Clipping for the Prevention of Immediate Bleeding after Polypectomy of Pedunculated Polyps: A Pilot Study

BACKGROUND/AIMS: Immediate postpolypectomy bleeding (IPPB) increases the procedure time and it may disturb performing a safe polypectomy. The purpose of this study is to investigate whether clipping before snare polypectomy of large pedunculated polyps is useful for the prevention of IPPB. METHODS: This is a single arm, pilot study. We enrolled patients with pedunculated colorectal polyps that were 1 cm in size or more from 4 university hospitals between June 2009 and June 2010. Clips were applied at the stalk and snare polypectomy was then performed. The complications, including IPPB, were investigated. RESULTS: Fifty six pedunculated polyps in 47 patients (Male:Female=36:11; age, 56+/-11 years) were included. The size of the polyp heads was 17+/-8 mm. Tubular adenoma was most common (57%). The number of clips used before snare polypectomy was 2+/-0.5. The procedure was successful in all cases. IPPB occurred in 2 cases (3.6%), and both of these were managed by additional clipping. Delayed bleeding occurred in another one case (1.8%), which improved with conservative treatment. No perforation occurred. CONCLUSIONS: We suggest that clipping before snare polypectomy of pedunculated polyps may be an easy and effective technique for the prevention of IPPB, and this should be confirmed in large scale, prospective, controlled studies.

IL-1beta and IL-1RN polymorphisms in gastroduodenal diseases / 대한내과학회지

BACKGROUND: IL-1beta and IL-1 receptor antagonist (IL-1RN) genetic polymorphisms have been associated with development of gastric atrophy and increased risk of gastric carcinoma. This study aimed to determine the effects of these polymorphisms in gastroduodenal diseases. METHODS: This study population was comprised of 297 patients and they were grouped into gastritis, gastric ulcer, duodenal ulcer, and gastric cancer. We determined IL-1beta-511/-31/+3954 and IL-1RN genotype by polymerase chain reaction using gastric biopsy specimens. RESULTS: The genotype of IL-1beta-511 C/T, -31 T/C, +3954 C/C, and IL-1RN *1/*1 was predominant in all four groups. Allelic and genotypic frequencies of IL-1beta-511/-31/+3954 and IL-1RN showed no significant difference in four groups. IL-1beta-511 T/T, -31 C/C, +3954 C/T, and IL-1RN *2 carriers did not show increased risk of gastric ulcer, duodenal ulcer and gastric cancer. Classification of gastric cancer into intestinal and diffuse type also showed no significant difference of IL-1beta-511/-31/+3954 and IL-1RN genotypic frequencies. CONCLSUION: There was no significant difference of IL-1beta and IL-1RN polymorphisms between patients with gastritis, gastric ulcer, duodenal ulcer and gastric cancer. Therefore, other endogenous or exogenous factors will play more important role in the development of gastroduodenal diseases in Korean.

An associatioin of cagA+ helicobacter pylori infection with cell proliferation in gastric mucosae of gastritis and gastric cancer patients / 대한내과학회지

BACKGROUND: It has been suggested that cytotoxin associated gene A (cagA) is a marker of more virulent strains of H. pylori and cagA bearing H. pylori is more pathogenic in the gastrointestinal diseases. On the other hand, according to several reports H. pylori causes the cell proliferation, which may be an important mechanism of gastric carcinogenesis. So, we studied to elucidate whether there is the association of the cagA positive H. pylori infection with cell proliferation on the gastric mucosae of the patients with gastritis and gastric cancer or not. METHODS: In this study, 27 gastritis and 35 gastric cancer patients were included. PCR assay for the detection of H. pylori(ureA PCR) and cagA bearing H. pylori(eagA PCR) were performed on the gastric mucosal biopsy specimen. Immunohistochemical study using the MIB 1 Ab against Ki 67 antigen was carried out to evaluate the cell proliferation. RESULTS: The prevalence of H. pylori infection was 85.2%(23/27) in the patients with gastritis and 54.3%(19/ 35) in the patients with gastric cancer. The prevalence of cagA+ strain of H. pylori was 52.2%(12/23) and 47.4%(9/ 19) in the patients with gastritis and gastric cancer. In the patients with gastritis, the degree of cell proliferation was not different in the ureA positive(24.8%) and ureA negative(21.7%) gastric mucosae. Moreover, the difference of cell proliferation was not observed according to the presence or absence of cagA gene(29.4% vs 19.9%) among the ureA positive gastric mucosae. In the patients with gastric cancer, cell proliferation indices were 25.5% and 27.5% in the ureA postive and cagA negative gastric mucosae, 28.1% and 22.2% in the cagA positive and cagA negative group among the ureA positive gastric mucosae. There was no significant difference statistically. CONCLUSIONS: There was no association of cagA+ strain of H. pylori with cell proliferation in the gastric mucosae of the patients with gastritis and gastric cancer. It was presumed that more studies are needed to elucidate the role of H. pylori infection in the gastric carcinogenesis.

Compositional Characteristics of Gallstones in Pusan & Kyungnam area / 대한내과학회지

OBJECTIVES: The composition of gallstones is very variable depending on many factors such as diet, sex, race, genetic background, and so on. The compositional changes of gallstones have been reported in Korean people. Author studied the compositional characteristics of gallstones in Pusan area to see geographical difference. MATERIAL AND METHODS: Gas chromatography and Mass spectrophotometry was performed on the gallstones obtained from the 34 patients who had been taken cholecystectomy because of acute or chronic cholecystitis. Cholesterol gallstone was defined as the composition of the cholesterol is more than 50%. RESULTS: The cholesterol gallstone was 67.6% (23/34) in the 34 patients. There was sexual difference in the cholesterol gallstone group, which the ratio of male and female was 1:2.3(7/16), while there was no difference in the non-cholesterol stone(5:6). The cholesterol stone consisted with cholesterol, bilirubin, bile acid, and palmitic acid and the propotion of them was 75.6%, 4.6%, 15.0%, and 1.8% respectively. While the proportion of non-cholesterol stone was 30.2%, 26.8%, 37.5%, and 5.5% respectively. CONCLUSIONS: The cholesterol stone was major fraction of gallstone of the patients in Pusan area. There was no difference on the compostion of gallstones between those of patients in Pusan area and in the other area of Korea.