Prevalence, Clinicopathologic Characteristics, and Predictors of Interval Colorectal Cancers in Korean Population (Intest Res 2013;11:178-183)
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Behçet's disease (BD) is a systemic immunological disorder characterized by recurrent mucosal ulcerative lesions including oral and genital ulcerations in association with skin and ocular involvements. BD also can involve the gastrointestinal tract. Gastrointestinal involvement of BD is one of the major causes of morbidity and mortality for this disease. However, clinical data are quite limited because of the rarity of intestinal BD. Therefore, the management of intestinal BD is heavily dependent on expert opinions and standardized medical treatments of intestinal BD are yet to be established. In this brief review, the authors summarized the currently available medical treatments such as 5-aminosalicylic acids, corticosteroids, immuno-modulators, and anti-TNF agents. Moreover, we sought to suggest a treatment algorithm for intestinal BD based on the recently published and updated data. (Intest Res 2013;11:155-160)
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A vast number of micro-organisms within the human gut play a crucial role in maintaining human health. Intestinal microbiota maintains the intestinal homeostasis and function by mutually interacting with the host's epithelial cells and mucosal immune system; and the immune tolerance towards intestinal commensals should be permitted for such interactions to occur. In recent years, the prevalence of inflammatory bowel diseases has greatly increased, and the pathogenic pathway behind is considered to be related to an aggressive immune response which is a subset of commensal enteric bacteria in a genetically susceptible host. The abnormal host-microbial interactions play an important role in the pathophysiology of inflammatory bowel diseases, which have been proved through numerous studies in the field of genetics, molecular microbiology, immunology, and experimental rodent models, as well as various translational researches and clinical trials. This review briefly summarizes the composition and function of intestinal microbiota, interactions between the microbiota and the immune system, and the possible roles of the intestinal microbiota in the pathogenesis of inflammatory bowel diseases. (Intest Res 2013;11:161-168)
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Background/Aims Colorectal cancer is the third most common cancer and the fourth leading cause of cancer death in Korea. Colonoscopic screening with removal of adenomas is an effective strategy for reducing the incidence and mortality of colorectal cancer. This study was conducted to investigate predictable factors of early colorectal cancer (ECC) in patients with advanced adenoma (AA), tumor in situ (Tis), and submucosal (SM) cancer diagnosed after colonoscopic polypectomy. Methods: etween August 2003 and June 2012, a total of 1,001 patients who underwent colonoscopic polypectomy in Jeju National University Hospital were enrolled in this study. Results: Patients were classified into four groups; non-AA, AA, Tis, and SM cancer. Compared to the AA group, the ECC group (n=50) had large adenoma size (12.2±5.9 mm vs. 15.3±6.5 mm, P<0.01), distal location (39.3% vs. 52.0%, P=0.05) and diabetes mellitus (13.1% vs. 25.0%, P=0.04). However, age, sex, body mass index, the mean number of polyps, and morphological features (polypoid vs. nonpolypoid lesions) were not significantly different between the AA and ECC groups. In multivariate analysis, adenoma size >15 mm (odds ratio [OR], 4.49; 95% confidence interval [CI] 2.40-8.38), distal location (OR, 2.59; 95% CI, 1.33-5.05), and diabetes mellitus (OR, 2.10; 95% CI, 1.07-4.43) were significantly associated with ECC. Of the 12 patients with SM cancer, 5 underwent additional operations and had no remnant carcinoma. Conclusions: Predictable factors of ECC after colonoscopic polypectomy may be adenoma size >15 mm, distal location and diabetes mellitus. (Intest Res 2013;11:169-177)
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Randomized Controlled Trial of Sodium Phosphate Tablets versus 2 L Polyethylene Glycol Solution for Bowel Cleansing prior to Colonoscopy Yun Ho Lee, Seong Yeon Jeong, You Sun Kim, Hye Jin Jung, Min Jung Kwon, Cheol Hun Kwak, Song I Bae, Jeong Seop Moon, Ji Won Kim, Su Hwan Kim, Kook Lae Lee The Korean Journal of Gastroenterology.2015; 65(1): 27. CrossRef
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Intest Res 2013;11(3):178-183. Published online July 30, 2013
Background/Aims A subset of patients may develop colorectal cancer after a colonoscopy that was negative for carcinoma. These missed or de novo developed lesions were termed as interval cancers. Many studies regarding interval cancer have been conducted in Western countries, whereas very limited data are available in Asian populations. Therefore, the purpose of this study was to investigate prevalence, clinicopathologic features, and predictors of interval colorectal cancers in the Korean population. Methods: Interval cancer was defined as a cancer that is diagnosed within 5 years of a negative colonoscopy result. Among the patients who were diagnosed colorectal cancers at Kangbuk Samsung Hospital from January 2007 to April 2012, clinicopathologic characteristics of interval cancers were compared with those of sporadic cancers. Results: Among the 785 patients, 482 responded to telephone calls. Of these, 30 (6.2%) developed interval cancers. Finally, 28 patients who had interval cancers were compared with 415 patients who had sporadic cancers. Interval cancer group was significantly younger and more frequent in the right side colon than sporadic cancer group. There was no differences in sex, tumor size, differentiation, and staging between two groups. In multivariate analysis, young age and right side colon cancer were independent factors associated with an interval cancer. Conclusions: A significant proportion of Korean patients developed interval colorectal cancer, especially at the young age and in the proximal colon. (Intest Res 2013;11:178-183)
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Intest Res 2013;11(3):184-190. Published online July 30, 2013
Background/Aims The purpose of this study was to determine whether preoperative carbohydrate antigen 19-9 (CA 19-9) levels can predict the stage of diseases or survival rate in patients with resectable colorectal cancer (CRC). Methods: A total of 247 patients who underwent curative resections at Kyung Hee University Hospital at Gangdong between 2006 and 2011 were enrolled. We investigated the correlations of preoperative serum levels of CA19-9 with clinicopathological features of CRC. Receiver operative curve was constructed for evaluating the efficiency of the serum CA 19-9 levels in the stratifying stage of CRC. Survival analysis was performed with Kaplan-Meire method and log-rank test. Cox regression analysis was used for the multivariate analysis for survival. Results: Abnormal level of serum CA 19-9 (>37 IU/mL) were associated with advanced T stage (P<0.001), N stage (P=0.002) and TNM stage (P<0.001) in patients with resectable CRC. Furthermore, abnormal level of serum CA 19-9 were related with vascular invasion (P=0.002) and lymphatic invasion (P=0.026). The area under the curve was 0.75 (95% confidence interval [CI] 0.67-0.83) for T4 stage CRC and 0.680 (95% CI 0.61-0.75) for TNM stage III CRC. In patients with TNM stage III CRC, a preoperative CA 19-9 higher than 60 IU/mL (P=0.033) and presence of vascular invasion (P=0.002) were identified as significant predictors of survival rate on multivariate analysis. Conclusions: In patients with resectable CRC, preoperative CA 19-9 correlates with T stage, N stage and TNM stage of disease. Serum CA 19-9 >60 U/mL was an independent predictor of survival rate in the patients with TNM stage III CRC. (Intest Res 2013;11:184-190)
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Background/Aims Colonoscopic polypectomy should be performed on the five to seven hour of clock (standard position). However, outcomes of polypectomy at non-standard positions have not yet been investigated. This study was to compare the clinical outcomes of colonoscopic polypectomy including procedure time, status of resection margin and complications between standard and non-standard position. Methods: Patients who underwent screening colonoscopy were prospectively recruited from Oct 2011 to Feb 2012 at Dongguk University Ilsan Hosptial, Goyang, Korea. Standard position was defined as polyps which were located from 5 to 7 hour of clock on colonoscopic view. Results: A total of 168 adenomatous polyps of 114 patients were investigated. Mean size of polyp was 7.1±3.2 mm. The most common shape of polyps was sessile in 77 cases (45.8%). Mean overall procedure time per patient was 25.5±12.3 min. 130 adenomatous polyps were resected in standard position (77.4%) and 38 polyps were in non-standard position (22.6%). Overall complete resection rate was 63.7% and immediate bleeding rate was 9.8%. There was no significant difference in overall polypectomy time per polyp (2.9±1.3 min vs. 3.0±1.8 min, P=0.32). Complete resection rates and complication were not statistically different. Conclusions: There was no difference according to procedure time, status of resection margin and complications between standard position and non-standard position. Colonoscopic polypectomy is thus safe and feasible on any position. (Intest Res 2013;11:191-197)
Background/Aims Although the quality of colonoscopy is considered important to improve screening efficacy, there is little evidence and few statistical reports which properly reflects the colonoscopy quality of clinical practices in Korea. We aimed to investigate the quality indicators of colonoscopy performing in clinical practice. Methods: We analyzed the computerized photo-documentation files of patients who were transferred to tertiary academic hospital from private clinics or primary and secondary hospitals from January 2012 to October 2012. Quality indicators including cecal intubation rate, withdrawal time, bowel preparation status, colonoscopy report form were analyzed. Bowel preparation was assessed by 4 steps on the preparation scale (excellent, good, fair, poor). Results: A total of 198 patients (134 male, 64 female) were enrolled and analyzed. Cecal intubation rate was 91.4% (181/198) and photo-documentation of appendiceal orifice and ileocecal valve was achieved as 84.3% (167/198) and 71.7% (142/198), relatively. Overall, 83.3% of cases were adequate bowel preparation state (excellent 52%, good 31.3%). Withdrawal time could be estimated at 94.4% (187/198) of cases and mean withdrawal time of diagonostic colonoscopy (n=165) was 8.6 minutes. However, the rate of cases which withdrawal time was more than 6 minutes was 69.7% (115/165). Total of 30 institution's colonoscopy report forms were analyzed and among nearly half enrolled institutions (46.6%, 14/30) were just recording patient's information and colonoscopic diagnosis. Conclusions: Considerable portion of colonoscopy examination in the primary clinical practice has been performed with low procedure quality. We thus need careful attention to maintain the quality of colonoscopy in daily practice routines. (Intest Res 2013;11:198-203)
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Gastrointestinal tracts are the most frequently involved sites of mucosa-associated lymphoid tissue (MALT) lymphoma. Stomach is the most common site of involvement among the gastrointestinal tract. Simultaneous occurrence of primary gastric and colonic MALT lymphoma is rarely reported. We report a case of synchronous double primary MALT lymphoma of the colon and stomach in a healthy subject. A 62-year-old male underwent an esophagogastroduodenoscopy and colonoscopy for medical checkup. An endoscopic examination of the stomach showed an erythematous mucosa in the great curvature of the lower body. The endoscopic finding of the colon was a flat elevated lesion in the sigmoid colon. Microscopic examinations revealed MALT lymphoma and gastric Helicobacter pylori infection. We performed imaging studies to evaluate distant metastasis and confirmed that there is no other metastasis. The patient was treated with H. pylori eradication therapy and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy. He had not experienced any recurrence since the treatments, and reached a complete remission state after six months. (Intest Res 2013;11:204-207)
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Endoscopic submucosal dissection has been a useful treatment of selected colorectal neoplasia cases. The incidence of perforation related to colorectal endoscopic submucosal dissection is 5-20%. However, while there have been numerous reports regarding retroperitoneal, mediastinal, pleural and subcutaneous emphysema after therapeutic colonoscopy, pneumoscrotum is a relatively rare manifestation of perforation associated with colorectal endoscopic submucosal dissection. In particular, pneumorrhachis, or air within the spinal cord, following therapeutic colonoscopy, is extremely rare. Herein, we report a conservatively treated perforation case as having pneumorrhachis, penumoscrotum, and pneumoperitoneum after colorectal endoscopic submucosal dissection. (Intest Res 2013;11:208-212)
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Colon barotrauma can be mostly caused by elevated intraluminal pressure. Air insufflation during colonoscopy procedure is the most common cause of iatrogenic colon barotrauma. Cat scratch colon can usually be seen in the mild type of colon barotrauma, and colon perforation can be seen in the severe type. We presently report a case of non-iatrogenic colon barotrauma caused by industrial compressed air. Multiple linear mucosal ulcers were noted in the recto-sigmoid colon, but the colon was not perforated. The patient was discharged without any further complications after conservative treatments. (Intest Res 2013;11:213-216)
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Familial adenomatous polyposis (FAP) is characterized by large numbers of adenomatous polyps in the colon and inherited as an autosomal dominant disease. Gardner's syndrome is a form of FAP accompanied by extra-colonic tumors and desmoid tumors. Desmoid tumors are rare, and benign tumors characterized by fibroblastic proliferation of fascial and musculoaponeurotic components. There is an approximate 1,000 times higher incidence of desmoid tumors in patients with FAP compared with the general population. Desmoid tumors in Gardner's syndrome occur in the small bowel mesentery in 80% of all cases, and the other 20% in the abdominal wall or the extremities. Almost all cases of desmoid tumors in Gardner's syndrome were incidentally found after prophylactic total proctocolectomy for colon cancer prevention in the patients with FAP. We report a case of Gardner's syndrome associated with codon 1099 mutation of the adenomatous polyposis coli gene, in which the patient was initially found to have desmoid tumors and subsequently diagnosed as FAP by screening colonoscopy. (Intest Res 2013;11:217-222)
Schwannomas are mainly benign tumors arising from the sheath of the peripheral nerves. Gastrointestinal schwannomas account for 2-6% of all gastrointestinal tumors; they originate most commonly in the stomach, and are extremely rare in the appendix. Their clinical features are non-specific, thus, they are usually found accidentally through radiologic examinations and confirmed by immunohistochemical stainings. A 39-year-old male was admitted with complaints of right lower quadrant pain. There was a well-enhancing tumor in the appendix on a computed tomography scan. It was laparoscopically resected and diagnosed as appendiceal schwannoma with histopathologic and immunohistochemical findings. There has been no evidence of specific complication or recurrence until now for the past 22 months. (Intest Res 2013;11:223-226)
A Shift from Oral to Intravenous Iron Supplementation Therapy Is Observed over Time in a Large Swiss Cohort of Patients with Inflammatory Bowel Disease (Inflamm Bowel Dis 2013;19:840-846)
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