Guidelines for Endoscopic Resection of Early Gastric Cancer: Comparison of Japanese and European Guidelines / 대한소화기학회지

An endoscopic resection is performed widely and has been established as a standard therapeutic modality for the treatment of early gastric cancer (EGC) without lymph node metastasis. On the other hand, the selection of suitable patients by a thorough pre-procedural evaluation is mandatory for the successful management of EGC. Moreover, a clear and unified interpretation of a resected specimen and the definition of a curative resection is the mainstay for decision-making of an additional surgical resection and post-procedural surveillance schedule. This paper summarizes the key statements of Eastern (Japan Gastroenterological Endoscopy Society) and Western (European Society of Gastrointestinal Endoscopy) guidelines for an endoscopic resection of EGC, regarding the clinical staging and indication; pre-operative evaluation; definition of a curative resection; and post-procedural surveillance, focusing on the similarities and differences between the two guidelines.

The Role of Helicobacter pylori Infection in Drug-induced Peptic Ulcer / 대한Helicobacter연구학회지

Nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin (LDA) are the main causes of peptic ulcer (PU), and cause major complication such as bleeding and perforation. The interaction of Helicobacter pylori infection with NSAIDs or LDA is complex and remains unclear. However, H. pylori infection may play additive, synergistic, or antagonistic roles in the development of drug-induced PU. H. pylori infection and NSAID use are independent risk factors for the development of PU, which is thought to be a synergistic effect. Eradication of H. pylori significantly reduces the incidence of PU in NSAID-naïve patients. However, the effect of secondary prevention is controversial, especially in chronic NSAID users. The use of a gastroprotective agent such as a proton pump inhibitor (PPI) is mandatory to prevent the recurrence of PU in patients with a previous history, especially in chronic NSAID users. H. pylori infection may also increase the risk of LDA-associated complicated and uncomplicated PU, including the risk of upper gastrointestinal bleeding. In patients taking LDA, H. pylori eradication alone may prevent the recurrence of PU bleeding. However, PPI maintenance is necessary with concomitant use of an NSAID, steroid, anticoagulant, or other antiplatelet agents.

Helicobacter pylori eradication in the treatment of gastric hyperplastic polyps: beyond National Health Insurance

No abstract available.

Factors Affecting Complete Small Bowel Study and Diagnostic Yield in MiroCam(R) Capsule Endoscopy

BACKGROUND/AIMS: Mirocam(R) capsule endoscopy has been widely used in Korea; however, data with respect to Mirocam(R) capsule endoscopy is lacking. We have assessed the factors affecting complete small bowel studies and diagnostic yield in Mirocam(R) capsule endoscopic studies. METHODS: We retrospectively analyzed 103 cases that were assessed with Mirocam(R) capsule endoscopy between June 2007 and February 2010 at Guro Korea University Hospital. RESULTS: The mean age of the 103 cases was 55.47 years (range, 16-99 years) and 67 cases (65%) were male. The indications for capsule endoscopy were hematochezia/melena (77 cases, 74.8%), anemia (8 cases, 7.8%), abdominal pain (12 cases, 11.7%), and miscellaneous (weight loss and chronic diarrhea; 6 cases, 5.8%). The mean stomach transit time was 59.9+/-88.3 minutes (range, 1-630 minutes) and the mean small bowel transit time was 396.0+/-131.7 minutes (range, 117-708 minutes). The rate of successfully performing a complete small bowel study was 82.5% (85 cases), and the stomach transit time was a significant factor for a complete small bowel study (OR=0.991, 95% CI=0.984-0.998, P=0.012). The diagnostic yield was 51.5% (53 cases); visual quality was a significant factor in determining the diagnostic yield (OR=6.776, 95% CI=1.32-34.70, P=0.022). CONCLUSIONS: In a Mirocam(R) capsule endoscopic study, short stomach transit time was a significant factor affecting completion of the small bowel study. Achieving excellent visual quality by good bowel preparation was a significant factor for improving the diagnostic yield.

Treatment Outcomes after Endoscopic Submucosal Dissection of Large Superficial Rectosigmoid Colon Tumors / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) of a colorectal tumor is technically difficult. This study aimed to analyze the clinical outcomes of superficial large rectosigmoid tumors after ESD. METHODS: Medical records of 15 patients with large rectosigmoid tumors (more than 30 mm), in which ESD performed, were reviewed retrospectively. RESULTS: The mean tumor size was 42.5+/-14.3 mm (range, 30~78 mm). A histological examination revealed a well-differentiated adenocarcinoma in five cases (33.3%), adenoma with high-grade dysplasia in six cases (40%), and low-grade dysplasia in four cases (26.7%). The mean procedural time was 90.5+/-60.7 min (range, 22~246 min). The en bloc resection rate was 86.7%, and the complete resection rate 100%. The lateral resection margin was positive in four cases (26.6%), but no cases with a positive vertical margin were observed. Bleeding occurred in three cases (20%), and all were treated successfully using endoscopic measures. Perforations occurred in three cases (20%); two cases were treated by clipping and the other by a laparotomy. CONCLUSIONS: ESD is a treatment option for superficial large rectosigmoid tumors. Further studies with larger cases and a longer term follow-up are needed to establish the efficacy and safety of ESD for colorectal tumors.

The Effect of Pantoprazole on Bone Turnover in Ovariectomized ICR Mice / 대한내과학회지

BACKGROUND/AIMS: Long-term exposure to proton pump inhibitors is associated with osteoporosis-related fractures; however, the mechanism is unknown. The purpose of this study was to evaluate the effect of pantoprazole on osteoporosis and bone turnover in ovariectomized ICR mice fed a calcium-free diet. METHODS: Ovariectomized female ICR mice were divided into a pantoprazole group (n=10) and a control group (n=10). The mice in the pantoprazole group were given an intraperitoneal injection of pantoprazole at 20 mg/kg twice daily. After 4 weeks, the mice were humanely euthanized, and bone mineral density (BMD) and dry tibia weight were measured. Serum osteocalcin and CTX-1 levels were measured by enzyme-linked immunosorbent assay. The mRNA expression levels of cytokines that stimulate osteoclast differentiation were determined using RT-PCR. Serum calcium, phosphorus, and alkaline phosphatase (ALP) levels were also analyzed. RESULTS: Serum osteocalcin concentration was significantly lower in the pantoprazole group compared with the control group (p=0.023). There was no difference in BMD, dry tibia weight, or serum ALP, calcium, phosphorus, or CTX-1 between the two groups. The expression of interleukin (IL)-1beta was lower in the pantoprazole group compared with the control group, but not significantly lower (p=0.058). The levels of tumor necrosis factor-alpha and IL-6 did not differ between the two groups. CONCLUSIONS: Pantoprazole, a proton pump inhibitor, decreased serum osteocalcin and suppressed IL-1beta expression, suggesting that pantoprazole affects bone formation and resorption in ovariectomized ICR mice. Further studies using larger sample sizes are needed.

Treatment Outcomes after Endoscopic Band Ligation of Symptomatic Internal Hemorrhoids / 대한내과학회지

BACKGROUND/AIMS: Elastic band ligation is a well-established method for the treatment of internal hemorrhoids. The aim of this study was to assess the treatment outcomes of flexible endoscopic rubber band ligation of internal hemorrhoids. METHODS: Using a flexible endoscope, 30 patients with symptomatic internal hemorrhoids were evaluated based on change in clinical symptoms (Goligher grade, bleeding score) and endoscopic classifications (range, size) before and after the procedure. RESULTS: Goligher grade and bleeding score showed significant improvement after the procedure (Goligher grade from 2.12 to 0.54, p<0.01, and bleeding score from 1.80 to 0.40, p<0.01). Endoscopic classification scores improved significantly after the procedure (range 3.03 to 1.55, p<0.01, and size from 1.80 to 0.85, p<0.01). As a complication, mild pain developed in 19 patients (90.5%) and severe pain in two patients (9.5%). Most (90.5%) were well controlled by conservative management, but one patient was operated on for hemorrhoidal thrombosis and in another patient the ligated rubber band had to be released promptly for pain relief. One patient (3.3%) experienced mild infection, which was relieved by medical treatment. During the 16.7+/-3.2-month period of follow-up, two patients relapsed, one was treated with additional endoscopic band ligation, and one underwent surgery. CONCLUSIONS: Flexible endoscopic band ligation is an effective and safe method of treatment in patients with symptomatic internal hemorrhoids.

Primary NK-/T- Cell Lymphoma of the Esophagus: a Case Presentation and Literature Review / 대한소화기내시경학회지

Extranodal natural killer/T-cell lymphoma (ENKL) is an uncommon neoplasm, and it is a subtype of non-Hodgkin's lymphoma. It most commonly presents in the nasal cavity and nasopharynx. But only 10% of ENKL may present on the skin or the gastrointestinal tract and this has a poor prognosis. We report here on a case of CD56+ NK/T-cell lymphoma that limited to the esophagus. A 55-year-old male patient presented with epigastric soreness. Esophagogastroduodenoscopy (EGD) showed well demarcated, longitudinal ulcerative lesions with an irregular base and a discrete margin on the lower esophagus. We performed EGDs and endoscopic biopsies 2 times, but these were insufficient to make a diagnosis. The 3rd time, we finally took a big piece of tissue using endoscopic mucosal resection with a cap-fitted panendoscope (EMR-C). The biopsies showed surface ulceration and a heavy lymphoid infiltration and a positive pattern for CD3, CD56 and granzyme B. The pathologic diagnosis was NK/T-cell lymphoma. The patient was treated with concurrent chemoradiation followed by additional chemotherapy and he achieved a complete response.

The clinical significance of interferon inducible protein-10 in patients having chronic hepatitis C with genotype I / 대한내과학회지

BACKGROUND/AIMS: Recent studies have shown that serum interferon gamma-inducible protein-10 (IP-10) concentration decreased after pegylated interferon and ribavirin therapy, and was associated with a sustained virologic response (SVR). The aim of this study was to investigate the clinical significance of the pretreatment IP-10 level and change in serum IP-10 level between 1 month before and after treatment and its association with various virologic responses in patients having chronic hepatitis C (CHC) with genotype 1 undergoing pegylated interferon and ribavirin therapy. METHODS: Thirty-six patients having CHC with genotype I undergoing pegylated interferon and ribavirin therapy who had available stored sera 1 month before and after treatment were enrolled retrospectively. Serum IP-10 levels were measured by ELISA. Serum HCV RNA was measured by RT-PCR (detection limit0.05). The change in serum IP-10 between 1 month before and after treatment had no clinical meaning based on various virologic responses (p>0.05). CONCLUSIONS: The level of pretreatment IP-10 and change in IP-10 level between 1 month before and after treatment were not predictive factors of a SVR. Additional large-scale studies to determine the SVR-predicting role of serum IP-10 levels in patients with CHC are needed.