ABSTRACT: BACKGROUND: Although endoscopic submucosal dissection (ESD) is standard therapy for early gastric cancer, the complication rate is unsatisfactory, with perforation as the major complication during ESD. There have been several reports regarding the complications of ESD for gastric tumor especially perforation; however, little is known about the predictors for complications in patients undergoing ESD. The purpose of this retrospective study was to determine the risk factors for perforation in patients with early gastric cancer during ESD. METHODS: Between February 2003 and May 2010, we performed ESD for 1,289 lesions in 1,246 patients at six tertiary academic hospitals in Daegu, Kyungpook, Korea. Patient-related variables (age, sex, and underlying disease), endoscopic-related variables (indication of ESD, lesion size, location, type, and mucosal ulceration), procedure-related variables (operation time, complete resection, and invasion of submucosa/vessel/lymph node), and the pathologic diagnosis were evaluated as potential risk factors. RESULTS: The mean age of the patients was 64 years. The mean size of the endoscopic lesion was 19.4 mm. The overall en bloc resection rate was 93.3 %. Perforation (microperforation and macroperforation) was seen in 35 lesions. The location of the lesion (long axis: body/short axis: greater and lesser curvature) and piecemeal resection were associated with perforation (p = 0.01/0.047 and p = 0.049). Upon multivariate analysis, the location (body vs. antrum) of the lesion (odds ratio (OR) 2.636; 95 % confidence interval (CI) 1.319-5.267; p = 0.006) and piecemeal resection (OR 2.651; 95 % CI 1.056-6.656; p = 0.038) were significant predictive factors for perforation. CONCLUSIONS: The result of this study demonstrated that the location of the lesion (body) and piecemeal resection were related to perforation during ESD.
Surgical Endoscopy 12/2012; · 4.01 Impact Factor
ABSTRACT: BackgroundThe endoscopic submucosal dissection (ESD) technique has been gaining popularity, with continued advances in this treatment
approach. However, ESD still is associated with potential complications such as severe bleeding and perforation.
MethodsThis study was performed to compare the clinical outcomes for macro- and microperforations with ESD procedures and to determine
the short-term prognosis after ESD. A macroperforation was defined as a gross perforation that occurred during an ESD procedure,
and a microperforation was defined by free air observed on simple radiography after the procedure. Immediate closure of macroperforations
was performed using endoclips. From July 2003 through May 2008, 1,711 patients underwent ESD for gastric lesions such as dysplasia,
early cancer, and subepithelial lesions.
ResultsAmong 39 perforation cases (2.3%), macroperforations occurred for 26 patients (67%) and microperforations for 13 patients
(33%). All the patients except one who underwent emergency surgery because of severe bleeding and perforation during ESD were
managed successfully by intravenous antibiotics and no oral intake. The clinical prognosis and endoscopic characteristics
of the patients with macroperforations did not differ from those of the patients with microperforations.
ConclusionsPerforations associated with ESD could be managed safely and successfully by nonsurgical methods. The clinical prognoses for
macro- and microperforations were favorable and comparable.
KeywordsGastroscopic surgical procedure-Pneumoperitoneum-Stomach neoplasia
Surgical Endoscopy 04/2012; 24(4):911-916. · 4.01 Impact Factor
ABSTRACT: The role of Helicobacter pylori eradication in patients with functional dyspepsia (FD) is still uncertain. We originally planned a randomized clinical study to observe dyspeptic symptoms after H. pylori eradication therapy. However, we failed to complete the study; therefore, we analyzed the factors that affected the failure of the study.
Interviews and questionnaire surveys were conducted to analyze the factors that induced early termination from the study.
Many patients were screened by gastroenterologists at 11 tertiary referral hospitals between July 2009 and August 2010; however, only 4 patients met the enrollment criteria. Most patients who visited our clinics had been experiencing FD symptoms for less than 6 months or were already taking medication. They also demanded to continue taking medications and using other drugs. Only 3 of the 4 patients signed informed consent.
The application of the current Rome III criteria to FD is difficult to evaluate in Korean patients with dyspeptic symptoms because of the early medical evaluation. Most Korean patients who were diagnosed with FD by the Rome III criteria did not overcome their fear of being unable to use rescue medications during the study period.
Gut and liver 12/2011; 5(4):468-71. · 0.83 Impact Factor
ABSTRACT: Recent studies suggest that the prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea. However, studies on risk factors for GERD have yielded inconsistent results. The aims of this study were to compare clinical features between symptomatic syndromes without esophageal injury (=non-erosive disease [NED]) and syndromes with esophageal injury (=erosive disease [ED]), and to determine risk factors associated ED.
A total of 450 subjects who visited gastroenterology clinics of six training hospitals in Daegu from March 2008 to April 2010 were consecutively enrolled. The subjects were asked to complete a questionnaire which inquired about gastroesophageal reflux symptoms. The questionnaire also included questions about smoking, alcohol drinking, consumption of coffee, use of drugs, exercise, and other medical history. The subjects were subdivided into NED and ED groups.
The proportion of subjects in each NED and ED group was 172 (38.2%) and 278 (61.8%). Male gender, smoking, alcohol drinking, consumption of coffee, large waist circumference, infrequent medication of antacids, aspirin and NSAIDs, infrequent and mild GERD symptoms were all significantly associated with ED on univariate analysis. Age, hiatal hernia, diabetes mellitus, body mass index, change in weight during 1 year, and number of typical GERD symptoms were not independent risk factors for ED. However, the association between ED and alcohol drinking, infrequent medication of antacids, mild typical GERD symptoms remained as strong risk factors after adjustments on multivariate logistic analysis.
Independent risk factors associated with ED were alcohol drinking, infrequent medication of antacids and mild typical GERD symptoms.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 05/2011; 57(5):281-7.
ABSTRACT: Little is known about whether a routinely inserted endoscopic nasobiliary drainage (ENBD) tube improves the clinical course in patients with choledocholithiasis-induced acute cholangitis after clearance of choledocholithiasis.
The aim of this study was to investigate the need for ENBD on the clinical outcomes of patients with acute cholangitis undergoing endoscopic clearance of common bile duct (CBD) stones.
Prospective, randomized study.
Tertiary referral center.
A total of 104 patients with choledocholithiasis-induced acute cholangitis who underwent primary endoscopic treatment were compared according to insertion of an ENBD tube (51 in the ENBD group and 53 in the no-ENBD group).
Insertion of an ENBD tube after clearance of CBD stones.
Recurrence of cholangitis and length of hospital stay after clearance of CBD stones.
Baseline clinical characteristics were similar between both groups. There were no significant differences in the recurrence rate of cholangitis at 24 weeks (3.9% for the ENBD group vs 3.8% for the no-ENBD group at 24 weeks; P = .99) and length of hospital stay (7.9 days [standard error = 1.2] for the ENBD group vs 7.9 days [standard error = 0.7] for the no-ENBD group; P = .98). However, procedure time was longer (26.2 [SE = 1.8] minutes vs 22.7 [SE = 1.0] minutes, respectively; P = .01) and the discomfort score was higher (4.9 [SE = 0.4] vs 2.8 [SE = 0.3], respectively; P = .02) in the ENBD group than in the no-ENBD group.
A routinely inserted ENBD tube did not improve the clinical course, despite patients having to endure increased procedure time and discomfort, and the insertion would therefore be unnecessary.
Gastrointestinal endoscopy 11/2009; 71(1):105-10. · 6.71 Impact Factor
ABSTRACT: The purposes of this study were to investigate various environmental factors for colon polyps and to analyze locoregional clinical characteristics of colon polyps in Gyeongju and Pohang area.
From October 2005 to September 2006, patients who underwent colonoscopy were analyzed based on their ages, genders, body mass indices (BMI), dietary habits, smoking behaviors, accompaying diseases, and medications as risk factors for the occurrence of colon polyps. Then clinical manifestations, gross appearances and pathologic findings of polyps were investigated.
Among 253 patients enrolled, a total of 296 colon polyps were found in 108 patients. The incidence of colon polyps in more than 50-year old patients was 3.2-fold greater compared to less than 50-year old patients. Smoking habits were also significantly associated with the occurence of colon polyps. Among adenomatous polyps, tubulovillous type and moderate to severe dysplasia were frequently observed as the size increased, yet the location of polyps was not significantly associated.
Older age and smoking habit increase the risk of colon polyps. Rectal polyps have less chance to be adenomatous type. The larger the polyp grows, the more likely it to be tubulovillous and dysplastic.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 10/2008; 52(3):142-9.
ABSTRACT: To examine the importance of intestinal inflammation in the diagnosis and pathogenesis of human cryptosporidiosis, stools of healthy adult volunteers before and after experimental infection were tested for fecal lactoferrin, interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha). Stool samples of Brazilian children with well-defined Cryptosporidium infection, with or without diarrhea, were also tested for IL-8 and TNF-alpha. Only one of the 14 volunteers challenged with Cryptosporidium had increased fecal lactoferrin. However, of 17 stool specimens from children with only Cryptosporidium infection from a previous study, 12 had mild to moderately elevated lactoferrin despite negative work-up for inflammatory enteritides. One of 10 adult volunteers who developed diarrhea with experimental cryptosporidiosis and three of 11 children with cryptosporidiosis and diarrhea had detectable fecal IL-8. The level of TNF-alpha was increased only in one of 14 volunteers and in none of the children. Although considered relatively non-inflammatory. cryptosporidiosis is often associated with mild inflammation, especially in children in an endemic area.
The American journal of tropical medicine and hygiene 04/2003; 68(3):325-8. · 2.59 Impact Factor