[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.
[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; · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Distinction is vague between severe constipation and postoperative ileus (POI) in terms of pathogenesis, clinical features, and treatment options. However, no data are available regarding their associations.
After retrospective review of data from patients who underwent orthopedic surgery during the first 6 months of 2011, a total of 612 patients were included. Severe constipation was defined as symptoms of constipation requiring treatment using at least 2 laxatives from different classes for at least 6 months. POI was defined as paralytic ileus lasting more than 3 days post-surgery and associated with 2 or more of the following: (1) nausea/vomiting, (2) inability to tolerate an oral diet over a 24-hour period, and (3) absence of flatus over a 24-hour period. The subjects were divided into non-POI and POI groups, and we com - pared patient-, surgery-, and pharmaceutical-related factors.
Thirteen (2.1%) out of 612 experienced POI. In comparisons between the non-POI and POI groups, univariate analysis showed significant differences in the mean age (51.4 vs. 71.6 years), mean body mass index (24.1 vs. 21.8 kg/m(2)), severe constipation (5.8% vs. 76.9%), co-morbidities (33.2% vs. 84.6%), type of orthopedic surgery (spine/hip/limb: 19.4/11.0/65.6% vs. 23.1/61.5/15.4%), and estimated blood loss (50 vs. 300 mL). Multivariate logistic regression analysis, after adjustment for age, body mass index, co-morbidities, type of orthopedic surgery, and estimated blood loss, showed that severe constipation was an independent risk factor for POI (OR 35.23; 95% CI, 7.72-160.82; P < 0.001).
Severe constipation is associated with POI after orthopedic surgery.
Journal of neurogastroenterology and motility 12/2014; · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 49-year-old woman visited our hospital with dysphagia and chest pain. In another hospital, she was diagnosed as reflux esophagitis. Although she had taken proton pump inhibitor and prokinetics drugs for a long time, she was not relieved of any symptoms. On the basis of high resolution manometry and endoscopic ultrasonography findings, Jackhammer esophagus was diagnosed. In this patient, peroral endoscopic myotomy (POEM) was performed for long myotomy of thickened circular muscle. During the procedure, there were no significant complications and she was discharged uneventfully. Symptoms were completely improved during three months after POEM. Here, we report on a case of Jackhammer esophagus treated by POEM. (Korean J Gastroenterol 2014;64:370-374).
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 12/2014; 64(6):370-4.
[Show abstract][Hide abstract] ABSTRACT: Currently, the videofluoroscopic swallowing study (VFSS) is the standard tool for evaluating dysphagia. We evaluated whether the addition of endoscopistdirected flexible endoscopic evaluation of swallowing (FEES) to VFSS could improve the detection rates of penetration, aspiration, and pharyngeal residue, compared the diagnostic efficacy between VFSS and endoscopist-directed FEES and assessed the adverse events of the FEES.
In single tertiary referral center, a retrospective analysis of prospectively collected data was conducted. Fifty consecutive patients suspected of oropharyngeal dysphagia were enrolled in this study between January 2012 and July 2012.
The agreement in the detection of penetration and aspiration between VFSS and FEES of viscous food (κ=0.34; 95% confidence interval [CI], 0.15 to 0.53) and liquid food (κ=0.22; 95% CI, 0.02 to 0.42) was "fair." The agreement in the detection of pharyngeal residue between the two tests was "substantial" with viscous food (κ=0.63; 95% CI, 0.41 to 0.94) and "fair" with liquid food (κ=0.37; 95% CI, 0.10 to 0.63). Adding FEES to VFSS significantly increased the detection rates of penetration, aspiration, and pharyngeal residue. No severe adverse events were noted during FEES, except for two cases of epistaxis, which stopped spontaneously without requiring any packing.
This study demonstrated that the addition of endoscopist-directed FEES to VFSS increased the detection rates of penetration, aspiration, and pharyngeal residue. (Gut Liver, Published online December 5, 2014).
[Show abstract][Hide abstract] ABSTRACT: Objective
To determine the long-term outcome after endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) patients, we analyzed the results and the clinical outcomes after ESD of EGC according to the pathologic extent.MethodsESDs were performed in 309 EGCs of 280 patients. They were classified by pathological severity based on absolute indication (AI), expanded indication (EI) or beyond expanded indication (BEI). The therapeutic outcomes were compared among the three groups.ResultsThe complete resection rates were 96.4% in the AI-EGCs, 78.7% in the EI-EGCs, and 41.2% in the BEI-EGCs (P = 0.000). The en bloc resection rates were 97.6% in the AI-EGCs, 87.4% in the EI-EGCs, and 86.3% in the BEI-EGCs (P = 0.023). The 5-year tumor recurrence rates were 1.8% in the AI-group, 1.5% in the EI-group and 15.4% in the BEI-group (P = 0.000). The 5-year disease-specific survival rates were 100% in the AI-group, 100% in the EI-group, and 97.4% in the BEI-group (P = 0.088). The 5-year disease-free survival rates were 98.2% in the AI-group, 98.5% in the EI-group, and 84.6% in the BEI-group (P = 0.000).ConclusionsESD was effective and safe in the AI or EI-EGCs but a comparatively high rate of recurrence resulted from ESD in the BEI-EGCs. However, the long-term outcome of BEI-EGCs that did not receive additional surgery was better compared with the natural course of EGCs. Thus, ESD may be considered in specific BEI-EGCs patients at high-risk for surgery.
Journal of Digestive Diseases 11/2014; 16(1). · 1.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We compared the long-term outcomes of balloon dilation versus botulinum toxin injection in Korean patients with primary achalasia and identified factors predicting remission.
The Korean Journal of Internal Medicine 11/2014; 29(6):738-45.
[Show abstract][Hide abstract] ABSTRACT: We used high-resolution impedance manometry (HRIM) to determine the length of breaks on the isobaric contour which would predict incomplete bolus clearance in patients in the sitting position.
Journal of neurogastroenterology and motility 10/2014; 20(4):491-6. · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and AimsThe clinical significance and prognosis of mixed adenocarcinoma in early gastric cancer (EGC) are incompletely understood. The aim of this study was to evaluate the clinicopathological characteristics and long-term outcomes of mixed adenocarcinoma diagnosed as EGC after endoscopic submucosal dissection (ESD).Methods
Four hundred and thirty EGCs were histologically proven by ESD in 395 patients. The clinicopathological characteristics and long-term outcomes, including the rates of local recurrence, were evaluated according to histological type in EGC treated with ESD.ResultsIn total, 430 EGCs were classified as 362 (84.4%) tubular adenocarcinomas, 41 (9.5%) poorly cohesive carcinomas (PCCs), 26 (6.0%) mixed adenocarcinomas, and 1 (0.2%) papillary adenocarcinoma according to the WHO classification. Although the en bloc resection rate was acceptable (92.3%) for mixed adenocarcinoma, the complete resection rate was lower (53.8%) than that in other types (P < 0.01). Local recurrence occurred in 5 (19.2%) of 26 mixed adenocarcinomas after ESD. In a multivariate analysis, mixed adenocarcinoma was an independent risk factor predicting local recurrence after ESD for EGC (hazard ratio, 7.039; P < 0.01).Conclusions
Mixed adenocarcinoma is more aggressive than other histological types of EGC based on clinical outcomes. Moreover, it is an independent prognostic factor for local recurrence after ESD for EGC.
Journal of Gastroenterology and Hepatology 10/2014; · 3.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: At present, automated analysis of high-resolution manometry (HRM) provides details of upper esophageal sphincter (UES) relaxation parameters. The aim of this study was to assess the accuracy of automatic analysis of UES relaxation parameters.
One hundred and fifty three subjects (78 males, mean age 68.6 years, range 26-97) underwent HRM. UES relaxation parameters were interpreted twice, once visually (V) by two experts and once automatically (AS) using the ManoView ESO analysis software. Agreement between the two analysis methods was assessed using Bland-Altman plots and Lin's concordance correlation coefficient (CCC).
The agreement between V and AS analyses of basal UES pressure (CCC 0.996; 95% confidence interval (CI) 0.994-0.997) and residual UES pressure (CCC 0.918; 95% CI 0.895-0.936) was good to excellent. Agreement for time to UES relaxation nadir (CCC 0.208; 95% CI 0.068-0.339) and UES relaxation duration (CCC 0.286; 95% CI 0.148-0.413) between V and AS analyses was poor. There was moderate agreement for recovery time of UES relaxation (CCC 0.522; 95% CI 0.397-0.627) and peak pharyngeal pressure (CCC 0.695; 95% CI 0.605-0.767) between V and AS analysis.
AS analysis was unreliable, especially regarding the time variables of UES relaxation. Due to the difference in the clinical interpretation of pharyngoesophageal dysfunction between V and AS analysis, the use of visual analysis is justified.
The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 10/2014; 25(5):473-80. · 0.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to compare the outcomes of endoscopic submucosal dissection (ESD) and gastrectomy based on the two sets of indications for ESD, namely guideline criteria (GC) and expanded criteria (EC).
[Show abstract][Hide abstract] ABSTRACT: NSAID-induced upper gastrointestinal (GI) damage occurs easily in people with a prior history of complicated or uncomplicated ulcers. Many recent clinical studies have proved the benefit of Helicobacter pylori eradication in NSAID users; however, the exact pathophysiologic relationship between concomitant H. pylori infection and NSAID use has not yet been fully elucidated. Testing and eradication of H. pylori are generally recommended in patients who are at a high risk for NSAID-induced GI damage. However, in high-risk patients, ulcer prophylaxis with proton pump inhibitor or misoprostol is needed even if H. pylori has been successfully eradicated. In low-risk patients, it is still questionable whether or not eradication of H. pylori can reduce upper GI damage. However, in western countries, due to its cost effectiveness, testing and eradication of H. pylori is recommended before starting aspirin or NSAID irrespective of the risk level. In regions with a high prevalence of H. pylori infection (>20%), the usefulness of testing and eradication of H. pylori has not yet been determined. (Korean J Gastroenterol 2014;64:70-75).
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 08/2014; 64(2):70-5.
[Show abstract][Hide abstract] ABSTRACT: BackgroundMalnutrition among inflammatory bowel disease (IBD) may arise from factors including inadequate dietary intake, malabsorption, and progression of disease. IBD has been reported an increased prevalence of low bone mass. The aims of the present study were to evaluate the nutritional status and to investigate the correlation between bone mineral density (BMD) and nutrient factors in patients with IBD.MethodsA total of 41 subjects were classified into normal group (n=21) and malnourished group (n=20) by the subjective global assessment result. We surveyed the dietary habit, nutrient intake, and BMD.ResultsSubjects' average age was 36.7 years old, and included 26 ulcerative colitis and 15 Crohn's disease. The serum C-reactive protein (CRP) was significantly higher and serum calcium was significantly lower in the malnourished group. Lower bone density subjects were more in the malnourished group but no significant difference. Intake of energy, protein, carbohydrate, fiber, iron, sodium, potassium, zinc, vitamin B6, vitamin C and folate were significantly lower in the malnourished group. The BMD of malnourished group showed correlation with triceps skin fold thickness (TSF), CRP, dietary calcium, phosphorous, iron, animal iron, zinc and vitamin.ConclusionsThe results suggested that adequate intake of nutrients is important to prevent bone loss and systemic education programs are need for IBD patients.
Journal of bone metabolism. 08/2014; 21(3):195-203.
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[Show abstract][Hide abstract] ABSTRACT: Amyloidosis is characterized by the abnormal deposition of extracellular amyloid fibrils. Cases involving amyloid light-chain amyloidosis in the small intestine have been reported infrequently in Korea. Here, we report a case of localized light chain protein amyloidosis in the small intestine. Esophagogastroduodenoscopy, push enteroscopy, and capsule endoscopy revealed submucosal tumor-like lesions, multiple shallow ulcers, and several erosions in the distal duodenum and jejunum. An endoscopic biopsy established the diagnosis of amyloidosis. In through an immunohistochemical analysis, the presence of lambda light chain protein was detected. The patient had no evidence of an underlying clonal plasma cell disorder or additional organ involvement. Therefore, we concluded that the patient had localized amyloidosis of the small intestine.
[Show abstract][Hide abstract] ABSTRACT: Impedance analysis using high-resolution impedance manometry (HRIM) enables the recognition of pharyngeal residue in patients with oropharyngeal dysphagia. The aims of this study were to evaluate appropriate criteria for impedance analysis in a large patient cohort, as well as the diagnostic accuracy and agreement of analysis performed by HRIM trainees.
Journal of neurogastroenterology and motility 06/2014; 20(3). · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective. Self-expandable metal stents (SEMSs) have been used as palliative treatment or bridge to surgery for obstructions caused by colorectal cancer (CRC). We assessed the long-term outcomes of palliative SEMSs and evaluated the risk factors influencing complications. Materials and methods. One hundred and seventy-five patients underwent SEMS placement for acute malignant colorectal obstruction. Of the 72 patients who underwent palliative treatment for primary CRC, 30 patients received chemotherapy (CT) for primary cancer (CT group) and 42 underwent best supportive treatment (BST) without CT (BST group). Results. There was a significant difference in late migration between the CT group and the BST group (20.0% in CT group, 2.4% in BST group, p = 0.018). Response to CT influenced the rate of late obstruction (0% in disease control, 35.7% in disease progression, p = 0.014). However, late obstruction was not associated with stent properties, such as diameter or type (≤22 mm vs. >22 mm, 13.5% vs. 14.3%, p = 1.00; uncovered stent vs. covered stent, 15.5% vs. 7.1%, p = 0.675) and migration (≤22 mm vs. >22 mm, 16.2% vs. 2.9%, p = 0.108; uncovered stent vs. covered stent, 8.6% vs. 14.3%, p = 0.615) in palliative SEMS. Conclusion. The administration of CT increases the rate of stent migration, and disease control by CT can reduce the risk of obstruction by maintaining the luminal patency of palliative SEMSs.
Scandinavian Journal of Gastroenterology 05/2014; 49(8):1-7. · 2.33 Impact Factor