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Ji Hoon Jung,
Kee Don Choi,
Seungbong Han,
Hwoon-Yong Jung,
Mi Young Do,
Hye-Sook Chang,
Jae-Won Choe,
Gin Hyug Lee, Ho June Song,
Do Hoon Kim,
Kwi-Sook Choi,
Jeong Hoon Lee,
Ji Yong Ahn,
Mi-Young Kim,
Suh Eun Bae,
Jin-Ho Kim
[show abstract]
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ABSTRACT: BACKGROUND: Studies on seroconversion and its reversion rate in Korean adults with Helicobacter pylori infection are very rare. The purpose of this study was to evaluate the overall seroprevalence, seroconversion rate, and seroreversion rate of H. pylori infection in an adult population. MATERIALS AND METHODS: We performed this retrospective cohort study on healthy adults who had visited our health screening center at Asan Medical Center more than twice between January 2000 and December 2010. We reviewed the anti- H. pylori Ab IgG profiles of the enrolled people and their family members and the results of esophagogastroduodenoscopies and a self-reported questionnaire. RESULTS: A total of 67,212 people were enrolled in this study. The mean follow-up duration was 4.6 years, and each participant visited the center for a mean of 3.8 visits. The overall proportions of participants demonstrating persistent seropositivity, persistent seronegativity, seroconversion, and seroreversion were 53.1%, 32.5%, 4.3%, and 10.1%, respectively. The annual seroconversion rate was 2.79%. The annual crude and spontaneous seroreversion rates of the entire study population were 3.64% and 2.42%, respectively. According to multivariate logistic regression, old age (HR = 1.015), smoking (HR = 1.216), alcohol consumption more than four times per week (HR = 1.263), marriage (HR = 2.735), and living with H. pylori-infected family members (HR = 1.525) were identified as statistically significant risk factors associated with seroconversion. CONCLUSION: The annual seroconversion rate was 2.79% in our study population. Marriage and living with H. pylori-infected family members were important risk factors affecting seroconversion in our adult population.
Helicobacter 03/2013; · 3.15 Impact Factor
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Hee Kyong Na,
Kee Don Choi,
Ji Yong Ahn,
Hyun Lim,
Mi-Young Kim,
Jeong Hoon Lee,
Kwi-Sook Choi,
Do Hoon Kim, Ho June Song,
Gin Hyug Lee,
Hwoon-Yong Jung,
Jin-Ho Kim,
Jung Bok Lee
[show abstract]
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ABSTRACT: BACKGROUND: The outcomes of balloon dilation for the treatment of strictures caused by endoscopic submucosal dissection (ESD) have not been evaluated previously. This study was designed to evaluate and compare the effectiveness and complications of balloon dilation for post-ESD strictures and peptic strictures. METHODS: The medical records of 14 patients with post-ESD strictures and 48 patients with peptic strictures who underwent fluoroscopically or endoscopically guided balloon dilation between January 1997 and April 2011 at the Asan Medical Center in Korea were reviewed retrospectively. RESULTS: The technical success rates (defined as successful dilation without major complications) of the post-ESD and peptic stricture groups were 92.9 % (13/14) and 93.8 % (45/48), respectively (p = 1.000). For the post-ESD and peptic stricture groups, the clinical success rates (defined as symptom improvement, as determined by the patient) at 1 month were 92.9 % (13/14) and 83.3 % (40/48), respectively (p = 0.67). Their clinical success rates at 6 months were 71.4 % (10/14) and 70 % (28/40), respectively (p = 1.000). The mean weight gains of the post-ESD stricture group 1 and 6 months after balloon dilation were 1.1 and 4.8 kg, respectively, whereas the peptic group gained 1.4 and 3.4 kg, respectively (p = 0.814). All complications were perforations. The complication rates of the post-ESD and peptic stricture groups were 7.1 % (1/14) and 10.5 % (5/48), respectively (p = 1.000). CONCLUSIONS: Balloon dilation is an effective and safe treatment for post-ESD strictures.
Surgical Endoscopy 03/2013; · 4.01 Impact Factor
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Ji Yong Ahn,
Kee Don Choi,
Hee Kyong Na,
Ji Young Choi,
Mi-Young Kim,
Kwi-Sook Choi,
Jeong Hoon Lee,
Do Hoon Kim, Ho June Song,
Gin Hyug Lee,
Hwoon-Yong Jung,
Jin-Ho Kim,
Seungbong Han
[show abstract]
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ABSTRACT: BACKGROUND: There are insufficient reports on the outcomes and local recurrence rates for gastric neoplasms treated using argon plasma coagulation (APC). The purpose of this study was to analyze the clinical outcomes in early gastric cancer or gastric adenoma patients following APC treatment. METHODS: Seventy-one patients were enrolled and all underwent APC at the Asan Medical Center between July 2007 and August 2011. Clinical and oncological outcomes were analyzed. RESULTS: The median follow-up period was 20 months (interquartile range 13-29 months). Among the 71 patients we evaluated, nonlifting after submucosal saline injection was found in 35 patients and 15 patients (21.2 %) experienced local recurrence with a median period of 10 months (IQR 5-13 months). The rate of local recurrence was higher in the nonlifting group and the 40-W group than in the lifting group and the 60- or 80-W groups (31.4 vs. 11.1 %, p = 0.045 and 31.7 vs. 6.7 %, p = 0.017, respectively). Multivariate analysis showed that the power setting with the 40-W and nonlifting groups after submucosal injection was associated with local recurrence. CONCLUSIONS: APC therapy after submucosal saline injection using high power (60 or 80 W) appears to be an effective alternative in the management of gastric neoplasm.
Surgical Endoscopy 02/2013; · 4.01 Impact Factor
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Yeon-Mi Ryu,
Seung-Jae Myung,
Young Soo Park,
Dong-Hoon Yang, Ho June Song,
Jin-Yong Jeong,
Sun Mi Lee,
Miyeoun Song,
Do Hoon Kim,
Hyo-Jeong Lee,
Soo-Kyung Park,
Stephen P Fink,
Sandy D Markowit,
Ki-Wook Jung,
Kyung-Jo Kim,
Byong-Duk Ye,
Jeong-Sik Byeon,
Hwoon-Yong Jung,
Suk-Kyun Yang,
Jin-Ho Kim
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ABSTRACT: Helicobacter pylori (H pylori) infection induces a chronic inflammatory response, which promotes gastric carcinogenesis. 15-hydroxyprostaglandin dehydrogenase (15-PGDH) plays a key role as a tumor suppressor in gastrointestinal cancers. The aim of this study was to elucidate the role of 15-PGDH in gastric carcinogenesis associated with H pylori. 15-PGDH expression in gastric biopsies from H pylori-infected (n=25) and non-infected (n=15) subjects was analyzed by quantitative real-time PCR, western blot analysis, and immunohistochemisty. 15-PGDH DNA methylation was evaluated by methylation specific PCR and pyrosequencing. The expression of 15-PGDH, Snail, ERK1/2, TLR4 and MyD88 in response to H pylori infection was assessed by immunoblot analysis. Compared to negative specimens, H pylori positive specimens had 2-fold lower 15-PGDH mRNA levels and significantly less 15-PGDH protein. In four H pylori infected subjects with longitudinal follow-up, the suppression of 15-PGDH expression was reversed by H pylori eradication therapy. In parallel with suppressing 15-PGDH expression, H pylori infection activated expression of TLR4 and MyD88 expression, increased levels of phospho-ERK1/2, and increased expression of epidermal growth factor receptor (EGFR)-Snail. Inhibition of Snail and MyD88 reversed suppression of 15-PGDH expression and small interfering Myd88 reduced phosphorylated ERK1/2. Similarly, treatment with an ERK1/2 and EGFR inhibitor also restored 15-PGDH expression. Heliocobacter pylori appeared to promote gastric carcinogenesis by suppressing15-PGDH. This process is mediated by the TLR4/MyD88 pathway via ERK1/2 or EGFR - Snail transcriptional regulation. 15-PGDH may be a useful marker and a potential therapeutic target in H pylori-induced gastric carcinogenesis.
Cancer Prevention Research 02/2013; · 4.91 Impact Factor
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Sang Gyun Kim, Ho June Song,
Il Ju Choi,
Won Young Cho,
Jeong Hoon Lee,
Bora Keum,
Yong Chan Lee,
Jae Gyu Kim,
Sue K Park,
Byung-Joo Park,
Hyun Chae Jung
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ABSTRACT: INTRODUCTION: The role of Helicobacter pylori (H. pylori) eradication has not been clarified in the healing of iatrogenic ulcer after endoscopic resection of gastric neoplasm. The aim of this study was to evaluate whether H. pylori eradication could facilitate the healing of iatrogenic ulcer after endoscopic resection of gastric neoplasm. METHODS: A total of 232 patients with H. pylori-positive early gastric cancer or gastric adenoma underwent endoscopic resection and were randomly allocated to eradication or placebo group in a prospective, double-blinded, and placebo-controlled manner. The primary outcome was measured by healing rate of ulcer, and the secondary outcomes by reduction rate of ulcer size, relief rate from ulcer-related symptoms, and adverse event rates. RESULTS: The healing rate of ulcer was 53% in eradication group and 51.6% in placebo group, respectively (p value=0.95). The reduction rate of ulcer size, relief rate from ulcer-related symptoms and adverse event rates were also not different between two groups. In multivariate analysis, initial ulcer size more than 3cm and histology of cancer were significant factors affecting iatrogenic ulcer healing. CONCLUSIONS: H. pylori eradication did not facilitate iatrogenic ulcer healing at early and late phase after endoscopic resection of gastric neoplasm.
Digestive and Liver Disease 01/2013; · 3.05 Impact Factor
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Sollip Kim,
Jun-Won Chung,
Tae-Dong Jeong,
Young-Soo Park,
Jeong Hoon Lee,
Ji Yong Ahn,
Do Hoon Kim,
Kee Don Choi,
Woochang Lee, Ho June Song,
Gin Hyug Lee,
Sail Chun,
Hwoon-Yong Jung,
Won-Ki Min,
Jin-Ho Kim
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ABSTRACT: The impact of CDH1 gene mutations and large deletions on hereditary diffuse gastric cancer (HDGC) and early onset diffuse gastric cancer (EODGC) has not been determined in Asians. We investigated the mutation status of the CDH1 gene in 25 Korean EODGC patients younger than 50 years and 23 HDGC patients who met the clinical criteria for HDGC. Polymerase chain reaction-direct sequencing was performed, and multiplex ligation-dependent probe amplification (MLPA) was used to evaluate the patients with negative sequencing results. We determined that 2 of 25 (8 %) EODGC patients had CDH1 germline mutations. One was a nonsense mutation (c.1003C>T, p.Arg335*, exon 7) in a 41-year-old female with no family history of cancer. The other was a missense mutation (c.715G>A, p.Gly239Arg, exon 6) in a 28-year-old male with no family history of cancer. One of 23 (4.3 %) HDGC patients had a CDH1 germline mutation (c.1003C>T). The patient's brother and sister died of stomach cancer. The MLPA results revealed no deletion or duplication in any patient. More research is needed to determine additional genetic targets that trigger HDGC. More comprehensive methods such as next-generation sequencing might be a good approach that can be used to identify the genetic causes of pathogenetically unexplained disorders.
Familial Cancer 12/2012; · 1.30 Impact Factor
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Ji Yong Ahn,
Kee Don Choi,
Jeong Hoon Lee,
Ji Young Choi,
Mi-Young Kim,
Kwi-Sook Choi,
Do Hoon Kim, Ho June Song,
Gin Hyug Lee,
Hwoon-Yong Jung,
Jin-Ho Kim,
Seunghee Baek
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ABSTRACT: BACKGROUND: The main problem in performing endoscopic submucosal dissection (ESD) of gastric neoplasms is that it is technically difficult, especially for beginners. METHODS: A total of 51 patients were randomly assigned to undergo transnasal endoscope-assisted or routine ESD performed by two endoscopists inexperienced in ESD while supervised by one expert. RESULTS: Total procedure time (p = 0.330), complete resection rate (p = 0.977), and complication rate (p = 0.157) were similar for the patients who underwent transnasal endoscope-assisted and routine ESD, but bleeding control time was significantly longer in the transnasal endoscope-assisted ESD group (p = 0.002). Three and six patients in the transnasal endoscope-assisted and routine ESD groups, respectively, were "dropped out" during the procedures (p = 0.291). The endoscopists tended to regard the traction with the transnasal endoscope as more useful for large tumors (p = 0.062). Bleeding control in patients who underwent the transnasal endoscope-assisted ESD was significantly longer for patients with tumors located in the anterior wall, posterior wall, and lesser curvature of the stomach (p = 0.001). CONCLUSION: Transnasal endoscope-assisted ESD does not result in improved outcomes when performed by beginners, except for some large tumors. The traction method used by beginners was not superior to proper supervision and advice by an expert during ESD and allowing the expert to perform the procedure when the risk of complications is high or the procedure is delayed.
Surgical Endoscopy 10/2012; · 4.01 Impact Factor
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Ji Yong Ahn,
Hwoon-Yong Jung,
Sue Eun Bae,
Ji Hoon Jung,
Ji Young Choi,
Mi-Young Kim,
Jeong Hoon Lee,
Kwi-Sook Choi,
Do Hoon Kim,
Kee Don Choi, Ho June Song,
Gin Hyug Lee,
Jin-Ho Kim,
Seungbong Han
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Reducing food residue by proper preparation methods before endoscopy after distal gastrectomy can increase the quality of examination and decrease patient discomfort. We evaluated the risk factors for food residue and proper methods of preparation for endoscopy after distal gastrectomy. METHODS: Follow-up endoscopy with questionnaires was performed on 1,001 patients who underwent distal gastrectomy at Asan Medical Center between December 2010 and July 2011. RESULTS: Endoscopic examination failed in 94 patients (9.4 %) as a result of large amounts of food residue. Rates of failure were significantly higher in patients who ate a regular diet rather than a soft diet at last dinner before examination (13.9 vs. 6.1 %, p = 0.050), and in those who ate lunch rather than not eating lunch on the day before examination (14.6 vs. 7.7 %, p = 0.020). Multivariate analysis showed that the rate of failed examination was lower in patients who had a history of abdominal surgery (p = 0.011), those who ate a soft (p < 0.001) or liquid (p = 0.003) diet as a last meal rather than a regular diet, those who underwent Billroth I rather than Billroth II reconstruction (p = 0.035), patients with longer fasting time (p = 0.009), and those with a longer gastrectomy-to-endoscopy time interval (p < 0.001). CONCLUSIONS: Patients who undergo follow-up endoscopy after surgery should fast more than 18 h and ingest a soft or liquid diet on the day before examination.
Surgical Endoscopy 10/2012; · 4.01 Impact Factor
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Changhoon Yoo,
Ji Hyun Park,
Dok Hyun Yoon,
Seung-Il Park,
Hyeong Ryul Kim,
Jong Hoon Kim,
Hwoon-Yong Jung,
Gin Hyug Lee,
Kee Don Choi, Ho June Song,
Ho-Young Song,
Ji Hoon Shin,
Kyung-Ja Cho,
Yong Hee Kim,
Sung-Bae Kim
[show abstract]
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ABSTRACT: BACKGROUND: Definitive chemoradiotherapy is associated with high local treatment failure rates, and surgical resection may be an appropriate salvage therapy. However, the efficacy and safety of salvage esophagectomy have not been elucidated fully. The clinical outcomes of salvage esophagectomy for locoregional failure after chemoradiotherapy were assessed. METHODS: Twelve patients who underwent salvage esophagectomy after chemoradiotherapy between January 2003 and November 2010 were included in this retrospective analysis. Baseline demographics and survivals of these patients were compared with 21 patients who did not receive salvage esophagectomy for locoregional failure only after chemoradiotherapy, identified from our own previous prospective trials. RESULTS: The median age was 62.5 years (range 50 to 69) and all patients had squamous cell carcinoma. The median radiation dose was 54.0 Gy (range 41.4 to 66.0) and the median interval between completion of chemoradiation and surgery was 8.0 months (range 2.0 to 32.9). There were no in-hospital deaths. Pulmonary complication was the most common postoperative morbidity (42%), and anastomotic leakage occurred in 1 patient (8%). With a median follow-up period of 29.3 months (range 5.8 to 73.0), the overall 3-year survival rate was 58%. Patients with early pathologic stage disease (T1/2 and N0) showed significantly prolonged survival (p = 0.03) compared with those with advanced pathologic stage (T3/T4 or N1). Patients with salvage esophagectomy had prolonged event-free survival and overall survival compared with those patients with locoregional failure who received primary chemotherapy or boost radiotherapy (p < 0.001). CONCLUSIONS: While salvage esophagectomy for locoregional failure after chemoradiotherapy should be employed with great caution, it appears to be a feasible and effective therapeutic option for highly selected patients, especially with early pathologic stage disease. Salvage esophagectomy can be recommended as the only current curative treatment option for patients with locoregional failure after chemoradiotherapy.
The Annals of thoracic surgery 09/2012; · 3.74 Impact Factor
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ABSTRACT: BACKGROUND: Brunner's gland proliferating lesions, termed Brunner's gland hamartoma, hyperplasia, or adenoma, is regarded as a benign condition. However, cancerous changes have been reported in Brunner's gland proliferating lesions. AIMS: The purpose of this study was to define the characteristic features of Brunner's gland proliferating lesions and evaluate any observed cancerous changes. METHODS: We analysed clinicopathologic features and mucin expression in 25 Brunner's gland proliferating lesions. RESULTS: Brunner's gland proliferating lesions were categorized as Brunner's gland hamartoma or hyperplasia according to their tissue components. Brunner's gland hamartoma commonly occurred in the duodenal bulb and exhibited a polypoid appearance, while Brunner's gland hyperplasia was primarily observed in the second portion of duodenum as a submucosal mass and was accompanied by symptoms more frequently than Brunner's gland hamartoma. The Brunner's glands in Brunner's gland proliferating lesions exhibited various morphologic characteristics, from normal-appearing glands to sclerotic glandular foci with atypia. Changes in MUC5 expression observed in both sclerotic glandular foci and dilated Brunner's glands suggest that they might share a common mechanism and are associated with gastric foveolar metaplasia. CONCLUSIONS: These findings indicate that most Brunner's gland proliferating lesions are either hamartoma or hyperplasia, and that true neoplastic Brunner's gland proliferating lesions are very rare. Thus, Brunner's gland adenomas or carcinomas arising in Brunner's gland proliferating lesions should be confirmed by ancillary tests, including immunostaining or molecular analysis, in addition to morphological criteria.
Digestive Diseases and Sciences 07/2012; · 2.12 Impact Factor
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Ji Yong Ahn,
Hwoon-Yong Jung,
Ji Young Choi,
Mi-Young Kim,
Jeong Hoon Lee,
Kwi-Sook Choi,
Do Hoon Kim,
Kee Don Choi, Ho June Song,
Gin Hyug Lee,
Jin-Ho Kim,
Seungbong Han
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ABSTRACT: Background/Aims: We reviewed the clinical outcome of metachronous gastric adenocarcinoma according to the endoscopic interval after curative treatment of squamous esophageal carcinoma by endoscopic resection or surgical resection. Methodology: Eighteen cases with gastric adenocarcinoma after treatment of esophageal carcinoma at Asan Medical Center between March 1994 and March 2010 were analyzed retrospectively. Results: Median interval between treatment of esophageal cancer and detection of metachronous gastric cancer was 44 months (interquartile range [IQR]=25.5-77.8 months), and median endoscopic interval before finding gastric cancer was 15 months (IQR=12.0-44.8 months). In cases with 12 resectable gastric cancers, the median interval of previous endoscopy before gastric cancer was shorter than that for 6 unresectable cancers (12.0 months, IQR=12-16 months vs. 59.5 months, IQR=37.5-68.5 months, p<0.001) and the rate of death was lower (16.7% [2/12] vs. 83.3% [5/6], p=0.006). Logistic regression showed that a shorter duration of endoscopic interval increased the rate of resectability of gastric cancer (p<0.001) and a higher rate of unresectable gastric cancer and longer duration of endoscopic interval increased death (p=0.029 and p=0.004, respectively). Conclusions: After treatment of esophageal cancer, endoscopic examination at 12-month intervals is important to lower the rate of death due to metachronous gastric cancer.
Hepato-gastroenterology 07/2012; 60(121). · 0.66 Impact Factor
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ABSTRACT: Helicobacter pylori eradication is essential for metachronous gastric cancer prevention in patients undergoing endoscopic mucosectomy (EMR). This study was aimed to determine the optimal biopsy site for H. pylori detection in the atrophic remnant mucosa of EMR patients.
Data were analyzed from 91 EMR patients. Three paired biopsies for histology were taken at antrum, corpus lesser (CLC), and greater curve (CGC). Additional specimens were obtained at antrum and CGC for rapid urease test (RUT). H. pylori infection was defined as at least two positive specimens on histology and/or RUT. Serologic atrophy was determined by pepsinogen levels.
Overall H. pylori infection rate was 72.5%. The proportions of moderate-to-marked atrophy/intestinal metaplasia at CGC (5.6/6.6%) were significantly lower than those at antrum (58.6/75.8%) and CLC (60.7/70.0%). Sensitivity of histology in detecting H. pylori was significantly higher at CGC than at antrum and CLC (84.8 vs 30.3 and 47.0%, respectively; p < .001). On RUT, detection at CGC also showed higher sensitivity than at antrum (77.3 vs 33.3%, p < .001). Specificities of all three biopsy sites were more than 90%. Regardless of serologic atrophy, CGC showed consistently higher sensitivities on histology and RUT. In patients with serologic atrophy, antral sensitivities were much lower than those of nonatrophic patients, 9.5 versus 40.0% on histology (p = .012) and 14.3 versus 42.2% on RUT (p = .025).
CGC is the optimal biopsy site for H. pylori diagnosis in EMR patients with extensive atrophy. Antral biopsy should be avoided, especially in serologically atrophic patients.
Helicobacter 07/2012; 17(6):405-10. · 3.15 Impact Factor
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ABSTRACT: Metastasis to the stomach from renal cell carcinoma (RCC) is extremely rare. Usually, gastric metastasis seems to be a late event in patients with RCC and is accompanied by disseminated tumor spread to other organs. Solitary synchronous gastric metastasis from small, localized RCC has rarely been reported. We report a case of 79-year-old man with synchronous gastric metastasis presenting with a single erosive lesion from pT1 RCC. The patient underwent radical nephrectomy and endoscopic resection for metastatic gastric cancer. The resected specimen showed an ill-defined tumor, approximately 0.6 cm long, with a clear resection margin. The morphologic features of the tumor cells were consistent with those of metastatic RCC of the clear cell type. At 6 months's follow-up, the patient did not show local recurrence or additional metastasis on upper endoscopy and computed tomography scan.
Gut and liver 07/2012; 6(3):388-94. · 0.83 Impact Factor
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ABSTRACT: Accessory spleen can be mistaken as a gastric subepithelial mass, and may not be differentiated in CT or endoscopic ultrasonography (EUS). A gastric subepithelial mass was detected on routine endoscopy in a 39-year old woman with history of splenectomy. In subsequent CT and EUS, the subepithelial mass was located on the fourth layer of the stomach. To make a definite diagnosis, EUS-guided fine needle aspiration (FNA) was performed, and a splenic tissue was demonstrated in histologic examination. EUS-guided FNA can be beneficial in the diagnosis of accessory spleen which mimics a gastric subepithelial mass.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 06/2012; 59(6):433-6.
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Tae-Hoon Oh,
Hwoon-Yong Jung,
Kee Don Choi,
Gin Hyug Lee, Ho June Song,
Kwi-Sook Choi,
Jun-Won Chung,
Jeong-Sik Byeon,
Seung-Jae Myung,
Suk-Kyun Yang,
Jin-Ho Kim
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ABSTRACT: Background There is no consensus regarding the degree of healing of endoscopic submucosal dissection (ESD)-induced ulcers and the optimal
duration of proton pump inhibitor (PPI) treatment. Aim To evaluate the degree of healing and the factors associated with healing of ESD-induced ulcers after PPI therapy for 4weeks.
Methods Fifty-six patients who underwent complete ESD for adenoma or early gastric cancer were enrolled. All patients underwent follow-up
endoscopy to evaluate the degree of ulcer healing after pantoprazole therapy (40mg per day) for 4weeks. We evaluated change
in size of ESD-induced ulcers between baseline and 4weeks, and correlated relevant factors with degree of healing of small
and large ulcers. Results At follow-up, 28 (50%) patients had large ulcers (area>10mm2). Ulcer size at 4weeks was closely correlated with initial ulcer size (P<0.001) and abruptly increased when initial ulcer size was larger than 4cm. Comorbidity, procedure time, and initial specimen
size were significantly associated with healing rate, but multivariate analysis showed that initial ulcer size was the only
significant parameter (P<0.015). Conclusions Healing degree of ESD-induced ulcers at 4weeks is dependent on initial ulcer size, indicating that duration of treatment
with PPI should be dependent on initial ulcer size.
Digestive Diseases and Sciences 04/2012; 54(7):1494-1499. · 2.12 Impact Factor
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ABSTRACT: A 66-year-old female presented with a 1-month history of dyspepsia. An initial upper gastrointestinal endoscopy with biopsy revealed a low-grade mucosa-associated lymphoid tissue (MALT) lymphoma. A rapid urease test was positive for Helicobacter pylori. Endoscopic ultrasound (EUS) and computed tomography (CT) revealed a 30×15-mm lymph node (LN) in the subcarinal area. Histopathologic and phenotypic analyses of the biopsy specimens obtained by EUS-guided fine-needle aspiration revealed a MALT lymphoma, and the patient was diagnosed with a stage 4E gastric MALT lymphoma. One year after H. pylori eradication, the lesion had disappeared, as demonstrated by endoscopy with biopsy, CT, fusion whole-body positron emission tomography, and EUS. Here, we describe a patient with gastric MALT lymphoma that metastasized to the mediastinal LN and regressed following H. pylori eradication.
Gut and liver 04/2012; 6(2):270-4. · 0.83 Impact Factor
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ABSTRACT: It is not clear which screening examinations are best suited for gastric cancer prevention, especially in patients with atrophic gastritis and intestinal metaplasia. Therefore, we investigated the gastric cancer screening methods and intervals that are performed in clinical practice in an area with a high prevalence of gastric cancer.
Eighty-seven physicians voted by keypad and discussed the consistency of endoscopic diagnosis of atrophic gastritis and intestinal metaplasia at the Annual Symposium of the Korean College of Helicobacter and Upper Gastrointestinal Research. Additionally, 100 core members of this academic society were asked via e-mail to complete the questionnaires related to screening strategies for gastric cancer.
The most common recommendation for the subjects with intestinal metaplasia was an annual endoscopic follow-up (95.5% vs. 80.4% in the expert and non-expert groups, respectively; P = 0.118). Annual endoscopic follow-up was also the most predominant recommendation for atrophic gastritis (95.5% vs. 76.5%; P = 0.092), regardless of the physicians' endoscopic experience, position, and degree of the hospital. However, the correct answer rate for the diagnosis of normal endoscopic findings was only 16.7 and 14.1% in the expert and non-expert groups, respectively (P = 0.883).
The most common practical screening strategy for patients with atrophic gastritis and intestinal metaplasia in Korea was annual endoscopic examination. However, a new program estimating individualized gastric cancer risk might be needed because of the low inter-observer agreement in the endoscopic diagnosis of atrophic gastritis and intestinal metaplasia.
Digestive Diseases and Sciences 03/2012; 57(3):746-52. · 2.12 Impact Factor
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Dong Hoe Koo,
Seung-Il Park,
Yong-Hee Kim,
Jong Hoon Kim,
Hwoon-Yong Jung,
Gin-Hyug Lee,
Kee Don Choi, Ho June Song,
Ho Young Song,
Ji Hoon Shin,
Kyung-Ja Cho,
Dok-Hyun Yoon,
Sung-Bae Kim
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ABSTRACT: This phase II study evaluated the feasibility and efficacy of one cycle of induction chemotherapy, followed by concurrent chemoradiotherapy (CRT) featuring capecitabine/cisplatin, followed in turn by surgery, in the treatment of patients with resectable esophageal squamous cell carcinoma.
Between March 2003 and April 2005, 54 patients with stage II or III esophageal cancer were treated with induction chemotherapy (cisplatin 60 mg/m(2) on day 1; capecitabine 1,000 mg/m(2) bid on days 1-14) followed by concurrent radiotherapy (46 Gy in 23 fractions) and chemotherapy (cisplatin 30 mg/m(2) on days 1, 8, 15, and 22; capecitabine 800 mg/m(2) bid 5 days/week). Surgery was performed within 8 weeks of the end of radiotherapy.
Median age of the patients was 64.5 years (range, 45-74 years). After CRT, 52 patients (96%) showed a clinical response, including 26 (48%) who exhibited a complete response (CR). Surgery was performed on 41 patients (76%), with 20 (37%) achieving pathologic CR and 3 (6%) dying of postoperative pneumonia. At a median follow-up time of 74.2 months (range, 64.3-84.8 months), 16 patients (30%) had experienced tumor recurrence and 36 (67%) had died. Of the 41 patients who underwent esophagectomy, 5 (12%) had exclusively locoregional disease and 7 (17%) had distant metastasis, whereas no one had both. The 5-year progression-free and overall survival rates were 30.2% (95% confidence interval [CI], 18.0-42.4%) and 37.0% (95% CI, 24.1-50.0%), respectively.
A trimodal approach, consisting of a single cycle of induction chemotherapy, CRT containing capecitabine and cisplatin, and surgery, was feasible and effective in patients with resectable esophageal squamous cell carcinoma.
Cancer Chemotherapy and Pharmacology 03/2012; 69(3):655-63. · 2.83 Impact Factor
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Hee-Jung Yoo,
Sung-Bae Kim,
Dok Hyun Yoon,
Seung-Il Park,
Jong-Hoon Kim,
David Cella,
Hwoon-Yong Jung,
Gin-Hyug Lee,
Kee Don Choi, Ho June Song,
Ho Young Song,
Ji Hoon Shin,
Kyung-Ja Cho
[show abstract]
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ABSTRACT: The Functional Assessment of Cancer Therapy-Esophageal (FACT-E) Scale version 4 has been used to assess quality of life in patients with squamous cell carcinoma undergoing chemoradiation. We sought to determine whether this scale can be used to assess quality of life in Korean patients with esophageal cancer undergoing chemoradiation.
The FACT-E scale version 4 was cross-culturally translated into Korean. Its reliability and validity were assessed in a group of 146 esophageal cancer patients who were scheduled for neoadjuvant chemoradiation (CRT). This procedure was followed by esophagectomy that took place between 2007 and 2010 at Asan Medical Center. All patients completed the FACT-E, Hospital Anxiety and Depression Scale (HADS) and Functional Living Index-Cancer (FLIC) questionnaires at baseline (pre-treatment) and 1 month after two cycles of induction chemotherapy followed by CRT.
In validating the FACT-E, we found high internal consistency coefficients ranging from 0.72 to 0.91. Good convergent and divergent validities were demonstrated by the FLIC and HADS scales. The FACT-E showed good clinical validity and effectively differentiated between patient groups with different performance status ratings and stages. Changes in clinical status were reflected by changes in FACT-E scores, demonstrating responsiveness to neoadjuvant CRT.
The FACT-E has been shown to be a reliable and valid instrument that can now be used to prospectively evaluate the quality of life of Korean patients with esophageal cancer.
Quality of Life Research 11/2011; 21(8):1451-7. · 2.30 Impact Factor
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ABSTRACT: Background/Aims: Endoscopic resection (ER) is an effective treatment in selected patients with early gastric cancer (EGC). We have evaluated the clinical outcomes of ER in patients with undifferentiated EGCs, including poorly differentiated adenocarcinoma or signet ring cell carcinoma. Methodology: We retrospectively examined the medical records of 77 patients diagnosed with undifferentiated EGC after ER (EMR for 22 patients and ESD for 56 patients) at a single center. Results: The mean±SD lesion size was 23.2±14.1mm. The 77 lesions included 65 (84.4%) intramucosal cancers and 12 (15.6%) involving the submucosal layer. Of these 77 patients, 35 underwent curative resection and 42 did not. After a mean follow-up period of 41 months (range, 9-152), local recurrences were observed in four patients (5.2%), all of whom had not undergone curative resection. No patient died of EGC. Univariate analysis showed that tumor involvement of the resection margins (p<0.001) and lymphatic invasion (p=0.003) were significant risk factors for recurrence after ER in undifferentiated EGCs. However, multivariate analysis did not show any significant risk factors. Conclusions: ER may be an alternative treatment modality for selected patients with undifferentiated EGCs.
Hepato-gastroenterology 08/2011; 59(114):607-11. · 0.66 Impact Factor
