Second-look endoscopy findings after endoscopic submucosal dissection for colorectal epithelial neoplasms

Background/Aims@#Although second-look endoscopy (SLE) is frequently performed after gastric endoscopic submucosal dissection (ESD) to prevent bleeding, no studies have reported SLE findings after colorectal ESD. This study aimed to investigate SLE findings and their role in preventing delayed bleeding after colorectal ESD. @*Methods@#Post-ESD ulcer appearances were divided into coagulation (with or without remnant minor vessels) and clip closure groups. SLE findings were categorized according to the Forrest classification (high-risk ulcer stigma [type I and IIa] and low-risk ulcer stigma [type IIb, IIc, III, or clip closure]), and risk factors for high-risk ulcer stigma were analyzed. @*Results@#Among the 375 cases investigated, SLEs were performed in 171 (45.6%) patients. The incidences of high-risk ulcer stigma and low-risk stigma were 5.3% (9/171) and 94.7% (162/171), respectively. During SLE, endoscopic hemostasis was performed more frequently in the high-risk ulcer stigma group than in the lowrisk ulcer stigma group (44.4% [4/9] vs. 1.9% [3/162], respectively; p < 0.001), but most of the endoscopic hemostasis in the high-risk ulcer stigma group (3/4, 75.0%) were prophylactic hemostasis. Post-ESD delayed bleeding occurred in three (0.8%) patients belonging to the SLE group, of which, one patient was from the high-risk stigma group and two were from the low-risk stigma group. @*Conclusions@#The incidence of high-risk ulcer stigma during SLE was low, and delayed bleeding occurred in, both, high-risk and low-risk groups of SLE. SLEs performed after colorectal ESD may not be effective in preventing delayed bleeding, and further prospective studies are needed to evaluate the efficacy of SLE in post-colorectal ESD.

Second-look endoscopy findings after endoscopic submucosal dissection for colorectal epithelial neoplasms

Background/Aims@#Although second-look endoscopy (SLE) is frequently performed after gastric endoscopic submucosal dissection (ESD) to prevent bleeding, no studies have reported SLE findings after colorectal ESD. This study aimed to investigate SLE findings and their role in preventing delayed bleeding after colorectal ESD. @*Methods@#Post-ESD ulcer appearances were divided into coagulation (with or without remnant minor vessels) and clip closure groups. SLE findings were categorized according to the Forrest classification (high-risk ulcer stigma [type I and IIa] and low-risk ulcer stigma [type IIb, IIc, III, or clip closure]), and risk factors for high-risk ulcer stigma were analyzed. @*Results@#Among the 375 cases investigated, SLEs were performed in 171 (45.6%) patients. The incidences of high-risk ulcer stigma and low-risk stigma were 5.3% (9/171) and 94.7% (162/171), respectively. During SLE, endoscopic hemostasis was performed more frequently in the high-risk ulcer stigma group than in the lowrisk ulcer stigma group (44.4% [4/9] vs. 1.9% [3/162], respectively; p < 0.001), but most of the endoscopic hemostasis in the high-risk ulcer stigma group (3/4, 75.0%) were prophylactic hemostasis. Post-ESD delayed bleeding occurred in three (0.8%) patients belonging to the SLE group, of which, one patient was from the high-risk stigma group and two were from the low-risk stigma group. @*Conclusions@#The incidence of high-risk ulcer stigma during SLE was low, and delayed bleeding occurred in, both, high-risk and low-risk groups of SLE. SLEs performed after colorectal ESD may not be effective in preventing delayed bleeding, and further prospective studies are needed to evaluate the efficacy of SLE in post-colorectal ESD.

A Clear Liquid Diet Is Not Mandatory for Polyethylene Glycol-Based Bowel Preparation for Afternoon Colonoscopy in Healthy Outpatients

BACKGROUND/AIMS: A dietary regimen consisting of a clear liquid diet (CLD) for at least 24 hours is recommended for colonoscopy preparation. However, this requirement results in problems in patient compliance with bowel preparation. The aim of this study was to evaluate the efficacy of a CLD compared with a regular diet (RD) for colonoscopy preparation using a polyethylene glycol (PEG) solution. METHODS: This was a multicenter, randomized, investigator-blind prospective study. A total of 801 healthy outpatients undergoing afternoon colonoscopy were randomized to either a CLD or RD in addition to a 4 L PEG regimen. RESULTS: The quality of bowel cleansing was not different between the CLD and RD groups in terms of the proportion with excellent or good preparation. In addition, no significant differences were observed between the two groups for polyp and adenoma detection rates and overall adverse events. Good compliance with bowel preparation was higher in the RD group than in the CLD group. CONCLUSIONS: A CLD for a full day prior to colonoscopy should not be mandatory for PEG-based bowel preparation. Dietary education concerning the avoidance of high-fiber foods for 3 days before colonoscopy is sufficient, at least for healthy outpatients.

Comparison of Bowel Preparation Quality between Clear-liquid Diet and No Diet Restriction

BACKGROUND/AIMS: Adequate bowel preparation is essential for full visualization of colonic mucosa because detection of small polyps and neoplasms depends on the quality of bowel cleansing. The aims of this study were to compare the efficacy, tolerability of preparation and side effect between two groups: clear-liquid diet with polyethylene glycol (PEG) solution versus no diet restriction with PEG solution. METHODS: This was a randomized single-blind prospective study. A total of 330 patients were randomly assigned to receive either 2 L PEG solution with a clear-liquid diet on the day before colonoscopy and another 2 L PEG solution on the day of the procedure (group 1) or 2 L PEG solution with a general diet on the day before colonoscopy and another 2 L PEG solution on the day of the procedure (group 2). RESULTS: 162 patients were assigned to group 1 and 168 patients to group 2. The satisfactory quality of bowel preparation was not significantly different between the two groups (80.2%, 78.6%, P=0.707). Patient's compliance of the clear-liquid diet in group 1 was 50%. The satisfactory quality of bowel preparation was weakly better when the clear-liquid diet was given 2 or 3 times a day (group 1A) than 0 or once a day (group 1B) (74.1%, 86.4%, P=0.048). The tolerability of the PEG solution and side effects of preparation were not significantly different in the two groups (P=0.573, 0.686). CONCLUSIONS: Bowel preparation with no diet restriction and split-dose PEG solution was similar to preparation with a clear-liquid diet in efficacy, tolerability and side effect. Therefore, the use of the clear-liquid diet protocol should improve patient's compliance.

Gastroduodenal Intussusception Due to Pedunculated Polypoid Gastrointestinal Stromal Tumor / 대한소화기학회지

The gastrointestinal stromal tumor (GIST) is a mesenchymal tumor of the digestive tract showing differentiation along the line of interstitial cell of Cajal. The most GISTs in the stomach generally show the appearance of submucosal tumors. It is rare for GISTs to appear as a pedunculated polypoid lesion on endoscopy. We experienced a case of a 51-year-old man who had a pedunculated polypoid GIST. He was admitted to our hospital for nausea, vomiting, melena and severe anemia (hemoglobin 3.4 g/dL, hematocrit 10.8%). An upper endoscopy showed gastroduodenal intussusception due to a pedunculated polypoid mass. This report presents a rare case of endoscopically proven gastroduodenal intussusceptions due to pedunculated polypoid GIST in the stomach.

Clinical impacts of hazardous alcohol use and obesity on the outcome of entecavir therapy in treatment-naive patients with chronic hepatitis B infection

BACKGROUND/AIMS: The aim of this study was to analyze the clinical impacts of obesity and hazardous alcohol use on the outcome of entecavir (ETV) therapy in chronic hepatitis B (CHB) patients. METHODS: The medical records of 88 treatment-naive patients who were diagnosed with CHB and received ETV between March 2007 and September 2009 were analyzed retrospectively. Body mass index (BMI) values and Alcohol Use Disorders Identification Test (AUDIT) scores were obtained at 6 months after the initiation of ETV (0.5 mg daily) treatment. RESULTS: A BMI of 25 kg/m2 or more was recognized as an indicator of obesity, and a total AUDIT score of 8 or more was recognized as an indicator of hazardous alcohol use. Of the cohort, 24 patients (27.3%) were obese and 17 (19.3%) were hazardous alcohol users. The rate of seroconversion, alanine aminotransferase (ALT) normalization, and hepatitis B virus (HBV)-DNA negativity (<300 copies/mL) at 3, 6, and 12 months of treatment did not differ significantly between the normal-BMI and high-BMI groups. Moreover, the rate of seroconversion and HBV-DNA negativity at 3, 6, and 12 months of treatment did not differ significantly between the nonhazardous and hazardous alcohol users. However, the frequency of ALT normalization at 12 months was significantly lower among hazardous alcohol users (91.5% vs. 70.6%; P=0.033). CONCLUSIONS: Obesity and hazardous alcohol drinking have no significant impact on the outcome of ETV treatment. However, the ALT normalization rate at 12 months after initiation of ETV treatment was significantly lower among the hazardous alcohol users.

Comparison of Infliximab and Infliximab/Azathioprine for Maintenance Therapy in Korean Patients with Luminal Crohn's Disease

BACKGROUND/AIMS: The benefits and risks of concomitant immunomodulators with infliximab maintenance therapy in patients with luminal Crohn's disease (CD) have not been adequately evaluated. We studied the influence of immunomodulator discontinuation in patients in remission with infliximab therapy through a restrospective case-control study. METHODS: Medical records of 37 patients with luminal CD who received infliximab at four medical centers were retrospectively analyzed. We compared clinical and follow-up data of patients who were treated with infliximab alone with that of patients with combination therapy. RESULTS: Among 37 patients, 31 (83.7%) were treated with infliximab plus azathioprine and six (16.2%) were treated with infliximab alone. Of the 31 patients receiving combination maintenance therapy, 26 (83.9%) were in complete remission after 12 months, as compared with five of six patients (83.3%) receiving infliximab alone. No significant difference was observed in remission rate between two groups (P=0.735). In total, 16.1% of patients in combination therapy and 16.7% in infliximab alone group reported side effects (P=1.000), but serious adverse events such as reactivation of tuberculosis were noted in only one patient in combination therapy group. CONCLUSIONS: Concomitant immunomodulators did not improve efficacy in patients with luminal CD who received scheduled infliximab maintenance.

A case of lymphoplasmacytic sclerosing pancreatitis with pancreatic adenocarcinoma / 대한내과학회지

Lymphoplasmacytic sclerosing pancreatitis (LPSP) is a rare entity that has been described under many different names; LPSP is an autoimmune form of chronic pancreatitis. LPSP may simulate a neoplastic process both clinically and radiologically. We report a case of LPSP with pancreatic adenocarcinoma. A 70-year-old woman was admitted to our hospital for evaluation of pancreatic duct dilatation. The CA 19-9 level was normal and the antinuclear antibody titer was negative. An abdominal CT revealed a low density nodule, 8 mm in size, in the body of the pancreas with parenchymal atrophy and mild dilatation of the main pancreatic duct in the body and tail portion. Endoscopic retrograde cholangiopancreaticography demonstrated a stricture of the main pancreatic duct in the body of the pancreas and mild dilatation of the upstream duct. She underwent subtotal pancreatectomy and splenectomy. The results of the pathologic examination of the resected tissue included pancreatic ductal adenocarcinoma with pancreatic intraepithelial neoplasia in the background of lymphoplasmacytic sclerosing pancreatitis.

A case of acute renal failure associated with non-fulminant acute hepatitis A / 대한내과학회지

Acute hepatitis A is generally a mild, self-limiting disease of the liver. Acute renal failure is extremely rare in patients with acute non-fulminant hepatitis A. Acute tubular necrosis is the most common form of renal injury found in such patients. The 27 years old male patient visited our hospital with complaint of fatigue, nausea and vomiting. He was diagnosed with acute renal failure associated with acute non-fulminant hepatitis A. The renal biopsy demonstrates tubulointerstitial nephritis with focal tubular necrosis on light microscopy. We report here on a case of acute renal failure associated with non-fulminant hepatitis A, and we include a review of the literature.

The association of sex hormones and the metabolic syndrome in apparently healthy Korean male adults / 대한내과학회지

BACKGROUND: Recent studies report an association of decreased testosterone levels with type 2 diabetes mellitus, insulin resistance, hyperinsulinemia, dyslipidemia and metabolic syndrome. However, studies on correlations of testosterone with dyslipidemia, insulin resistance and metabolic syndrome in Koreans are scarce. We analyzed the relationship between levels of sex hormones and metabolic syndrome, lipid profiles and insulin resistance in Korean adult males. METHODS: A total of 289 males were selected among the participants in a medical health check-up from June to July 2003 at Kangbuk Samsung Hospital Health Promotion Center. Metabolic syndrome was defined according to the Modified National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) III. The serum total testosterone level was measured using a radioimmunoassay and sex hormone binding globulin (SHBG) was measured using a radioimmunometric assay. RESULTS: The prevalence of metabolic syndrome was 15.6% and the total testosterone level showed a significant correlation with the levels of high-density lipoprotein cholesterol, fasting insulin, and uric acid even after adjustment for age and body mass index (BMI). Serum SHBG showed a significant correlation with diastolic blood pressure, uric acid, triglyceride, fasting insulin and insulin resistance indices. In logistic regression analysis in which age, drinking history, and smoking status were adjusted, decreased total testosterone and SHBG levels as well as increased estradiol levels showed significant correlations with an increased prevalence of metabolic syndrome. CONCLUSION: This study shows that decreased total testosterone and SHBG levels and an increased estradiol level were significantly correlated with increased metabolic syndrome prevalence and dyslipidemia in healthy Korean male adults. Further studies are suggested for the association of sex hormone replacement and the changes in the metabolic status.