Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases

The introduction of device-assisted enteroscopy (DAE) in the beginning of 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of the small bowel diseases, DAE has the unique advantages of observing the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how to perform it and what technical factors should be considered. In response to these needs, the Korean Association for the Study of Intestinal Diseases developed an expert consensus statement on the performance of DAE by reviewing the current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points.

Use of Device-Assisted Enteroscopy in Small Bowel Disease: An Expert Consensus Statement by the Korean Association for the Study of Intestinal Diseases / 대한소화기학회지

The introduction of device-assisted enteroscopy (DAE) in the beginning of the 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of small bowel diseases, DAE has the unique advantages of allowing the observation of the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how it is to be performed and what technical factors should be taken into consideration. In response to these needs, the Korean Association for the Study of Intestinal Diseases has developed an expert consensus statement on the performance of DAE by reviewing current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points.

Rehabilitation Program for Improved Musculoskeletal Pain in Gastrointestinal Endoscopists: Multicenter Prospective Cohort Study

Background/Aims@#This study aimed to develop a rehabilitation program for musculoskeletal pain experienced by gastrointestinal endoscopists and to investigate its usefulness. @*Methods@#This was a multicenter cohort study. During the first 2 weeks, a questionnaire regarding daily workload and musculoskeletal symptoms was administered. Then, a rehabilitation program including equipment/posture correction and stretching was conducted during the remaining 6 weeks. Follow-up daily workload and musculoskeletal symptom surveys were distributed during the last 2 weeks. The program satisfaction survey was performed at the 6th and 8th weeks. @*Results@#Among 118 participants (69 men), 94% (n=111) complained of musculoskeletal pain at baseline. Various hospital activities at baseline were associated with multisite musculoskeletal pain, whereas only a few workloads were correlated with musculoskeletal pain after the rehabilitation program. Follow-up musculoskeletal pain was negatively correlated with equipment/ posture program performance; arm/elbow pain was negatively correlated with elbow (R=–0.307) and wrist (R=–0.205) posture; leg/foot pain was negatively correlated with monitor position, shoulder, elbow, wrist, leg, and foot posture. Higher performance in the scope position (86.8% in the improvement vs 71.3% in the aggravation group, p=0.054) and table height (94.1% vs 79.1%, p=0.054) were associated with pain improvement. An increased number of colonoscopy procedures (6.27 in the aggravation vs 0.02 in the improvement group, p=0.017) was associated with pain aggravation. Most participants reported being average (32%) or satisfied (67%) with the program at the end of the study. @*Conclusions@#Our rehabilitation program is easily applicable, satisfactory, and helpful for improving the musculoskeletal pain experienced by gastrointestinal endoscopists.

Risk factors of advanced metachronous neoplasms in surveillance after colon cancer resection

Background/Aims@#Regular surveillance colonoscopy after colon cancer resection is recommended for detecting metachronous adenoma and cancer. However, risk factors for metachronous neoplasms have not been fully evaluated. We aimed to assess risk factors for advanced metachronous neoplasms during surveillance colonoscopy after colon cancer resection. @*Methods@#Patients who underwent curative colectomy for nonmetastatic colon cancer between January 2002 and December 2012 were evaluated and followed up to December 2017. @*Results@#A total of 293 patients were enrolled in this study. Among these, 179 (61.1%) were male, and the mean age was 63.2 ± 10.4 years. On perioperative clearing colonoscopy, synchronous high-risk adenomas (number ≥ 3, size ≥ 10 mm, high-grade dysplasia, villous histology, and serrated adenoma ≥ 10 mm) were detected in 95 patients (32.4%), and they were significantly associated with male sex, old age (≥ 65 years), current alcohol consumption, and current smoking (p < 0.05). During the follow-up period (mean 74.4 ± 36.4 months), advanced metachronous neoplasms were found in 45 patients (15.4%), including metachronous cancer in four (1.4%). In multivariate analysis, distal colon cancer (distal-to-splenic flexure; odds ratio [OR], 4.402; 95% confidence interval [CI], 1.658 to 11.689; p = 0.003), synchronous highrisk adenomas (OR, 3.225; 95% CI, 1.503 to 6.918; p = 0.003), and hypertension (OR, 2.270; 95% CI, 1.058 to 4.874; p = 0.035) were significant risk factors for advanced metachronous neoplasms. @*Conclusions@#During surveillance after curative colon cancer resection, patients with distal colon cancer, synchronous high-risk adenomas, and hypertension may need meticulous follow-up to improve overall outcomes.

Duodenal Diverticulitis Accompanied by Portal Vein Thrombosis Treated with Endoscopic Therapy / 대한소화기학회지

A 44-year-old woman presented with right upper abdominal pain and nausea with a 4-day duration. An abdominopelvic CT scan revealed a 2.3-cm sized cystic lesion in the duodenum with inflammatory changes and partial thrombosis in the distal main portal vein. Empirical antibiotics were initiated considering acute duodenal diverticulitis, but the symptoms worsened. Side-viewing duodenoscopy revealed purulent fluid draining spontaneously from a small diverticular opening. After enlarging the opening using an extraction balloon, sweeping followed by saline irrigation was performed, and pus and food debris gushed out into the duodenal lumen. The patient recovered rapidly and was discharged uneventfully on the 5th day post-hospitalization with oral antibiotics and warfarin. A follow-up CT scan and duodenoscopy 1 month later revealed a normal-appearing duodenal diverticulum and complete resolution of the portal vein thrombosis. This paper reports a rare case of portal vein thrombosis associated with duodenal diverticulitis. Overall, endoscopic therapy can be effective when conservative management fails and might be a viable alternative to surgery for treating duodenal diverticulitis.

Duodenal Diverticulitis Accompanied by Portal Vein Thrombosis Treated with Endoscopic Therapy / 대한소화기학회지

A 44-year-old woman presented with right upper abdominal pain and nausea with a 4-day duration. An abdominopelvic CT scan revealed a 2.3-cm sized cystic lesion in the duodenum with inflammatory changes and partial thrombosis in the distal main portal vein. Empirical antibiotics were initiated considering acute duodenal diverticulitis, but the symptoms worsened. Side-viewing duodenoscopy revealed purulent fluid draining spontaneously from a small diverticular opening. After enlarging the opening using an extraction balloon, sweeping followed by saline irrigation was performed, and pus and food debris gushed out into the duodenal lumen. The patient recovered rapidly and was discharged uneventfully on the 5th day post-hospitalization with oral antibiotics and warfarin. A follow-up CT scan and duodenoscopy 1 month later revealed a normal-appearing duodenal diverticulum and complete resolution of the portal vein thrombosis. This paper reports a rare case of portal vein thrombosis associated with duodenal diverticulitis. Overall, endoscopic therapy can be effective when conservative management fails and might be a viable alternative to surgery for treating duodenal diverticulitis.

Chronic Functional Constipation / 대한소화기학회지

Constipation is a common functional problem of the digestive system and may occur secondary to diet, drugs, endocrine diseases, metabolic diseases, neurological diseases, psychiatric disorders, or gastrointestinal obstruction. When there is no secondary cause, constipation is diagnosed as functional constipation. The first steps that should be taken to relieve symptoms are diet and lifestyle modifications, and if unsuccessful, laxative therapy should be initiated. If a patient does not respond to laxative therapy, diagnostic anorectal physiological tests are performed, though they are not routinely recommended. However, these tests may be considered earlier in patients strongly suspected to have a defecatory disorder. The revised guideline on the diagnosis and treatment of chronic constipation will undoubtedly aid the individualized management of chronic constipation in clinical practice.

Acute gastric dilatation and ischemia associated with portal vein gas caused by binge eating

No abstract available.

Can Certain Foods Cause Gastrointestinal Symptoms in Korean Patients With Irritable Bowel Syndrome?

No abstract available.

Change in the Prevalences and Risk Factors of Atrophic Gastritis and Intestinal Metaplasia in Korea: Multicenter Clinical Trials

BACKGROUND/AIMS: The aim of this study was to analyze the trend of the prevalences of atrophic gastritis (AG) and intestinal metaplasia (IM) from 2011 to 2016~2017 in Korea. And, the risk factors of AG and IM were compared between 2011 and 2016~2017. MATERIALS AND METHODS: A total of 4,023 subjects in 2011 and 2,506 subjects in 2016~2017 were enrolled. AG and IM were diagnosed on the basis of endoscopic findings. Multivariate analysis was performed for risk factors of AG and IM. Seventeen factors were analyzed. RESULTS: The seroprevalence of Helicobacter pylori decreased from 2011 (59.8%; 2,407/4,023) to 2016~2017 (51.6%; 1,293/2,506; P < 0.001). The prevalence of AG decreased from 2011 to 2016~2017 (P=0.018), but that of IM increased (P < 0.001). The risk factors of AG in 2011 were male sex, old age, H. pylori immuoglobulin G (IgG) positivity, family history of gastric cancer (GC), and high-salt diet. For IM in 2011, the risk factors were male sex, old age, H. pylori IgG positivity, and family history of GC. Risk factors of AG in 2016~2017 were old age, H. pylori IgG positivity, and country of residence. For IM in 2016~2017, the risk factors were male sex, old age, family history of GC, high fasting glucose level (≥126 mg/dL), H. pylori IgG positivity, and low income level. CONCLUSIONS: The difference in prevalence trends of AG and IM between 2016~2017 and 2011 could be the result of the different risk factors of AG and IM, such as decreased prevalence of H. pylori infection.

Prevalence and Risk Factors of Functional Dyspepsia in Health Check-up Population: A Nationwide Multicenter Prospective Study

BACKGROUND/AIMS: Functional dyspepsia (FD) is one of the most common gastrointestinal disorders, and FD imposes social and economic burden worldwide. The aim of this study is to identify the prevalence and risk factors of FD in health check-up population in tertiary centers in Korea. METHODS: A nationwide multicenter prospective study was performed at 9 tertiary healthcare centers in Korea between September 2016 and June 2017. A total of 2525 subjects were investigated based on endoscopic findings and questionnaires with the Rome III criteria, and Helicobacter pylori serology (IgG). RESULTS: A total of 1714 subjects without organic disease were enrolled. The mean (± SD) age was 51.5 (± 12.7) years, and 917 patients (53.5%) were female. The proportion of H. pylori seropositivity was 51.0% (874/1714). The prevalence of FD was 10.3% (176/1714), and the subtypes of postprandial distress syndrome alone, epigastric pain syndrome alone, and postprandial distress syndrome-epigastric pain syndrome overlap were 4.8%, 3.0%, and 2.5%, respectively. Multivariate analysis showed that female gender (OR, 1.58; 95% CI, 1.14–2.21) and education below college level (OR, 1.45; 95% CI, 1.01–2.07) were related to FD. Multivariate analysis based on age 60 showed female gender as a significant (OR, 2.90; 95% CI, 1.06–7.94) factor in the group ≥60 years. CONCLUSIONS: The prevalence of FD was 10.3% in the health check-up population in Korea. Female sex and education below college level were risk factors for FD. Female sex is a risk factor for FD in old age, underscoring the need for close attention in this age group.

Cronkhite-Canada Syndrome Showing Good Early Response to Steroid Treatment / 대한소화기학회지

No abstract available.

Conversion of Percutaneous Cholecystostomy to Endoscopic Gallbladder Stenting by Using the Rendezvous Technique

We report the successful conversion of percutaneous cholecystostomy (PC) to endoscopic transpapillary gallbladder stenting (ETGS) with insertion of an antegrade guidewire into the duodenum. An 84-year-old man presented with severe acute cholecystitis and septic shock. He had significant comorbidities, and emergent PC was successfully performed. Subsequent ETGS was attempted but unsuccessful owing to difficulties with cystic duct cannulation. However, via the PC tract, the guidewire was passed antegradely into the duodenum, and ETGS with a double-pigtail plastic stent was successfully performed with the rendezvous technique. The PC tube was removed, and no recurrence was reported during the 17-month follow-up period. Conversion of PC to ETGS is a viable option in patients with acute cholecystitis who are not candidates for surgery. Antegrade guidewire insertion via the PC tract may increase the success rate of conversion and decrease the risk of procedure-related complications.

Acute Necrotizing Pancreatitis Caused by Iatrogenic Hypercalcemia / 대한췌담도학회지

Gallstones and alcohol consumption are well-known causes of acute pancreatitis, which usually follows a mild and self-limited course. Although extremely rare, hypercalcemia is a possible cause of acute pancreatitis. There are only few reported cases, all of which were mild and self-limited. Here we report a patient with iatrogenic hypercalcemia-induced necrotizing pancreatitis that progressed to serious adverse events such as biliary obstruction, peripancreatic fluid collection with walled-off necrosis, and acute cholecystitis. The patient was successfully treated with appropriate endoscopic and radiologic interventions, and recovered well.

Endoscopic Ultrasound Guided Intervention / 대한내과학회지

Endoscopic ultrasound (EUS) has recently become widely used for the diagnosis and treatment of gastrointestinal disease. With applications of linear EUS and EUS-guided fine needle aspiration, many EUS-guided interventions are now emerging as feasible treatment options for patients with pancreatobiliary disease. EUS-guided drainage from pseudocyst, bile duct, pancreatic duct, and the gallbladder are becoming routine procedure. EUS-guided celiac plexus neurolysis and block can relieve intractable pancreatic pain. Moreover, EUS-guided local tumor therapy (ethanol ablation and radiofrequency ablation) may be feasible in selected patients. Safe EUS-guided intervention requires a good deal of experience but is becoming widely used to treat pancreatobiliary disease.