[Show abstract][Hide abstract] ABSTRACT: Background/aims:
Pneumoperitoneum is recognized as a benign and self-limiting finding after the insertion of a percutaneous endoscopic gastrostomy (PEG) tube, while complicated pneumoperitoneum is rarely reported. The aim of this study was to reappraise pneumoperitoneum following PEG.
We retrospectively reviewed 193 patients who underwent PEG from May 2008 to May 2014. All patients had a follow-up upright chest or simple abdominal radiograph after PEG. Pneumoperitoneum was quantified by measuring the height of the air column under the diaphragm and graded as small (<2 cm), moderate (2-4 cm), or large (>4 cm). Clinically significant signs were defined as fever, abdominal tenderness or leukocytosis occurring after PEG insertion.
Of the 193 study patients, 9 (4.6%) had a pneumoperitoneum visualized by radiographic imaging, graded as small in 5 patients, moderate in 2 patients and large in 2 patients. Clinically significant signs were observed in 5 (55.5%) patients with fever reported in 4 patients, abdominal tenderness in 4 patients and leukocytosis in 4 patients. The time to resolution of free air was 2-18 days. Two patients (22.2%) with moderate or large pneumoperitoneum after PEG died from either pneumonia or septic shock.
The clinical course of pneumoperitoneum after PEG is not always benign and self-limiting. These findings suggest that clinicians should not neglect a moderate or large pneumoperitoneum, particularly in patients who have an altered mental status or received antibiotics, since peritoneal irritation cannot be observed under these circumstances.
[Show abstract][Hide abstract] ABSTRACT: Background
The efficacy of proton-pump inhibitor–amoxicillin–clarithromycin therapy for H. pylori eradication has decreased over time.Objective
We assessed the trend of H. pylori eradication rates over the last 10 years and the relationship between the eradication rates and the amount of macrolide antibiotic use in a country with a high prevalence of H. pylori infection.Methods
This vast nationwide multicenter study was conducted with 34,139 adults treated for H. pylori infection from January 2001 to December 2010. The defined daily dose per km2 (DSD) of macrolide antibiotics was calculated (n = 141,019) using the Health Insurance Review & Assessment data base from 2008 to 2010 in the two cities which had the lowest (Jeju city) or highest (Chuncheon city) eradication rate.ResultsThe eradication rates of proton-pump inhibitor–amoxicillin–clarithromycin therapy ranged 84.9–87.5% from 2001 to 2007, and those of 2008 to 2010 ranged 80.0–81.4% with a decreasing trend (p < 0.0001). The decreasing trend of eradication rates for the overall first-line therapy was observed only in three of the seven geographic areas in Korea (p < 0.0001). The DSD of macrolide antibiotics was significantly higher in Jeju than Cheunchon city (0.85 vs 0.52, p < 0.0001).ConclusionsH. pylori eradication rates with clarithromycin-containing triple therapy in Korea showed a decreasing trend over the past 10 years, although the trend varied among geographic areas. This difference may be associated with the amount of macrolide antibiotic use.
[Show abstract][Hide abstract] ABSTRACT: Background and aims:
A previous study reported that cold snare polypectomy (CSP) was superior to cold forcep polypectomy (CFP) for the removal of diminutive colorectal polyps (DCPs, ≤5 mm) when assessed for completeness of resection. However, completeness is expected to be greater with CFP when strict investigation of the remnant polyp is performed. The aim of this study was to assess the efficacy of CFP with narrow-band imaging (NBI) evaluation of polypectomy site in removal of DCPs compare with CSP.
This was a randomized, controlled, noninferiority trial at a tertiary referral hospital. Of the 380 patients screened, 146 patients with 231 DCPs were enrolled. CFP was used to resect DCPs until no remnant polyp was visible by NBI endoscopy. The primary noninferiority endpoint was histological eradication of polyps, with a noninferiority margin of -10%.
A size of >3 mm was seen in 129 (55.8%) polyps. The overall rates of histological eradication were 90.5% in the CFP group and 93.0% in the CSP group (difference, 2.5%; 95% CI, -9.67 to 4.62). However, when confined to the polyps >3 mm, histological eradication rate was 86.8% and 93.4% (95% CI, -17.2 to 3.6), respectively. Polyp size, histology, location, and the time taken for polypectomy did not differ between the groups. The failure rate of tissue retrieval was higher in the CSP than CFP group (7.8% vs. 0.0%, respectively; P =.001).
In this study, more than 90% of all DCPs were completely resected using CFP with NBI evaluation of polypectomy site, showing noninferiority compared with CSP. However, in polyps measuring >3 mm, CFP failed to show noninferiority versus CSP. CFP appears to be proper method for the resection of DCPs 1 to 3 mm in size if no remnant polyp is visible by NBI endoscopy, but is likely insufficient for larger polyps, number: NCT02201147.).
[Show abstract][Hide abstract] ABSTRACT: Endoscopic resection of a foregut neuroendocrine tumor (NET) is increasingly performed instead of surgery. This study aimed to verify the long-term therapeutic results of endoscopic resection (ER) and surgical resection (SR) in foregut NETs.
From 2002 to 2012, a total of 49 patients were confirmed histologically as foregut NETs treated by ER (stomach = 19, duodenum = 14) and SR (stomach = 11, duodenum = 5). The clinicopathological characteristics and therapeutic outcomes were evaluated.
Of the 33 patients who underwent ER (endoscopic mucosal resection = 26, endoscopic mucosal dissection = 7), 32 cases were diagnosed as type NET-G1 and one case as neuroendocrine carcinoma (NEC). Of the 16 patients who underwent SR, 10 were diagnosed as NET-G1, two as NET-G2 and four as NEC. The median tumor size was significantly smaller in ER than SR patients (0.7 cm vs. 1.9 cm, p = 0.001). In almost all ER patients (32/33 cases), NET invasion was limited to mucosa and submucosa. Non-curative resections were achieved in eight ER patients (8/33, 24.2%) and in four SR patients (4/16, 25%). No recurrence occurred in seven NET cases defined as non-curative resection with positive resection margins by ER; however, all cases of non-curative resection with lymphatic invasion (ER = 1, SR = 4) experienced recurrence during the follow up period despite complete resections. They were all NEC histologically.
ER may have a good prognosis if the tumor size is small and histologically low-grade without lymphatic invasion. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Journal of Digestive Diseases 08/2015; DOI:10.1111/1751-2980.12279 · 1.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We compared the biological characteristics of early gastric cancer (EGC) using immunohistochemical (IHC) staining among histological types.
IHC staining results were analyzed in 86 EGCs resected with endoscopic submucosal dissection to identify mucin phenotype and biological characteristics.
The histological type was classified as tubular adenocarcinoma (TAC), mixed adenocarcinoma (MAC), or poorly cohesive carcinoma (PCC). Significant differences in MUC-2 (34.4% vs. 10.7%, p < 0.05) and MUC-5AC (59.4% vs. 85.7%, p < 0.05) expression were observed between TAC and PCC. The poorly cohesive component of MAC showed stronger immunoreactivity to CD10 (46.2% vs. 14.3%, p < 0.05) but weaker reactivity to MUC-5AC (57.7% vs. 85.7%, p < 0.05), compared to that of PCC. E-cadherin and β-catenin expression levels significantly decreased in the poorly cohesive component of MAC (15.4% vs. 90.6%, p < 0.05; 7.7% vs. 90.6%, p < 0.05, respectively) and PCC (10.7% vs. 90.6%, p < 0.05; 14.3% vs. 90.6%, p < 0.05, respectively), compared to TAC. However, vascular endothelial growth factor expression significantly increased in the poorly cohesive component of MAC (42.3% vs. 9.4%, p < 0.05) and PCC (39.3% vs. 9.4%, p < 0.05), compared to TAC.
IHC analysis showed that EGC histological types differ in terms of mucin phenotype and biological characteristics. The poorly cohesive components showed decreased E-cadherin and β-catenin expression levels and increased vascular endothelial growth factor expression. These characteristics may contribute to the poor prognosis of patients with MAC and PCC.
[Show abstract][Hide abstract] ABSTRACT: Non-curative resection after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) can contribute to local recurrence or lymphatic and distant metastasis of the tumor. We stratified the risk of local recurrence according to the histological characteristics in non-curative resection after ESD for EGC.
Among 892 EGCs treated with ESD, 152 (17.0 %) were classified as non-curative resection based on the histology after ESD. The clinical outcomes and risk factors associated with local recurrence were analyzed retrospectively in non-curative resections.
Of 152 non-curative resections, 46 (30.3 %) were stratified as Group 1 (incomplete resection and met the ESD criteria), 31 (20.4 %) as Group 2 (complete resection and exceeded the ESD criteria), 41 (27.0 %) as Group 3 (incomplete resection and exceeded the ESD criteria), and 34 (22.4 %) as Group 4 (lymphovascular invasion regardless of complete resection). Group 3 [odds ratio (OR) 3.991; p = 0.015] and Group 4 (OR 4.487; p = 0.014) had higher rates of local recurrence after non-curative resection. In those high-risk groups, endoscopic surveillance without additional treatment detected significantly more local recurrence than in those receiving additional treatment (p = 0.029).
Risk stratification for non-curative resection is important for EGC prognosis after ESD. Moreover, additional treatment for non-curative resection influences long-term outcomes, especially in high-risk groups.
[Show abstract][Hide abstract] ABSTRACT: "Cat scratch colon" is a gross finding characterized by hemorrhagic mucosal scratches on colonoscopy. It is usually associated with a normal colon and is rarely associated with collagenous colitis. In a previous report, cat scratch colon was noted in the cecum and ascending colon, but has also been observed in the distal transverse colon. The patient in this study was also diagnosed with ischemic colitis that may have played a role in the development of cat scratch colon.
[Show abstract][Hide abstract] ABSTRACT: There is a growing emphasis on quality management in endoscope reprocessing. Previous surveys conducted in 2002 and 2004 were not practitioner-oriented. Therefore, this survey is significant for being the first to target actual participants in endoscope reprocessing in Korea.
This survey comprised 33 self-filled questions, and was personally delivered to nurses and nursing auxiliaries in the endoscopy departments of eight hospitals belonging to the society. The anonymous responses were collected after 1 week either by post or in person by committee members.
The survey included 100 participants. In the questionnaire addressing compliance rates with the reprocessing guideline, the majority (98.9%) had a high compliance rate compared to 27% of respondents in 2002 and 50% in 2004. The lowest rate of compliance with a reprocessing procedure was reported for transporting the contaminated endoscope in a sealed container. Automated endoscope reprocessors were available in all hospitals. Regarding reprocessing time, more than half of the subjects replied that reprocessing took more than 15 minutes (63.2%).
The quality management of endoscope reprocessing has improved as since the previous survey. A national survey expanded to include primary clinics is required to determine the true current status of endoscope reprocessing.
[Show abstract][Hide abstract] ABSTRACT: Helicobacter pylori infection, a common infection in many countries, is related to the clinical course of upper gastrointestinal diseases. Gastroesophageal reflux disease (GERD) is a common esophageal disease in Western countries and its prevalence is increasing in Asian countries. The pathophysiology of GERD is multifactorial. Although no single factor has been isolated as the cause of GERD, a negative association between the prevalence of H. pylori and the severity of GERD, including Barrett's esophagus, has been demonstrated in epidemiological studies. The high prevalence of H. pylori infection affects the incidence of GERD in Asian countries. In the subjects with East Asian CagA-positive strains, acid injury may be minimized by hypochlorhydria from pangastritis and gastric atrophy. Additionally, host genetic factors may affect the development of GERD. The interactions between genetic factors and the virulence of H. pylori infection may be the reason for the low prevalence of GERD in Asian countries. H. pylori eradication is not considered pivotal in GERD exacerbation based on evidence from Western studies. A recent meta-analysis demonstrated that eradication therapy of H. pylori was related to a higher risk of developing de novo GERD in Asian studies. H. pylori infection remains an inconclusive and important issue in GERD in Asian countries.
Gastroenterology Research and Practice 01/2015; 2015:985249. DOI:10.1155/2015/985249 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dual-focus two-stage optical lens technology has been introduced recently. In near-focus mode (NFM), endoscopists can easily examine the mucosal tissue and capillary networks. This study compared the magnified images obtained using NFM and the conventional magnification method (CMM) under narrow-band imaging in patients with gastric epithelial tumors.
[Show abstract][Hide abstract] ABSTRACT: Hepatoid adenocarcinoma of the stomach (HAS) is a rare form of gastric cancer that histologically resembles hepatocellular carcinoma and is characterized by large amounts of alpha fetoprotein in the serum. The prognosis of HAS is poor compared to that of primary gastric cancer with five-year survival rates of 9% and 44%, respectively. Here, we report five patients diagnosed with HAS. Our experience suggests that an advanced stage of HAS has an extremely poor prognosis, but early detection and radical surgery can help improve the prognosis of the disease.
[Show abstract][Hide abstract] ABSTRACT: To date, high-resolution manometry has been used mainly in the study of esophageal motility disorders and has been shown to provide more physiological information than conventional manometry, and is easier to interpret. This study aimed to evaluate the usefulness of high-resolution anorectal manometry (HRARM) compared to water-perfused anorectal manometry.
Patients who complained of chronic constipation with/without fecal incontinence underwent both water-perfused anorectal manometry and HRARM in a random order on the same day. Resting and squeezing pressures of the anal sphincter, attempted defecation, rectoanal inhibitory reflex, rectoanal contractile reflex, Rao's type of dyssynergia during attempted defecation, anal canal length, defecation dynamic parameters and measurement times for each method were analyzed.
Of 14 patients, 7 were female, and the median age was 59 years (range 35-77). Indications for manometry were constipation (n = 8) and constipation with fecal incontinence (n = 6). Resting and squeezing pressures showed that the two methods were strongly correlated (resting pressure: r = 0.746, P = 0.002; squeezing pressure: r = 0.921, P < 0.001). In attempted defection, one equivocal case with water-perfused anorectal manometry was diagnosed type I pelvic floor dyssynergia with HRARM providing detailed pressure changes in internal and external anal spincters, and puborectalis muscle which improved assessment of anorectal disorders. The measurement time for HRARM was significantly shorter than that for water-perfused anorectal manometry (11.3 vs. 23.0 minutes, P < 0.001).
Both water-perfused anorectal manometry and HRARM are well tolerated and reliable methods of evaluating defecation disorders of pelvic floor dysfunction. HRARM is likely to provide better physiological information and to require a shorter measurement time compared to water-perfused anorectal manometry.
Journal of neurogastroenterology and motility 12/2014; 21(1). DOI:10.5056/jnm14025 · 2.30 Impact Factor