Visceral Obesity If Associated with Gallbladder Polyps

BACKGROUND/AIMS: Gallbladder polyps (GBP) are a common clinical finding and may possess malignant potential. We conducted this study to determine whether visceral obesity is a risk factor for GBP. METHODS: We retrospectively reviewed records of subjects who received both ultrasonography and computed tomography with measurements of the areas of visceral adipose tissue and total adipose tissue (TAT) on the same day as health checkups. RESULTS: Ninety-three of 1,615 subjects (5.8%) had GBP and were compared with 186 age- and sex-matched controls. VAT (odds ratio [OR], 2.941; 95% confidence interval [CI], 1.325 to 6.529; p=0.008 for the highest quartile vs the lowest quartile) and TAT (OR, 3.568; 95% CI, 1.625 to 7.833; p=0.002 for the highest quartile vs the lowest quartile) were independent risk factors together with hypertension (OR, 2.512; 95% CI, 1.381 to 4.569; p=0.003), diabetes mellitus (OR, 2.942; 95% CI, 1.061 to 8.158; p=0.038), hepatitis B virus positivity (OR, 3.548; 95% CI, 1.295 to 9.716; p=0.014), and a higher level of total cholesterol (OR, 2.232; 95% CI, 1.043 to 4.778; p=0.039 for or =240 mg/dL). Body mass index and waist circumference were not meaningful variables. CONCLUSIONS: Visceral obesity measured by VAT and TAT was associated with GBP irrespective of body mass index or waist circumference.

Comparison between Intravenous Pantoprazole and Oral Lansoprazole about the Prevention against Bleeding after Endoscopic Submucosal Dissection

BACKGROUND/AIMS: Proton pump inhibitor (PPI) is generally prescribed to prevent post endoscopic submucosal dissection (ESD) bleeding. However, there was no consensus about the effectiveness of intravenous (IV) or oral PPI. We conducted this investigation to evaluate whether oral PPI can be also safely and effectively used to prevent post-ESD bleeding by measurement of intragastric pH. MATERIALS AND METHODS: Patients were assigned in the fixed order to IV pantoprazole by 40 mg every 12 hours and oral lansoprazole fast disintegrating tablet (LFDT) by 30 mg every 8 hours. We checked intragastric pH and hemoglobin (Hb) levels at pre and post-ESD procedure. RESULTS: A total of 10 patients (LFDT group: 6 patients, IV pantoprazole group: 4 patients) were included. There was no difference of baseline Hb level between two groups (LFDT, 14.38+/-0.46 mg/dL; IV pantoprazole, 13.85+/-0.83 mg/dL; P=0.18). After 24 hours, change of Hb level was not different between LFDT (0.95+/-0.30 mg/dL) and IV pantoprazole group (0.98+/-0.45 mg/dL; P=0.96). Baseline intragastric pH was 3.72+/-0.19 with LFDT and 4.31+/-0.41 with IV pantoprazole group (P=0.18). After 24 hours, there was no significant difference of the extent of pH increase between LFDT (2.38+/-0.28) and IV pantoprazole group (2.17+/-0.21; P=0.60). CONCLUSIONS: There was no difference in both the increase of post-24 hour intragastric pH and decrease of post-24 hour Hb between LFDT and IV pantoprazole group. Oral PPI regimen may be able to replace IV PPI therapy for the prevention of post-ESD bleeding and LFDT might be superior to IV PPIs in the aspect of cost-effectiveness.

Comparison between Intravenous Pantoprazole and Oral Lansoprazole about the Prevention against Bleeding after Endoscopic Submucosal Dissection

BACKGROUND/AIMS: Proton pump inhibitor (PPI) is generally prescribed to prevent post endoscopic submucosal dissection (ESD) bleeding. However, there was no consensus about the effectiveness of intravenous (IV) or oral PPI. We conducted this investigation to evaluate whether oral PPI can be also safely and effectively used to prevent post-ESD bleeding by measurement of intragastric pH. MATERIALS AND METHODS: Patients were assigned in the fixed order to IV pantoprazole by 40 mg every 12 hours and oral lansoprazole fast disintegrating tablet (LFDT) by 30 mg every 8 hours. We checked intragastric pH and hemoglobin (Hb) levels at pre and post-ESD procedure. RESULTS: A total of 10 patients (LFDT group: 6 patients, IV pantoprazole group: 4 patients) were included. There was no difference of baseline Hb level between two groups (LFDT, 14.38+/-0.46 mg/dL; IV pantoprazole, 13.85+/-0.83 mg/dL; P=0.18). After 24 hours, change of Hb level was not different between LFDT (0.95+/-0.30 mg/dL) and IV pantoprazole group (0.98+/-0.45 mg/dL; P=0.96). Baseline intragastric pH was 3.72+/-0.19 with LFDT and 4.31+/-0.41 with IV pantoprazole group (P=0.18). After 24 hours, there was no significant difference of the extent of pH increase between LFDT (2.38+/-0.28) and IV pantoprazole group (2.17+/-0.21; P=0.60). CONCLUSIONS: There was no difference in both the increase of post-24 hour intragastric pH and decrease of post-24 hour Hb between LFDT and IV pantoprazole group. Oral PPI regimen may be able to replace IV PPI therapy for the prevention of post-ESD bleeding and LFDT might be superior to IV PPIs in the aspect of cost-effectiveness.

A Case with Primary Pneumatosis Cystoides Treated after Colonoscopic Endoscopic Mucosal Resection / 대한소화기학회지

No abstract available.

Primary Mucosa-associated Lymphoid Tissue Lymphoma of the Esophagus, Manifesting as a Submucosal Tumor / 대한소화기학회지

We report a case of primary mucosa-associated lymphoid tissue (MALT) lymphoma in the esophagus that manifested as a large submucosal tumor (SMT). Primary esophageal lymphoma is very rare, occurring in less than 1% of all patients with gastrointestinal lymphoma. Only a few cases of MALT lymphoma in the esophagus have been reported in the English literature. A 53-year-old man was referred to Dongguk University Ilsan Hospital (Goyang, Korea) in July 2012 for further evaluation and treatment of an esophageal SMT. Endoscopy showed a cylindrically elongated submucosal mass with normal overlying mucosa in the mid esophagus, 25-30 cm from the incisor teeth. He underwent surgery to confirm the diagnosis. Pathologic findings showed diffuse small atypical lymphoid cells which were stained with Bcl-2, CD20, but not with CD3, CD5, CD23, Bcl-6, or cyclin D1. These cells showed a positive monoclonal band for immunoglobulin heavy chain gene rearrangement. Based on the pathological, immunohistochemical, and molecular biological features, the esophageal mass was diagnosed as extranodal marginal zone B-cell lymphoma of the MALT type.

Comprehension and conduct of physicians when acquiring informed consent for chemotherapy / 대한내과학회지

BACKGROUND/AIMS: Given that the use of chemotherapy has increased, together with the incidence of cancer, the importance of patient autonomy in decision-making is being emphasized. This study aimed to promote understanding of informed consent by analyzing doctors' perceptions of, and conduct during, the acquisition of written informed consent before chemotherapy. METHODS: Forty-eight doctors directing or performing chemotherapy were surveyed in August 2009. In addition, the electronic medical records of patients who underwent chemotherapy between August 1, 2008, and August 31, 2009, were reviewed retrospectively. RESULTS: All 48 respondents replied that acquiring informed consent was necessary before chemotherapy, but only 27 (56.3%) were aware of the format of the consent that had been obtained. Regarding the format of informed consent, 34 (70.8%) felt that it should be brief and 21 (43.8%) indicated that the time they spent in acquiring informed consent ranged from 10 to 14 minutes. Reviewing actual performance in acquiring informed consent, only 22 (15.6%) out of 141 patients who underwent chemotherapy had written informed consent documents in their electronic medical records. CONCLUSIONS: To properly acquire informed consent for chemotherapy, its meaning and importance must be understood by both physicians and patients. Moreover, patients need a standardized format of appropriate length for informed consent, with easily understood terms.

Severe Hypertriglyceridemia in Diabetic Ketoacidosis Accompanied by Acute Pancreatitis: Case Report

We report a case of diabetic ketoacidosis (DKA) and hypertriglyceridemia (severely elevated to 15,240 mg/dL) complicated by acute pancreatitis, which was treated successfully with insulin therapy and conservative management. A 20-yr-old woman with a history of type 1 diabetes came to the emergency department 7 months after discontinuing insulin therapy. DKA, severe hypertriglyceridemia and acute pancreatitis were diagnosed, with DKA suspected of contributing to the development of the other conditions. In Korea, two cases of DKA-induced hypertriglyceridemia and 13 cases of hypertriglyceridemia-induced acute pancreatitis have been previously reported separately.

Clinical Characteristics of Large Brunner's Gland Tumors in Korea / 대한소화기내시경학회지

BACKGROUND/AIMS: Brunner's gland tumor is a common benign tumor noted in duodenum and might be designated as Brunner's gland hamartoma, adenoma or hyperplasia. But, a large duodenal polyp (over 1 cm in diameter) pathologically proven as a tumor of Brunner's gland origin is rare. METHODS: We analyzed a total of 39 cases including our direct experience of two cases and reports of 37 cases to clarify the clinical features of large Brunner's gland tumors. RESULTS: This tumor tends to present predominantly after the fourth decade: Median age is 52.6 years. Neither gender showed predominance. The size of the tumor ranged from 1 to 8 cm and the mean diameter was 2.9 cm. The most common location was the bulb. A pedunculated polyp was the common appearance. Epigastric pain was the most common symptom. Brunner's gland tumor can cause gastrointestinal hemorrhage or obstruction. Most of the polyps had non-diagnostic pathologic yield at pinch biopsy and only one case was diagnosed as focal adenocarcinoma. Endoscopic or surgical removal was undertaken for treatment. Most cases had no recurrence after removal. Snare polypectomy or submucosal dissection very safe and useful treatment modalities. CONCLUSIONS: Large Brunner's gland tumors are mostly found during a check up or epigastric pain. Anemia, melena and obstruction often develop. Endoscopic polypectomy is recommended as a first line treatment.

Satisfaction Survey of Care Providers for Enteral Feeding by the Use of Percutaneous Endoscopic Gastrostomy / 대한소화기내시경학회지

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a widely used procedure for enteral feeding that is convenient and safe. We investigated the satisfaction of enteral feeding by the use of a nasogastric tube and PEG as well as PEG-related complications. METHODS: A total of 57 patients (121 cases) who underwent PEG in a teaching hospital were investigated about complications based on the use of electronic medical records. Questionnaires comprised of 11 questions were administered by telephone or by direct contact with care providers. RESULTS: The median interval period of exchange for PEG was 184.94 days. The causes for exchange included regular exchange (36, 41.86%), accidental or self- removal of the PEG tube (26, 30.23%), profuse discharge, rash or infection around the PEG insertion site (13, 15.12%) and PEG tube malfunction (11, 12.79%). The satisfaction index (VAS scale) for the use of the nasogastric tube was 4.32, while the satisfaction index for the use of PEG was 7.72, which indicates that the care providers were more satisfied with nutrition provided by the use of PEG (p <0.0001). The 28 care providers (80.00%) replied that PEG was a good method to maintain a high quality of life. CONCLUSIONS: Care providers had a high degree of satisfaction for the use of PEG. PEG is safe and effective method for enteral nutrition. If continuous education or management to reduce accidental removal and to lessen complications is enforced, higher satisfaction can be expected.