Intestinal Research

Original Articles

Reappraisal of Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy: Won Young Park, Tae Hee Lee, Joon Seong Lee, Su Jin Hong, Seong Ran Jeon, Hyun Gun Kim, Joo Young Cho, Jin Oh Kim, Jun Hyung Cho, Sang Wook Lee, Young Kwan Cho; Intest Res 2015;13(4):313-317. Published online October 15, 2015; DOI: https://doi.org/10.5217/ir.2015.13.4.313

Background/Aims

Pneumoperitoneum is recognized as a benign and self-limiting finding after the insertion of a percutaneous endoscopic gastrostomy (PEG) tube, while complicated pneumoperitoneum is rarely reported. The aim of this study was to reappraise pneumoperitoneum following PEG.

Methods

We retrospectively reviewed 193 patients who underwent PEG from May 2008 to May 2014. All patients had a follow-up upright chest or simple abdominal radiograph after PEG. Pneumoperitoneum was quantified by measuring the height of the air column under the diaphragm and graded as small (<2 cm), moderate (2-4 cm), or large (>4 cm). Clinically significant signs were defined as fever, abdominal tenderness or leukocytosis occurring after PEG insertion.

Results

Of the 193 study patients, 9 (4.6%) had a pneumoperitoneum visualized by radiographic imaging, graded as small in 5 patients, moderate in 2 patients and large in 2 patients. Clinically significant signs were observed in 5 (55.5%) patients with fever reported in 4 patients, abdominal tenderness in 4 patients and leukocytosis in 4 patients. The time to resolution of free air was 2-18 days. Two patients (22.2%) with moderate or large pneumoperitoneum after PEG died from either pneumonia or septic shock.

Conclusions

The clinical course of pneumoperitoneum after PEG is not always benign and self-limiting. These findings suggest that clinicians should not neglect a moderate or large pneumoperitoneum, particularly in patients who have an altered mental status or received antibiotics, since peritoneal irritation cannot be observed under these circumstances.

Citations

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Behind the Ink: Unmasking Asymptomatic Micro-perforations Following Endoscopic Tattooing
Woo Suk Kim, Tasur Seen, Joel Baum, Aaron Walfish
Cureus.2025;[Epub] CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Gut and Liver.2024; 18(1): 10. CrossRef
Endoscopic Complications Are More Frequent in Levodopa–Carbidopa Intestinal Gel Treatment via JET-PEG in Parkinson’s Disease Patients Compared to Nutritional PEG in Non-Parkinson’s Disease Patients
Laura Gombošová, Jana Deptová, Ivana Jochmanová, Tatiana Svoreňová, Eduard Veseliny, Mária Zakuciová, Vladimír Haň, Alexandra Lacková, Kristína Kulcsárová, Miriama Ostrožovičová, Joaquim Ribeiro Ventosa, Lenka Trcková, Ivica Lazúrová, Matej Škorvánek
Journal of Clinical Medicine.2024; 13(3): 703. CrossRef
Clinical practice guidelines for percutaneous endoscopic gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Clinical Endoscopy.2023; 56(4): 391. CrossRef
Pneumoperitoneum After Jejunostomy Tube Placement Managed by Needle Decompression: A Case Report
Khalid Al Shamousi, Masoud Salim Kashoob, Jawahir Lal, Said A Al-Busafi
Cureus.2023;[Epub] CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
The Korean Journal of Gastroenterology.2023; 82(3): 107. CrossRef
Incidence of Pneumoperitoneum After Gastrostomy Tube Removal
Anas Mahmoud, Nizar Alyassin, Eyad Baghal, Ruhin Yuridullah, Yana Cavanagh, Matthew A Grossman
Cureus.2023;[Epub] CrossRef
Prevention and management of major complications in percutaneous endoscopic gastrostomy
Kurt Boeykens, Ivo Duysburgh
BMJ Open Gastroenterology.2021; 8(1): e000628. CrossRef
Massive Incidental Pneumoperitoneum in an Amyotrophic Lateral Sclerosis Patient
Jasmin Jaber, Nur Magadle, Lojain Arda, Francisco J Somoza-Cano
Cureus.2021;[Epub] CrossRef
Percutaneous Endoscopic Gastrostomy Tube Gone Wrong: Endoscopic Closure to the Rescue
Jahnvi Dhar, Naveen Kumar, Pankaj Gupta, Rakesh Kochhar, Jayanta Samanta
Journal of Digestive Endoscopy.2021; 12(03): 169. CrossRef
Symptomatic Pneumoperitoneum After Gastrostomy Tube Placement Managed by Pneumocentesis
Tim Brotherton, Anuj Chhaparia, Michael Presti, Gregory Sayuk, Jill Elwing
ACG Case Reports Journal.2021; 8(11): e00700. CrossRef
TWO APPROACHES TO PNEUMOPERITONEUM: SURGERY AND CONSERVATIVE
Şehmus Ölmez, Bünyamin Sarıtaş, Mesut Aydın, Banu Kara
Gastroenterology Nursing.2020; 43(4): 317. CrossRef
Diagnosis and treatment of pediatric benign pneumoperitoneum
Shou-Xing Duan, Zong-Bo Sun, Guang-Huan Wang, Jun Zhong, Wen-Hui Ou, Ma-Xian Fu, Fu-Sheng Wang, Shu-Hua Ma, Jian-Hong Li
Medicine.2017; 96(2): e5814. CrossRef
Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis
Joo Hyun Lim, Seung Ho Choi, Changhyun Lee, Ji Yeon Seo, Hae Yeon Kang, Jong In Yang, Su Jin Chung, Joo Sung Kim
Intestinal Research.2016; 14(4): 333. CrossRef
The role of surgery in the treatment of endoscopic complications
Peter Dixon, Gopal C. Kowdley, Steven Clark Cunningham
Best Practice & Research Clinical Gastroenterology.2016; 30(5): 841. CrossRef
Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy: Does It Have Clinical Significance?
Ju Yup Lee, Kyung Sik Park
Intestinal Research.2015; 13(4): 295. CrossRef

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Does Metformin Affect The Incidence of Colonic Polyps and Adenomas in Patients with Type 2 Diabetes Mellitus?: Youn Hee Cho, Bong Min Ko, Shin Hee Kim, Yu Sik Myung, Jong Hyo Choi, Jae Pil Han, Su Jin Hong, Seong Ran Jeon, Hyun Gun Kim, Jin Oh Kim, Moon Sung Lee; Intest Res 2014;12(2):139-145. Published online April 29, 2014; DOI: https://doi.org/10.5217/ir.2014.12.2.139

Abstract PDF PubReader

Background/Aims

Colorectal cancer (CRC) develops from colonic adenomas. Type 2 diabetes mellitus (DM) is associated with a higher risk of CRC and metformin decreases CRC risk. However, it is not certain if metformin affects the development of colorectal polyps and adenomas. This study aimed to elucidate if metforminaffects the incidence of colonic polyps and adenomas in patients with type 2 DM.

Methods

Of 12,186 patients with type 2 DM, 3,775 underwent colonoscopy between May 2001 and March 2013. This study enrolled 3,105 of these patients, and divided them in two groups: 912 patients with metformin use and 2,193 patients without metformin use. Patient clinical characteristics, polyp and adenoma detection rate in the two groups were analyzed retrospectively.

Results

The Colorectal polyp detection rate was lower in the metformin group than in the non-meformin group (39.4% vs. 62.4%, P<0.01). Colorectal adenoma detection rate was significantly lower in the metformin group than in the non-metformin group (15.2% vs. 20.5%, P<0.01). Fewer advanced adenomas were detected in the metformin group than in the non-metformin group (12.2% vs. 22%, P<0.01). Multivariate analysis identified age, sex, Body mass index and metformin use as factors associated with polyp incidence, whereas only metforminwas independently associated with decreased adenoma incidence (Odd ratio=0.738, 95% CI=0.554-0.983, P=0.03).

Conclusions

In patients with type 2 DM, metformin reduced the incidence of adenomas that may transform into CRC. Therefore, metformin may be useful for the prevention of CRC in patients with type 2 DM.

Citations

Citations to this article as recorded by

Metformin for primary prevention of colorectal neoplasms in adenoma-free populations: a systematic review and dose-response meta-analysis
Mengdan Shen, Shan Lu, Zihao Xu, Feifei Zhou, Li-Ting Sheng, Qiang Yu
Frontiers in Pharmacology.2025;[Epub] CrossRef
Is Metformin Associated with a Lower Prevalence of Polyps, Adenomas, and Colorectal Carcinoma in Patients with Diabetes Mellitus?
Maria Inês Canha, Gonçalo Ramos, Rita Prata, Pedro Lages Martins, Marta Viúla Ramos, João Coimbra
Journal of Gastrointestinal Cancer.2024; 55(1): 435. CrossRef
Metformin administration in prevention of colorectal polyps in type 2 diabetes mellitus patients
Xiao-Qing Wu, Li-Hua Deng, Qian Xue, Xia Li, Meng-Han Li, Jing-Tong Wang
World Journal of Clinical Cases.2024; 12(20): 4206. CrossRef
Anti-cancer Efficacy of Metformin: Recent Updates on Breast and Other Cancers
Md. Imtiazul Kabir, Robin Kumar, Lakshmi Sai Pratyusha Bugata, Komal Raina
Current Pharmacology Reports.2023; 9(5): 284. CrossRef
Metformin Use Is Inversely Associated with Prevalent, but Not Incident Colorectal Adenomas
Anna Krigel, Snow Trinh T. Nguyen, Nawar Talukder, Ching-Ho Huang, Carlos Buitrago, Gabriel Karkenny, Benjamin Lebwohl, Julian A. Abrams, James L. Araujo
Digestive Diseases and Sciences.2022; 67(10): 4886. CrossRef
Effect of metformin on thyroid cancer risk in patients with acromegaly: A preliminary observational study
Cem Sulu, Ayyuce Begum Bektas, Suleyman Sami Guzel, Kubilay Tay, Serdar Sahin, Emre Durcan, Hande Mefkure Ozkaya, Pinar Kadioglu
Growth Hormone & IGF Research.2022; 66: 101484. CrossRef
Metformin Modifies the Gut Microbiota of Mice Infected with Helicobacter pylori
Marine Jauvain, Sarah Courtois, Philippe Lehours, Emilie Bessède
Pharmaceuticals.2021; 14(4): 329. CrossRef
Bovine Meat and Milk Factors (BMMFs): Their Proposed Role in Common Human Cancers and Type 2 Diabetes Mellitus
Ethel-Michele de Villiers, Harald zur Hausen
Cancers.2021; 13(21): 5407. CrossRef
Suppressive effects of metformin on colorectal adenoma incidence and malignant progression
Min Deng, Siqin Lei, Dongdong Huang, Hui Wang, Shuli Xia, Enping Xu, Yihua Wu, Honghe Zhang
Pathology - Research and Practice.2020; 216(2): 152775. CrossRef
Use of metformin and risk of breast and colorectal cancer
Gad Rennert, Hedy S. Rennert, Naomi Gronich, Mila Pinchev, Stephen B. Gruber
Diabetes Research and Clinical Practice.2020; 165: 108232. CrossRef
Diabetes Mellitus: a Clinical Condition Associated with Metabolic Syndrome and Colorectal Cancer Risk
Vesna Brzacki, Aleksandar Nagorni, Manolis Kallistratos, Athanasios Manolis, Dragan Lovic
Current Pharmacology Reports.2019; 5(4): 205. CrossRef
Diabetes Mellitus and Colon Carcinogenesis: Expectation for Inhibition of Colon Carcinogenesis by Oral Hypoglycemic Drugs
Junichi Kato, Yohei Shirakami, Masahito Shimizu
Gastrointestinal Disorders.2019; 1(2): 273. CrossRef
Metformin in colorectal cancer: molecular mechanism, preclinical and clinical aspects
Muhamad Noor Alfarizal Kamarudin, Md. Moklesur Rahman Sarker, Jin-Rong Zhou, Ishwar Parhar
Journal of Experimental & Clinical Cancer Research.2019;[Epub] CrossRef
Postoperative adjuvant chemotherapy is associated with a lower incidence of colorectal adenomas in patients with previous colorectal cancer
Hee Seung Lee, Sung Bae Kim, Hyun Jung Lee, Soo Jung Park, Sung Pil Hong, Jae Hee Cheon, Won Ho Kim, Tae Il Kim
Gastrointestinal Endoscopy.2018; 87(3): 688. CrossRef
Parameters of Glucose and Lipid Metabolism Affect the Occurrence of Colorectal Adenomas Detected by Surveillance Colonoscopies
Nam Hee Kim, Jung Yul Suh, Jung Ho Park, Dong Il Park, Yong Kyun Cho, Chong Il Sohn, Kyuyong Choi, Yoon Suk Jung
Yonsei Medical Journal.2017; 58(2): 347. CrossRef
Diabetes-induced mechanophysiological changes in the small intestine and colon
Mirabella Zhao, Donghua Liao, Jingbo Zhao
World Journal of Diabetes.2017; 8(6): 249. CrossRef
Metformin use and the risk of colorectal adenoma: A systematic review and meta‐analysis
Yoon Suk Jung, Chan Hyuk Park, Chang Soo Eun, Dong Il Park, Dong Soo Han
Journal of Gastroenterology and Hepatology.2017; 32(5): 957. CrossRef
Energy sensing pathways: Bridging type 2 diabetes and colorectal cancer?
Juhong Yang, Reiko Nishihara, Xuehong Zhang, Shuji Ogino, Zhi Rong Qian
Journal of Diabetes and its Complications.2017; 31(7): 1228. CrossRef
Metformin therapy and the risk of colorectal adenoma in patients with type 2 diabetes: A meta-analysis
Yi-Chao Hou, Qiang Hu, Jiao Huang, Jing-Yuan Fang, Hua Xiong
Oncotarget.2017; 8(5): 8843. CrossRef
Metformin therapy and risk of colorectal adenomas and colorectal cancer in type 2 diabetes mellitus patients: A systematic review and meta-analysis
Feifei Liu, Lijing Yan, Zhan Wang, Yuanan Lu, Yuanyuan Chu, Xiangyu Li, Yisi Liu, Dongsheng Rui, Shaofa Nie, Hao Xiang
Oncotarget.2017; 8(9): 16017. CrossRef
Therapeutic strategies against cancer stem cells in human colorectal cancer (Review)
Magdalena Szaryńska, Agata Olejniczak, Jarosław Kobiela, Piotr Spychalski, Zbigniew Kmieć
Oncology Letters.2017;[Epub] CrossRef
Potential Benefit of Metformin as Treatment for Colon Cancer: the Evidence so Far
Azza Ali Abdelsatir, Nazik Elmalaika Husain, Abdallah Tarig Hassan, Wadie M Elmadhoun, Ahmed O Almobarak, Mohamed H Ahmed
Asian Pacific Journal of Cancer Prevention.2016; 16(18): 8053. CrossRef
Weight Change and Obesity Are Associated with a Risk of Adenoma Recurrence
Yoon Suk Jung, Jung Ho Park, Dong Il Park, Chong Il Sohn, Kyuyong Choi
Digestive Diseases and Sciences.2016; 61(9): 2694. CrossRef
Associations between amount of smoking and alcohol intake and risk of colorectal neoplasm
Yoon Suk Jung, Hwanseok Jung, Kyung Eun Yun, Seungho Ryu, Yoosoo Chang, Dong Il Park, Kyuyong Choi
Journal of Gastroenterology and Hepatology.2016; 31(4): 788. CrossRef
Metformin, Diabetes, and Survival among U.S. Veterans with Colorectal Cancer
Jessica K. Paulus, Christina D. Williams, Furha I. Cossor, Michael J. Kelley, Robert E. Martell
Cancer Epidemiology, Biomarkers & Prevention.2016; 25(10): 1418. CrossRef
Inhibitory Effect of Metformin Therapy on the Incidence of Colorectal Advanced Adenomas in Patients With Diabetes
Yo Han Kim, Ran Noh, Sun Young Cho, Seong Jun Park, Soung Min Jeon, Hyun Deok Shin, Suk Bae Kim, Jeong Eun Shin
Intestinal Research.2015; 13(2): 145. CrossRef

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Endoscopic Treatment Strategy for Large Laterally Spreading Tumor: Endoscopic Piecemeal Mucosal Resection or Endoscopic Submucosal Dissection: Sang Goo Kang, Suck-Ho Lee, Seung Kyu Chung, Jae Min Shin, Seong Ran Jeon, Tae Hee Lee, Hyun Gun Kim, Jin Oh Kim; Intest Res 2011;9(3):211-216. Published online December 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.3.211

Abstract PDF

Background/Aims
The therapeutic strategy between endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) for large laterally spreading tumors (LSTs) has not been clearly defined. The aim of this study was to compare the clinical outcomes between EPMR and ESD in patients with large LST. Methods: From July 2006 to September 2010, 106 patients who underwent endoscopic resection for large (＞20 mm) LSTs were included in our retrospective analysis. Results: Baseline characteristics of the patients and tumors were not different between two groups except for location (EPMR-right colon, ESD-rectum). The en bloc resection rate and complete resection rate were significantly higher in the ESD group than those in the EPMR group (EPMR vs. ESD, 53.5% vs. 88.6, P＜0.01, 45.1% vs. 71.4%, P=0.01, respectively). However, total procedure time was significantly shorter in the EPMR group (21.3 min vs. 44.4 min, P＜0.01). Furthermore, the rates of complication including perforation and bleeding were significantly lower in the EPMR group than those in the ESD group (perforation, 1.4% vs. 11.4%, P=0.02; bleeding, 4.2% vs. 17.1%, P=0.03, respectively). During 19.9 months of follow-up, no significant difference was observed in terms of recurrence (1.5% vs. 3.2%). Non-granular, pseudo-depressed type (LST-PD) showed a significantly higher presence of adenocarcinoma and deeper submucosal invasion than other types of LSTs. Conclusions: The therapeutic strategy for choosing between EPMR and ESD for large LST lesions should be determined based on the macroscopic findings of their subtype. En bloc resection with ESD should be applied to LST-PDs due to their higher rate of submucosal invasion. (Intest Res 2011;9:211-216)

Citations

Citations to this article as recorded by

Long‐term clinical outcomes of endoscopic submucosal dissection for colorectal neoplasia with or without the hybrid technique
DU Kang, JC Park, SW Hwang, SH Park, DH Yang, KJ Kim, BD Ye, SJ Myung, SK Yang, JS Byeon
Colorectal Disease.2020; 22(12): 2008. CrossRef
Current practices in endoscopic submucosal dissection for colorectal neoplasms: a survey of indications among Korean endoscopists
Tae Jun Kim, Eun Ran Kim, Sung Noh Hong, Young-Ho Kim, Dong Kyung Chang
Intestinal Research.2017; 15(2): 228. 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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Molecular Characterization of hSRBC, a Candidate Tumor Suppressor Gene anda Upstream Regulator of p53 in Human Colon Cancer: Wan Jung Kim, Hyo Jong Kim, Sung-Gil Chi, Jin Oh Kim, Joo Young Cho, Chan Sup Shim; Intest Res 2007;5(2):131-143. Published online December 30, 2007

Abstract PDF: Background/Aims
hSRBC [human Serum deprivation response (sdr)-Related gene product that Binds to c-kinase] was identified using PKCδ or BRCA1 as a probe and located at 11p15.5-p15.4 region. Expression of hSRBC protein was also decreased in a number of breast, lung, and ovarian cancer cell lines, suggesting that hSRBC might be a putative tumor suppressor gene. Methods: The expression status of hSRBC was analyzed in 50 primary colon tumors and their adjacent 50 normal tissues, and 20 colon cancer cell lines. Transcript and protein expression of hSRBC was studied by quantitative RT-PCR and Western blot, respectively. siRNA-mediated knockdown of hSRBC expression was utilized to investigate its association with p53. Results: The mRNA expression of hSRBC was decreased in 60% (12/20) of colon cancer cell lines and 44% (22/50) of patient's colon cancer tissues. Expression of hSRBC mRNA was significantly decreased in tumors compared to non-cancerous cells, while genomic level of hSRBC was not decreased in tumors. hSRBC expression was increased by 5-aza-2’-deoxycytidine treatment and hypermethylation of CpG sites was strongly associated with decreased expression. Ectopic transfection of hSRBC suppressed RKO cell count and hSRBC knockdown by siRNA augmented HCT116 cell numbers. Flow cytometry showed G1 arrest and apoptosis of colon cancer cells by restoration of hSRBC expression in RKO cells. Both basal and etoposide-mediated p53 expression was decreased when hSRBC expression was knockdowned with siRNA. Conclusions: hSRBC expression is frequently decreased by promoter CpG site hypermethylation. hSRBC down-regulates p53 expression in G1 phase and might be a novel upstream regulator of p53. (Intest Res 2007;5:131-143)

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Factors Affecting the Efficacy of Tegaserod in Patients with Chronic Constipation: Hwang Choi, Sang Heon Yoon, Won Chul Lee, Joo Sung Kim, Dong Kyung Chang, Yoon Tae Jeen, Jin Oh Kim, Dong Soo Han, Hyo Jong Kim, Sang Yong Seol, Won Ho Kim, Suk Kyun Yang, Jin Ho Kim; Intest Res 2007;5(2):170-176. Published online December 30, 2007

Abstract PDF: Background/Aims
The effect of tegaserod has been found to differ for Caucasian and black patients. The aims of this study were to demonstrate the efficacy of tegaserod on bowel habits and to investigate the factors affecting the efficacy of tegaserod in Korean patients suffering from chronic constipation (CC). Methods: This was an open-label, multi-center, observational study. Analysis of covariance with repeated measures was used to determine the overall effect of treatment and was used to determine the changes in the number of complete spontaneous bowel movements (CSBM) from baseline during the 8-week treatment period. Demographic and baseline characteristics were compared between responders (3 or more CSBM at 8-weeks) and non-responders by the use of multivariate analysis. Results: A total of 1,798 patients were included in the study. Tegaserod treatment resulted in a significant increase in the mean number of CSBM per week over weeks 2-8 from baseline levels (from 1.0 to 3.1 CSBM per week, p＜0.0001). Tegaserod treatment was more effective for female patients, younger patients (age less than 65 years), patients with a high Bristol score at baseline, and patients with a short duration of constipation symptoms. Conclusions: Treatment with tegaserod improved bowel movements and more effective in female patients, patients under the age of 65 years, patients with a high Bristol score at baseline, and patients with a short duration of constipation symptoms. (Intest Res 2007;5:170-176)

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Case Report

A Case of Gastrointestinal Stromal Tumor of the Jejunum with Hemorrhage Which was Preoperatively Diagnosed by Double Balloon Enteroscopy: Sang Hoon Han, Chang Bum Ryu, Hyun Sik Na, Sang Gyune Kim, Bong Min Ko, Kye Won Kwon, Su Jin Hong, Young Suk Kim, Jin Oh Kim, Joon Seong Lee, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim; Intest Res 2006;4(2):110-113. Published online December 30, 2006

Abstract PDF: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tracts that usually arise in the stomach and small intestine. Recent studies, suggest that they originate from gastrointestinal pacemaker cells (interstitial cell of Cajal). In most cases symptoms are nonspecific and diagnosis is achieved incidentally after radiologic evaluation. Some patients initially present with obscure GI bleeding and are diagnosed after sugical intervention. We report a patient who presented with hematochezia who was diagnosed preoperatively with gastrointestinal stromal tumor of the jejunum by double-balloon enteroscopy and multi-directional computed tomogram. (Intestinal Research 2006;4:110-114)

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Original Articles

Usefulness of Double Balloon Enteroscopy in Small Bowel Disease: Jun Hwan Wi, Jin Oh Kim, In Seop Jung, Bong Min Ko, Joo Young Cho, Joon Seong Lee, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim; Intest Res 2005;3(2):140-144. Published online December 30, 2005

Abstract PDF: Background/Aims
Conventional studies for small bowel such as small bowel series, enteroscopy with Push, Sonde and Ropeway method had some limitations such as high missing rate, incomplete study, long procedure time and patient inconvenience. Double balloon enteroscopy is a promising method to overcome these limitations. Our aim was to evaluate the usefulness of double balloon enteroscopy. Methods: Between Nov. 2004 and Feb. 2005, 24 patients with suspected small bowel disease underwent double balloon enteroscopy. Results: Indications for double balloon enteroscopy were obscure gastrointestinal bleeding, chronic abdominal pain and Crohn's disease etc. Thirty eight cases of double balloon enteroscopy in 24 patients were performed. We could identify positive diagnostic findings in 20 of the 24 patients. In 16 obscure gastrointestinal bleeding patients, the causes of bleeding were 7 small bowel ulcers, 4 angiodysplasias, 3 Crohn's diseases etc. Procedure-related complications were not observed in any patients. Conclusions: Double balloon enteroscopy is a useful and safe diagnostic tools in small bowel disease with high diagnostic accuracy (83%). (Intestinal Research 2005;3:140-144)

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Endoscopic Mucosal Resection of Early Colon Cancer: Additional Therapy and Clinical Outcomes: Sang Gyune Kim, Chang Beom Ryu, Moon Sung Lee, Bong Min Ko, Sung Won Jung, Su Jin Hong, Young Seok Kim, Jin Oh Kim, Kye Won Kwon, Chan Sup Shim, Boo Sung Kim; Intest Res 2004;2(2):65-70. Published online December 22, 2004

Abstract PDF: Background/Aims
The prevalence of early colon cancer is increasing and endoscopic removal of it has been widely accepted. After endoscopic resection, a number of remnant or recurrent tumors were managed successfully through salvage endoscopic mucosal resection (EMR) or argon plasma coagulation (APC). This study evaluated the outcomes of EMR for early colon cancer and efficacy of additional therapy in preventing recurrence. Methods: During the period from March 2001 to April 2004, a total of 50 early colon cancers were resected and analyzed retrospectively. EMR was performed either piecemeal by snare and cap aspiration or en bloc by conventional EMR and submucosal dissection. The patients were followed up at 3, 6, 12, 24 months and median follow up period was 21.8 months. By using the magnifying endoscopy, If the endoscopists judged the tumors incompletely excised or recurred. APC and EMR as additional therapy were done. Results: 50 early colon cancers comprised 44 mucosal cancers and 6 submucosal cancers in which en bloc resection was 34 (68%) and piecemeal resection was 16 (32%). Apart from the 13 cases which is unable to decide its lateral margin free because of piecemeal resection, Complete resection rate was 26/37(70.3%). The 20 cases receiving additional therapy consisted of en bloc resection 8 cases and piecemeal resection 12 cases. Recurrence rate of previous additional therapy was 1/20(5%) and had no significant difference with no additional therapy. Conclusions: For endoscopic treatment of early colon cancer En bloc resection is much better than piecemeal resection. Because of its high complete resection rate. But, in case of suggestive incomplete resection, recurrence rate will be decreased through the additional therapy. The long term results of additional therapy after EMR for Early colon cancer seem to be required for more study. (Intestinal Research 2004;2:65-70)

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Clinical Study for Gastrointestinal Carcinoid Tumor; Aspect of Endoscopic, Endosonographic Findings and Endoscopic Treatment: Bong Min Ko, Chang Beom Ryu, Moon Sung Lee, Kye Won Kwon, Sang Gyune Kim, Sung Won Jung, Su Jin Hong, Jin Oh Kim, Chan Sup Shim, Boo Sung Kim; Intest Res 2004;2(2):89-95. Published online December 22, 2004

Abstract PDF: Background/Aims
Because screening for colonic cancer includes colonoscopy, more of carcinoid tumors may be diagnosed at an earlier stage. Metastatic disease is rare in lesions smaller than 1cm and common in lesions larger than 2cm. Small lesions are managed with local excision or endoscopic resection. Endoscopic resection, a major advance in endoscopy, provides an endoscopic option for management of carcinoid tumor of the GI tract. We study to evaluate the efficacy and safety of high-frequency probe EUS-assisted endoscopic resection in the management of carcinoid tumor of the GI tract, to evaluate of clinical usefulness of cap aspiration method in comparison with snare polypectomy. Methods: For 31 patients, snare polypectomy and cap aspiration lumpectomy were performed between February 2001 and September 2004 after evaluating by endosonography. Results: EUS examination confirmed that all of the rectal carcinoid tumor were hypoechic mass confined to the second or third layer of the rectum. The rate of complete removal of carcinoid tumors with aspiration lumpectomy was significantly higher than with snare polypectomy (p<0.05). Conclusions: EUS can provide precise information about size, layer of origin, and echogenicity of the carcinoid tumor. It is useful in the diagnosis of carcinoid of the rectum and can have an important role in the choice of therapy. Endoscopic resection with cap is a useful and safe method for resection of small carcinoid tumor of the rectum according to endoscopic shape and EUS findings. (Intestinal Research 2004;2:89-94)

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High Dose Midazolam versus Propofol plus Midazolam in Conscious Sedation during Colonoscopy: Sung Won Jung, Sang Kyune Kim, Moon Sung Lee, Bong Min Ko, Su Jin Hong, Chang Beom Ryu, Young Seok Kim, Jin Oh Kim, Chan Sup Shim, Boo Sung Kim; Intest Res 2004;2(2):107-112. Published online December 22, 2004

Abstract PDF: Background/Aims
Colonoscopy under sedation has grown in popularity recently. Midazolam and propofol are generally used for conscious sedation during colonoscopy. In comparison of midazolma, propofol is shorter-acting hypnotic agent and has shorter plasma half-life and it was reported that combined use of propofol with benzodiazepines, barbiturates or opioids enhanced sedative effect by drug interaction. We investigated the effect of high dose midazolam and combined use of midazolam and propofol in conscious sedation during colonoscopy. Methods: We injected midazolam intravenously in 61 patients for sedation before colonoscopy. We divided patients into two groups; one group was injected with additional midazolam (31 patients, high dose midazolam group) and the other was injected with additional propofol (30 patients, combined group). We compared followings in both groups; 1) decrease of systolic and diastolic blood pressure, heart rate, respiration rate per minute, and oxygen saturation rate 2) recovery time 3) degree of amnesia 4) content of patient 5) adverse effects. Results: There is no significant difference between two groups in sex and mean age. In both groups, significant difference was not observed in decrease of systolic and diastolic blood pressure, heart rate, respiration rate, and peripheral blood oxygen saturation rate (p>0.05). Recovery time was shorter in combined group than in high dose midazolam group (p<0.05). Content of patients was higher in combined group (p<0.05), Fatal adverse effect was not found in both groups. Conclusions: Combine use of midazolam and propofol is more effective sedative method than use of high dose midazolam because of shorter recovery time and increased content of patients without increasing adverse effect. (Intestinal Research 2004;2:107-112)

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Brief Report

A case of Small Bowel Obstruction due to Jejunal Adenocarcinoma Diagnosed by Double-balloon Enteroscopy: Su Jin Hong, Jun Yong Bae, Moon Sung Lee, Sung Won Jung, Sang Gyune Kim, Bong Min Ko, Chang Beom Ryu, Young Seok Kim, Jin Oh Kim, Chan Sup Shim, Boo Sung Kim; Intest Res 2004;2(2):124-128. Published online December 22, 2004

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Original Articles

Usefulness of Follow-up Colonoscopy in Laterally Spreading Tumor Resected by Endoscopic Piecemeal Mucosal Resection: Hwan Yeol Kim, Bong Min Ko, Sang Woo Cha, Kye Won Kwon, Soo Jin Hong, Chang Beom Ryu, Young Seok Kim, Jong Ho Moon, Jin Oh Kim, Joo Young Cho, Joon Sung Lee, Moon Sung Lee, Chan Sup Shim, Boo Sung Sung Kim; Intest Res 2003;1(2):186-191. Published online November 27, 2003

Abstract PDF: Background/Aims
Laterally spreading tumors (LST) of the colon are defined as tumors over 10 mm in diameter that are low in height and grow superficially. These tumors are highly malignant and usually mucosal lesions, therefore endoscopic mucosal resection is desirable. We analysed retrospectively the result of endoscopic piecemeal mucosal resection (EPMR) in LSTs larger than 20 mm in diameter. Methods: 21 patients with LSTs larger than 20 mm in diameter were treated using EPMR. The resection sites were examined for residual or recurrent lesions by follow-up colonoscopy. Results: Of the 21 patients who underwent EPMR, 2 patients performed surgical resection and 4 patients were lost during follow-up period. Residual or recurrent lesions were detected in 5 of these 15 patients after EPMR. After additional endoscopic therapy, no more residual or recurrent lesions were detected. Conclusions: After EPMR for large LSTs, it is necessary to strictly follow-up at least within 1 year. (Intestinal Research 2003;2:186-191)

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Usefulness of a Self-expandable Metal Stent Through the Scope for Malignant Colorectal Obstruction: Chang Beom Ryu, Hwan Yeol Kim, Kang An Kwon, In Sup Jung, Su Jin Hong, Jin Oh Kim, Joo Young Cho, Joon Sung Lee, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim; Intest Res 2003;1(1):45-50. Published online May 27, 2003

Abstract PDF: Background/Aims
The optimal palliative treatment of unresectable colorectal malignant obstruction is still debated. Recently, successful short-term palliation of malignant colorectal obstruction using self-expandable metal stents has been reported by several groups of investigators. Aims: The aim of this study was to evaluate the clinical usefulness of these self-expandable metal stents (SEMS) through the scope for the treatment of malignant colorectal cancer. Methods: Between May 1999 and December 2002, 35 patients (M:F=19:16) with malignant colorectal obstruction were treated for relief from the obstruction with endoscopically guided intubation of a SEMS through the working channel of an endoscope. Uncovered stents were intserted in 29 patients and covered stents in 6 patients. The technical and clinical success rates and complication were evaluated. Results: The sites of obstructions were on the rectum (n=3), sigmoid colon (n=9), descending colon (n=9), transverse colon (n=8) and ascending colon (n=6). SEMS insertion was successful in 34 of 35 patients (97%). In 31 of 34 patients with successful placement of the stent, symptoms of obstruction resolved within 72 hours. Two patients underwent the formal bowel preparation and elective single-stage surgery without complication 10 and 60 days after stent placement. Perforation occurred in 1 patients during stent placement and died. The mean follow up was 144 days (5-610 days). Stent migration occurred in 7 patients during follow-up who were 2 (33.3%) of 6 patients with covered stent and 5 (17.8%) of 28 patients with uncovered stent. After migration of stents, another stent was reinserted in 3 of 7 patients. Obstruction of the stent because of tumor ingrowth and overgrowth was observed in 4 patients with uncovered stent. Conclusions: SEMS placement through the working channel of an endoscope provide not only palliative decompression in cases with inoperable malignant colorectal obstruction but preoperative decompression to undergo the one-step surgery in patients with malignant colorectal obstruction. (Intestinal Research 2003;1:45-50)

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Case Report

A Case of Colonic Ameboma: Hwan Yeo Kim, Bong Min Ko, Kye Won Kwon, Soo Jin Hong, Chang Beom Ryu, Jin Oh Kim, Joo Young Cho, Joon Sung Lee, Moon Sung Lee, Chan Sup Shim, Boo Sung. Kim; Intest Res 2003;1(1):68-71. Published online May 27, 2003

Abstract PDF: Amebiasis is observed worldwide. Usual symptoms of amebiasis include bloody stool, diarrhea, abdominal pain, fever and weight loss. Severe form of amebiasis is associated with perforation, pseudopolyp, peritonitis, toxic megacolon and ameboma. An ameboma represents a localized amebic infection with organized granulation tissue and is almost found in cecum and rectum. We report a case of ameboma of rectum detected incidentally without specific symptom, with review of relevant literature. (Intestinal Research 2003;1:68-71)

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