Review Article 2024-06-25 2024-06-25 0 834 818

Others

소화기 내시경 시술 전후 항혈전제 사용 임상진료지침: 2023 IDEN 합의

IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy

강승주^1,*, 태정현^2,*, 방창석³, 신철민⁴, 정영훈⁵, 최미영⁶, 황주하⁷, Yutaka Saito⁸, Philip Wai Yan Chiu⁹, Rungsun Rerknimitr¹⁰, Christopher Khor¹¹, Vu Van Khien¹², 최기돈¹³, 심기남², 송근암¹⁴, 이오영¹⁵; 대한소화기내시경학회 진료지침 TF

Seung Joo Kang^1*, Chung Hyun Tae^2*, Chang Seok Bang³, Cheol Min Shin⁴, Young-Hoon Jeong⁵, Miyoung Choi⁶, Joo Ha Hwang⁷, Yutaka Saito⁸, Philip Wai Yan Chiu⁹, Rungsun Rerknimitr¹⁰, Christopher Khor¹¹, Vu Van Khien¹², Kee Don Choi¹³ , Ki-Nam Shim² , Geun Am Song¹⁴, Oh Young Lee¹⁵, the Korean Society of Gastrointestinal Endoscopy Task Force on Clinical Practice Guidelines

Abstract

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Antithrombotic agents, including antiplatelet agent and anticoagulants are widely used in Korea due to increasing incidence of cardio-cerebrovascular disease and aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. Clinical practice guideline regarding this issue which was developed by the Korean Society of Gastrointestinal Endoscopy was published in 2020. However, since then, new evidence has emerged for the use of dual antiplatelet therapy and direct anticoagulant management, and revised guidelines were issued in the US and Europe. Accordingly, the previous guidelines were revised, cardiologists also participated in the development group, and the recommendations went through a consensus process among international experts. This guideline presents 14 recommendations made according to the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and was reviewed by multidisciplinary experts. This guideline provides useful information that can assist endoscopists in the management of patients on antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

Review Article 2024-06-25 2024-06-25 0 615 608

Lower GI Tract

염증성 장질환 치료 약물들의 암 발생 위험

Risks of Cancer Associated with Therapeutic Drugs for Inflammatory Bowel Disease

문원¹, 박재준²

Won Moon¹, Jae Jun Park²

Abstract

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Crohn's disease and ulcerative colitis are lifelong chronic inflammatory conditions, with many patients requiring ongoing immunomodulatory drug therapy for maintenance treatment. Recent therapeutic goals in inflammatory bowel disease (IBD) are not only aimed at symptomatic remission but also at achieving mucosal healing to improve the natural course of the disease. In this context, therapeutic approaches are being applied in clinical settings that involve early and appropriate use of drugs, such as immunomodulators or biologics, that have the potential to induce healing of the inflamed intestine before irreversible intestinal damage occurs. All drugs that continuously control intestinal inflammation in IBD can heal the mucosa and potentially reduce the incidence of colitis-associated bowel cancer; however, the continuous use of immunosuppressants can potentially increase the risk of malignancies. The safety issues of the drugs used in clinical practice are partly confirmed during their development processes or shortly after initial marketing, but in other cases, they are estimated through post-marketing case reports or epidemiological studies, sometimes decades after drug approval. This review explores the risks associated with malignancies related to the treatment of IBD, focusing on drugs currently approved in Republic of Korea.

Case Report 2024-06-25 2024-06-25 0 499 280

거대 식도 지방육종에 대한 효과적인 내시경 점막하 박리술: 증례보고

Effective Endoscopic Submucosal Dissection of a Huge Esophageal Liposarcoma: A Case Report

이명진¹, 이문원^1,2, 주동찬^1,2, 홍승민^1,2, 백동훈^1,2, 이봉은^1,2, 김광하^1,2, 송근암^1,2

Myeong Jin Lee¹, Moon Won Lee^1,2 , Dong Chan Joo^1,2, Seung Min Hong^1,2, Dong Hoon Baek^1,2, Bong Eun Lee^1,2, Gwang Ha Kim^1,2, Geun Am Song^1,2

Abstract

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This case report presents the successful endoscopic submucosal dissection (ESD) of a well-differentiated esophageal liposarcoma in a 51-year-old male with persistent dysphagia. The cause was initially diagnosed as a 10 cm pedunculated lesion extending from the upper esophageal sphincter to the mid-esophagus. An ESD was chosen over traditional surgery because it is less invasive. The procedure involved a precise submucosal injection and excision with special techniques to manage bleeding from a central vessel. Despite the extraction challenges owing to the size of the lesion, it was successfully removed orally. A histopathological examination of the 8.3×4.2×2.3 cm specimen revealed the characteristic features of a well-differentiated liposarcoma, including MDM2 and CDK4 positivity. The follow-up revealed no recurrence, and active surveillance has been performed since. This report highlights the versatility of ESD in treating significant esophageal tumors and provides evidence for its efficacy as a minimally invasive alternative.

Case Report 2024-06-25 2024-06-25 0 811 410

Atypical Toxocara canis-Induced Hepatic Visceral Larva Migrans: Diagnostic Challenges and Literature Review

Tien Manh Huynh¹, Khanh Quoc Le Tran¹, Trung Hoang Dinh¹, Man Minh Vo², Thong Quang Pham³, Thong Duy Vo^1,4

Abstract

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Toxocariasis, a zoonotic infection transmitted by Toxocara canis (from dogs) and Toxocara cati (from cats) larvae, poses rare but severe risks to humans. We present a case of hepatic visceral larva migrans (VLM) caused by Toxocara canis in a 21-year-old male with a history of close contact with a pet dog. Initial symptoms and imaging findings mimicked a pyogenic liver abscess. The initial laboratory investigations revealed neutrophilia and elevated levels of IgE. Despite broad-spectrum antibiotics, persistent fever prompted further investigation. Subsequent serological testing for Toxocara antibodies and histopathological analysis of liver tissue demonstrating eosinophil infiltrates and Charcot-Leyden crystals led to a confirmed diagnosis of a liver abscess caused by Toxocara canis. Serological testing for Toxocara antibodies and histopathological analysis of liver tissue confirmed a Toxocara canis-induced liver abscess. Albendazole treatment yielded significant clinical improvement. This case highlights the necessity of considering toxocariasis in liver abscess differentials, particularly in high-seroprevalence regions like Vietnam. Relying solely on serological tests may be insufficient, emphasizing the need for corroborative evidence, including invasive procedures like liver biopsy, for accurate hepatic toxocariasis diagnosis.

Research update 2024-06-25 2024-06-25 0 1375 346

간섬유화를 동반한 비알코올 지방간염 환자를 대상으로 한 Resmetirom 3상, 무작위 대조 임상시험

A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis

홍혜연, 최종기

Hyeyeon Hong, Jonggi Choi

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