Intestinal Research

Unsedated Colonoscopy and the Water Method for Minimizing Discomfort in the Unsedated Patients: Felix W. Leung; Intest Res 2011;9(2):73-84. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.73

A decade ago, failure of cecal intubation due to pain in ~20% of scheduled unsedated patients in the author's veterans practice prompted the search for a less uncomfortable approach. Methods that minimized discomfort or enhance cecal intubation included use of pediatric, variable stiffness, computer-assisted, 3-dimensional magnetic imaging colonoscope, gastroscope, and inhalation of nitrous oxide or insufflation of carbon dioxide; use of hypnosis, music, audio distraction, or simply allowing patients to participate in medication administration. In addition, several water-related techniques (as adjuncts to air insufflation) enhanced speed and success of intubation, reduced discomfort but did not appear to alter the amount of medications used. Because of simplicity, the water-related techniques added to turning off of the air pump were evaluated in a series of trial-and-error modifications. The result was the development of a water infusion in lieu of air insufflation method. Subsequent refinements included suction removal of all residual air to minimize angulations at flexures. Water exchange during insertion was used to suspend and removal feces to clear the luminal view while distention of the colonic lumen was minimize. Observational studies followed by randomized controlled trials confirmed the water method (simplified nomenclature) had significant impacts on discomfort both during and after colonoscopy: reduction of medication requirement; attenuation of insertion-related discomfort, enhancement of cecal intubation, decrease of pain after colonoscopy, increase in reported willingness to repeat unsedated colonoscopy in the patients examined without sedation and reduction of recovery time burden in patients accepting the option of sedation on demand. (Intest Res 2011;9:73-84)

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Water-aided colonoscopy: a systematic review
Felix W. Leung, Arnaldo Amato, Christian Ell, Shai Friedland, Judith O. Harker, Yu-Hsi Hsieh, Joseph W. Leung, Surinder K. Mann, Silvia Paggi, Jürgen Pohl, Franco Radaelli, Francisco C. Ramirez, Rodelei Siao-Salera, Vittorio Terruzzi
Gastrointestinal Endoscopy.2012; 76(3): 657. CrossRef

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The Effect of Sleep Disturbances and Melatonin in Inflammatory Bowel Disease: Young Sook Park; Intest Res 2011;9(2):85-89. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.85

Abstract PDF: Inflammatory bowel disease (IBD) is an idiopathic condition which increases and decreases in intensity and results in a poor quality of life for those afflicted. Advances in the molecular machinery of the circadian clock, and the discovery of clock genes in the gastrointestinal tract have led to an increase in research into the role of sleep in IBD. Altering circadian rhythm significantly worsens the development of colitis in animal models, and preliminary human studies have shown that patients with IBD are at increased risk for sleep disruption. Melatonin, a hormone and marker of the central circadian clock, has been shown to be protective in animal models of colitis and there are several anecdotal findings of melatonin supplementation alleviating ulcerative colitis. Further human studies are needed to determine the effect of sleep disorders on IBD and whether supplemental melatonin can be used to reverse sleep disturbances and mucosal inflammation. (Intest Res 2011;9:85-89)

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Molecular Imaging of Gastrointestinal Malignancies: Jong Wook Kim, Soon Man Yoon, Seung-Jae Myung; Intest Res 2011;9(2):90-96. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.90

Abstract PDF

Endoscopic detection of gastrointestinal cancer currently depends in large part on white light images, which show mucosal surface changes in real time. Molecular imaging is a rapidly growing new field in gastrointestinal endoscopy, which could provide additional information about molecular expression of cells and processes involved in cancer biology. It uses the molecular signature of cells for minimally-invasive, targeted imaging of gastrointestinal pathologies. Exogenous fluorescent agents serve as molecular beacons and include labeled peptides and antibodies, and probes with tumor-specific activation. An advantage of molecular imaging in digestive tract is the opportunity to apply such agents topically, overcoming the hurdles for delivery of these agents to the region of involvement, including immunogenic reaction and potential toxicity. Recently developed molecular targets include proteolytic enzymes, endothelial-specific markers, and apoptosis reporters. Molecular imaging has the potential to greatly impact on future endoscopy in gastroenterology. (Intest Res 2011;9:90-96)

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Endoscopic molecular imaging in inflammatory bowel disease
Nam Seok Ham, Seung-Jae Myung
Intestinal Research.2021; 19(1): 33. CrossRef

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The Clinical Utility of Positron Emission Tomography-computed Tomography in the Evaluation of Inflammatory Bowel Diseases: Sung Ho Ryu, Jae Hee Cheon, Won Jun Kang, Jin Young Kim, Bo Kyung Kim, Jin Young Yoon, Yoon Suk Jung, Hyun Mi Heo, Jin Ha Lee, Soung Min Jeon, Sung Pil Hong, Tae Il Kim, Won Ho Kim; Intest Res 2011;9(2):97-104. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.97

Abstract PDF: Background/Aims
Positron emission tomography-computed tomography (PET-CT) is a nuclear imaging technique that provides noninvasive, three dimensional, quantitative images. Recently, PET-CT has been shown to be valuable in assessing patients with inflammatory diseases; however, the clinical utility of PET-CT in the evaluation of inflammatory bowel disease (IBD) has not been defined. Thus, the aim of this study was to determine the clinical utility of PET-CT in the evaluation of IBD. Methods: Between November 2006 and September 2010, clinical, endoscopic, and radiological data on 14 patients (6 males and 8 females: age range, 33-79 years) with suspected IBD were collected. The standard work-up method for a definite diagnosis of IBD included ileocolonoscopy. Results: The 14 patients were divided into the following five groups: ulcerative colitis (n=4, 29%), intestinal Behcet's disease (n=3, 21%), intestinal tuberculosis (n=2, 14%), malignancy (n=2, 14%), and no abnormal findings with colonoscopy (n=3, 21%). A PET-CT based-diagnosis of IBD correlated with a colonoscopic diagnosis in nine cases (64.3%), but the matching ratio of the distribution of lesions between PET-CT findings and colonoscopic findings was only 18.1% (2/11). Conclusions: The utility of PET-CT in the diagnosis of IBD requires further evaluation. (Intest Res 2011;9:97-104)

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Usefulness of Polyp Detection Rate as a Quality Indicator in Colonoscopy: Su Hee Lee, Dong Il Park, Jun Mo Sung, Jae Hyun Jang, Seung Ho Ryu, Young Ho Kim, Suck-Ho Lee, Chang Kyun Lee, Chang Soo Eun, Dong Soo Han; Intest Res 2011;9(2):105-111. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.105

Abstract PDF

Background/Aims
The adenoma detection rate (ADR) has been proposed as a quality indicator of colonoscopy; however, ADR cannot be measured easily with commonly used endoscopy reporting systems because substantial time and effort is required to acquire data from histologic assessments. The purpose of this study was to determine if polyp detection rate (PDR) could be used as a valid proxy for ADR. Methods: A total of 1,156 consecutive, asymptomatic, individuals of average risk between 50 and 75 years-of-age who underwent screening colonoscopies at four tertiary medical centers by 27 gastroenterologists were included in this study. Each individual endoscopist performed at least 10 colonoscopies during the study period. The ADR and PDR were calculated as the proportion of an endoscopist's cases with an adenoma or polyp divided by the total number of colonoscopies. Pearson's correlation coefficient and the intraclass correlation coefficient were used to determine the level of agreement between ADR and PDR. Results: The mean PDR and ADR for endoscopists was 47.4% (range, 21.7-75.0) and 36.5% (range, 13.0-66.7), respectively. There was a strong correlation between PDR and ADR (Pearson's correlation coefficient 0.94, P＜0.001) and there was also good agreement between performance quintiles defined by ADR and PDR (intraclass correlation coefficient 0.94, P＜0.001). Conclusions: PDR is a valid proxy for ADR and may be useful for quality assurance at centers where ADR cannot be easily measured. (Intest Res 2011;9:105-111)

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Usefulness of Polyp and Adenoma Detection Rate in the Proximal and Distal Colon
Sung Youn Choi, Dong Il Park, Chang Kyun Lee, Jae Myung Cha, Suck Ho Lee, Young Whangbo, Chang Soo Eun, Dong Soo Han, Bo In Lee, Jeong Eun Shin
The Korean Journal of Gastroenterology.2014; 63(1): 11. CrossRef
Correlation between Adenoma Detection Rate and Advanced Adenoma Detection Rate
Shin Yeoung Lee, Nam Hee Kim, Hyun Beom Chae, Ki Joong Han, Tae Hoon Lee, Choel Min Jang, Kyung Mo Yoo, Yoon Suk Jung, Jung Ho Park, Hong Joo Kim, Yong Kyun Cho, Chong Il Sohn, Woo Kyu Jeon, Byung Ik Kim, Dong Il Park
The Korean Journal of Gastroenterology.2014; 64(1): 18. CrossRef
The Correlation between Polyp Detection Rate and Adenoma Detection Rate: Mainly Determined by the Colon Segment
Geom Seog Seo
The Korean Journal of Gastroenterology.2014; 63(1): 1. CrossRef

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Prevalence and Risk Factors of Colorectal Neoplasms according to Coronary Artery Obstructive Disease: Ki Tae Suk, Hyun Soo Kim, Hyun Jun Min, Hong Jun Park, Hyo Keun Jeon, Moon Young Kim, Jae Woo Kim, Soon Koo Baik, Sang Ok Kwon; Intest Res 2011;9(2):112-117. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.112

Abstract PDF: Background/Aims
Both colorectal neoplasm (CN) and coronary artery obstructive disease (CAOD) are prevalent and major leading causes of death in Korea. Although CN and CAOD share similar risk factors such as male gender, smoking, hyperlipidemia, diabetes mellitus, and obesity, few studies of both CN and CAOD have been reported. In this study, we evaluated clinical correlations between CN and CAOD. Methods: Between June 2003 and December 2007, 176 patients (Male: 101, average age: 62.1±9.7 yr) who underwent colonoscopy after or before coronary angiography were retrospectively enrolled. The colonoscopic findings (normal, adenoma, or cancer) of patients as well as clinical and laboratory data according to the extent of CAOD (normal, minimal CAOD, or CAOD) were compared. Results: CAOD negative, minimal CAOD, and CAOD patients totaled 36, 40, and 100, respectively. The presence of CN (adenoma and adenocarcinoma) in CAOD negative, minimal CAOD, and CAOD cases was 42%, 48%, and 63%, respectively, which was significantly different (P＜0.05). In multivariate analysis, old age (≥60 yr; P=0.03, odds ratio 2.47) and the presence of CAOD (P=0.02, odds ratio 4.11) were associated with the presence of CN. Conclusions: The prevalence of CN increased in proportion to the severity of CAOD. Colorectal cancer screening by fecal occult blood tests or colonoscopy should be a priority in patients with CAOD, particularly the elderly. (Intest Res 2011;9:112-116)

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A Survey for Post-polypectomy Surveillance: Sung Noh Hong, Dong-Hoon Yang, Young-Ho Kim, Seong-Eun Kim, Sung Jae Shin, Sung Pil Hong, Bo In Lee, Suck-Ho Lee, Dong Il Park, Hyun Soo Kim, Suk-Kyun Yang, Hyo Jong Kim, Se Hyung Kim, Multi-Society Task Force for the Guidelines for Colorectal Polyp Screening, Surveillance and Managem; Intest Res 2011;9(2):118-128. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.118

Abstract PDF

Background/Aims
There is a paucity of information on postpolypectomy surveillance currently practiced in Korea. Thus, we investigated the present state of postpolypectomy surveillance in Korea using a web-based survey. Methods: A multiple choice questionnaire was used to determine the preferred surveillance modality, the colonoscopic surveillance interval used in 11 case scenarios, and clinical factors influencing surveillance intervals. The form was sent via e-mail to members of the Korean Association for the Study of Intestinal Diseases and primary care physicians involved in a colonoscopy surveillance program. Of 425 colonoscopists contacted, 263 replied (response rate, 62%). Of the respondents, 94% were internists and 54% practiced in tertiary referral hospitals. Results: All respondents chose colonoscopy as a preferred surveillance modality following polyp removal. Colonoscopy at 3 years was the most frequent answer after removal of 1 or 2 tubular adenoma(s) ＜1 cm in size, while 1 year was the most frequent answer after removal of an advanced adenoma or ≥3 adenomas, and 6 months was the most frequent choice after removal of adenoma with high-grade dysplasia or a sessile polyp ≥2 cm. The agreement rate for the time of first surveillance between preferred guideline recommendations and respondent answers was in the low range at 14-43%. Conclusions: A significant disagreement exists between current postpolypectomy surveillance practices of Korean colonoscopists and preferred guideline recommendations. This discrepancy may be due to the fact that the guidelines do not reflect recent studies and the specific medical environment in Korea. Thus, there is a need to develop new evidence-based Korean guidelines for postpolypectomy surveillance. (Intest Res 2011;9:118-128)

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A survey of current practices in post-polypectomy surveillance in Korea
Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Eun Ran Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoo
Intestinal Research.2024; 22(2): 186. CrossRef
The current capacity and quality of colonoscopy in Korea
Jae Ho Choi, Jae Myung Cha, Jin Young Yoon, Min Seob Kwak, Jung Won Jeon, Hyun Phil Shin
Intestinal Research.2019; 17(1): 119. CrossRef
Guideline Adherence to Colonoscopic Surveillance Intervals after Polypectomy in Korea: Results from a Nationwide Survey
Seri Hong, Mina Suh, Kui Son Choi, Boyoung Park, Jae Myung Cha, Hyun-Soo Kim, Jae Kwan Jun, Dong Soo Han
Gut and Liver.2018; 12(4): 426. CrossRef
The Risk of Metachronous Advanced Colorectal Neoplasia Rises in Parallel with an Increasing Number of High-Risk Findings at Baseline
Seung Min Lee, Jeong Hwan Kim, In Kyung Sung, Sung Noh Hong
Gut and Liver.2015; 9(6): 741. CrossRef
A Survey of Colonoscopic Surveillance After Polypectomy
Dae Kyung Sohn
Annals of Coloproctology.2014; 30(2): 88. CrossRef
Clinical Practice of Surveillance Colonoscopy according to the Classification of Colorectal Intraepithelial Neoplasia in Korea: High-grade Dysplasia/CarcinomaIn SituVersus Intramucosal Carcinoma
Sung Pil Hong, Tae Il Kim, Hyun Gun Kim, Hyun-Soo Kim, Seong-Eun Kim, Kyu Chan Huh, Jeong Eun Shin, Jae Myung Cha, Suck-Ho Lee
Intestinal Research.2013; 11(4): 276. CrossRef
A Korean National Survey for Colorectal Cancer Screening and Polyp Diagnosis Methods Using Web-based Survey
Seong-Eun Kim, Sung Pil Hong, Hyun-Soo Kim, Bo In Lee, Se Hyung Kim, Sung Noh Hong, Dong-Hoon Yang, Suck Ho Lee, Sung Jae Shin, Dong Il Park, Young-Ho Kim, Suk-Kyun Yang, Hyo Jong Kim
The Korean Journal of Gastroenterology.2012; 60(1): 26. CrossRef

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Capsule Endoscopy for Suspected Small Bowel Bleeding in Patients with Portal Hypertension: Gang Il Cheon, Jin Oh Kim, Sung Wook Hong, Seong Ran Jeon, Tae Hee Lee, Hyun Gun Kim, Won Young Cho, Wan Jung Kim, Min Jeong Kim, Sung Won Jeong, Jae Young Jang, Bong Min Ko, Joo Young Cho, Joon Seong Lee; Intest Res 2011;9(2):129-138. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.129

Abstract PDF: Background/Aims
In Korea, limited data are available on small bowel bleeding in patients with portal hypertension. This study reports on the use of capsule endoscopy in cases of suspected small bowel bleeding in patients with portal hypertension. Methods: Capsule endoscopy was used at our hospital to evaluate small bowel disease in 501 cases from July 2003 to June 2010. Of those cases, nine patients with portal hypertension due to liver cirrhosis with suspected small bowel bleeding were selected for the study. A retrospective analysis was performed using data from medical records. Results: Six of the nine (66.7%) patients were males with an average age of 53.4 years. The average hemoglobin level was 8.1 g/dL. Abnormalities noted during capsule endoscopy included portal hypertensive enteropathy in all nine cases (100%), jejunal varices in four (44.4%), jejunal and ileal angiodysplasia in five (55.5%), multiple small bowel erosions in one (11.1%), granularity of the jejunal mucosa in one (11.1%), and small bowel erythema in three (33.3%). Active bleeding from jejunal varices was detected in two patients (22.2%). Despite having no obvious active bleeding during the capsule endoscopy, four patients (44.4%) were diagnosed with portal hypertensive enteropathy with obscure small bowel bleeding. Conclusions: Capsule endoscopy is a useful diagnostic tool for the evaluation of small bowel bleeding in patients with portal hypertensive enteropathy. Additional prospective and multicenter studies on the use of capsule endoscopy are needed to evaluate the incidence and clinical importance of portal hypertensive enteropathy. (Intest Res 2011;9:129-138)

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A Case of Methicillin-Resistant Staphylococcal Enterocolitis with Subsequent Development of Lymphocytic Colitis: Joong Ho Bae, Dong Soo Han, Hye Sun Park, Yil Sik Hyun, Tae Yeob Kim, Chang Soo Eun, Yong Cheol Jeon, Joo Hyun Sohn; Intest Res 2011;9(2):139-143. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.139

Abstract PDF: Staphylococcus aureus (S. aureus) is occasionally a normal inhabitant of the gastrointestinal tract, and rarely considered a cause of enterocolitis. Methicillin-resistant Staphylococcal enterocolitis may cause persistent diarrhea leading to severe complications and even death, without appropriate treatment. Lymphocytic colitis (LC), a subtype of microscopic colitis, is a relatively common cause of chronic watery diarrhea. We report the case of a 73-year-old woman with profuse watery diarrhea caused by methicillin-resistant S. aureus. Soon after treatment of her enterocolitis with vancomycin the patient's general condition and symptoms improved, although the diarrhea persisted. Through colonoscopic biopsy and immunohistochemical staining, overt LC was diagnosed, and prompt therapy with budesonide was initiated. (Intest Res 2011;9:139-143)

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Ulcerative Colitis Complicating Pseudomembranous Colitis of the Right Colon: Hee Rin Joo, Tae Oh Kim, Tae Gyoon Kim, Eun Hee Seo, Jongha Park, Seung Ha Park, Sung Yeon Yang, Young Soo Moon; Intest Res 2011;9(2):144-147. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.144

Abstract PDF: Clostridium difficile (C. difficile) is a cytotoxin-producing anaerobic gram-positive rod that is responsible for pseudomembranous colitis (PMC). The incidence of C. difficile is increasing in ulcerative colitis (UC) and inflammatory bowel disease patients and is associated with a more severe course, a longer hospital stay, higher financial costs, a greater likelihood of colectomy, and high mortality. PMC may occur anywhere along the intestinal tract, but it is often found in the distal colon. PMC involving the proximal colon with rectosigmoid sparing is rarely reported in patients with UC. We describe the case of a 35-year-old woman in remission from UC who presented with frequent diarrhea and abdominal pain. She was treated with ciprofloxacin for infectious enterocolitis at a local hospital; however, her symptoms did not improve. A colonoscopy revealed yellow-white plaques with edematous, erythematous from the proximal ascending colon to the cecum, and feces positive for C. difficile toxin. She was treated with metronidazole (500 mg, three times a day) for two weeks, and improved rapidly. Physicians should carefully examine the entire colon via colonoscopy, and perform stool exams for C. difficile in patients with UC who have been treated with antibiotics and in those who develop prolonged diarrhea despite medical treatment. (Intest Res 2011;9:144-147)

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A Case of Henoch-Schönlein Purpura with Suspicious Focal Bowel Necrosis in an Adult: Su Jin Kim, Cheol Hee Park, So Yeon Kim, In Joung Lee, Chul Min Park, Chang Beom Cho, Jin Woo Kwon, Ji Won Park, Kyung Rim Huh, Kyoung Oh Kim, Il Hyun Baek, Kyo Sang Yoo, Jong Hyeok Kim, Choong Kee Park; Intest Res 2011;9(2):148-152. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.148

Abstract PDF: Henoch-Schönlein purpura (HSP) is a vasculitis of the small vessels of the skin, joints, gastrointestinal tract, and kidneys characterized by immunoglobulin A deposits in the involved organs. HSP is typified by the classic tetrad of purpura, arthralgia, abdominal pain, and renal involvement. It is common in childhood, but may also occur in adults and can be accompanied by severe complications. Gastrointestinal symptoms occur in up to 85% of patients, and gastrointestinal involvement can manifest as severe problems including intussusception, obstruction, and perforation. The disease course is often self-limited, but severe manifestations occasionally require surgical intervention. We report the case of a 24-year-old man with HSP who presented with abdominal pain and vomiting. Computerized tomography revealed thickening of the ileal wall and multifocal disrupted prominent mucosal enhancement. These findings suggested hemorrhagic enteritis and mucosal necrosis. After treatment with high dose corticosteroids, the lesion improved and surgical intervention was avoided. Our experience suggests that corticosteroid therapy may help in controlling HSP with suspicious small bowel necrosis. (Intest Res 2011;9:148-152)

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A Case of Massive Portal Venous Gas Caused by Fatal Intestinal Infarction: Jun Gu Chung, Chang-Il Kwon, Do Hyung Kim, Han-Gyung Seon, Kwang Hyun Ko, Sung Pyo Hong, Pil Won Park; Intest Res 2011;9(2):153-157. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.153

Abstract PDF

Hepatic portal venous gas (HPVG), a rare radiologic finding, is associated in some cases with severe or lethal conditions requiring urgent surgical intervention. Computed tomography has recently demonstrated a wider range of clinical conditions associated with HPVG, some of which are benign and do not necessarily require surgery. However, HPVG remains an ominous sign in cases of bowel ischemia or necrosis. We report on a case of massive HPVG caused by a fatal intestinal infarction, which showed rapid disease progression, eventually resulting in death due to septic shock. The HPVG in this case was huge and could therefore be confused with an air-biliarygram. (Intest Res 2011;9:153-157)

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Hepatic portal venous gas in paralytic ileus
Ji Eun Lee, Min Soo Sohn, Jun Ho Hur, Sun Young Cho, Sun Taek Choi, Young Ho Sung
Yeungnam University Journal of Medicine.2014; 31(1): 56. CrossRef

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Jejunal Adenocarcinoma as Part of Metachronous Triple Primary Cancers of the Digestive Tract in Patient with Hereditary Nonpolyposis Colorectal Cancer: Mun Sun Choi, Hyun Chae Jung; Intest Res 2011;9(2):158-161. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.158

Abstract PDF: Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant inherited disease characterized by onset at a relatively early age, an excess of synchronous and metachronous tumors, and a variety of extracolorectal malignancies. Small bowel carcinoma reported, is included in the tumor spectrum of HNPCC, but the frequency of occurrence of this tumor in HNPCC patients is comparatively rare. In Korea, several cases of multiple primary cancers in patients with HNPCC have been reported, however, primary jejunal adenocarcinoma in conjunction with multiple primary cancers in the digestive tract has rarely been reported. Recently, we evaluated a 61-year-old male diagnosed with metachronous triple primary cancers of the jejunum, stomach, and colon. We report this rare case of primary jejunal adenocarcinoma as a part of metachronous triple cancers along with a review of the relevant literature. (Intest Res 2011;9:158-161)

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A Case of Warfarin-Induced Intramural Hematoma Diagnosed by Double-Balloon Enteroscopy: Dong Hwi Rim, Chang Soo Eun, Shin Jae Moon, Jung Ho Bae, Tae Yeob Kim, Hang Lak Lee, Joo Hyun Sohn, Yong Cheol Jeon, Dong Soo Han; Intest Res 2011;9(2):162-165. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.162

Abstract PDF: Although bleeding is a major complication of oral anticoagulant therapy, warfarin-induced spontaneous intramural hematoma of the small bowel is a very rare complication. The clinical features of spontaneous intramural hematoma vary from mild abdominal pain to panperitonitis due to bowel perforation. Because spontaneous intramural hematoma can proceed to a life threatening situation, early diagnosis is of vital importance. Although there are a number of radiologic diagnostic tools available including abdominal ultrasonography and computed tomography, confirmation of the diagnosis through direct visualization of the involved bowel mucosa is very helpful. Direct confirmation of warfarin-induced spontaneous intramural hematoma of the small bowel is possible using double-balloon enteroscopy. We report a case of warfarin-induced spontaneous intramural hematoma with a review of the relevant literature. (Intest Res 2011;9:162-165)

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Dysbiosis of the Faecal Microbiota in Patients with Crohn's Disease and Their Unaffected Relatives (Gut 2011;60:631-637): Seung Joo Kang, Jong Pil Im; Intest Res 2011;9(2):166-168. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.166

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