Enhancing Mural Nodules in the Main Pancreatic Duct of Main and Mixed Types of Intraductal Papillary Mucinous Neoplasms: Does Size Matter in Malignancy Risk?

Background/Aims@#Most guidelines recommend surgical resection of all main duct (MD) and mixed-type (MT) intraductal papillary mucinous neoplasms (IPMNs) in suitable patients. However, there is little evidence regarding the malignancy risk of enhancing mural nodules (EMNs) that are present only in the main pancreatic duct (MPD) in patients with MD- and MT-IPMNs.Therefore, this study aimed to identify the clinical and morphological features associated with malignancy in MD- and MT-IPMNs with EMNs only in the MPD. @*Methods@#We retrospectively enrolled 50 patients with MD- and MT-IPMNs with EMNs only in the MPD on contrast-enhanced magnetic resonance imaging. We evaluated the clinical characteristics and preoperative radiologic imaging results of MPD morphology and EMN size and analyzed the risk factors associated with malignancy. @*Results@#Histological findings of EMNs were low-grade dysplasia (38%), malignant lesions (62%), high-grade dysplasia (34%), and invasive carcinoma (28%). On the receiver operating characteristic curve, the cutoff value of EMN size on magnetic resonance imaging for best predicting malignancy was 5 mm (sensitivity, 93.5%; specificity, 52.6%; area under the curve, 0.753).Multivariate analysis showed that only EMN >5 mm (odds ratio, 27.69; confidence interval, 2.75 to 278.73; p=0.050) was an independent risk factor for malignancy. @*Conclusions@#EMNs of >5 mm are associated with malignancy in patients with MD- and MTIPMNs with EMNs that are present only in the MPD, in accordance with the international consensus guidelines.

Effect of graded running on esophageal motility and gastroesophageal reflux in fed volunteers

The effects of different grades of running on esophageal motility and gastroesophageal reflux in the fed state were evaluated. We studied healthy volunteers (male: 12, age: 27+/-5 yr) using ambulatory esophageal manometry, pH catheter and portable digital data recorder. Each exercise was performed 30 min after meal, with 20 min of rest between exercises. Subjects exercised on a treadmill at 40% and 70% maximal heart rate. The number of gastroesophageal reflux episodes, the duration of esophageal acid exposure and percent time pH below 4 were significantly (p<0.01) increased during exercise at 70% maximal heart rate. The frequency of contraction (contraction/min) (p<0.05), frequency of repetition (p<0.01), percent of simultaneous contraction (p<0.01), percent of above 100 mmHg amplitude (p<0.05), and frequency of 2-peak contraction (p<0.01) were significantly increased during exercise at 70% maximal heart rate. However, median amplitude and median duration showed no significant changes between each exercise session. Postprandial running exercises induce gastroesophageal reflux, which correlates with exercise intensity. These effects are mediated by disorganized esophageal motility.

A Case of Small Duodenal Carcinoid Tumor Treated by Strip Biopsy Technique / 대한소화기내시경학회지

Carcinoid tumors of the duodenum are infrequent, represent 2.0-3.0% of all gastrointestinal carcinoid tumors in western countries and 14.8% of those in Japan. Small carcinoid tumors of the duodenum are often asymptomatic, discovered endoscopically, Duodenal carcinoid tumors have been treated by surgical resection or endoscopic resection with strip biopsy or polypectomy. We experience a case of carcinoid tumor of duodenum in 49 years woman. Endoscopic examination, 0.7 cm sized polypoid mass with central depression was noted on duodenal bulb area. We present a case of a small duodenal carcinoid treated with strip biopsy technique.

Studies for Technical Factors and Measurements of Gastric Emptying Rates / 대한소화관운동학회지

BACKGROUND/AIMS: Not only scintigraphic measurement of gastric emptying(GE) is not standarized, but also several discrepancies exist in the influence of technical factors including instrument and methods of analysis on gastric emptying studies. The aim of this study was to determine whether investigating instruments, methods of analysis, affect gastric emptying rates of a radiolabeled meal in scintigraphic measurement. METHODS: Using two different scanners (single-headed gammma camera and double headed gammma camera), gastric emptying studies of radiolabeled meal (consisting of 1 g of resin) labeled with 2mCi of 99mTc-DTPA (50g of egg, 150ml of milk, 100g of rice; 611Kcal) were done in 16 healthy volunteers (16 men, age 27.5+/-3yrs). Anterior and posterior image were obtained from the supine position with two scanners at every timing interval. Anterior image only was analyzed to determine whether the differences in instruments affect gastric emptying rates. Sum of anterior and posterior counts obtained by double-headed gamma camera were compared to geometric mean. RESULTS: There were significant difference in gastric emptying rates obtained with anterior image between a single-headed scanner and a dual-headed scanner (P < 0.05, T1/2= 105.8+/-16.3 min vs 80.9+/-14.7 min). Sum of anterior and posterior counts was correlated well with geometric mean (r=0.93). Also observed difference between intraobserver and interobserver variation. CONCLUSIONS: These results indicate that instrumental variations in gastric emptying studies should be considered in interpreting individual study results. The simple sum of anterior and posterior counts could be an useful parameter in the analysis and interpretation of gastric emptying data.