The Clinical Characteristics of Colonic Pseudo-obstruction and the Factors Associated with Medical Treatment Response: A Study Based on a Multicenter Database in Korea

Colonic pseudo-obstruction (CPO) is defined as marked colonic distension in the absence of mechanical obstruction. We aimed to investigate the clinical characteristics of CPO and the factors associated with the response to medical treatment by using a multicenter database in Korea. CPO was diagnosed as colonic dilatation without mechanical obstruction by using radiologic and/or endoscopic examinations. Acute CPO occurring in the postoperative period in surgical patients or as a response to an acute illness was excluded. CPO cases were identified in 15 tertiary referral hospitals between 2000 and 2011. The patients' data were retrospectively reviewed and analyzed. In total, 104 patients (53 men; mean age at diagnosis, 47 yr) were identified. Seventy-seven of 104 patients (74%) showed a transition zone on abdominal computed tomography. Sixty of 104 patients (58%) showed poor responses to medical treatment and underwent surgery at the mean follow-up of 7.4 months (0.5-61 months). Younger age at the time of diagnosis, abdominal distension as a chief complaint, and greater cecal diameter were independently associated with the poor responses to medical treatment. These may be risk factors for a poor response to medical treatment.

Influenza A (H1N1) 2009 Pandemic Calm Down the Prevalence of Acute Hepatitis A in the Latter Half of 2009: Korean Population Study / 대한소화기학회지

BACKGROUND/AIMS: There was a spiking incidence of acute hepatitis A (AHA) in 2009 summer, but it went down drastically after an outbreak of influenza A (H1N1). We assessed the relationship between 2009 H1N1 pandemic and AHA prevalence from August to December 2009. METHODS: We compared AHA cases nationwide and in our hospital for the period from the latter half of 2008 to the end of 2010. H1N1 cases in our hospital from August 2009 to December 2009 were included in the study and the correlation between 2009 H1N1 pandemic and AHA prevalence was assessed. RESULTS: The national surveillance system reported 2,233, 7,895, 15,231 and 7,660 AHA cases from 2007 to 2010, respectively. A similar trend was noted in our hospital in the same periods. Although the national total incidence was increased in 2009, it showed steep decreasing trend line in the final 21 weeks of 2009 (weeks 32-52), as compared with 2008 and 2010. The mean weekly incidence percentage (AHA cases in a week/total in a year) in weeks 32-52 of 2009 was 1.17+/-0.55%, significantly lower than that in 2008 and 2010 (1.61+/-0.43% and 1.56+/-0.51%; p<0.001). Furthermore, we found a significant negative correlation between 2009 H1N1 pandemic and AHA in our hospital for weeks 32-52 of 2009 (r=-0.597; p<0.001). CONCLUSIONS: The widespread occurrence of 2009 H1N1 pandemic highlighted the benefits of health care and good hygiene, such as effective hand washing and wearing of masks, which may have also interrupted hepatitis A virus transmission.

Rectal Cancer Presenting Tumor Thrombosis in the Inferior Vena Cava and Common Iliac Vein: Case Report

We report the radiologic findings of a rectal carcinoma case with tumor thrombus in the inferior vena cava and left common iliac vein of a 48-year-old woman. The patient complained of swelling in the left leg and consequently underwent a lymphoscintigraphy, CT venography, abdominal CT, PET-CT, pelvis MRI, and ultrasound doppler. The rectal cancer was determined via a colonoscopy. The tissue biopsy of tumor thrombus in the IVC was done during insertion of IVC filter and poorly differentiated adenocarcinoma was revealed by pathology.

Synchronous Early Gastric Cancer Resembling Submucosal Tumor at the Fundus

Concern about detecting gastric carcinoma in its early stages has increased the incidence of detecting multiple synchronous gastric carcinomas. Although gastric carcinomas may present with various gross features, those showing the features of submucosal tumor (SMT) are rare. We report on a case of synchronous gastric carcinomas comprising one lesion with typical features of superficial early gastric carcinoma and the other with atypical features that mimicked SMT. Even though synchronous gastric carcinoma is rare, it may be worthwhile to make a pathological diagnosis of coexisting SMT using endoscopic-ultrasound-guided fine-needle aspiration or endoscopic mucosal resection.

Effectiveness of Sodium Alginate as a Submucosal Injection Material for Endoscopic Mucosal Resection in Animal

BACKGROUND/AIMS: Although various solutions are being tested for submucosal injection during endoscopic resection, ideal solution has not been established yet. We performed an animal study to evaluate the possibility of sodium alginate as an ideal submucosal injection solution for endoscopic mucosal resection (EMR). METHODS: To compare the lesion-lifting properties of different solutions, injection was done to the submucosal layer of porcine stomach. Then the height of mucosal elevation was measured. In addition, EMR was performed after submucosal injection of sodium alginate solution in six dogs. Two were euthanized after 30 minutes of endoscopic observation while the others were euthanized after 1-4 weeks. Retrieved stomachs were examined microscopically. RESULTS: Sodium alginate and sodium hyaluronate solutions maintained longer elevation of the submucosal layer than other solutions. There was no significant difference in the height between two solutions. A clear separation of the mucosal layer from the proper muscle layer was achieved by injecting sodium alginate solution. Histological examination of EMR-induced artificial ulcers revealed no apparent tissue damage and showed normal healing process. CONCLUSIONS: Sodium alginate solution creates a sufficient submucosal fluid cushion without apparent tissue damage. It can be considered as an effective submucosal injection material.

What is the best method to diagnose Helicobacter infection in bleeding peptic ulcers?: a prospective trial

BACKGROUND: It has been debated which diagnostic test should be preferred for the diagnosis of Helicobacter pylori (HP) in patients with peptic ulcer diseases. Several limitations are reported in bleeding peptic ulcers because of intragastric blood and possibility of changed numbers of organisms by medication. This study was designed to find out the best method for diagnosis of HP infection, in aspect of deciding the times of detection and the specific tests in bleeding peptic ulcers. METHODS: We prospectively examined histology, rapid urease test (CLO test), urea breath test (13C-UBT) and serology in HP diagnostics in 32 patients with bleeding peptic ulcers to detect HP infection. Each test was performed two times (four methods at first 24 hours and former three methods at 7th day after initial therapeutic endoscopy). We evaluated the sensitivity of each test, compared the two-times results and evaluated the effect of these tests to an outcome of endoscopic hemostasis. RESULTS: Diagnostic sensitivities of histology, CLO test, 13C-UBT and serology are 75%, 67.8%, 100% and 100% at first endoscopy, and 71.4%, 78.5%, 89.3% at 7th day endoscopy, respectively. Histologic study and CLO test had diagnostic limitation at emergent first endoscopy contrary to UBT (p < 0.01). Histologic study, CLO test and UBT have limitations at 7th day endoscopy. Only 3 patients (9.4%) rebled with subsequent complete endoscopic hemostasis and all diagnostic tests at initial endoscopy did not influence the outcome of hemostasis. CONCLUSION: First day histologic and CLO tests are inadequate methods in detecting HP infection in patients with bleeding peptic ulcers. 7-day histologic, CLO test and UBT have a low sensitivity. First-day UBT can be a standard test to diagnose HP infection in patients with bleeding peptic ulcers.

A Case of Primary Gastric Choriocarcinoma / 대한소화기내시경학회지

Gastational choriocarcinoma is a malignant neoplasm of trophoblast. It may occur after hydatidiform mole, spontaneous abortion, normal pregnancy, and even an ectopic pregnancy. Extragenital choriocarcinoma is a rare tumor which attracts interest because of its controversial pathogenesis. It has been reported to occur within the lung, mediastinum, breast, prostate, thymus, pineal, nose, liver, bladder, and biliary tree, as well as most parts of the gastrointestinal tract. We experienced a case of primary choriocarcinoma of stomach with a metastasis to the liver of a 54-year-old man. So, we present a case with a review of literature.

A Case of Gallbladder Perforation Treated By Percutaneous Transhepatic Cholecystic Drainage and Percutaneous Peritoneal Drainage / 대한소화기내시경학회지

Perforation of gallbladder is a serious complication of acute cholecystitis with alarmingly high mortality rate. These high mortality and morbidity rates were caused by delay in prompt diagnosis and adequate therapy. Especially, mortality and morbidity rates rise markedly in the elderly patient with severe systemic illness. In the patients of gallbladder perforation who are poor candidate for general anesthesia and major operation, percutaneous cholecystic drainage procedure is good alternatives. We experienced a case of gallbladder perforation which was treated successfully by non-operative percutaneous transhepatic cholecystic drainage(PTCCD) in 65-year-old female. She couldn't be a candidate for cholecystectomy or operative chlecystostomy because of severe adhesion of gallbladder to adjacent organ and tissue due to previous gallbladder empyema. We decided to take non-operative percutaneous transhepatic cholecystic drainage and percutaneous peritoneal drainage of abdominal abscess. Thereafter, we examined gallbladder by percutaneous transhepatic cholecystoscopylPTCCS)and rule out gallstone and gallbladder malignancy. So, we presented the case with the brief review of the literatures.