ABSTRACT
Colorectal cancer is a common malignancy and a major health concern in Korea. The increased use of screening colonoscopies has led to improved survival of patients with colorectal cancer despite its high prevalence; this highlights the importance of early detection and removal of neoplastic polyps such as adenoma and sessile serrated lesions. Therefore, optical diagnosis of colorectal polyps is crucial in deciding whether the lesion requires removal and if endoscopic procedures can be used for its removal.Current Concepts: Several image-enhanced endoscopy (IEE) techniques and classifications can be used to improve the optical diagnosis of different polyps that match the histopathologic findings. Kudo’s pit pattern classification is based on features of pit patterns observed from different types of polyps via chromoendoscopy. The Narrow-Band Imaging (NBI) International Colorectal Endoscopic (NICE) classification is an international classification based on patterns observed from NBI findings. The Japan NBI Expert Team (JNET) classification identifies different patterns observed from magnified images with NBI. The Workgroup serrAted polypS and Polyposis (WASP) classification helps to differentiate hyperplastic polyps from sessile serrated lesions. Endoscopy manufacturers have also developed IEE techniques such as I-scan, flexible spectral imaging color enhancement, and blue laser imaging/linked color imaging to highlight, delineate, and differentiate various polyps.Discussion and Conclusion: Optical diagnosis of colorectal polyps using IEE such as NBI with different classifications such as NICE, JNET, and WASP is important for differentiating neoplastic polyps and removing them with an appropriate method.
ABSTRACT
Background@#With the increase in meals at home due to coronavirus disease 2019 (COVID-19), the pattern and incidence of enteritis seemed to change. Some types of enteritis, such as Campylobacter enteritis, appear to have increased. Our study aimed to evaluate the change in the trend of enteritis, especially Campylobacter enteritis, before COVID-19 (2016– 2019) and at the present time during COVID-19 in South Korea. @*Methods@#We analyzed data from the Health Insurance Review and Assessment Service. From 2016 to 2020, the International Classification of Diseases codes related to enteritis were examined to distinguish bacterial and viral enteritis and the trends of each were analyzed.The aspects of enteritis, before and after the COVID-19 outbreak, were compared. @*Results@#Both bacterial and viral enteritis declined in all age groups from 2016 to 2020 (P< 0.001). In 2020, the reduction rate of viral enteritis was higher than that of bacterial enteritis. However, unlike other causes of enteritis, even after COVID-19, Campylobacter enteritis increased in all age groups. An increase of Campylobacter enteritis in 2020 was particularly noticeable in children and adolescents. The prevalence of viral and bacterial enteritis was higher in urban areas than in rural areas (P < 0.001). Campylobacter enteritis was more common in the rural areas (P< 0.001). @*Conclusion@#Although the prevalence of bacterial and viral enteritis have decreased in COVID-19, Campylobacter enteritis has increased in all age groups and in rural areas compared to urban areas. Recognizing that the trend of Campylobacter enteritis before and during COVID-19 is helpful for future public health measures and interventions.
ABSTRACT
Background/Aims@#Endoscopic submucosal dissection (ESD) is a curative treatment modality for early gastric neoplasms; however, ESD can be a time-consuming process. To overcome this pitfall, we developed the one-step knife (OSK) approach, which combines an endoscopic knife and injection needle on a single sheath. We aimed to evaluate whether this approach could reduce the ESD procedure time. @*Methods@#This single-blinded randomized multicenter trial at four tertiary hospitals from June 2019 to June 2020 included patients aged 19 to 85 years undergoing ESD. Patients were randomly assigned to two groups (OSK or conventional knife [CK]). The injection time, total procedure time, resected specimen size, submucosal fluid amount, degree of device satisfaction, and adverse events were evaluated and compared between groups. @*Results@#Fifty-one patients were analyzed (OSK: 25 patients and CK: 26 patients). No baseline differences were observed between groups, with the exception of a higher portion of males in the OSK group. The mean injection time was significantly reduced in the OSK group (39.0 seconds) compared to that in the CK group (87.5 seconds, p<0.001). A decrease of more than 10 minutes in the total procedure time (18.0 minutes vs 28.1 minutes, p=0.055) in the OSK group compared to the CK group was observed. Second-look esophagogastroduodenoscopy revealed two delayed bleeding cases in the OSK group that were easily controlled by endoscopic hemostasis. @*Conclusions@#OSK reduced the injection time and showed a decrease in total procedure time compared with the CK approach. OSK can be a feasible tool for ESD, especially in difficult cases.
ABSTRACT
Intrathecal pump (ITP) is a procedure performed for pain control in patients with cancer pain and refractory pain. Complications such as catheter-related infection, granuloma, and migration may occur, so continuous management is required. In this case, ITP insertion was performed due to central cord syndrome that occurred after a traffic accident. T-L spine computed tomography was performed due to persistent pain exacerbation 22 months after insertion, and epidural granuloma was confirmed. After that, granuloma removal and ITP revision surgery were performed, and pain control has been good so far. The purpose of this case was to investigate the risk factors and evaluation methods for catheter-related granuloma.
ABSTRACT
Serrated polyposis syndrome (SPS) can transform to malignant lesions through the sessile serrated pathway and traditional serrated pathway. These pathways may cause rapid neoplastic progression compared to the adenoma-carcinoma sequence, which may cause interval colorectal cancer. The authors experienced a case of SPS with a synchronous colon adenocarcinoma that was treated with an endoscopic mucosal resection. In pathology reviews, other parts of the adenocarcinoma showed sessile serrated adenoma. Therefore, patients with SPS have a potential for malignant transformation, highlighting the need for strict colonoscopy surveillance starting at the time of SPS diagnosis.
ABSTRACT
Interstitial cells of Cajal (ICC) are known as the pacemaker cells of gastrointestinal tract, and it has been reported that acute gastroenteritis induces intestinal dysmotility through antibody to vinculin, a cytoskeletal protein in gut, resulting in small intestinal bacterial overgrowth, so that anti-vinculin antibody can be used as a biomarker for irritable bowel syndrome. This study aimed to determine correlation between serum anti-vinculin antibody and ICC density in human stomach. Gastric specimens from 45 patients with gastric cancer who received gastric surgery at Kangwon National University Hospital from 2013 to 2017 were used. ICC in inner circular muscle, and myenteric plexus were counted. Corresponding patient's blood samples were used to determine the amount of anti-vinculin antibody by enzyme-linked immunosorbent assay. Analysis was done to determine correlation between anti-vinculin antibody and ICC numbers. Patients with elevated anti-vinculin antibody titer (above median value) had significantly lower number of ICC in inner circular muscle (71.0 vs. 240.5, p = 0.047), and myenteric plexus (12.0 vs. 68.5, p < 0.01) compared to patients with lower anti-vinculin antibody titer. Level of serum anti-vinculin antibody correlated significantly with density of ICC in myenteric plexus (r = −0.379, p = 0.01; Spearman correlation). Increased level of circulating anti-vinculin antibody was significantly correlated with decreased density of ICC in myenteric plexus of human stomach.
ABSTRACT
Interstitial cells of Cajal (ICC) are known as the pacemaker cells of gastrointestinal tract, and it has been reported that acute gastroenteritis induces intestinal dysmotility through antibody to vinculin, a cytoskeletal protein in gut, resulting in small intestinal bacterial overgrowth, so that anti-vinculin antibody can be used as a biomarker for irritable bowel syndrome. This study aimed to determine correlation between serum anti-vinculin antibody and ICC density in human stomach. Gastric specimens from 45 patients with gastric cancer who received gastric surgery at Kangwon National University Hospital from 2013 to 2017 were used. ICC in inner circular muscle, and myenteric plexus were counted. Corresponding patient's blood samples were used to determine the amount of anti-vinculin antibody by enzyme-linked immunosorbent assay. Analysis was done to determine correlation between anti-vinculin antibody and ICC numbers. Patients with elevated anti-vinculin antibody titer (above median value) had significantly lower number of ICC in inner circular muscle (71.0 vs. 240.5, p = 0.047), and myenteric plexus (12.0 vs. 68.5, p < 0.01) compared to patients with lower anti-vinculin antibody titer. Level of serum anti-vinculin antibody correlated significantly with density of ICC in myenteric plexus (r = −0.379, p = 0.01; Spearman correlation). Increased level of circulating anti-vinculin antibody was significantly correlated with decreased density of ICC in myenteric plexus of human stomach.
ABSTRACT
Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.
Subject(s)
Aged , Female , Humans , Actinomycosis , B-Lymphocytes , Biopsy , Colon , Colon, Ascending , Colonic Neoplasms , Colonoscopy , Diagnosis , Drug Therapy , Flank Pain , Follow-Up Studies , Lymphoma , Lymphoma, B-Cell , Lymphoma, Large B-Cell, Diffuse , Masks , Penicillin G , Sulfur , Tomography, X-Ray Computed , Weight LossABSTRACT
After gastrojejunostomy, a small space can occur between the jejunum at the anastomosis site, the transverse mesocolon, and retroperitoneum, which may cause an intestinal hernia. This report presents a rare case of intestinal ischemic necrosis caused by retroanastomotic hernia after subtotal gastrectomy. A 56-year-old male was admitted to Kangwon National University Hospital with melena, abdominal pain, and nausea. His only relevant medical history was gastrectomy due to stomach cancer. Endoscopic findings revealed subtotal gastrectomy with Billroth-II reconstruction and a bluish edematous mucosal change with necrotic tissue in afferent and efferent loops including the anastomosis site. Abdominopelvic CT showed strangulation of proximal small bowel loops due to mesenteric torsion and thickening of the wall of the gastric remnant. Emergency laparotomy was performed. Surgical findings revealed the internal hernia through the defect behind the anastomosis site with strangulation of the jejunum between 20 cm below the Treitz ligament and the proximal ileum. Roux-en-Y anastomosis was performed, and he was discharged without complication. Retroanastomotic hernia, also called Petersen's space hernia, is a rare complication after gastric surgery, cannot be easily recognized, and leads to strangulation.
Subject(s)
Humans , Male , Middle Aged , Abdominal Pain , Anastomosis, Roux-en-Y , Emergencies , Gastrectomy , Gastric Bypass , Gastric Stump , Hernia , Ileum , Ischemia , Jejunum , Laparotomy , Ligaments , Melena , Mesocolon , Nausea , Necrosis , Stomach NeoplasmsABSTRACT
Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.
Subject(s)
Aged , Female , Humans , Actinomycosis , B-Lymphocytes , Biopsy , Colon , Colon, Ascending , Colonic Neoplasms , Colonoscopy , Diagnosis , Drug Therapy , Flank Pain , Follow-Up Studies , Lymphoma , Lymphoma, B-Cell , Lymphoma, Large B-Cell, Diffuse , Masks , Penicillin G , Sulfur , Tomography, X-Ray Computed , Weight LossABSTRACT
Cytomegalovirus (CMV) reactivation is common in patients with severe ulcerative colitis (UC), and may ref lect exacerbation of mucosal inf lammation and/or administration of immunosuppressants. The question of whether CMV is an active pathogen or ‘an innocent bystander’ in the exacerbation of UC remains controversial. Patients with UC exacerbated by reactivated CMV experience worse prognoses than those without CMV reactivation and antiviral therapy significantly reduces the need for colectomy in patients with severe UC and high-grade CMV infection, indicating that CMV plays a role in UC prognosis. Therefore, the CMV status of patients on immunosuppressants, particularly those with steroid-refractory or -dependent UC, should be tested. When CMV is detected, be performed based on should adequate treatment the extent of the viral load and the presence of certain clinical features including a large ulcer. Anti-tumor necrosis factor agents may be useful for treating CMV colitis complicating UC.
Subject(s)
Humans , Colectomy , Colitis , Colitis, Ulcerative , Cytomegalovirus Infections , Cytomegalovirus , Immunosuppressive Agents , Necrosis , Prognosis , Ulcer , Viral LoadABSTRACT
BACKGROUND/AIMS: Laryngopharyngeal reflux (LPR) is an extraesophageal manifestation of gastroesophageal reflux disease. Endoscopic assessment of LPR is needed for convenient diagnosis and documentation of treatment efficacy. The aim of this study was to investigate the interrater reliability of LPR among endoscopists based on endoscopic laryngeal images. MATERIALS AND METHODS: Nineteen endoscopists participated in this study. Before the test, they completed an intensive education program by an otorhinolaryngologist on the reflux finding score (RFS), which is a validated laryngoscopic assessment of LPR. A total of 100 endoscopic laryngeal images were used for 3 tests of RFS. Cohen's and Fleiss' kappa coefficients were used to determine the degree of interrater agreement in the diagnosis of LPR. RESULTS: In the first test, the mean of Cohen's kappa coefficients for LPR diagnosis between the otorhinolaryngologist and each of the 19 endoscopists was 0.3. In the second test, after additional education, the mean kappa value was 0.32. Fleiss' kappa coefficients for diagnosis of LPR among the 19 endoscopists in the first and second tests were 0.30 and 0.26, respectively. CONCLUSIONS: A short-term education program for endoscopists did not result in an improvement of accuracy in the diagnosis of LPR. Further studies using advanced educational programs for endoscopists are required.
Subject(s)
Diagnosis , Education , Endoscopy , Gastroesophageal Reflux , Laryngopharyngeal Reflux , Treatment OutcomeABSTRACT
No abstract available.
Subject(s)
Humans , Asian People , Crohn Disease , Risk Factors , Smoke , SmokingABSTRACT
Gastroesophageal reflux disease (GERD) is prevalent in Korea. Clinical manifestations include typical symptoms which are heartburn and regurgitation and atypical symptoms that can be esophageal or extraesophageal. Various extraesophageal manifestations are associated with GERD, and the most significant of these are chronic cough, laryngitis, and asthma. The diagnosis of extraesophageal syndrome is often difficult due to the poor sensitivity and specificity of available diagnostic modalities, including endoscopy, pH monitoring, and laryngoscopy. Consequently, empirical treatment with a proton pump inhibitor (PPI) is considered to be the most cost-effective tool for the diagnosis and management of patients suspected of having extraesophageal syndrome without alarm features. Those who do not respond to PPI therapy should undergo an additional work-up that includes monitoring esophageal pH or impedance, and motility tests to evaluate the relationship between reflux and symptoms. Surgical management should cautiously be considered for very carefully selected patients.
Subject(s)
Humans , Asthma , Cough , Diagnosis , Electric Impedance , Endoscopy , Gastroesophageal Reflux , Heartburn , Hydrogen-Ion Concentration , Korea , Laryngitis , Laryngoscopy , Proton Pumps , Sensitivity and SpecificityABSTRACT
BACKGROUND/AIMS: The management of job-related stress among health-care workers is critical for the improvement of healthcare services; however, there is no existing research on endoscopy unit workers as a team. Korea has a unique health-care system for endoscopy unit workers. In this study, we aimed to estimate job stress and job satisfaction among health-care providers in endoscopy units in Korea. METHODS: We performed a cross-sectional survey of health-care providers in the endoscopy units of three university-affiliated hospitals in Korea. We analyzed the job stress levels by using the Korean occupational stress scale, contributing factors, and job satisfaction. RESULTS: Fifty-nine workers completed the self-administered questionnaires. The job stress scores for the endoscopy unit workers (46.39±7.81) were relatively lower compared to those of the national sample of Korean workers (51.23±8.83). Job stress differed across job positions, with nurses showing significantly higher levels of stress (48.92±7.97) compared to doctors (42.59±6.37). Job stress and job satisfaction were negatively correlated with each other (R2=0.340, p<0.001). CONCLUSIONS: An endoscopy unit is composed of a heterogeneous group of health-care professionals (i.e., nurses, fellows, and professors), and job stress and job satisfaction significantly differ according to job positions. Job demand, insufficient job control, and job insecurity are the most important stressors in the endoscopy unit.