Editorial 2017-07-25 2017-07-25 0 252 183

조기 위암의 내시경적 점막하 박리술 전후 복부 전산화단층촬영의 유용성

The Usefulness of Computed Tomography before and after Endoscopic Submucosal Dissection of Early Gastric Cancer

서명숙, 김병욱

Myeongsook Seo, Byung-Wook Kim

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The Value of Computed Tomography in the Preoperative N Staging of Early Gastric Cancer Meeting the Endoscopic Resection Criteria (Korean J Gastroenterol 2017;70:21-26)

Image of the month 2017-07-25 2017-07-25 0 229 228

궤양성 대장염 환자에서 발생한 모자 용종증

Cap Polyposis in a Patient with Ulcerative Colitis

이준, 홍란¹

Jun Lee, Ran Hong¹

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Research update 2017-07-25 2017-07-25 0 178 284

담낭 절제술 후 우연히 발견된 담낭암에서 재수술 여부의 평가

When Do We Need Reoperation in Incidental Gallbladder Cancer after Laparoscopic Cholecystectomy?

최진호, 백우현

Jin Ho Choi, Woo Hyun Paik

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A Novel Pathology-Based Preoperative Risk Score to Predict Locoregional Residual and Distant Disease and Survival for Incidental Gallbladder Cancer: A 10-Institutional Study from the U.S. Extrahepatic Biliary Malignancy Consorium (Ann Surg Oncol 2017;24:1343-1350)

Review Article 2017-07-25 2017-07-25 24 1948 2034

H₂ 수용체 길항제의 위산분비 억제 효과 및 임상적 응용

The Effect of H₂ Receptor Antagonist in Acid Inhibition and Its Clinical Efficacy

심영광¹, 김나영^1,2

Young Kwang Shim¹, Nayoung Kim^1,2

Abstract

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The first histamine H₂ receptor antagonists (H₂RAs) were developed in the early 1970s. They played a dominant role in treating peptic ulcer disease and gastroesophageal reflux disease (GERD). H₂RAs block the production of acid by H⁺, K⁺-ATPase at the parietal cells and produce gastric luminal anacidity for varying periods. H₂RAs are highly selective, and they do not affect H₁ receptors. Moreover, they are not anticholinergic agents. Sequential development of H₂RAs, proton pump inhibitors (PPIs), and discovery of Helicobacter pylori infection changed the paradigm of peptic ulcer disease with marked decrease of morbidity and mortality. PPIs are known to be the most effective drugs that are currently available for suppressing gastric acid secretion. Many studies have shown its superiority over H₂RAs as a treatment for acid-related disorders, such as peptic ulcer disease, GERD, and Zollinger-Ellison syndrome. However, other studies have reported that PPIs may not be able to render stomach achlorhydric and have identified a phenomenon of increasing gastric acidity at night in individuals receiving a PPI twice daily. These nocturnal acid breakthrough episodes can be eliminated with an addition of H₂RAs at night. The effectiveness of nighttime dose of H₂RA suggests a major role of histamine in nocturnal acid secretion. H₂RAs reduce secretion of gastric acid, and each H₂RA also has specific effects. For instance, nizitidine alleviates not only symptoms of GERD, but also provokes gastric emptying, resulting in clinical symptom improvement of functional dyspepsia. The aim of this paper was to review the characteristics and role of H₂RAs and assess the future strategy and treatment of upper gastrointestinal disease, including acid related disorders.

Review Article 2017-07-25 2017-07-25 2 389 641

외래에서 우연히 발견된 췌장 낭성 종양에 대한 임상적 접근

Clinical Approach to Incidental Pancreatic Cystic Neoplasm in Outpatient Clinics

우용식, 이규택¹

Young Sik Woo, Kyu Taek Lee¹

Abstract

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Cystic lesions of the pancreas are increasingly observed due to increased use of abdominal images. The malignant rate of pancreas cystic lesion varies widely between various types. Identification of malignant or high-risk lesions is important when determining the appropriate course of management. Using these image findings, including cyst size, presence of solid components, and pancreatic duct involvement, the 2012 International Association of Pancreatology (IAP) and the 2015 American Gastroenterological Association (AGA) guidelines provide a rationale in identifying higher risk patients requiring further workups using an endoscopic ultrasound (EUS). EUS with fine needle aspiration and cytology allows confirmation of the cyst type and determines the risk of malignancy. Small cysts with no suspicious features may undergo the regular imaging study for regular surveillance due to low risk for malignancy. In this review, the differences between the 2012 IAP and 2015 AGA guidelines are presented, In addition to possible recommendations for management and surveillance.

Original Article 2017-07-25 2017-07-25 1 358 398

내시경 절제술 적응증이 되는 조기 위암에서 림프절 전이 예측을 위한 전산화단층촬영술의 유용성

The Value of Computed Tomography in Preoperative N Staging of Early Gastric Cancer Meeting the Endoscopic Resection Criteria

김수진^1,2, 김태언^2,3, 최철웅^1,2, 강대환^1,2, 김형욱^1,2, 박수범^1,2, 남형석^1,2, 유대곤^1,2

Su Jin Kim^1,2, Tae Un Kim^2,3, Cheol Woong Choi^1,2, Dae Hwan Kang^1,2, Hyung Wook Kim^1,2, Su Bum Park^1,2, Hyeong Seok Nam^1,2, Dae Gon Ryu^1,2

Abstract

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Background/Aims: This study evaluated the value of abdominal computed tomography (CT) in preoperative N staging of early gastric cancers (EGCs) within standard and expanded indications of endoscopic resection (ER) and investigated the factors affecting accuracy.
Methods: Between March 2009 and March 2016, a total of 268 patients with EGC within the standard and expanded indications of ER underwent preoperative abdominal CT and surgical gastrectomy with lymph node (LN) dissection. Preoperative N staging of CT was compared with the pathologic result.
Results: The accuracy of N staging for EGCs within the standard and expanded indications was 86.1% (235/268). There was no LN metastasis in patients with cN1 in CT staging. LN metastasis was found in 7 patients with EGCs that met the expanded ER indication and cN0 in CT staging. According to the univariate analysis, ulcers, including scars, were associated with the false positive of lymph node metastasis in abdominal CT (odds ratio 3.56; 95% confidence interval 1.56-8.15).
Conclusions: The present study suggests that the value of abdominal CT is limited for nodal staging of EGCs that meet the ER indication.

Original Article 2017-07-25 2017-07-25 13 401 411

헬리코박터 파일로리 제균 치료가 위 이형성의 내시경 절제술 후 이시성 재발에 미치는 영향

The Effect of Helicobacter pylori Eradication on the Metachronous Neoplasm after Endoscopic Resection for Gastric Dysplasia

송지현, 양선영, 임주현, 최지민, 김상균¹

Ji Hyun Song, Sun Young Yang, Joo Hyun Lim, Ji Min Choi, Sang Gyun Kim¹

Abstract

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Background/Aims: Helicobacter pylori (Hp) infection is an important risk factor for gastric carcinogenesis. Although several studies have investigated the effect of Hp eradication on the development of metachronous neoplasm after endoscopic resection of the gastric dysplasia, the evidence is still insufficient to make a clear conclusion. The aims of this study was to evaluate the risk factors for the development of metachronous neoplasm after endoscopic resection of gastric dysplasia and to investigate the effect of Hp eradication.
Methods: Between 2005 and 2011, a total of 887 patients underwent endoscopic resection for gastric dysplasia. Among them, 521 patients who had undergone tests for Hp infection and been followed-up for at least one year were included in the final analyses. Of the 292 Hp-positive patients, 116 patients were successfully eradicated, while 176 failed or did not undergo eradication.
Results: During a mean follow-up of 59.1 months (range 12-125 months), metachronous neoplasm had developed in 63 patients (12.1%, dysplasia in 38, carcinoma in 25). In multivariate analyses, age ≥65 (hazard ratio [HR]=2.247, 95% confidence interval [CI] 1.297-3.895), tumor size (HR=1.283, 95% CI 1.038-1.585), synchronous lesion (HR=2.341, 95% CI 1.244-4.405), family history of gastric cancer (HR=3.240, 95% CI 1.776-5.912), and smoking (HR=1.016, 95% CI 1.003-1.029) were risk factors for metachronous neoplasm after endoscopic resection of gastric dysplasia. However, Hp eradication was not associated with metachronous neoplasm (HR=0.641, 95% CI 0.297-1.384).
Conclusions: Hp eradication was not shown to be associated with the development of metachronous cancer after endoscopic resection of gastric dysplasia.

Original Article 2017-07-25 2017-07-25 2 462 296

불완전하게 절제된 진행성 대장 선종의 국소 재발과 위험 인자: 단일기관 후향 연구

Local Recurrence and Its Risk Factor after Incomplete Resection of Colorectal Advanced Adenomas: A Single Center, Retrospective Study

오대명, 이재광, 김현수, 박창근, 정재권, 김대진, 정윤진, 김태훈, 박명일, 박종필

Dae Myung Oh, Jae Kwang Lee, Hyunsoo Kim, Chang Keun Park, Jae Kwon Jung, Dae Jin Kim, Yun Jin Chung, Tae Hoon Kim, Myung Il Park, Jong Pil Park

Abstract

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Background/Aims: Colonoscopy can detect precancerous lesions, which can subsequently be removed and reduce incidences of and mortality from colorectal cancer (CRC). However, recently published data have highlighted a significant rate of CRC in patients who previously underwent colonoscopy. Among many reasons, incomplete resection has been considered as a significant contributor. However, to date, there have only been a few studies regarding incompletely resected polyps, especially advanced colorectal adenoma (ACA). Hence, we aimed to evaluate the prognosis of incompletely resected ACA.
Methods: We retrospectively reviewed the medical records of patients with ACA who had underwent endoscopic treatment with incomplete resection. The primary outcomes were (1) the incomplete resection rate of ACA, as determined by a histopathologic examination and (2) the recurrence rate of incompletely resected ACA. We also investigated the probable contributing factors that may have led to a relapse of incompletely resected ACA.
Results: A total of 7,105 patients had their colorectal polyps resected by endoscopic treatment, and 2,233 of these were considered as ACA. Of these, 354 polyps (15.8%) were resected incompletely, and only 163 patients were followed-up. Of those followed-up, 31 patients (19.0%) experienced local recurrence. The risk factors for recurrence after incomplete resection were evaluated; age, morphology of adenoma, and use of rescue therapy, such as argon plasma coagulation, were found to be associated with adenoma recurrence.
Conclusions: Incompletely resected ACA in older patients or in patients with sessile-type adenomas should be monitored strictly, and if incomplete resection is suspected, rescue therapy must be considered.

Original Article 2017-07-25 2017-07-25 3 366 276

Defecographic Findings in Patients with Severe Idiopathic Chronic Constipation

Rahmatollah Rafiei¹, Azadeh Bayat², Masoud Taheri³, Zahra Torabi², Lotfollah Fooladi⁴, Saideh Husaini¹

Abstract

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Background/Aims: Chronic constipation is a common gastrointestinal disorder diagnosed using Rome III criteria. Defecography is a radiographic method used to identify anatomic abnormalities of anorectum. The present study aimed to evaluate the defecographic findings in patients with severe idiopathic chronic constipation.
Methods: One hundred patients, who complained of severe idiopathic chronic constipation with abnormal balloon expulsion test, underwent defecography after injection of barium. An analysis of radiographs was performed by an expert radiologist for the diagnosis of descending perineum syndrome, rectocele, enterocele, rectal ulcer, rectal prolapse, fecal residue of post defecation, and etc. Then, they were compared between the two sexes.
Results: Normal defecography was only observed in two participants. Descending perineum syndrome was the most common abnormality (73.3%). The results showed that rectocele (80.8%) and descending perineum syndrome (69.2%) were most frequent in women. In males, descending perineum syndrome and rectal prolapse were more prevalent (87% and 43.5%, respectively). Compared with men, rectocele and rectal ulcer were more frequently observed in women (p<0.001, and p=0.04, respectively), while men were more affected by descending perineum syndrome (p=0.04). In total, women had a greater incidence of abnormal defecographic findings compared with men (p=0.02).
Conclusions: Defecography can be performed to detect anatomic abnormalities in patients with severe idiopathic chronic constipation and abnormal balloon expulsion test. This technique can assist physicians in making the most suitable decision for surgical procedure.

Case Report 2017-07-25 2017-07-25 2 423 298

거대세포바이러스 장염에 중복감염된 궤양성 대장염 환자에서 발생한 폐동맥 색전증에 대한 새로운 경구 항응고제 치료 1예

Use of Novel Oral Anticoagulant to Treat Pulmonary Thromboembolism in Patient with Ulcerative Colitis Superinfected Cytomegalovirus Colitis

김석환, 장선희¹, 성예규¹, 박준규¹, 박연정¹, 윤진탁, 강상범

Seok-Hwan Kim, Sunhee Jang¹, Yegyu Sung¹, Jun Kyu Park¹, Yunjung Park¹, Jintak Yun, Sang-Bum Kang

Abstract

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Crohn’s disease and ulcerative colitis are the two major types of inflammatory bowel disease, and affect mainly the gastrointestinal tract but also have extraintestinal sequelae, such as arterial and venous thromboembolism. Thromboembolic complications, particularly pulmonary thromboembolism, can be life threatening and require prompt management with anticoagulants. Conventional vitamin K antagonists have been used for the treatment of thromboembolic complications, but the development of novel oral anticoagulants has shifted the paradigm. We report a case of a 42-year-old female with ulcerative colitis who experienced an acute flare-up due to cytomegalovirus superinfection with pulmonary thromboembolism. She was treated with oral mesalamine, intravenous steroid and ganciclovir and low-molecular-weight heparin, followed by rivaroxaban, a novel oral anticoagulant. Her symptoms resolved after treatment, and no recurrence was noted during a 6-month post-treatment follow-up.