatment with anti-TNFs were identified.RESULTS:Overall,376 IBD patients treated with antiTNF agents were recruited(male 255,mean age of anti-TNF therapy 32.5±13.0 years);277 had Crohn’s disease,99 had ulcerative colitis,294 used infliximab,and 82 used adalimumab.Before anti-TNF treatment,screening tests for LTBI including an interferon gamma release assay or a tuberculin skin test were performed in 82.2%of patients.Thirty patients(8%)had LTBI.Sixteen cases of active TB infection including one TB-related mortality occurred during 801 personyears(PY)follow-up(1997.4 cases per 100000 PY)after anti-TNF treatment.LTBI(OR=5.76,95%CI:1.57-21.20,P=0.008)and WBC count<5000 mm3(OR=4.5,95%CI:1.51-13.44,P=0.007)during follow-up were identified as independently associated risk factors.CONCLUSION:Anti-TNFs significantly increase the risk of TB infection in Korean patients with IBD.The considerable burden of TB and marked immunosuppression might be attributed to this risk.展开更多
AIM: To find risk factors of lymph node metastasis(LNM) in early gastric cancer(EGC) and to find proper endoscopic therapy indication in EGC.METHODS: We retrospectively reviewed the 2270 patients who underwent curativ...AIM: To find risk factors of lymph node metastasis(LNM) in early gastric cancer(EGC) and to find proper endoscopic therapy indication in EGC.METHODS: We retrospectively reviewed the 2270 patients who underwent curative operation for EGC from January 2001 to December 2008. EGC was defined as malignant lesions that do not invade beyond the submucosal layer of the stomach wall irrespective of presence of lymph node metastasis.RESULTS: Among 2270 enrolled patients, LNM was observed in 217(9%) patients. LNM in intramucosal(M) cancer and submucosal(SM) cancer was detectedin 3 8( 2. 8 %, 3 8 / 1 3 4 0) patients and 1 7 9(19%, 179/930) patients, respectively. In univariate analysis, the risk factors for LNM in EGC were size of tumor, Lauren classification, ulcer, lymphatic invasion, vascular invasion, and depth of invasion. However, in multivariate analysis, size of tumor, lymphatic invasion, vascular invasion, and depth of invasion were risk factors for LNM in EGC. Size of tumor, lymphatic invasion, vascular invasion, and depth of invasion were risk factors for LNM in cases of intramucosal cancer and submucosal cancer. In particular, there was no lymph node metastasis in cases of well differentiated early gastric cancer below 1 cm in size without ulcer regardless of lymphovascular invasion.CONCLUSION: Tumor size, perilymphatic-vascular invasion, and depth of invasion were risk factors for LNM in EGC. There was no LNM in EGC below 1 cmregardless risk factors.展开更多
AIM: To compare outcomes using the novel portable endoscopy with that of nasogastric(NG) aspiration in patients with gastrointestinal bleeding.METHODS: Patients who underwent NG aspiration for the evaluation of upper ...AIM: To compare outcomes using the novel portable endoscopy with that of nasogastric(NG) aspiration in patients with gastrointestinal bleeding.METHODS: Patients who underwent NG aspiration for the evaluation of upper gastrointestinal(UGI) bleeding were eligible for the study. After NG aspiration, we performed the portable endoscopy to identify bleeding evidence in the UGI tract. Then, all patients underwent conventional esophagogastroduodenoscopy as the gold-standard test. The sensitivity, specificity, and accuracy of the portable endoscopy for confirming UGI bleeding were compared with those of NG aspiration.RESULTS: In total, 129 patients who had GI bleedingsigns or symptoms were included in the study(age 64.46 ± 13.79, 91 males). The UGI tract(esophagus, stomach, and duodenum) was the most common site of bleeding(81, 62.8%) and the cause of bleeding was not identified in 12 patients(9.3%). Specificity for identifying UGI bleeding was higher with the portable endoscopy than NG aspiration(85.4% vs 68.8%, P = 0.008) while accuracy was comparable. The accuracy of the portable endoscopy was significantly higher than that of NG in the subgroup analysis of patients with esophageal bleeding(88.2% vs 75%, P = 0.004). Food material could be detected more readily by the portable endoscopy than NG tube aspiration(20.9% vs 9.3%, P = 0.014). No serious adverse effect was observed during the portable endoscopy.CONCLUSION: The portable endoscopy was not superior to NG aspiration for confirming UGI bleeding site. However, this novel portable endoscopy device might provide a benefit over NG aspiration in patients with esophageal bleeding.展开更多
Endoscopic submucosal dissection(ESD)is now recognized as the preferred treatment modality for gastrointestinal epithelial lesions.A 21-month-old female was admitted with a giant hyperplastic polyp causing a gastric o...Endoscopic submucosal dissection(ESD)is now recognized as the preferred treatment modality for gastrointestinal epithelial lesions.A 21-month-old female was admitted with a giant hyperplastic polyp causing a gastric outlet obstruction.Successful ESD was performed with caution.The post-procedural course was uneventful without a bleeding episode.Although further study of the feasibility of ESD in early children is necessary,ESD could be applied to avoid laparotomy even in young children.展开更多
AIM:To compare the esophagogastric junction(EGJ)areas observed in sedated and non-sedated patients during esophagogastroduodenoscopy(EGD).METHODS:Data were collected prospectively from consecutive patients who underwe...AIM:To compare the esophagogastric junction(EGJ)areas observed in sedated and non-sedated patients during esophagogastroduodenoscopy(EGD).METHODS:Data were collected prospectively from consecutive patients who underwent EGD for various reasons.The patients were divided into three groups according to the sedation used:propofol,midazolam,and control(no sedation).The EGJ was observed during both insertion and withdrawal of the endoscope.The extent of the EGJ territory observed was classified as excellent,good,fair,or poor.In addition,the time the EGJ was observed was estimated.RESULTS:The study included 103 patients(50 males;mean age 58.44±10.3 years).An excellent observation was achieved less often in the propofol and midazolam groups than in the controls(27.3%,28.6%and91.4%,respectively,P<0.001).There was a significant difference in the time at which EGJ was observed among the groups(propofol 20.7±11.7 s vs midazolam 16.3±7.3 s vs control 11.6±5.8 s,P<0.001).Multivariate analysis showed that sedation use was the only independent risk factor for impaired EGJ evaluation(propofol,OR=24.4,P<0.001;midazolam,OR=25.3,P<0.001).Hiccoughing was more frequent in the midazolam group(propofol 9%vs midazolam25.7%vs control 0%,P=0.002),while hypoxia(SaO2<90%)tended to occur more often in the propofol group(propofol 6.1%vs midazolam 0%vs control 0%,P=0.101).CONCLUSION:Sedation during EGD has a negative effect on evaluation of the EGJ.展开更多
基金Supported by The research promoting grant from the Keimyung University Dongsan Medical Center in 2004
文摘Endoscopic retrograde cholangiopancreatography(ERCP) has become the mainstay of treatment in hepato-pancreato-biliary disease. However, ERCP requires a high level of technical skills and experience in therapeutic endoscopy, there is always a risk of complications. Especially, the perforation per se affects the patient adversely, and the clinical course may lead to a poor prognosis, even with appropriate management. The treatments for ERCPrelated perforation are diverse, depending on the location and mechanism of the bowel perforation and the time of diagnosis. Thus, we reviewed the appropriate surgical and non-surgical management options for therapeutic ERCP-related perforations, especially, evaluating metallic stenting as a treatment modality in perivaterian perforation.
文摘The high incidence of gastric cancer has led to the initiation of cancer screening programs.As a result,the number of early gastric cancer cases has increased and consequentially,the cancer mortality rate has decreased.Moreover,the development of minimally invasive endoscopic treatment has been introduced for these early lesions.Endoscopic submucosal dissection(ESD) is now recognized as one of the preferred treatment modalities for premalignant gastrointestinal epithelial lesions and early gastric cancer without lymph node metastasis.We review the results of ESD including experiences in Japan and Korea,as well as western countries.
基金Supported by the National Research Foundation of Korea Grant funded by the Korean Government,No.2014R1A5A2010008
文摘AIM To investigate histologic abnormalities in the gastric smooth muscle of patients with diabetes mellitus(DM).METHODS Full-thickness gastric specimens were obtained from patients undergoing surgery for gastric cancer. H&E stain and Masson's Trichrome stain were performed to assess the degree of fibrosis. Immunohistochemical staining using various antibodies was also performed [antibodies against protein gene product 9.5(PGP9.5), neuronal nitric oxide synthase(n NOS), vasoactive intestinal peptide(VIP), neurokinin-1(NK1) receptor, c-Kit, and platelet-derived growth factor receptor-alpha,(PDGFRα)]. Immunofluorescent staining and evaluation with confocal microscopy were also conducted.RESULTS Twenty-six controls and 35 diabetic patients(21 shortduration patients and 14 long-duration patients) were included. There were no significant differences in basic demographics between the two groups except in mean body mass index(BMI)(higher in the DM group). Proportions of moderate-to-severe intercellular fibrosis in the muscle layer were significantly higher in the DM group than in the control group(P < 0.01). On immunohistochemical staining, c-Kit- and PDGFRα-positive immunoreactivity were significantly decreased in the DM group compared with the control group(P < 0.05). There were no statistically significant differences in PGP9.5, n NOS, VIP, and neurokinin 1 expression. On immunofluorescent staining, cellularity of interstitial cells of Cajal(ICC) was observed to decrease with increasing duration of DM.CONCLUSION Our study suggests that increased intercellular fibrosis, loss of ICC, and loss of fibroblast-like cells are found in the smooth muscle of DM patients. These abnormalities may contribute to changes in gastric motor activity in patients with DM.
文摘AIM: To investigate factors related to recurrence following en bloc resection using endoscopic submucosal dissection(ESD) in patients with early gastric cancer(EGC). METHODS: A total of 1121 patients(1215 lesions) who had undergone ESD for gastric neoplasia between April 2003 and May 2010 were retrospectively reviewed. Data from 401 patients(415 lesions) were analyzed, following the exclusion of those who underwent piecemeal resection, with deep resection margin invasion or lateral margin infiltration, and diagnosed with benign lesions. RESULTS: Local recurrence after en bloc ESD was found in 36 cases(8.7%). Unclear resection margins, long procedure times, and narrow safety margins were identified as risk factors for recurrence. Lesions located in the upper third of the stomach showed a higher rate of recurrence than those located in the lower third of the stomach(OR = 2.9, P = 0.03). The probability of no recurrence for up to 24 mo was 79.9% in those with a safety resection margin ≤ 1 mm and 89.5% in those with a margin > 1 mm(log-rank test, P = 0.03). CONCLUSION: Even in cases in which en bloc ESD is performed for EGC, local recurrence still occurs. To reduce local recurrences, more careful assessment will be needed prior to the implementation of ESD in casesin which the tumor is located in the upper third of the stomach. In addition, clear identification of tumor boundaries as well as the securing of sufficient safety resection margins will be important.
文摘AIM:To evaluate the incidence and risk factors of Korean tuberculosis(TB) infection in patients with inflammatory bowel disease(IBD) undergoing anti-TNF treatment.METHODS:The data of IBD patients treated with anti-TNFs in 13 tertiary referral hospitals located in the southeastern region of Korea were collected retrospectively.They failed to show response or were intolerant to conventional treatments,including steroids or immunomodulators.Screening measures for latent TB infection(LTBI)and the incidence and risk factors ofactive TB infection after treatment with anti-TNFs were identified.RESULTS:Overall,376 IBD patients treated with antiTNF agents were recruited(male 255,mean age of anti-TNF therapy 32.5±13.0 years);277 had Crohn’s disease,99 had ulcerative colitis,294 used infliximab,and 82 used adalimumab.Before anti-TNF treatment,screening tests for LTBI including an interferon gamma release assay or a tuberculin skin test were performed in 82.2%of patients.Thirty patients(8%)had LTBI.Sixteen cases of active TB infection including one TB-related mortality occurred during 801 personyears(PY)follow-up(1997.4 cases per 100000 PY)after anti-TNF treatment.LTBI(OR=5.76,95%CI:1.57-21.20,P=0.008)and WBC count<5000 mm3(OR=4.5,95%CI:1.51-13.44,P=0.007)during follow-up were identified as independently associated risk factors.CONCLUSION:Anti-TNFs significantly increase the risk of TB infection in Korean patients with IBD.The considerable burden of TB and marked immunosuppression might be attributed to this risk.
文摘AIM: To find risk factors of lymph node metastasis(LNM) in early gastric cancer(EGC) and to find proper endoscopic therapy indication in EGC.METHODS: We retrospectively reviewed the 2270 patients who underwent curative operation for EGC from January 2001 to December 2008. EGC was defined as malignant lesions that do not invade beyond the submucosal layer of the stomach wall irrespective of presence of lymph node metastasis.RESULTS: Among 2270 enrolled patients, LNM was observed in 217(9%) patients. LNM in intramucosal(M) cancer and submucosal(SM) cancer was detectedin 3 8( 2. 8 %, 3 8 / 1 3 4 0) patients and 1 7 9(19%, 179/930) patients, respectively. In univariate analysis, the risk factors for LNM in EGC were size of tumor, Lauren classification, ulcer, lymphatic invasion, vascular invasion, and depth of invasion. However, in multivariate analysis, size of tumor, lymphatic invasion, vascular invasion, and depth of invasion were risk factors for LNM in EGC. Size of tumor, lymphatic invasion, vascular invasion, and depth of invasion were risk factors for LNM in cases of intramucosal cancer and submucosal cancer. In particular, there was no lymph node metastasis in cases of well differentiated early gastric cancer below 1 cm in size without ulcer regardless of lymphovascular invasion.CONCLUSION: Tumor size, perilymphatic-vascular invasion, and depth of invasion were risk factors for LNM in EGC. There was no LNM in EGC below 1 cmregardless risk factors.
基金Supported by Grant of the Korea Healthcare technology RD Project,Ministry of Health and Welfare,Republic of Korea No.A102065
文摘AIM: To compare outcomes using the novel portable endoscopy with that of nasogastric(NG) aspiration in patients with gastrointestinal bleeding.METHODS: Patients who underwent NG aspiration for the evaluation of upper gastrointestinal(UGI) bleeding were eligible for the study. After NG aspiration, we performed the portable endoscopy to identify bleeding evidence in the UGI tract. Then, all patients underwent conventional esophagogastroduodenoscopy as the gold-standard test. The sensitivity, specificity, and accuracy of the portable endoscopy for confirming UGI bleeding were compared with those of NG aspiration.RESULTS: In total, 129 patients who had GI bleedingsigns or symptoms were included in the study(age 64.46 ± 13.79, 91 males). The UGI tract(esophagus, stomach, and duodenum) was the most common site of bleeding(81, 62.8%) and the cause of bleeding was not identified in 12 patients(9.3%). Specificity for identifying UGI bleeding was higher with the portable endoscopy than NG aspiration(85.4% vs 68.8%, P = 0.008) while accuracy was comparable. The accuracy of the portable endoscopy was significantly higher than that of NG in the subgroup analysis of patients with esophageal bleeding(88.2% vs 75%, P = 0.004). Food material could be detected more readily by the portable endoscopy than NG tube aspiration(20.9% vs 9.3%, P = 0.014). No serious adverse effect was observed during the portable endoscopy.CONCLUSION: The portable endoscopy was not superior to NG aspiration for confirming UGI bleeding site. However, this novel portable endoscopy device might provide a benefit over NG aspiration in patients with esophageal bleeding.
文摘Endoscopic submucosal dissection(ESD)is now recognized as the preferred treatment modality for gastrointestinal epithelial lesions.A 21-month-old female was admitted with a giant hyperplastic polyp causing a gastric outlet obstruction.Successful ESD was performed with caution.The post-procedural course was uneventful without a bleeding episode.Although further study of the feasibility of ESD in early children is necessary,ESD could be applied to avoid laparotomy even in young children.
文摘AIM:To compare the esophagogastric junction(EGJ)areas observed in sedated and non-sedated patients during esophagogastroduodenoscopy(EGD).METHODS:Data were collected prospectively from consecutive patients who underwent EGD for various reasons.The patients were divided into three groups according to the sedation used:propofol,midazolam,and control(no sedation).The EGJ was observed during both insertion and withdrawal of the endoscope.The extent of the EGJ territory observed was classified as excellent,good,fair,or poor.In addition,the time the EGJ was observed was estimated.RESULTS:The study included 103 patients(50 males;mean age 58.44±10.3 years).An excellent observation was achieved less often in the propofol and midazolam groups than in the controls(27.3%,28.6%and91.4%,respectively,P<0.001).There was a significant difference in the time at which EGJ was observed among the groups(propofol 20.7±11.7 s vs midazolam 16.3±7.3 s vs control 11.6±5.8 s,P<0.001).Multivariate analysis showed that sedation use was the only independent risk factor for impaired EGJ evaluation(propofol,OR=24.4,P<0.001;midazolam,OR=25.3,P<0.001).Hiccoughing was more frequent in the midazolam group(propofol 9%vs midazolam25.7%vs control 0%,P=0.002),while hypoxia(SaO2<90%)tended to occur more often in the propofol group(propofol 6.1%vs midazolam 0%vs control 0%,P=0.101).CONCLUSION:Sedation during EGD has a negative effect on evaluation of the EGJ.