Intestinal Research

Original Articles

Change in the diagnosis of inflammatory bowel disease: a hospital-based cohort study from Korea: Ho-Su Lee, Jaewon Choe, Hyo Jeong Lee, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Yong Sik Yoon, Chang Sik Yu, Jin-Ho Kim, Suk-Kyun Yang; Intest Res 2016;14(3):258-263. Published online June 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.3.258

Background/Aims

Accurately diagnosing inflammatory bowel disease (IBD) remains a challenge, but is crucial for providing proper management for affected patients. The aim of the present study was to evaluate the frequency of change in diagnosis in Korean patients who were referred to our institution with a diagnosis of IBD.

Methods

We enrolled 1,444 patients diagnosed with ulcerative colitis (UC) and 1,452 diagnosed with Crohn's disease (CD), who had been referred to the Asan Medical Center between January 2010 and December 2014. These patients were assessed and subsequently classified as having UC, CD, indeterminate colitis, possible IBD, or non-IBD.

Results

During a median follow-up of 15.9 months, 400 of the 2,896 patients (13.8%) analyzed in this study experienced a change in diagnosis. A change in diagnosis from UC to CD, or vice-versa, was made in 24 of 1,444 patients (1.7%) and 23 of 1,452 patients (1.6%), respectively. A change to a non-IBD diagnosis was the most common modification; 7.5% (108 of 1444) and 12.7% (184 of 1452) of the patients with a referral diagnosis of UC and CD, respectively, were reclassified as having non-IBD. Among the 292 patients who were ultimately determined not to have IBD, 135 (55 UC and 80 CD cases) had received IBD-related medication.

Conclusions

There are diagnostic uncertainties and difficulties in relation to IBD. Therefore, precise assessment and systematic follow-up are essential in the management of this condition.

Citations

Citations to this article as recorded by

Diagnosis change in pediatric inflammatory bowel disease
Harold Duarte, Adrienne Stolfi, Courtney McCall, Shehzad Saeed, Kelly Sandberg
Journal of Pediatric Gastroenterology and Nutrition.2024; 78(3): 623. CrossRef
A Case Report and Literature Review of Rectosigmoid Crohn’s Disease: A Diagnostic Pitfall Ultimately Leading to Spontaneous Colonic Perforation
Muhammad Z Ali, Muhammad Usman Tariq, Muhammad Hasan Abid, Hamma Abdulaziz, Mohmmad AlAdwani, Arif Khurshid, Muhammad Rashid, Fawaz Al Thobaiti , Amjad Althagafi
Cureus.2023;[Epub] CrossRef
Efficacy of vedolizumab as maintenance therapy in a patient with ulcerative colitis receiving haemodialysis in end-stage kidney failure: A case report
Guglielmo Albertini Petroni, Laura Francesca Pisani, Edoardo Borsotti, Maria Doria, Maria Laura Annunziata
SAGE Open Medical Case Reports.2023;[Epub] CrossRef
Thirty-year Trend in Inflammatory Bowel Disease on Jeju Island, South Korea
Jin Woo Kim, Hyun Joo Song, Sun-Jin Boo, Heung Up Kim, Ki Soo Kang, Soo-Young Na
The Korean Journal of Gastroenterology.2023; 81(6): 243. CrossRef
PD-1-positive cells contribute to the diagnosis of inflammatory bowel disease and can aid in predicting response to vedolizumab
Min Kyu Kim, Su In Jo, Sang-Yeob Kim, Hyun Lim, Ho Suk Kang, Sung‑Hoon Moon, Byong Duk Ye, Jae Seung Soh, Sung Wook Hwang
Scientific Reports.2023;[Epub] CrossRef
IBD barriers across the continents – East Asia
Joyce Wing Yan Mak, Agnes Hiu Yan Ho, Siew Chien Ng
Therapeutic Advances in Gastroenterology.2023;[Epub] CrossRef
Inflammatory bowel disease in Korea: epidemiology and pathophysiology
Jung Won Lee, Chang Soo Eun
The Korean Journal of Internal Medicine.2022; 37(5): 885. CrossRef
Systematic evaluation of the diagnostic approach of inflammatory bowel disease guidelines
Bing‐He Xiao, Xu‐Dong Ma, Jia‐Jun Lv, Ting Yang, Xin‐Jie Liu, Li‐Ya An, Yu‐Xing Qi, Ming‐Liang Lu, Yong‐Qing Duan, Da‐Li Sun
International Journal of Clinical Practice.2021;[Epub] CrossRef
Clinical characteristics and prognosis of patients with ulcerative colitis that shows rectal sparing at initial diagnosis
Yong-Sung Choi, Jong-Kyu Kim, Wan-Jung Kim
World Journal of Gastrointestinal Endoscopy.2021; 13(9): 407. CrossRef
Current status of inflammatory bowel diseases in Korea
Suk-Kyun Yang
Journal of the Korean Medical Association.2021; 64(9): 572. CrossRef
EpidemIBD: rationale and design of a large-scale epidemiological study of inflammatory bowel disease in Spain
María Chaparro, Manuel Barreiro-de Acosta, José Manuel Benítez, José Luis Cabriada, María José Casanova, Daniel Ceballos, María Esteve, Hipólito Fernández, Daniel Ginard, Fernando Gomollón, Rufo Lorente, Pilar Nos, Sabino Riestra, Montserrat Rivero, Pilar
Therapeutic Advances in Gastroenterology.2019;[Epub] CrossRef
Illuminating an Invisible Epidemic: A Systemic Review of the Clinical and Economic Benefits of Early Diagnosis and Treatment in Inflammatory Disease and Related Syndromes
Lukasz S. Wylezinski, Jamieson D. Gray, Julia B. Polk, Andrew J. Harmata, Charles F. Spurlock
Journal of Clinical Medicine.2019; 8(4): 493. CrossRef
Impact of Cumulative Corticosteroid Dosage on Preventable Hospitalization among Taiwanese Patients with Ankylosing Spondylitis and Inflammatory Bowel Disease
Beth I. Wallace, Chelsea A. Harris, Lu Wang, Mochuan Liu, Jung-Sheng Chen, Chang-Fu Kuo, Kevin C. Chung
Journal of Clinical Medicine.2019; 8(5): 614. CrossRef
Perforated diverticulitis in the setting of ulcerative colitis: An unusual case report
M. Baimas-George, L. Cetrulo, A. Kao, K.R. Kasten
International Journal of Surgery Case Reports.2018; 49: 126. CrossRef
Assessment of factors associated with smoking cessation at diagnosis or during follow‐up of Crohn's disease
Eun Mi Song, Gwang‐Un Kim, Myeongsook Seo, Sung Wook Hwang, Sang Hyoung Park, Eunja Kwon, Ho‐Su Lee, Dong‐Hoon Yang, Kyung‐Jo Kim, Byong Duk Ye, Jeong‐Sik Byeon, Seung‐Jae Myung, Suk‐Kyun Yang
Journal of Gastroenterology and Hepatology.2018; 33(1): 180. CrossRef
Incidence and Clinical Outcomes of Inflammatory Bowel Disease in South Korea, 2011–2014: A Nationwide Population-Based Study
Yoon Suk Jung, Minkyung Han, Won Ho Kim, Sohee Park, Jae Hee Cheon
Digestive Diseases and Sciences.2017; 62(8): 2102. CrossRef
Human alpha defensin 5 is a candidate biomarker to delineate inflammatory bowel disease
Amanda D. Williams, Olga Y. Korolkova, Amos M. Sakwe, Timothy M. Geiger, Samuel D. James, Roberta L. Muldoon, Alan J. Herline, J. Shawn Goodwin, Michael G. Izban, Mary K. Washington, Duane T. Smoot, Billy R. Ballard, Maria Gazouli, Amosy E. M'Koma, Shree
PLOS ONE.2017; 12(8): e0179710. CrossRef
Clinical course of ulcerative colitis patients who develop acute pancreatitis
Jong Wook Kim, Sung Wook Hwang, Sang Hyoung Park, Tae Jun Song, Myung-Hwan Kim, Ho-Su Lee, Byong Duk Ye, Dong-Hoon Yang, Kyung-Jo Kim, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang
World Journal of Gastroenterology.2017; 23(19): 3505. CrossRef
Overall and cause‐specific mortality in Korean patients with inflammatory bowel disease: A hospital‐based cohort study
Ho‐Su Lee, Jaewon Choe, Seon‐Ok Kim, Sun‐Ho Lee, Hyo Jeong Lee, Hyungil Seo, Gwang‐Un Kim, Myeongsook Seo, Eun Mi Song, Sung Wook Hwang, Sang Hyoung Park, Dong‐Hoon Yang, Kyung‐Jo Kim, Byong Duk Ye, Jeong‐Sik Byeon, Seung‐Jae Myung, Yong Sik Yoon, Chang S
Journal of Gastroenterology and Hepatology.2017; 32(4): 782. CrossRef
Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease
Ji Min Lee, Kang-Moon Lee
Clinical Endoscopy.2016; 49(4): 370. CrossRef

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Colonic Chicken Skin Mucosa is an Independent Endoscopic Predictor of Advanced Colorectal Adenoma: Eun Ju Chung, Ji Young Lee, Jaewon Choe, Hye-Sook Chang, Jongcheol Kim, Dong Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Kyung-Jo Kim, Suk-Kyun Yang, Jin-Ho Kim, Seung-Jae Myung; Intest Res 2015;13(4):318-325. Published online October 15, 2015; DOI: https://doi.org/10.5217/ir.2015.13.4.318

Abstract PDF PubReader ePub

Background/Aims

Chicken skin mucosa (CSM), surrounding colorectal adenoma, is an endoscopic finding with pale yellow-speckled mucosa; however, its clinical significance is unknown. This study aimed to evaluate the prevalence and clinical characteristics of CSM, and the association between colorectal carcinogenesis and CSM.

Methods

This cross-sectional study was performed in 733 consecutive patients who underwent endoscopic polypectomy for colorectal adenoma after the screening of colonoscopy at the Asan Health Promotion Center between June 2009 and December 2011. The colonoscopic and pathological findings of colorectal adenoma including number, size, location, dysplasia, morphology, and clinical parameters were reviewed.

Results

The prevalence of CSM was 30.7% (225 of 733 patients), and most CSM-related adenomas were located in the distal colon (93.3%). Histological analysis revealed lipid-laden macrophages in the lamina propria of the mucosa. Multivariate analyses showed that CSM was significantly associated with advanced pathology, including villous adenoma and high-grade dysplasia (odds ratio [OR], 2.078; 95% confidence interval [CI], 1.191-3.627; P=0.010), multiple adenomas (i.e., ≥2 adenomas; OR, 1.692; 95% CI, 1.143-2.507; P=0.009), and a protruding morphology (OR, 1.493; 95% CI, 1.027-2.170; P=0.036). There were no significant differences in polyp size or clinical parameters between patients with and without CSM.

Conclusions

CSM-related adenoma was mainly found in the distal colon, and was associated with advanced pathology and multiple adenomas. CSM could be a potential predictive marker of the carcinogenetic progression of distally located colorectal adenomas.

Citations

Citations to this article as recorded by

Mucosa color and size may indicate malignant transformation of chicken skin mucosa-positive colorectal neoplastic polyps
Ying-Jie Zhang, Meng-Xia Yuan, Wu Wen, Fan Li, Yi Jian, Chuan-Ming Zhang, Ye Yang, Feng-Lin Chen
World Journal of Gastrointestinal Oncology.2024; 16(3): 750. CrossRef
White spots around colorectal tumors are cancer-related findings and may aid endoscopic diagnosis: a prospective study in Japan
Kai Korekawa, Yusuke Shimoyama, Fumiyoshi Fujishima, Hiroshi Nagai, Takeo Naito, Rintaro Moroi, Hisashi Shiga, Yoichi Kakuta, Yoshitaka Kinouchi, Atsushi Masamune
Clinical Endoscopy.2024; 57(5): 637. CrossRef
Solitary juvenile polyp of the rectum with intramucosal adenocarcinoma
Kazuki Nagai, Uichiro Fuchizaki, Yoshimichi Ueda
Clinical Journal of Gastroenterology.2023; 16(4): 532. CrossRef
Chicken skin mucosa surrounding small colorectal cancer could be an endoscopic predictive marker of submucosal invasion
Ying-Jie Zhang, Wu Wen, Fan Li, Yi Jian, Chuan-Ming Zhang, Meng-Xia Yuan, Ye Yang, Feng-Lin Chen
World Journal of Gastrointestinal Oncology.2023; 15(6): 1062. CrossRef
Characteristics and potential malignancy of colorectal juvenile polyps in adults: a single-center retrospective study in China
Jie Dong, Tian-Shi Ma, Yuan-Hong Xu, Peng Li, Wan-Yuan Chen, Jiang-Feng Tu, You-Wei Chen
BMC Gastroenterology.2022;[Epub] CrossRef
Colonic Chicken Skin Mucosa Surrounding Colon Polyps Is an Endoscopic Predictive Marker for Colonic Neoplastic Polyps
Yu Mi Lee, Kyung Ho Song, Hoon Sup Koo, Choong-Sik Lee, Inseok Ko, Sang Hyuk Lee, Kyu Chan Huh
Gut and Liver.2022; 16(5): 754. CrossRef
Diagnosis and management of a solitary colorectal juvenile polyp in an adult during follow-up for ulcerative colitis: A case report
You-Wei Chen, Jiang-Feng Tu, Wen-Juan Shen, Wan-Yuan Chen, Jie Dong
World Journal of Gastroenterology.2020; 26(8): 877. CrossRef
Hepatitis B Virus Infection Is Independently Associated With Advanced Colorectal Adenoma
Su Hwan Kim, Ji Won Kim, Kook Lae Lee, Seohui Lee, Seong-Joon Koh, Ji Bong Jeong, Byeong Gwan Kim
The American Journal of the Medical Sciences.2018; 356(2): 141. CrossRef
Current strategies for malignant pedunculated colorectal polyps
Adriana Ciocalteu, Dan Ionut Gheonea, Adrian Saftoiu, Liliana Streba, Nicoleta Alice Dragoescu, Tiberiu Stefanita Tenea-Cojan
World Journal of Gastrointestinal Oncology.2018; 10(12): 465. CrossRef

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Case Report

Natural Course of an Untreated Metastatic Perirectal Lymph Node After the Endoscopic Resection of a Rectal Neuroendocrine Tumor: Sang Hyung Kim, Dong-Hoon Yang, Jung Su Lee, Soyoung Park, Ho-Su Lee, Hyojeong Lee, Sang Hyoung Park, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim, Chan Wook Kim, Jihun Kim; Intest Res 2015;13(2):175-179. Published online April 27, 2015; DOI: https://doi.org/10.5217/ir.2015.13.2.175

Abstract PDF PubReader

Lymph node metastasis is rare in small (i.e., <10 mm) rectal neuroendocrine tumors (NETs). In addition to tumor size, pathological features such as the mitotic or Ki-67 proliferation index are associated with lymph node metastasis in rectal NETs. We recently treated a patient who underwent endoscopic treatment of a small, grade 1 rectal NET that recurred in the form of perirectal lymph node metastasis 7 years later. A 7-mm-sized perirectal lymph node was noted at the time of the initial endoscopic treatment. The same lymph node was found to be slightly enlarged on follow-up and finally confirmed as a metastatic NET. Therefore, the perirectal lymph node metastasis might have been present at the time of the initial diagnosis. However, the growth rate of the lymph node was extremely low, and it took 7 years to increase in size from 7 to 10 mm. NETs with low Ki-67 proliferation index and without mitotic activity may grow extremely slowly even if they are metastatic.

Citations

Citations to this article as recorded by

Clinical application of endoscopic ultrasonography in the management of rectal neuroendocrine tumors
Soo-Young Na, Seong Jung Kim, Hyoun Woo Kang
International Journal of Gastrointestinal Intervention.2023; 12(3): 105. CrossRef
Tumor grade 2 as the independent predictor for lymph node metastasis in 10–20 mm sized rectal neuroendocrine tumor
Byung-Soo Park, Sung Hwan Cho, Gyung Mo Son, Hyun Sung Kim, Su Jin Kim, Su Bum Park, Cheol Woong Choi, Hyung Wook Kim, Dong Hoon Shin
Korean Journal of Clinical Oncology.2021; 17(1): 37. CrossRef
Lymphovascular invasion as a prognostic value in small rectal neuroendocrine tumor treated by local excision: A systematic review and meta-analysis
Ho Suk Kang, Mi Jung Kwon, Tae-Hwan Kim, Junhee Han, Young-Su Ju
Pathology - Research and Practice.2019; 215(11): 152642. CrossRef
Trans‐anal full‐thickness endoscopic resection of a rectal neuroendocrine neoplasm performed with a TEO® (Karl Storz microsurgery device) and laparoscopic indocyanine‐green‐guided lymphatic sampling – a video vignette
P. Leon, A. Balduzzi, M. Troian, N. de Manzini
Colorectal Disease.2017; 19(4): 399. CrossRef
Usefulness of endoscopic resection using the band ligation method for rectal neuroendocrine tumors
Ju Seung Kim, Yoon Jae Kim, Jun-Won Chung, Jung Ho Kim, Kyoung Oh Kim, Kwang An Kwon, Dong Kyun Park, Jung Suk An
Intestinal Research.2016; 14(2): 164. CrossRef
Lymphovascular invasion in more than one-quarter of small rectal neuroendocrine tumors
Mi Jung Kwon, Ho Suk Kang, Jae Seung Soh, Hyun Lim, Jong Hyeok Kim, Choong Kee Park, Hye-Rim Park, Eun Sook Nam
World Journal of Gastroenterology.2016; 22(42): 9400. CrossRef
Cap-assisted EMR for rectal neuroendocrine tumors: comparisons with conventional EMR and endoscopic submucosal dissection (with videos)
Dong-Hoon Yang, Yangsoon Park, Sang Hyoung Park, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang
Gastrointestinal Endoscopy.2016; 83(5): 1015. CrossRef
Are Small Rectal Neuroendocrine Tumors Safe?
Jae Ho Choi, Jae Myung Cha
Intestinal Research.2015; 13(2): 103. CrossRef

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8 Crossref

Original Articles

Patient Descriptions of Rectal Effluents May Help to Predict the Quality of Bowel Preparation With Photographic Examples: Hoonsub So, Sun-Jin Boo, Hyungil Seo, Ho-Su Lee, Hyojeong Lee, Sang Hyoung Park, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim, Seungbong Han, Dong-Hoon Yang; Intest Res 2015;13(2):153-159. Published online April 27, 2015; DOI: https://doi.org/10.5217/ir.2015.13.2.153

Abstract PDF PubReader

Background/Aims

Previous studies have suggested a weak correlation between self-reported rectal effluent status and bowel preparation quality. We aim to evaluate whether photographic examples of rectal effluents could improve the correlation between patient descriptions of rectal effluents and bowel preparation quality.

Methods

Before colonoscopy, patients were asked to describe the nature of their last three rectal effluents. Photographic examples of rectal effluents were provided as a reference for scoring. Bowel preparation was subsequently assessed by a single endoscopist using a global preparation assessment scale. Preparation outcomes were grouped into two levels (excellent to good vs. fair to inadequate). Both univariate and multivariate logistic regression models were used to find any association between bowel preparation quality and patient characteristics.

Results

A total of 138 patients completed the questionnaires. The mean age was 56.5±10.4 years. The mean sum of the last three rectal effluent scores was 5.9±2.0. Higher rectal effluent scores (odds ratio [OR], 0.82; P=0.043) and the presence of diverticula (OR, 0.16; P<0.001) were risk factors for suboptimal preparation.

Conclusions

Photographic example-guided patient descriptions of rectal effluents showed a statistically significant association with bowel preparation quality. However, clinical significance seemed to be low. The presence of diverticula was an independent predictive factor for suboptimal bowel preparation quality.

Citations

Citations to this article as recorded by

Individualized intervention based on a preparation-related prediction model improves adequacy of bowel preparation: A prospective, multi-center, randomized, controlled study
Long Chen, Xiaoyu Kang, Gui Ren, Hui Luo, Linhui Zhang, Limei Wang, Jianghai Zhao, Rongchun Zhang, Xiaoying Zhang, Lina Zhao, Yanglin Pan
Digestive and Liver Disease.2024; 56(3): 436. CrossRef
Comparison of Objectively Assessed Versus Patient-Reported Clarity of Last Rectal Effluent for the Prediction of Quality of Bowel Preparation for Colonoscopy: A Prospective, Case-Control Study
Ajay Patwa, Satish Kumar, Deepak Bhagchandani, Amit Kumar, Virendra Atam, Navneet Anil, Priya Mishra, Abhishek Singh, Archana Devi, Ajay K Pal
Cureus.2024;[Epub] CrossRef
Development and validation of a novel scoring system based on a nomogram for predicting inadequate bowel preparation
Xiaxia Zhao, Yanglin Pan, Jinyong Hao, Jie Feng, Zhongyuan Cui, Huimin Ma, Xiaojun Huang
Clinical and Translational Oncology.2024; 26(9): 2262. CrossRef
Patients' Description of Rectal Effluents Help Predict the Quality of Colonoscopy Preparation
Manuel Antonio Lescano Lescano, Rodrigo Strehl Machado, Maria Rachel Rohr, Sender Jankiel Miszputen
Journal of Coloproctology.2024; 44(02): e106. CrossRef
Superiority of a preparation‐related model for predicting inadequate bowel preparation in patients undergoing colonoscopy: A multicenter prospective study
Long Chen, Gui Ren, Hui Luo, Linhui Zhang, Limei Wang, Jianghai Zhao, Rongchun Zhang, Xiaoying Zhang, Xiaoyu Kang, Yanglin Pan
Journal of Gastroenterology and Hepatology.2022; 37(12): 2297. CrossRef
Comparison of bowel-cleansing efficacy of split-dose and same-day dose bowel preparation for afternoon colonoscopy in patients with gastrectomy: a prospective randomized study
Tae-Geun Gweon, Cheal Wung Huh, Jeong Seon Ji, Chang Hyun Kim, Jin-Jo Kim, Seung-Man Park
Surgical Endoscopy.2020; 34(10): 4413. CrossRef
Evaluating the practice of canceling colonoscopies for presumed inadequate bowel preparation
Reid L. Hopkins, David Parsons, Leonie Hoyo, Brian C. Jacobson
Gastrointestinal Endoscopy.2020; 92(2): 382. CrossRef
A Randomized Controlled Trial Comparing Colonoscopic Enema With Additional Oral Preparation as a Salvage for Inadequate Bowel Cleansing Before Colonoscopy
Hyo-Joon Yang, Dong Il Park, Soo-Kyung Park, Sunyong Kim, Taeheon Lee, Yunho Jung, Chang Soo Eun, Dong Soo Han
Journal of Clinical Gastroenterology.2019; 53(8): e308. CrossRef
Comparison of Bowel Cleansing Efficacy, Safety, Bowel Movement Kinetics, and Patient Tolerability of Same-Day and Split-Dose Bowel Preparation Using 4 L of Polyethylene Glycol: A Prospective Randomized Study
Myeongsook Seo, Tae-Geun Gweon, Cheal Wung Huh, Jeong Seon Ji, Hwang Choi
Diseases of the Colon & Rectum.2019; 62(12): 1518. CrossRef
Randomized trial comparing oral sulfate solution with 4‐L polyethylene glycol administered in a split dose as preparation for colonoscopy
Hyo‐Joon Yang, Soo‐Kyung Park, Jee Hyun Kim, Jong Pil Im, Dong Han Yeom, Geom Seog Seo, Dong Il Park
Journal of Gastroenterology and Hepatology.2017; 32(1): 12. CrossRef
Patient Description of Rectal Effluents With Photographic Examples as a Predictive Indicator for the Quality of Bowel Preparation
Hyoun Woo Kang
Intestinal Research.2015; 13(4): 362. CrossRef
Author's Reply
Hoonsub So, Seungbong Han, Dong-Hoon Yang
Intestinal Research.2015; 13(4): 364. CrossRef

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The Clinical Usefulness of Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy for Rectal and Perirectal Lesions: Jae Seung Soh, Ho-Su Lee, Seohyun Lee, Jungho Bae, Hyo Jeong Lee, Sang Hyoung Park, Dong-Hoon Yang, Kyung-Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim, Jeong-Sik Byeon; Intest Res 2015;13(2):135-144. Published online April 27, 2015; DOI: https://doi.org/10.5217/ir.2015.13.2.135

Abstract PDF PubReader

Background/Aims

Endoscopic ultrasound-guided fine needle aspiration and/or biopsy (EUS-FNA/B) have been used to diagnose subepithelial tumors (SETs) and extraluminal lesions in the gastrointestinal tract. Our group previously reported the usefulness of EUS-FNA/B for rectal and perirectal lesions. This study reports our expanded experience with EUS-FNA/B for rectal and perirectal lesions in terms of diagnostic accuracy and safety. We also included our new experience with EUS-FNB using the recently introduced ProCore needle.

Methods

From April 2009 to March 2014, EUS-FNA/B for rectal and perirectal lesions was performed in 30 consecutive patients. We evaluated EUS-FNA/B performance by comparing histological diagnoses with final results. We also investigated factors affecting diagnostic accuracy.

Results

Among 10 patients with SETs, EUS-FNA/B specimen results revealed a gastrointestinal stromal tumor in 4 patients and malignant lymphoma in 1 patient. The diagnostic accuracy of EUS-FNA/B was 50% for SETs (5/10). Among 20 patients with non-SET lesions, 8 patients were diagnosed with malignant disease and 7 were diagnosed with benign disease based on both EUS-FNA/B and the final results. The diagnostic accuracy of EUS-FNA/B for non-SET lesions was 75% (15/20). The size of lesions was the only factor related to diagnostic accuracy (P=0.027). Two complications of mild fever and asymptomatic pneumoperitoneum occurred after EUS-FNA/B.

Conclusions

The overall diagnostic accuracy of EUS-FNA/B for rectal and perirectal lesions was 67% (20/30). EUS-FNA/B is a clinically useful method for cytological and histological diagnoses of rectal and perirectal lesions.

Citations

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Colonoscopic Ultrasound-Guided Fine-Needle Aspiration Using a Curvilinear Array Transducer: A Single-Center Retrospective Cohort Study
Spencer Cheng, Sergio E. Matuguma, Guilherme H. P. de Oliveira, Gustavo L.R. Silva, Henrique Cheng, Sergio A. Sánchez-Luna, Mauricio K Minata
Diseases of the Colon & Rectum.2022; 65(2): e80. CrossRef
Diagnosis and Management of Rectal Neuroendocrine Tumors (NETs)
Francesco Maione, Alessia Chini, Marco Milone, Nicola Gennarelli, Michele Manigrasso, Rosa Maione, Gianluca Cassese, Gianluca Pagano, Francesca Paola Tropeano, Gaetano Luglio, Giovanni Domenico De Palma
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Long-term experience with percutaneous biopsies of pelvic lesions using CT guidance
Petr Hoffmann, Michal Balik, Martina Hoffmannova, Jiri Spacek, Jiri Vanasek, Adam Rezac, Petr Dvorak
Science Progress.2021;[Epub] CrossRef
Prospective histological evaluation of a 20G core trap with a forward-cutting bevel needle for EUS-FNA of pancreatic lesions
Nobu Nishioka, Takeshi Ogura, Yoshitaka Kurisu, Miyuki Imanishi, Saori Onda, Wataru Takagi, Tatsushi Sano, Atsushi Okuda, Akira Miyano, Mio Amano, Kazuhide Higuchi
Surgical Endoscopy.2018; 32(10): 4125. CrossRef
Concise review on the comparative efficacy of endoscopic ultrasound-guided fine-needle aspiration vs core biopsy in pancreatic masses, upper and lower gastrointestinal submucosal tumors
Tawfik Khoury, Wisam Sbeit, Nicholas Ludvik, Divya Nadella, Alex Wiles, Caitlin Marshall, Manoj Kumar, Gilad Shapira, Alan Schumann, Meir Mizrahi
World Journal of Gastrointestinal Endoscopy.2018; 10(10): 267. CrossRef
Endoscopic ultrasound-guided fine needle aspiration of extra-rectal lesions
J. Lim, S. A. Norton, N. A. Wong, M. G. Thomas
Techniques in Coloproctology.2017; 21(5): 393. CrossRef
Application of Endoscopic Ultrasonography in the Diagnosis and Treatment of Lower Gastrointestinal Disease
Eun Young Kim
Intestinal Research.2015; 13(2): 101. CrossRef
Benign Prostatic Hyperplasia Mimicking a Symptomatic Rectal Submucosal Tumor
Seung Wook Hong, Jaeyoung Chun, Kyu Joo Park, Cheol Kwak, Joo Sung Kim
Soonchunhyang Medical Science.2015; 21(2): 164. CrossRef

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Case Report

A Case of Cronkhite-Canada Syndrome Showing Spontaneous Remission: Dong-Uk Kang, Dong-Hoon Yang, Yunsik Choi, Ji-Beom Kim, Ho-Su Lee, Hyo Jeong Lee, Sang Hyoung Park, Kee Wook Jung, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2013;11(4):317-322. Published online October 30, 2013; DOI: https://doi.org/10.5217/ir.2013.11.4.317

Abstract PDF

Cronkhite-Canada syndrome (CCS) is a rare, noninherited gastrointestinal polyposis syndrome associated with ectodermal changes such as alopecia, nail dystrophy, and cutaneous hyperpigmentation. The etiology and pathogenesis of CCS are not known, but diarrhea, malnutrition, gastrointestinal bleeding, and infection may occur in the affected patient; moreover, this condition could be fatal. However, previous reports have described several cases of spontaneous remission. We report a 60-year-old man who was incidentally found to have colonic polyposis, alopecia, and hypogeusia and was diagnosed to have CCS. However, this patient experienced spontaneous remission, including regrowth of body hair and alleviation of bowel inflammation, without any specific medications such as steroids, antibiotics, or proton pump inhibitors. (Intest Res 2013;11:317-322)

Citations

Citations to this article as recorded by

Cronkhite-Canada Syndrome Showing Good Early Response to Steroid Treatment
Woohee Cho, Kwangwoo Nam, Ki Bae Bang, Hyun Deok Shin, Jeong Eun Shin
The Korean Journal of Gastroenterology.2018; 71(4): 239. CrossRef

2,737 View
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1 Crossref

Original Articles

Near-infrared Fluorescence Imaging Using a Protease-activatable Nanoprobe in Tumor Detection: Comparison with Narrow-band Imaging: Soon Man Yoon, In-Wha Kim, Miyeoun Song, Eun-Ju Do, Ju Hee Ryu, Kwangmeyung Kim, Ick Chan Kwon, Mi Jung Kim, Dae Hyuk Moon, Dong-Hoon Yang, Kyoung Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Suk-Kyun Yang, Jin-Ho Kim, Seung-Jae Myung; Intest Res 2013;11(4):268-275. Published online October 30, 2013; DOI: https://doi.org/10.5217/ir.2013.11.4.268

Abstract PDF

Background/Aims
Advances in endoscopic technology seek to improve the accuracy of neoplastic tumor detection. Recently developed endoscopy devices such as narrow-band imaging (NBI) nevertheless have limitations in morphologic diagnosis. The purpose of this study was to investigate whether a novel imaging technique—near-infrared fluorescence (NIRF) imaging using a protease-activatable nanoprobe—could provide more accurate neoplastic tumor detection, compared to NBI. Methods: Images of the intestines of ApcMin/+ mice were obtained by NIRF using a matrix metalloproteinase (MMP)-sensing probe, which was based on a nanoparticle platform. Immediately after imaging, endoscopy with NBI capability was performed on the same excised intestine. Macroscopic and microscopic findings in the intestines were assessed, and MMP expression was analyzed by Western blotting and real-time polymerase chain reaction. Results: Numerous tiny polypoid lesions were present in the intestines of aged ApcMin/+ mice. These lesions included adenomas, lymphoid follicles, and protruding normal tissues. When using NIRF imaging with an MMP-activatable nanoprobe, adenomatous polyps showed higher fluorescence, compared to lymphoid follicles or adjacent normal tissues. The expression of MMP was higher in the adenomatous tissue than in the other tissues. The sensitivity and specificity for adenoma detection were 88.9% and 82.2%, respectively, when using NIRF imaging with a MMP-nanoprobe, compared to 77.8% and 66.7%, respectively, when using NBI (P<0.05). Conclusions: Near-infrared fluorescence imaging with a protease-activatable nanoprobe could aid in the differentiation of tumor characteristics. Clinical application of this approach may improve the endoscopic detection of neoplastic tumors. (Intest Res 2013;11:268-275)

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Feasibility of moxifloxacin and proflavine dual fluorescence imaging for detecting gastrointestinal neoplastic lesions: A prospective study
Kwangwoo Nam, Noseong Park, Seunghun Lee, Suil Jeon, Jungbin Lee, Seung‐Mo Hong, Sung Wook Hwang, Sang Hyoung Park, Dong‐Hoon Yang, Byong Duk Ye, Jeong‐Sik Byeon, Suk‐Kyun Yang, Jeong Hoon Lee, Do Hoon Kim, Ki Hean Kim, Seung‐Jae Myung
Lasers in Surgery and Medicine.2023; 55(4): 378. CrossRef
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Intestinal Research.2013; 11(4): 233. CrossRef

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Endoscopic Resection for Rectal Carcinoid Tumor: Efficacy and Clinical Results of Follow-up: Gwang Un Kim, Byong Duk Ye, Jeong-Sik Byeon, Hwan Sung Park, Tae Jin Ok, Dong-Hoon Yang, Kee Wook Jung, Kyung Jo Kim, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2011;9(3):217-224. Published online December 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.3.217

Abstract PDF

Background/Aims
With the growing volume of screening colonoscopies, the incidence of rectal carcinoids and the number of endoscopic resections for rectal carcinoids are also increasing. However, the prognosis including recurrence and metachronous lesions after endoscopic resection is unclear. Methods: The medical records of 255 patients who had undergone endoscopic resection for rectal carcinoids between October 1999 and April 2010 were retrospectively reviewed. Results: The number of males was 150 (58.8%), and the mean age was 54.1 years (range, 27-85 years). Mean tumor size was 6.9 mm. In total, 162 cases (63.5%) were treated with endoscopic mucosal resection and 93 (36.5%) were treated with endoscopic submucosal dissection. Although endoscopic complete resections were achieved in all cases, the histological examination showed 47 cases with a positive resection margin (18.4%) and three with lymphovascular invasion (1.2%). In the 54 patients with a free resection margin, who were followed for more than 12 months, abdominopelvic computed tomography and endoscopy did not show recurrence after a median of 30.5 and 36 months, respectively. Three patients with lymphovascular invasion did not show recurrence during follow-up period of 13, 30, and 37 months, respectively. Metachronous rectal carcinoids were detected in four patients at 23, 58, 61, and 89 months, respectively, after initial endoscopic resection, leading to a second endoscopic treatment. Conclusions: Small rectal carcinoids completely resected grossly and pathologically without lymphovascular invasion appear to have low probability of short-term recurrence. However, considering the slow growth rate of carcinoids, long-term follow-up for recurrence and metachronous carcinoids is required. (Intest Res 2011;9:217-224)

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Clinical outcomes and risk factors associated with poor prognosis after endoscopic resection of 10–20 mm rectal neuroendocrine tumors: a multicenter, retrospective study of 10-year experience
Ja Jun Goo, Dong Hoon Baek, Hyung Wook Kim, Hong Sub Lee, Jong Yoon Lee, Su Bum Park, Geun Am Song, Sang Heon Lee, Jong Hoon Lee
Surgical Endoscopy.2023; 37(7): 5196. CrossRef
Risk Factors for Lymph Node Metastasis and Oncologic Outcomes in Small Rectal Neuroendocrine Tumors with Lymphovascular Invasion
Seung-Joo Nam, Byung Chang Kim, Hee Jin Chang, Han Ho Jeon, Junho Kim, Su Young Kim
Gut and Liver.2022; 16(2): 228. CrossRef
Multiple small, rectal neuroendocrine tumors with numerous micronests
Sung Sil Park, Nayoung Han, Jihyeon Lee, Hee Jin Chang, Jae Hwan Oh, Dae Kyung Sohn
Journal of Digestive Diseases.2018; 19(9): 572. CrossRef
Clinical outcomes of endoscopic mucosal resection for rectal neuroendocrine tumor
Jihye Kim, Jee Hyun Kim, Joo Young Lee, Jaeyoung Chun, Jong Pil Im, Joo Sung Kim
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Jae Ho Choi, Jae Myung Cha
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Keun Young Kim, Won Cheol Park
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Case Report

A Case of Isolated Ileal Ganglioneuroma: Ju Hyung Song, Byong Duk Ye, Yong Sik Yoon, Mi-Jung Kim, Dong-Hoon Yang, Kee Wook Jung, Kyung-Jo Kim, Jung-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2011;9(1):46-50. Published online April 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.1.46

Abstract PDF

Ganglioneuromas of the gastrointestinal tract are rare, but have an established association with genetic disorders, such as the multiple endocrine neoplasia (MEN) syndrome (type 2b) and neurofibromatosis (type 1). However, solitary ganglioneuromas are not associated with an increased risk for MEN 2b, neurofibromatosis type 1, or any other systemic conditions. Ganglioneuromas of the gastrointestinal tract have been reported to predominantly involve the colon and rectum, and are thereby occasionally detected during colonoscopy or surgery. Although there are no characteristic symptoms of solitary ganglioneuromas, symptoms can be induced by solitary ganglioneuromas, such as abdominal pain, bleeding, or obstruction, depending on the location and size. Herein we report a case of a solitary ganglioneuroma of the ileum. A 34-year-old man sought evaluation at our hospital for anemia. The medical and family histories were benign and there was no history of genetic disorders. The evaluation for anemia revealed iron-deficiency anemia and CT enterography revealed a single mass in the ileum. Laparoscopic resection of the lesion was performed and the pathologic examination confirmed an ileal ganglioneuroma. (Intest Res 2011;9: 11-50)

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A Case of Duodenal Ganglioneuroma Manifesting as a Subepithelial Tumor
Dong Chan Joo, Gwang Ha Kim, Chul Byung Chae, So Jeong Lee, Do Youn Park
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2018; 18(4): 271. CrossRef

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Original Articles

Clinical Characteristics of Constipation with Hypothyroidism: Jaeil Kim, Seung-Jae Myung, Dong-Hoon Yang, In Ja Yoon, So Young Seo, Heun Sook Ku, Soon Man Yoon, Kyung-Jo Kim, Byong Duk Ye, Jung-Sik Byeon, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2010;8(1):48-57. Published online June 30, 2010; DOI: https://doi.org/10.5217/ir.2010.8.1.48

Abstract PDF

Background/Aims
Constipation is a well-recognized gastrointestinal symptom in patients with untreated hypothyroidism. Although thyroid function tests are recommended to exclude hypothyroidism in patients with constipation, there have been no reports to determine the causal relationship between thyroid function and constipation. The aim of this study was to determine the prevalence of hypothyroidism in constipated patients and the clinical features of constipation associated with hypothyroidism. Methods: A total of 1,481 constipated patients were included. These patients were divided into overt hypothyroidism, subclinical hypothyroidism, and normal thyroid function groups based on thyroid function tests. We reviewed the clinical presentation, anorectal function, colonic transit time, defecographic findings, and response to biofeedback therapy. Results: The prevalence of overt and subclinical hypothyroidism was 0.41% (men, 0.36%; women, 0.53%) and 1.76% (men, 1.28%; women 2.03%), respectively. There were no differences in total or segmental colonic transit times and subtypes of constipation among the normal thyroid function (n=54), overt hypothyroidism (n=4), and subclinical hypothyroidism groups (n=21). On anorectal manometry, the prevalence of dyssynergic defecation did not differ between the three groups. Rectal hyposensitivity was more frequent in the overt hypothyroidism group (overt hypothyroidism group, 50.0%; subclinical hypothyroidism group, 19.0%; normal thyroid function group, 20.4%) without statistical significance (P=0.372). Conclusions: The prevalence of overt and subclinical hypothyroidism in constipated patients was very low. The colonic transit time is not affected by thyroid function. (Intest Res 2010;8:48-57)

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Eun Mi Song, Hyo Jeong Lee, Kee Wook Jung, Mi Jung Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Jaewon Choe, Suk-Kyun Yang, Satish S.C. Rao, Seung-Jae Myung
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Amir Mari, Mahmud Mahamid, Hana Amara, Fadi Abu Baker, Afif Yaccob
Korean Journal of Family Medicine.2020; 41(3): 139. CrossRef
Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool
Kok-Ann Gwee, Uday C Ghoshal, Sutep Gonlachanvit, Andrew Seng Boon Chua, Seung-Jae Myung, Shaman Rajindrajith, Tanisa Patcharatrakul, Myung-Gyu Choi, Justin C Y Wu, Min-Hu Chen, Xiao-Rong Gong, Ching-Liang Lu, Chien-Lin Chen, Nitesh Pratap, Philip Abraham
Journal of Neurogastroenterology and Motility.2013; 19(2): 149. CrossRef

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The Efficacy of Bedside Colonoscopy for Critically Ill Patients with Acute Lower Gastrointestinal Hemorrhage: Jongha Park, Byong Duk Ye, Jae Keun Lee, Dong-Hoon Yang, Soon Man Yoon, Kyung-Jo Kim, Jung-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2009;7(2):86-92. Published online December 30, 2009

Abstract PDF: Background/Aims
Most studies on acute gastrointestinal (GI) hemorrhage of intensive care unit (ICU) patients have focused on upper GI hemorrhage (UGIH), but reports on acute lower GI hemorrhage (LGIH) with the role of bedside colonoscopy are still lacking. Therefore, we determined the clinical characteristics of acute LGIH in ICU patients and the efficacy of bedside colonoscopy in ICU setting. Methods: We reviewed the medical records of 76 ICU patients who underwent bedside colonoscopy for acute LGIH between January 2005 and December 2007. The clinical characteristics of the patients, the outcomes of colonoscopy, and the clinical course after colonoscopy were investigated. Results: Of 76 patients, 43 patients (56.6%) were males and the median age was 67 years. End-stage renal diseases were the most common underlying diseases, followed by cardiovascular diseases. Cecal intubation was possible in 18 patients (23.7%) and bleeding foci were identified in 41 patients (53.9%). The two main causes of bleeding were rectal ulcers (48.8%) and ischemic colitis (22.0%). Endoscopic treatments were successful in 12 patients (15.8%), and there was only 1 case of rebleeding after 7 days. There were no severe complications associated with bedside colonoscopy; 3 patients (3.9%) died of uncontrolled LGIH during hospital period. Conclusions: Bedside colonoscopy is effective and safe for the diagnosis of acute LGIH in ICU patients. In addition, endoscopic treatment can be successfully performed in select patients. Therefore, in acute LGIH of ICU patients, bedside colonoscopy can be performed as a first-line procedure. (Intest Res 2009;7:86-92)

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The Safety and Efficacy of Azathioprine and 6-Mercaptopurine in the Treatment of Korean Patients with Crohn's Disease: Hyun Ju Lee, Suk-Kyun Yang, Kyung-Jo Kim, Jae-Won Choe, Soon Man Yoon, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Jin-Ho Kim; Intest Res 2009;7(1):22-31. Published online June 30, 2009

Abstract PDF: Background/Aims
This study aimed to evaluate the adverse events and efficacy of azathioprine (AZA) and 6-mercaptopurine (6-MP) in Korean patients with Crohn's disease (CD). Methods: We retrospectively analyzed 700 patients with CD (male：female=469：231; median age at diagnosis, 22 years; agerange, 9-74 years) who were treated at the Asan Medical Center between January 1997 and January 2006. Results: Of 700 patients, 372 (53.1%) were treated with AZA/6-MP. The cumulative rates of AZA/6-MP treatment at 1, 5, 10, and 20 years were 17.4%, 51.6%, 73.1%, and 94.5%, respectively. Of 372 patients treated with AZA/6-MP, 217 patients (58.3%) experienced 291 adverse events, requiring discontinuation of therapy in 41 patients (11%). Nausea occurred in 120 patients (32.3%) and led to discontinuation of therapy in 11 patients (3.0%). Leukopenia developed in 116 patients (31.2%), requiring dose adjustments in 100 patients (26.9%) and discontinuation of medications in 16 patients (4.3%). Other adverse events included infections (2.7%), abnormal liver function tests (2.7%), fever (0.8%), hair loss (0.8%), arthralgias (0.5%), pancreatitis (0.5%), headaches (0.5%), and skin rashes (0.3%). Complete corticosteroids withdrawal was achieved in 70.9% of the patients based on an intention-to-treat analysis. The remission rate of perianal fistulas was 32.6%. Conclusions: The risk of leukopenia by AZA/6-MP is higher in Korean patients with CD than in Western patients. Although the adverse events of AZA/6-MP are not uncommon in Korean patients with CD, the actual discontinuation rate of the treatment is low. Therefore, AZA/6-MP can be administered to most Korean patients with CD without serious adverse events. (Intest Res 2009;7:22-31)

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Diverticulitis: Focused on Clinical Course and Relapse: Kwi-Sook Choi, Jeong-Sik Byeon, Soon Man Yoon, Kyung-Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2008;6(1):37-44. Published online June 30, 2008

Abstract PDF: Background/Aims
There are a limited number of studies concerning the outcomes of diverticulitis in the Oriental population. We sought to evaluate the clinical features and the long-term outcomes of diverticulitis in Korean patients. Methods: We retrospectively reviewed the clinical courses of 104 patients (59 men, 45 women; median age 48.5 years [range: 24-83 years]) hospitalized for their first episode of diverticulitis between 1989 and 2005. Results: Right-sided diverticulitis was more common (71/104, 68%). However, the proportion of left-sided diverticulitis increased as age increased. Thirty-two patients underwent operations: 30 because of complications and 2 because of presumed appendicitis. Left-sided diverticulitis was an independent risk factor for complications (OR=7.6, p＜ 0.001), and it required surgical treatment more often than right-sided diverticulitis did (61% vs. 17%, p＜0.001). Eighty-five patients were followed for a median of 36 months. Four of the 62 medically treated patients developed recurrence of diverticulitis, with a 3-year cumulative recurrence rate of 4.8%. None of the 4 recurrences showed complications, and all were successfully managed using conservative treatment. No predictive factors for the recurrence of diverticulitis could be determined. Conclusions: The recurrence rate and risk of complications associated with recurrence are low in patients treated conservatively for the first episode of diverticulitis. Therefore, elective surgery to prevent recurrence and complications should be utilized sparingly in patients with diverticulitis. (Intest Res 2008;6:37-44)

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Response to Biofeedback Therapy for Patients with Rectal Hyposensitivity: Kee Wook Jung, Seung-Jae Myung, Jeong-Sik Byeon, In Ja Yoon, Jung Eun Ko, So Young Seo, Soon Man Yoon, Mi Young Do, Do Hoon Kim, Benjamin Kim, Seunghyun Kwon, Byong Duk Ye, Hwoon-Yong Jung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2008;6(1):56-69. Published online June 30, 2008

Abstract PDF: Background/Aims
Rectal hyposensitivity (RH) has been treated with conventional biofeedback therapy (BFT), whereas the effectiveness and long term results of this therapy are not known. We aimed to investigate the effectiveness of BFT for patients with RH by conducting a retrospective review of prospectively collected data. Methods: From June 2004 to March 2007, we enrolled those RH patients who underwent BFT. BFT was performed two or three times every week. Six months after BFT, the clinical response was evaluated by subjective and objective parameters. Results: A total of 82 RH patients underwent BFT. Fifty three patients finished BFT and the other 29 patients dropped out during BFT. Thirty six patients (67.9%) showed responsiveness (R) to BFT and 17 (31.5%) showed non-responsiveness (NR). The characteristics between the two groups showed no difference, except for the "desire to defecate" volume (116.1±25.2 in the R group vs. 140.0±43.9 in the NR group, p value ＜0.05) and the rectoanal inhibitory reflex (RAIR) (15.6±0.5 in the R group R vs. 27.6±18.2 in the NR group, p value ＜0.05). The R group showed a shorter colon transit time compared to NR group. At six months after BFT, a total of 20 patients were interviewed; 15 patients answered that they still had responsiveness (75%). Conclusions: The patients with RH showed a similar BFT response to that of the constipated patients. However, the patients with a more hyposensitive rectum and a longer colonic transit showed NR to BFT, suggesting RH is an important factor in BFT responsiveness. (Intest Res 2008;6:56-69)

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Usefulness of Sigmoidoscopy in Pseudomembranous Colitis: Focused on the Comparison with Immunological Assay for C. difficile Toxin and the Role as a Predictive Factor for Clinical Outcome: Jun-Won Chung, Jeong-Sik Byeon, Kwi-Sook Choi, Benjamin Kim, Seunghyun Kwon, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2007;5(1):45-51. Published online June 30, 2007

Abstract PDF: Background/Aims
Pseudomembranous colitis (PMC) shows a diverse clinical course. The aim of this study is to evaluate the usefulness of sigmoidoscopy in PMC. Methods: Sigmoidoscopic findings and medical records were analyzed in 74 patients with PMC (male：female=38：36, 62⁑16 years). Sigmoidoscopic grades of PMC were classified into mild (n=45) when pseudomembrane covered ＜1/3 of lumen, moderate (n=18) when it covered 1/3-2/3 of lumen, and severe (n=11) when its extent was ＞2/3 of lumen. Results: In comparison to sigmoidoscopy, diagnostic sensitivity of enzyme immunoassay (EIA) for C. difficile toxin A was 29%. EIA sensitivity was 38% in mild, 28% in moderate, 0% in severe sigmoidoscopic grade (p=0.02). Risk factors for severe sigmoidoscopic grade were ileus, nasogastric tube insertion, and serum albumin below 2.3 g/dL. Initial treatment success rate was lower in severe grade (33%) than mild (96%) and moderate grade (83%) (p＜0.01). One year mortality rate was lower in severe grade (17%) than mild (85%) and moderate grade (84%) (p=0.01). Old age and severe sigmoidoscopic grade were risk factors for death. Conclusions: Sigmoidoscopic severity grading may be useful in the prediction of prognosis in PMC patients. Sigmoidoscopy may also be useful in the diagnosis of PMC, especially in patients with severe PMC. (Intest Res 2007;5:45-51)

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Clinical Factors Predicting the Detection of Abnormalities by Double Balloon Endoscopy in Patients with Obscure Overt Gastrointestinal Bleeding: Jun-Won Chung, Jeong-Sik Byeon, Kee Don Choi, Kwi-Sook Choi, Benjamin Kim, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2006;4(2):95-100. Published online December 30, 2006

Abstract PDF: Background/Aims
The most frequent indication of double balloon endoscopy (DBE) is obscure gastrointestinal bleeding (OGIB). The aim of the study was to evaluate the clinical factors predicting the detection of bleeding focus by DBE in patients with overt OGIB. Methods: Twenty eight patients (male：female=16：12, 13-82 years) with overt OGIB who underwent DBE were enrolled. Medical records were reviewed and analyzed. Results: Bleeding focus was found in 21 patients (75.0%). Age, gender, time interval between the last blood passage and DBE, transfusion amount, hemodynamic instability, and the number of past bleeding episodes were not different between patients whose bleeding focus was found by DBE and those whose bleeding focus was not found. Duration of bleeding was significantly longer in patients whose bleeding focus was found by DBE than those whose bleeding focus was not found (196.8⁑238.5 vs. 15.5⁑13.7 days, p=0.04). Conclusions: Duration of bleeding may be a useful clinical parameter which predicts the detection of bleeding focus by DBE in overt OGIB. (Intestinal Research 2006;4:95-100)

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Clinical Characteristics and Long-term Course of Ulcerative Colitis in Korea: Young Min Kim, Sang Hyoung Park, Suk-Kyun Yang, Jae-Won Choe, Sai-Hui Kim, Jeong-Sik Byeon, Seung-Jae Myung, Yun Kyung Cho, Chang-Sik Yu, Kwi-Sook Choi, Jun-Won Chung, Benjamin Kim, Kee Don Choi, Jin-Ho Kim; Intest Res 2006;4(1):12-21. Published online June 30, 2006

Abstract PDF: Background/Aims
Clinical characteristics of ulcerative colitis (UC) in Asian populations are not well recognized. We therefore investigated the clinical features and natural history of UC in Korea. Methods: We retrospectively analyzed 304 Korean UC patients first diagnosed at Asan Medical Center between June 1989 and August 2005. Results: The male to female ratio was 0.94：1 and the median age at diagnosis was 40.0 years (range, 12-72 years). At diagnosis, proctitis was noted in 134 patients (44.1%), left-sided colitis in 69 (22.7%), and extensive colitis in 101 (33.2%). Disease activity at diagnosis was mild in 149 patients (49.0%), moderate in 125 (41.1%), and severe in 26 (8.6%). In addition, 4 (1.3%) asymptomatic patients were detected as a result of a screening colonoscopy. Clinical remission after the first attack was documented in 97.4% of patients. The cumulative relapse rates at 1, 5, 10 years were 30.2%, 72.0%, and 88.4%, respectively. The cumulative risk of proximal extension in patients with proctitis or left-sided colitis was 33.0% at 5 years and 44.5% at 10 years. The cumulative probability of colectomy was 2.0% at 1 year, 2.8% at 3 years, and 3.3% at 5-15 years. The cumulative survival rates at 1, 5, and 10 years were 100%, 99.4%, and 97.4%, respectively. Conclusions: Clinical features of Korean UC patients at diagnosis are similar to those of Westerners. However, UC in Koreans may have a milder course than in Westerners, since Koreans have a lower rate of colectomy. (Intestinal Research 2006;4:12-21)

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The Incidence and Natural History of Perianal Fistulas in Korean Patients with Crohn's Disease: Ja Young Kim, Suk-Kyun Yang, Jeong-Sik Byeon, Seung-Jae Myung, Jae-Won Choe, Ji-Yun Jo, Dong-Hoon Yang, Yun Kyung Cho, Jin-Ho Kim; Intest Res 2006;4(1):22-31. Published online June 30, 2006

Abstract PDF: Background/Aims
We performed this study to investigate the incidence and natural history of perianal fistulas in Korean patients with Crohn's disease (CD). Methods: A total of 546 patients diagnosed with CD at Asan Medical Center were included. Results: Perianal fistulas occurred in 265 patients (48.5%), with 355 episodes. Eighty-two patients (15.0%) initially presented with perianal fistulas in the absence of other symptoms suggestive of CD. Out of 265 patients who developed perianal fistulas, 205 (77.4%) presented with perianal fistulas before, or at the time of, the diagnosis of CD. The cumulative incidence of perianal fistulas at 1, 5, 10, 20 years was 40.7%, 48.2%, 55.3% and 62.1%, respectively. Medical treatment was done in 30.7%, and surgery in 80.8% of perianal fistulas. The remission rate was 23.9% with medical treatment, and 83.6% with surgery. At least 1 recurrent fistula occurred in 77 patients (29.1%). The cumulative recurrence rate of perianal fistulas at 1, 5, 10, 20 years was 10.1%, 26.9%, 42.4% and 68.8%, respectively. Conclusions: The incidence of perianal fistulas in Korean patients with CD appears to be higher than that of Western patients. Also, the proportion of patients who develop perianal fistulas before the diagnosis of CD is very high. Therefore, we should consider the possibility of CD in patients with perianal fistulas to manage them properly, and thereby to reduce there complications. (Intestinal Research 2006;4:22-31)

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Clinical Manifestations and Course of Intestinal Behet's Disease: An Analysis in Relation to Disease Subtypes: Dae-Kyoum Kim, Suk-Kyun Yang, Jeong-Sik Byeon, Seung-Jae Myung, Ji-Yun Jo, Kee Don Choi, Gin Hyug Lee, Hwoon-Yong Jung, Weon-Seon Hong, Jin-Ho Kim, Young Il Min, Chang Sik Yu; Intest Res 2005;3(1):48-54. Published online June 30, 2005

Abstract PDF: Background/Aims
Intestinal Behet's disease (BD) is one of the main causes of morbidity and mortality of BD because it frequently results in serious complications such as perforation and bleeding. But clinical course of intestinal BD is not well-known. The aim of this study was to review clinical manifestations of intestinal BD, and to compare clinical findings of complete and incomplete types with those of suspected type. Methods: From June 1989 to January 2005, 87 patients who had colonoscopic evidence of intestinal BD and met the criteria proposed by BD Research Committee of Japan were enrolled in this study. Clinical manifestations were collected by retrospective review of medical records. Results: Mean age at diagnosis was 38.4 years (14-66) and sex ratio was 2：1. Abdominal pain was the most frequent gastrointestinal symptom. A single, round ulcer localized at the ileocecal area was the most common colonoscopic finding. Cumulative incidence of first and second operation in 10 years was 30.9% and 38.2%, respectively. Clinical manifestations of suspected type were not different from those of complete and incomplete types. Conclusions: Long-term follow up and close observation is needed for patients with intestinal BD. Although suspected type does not meet the criteria proposed by International Study Group for BD, it should be considered as BD. (Intest Res 2005; 3:48-54)

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Clinical Usefulness of Telomerase and hTERT for the Detection of Colon Cancer in Ulcerative Colitis: Kyu-Jong Kim, Seung-Jae Myung, Seong Soo Hong, Sun-Mi Lee Lee, Jeong-Sik Byeon, Suk-Kyun Yang, Weon-Seon Hong, Jin-Ho Kim, Young Il Min; Intest Res 2004;2(1):15-20. Published online April 16, 2004

Abstract PDF: Background/Aims
Telomerase and telomerase reverse transcriptase (hTERT), are specifically expressed in cancer cells, making them candidate markers for the early detection of cancer. The aims of our study were to determine whether these assays may be useful in the diagnosis of colorectal cancer (CRC) developed in ulcerative colitis (UC) patients. Methods: Luminal washings and biopsies were collected during colonoscopy in 66 patients; 34 with CRC, 21 with UC, and 11 controls. Telomerase activity was detected by telomeric repeat amplification protocol (TRAP) and hTERT was assayed by RT-PCR. Results: Telomerase activity was detected in biopsies from 33/34 (97%) CRC, 14/21 (67%) UC, and 3/11 (27%) controls. hTERT was positive in biopsies from 32/34 (94%) CRC, 12/21 (57%) UC, and 5/11 (45%) controls. In washing fluid, 21/34 (62%) of CRC patients were positive for telomerase, but UC patients and controls were negative. The sensitivity of telomerase for CRC was 97% in tissues and 62% in washing fluid. The specificity of telomerase in washing fluid was 100%, whereas the specificity of telomerase or hTERT mRNA in tissues was 47% each. Conclusions: The low specificity of telomerase and hTERT in colonic tissue suggest that these are not candidate markers for CRC arising in UC. Telomerase in colonoscopic luminal washings, however, may be a novel marker for early CRC in UC. (Intestinal Research 2004;2:15-20)

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The Influence of Inflammatory Bowel Disease and Its Treatment with 5-Aminosalicylic Acid on Pregnancy and Fetal Outcome: Ji Hun Choi, Hye Seung Yoo, Suk-Kyun Yang, Seung-Jae Myung, Yun Kyung Cho, Yun-Jung Lee, Jeong-Sik Byeon, Gin Hyug Lee, Hwoon-Yong Jung, Weon-Seon Hong, Jin-Ho Kim, Young Il Min; Intest Res 2004;2(1):26-30. Published online April 16, 2004

Abstract PDF: Background/Aims
5-Aminosalicylic acid (5-ASA) preparations are the first-line drugs in the treatment of inflammatory bowel disease (IBD). The aim of this study was to examine the influence of IBD and its treatment with 5-ASA on pregnancy and fetal outcome. Methods: A total of 56 patients (ulcerative colitis 41, Crohn's disease 15) experienced 84 pregnancies among 634 female patients with IBD between June 1989 and August 2003. The outcomes of 42 pregnancies exposed to 5-ASA during pregnancy were compared with those of 42 non-exposed pregnancies. Results: Pregnancy outcomes were not different between the exposed and non-exposed pregnancies in terms of live birth (85.7% vs 80.9%), abortion (11.9% vs 19.0%), stillbirth (2.4% vs 0%), preterm delivery (11.1% vs 5.9%), low birth weight (11.1% vs 8.8%), congenital malformation (2.8% vs 2.9%), and aggravation of disease during pregnancy (21.4% vs 16.7%). These figures appear to be similar to those of general population. Conclusions: Neither ulcerative colitis nor Crohn's disease has any significant impact on pregnancy outcome, and 5-ASA does not increase the risk of congenital malformation. (Intestinal Research 2004;2:26-30)

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The Prevalence of Colorectal Neoplasms and the Role of Screening Colonoscopy in Asymptomatic Korean Adults: Hye-Sook Chang, Jae-Won Choe, Suk-Kyun Yang, Seung-Jae Myung, Hwoon-Yong Jung, Gin Hyug Lee, Weon-Seon Hong, Jin-Ho Kim, Young-Il Min; Intest Res 2003;1(2):179-185. Published online November 27, 2003

Abstract PDF: Background/Aims
Recent studies have reported the importance of screening colonoscopy for colorectal cancer. However, the prevalence of colorectal neoplasms in asymptomatic Korean population has not been determined until now. The purpose of this study was to evaluate the prevalence of colorectal neoplasms in asymptomatic Korean population and to assess the role of colonoscopy in colorectal cancer screening. Methods: We reviewed the endoscopic and pathologic reports of 3,325 patients who underwent colonoscopy at the Health Promotion Center, Asan Medical Center, from 1998 to 2002. Of them, 2,208 asymptomatic patients who underwent colonoscopy for the purpose of colorectal cancer screening were enrolled. Results: The mean age was 49.2 years and 70.8% were men. The overall prevalence of colorectal neoplasms was 18.6% and the prevalence among patients 50 years of age or older was 26.3%. The prevalence of neoplasms increased with age and was higher in the male. Patients with distal neoplasms were more likely to have proximal neoplasms than those without distal neoplasms. However, 69.2% of the patients with advanced proximal neolplasms had no synchronous distal neoplasms. Conclusions: The prevalence of colorectal neoplasms in asymptomatic average-risk Koreans seems to be lower than that in corresponding Westerns and shows a gender-difference. These results should be considered when establishing a guideline for colorectal cancer screening in Korea. Over half of the patients with advanced proximal neoplasms will not be detected if only those with distal neoplasms undergo colonoscopic screening. Therefore, colonoscopy may be useful as a screening test for colorectal cancer. (Intestinal Research 2003;2:179-185)

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Case Report

Familial Occurrence of Ulcerative Colitis in All 4 Family Members: Jeong-Sik Byeon, Suk-Kyun Yang, Yun Jung Lee, Jae Won Choe, Gin Hyug Lee, Seung-Jae Myung, Hwoon-Yong Jung, Weon-Seon Hong, Jin-Ho Kim, Young Il Min; Intest Res 2003;1(1):72-82. Published online May 27, 2003

Abstract PDF: The pathogenesis of ulcerative colitis is complicated and both the genetic and environmental factors contribute to its development. Familial occurrence is an example indicating that both the genetic and environmental factors play some parts in the development of ulcerative colitis because family members have similar genetic characteristics and have been exposed to similar environment. Familial ulcerative colitis is observed in about 10% to 20% of patients. Most such families contain only 2 affected members and families containing more than 2 affected members are relatively rare. We experienced a case of familial ulcerative colitis in which all 4 members (both spouses and their 2 sons) were affected. They had lived together for 29 years before all 4 members were affected. The first patient was diagnosed after 14 years of cohabitation and the rest were affected 13, 14, and 15 years after the first diagnosis. We report this case with a review of literature. (Intestinal Research 2003;1:72-77)

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