Long-term Outcome of Endoscopic Mucosal Resection for Gastric Adenoma and Factors Related to Recurrence / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been known as a method of local treatment for early gastric cancer (EGC) or gastric adenoma. It has been widely accepted as a useful method due to its minimal invasiveness, safety and satisfactory result. The purpose of this study was to identify the factors affecting the recurrence after EMR. METHODS: Three hundred twenty adenomas in 297 patients were treated by EMR from January, 1991 until July 2003. Among those, 197 lesions in 184 patients that could have been followed-up were analyzed retrospectively. RESULTS: The mean follow-up period was 15.0 (1~89) months. Of the 197 lesions, there were 35 recurrences (17.7%). The recurrence rate was higher in lesions associated with severe mucosal atrophy and intestinal metaplasia in surrounding mucosa (p=0.035). Other factors showed no statistically significant difference in recurrence rate. CONCLUSIONS: In this study, we concluded that the presence of intestinal metaplasia and severe atrophic background mucosa were related to the recurrence of gastric adenoma after EMR.

Expression of Cyclooxygenase-2 and p53 Protein in Colonic Adenoma with Malignant Change / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to investigate the value of expression of COX-2 and p53 protein in colonic adenoma with or without malignant change. METHODS: We studied twenty-five cases of colonic adenoma with malignant change and twenty-five cases of colonic adenoma without malignant change treated by colonoscopic polypectomy in Chungnam National University Hospital from January, 1999 to July, 2002. We compared the expression of COX-2 and p53 protein by immunohistochemical stain in both group. RESULTS: In immunohistochemical staining, the expression of COX-2 was demonstrated 68.0% (17 of 25) of colonic adenoma with malignant change and not different with that of colonic adenoma without malignant change. The overexpression of p53 protein was detected immunohistochemically in 88.0% (22 of 25) of colonic adenoma with malignant change and 32% (8 of 25) of colonic adenoma only (p <0.05). CONCLUSIONS: The degree of COX-2 expression was similar in colonic adenoma and colonic adenoma with malignant change, but the expression of p53 in colonic adenoma with malignant change was significantly higher (p <0.05). These results suggest COX-2 might operate on early step of adenoma-carcinoma sequence. Also these results remind us that mutation of p53 gene operates on the late step of adenoma-carcinoma sequence.

Clinical Significance of Transiently Elevated Serum AFP Level in Developing Hepatocellular Carcinoma in HBsAg Positive-Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: Serum alpha fetoprotein (alpha-FP) measurement has a limitation to detect hepatocellular carcinoma (HCC) because it is elevated in various liver diseases. Therefore, we studied the sensitivity and specificity of high alpha-FP in the diagnosis of HCC. METHODS: We studied 253 patients with HBsAg positive liver cirrhosis prospectively. We analyzed incidence of HCC related cut-off values of serum alpha-FP levels. During the follow-up period, we analyzed sensitivity and specificity of cut-off values of alpha-FP for the diagnosis of HCC, and alpha-FP elevation rate in relation to mass size. RESULTS: One hundred and twenty-five patients had a transient elevation of alpha-FP levels above 20 ng/mL. The corresponding incidences of HCC were 27.2% (34/125) and 15.6% (20/128 patients without elevation of alpha-FP), respectively with a statistically significant difference (p=0.03). Among 54 patients with HCC, 18 patients (33.0%) had levels of alpha-FP below 20 ng/mL on the time of diagnosis of HCC. When we defined cut-off values of serum alpha-FP as 20, 100 and 500 ng/mL, the corresponding sensitivity and specificity for HCC were 62.9% and 24.0%, 7.4% and 54.2%, 77.3% and 91.9%, respectively. We studied sensitivity according to cut-off values of alpha-FP defined as 20, 100, 200, 500 ng/mL in patients with small HCC below 2 cm. The corresponding sensitivity were 50.0%, 43.7%, 25.0%, 18.7%, respectively. In patients with levels of serum alpha-FP below 20 ng/mL, percentages of mass size less than 2 cm, 2~3 cm, 3~5 cm and more than 5 cm were 50.0%, 25.0%, 28.5% and 25.0%, respectively. CONCLUSIONS: We suggested that in order to detect HCC, careful periodic monitoring with alpha-FP, ultrasonography and abdominal computed tomography is needed in patients with HBsAg positive liver cirrhosis and whose serum level of alpha-FP is above 20 ng/mL.

Examination of Endoscopic Mucosal Resection as a Curative Treatment of Early Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been accepted as a treatment option for cases of early gastric cancer (EGC) where the probability of lymph node metastasis is low. The purpose of this study was to define the indication and limitation of EMR of EGC. METHODS: We studied thirty-five cases of EGC treated by EMR in Chungnam National University Hospital from January, 1999 to July, 2001. RESULTS: The rate of complete resection on EGC was 94.3% (33/35). The size affected the curability; 94.4% (17/18) of lesions less than 10 mm, 93.3% (14/15) of lesions 11 to 20 mm and 100% (2/2) of those larger than 20 mm were resected completely. The depth of cancer invasion also affected the curability; 100% of lesion was confined to mucosa while 71.4% of those invaded submucosa. Of the thirty-three lesions which were completely resected, twenty-seven lesions had no recurrences during the follow-up period, four lesions were residual cancers and two developed local recurrences. CONCLUSIONS: In curative treatement for EGC with EMR, although follow-up period was short there is a possibility that indications for EMR could extend to the elevated lesion which is larger than 20 mm and to the superficial submucosal (sm1) cancer.

Clinicopathological Study on Laterally Spreading Tumor (LST) / 대한소화기내시경학회지

BACKGROUND/AIMS: Laterally spreading tumors (LST) were growthed along the colonic wall. These tumors were high malignant potential compared to colon polyp. We analyzed clinicopathological characteristics of these tumors. METHODS: From June 1996 to June 2001, twenty nine patients were diagnosed by colonoscopy. These lesions were classificated macroscopic (granular type and nongranular type) and microscopic findings. RESULTS: 20 male and 9 female were enrolled (mean age, 68.1). Among the LST, 41.4% were 20~30 mm in diameter, and 7% were larger than 30 mm. According to macroscopic findings granular types were 72.4% (21/29) and nongranular types were 27.6% (8/29). In macroscopic findings, tubular types were 48.4% (14/29), malignant changes were 31.3% (9/29). Tumor size was only significant factor in malignant potential of LST (p=0.004). Endoscopic mucosal resection was performed in 72.4% (21/29), operation in 8 (27.6%). Rate of submucosal invasion in LST was 3.4% (1/29, sm1). Recurrent rate of endoscopic treatment group was 9.5% (2/21). CONCLUSIONS: Most of LST were good indication for endoscopic treatment, but larger tumor size and irregular surface of tumor were suspected to be submucosal invasion. Therefore these lesions were performed other procedures as endoscopic ultrasound or computerized tomography for invasion depth.

The Comparative Study of Ligation and Histoacryl(R) Injection in Gastric Varix Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: The variceal bleeding has high rebleeding rate, and mortality rate was higher in gastrix varix. Managements of variceal bleeding were included such as drugs, endoscopic procedures, surgical management and radiological intervention. Recently histoacryl(R) injection method has been introduced. We have compared the effects of the endoscopic ligation and Histoacryl(R) injection therapy (HAI) in patient with gastric variceal bleeding. METHODS: We analyzed the effects of hemostasis, complications, rebleeding rates, and survival rates in gastric varix bleeding of 22 patients with Histoacryl(R) injection therapy and 20 patients with endoscopic ligation therapy, from January 1995 to March 1999. RESULTS: There were no difference in the complication rate between the 2 stretigies (12/14). Most common complication was chest pain in EVL group, but fever was common in HAI group. Also early and post rebleeding rates were not different in both groups. The main cause of death during follow up period was rebleeding in both groups. The survival rates were 65.0% in EVL group and 77.0% in HAI group (p>0.05, duration: 23+/-2, 28+/-4 month), and there was no difference in mortlity rate (p=0.77). CONCLUSIONS: There were no difference in the hemostatic effect, complications, rebleeding rate and survival rate in EVL group and HAI group. However, evaluation of larger numbers of patients and prospective studies were needed to define the effectiveness and complications of these therapies.

The Correlation of Bile Acid and Gastroduodenal Lesions in Hepatobiliary, Pancreas Diseases / 대한소화기내시경학회지

BACKGROUND/AIMS: Various gastric and duodenal lesions were observed in patients with obstructive biliary disease. Previously we knew that serum bile acid level may be correlated with gastric and duodenal lesion in obstructive biliary disease. Now we will confirm the correlation of the serum bile acid concentration and gastro-duodenal lesions. METHODS: A clinical analysis of the endoscopic finding and serum bile acid concentration was carried out in 120 patients with hepatobiliary and pancreas disease, from January 1999 to December 1999, in the department of Internal medicine, Chungnam National University Hospital. RESULTS: 1) In the 120 patients, sex distribution showed predominance in the males (84/36). 2) Disease profiles were included, liver cirrhosis (66.7%), hepatocellular carcinoma (38.3%), pancreatic cancer (15.8%). 3) The gastroduodenal lesions were erosive gastritis (33.3%), gastric ulcer (20.0%), duodenal ulcer (16.7%) in orders. 3) According to serum bile acid concentration, gastroduodenal lesions were more than in elevated bile acid concentration group. CONCLUSIONS: Gastroduodenal lesions in hepatobiliary and pancreas disease patients were related with serum bile acid concentration.