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1Relationship between plasma D(-)-lactate and intestinal damage after severe injuries in rats显示文摘AIM To explore the kinetic changes in plasma D (-)lactate and lipopolysaccharide ( LPS ) levels, and investigate whether D (-)-lactate could be used as a marker of intestinal injury in rats following gut ischemia/reperfusion, burn, and acute necrotizing pancreatitis (ANP).METHODS Three models were developed in rats:gut ischemia/reperfusion obtained by one hour of superior severe burn injury created by 30% of total body surface induced by continuous inverse infusion of sodium taurocholate and trypsin into main pancreatic duct.Plasma levels of D( - )-lactate in systemic circulation and LPS in portal circulation were measured by enzymaticspectrophotometric method and limulus amebocyte lysate (LAL) test kit, respectively. Tissue samples of intestine were taken for histological analysis.RESULTS One hour gut ischemia followed by reperfusion injuries resulted in a significant elevation in plasma D( - )lactate and LPS levels, and there was a significant correlation between the plasma D( - )-lactate and LPS (r =0.719, P<0.05). The plasma concentrations of D(-)lactate and LPS increased significantly at 6 h postburn,and there was also a remarkable correlation between them (r = 0.877, P < 0.01). D ( - )-lactate and LPS levels elevated significantly at 2 h after ANP, with a similar significant correlation between the two levels (r-0.798,P < 0.01 ). The desquamation of intestine villi and infiltration of inflammatory cells in the lamina propria were observed in all groups.CONCLUSION The changes of plasma D( - )-lactate levels in systemic blood paralleled with LPS levels in the portal vein blood. The measurement of plasma D (-)-lactate level may be a useful marker to assess the intestinal injury and to monitor an increase of intestinal permeability and endotoxemia following severe injuries in early stage.Xiao-Qing Sun Xiao-Bing Fu Rong-Zhan Yi Lü Qun Deng Xiao-Guo Jian Zhi-Yong Sheng Bum Institute, 304~(th)Hospital,Beijing 100037,China Department of General Surgery,Chinese PLA 304 Hospital,Beijing 100037,China 2001World Journal of Gastroenterology2001,7,4:56
2Worldwide experiences of endoscopic submucosal dissection:Not just Eastern acrobatics显示文摘The high incidence of gastric cancer has led to the initiation of cancer screening programs.As a result,the number of early gastric cancer cases has increased and consequentially,the cancer mortality rate has decreased.Moreover,the development of minimally invasive endoscopic treatment has been introduced for these early lesions.Endoscopic submucosal dissection(ESD) is now recognized as one of the preferred treatment modalities for premalignant gastrointestinal epithelial lesions and early gastric cancer without lymph node metastasis.We review the results of ESD including experiences in Japan and Korea,as well as western countries.Kwang Bum Cho Won Joong Jeon Jae J Kim 2011World Journal of Gastroenterology2011,17,21:48
3Histologic characteristics of gastric polyps in Korea: Emphasis on discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimen显示文摘瞄准:在朝鲜人口调查胃的息肉的组织学的特征。方法:我们与胃的息肉考察了内视镜的相片和病人的医药记录通过 2003 年 2 月从 1996 年 4 月经历了内视镜的粘膜切除术。结果:从 74 个病人的 85 胃的息肉的一个总数被考察。Male-to-female 比率是 1:1.96。吝啬的年龄是 59.9 +/- 10.8 年。多重息肉在 10.8% 被观察。胃的息肉最经常发生在窦(58.8%) 。resected 标本上的病理学的结果如下:管状腺瘤 45.9% ,增生的息肉 31.8% ,煽动性的息肉 9.4% ,错构瘤 3.5% ,底的腺息肉 2.4% , tubulovillous 腺瘤 2.4% ,腺癌 2.4% ,发育异常 1.1% ,并且粘膜 pseudolipomatosis 1.1% 。在 resected 标本的内视镜的活体检视和病理之间的差异率是 27.1% 。在息肉和词语索引率的尺寸之间没有关系。结论:在在内视镜的钳活体检视和 resected 标本之间的 histologic 调查结果有可观的差异。全部息肉的组织学的评论的途径应该被执行,特别当一个腺瘤被怀疑时。Won Jae Yoon Dong Ho Lee Yong Jin Jung Ji Bong Jeong Ji Won Kim Byeong Gwan Kim Kook Lae Lee Kwang Hyuck Lee Young Soo Park Jin-Hyeok Hwang Jin-Wook Kim Nayoung Kim Jun Kyu Lee Hyun Chae Jung Yong Bum Yoon In Sung Song 2006World Journal of Gastroenterology2006,12,25:19
4Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach显示文摘BACKGROUND: For palliative treatment of the obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC), percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde biliary drainage (ERBD) has been performed. PTBD is preferred as an initial procedure. Little is known about the better option for patients with obstructive jaundice caused by unresectable HCC. METHODS: Sixty patients who had received ERBD or PTBD for the palliative treatment of obstructive jaundice caused by unresectable HCC between January 2006 and May 2010 were included in this retrospective study. Successful drainage, drainage patency, and the overall survival of patients were evaluated. RESULTS: Univariate analysis revealed that the overall frequency of successful drainage was higher in the ERBD group (22/29, 75.9%) than in the PTBD group (15/31, 48.4%) (P=0.029); but multivariate analysis showed marginal significance (P=0.057). The duration of drainage patency was longer in the ERBD group than in the PTBD group (82 vs 37 days, respectively, P=0.020). Regardless of what procedure was performed, the median survival time of patients who had a successful drainage was much longer than that of the patients who did not have a successful drainage (143 vs 38 days, respectively, P<0.001).CONCLUSION: Besides PTBD, ERBD may be used as the initial treatment option to improve obstructive jaundice in patients with unresectable HCC if there is a longer duration of drainage patency after a successful drainage.Jongkyoung Choi Ji Kon Ryu Sang Hyub Lee Dong-Won Ahn Jin-Hyeok Hwang Yong-Tae Kim Yong Bum Yoon Joon Koo Han 2012Hepatobiliary & Pancreatic Diseases International2012,11,6:17
5Optimal biliary drainage for inoperable Klatskin's tumor based on Bismuth type显示文摘AIM: To investigate differences in the effects of biliary drainage procedures in patients with inoperable Klatskin’s tumor based on Bismuth type, considering endoscopic retrograde biliary drainage (ERBD), external percutaneous transhepatic biliary drainage (EPTBD) and internal biliary stenting via the PTBD tract (IPTBD). METHODS: The initial success rate, cumulative patency rate, and complication rate were compared retrospectively, according to the Bismuth type and ERBD, EPTBD, and IPTBD. Patency was defined as the duration for adequate initial bile drainage or to the point of the patient’s death associated with inadequate drainage. RESULTS: One hundred thirty-four patients (93 men, 41 women; 21 Bismuth type Ⅱ, 47 Ⅲ, 66 Ⅳ; 34 ERBD, 66 EPTBD, 34 IPTBD) were recruited. There were no differences in demographics among the groups. Adequate initial relief of jaundice was achieved in 91% of patients without a significant difference in the results among different procedures or Bismuth types. The cumulative patency rates for ERBD and IPTBD were better than those for EPTBD with Bismuth type Ⅲ. IPTBD provided an excellent response for Bismuth type Ⅳ. However, there was no difference in the patency rate among drainage procedures for Bismuth type Ⅱ. Procedure-related cholangitis occurred less frequently with EPTBD than with ERBD and IPTBD. CONCLUSION: ERBD is recommended as the first- line drainage procedure for the palliation of jaundice in patients with inoperable Klatskin’s tumor of Bismuth type Ⅱ or Ⅲ, but IPTBD is the best option for Bismuth type Ⅳ.Sang Hyub Lee Joo Kyung Park Won Jae Yoon Jun Kyu Lee Ji Kon Ryu Yong Bum Yoon Yong-Tae Kim 2007World Journal of Gastroenterology2007,13,29:17
6The dynamics of the piglet gut microbiome during the weaning transition in association with health and nutrition显示文摘Background: Understanding the composition of the microbial community and its functional capacity during weaning is important for pig production as bacteria play important roles in the pig's health and growth performance. However,limited information is available regarding the composition and function of the gut microbiome of piglets in early-life.Therefore, we performed 16 S rRNA gene and whole metagenome shotgun sequencing of DNA from fecal samples from healthy piglets during weaning to measure microbiome shifts, and to identify the potential contribution of the early-life microbiota in shaping piglet health with a focus on microbial stress responses, carbohydrate and amino acid metabolism.Results: The analysis of 16 S rR NA genes and whole metagenome shotgun sequencing revealed significant compositional and functional differences between the fecal microbiome in nursing and weaned piglets. The fecal microbiome of the nursing piglets showed higher relative abundance of bacteria in the genus Bacteroides with abundant gene families related to the utilization of lactose and galactose. Prevotel a and Lactobacil us were enriched in weaned piglets with an enrichment for the gene families associated with carbohydrate and amino acid metabolism. In addition, an analysis of the functional capacity of the fecal microbiome showed higher abundances of genes associated with heat shock and oxidative stress in the metagenome of weaned piglets compared to nursing piglets.Conclusions: Overal, our data show that microbial shifts and changes in functional capacities of the piglet fecal microbiome resulted in potential reductions in the effects of stress, including dietary changes that occur during weaning.These results provide us with new insights into the piglet gut microbiome that contributes to the growth of the animal.Robin B.Guevarra Sang Hyun Hong Jin Ho Cho Bo-Ra Kim Jiwon Shin Jun Hyung Lee Bit Na Kang Young Hwa Kim Suphot Wattanaphansak Richard E.Isaacson Minho Song Hyeun Bum Kim 2018Journal of Animal Science and Biotechnology2018,9,4:16
7Somatostatin adjunctive therapy for non-variceal upper gastrointestinal rebleeding after endoscopic therapy显示文摘AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective database in a tertiary care university hospital.From October 2006 to October 2008,we enrolled 101 patients with NVUGIB that had a high-risk stigma on endoscopy.Within 24 h of hospital admission,all patients underwent endoscopic therapy.After successful endoscopic hemostasis,all patients received an 80-mg bolus of pantoprazole followed by continuous intravenous infusion(8 mg/h for 72 h).The somatostatin adjunct group(n=49)also received a 250-μg bolus of somatostatin,followed by continuous infusion (250μg/h for 72 h).Early rebleeding rates,disappearance of endoscopic stigma and risk factors associated with early rebleeding were examined.RESULTS:Early rebleeding rates were not significantly different between treatment groups(12.2%vs 14.3%,P=0.766).Disappearance of endoscopic stigma on the second endoscopy was not significantly different between treatment groups(94.2%vs 95.9%,P=0.696).Multivariate analysis showed that the complete Rockall score was a significant risk factor for early rebleeding(P =0.044,OR:9.080,95%CI:1.062-77.595).CONCLUSION:The adjunctive use of somatostatin was not superior to pantoprazole monotherapy after successful endoscopic hemostasis in patients with NVUGIB.Cheol Woong Choi Dae Hwan Kang Hyung Wook Kim Su Bum Park Kee Tae Park Gwang Ha Kim Geun Am Song Mong Cho 2011World Journal of Gastroenterology2011,17,29:15
8Prevalence of clonorchiasis in patients with gastrointestinal disease: A Korean nationwide multicenter survey显示文摘AIM: To investigate prevalence of Clonorchis sinensis in patients with gastrointestinal symptoms, and the relation of the infection to hepatobiliary diseases in 26 hospitals in Korea.METHODS: Consecutive patients who had been admitted to the Division of Gastroenterology with gastrointestinal symptoms were enrolled from March to April 2005. Of those who had been diagnosed with clonorchiasis, epidemiology and correlation between infection and hepatobiliary diseases were surveyed by questionnaire.RESULTS: Of 3080 patients with gastrointestinal diseases, 396 (12.9%) had clonorchiasis and 1140 patients (37.2%) had a history of eating raw freshwater fish. Of those with a history of raw freshwater fish ingestion, 238 (20.9%) patients had clonorchiasis. Cholangiocarcinoma was more prevalent in C. sinensis-infected patients than non-infected patients [34/396 (8.6%) vs 145/2684 (5.4%), P = 0.015]. Cholangiocarcinoma and clonorchiasis showed statistically significant positive cross-relation (P = 0.008). Choledocholithiasis, cholecystolithiasis, cholangitis, hepatocellular carcinoma, and biliary pancreatitis did not correlate with clonorchiasis.CONCLUSION: Infection rate of clonorchiasis was still high in patients with gastrointestinal diseases in Korea, and has not decreased very much during the last two decades. Cholangiocarcinoma was related to clonorchiasis, which suggested an etiological role for the parasite.Ho Gak Kim Jimin Han Myung-Hwan Kim Kyu Hyun Cho Im Hee Shin Gwang Ha Kim Jae Seon Kim Jin Bong Kim Tae Nyeun Kim Tae Hyeon Kim Tae Hyo Kim Jae Woo Kim Ji Kon Ryu Young-Soo Moon Jong Ho Moon Sung Jae Park Chan Guk Park Sung-Jo Bang Chang Heon Yang Kyo-Sang Yoo Byung Moo Yoo Kyu Taek Lee Dong Ki Lee Byung Seok Lee Sang Soo Lee Seung Ok Lee Woo Jin Lee Chang Min Cho Young-Eun Joo Gab Jin Cheon Young Woo Choi Jae Bok Chung Yong Bum Yoon 2009World Journal of Gastroenterology2009,15,1:15
9Piglet gut microbial shifts early in life:causes and effects显示文摘The gut microbiome has long been known to play fundamentally important roles in the animal health and the well-being of its host. As such, the establishment and maintenance of a beneficial gut microbiota early in life is crucial in pigs, since early gut colonizers are pivotal in the establishment of permanent microbial community structures affecting the health and growth performance of pigs later in life. Emphasizing this importance of early gut colonizers, it is critical to understand the factors impacting the establishment of the piglet gut microbiome at weaning. Factors include, among others, diet, in-feed antibiotics, probiotics and prebiotic administration. The impact of these factors on establishment of the gut microbiome of piglets at weaning includes effects on piglet gut microbial diversity, structure, and succession. In this review, we thoroughly reviewed the most recent findings on the piglet gut microbiome shifts as influenced by weaning, and how these microbiome changes brought about by various factors that have been shown to affect the development of microbiota in piglets. This review will provide a general overview of recent studies that can help to facilitate the design of new strategies to modulate the gut microbiome in order to enhance gastrointestinal health, growth performance and well-being of piglets.Robin B.Guevarra Jun Hyung Lee Sun Hee Lee Min-Jae Seok Doo Wan Kim Bit Na Kang Timothy J.Johnson Richard E.Isaacson Hyeun Bum Kim 2019Journal of Animal Science and Biotechnology2019,10,3:13
10Association between preoperative high sensitive troponin I levels and cardiovascular events after hip fracture surgery in the elderly显示文摘ObjectiveCardiovascular 复杂并发症在老新潮的破裂病人贡献手术后的病态和死亡。有限数据关于外科手术前的风险因素哪个预言心血管的功课追随者臀部骨折外科(HFS ) 是可得到的。我们使用了高敏感的 troponin 我(hs-TnI ) 试金和临床的参数在老新潮的破裂 patients.MethodFrom 2014 年 8 月与主要不利心脏的事件(向) 联系了识别外科手术前的风险因素到 2016 年 11 月,有新潮的骨折的 575 个病人在一张回顾的、单个中心的注册表被注册。262 个这些病人的一个总数经历了 HFS 和 hs-TnI 试金。向被定义为手术后的所有原因死亡,心失败(HF ) ,新发作的 atrial 纤维性颤动(AF ) ,心肌的梗塞(MI ) 和发生在 90 天 postoperative.ResultsOf 以内的心血管的再进医院 262 个 HFS 病人,开发的向在 65 的后面的 HFS (24.8%) 。有向的病人是肾的不足,冠的动脉疾病,优先的 HF,低左室的喷射部分和贝它 blockers 的使用的更旧、有的更高的率;支持大脑的 natriuretic 肽(NT-proBNP ) 和更高修订的心脏的风险索引的 hs-TnI 和 N 终端高级。外科手术前的 hs-TnI 6.5 ng/L 与手术后的 HF,新发作的 AF 和向的高风险被联系。在 multivariable 分析,为向的外科手术前的独立预言者是很长时间 > 80 年[调整危险比率(HR ) :1.79, 95% 充满信心的间隔(CI ) :1.03-3.13, P = 0.04 ] ,左室的喷射部分(LVEF )<50%( 调整 HR:3.17, 95% CI:1.47-6.82, P < 0.01 ) 并且 hs-TnI > 6.5 ng/L (调整 HR:3.75, 95% CI:2.09-6.17, P < 0.01 ).ConclusionIn 经历 HFS 的有新潮的骨折的老病人,对 hs-TnI 的一个外科手术前的评价可以帮助心血管的复杂并发症的风险精炼。Bum Sung Kim Tae-Hoon Kim Jeong-Hwan Oh Chang Hee Kwon Sung Hea Kim Hyun-Joong Kim Heung Kon Hwang Sang-Man Chung 2018Journal of Geriatric Cardiology2018,15,3:13
11Characterization of smooth muscle, enteric nerve, interstitial cells of Cajal, and fibroblast-like cells in the gastric musculature of patients with diabetes mellitus显示文摘AIM To investigate histologic abnormalities in the gastric smooth muscle of patients with diabetes mellitus(DM).METHODS Full-thickness gastric specimens were obtained from patients undergoing surgery for gastric cancer. H&E stain and Masson's Trichrome stain were performed to assess the degree of fibrosis. Immunohistochemical staining using various antibodies was also performed [antibodies against protein gene product 9.5(PGP9.5), neuronal nitric oxide synthase(n NOS), vasoactive intestinal peptide(VIP), neurokinin-1(NK1) receptor, c-Kit, and platelet-derived growth factor receptor-alpha,(PDGFRα)]. Immunofluorescent staining and evaluation with confocal microscopy were also conducted.RESULTS Twenty-six controls and 35 diabetic patients(21 shortduration patients and 14 long-duration patients) were included. There were no significant differences in basic demographics between the two groups except in mean body mass index(BMI)(higher in the DM group). Proportions of moderate-to-severe intercellular fibrosis in the muscle layer were significantly higher in the DM group than in the control group(P < 0.01). On immunohistochemical staining, c-Kit- and PDGFRα-positive immunoreactivity were significantly decreased in the DM group compared with the control group(P < 0.05). There were no statistically significant differences in PGP9.5, n NOS, VIP, and neurokinin 1 expression. On immunofluorescent staining, cellularity of interstitial cells of Cajal(ICC) was observed to decrease with increasing duration of DM.CONCLUSION Our study suggests that increased intercellular fibrosis, loss of ICC, and loss of fibroblast-like cells are found in the smooth muscle of DM patients. These abnormalities may contribute to changes in gastric motor activity in patients with DM.Kyung Sik Park Kwang Bum Cho Il Seon Hwang Jae Hyung Park Byung Ik Jang Kyeong Ok Kim Sung Woo Jeon Eun Soo Kim Chang Sik Park Joong Goo Kwon 2016World Journal of Gastroenterology2016,22,46:11
12Risk factors for local recurrence after en bloc endoscopic submucosal dissection for early gastric cancer显示文摘AIM: To investigate factors related to recurrence following en bloc resection using endoscopic submucosal dissection(ESD) in patients with early gastric cancer(EGC). METHODS: A total of 1121 patients(1215 lesions) who had undergone ESD for gastric neoplasia between April 2003 and May 2010 were retrospectively reviewed. Data from 401 patients(415 lesions) were analyzed, following the exclusion of those who underwent piecemeal resection, with deep resection margin invasion or lateral margin infiltration, and diagnosed with benign lesions. RESULTS: Local recurrence after en bloc ESD was found in 36 cases(8.7%). Unclear resection margins, long procedure times, and narrow safety margins were identified as risk factors for recurrence. Lesions located in the upper third of the stomach showed a higher rate of recurrence than those located in the lower third of the stomach(OR = 2.9, P = 0.03). The probability of no recurrence for up to 24 mo was 79.9% in those with a safety resection margin ≤ 1 mm and 89.5% in those with a margin > 1 mm(log-rank test, P = 0.03). CONCLUSION: Even in cases in which en bloc ESD is performed for EGC, local recurrence still occurs. To reduce local recurrences, more careful assessment will be needed prior to the implementation of ESD in casesin which the tumor is located in the upper third of the stomach. In addition, clear identification of tumor boundaries as well as the securing of sufficient safety resection margins will be important.Ju Yup Lee Kwang Bum Cho Eun Soo Kim Kyung Sik Park Yoo Jin Lee Yoon Suk Lee Byoung Kuk Jang Woo Jin Chung Jae Seok Hwang 2016World Journal of Gastrointestinal Endoscopy2016,8,7:8
13Characteristics of and risk factors for colorectal neoplasms in young adults in a screening population显示文摘AIM: To investigate prevalence and risk factors for colorectal neoplasms in adults aged < 50 years, for whom screening is not recommended.METHODS: This cross-sectional study compared prevalence and characteristics of colorectal and advanced adenomas in patients aged < 50 years who underwent colonoscopy screening with subjects aged ≥ 50 years. To evaluate risk factors for colorectal and advanced adenoma in young adults, we used multivariable logistic regression models. Colorectal neoplasm characteristics were evaluated and compared with those in older patients.RESULTS: Among 2819 patients included, prevalences of colorectal adenoma and advanced adenoma were 19.7% and 1.5%, respectively. As patient age increased, so did the prevalence of colorectal neoplasm. However, prevalence of advanced adenoma did not differ between age-groups 45-49 years and ≥ 50 years(OR = 0.43, 95%CI: 0.17-1.07, P = 0.070). In younger age-group(< 50 years), colorectal adenoma was significantly associated with older age, waist circumference(OR = 1.72, 95%CI: 1.15-2.55, P = 0.008), and current smoking(OR = 1.60, 95%CI: 1.07-2.41, P = 0.023). Alcohol consumption was an independent risk factor for colorectal advanced adenoma(OR = 3.69, 95%CI: 1.08-12.54, P = 0.037). Multiple neoplasms and large neoplasms(≥ 1 cm) were more prevalent in subjects ≥ 50 years.CONCLUSION: Current screening strategies for colorectal cancer may need to be amended to account for patient age, especially in young subjects with abdominal obesity, current smoking and alcohol consumption.Seung Eun Lee Hee Bum Jo Won Gun Kwack Yun Jin Jeong Yeo-Jin Yoon Hyoun Woo Kang 2016World Journal of Gastroenterology2016,22,10:8
14Association between Helicobacter pylori status and metachronous gastric cancer after endoscopic resection显示文摘AIM To investigate the effect of Helicobacter pylori(H. pylori) status test and H. pylori eradication on the occurrence of metachronous gastric cancer(MGC) after endoscopic submucosal dissection(ESD) of early gastric cancer(EGC) and risk factors of MGC. METHODS The authors retrospectively reviewed the medical records of 433 patients(441 lesions) who underwent ESD for EGC from January 2005 to January 2015 in Yeungnam University Hospital. Patients were categorized into two groups; the H. pylori tested group(n = 257) and the H. pylori non-tested group(n = 176) based on performance of H. pylori status test after ESD of EGC. The H. pylori tested group was further categorized into three subgroups based on H. pylori status; the H. pylori-eradicated subgroup(n = 120), the H. pylori-persistent subgroup(n = 42), and the H. pylori-negative subgroup(n = 95). Incidences of MGC and risk factors of MGC were identified.RESULTS Median follow-up duration after ESD was 30.00 mo(range, 6-107 mo). Total 15 patients developed MGC during follow-up. MGC developed in 11 patients of the H. pylori tested group(7 in the H. pylori-negative subgroup, 3 in the H. pylori-eradicated subgroup, and 1 in the H. pylori-persistent subgroup) and 4 patients of the H. pylori non-tested group(P > 0.05). The risk factors of MGC were endoscopic mucosal atrophy in the H. pylori tested group and intestinal metaplasia in all patients. CONCLUSION H. pylori eradication and H. pylori status test seems to have no preventive effect on the development of MGC after ESD for EGC. The risk factors of MGC development were endoscopic mucosal atrophy in the H. pylori tested group alone and intestinal metaplasia in all patients.Sung Bum Kim Si Hyung Lee Seung Il Bae Yo Han Jeong Se Hoon Sohn Kyeong Ok Kim Byung Ik Jang Tae Nyeun Kim 2016World Journal of Gastroenterology2016,22,44:8
15Esophageal subepithelial lesion diagnosed as malignant gastrointestinal neuroectodermal tumor显示文摘A 21-year-old male visited our hospital with a complaint of aggravating dysphagia and odynophagia for a few days.Esophagogastroduodenoscopy showed huge bulging mucosa with an intact surface causing luminal narrowing at 35 cm from the incisor teeth.Endoscopic ultrasonography showed an about 35 mm sized irregular margined in-homogenous hypoechoic lesion with an obscure layer of origin.Endoscopic ultrasonography fine needle aspiration revealed spindle cell proliferation without immunoreactivity for CD117,SMA,and cytokeratin.The patient underwent excision of the subepithelial lesion at the distal esophagus.On pathologic examination of the specimen,the tumor was composed of short fascicles of oval to spindle cells with eosinophilic and clear cytoplasm and vesicular nuclei.The tumor cells were positive for S-100 and SOX10and negative for CD117,SMA,HMB-45,melan-A,cytokeratin,and CD99.The split-apart signal was detected in EWSR1 on FISH,suggesting a malignant gastrointestinal neuroectodermal tumor.At the time of writing,the patient is on radiation therapy at the operated site of esophagus and doing well,with no recurrence for three months.Malignant gastrointestinal neuroectodermal tumor is a rare gastrointestinal tumor with features of clear cell sarcoma,without melanocytic differentiation,and shows a poor prognosis.This is the first reported case of malignant gastrointestinal neuroectodermal tumor arising as subepithelial lesion in the esophagus.Sung Bum Kim Si Hyung Lee Mi Jin Gu 2015World Journal of Gastroenterology2015,21,18:8
16Efficacy of cap-assisted colonoscopy according to lesion location and endoscopist training level显示文摘AIM: To evaluate the efficacy of cap-assisted colonoscopy(CAC) for detection of colorectal polyps and adenomas according to the lesion location and endoscopist training level.METHODS: Patients 20 years or older, who underwent their first screening colonoscopy in a single tertiary center from May 2011 to December 2012 were enrolled in this study. All patients underwent either CAC or standard colonoscopy(SC), and all of the procedures were performed by 11 endoscopists(8 trainees and 3 experts). All procedures were performed with highdefinition colonoscopes and narrow band imaging. The eight trainees had experiences of performing 150 to 500 colonoscopies, and the three experts had experiences of performing more than 3000 colonoscopies. A 4-mmlong transparent cap was attached to the end of a colonoscope in the CAC group. We retrospectively evaluated the number of polyps and adenomas, polyp detection rate(PDR), and the number of adenomas and adenoma detection rate(ADR) according to the lesion location and endoscopist training level between CAC and SC. We also evaluated the number of polyps and adenomas according to their size between CAC and SC.RESULTS: Overall, PDR and ADR using CAC were significantly higher than those using SC for both whole colon(48.5% vs 40.7%, P = 0.012; 35.7% vs 28.3%, P = 0.012) and right-side colon(35.3% vs 26.6%, P = 0.002; 27.0% vs 16.9%, P < 0.001). The number of polyps and adenomas per patient using CAC was significantly higher than that using SC for both the whole colon(1.07 ± 1.59 vs 0.82 ± 1.31, P = 0.008; 0.72 ± 1.32 vs 0.50 ± 1.01, P = 0.003) and right-side colon(0.66 ± 1.18 vs 0.41 ± 0.83, P < 0.001; 0.46 ± 0.97 vs 0.25 ± 0.67, P < 0.001). In the trainee group, the PDR and ADR using CAC were significantly higher than those using SC for both the whole colon(46.7% vs 39.7%, P = 0.040; 33.9% vs 26.0%, P =0.012) and right-side colon(34.2% vs 26.5%, P = 0.015; 25.3% vs 15.9%, P = 0.001). In the expert group, the PDR and ADR using CAC were significantly higher than those using SC only for the right-side colon(42.1% vs 27.0%, P =0.035; 36.8% vs 21.0%, P = 0.020).CONCLUSION: CAC is more effective than SC for detection of colorectal polyps and adenomas, especially when performed by trainees and when the lesions are located in the right-side colon.Dong Jun Kim Hyung Wook Kim Su Bum Park Dae Hwan Kang Cheol Woong Choi Joung Boom Hong Byoung Hoon Ji Chang Seok Lee 2015World Journal of Gastroenterology2015,21,20:8
17Clinical characteristics of Helicobacter pylori-negative drugnegative peptic ulcer bleeding显示文摘AIM:To investigate the clinical characteristics and outcomes of idiopathic Helicobacter pylori(H.pylori)-negative and drug-negative]peptic ulcer bleeding(PUB).METHODS:A consecutive series of patients who experienced PUB between 2006 and 2012 was retrospectively analyzed.A total of 232 patients were enrolled in this study.The patients were divided into four groups according to the etiologies of PUB:idiopathic,H.pylori-associated,drug-induced and combined(H.pylori-associated and drug-induced)types.We compared the clinical characteristics and outcomes between the groups.When the silver stain or rapid urease tests were H.pylori-negative,we obtained an additional biopsy specimen by endoscopic re-examination and performed an H.pylori antibody test 6-8 wk after the initial endoscopic examination.For a diagnosis of idiopathic PUB,a negative result of an H.pylori antibody test was confirmed.In all cases,re-bleeding was confirmed by endoscopic examination.For the risk assessment,the Blatchford and the Rockall scores were calculated for all patients.RESULTS:For PUB,the frequency of H.pylori infection was 59.5%(138/232),whereas the frequency of idiopathic cases was 8.6%(20/232).When idiopathic PUB was compared to H.pylori-associated PUB,the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis during the hospital stay(30%vs 7.4%,P = 0.02).When idiopathic PUB was compared to drug-induced PUB,the patients in the idiopathic PUB group showed a higher rate of rebleeding after initial hemostasis upon admission(30%vs 2.7%,P < 0.01).When drug-induced PUB was compared to H.pylori-associated PUB,the patients in the drug-induced PUB were older(68.49 ± 14.76 years vs 47.83 ± 15.15 years,P< 0.01) and showed a higher proportion of gastric ulcer(77%vs 49%,P < 0.01).However,the Blatchford and the Rockall scores were not significantly different between the two groups.Among the patients who experienced drug-induced PUB,no significant differences were found with respect to clinical characteristics,irrespective of H.pylori infection.CONCLUSION:Idiopathic PUB has unique clinical characteristics such as re-bleeding after initial hemostasis upon admission.Therefore,these patients need to undergo close surveillance upon admission.Woo Chul Chung Eun Jung Jeon Dae Bum Kim Hea Jung Sung Yeon-Ji Kim Eun Sun Lim Min-ah Kim Jung Hwan Oh 2015World Journal of Gastroenterology2015,21,28:8
18Clinical significance and risk factors of postembolization fever in patients with hepatocellular carcinoma显示文摘AIM:To investigate tumor response and survival in patients with postembolization fever(PEF) and to determine the risk factors for PEF.METHODS:Four hundred forty-three hepatocellular carcinoma(HCC) patients who underwent the first session of transcatheter arterial chemoembolization(TACE) between January 2005 and December 2009 were analyzed retrospectively.PEF was defined as a body temperature greater than 38.0 ℃ that developed within 3 d of TACE without evidence of infection.The tumor progression-free interval was defined as the interval from the first TACE to the second TACE based on mRECIST criteria.Clinical staging was based on the American Joint Committee on Cancer tumor,node,metastases(TNM) classification of malignant tumors.All patients were admitted before their 1 st TACE treatment,and blood samples were obtained from all patients before and after treatment.Clinicoradiological variables and host-related variables were compared between two groups:patients with PEF vs patients without PEF.Additionally,variables related to 20-mo mortality and tumor progression-free survival were analyzed.RESULTS:The study population comprised 370(85.4%) men and 73(14.6%) women with a mean age of 62.29 ± 10.35 years.A total of 1836 TACE sessions were conducted in 443 patients,and each patient received between 1 and 27(mean:4.14 ± 3.57) TACE sessions.The mean follow-up duration was 22.23 ± 19.6 mo(range:0-81 mo).PEF developed in 117 patients(26.41%) at the time of the first TACE session.PEF was not associated with 20-mo survival(P = 0.524) or computed tomography(CT) response(P = 0.413) in a univariate analysis.A univariate analysis further indicated that diffuse-type HCC(P = 0.021),large tumor size(≥ 5 cm)(P = 0.046),lipiodol dose(≥ 7 mL,P = 0.001),poor blood glucose control(P = 0.034),alanine aminotransferase(ALT) value after TACE(P = 0.004) and C-reactive protein(CRP) value after TACE(P = 0.036) served as possible risk factors correlated with PEF.The ALT value after TACE(P = 0.021) and lipiodol dose over 7 mL(P = 0.011) were independent risk factors for PEF in the multivariate analysis.For the 20-mo survival,poor blood sugar control(P < 0.001),portal vein thrombosis(P = 0.001),favorable CT response after TACE(P < 0.001),initial aspartate aminotransferase(P = 0.02),initial CRP(P = 0.042),tumor size(P < 0.001),TNM stage(P < 0.001) and lipiodol dose(P < 0.001) were possible risk factors in the univariate analysis.Tumor size(P = 0.03),poor blood sugar control(P = 0.043),and portal vein thrombosis(P = 0.031) were significant predictors of survival in the multivariate analysis.Furthermore,the tumor progression-free interval was closely associated with CRP > 1 mg/dL(P = 0.003),tumor size > 5 cm(P < 0.001),tumor type(poorly defined)(P < 0.001),and lipiodol dose(> 7 mL,P < 0.001).CONCLUSION:PEF has no impact on survival at 20 mo or radiologic response.However,the ALT level after TACE and the lipiodol dose represent significant risk factors for PEF.Chung Hwan Jun Ho Seok Ki Hoon Ki Lee Kang Jin Park Seon Young Park Sung Bum Cho Chang Hwan Park Young Eun Joo Hyun Soo Kim Sung Kyu Choi Jong Sun Rew 2013World Journal of Gastroenterology2013,19,2:7
19Risk factors for hepatocellular carcinoma in patients with drug-resistant chronic hepatitis B显示文摘AIM:To investigate the risk factors and characteristics of hepatocellular carcinoma(HCC) in the patients with drug-resistant chronic hepatitis B(CHB).METHODS:A total of 432 patients with drug-resistant CHB were analyzed retrospectively from January 2004to December 2012. The patients were divided into two groups:the HCC group(n = 57) and the non-HCC group(n = 375). Two groups compared using logistic regression for various patients and viral characteristics in order to identify associated risk factors for HCC.Secondarily,patient and tumor characteristics of HCC patients with na ve CHB(N group,n = 117) were compared to the HCC group(R group,n = 57) to identify any difference in HCC characteristics between them.RESULTS:A significant difference was found for age,platelet count,alpha-fetoprotein(AFP),positivity of HBeAg,seroconversion rate of HBeAg,virologic response,the Child-Pugh score,presence of rtM204I,and the duration of antiviral treatment in non-HCC and HCC group. Cirrhosis,age(> 50 years),HBeAg(+),virologic non-responder status,and rtM204I mutants were independent risk factors for the development of HCC. The R group had lower serum C-reactive protein(CRP) and AFP levels,earlier stage tumors,and a shorter mean tumor surveillance period than the N group. However,the total follow-up duration was not significantly different between the two groups.CONCLUSION:13.2% of patients with drug-resistant CHB developed HCC. Age,cirrhosis,YIDD status,HBeAg status,and virologic response are associated with risk of HCC. Patients with drug-resistant CHB and these clinical factors may benefit from closer HCC surveillance.Chung Hwan Jun Hyoung Ju Hong Min Woo Chung Seon Young Park Sung Bum Cho Chang Hwan Park Young Eun Joo Hyun Soo Kim Sung Kyu Choi Jong Sun Rew 2013World Journal of Gastroenterology2013,19,40:7
20Efficacy and safety of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction显示文摘AIM To evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of selfexpandable metal stent(SEMS).METHODS This was a retrospective analysis of 244 consecutive patients with unresectable malignant biliary obstruction, who underwent placement of SEMSs following limited ES from December 2008 to February 2015. The diagnosis of malignant biliary obstruction and assessment of patient eligibility for the study was established by a combination of clinical findings, laboratory investigations, imaging and pathological results. All patients were monitored in the hospital for at least 24 h following endoscopic retrograde cholangio pancreatography(ERCP). The incidence of immediate or early post-ERCP complications such as post-ERCP pancreatitis(PEP) and bleeding related to limited ES were considered as primary outcomes. Also, characteristics and complications according to the cancer type were classified.RESULTS Among the 244 patients included, the underlying diagnosis was cholangiocarcinoma in 118 patients,pancreatic cancer in 79, and non-pancreatic or nonbiliary malignancies in the remaining 47 patients. Early post-ERCP complications occurred in 9 patients(3.7%), with PEP in 7 patients (2.9%; mild, 6; moderate, 1) and mild bleeding in 2 patients (0.8%). There was no significant association between the incidence of post-ERCP complications and the type of malignancy(cholangiocarcinoma vs pancreatic cancer vs others, P = 0.696) or the type of SEMS used (uncovered vs covered, P = 1.000). Patients who had more than one SEMS placed at the first instance were at a significantly higher risk of post-ERCP complications (one SEMS vs two SEMS, P = 0.031). No other factors were predictive of post-ERCP complications.CONCLUSION Limited ES is feasible and safe, and effectively facilitates the placement of SEMS, without any significant risk of PEP or severe bleeding.Hyeong Seok Nam Dae Hwan Kang Hyung Wook Kim Cheol Woong Choi Su Bum Park Su Jin Kim Dae Gon Ryu 2017World Journal of Gastroenterology2017,23,9:7
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