Antral or Pyloric Deformity Is a Risk Factor for the Development of Postendoscopic Submucosal Dissection Pyloric Strictures

BACKGROUND/AIMS: Surgeons must be aware of risk factors for strictures before performing endoscopic submucosal dissection (ESD), to enable early interventions to prevent severe strictures. METHODS: This study was a single-center retrospective study. We reviewed the clinical data of patients who has undergone gastric ESD from January 2007 to December 2012. RESULTS: Among the 3,819 patients who had undergone gastric ESD, 11 patients (7.2%) developed pyloric strictures and received successful endoscopic balloon dilation. Significant differences were noted between the patients without and with post-ESD strictures for pretreatment of antral or pyloric deformities (46.4% vs 81.8%), the proportion of extension to the lumen circumference (>3/4, 9.4% vs 54.5%), the longitudinal extent of mucosal defects (27.9±10.1 mm vs 51.5±10.8 mm), and post-ESD bleeding (2.9% vs 27.3%). Multivariate analysis revealed that pretreatment antral or pyloric deformities (odds ratio [OR], 30.53; 95% confidence interval [CI], 1.476 to 631.565; p=0.027), larger longitudinal extent of mucosal defects (OR, 1.20; 95% CI, 1.074 to 1.340; p=0.001), and circumferential extension of 3/4 (OR, 13.69; 95% CI, 1.583 to 118.387; p=0.017) were independent risk factors for post-ESD stricture. CONCLUSIONS: Antral or pyloric deformities, sub-circumferential resection over more than 75% of the circumference and greater longitudinal extent of mucosal defects are independent risk factors for post-ESD stricture.

Clinical Outcomes of Endoscopic Submucosal Dissection in Patients under 40 Years Old with Early Gastric Cancer

BACKGROUND/AIMS: The clinicopathologic features of gastric cancer in young patients are different from those of older patients. However, endoscopic submucosal dissection (ESD) is performed regardless of age. The purpose of this study was to characterize younger patients (≤40 years) who underwent ESD for early gastric cancer (EGC) and analyze the results of ESD. MATERIALS AND METHODS: From January 2006 to June 2014, 55 patients aged 40 years or younger with newly diagnosed EGC underwent ESD at two tertiary hospitals. The clinicopathologic features of EGC and clinical outcomes of ESD in these young patients were reviewed retrospectively. RESULTS: A total 55 patients with 57 EGC lesions underwent ESD. Female sex, superficial flat or depressed lesions, and undifferentiated histology were more common in younger patients than in older patients in our institutional ESD cohort. The en bloc resection rate was 92.7% and the complete resection rate was 94.5%. Although there was a high proportion of undifferentiated cancer in the younger patient group, the curative resection rate was 72.7%. Among 15 patients with non-curative resection, 4 patients underwent additional surgery and 1 patient underwent argon plasma coagulation at the ESD ulcer margin. Eight patients were placed under close surveillance without additional treatment, and no recurrent tumors developed, with a median follow-up period of 37.2±23.6 months. CONCLUSIONS: Younger EGC patients who underwent ESD showed the typical characteristics seen in younger patients with gastric cancer. ESD in younger EGC patients showed comparable outcomes to those in patients with undifferentiated EGC in general.

A Case of von Hippel-Lindau Disease with Colorectal Adenocarcinoma, Renal Cell Carcinoma and Hemangioblastomas / Journal of the Korean Cancer Association, 대한암학회지

von Hippel-Lindau (VHL) disease is an autosomal dominant inherited tumor syndrome associated with mutations of the VHL tumor suppressor gene located on chromosome 3p25. The loss of functional VHL protein contributes to tumorigenesis. This condition is characterized by development of benign and malignant tumors in the central nervous system (CNS) and the internal organs, including kidney, adrenal gland, and pancreas. We herein describe the case of a 74-year-old man carrying the VHL gene mutation who was affected by simultaneous colorectal adenocarcinoma, renal clear cell carcinoma, and hemangioblastomas of CNS.

A Case of Successful Endoscopic Clipping for Iatrogenic Colon Perforation Induced by Peritoneal Catheter Insertion / 대한소화기학회지

Advanced cancer patients with refractory ascites often do not respond to conventional treatments including dietary sodium restriction, diuretics, and repeated large volume paracentesis. In these patients, continuous peritoneal drainage by an indwelling catheter may be an effective option for managing refractory ascites with a relative low complication rate. Peritoneal catheter-induced complications include hypotension, hematoma, leakage, cellulitis, peritonitis, and bowel perforation. Although bowel perforation is a very rare complication, it can become disastrous and necessitates emergency surgical treatment. Herein, we report a case of a 57-year-old male with refractory ascites due to advanced liver cancer who experienced iatrogenic colonic perforation after peritoneal drainage catheter insertion and was treated successfully with endoscopic clipping.

Vaccination and Complementary and Alternative Medicine in Patients with Inflammatory Bowel Disease

BACKGROUND/AIMS: Vaccinations in patients with inflammatory bowel disease (IBD) are recommended to prevent infectious diseases. However, there are few reports of vaccination in IBD patients in Korea. The frequency of complementary and alternative medicine (CAM) use is high despite its uncertain effectiveness. This study aimed to identify the rates of vaccination and use of CAM in patients with IBD. METHODS: A total of 219 patients attended an education session for IBD patients held at Severance Hospital on March 23, 2013. We conducted a survey on vaccination and CAM use in IBD patients; 120 patients completed the questionnaire. RESULTS: The influenza vaccination rate was 44.2% and pneumococcal vaccination rate was 4.2%. Thirty-one (66%) patients were aware of the importance of vaccination. The vaccination rate was higher in patients who were aware of the importance of vaccination compared with that in patients who were unaware of the importance of vaccination (70.1% vs. 41.7%, P=0.004). The rate of CAM use was 30.0%. The most commonly used CAMs were oral products: vitamins (33.3%), red ginseng (25.0%), and probiotics (19.4%). CONCLUSIONS: Awareness of the importance of vaccination and actual vaccination rates were low in IBD patients. Despite insufficient evidence on the effectiveness of CAMs in IBD patients, many patients used CAMs. We believe that repeated education and promotion of vaccination are important. Further large-scale studies to investigate the efficacy and safety of CAMs are warranted in patients with IBD.

Suicide Trend of Standardized Mortality Ratio and Age Standardized Proportion Mortality Ratio According to Occupational Groups in Korea: 1993-2007 / 대한산업의학회지

OBJECTIVES: A number of studies on the trends of socioeconomic differences in suicide mortality have indicated that these inequality gaps have widened over time and highlight that certain occupations have more suicide risk than others. However suicide rates according to occupation based socioeconomic position have not been frequently studied in Korea. The purpose of this study is to report trends and inequality of suicide according to occupation based social class during 1993-2007 in Korea and to identify occupations with significantly high standardized mortality ratios (SMRs) and proportional mortality ratios (PMRs) for both men and women. METHODS: Korean census records for the years 1995, 2000, and 2005 were linked with the cause of death records from Korean National Statistical Office (KNSO) for the periods 1993-1997, 1998-2003, and 2004-2007 respectively. This data was used to calculate age adjusted proportional mortality ratios (PMRs) and standardized mortality ratios (SMRs) for both men and women aged 25~54 years according to five occupation based socioeconomic positions. RESULTS: Among men, the agricultural-fishery-forestry group had the greatest suicide rate (SMR: 341) with a high PMR (113) and the manual labor group showed the highest PMR (118), while the managers-professional occupation group showed the lowest sPMR (78) and SMR (21). Among women, the agricultural-fishery group had the highest score in SMR (316) and PMR (130), and the technical-artificer group showed the lowest sPMR (71) and SMR (27). The inequality gaps in the suicide mortality rate according to occupation had widened during 1998-2002, but showed a recovery trend plot after 2003. CONCLUSIONS: Although the occupation based socioeconomic inequalities show a recovery trend after 2003, the excess inequality from suicide remains as high as it was prior to the 2002 year in some occupational groups. The results of the current study indicate that the manual and agricultural-fishery-forestry groups were high risk groups of suicide.