Intestinal Research

Original Article

Colorectal neoplasia

A survey of current practices in post-polypectomy surveillance in Korea: Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Eun Ran Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoon Yang, on behalf of the Intestinal Tumor Research Group of the Korean Association for the Study of Intestinal Diseases (KASID); Intest Res 2024;22(2):186-207. Published online April 25, 2024; DOI: https://doi.org/10.5217/ir.2023.00109

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
We investigated the clinical practice patterns of post-polypectomy colonoscopic surveillance among Korean endoscopists.
Methods
In a web-based survey conducted between September and November 2021, participants were asked about their preferred surveillance intervals and the patient age at which surveillance was discontinued. Adherence to the recent guidelines of the U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF) was also analyzed.
Results
In total, 196 endoscopists completed the survey. The most preferred first surveillance intervals were: a 5-year interval after the removal of 1–2 tubular adenomas < 10 mm; a 3-year interval after the removal of 3–10 tubular adenomas < 10 mm, adenomas ≥ 10 mm, tubulovillous or villous adenomas, ≤ 20 hyperplastic polyps < 10 mm, 1–4 sessile serrated lesions (SSLs) < 10 mm, hyperplastic polyps or SSLs ≥ 10 mm, and traditional serrated adenomas; and a 1-year interval after the removal of adenomas with highgrade dysplasia, >10 adenomas, 5–10 SSLs, and SSLs with dysplasia. In piecemeal resections of large polyps ( > 20 mm), surveillance colonoscopy was mostly preferred after 1 year for adenomas and 6 months for SSLs. The mean USMSTF guideline adherence rate was 30.7%. The largest proportion of respondents (40.8%–55.1%) discontinued the surveillance at the patient age of 80–84 years.
Conclusions
A significant discrepancy was observed between the preferred post-polypectomy surveillance intervals and recent international guidelines. Individualized measures are required to increase adherence to the guidelines.

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Review

Colorectal neoplasia

Summary and comparison of recently updated post-polypectomy surveillance guidelines: Yoon Suk Jung; Intest Res 2023;21(4):443-451. Published online October 26, 2023; DOI: https://doi.org/10.5217/ir.2023.00107

Abstract PDF PubReader ePub

Recently, updated guidelines for post-polypectomy surveillance have been published by the U.S. Multi‐Society Task Force (USMSTF), the British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE), the European Society of Gastrointestinal Endoscopy (ESGE), the Japan Gastroenterological Endoscopy Society (JGES), and the Korean Multi-Society Taskforce Committee. This review summarizes and compares the updated recommendations of these 5 guidelines. There are some differences between the guidelines for the recommended post-polypectomy surveillance intervals. In particular, there are prominent differences between the guidelines for 1–4 tubular adenomas < 10 mm with low-grade dysplasia (nonadvanced adenomas [NAAs]) and tubulovillous or villous adenomas. The USMSTF, JGES, and Korean guidelines recommend colonoscopic surveillance for patients with 1–4 NAAs and those with tubulovillous or villous adenomas, whereas the BSG/ACPGBI/PHE and ESGE guidelines do not recommend endoscopic surveillance for such patients. Surveillance recommendations for patients with serrated polyps (SPs) are limited. Although the USMSTF guidelines provide specific recommendations for patients who have undergone SPs removal, these are weak and based on very lowquality evidence. Future studies should examine this topic to better guide the surveillance recommendations for patients with SPs. For countries that do not have separate guidelines, we hope that this review article will help select the most appropriate guidelines as per each country’s healthcare environment.

Citations

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Causal association between telomere length and colorectal polyps: A bidirectional two-sample Mendelian randomization study
Yin Zhang, Jiaying Wang, Mingyu Zheng, Huanwei Qu, Shuya Yang, Fuzhou Han, Nan Yao, Wenqiang Li, Jun Qu
Medicine.2024; 103(1): e36867. CrossRef
Screening and surveillance for hereditary colorectal cancer
Hee Man Kim, Tae Il Kim
Intestinal Research.2024; 22(2): 119. CrossRef
Screening and Surveillance of Colorectal Cancer: A Review of the Literature
Marcello Maida, Dushyant Singh Dahiya, Yash R. Shah, Angad Tiwari, Harishankar Gopakumar, Ishaan Vohra, Aqsa Khan, Fouad Jaber, Daryl Ramai, Antonio Facciorusso
Cancers.2024; 16(15): 2746. CrossRef

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Original Article

Colorectal neoplasia

The elderly population are more vulnerable for the management of colorectal cancer during the COVID-19 pandemic: a nationwide, population-based study: Hong Sun Kang, Seung Hoon Jeon, Su Bee Park, Jin Young Youn, Min Seob Kwak, Jae Myung Cha; Intest Res 2023;21(4):500-509. Published online August 29, 2023; DOI: https://doi.org/10.5217/ir.2023.00004

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
The impact of coronavirus disease 2019 (COVID-19) on the management of colorectal cancer (CRC) may worse in elderly population, as almost all COVID-19 deaths occurred in the elderly patients. This study aimed to evaluate the impact of COVID-19 on CRC management in the elderly population.
Methods
The numbers of patients who underwent colonoscopy, who visited hospitals or operated for CRC in 2020 and 2021 (COVID-19 era) were compared with those in 2019, according to 3 age groups (≥70 years, 50–69 years, and ≤49 years), based on the nationwide, population-based database (2019–2021) in South Korea.
Results
The annual volumes of colonoscopy and hospital visits for CRC in 2020 were more significantly declined in the old age group than in the young age group (both P<0.001). In addition, the annual volume of patients operated for CRC numerically more declined in old age group than in young age group. During the first surge of COVID-19 (March and April 2020), old age patients showed statistically significant declines for the monthly number of colonoscopies (–46.5% vs. –39.3%, P<0.001), hospital visits (–15.4% vs. –7.9%, P<0.001), CRC operations (–33.8% vs. –0.7%, P<0.05), and colonoscopic polypectomies (–41.8% vs. –38.0%, P<0.001) than young age patients, compared with those of same months in 2019.
Conclusions
Elderly population are more vulnerable for the management of CRC during the COVID-19 pandemic. Therefore, the elderly population are more carefully cared for in the management of CRC during the next pandemic.

Citations

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To overcome medical gap in screening and surveillance of colorectal cancer during the COVID-19 pandemic
Yoo Min Han
Intestinal Research.2023; 21(4): 418. CrossRef

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Review

IBD

Animal models of inflammatory bowel disease: novel experiments for revealing pathogenesis of colitis, fibrosis, and colitis-associated colon cancer: Chan Hyung Lee, Seong-Joon Koh, Zaher A Radi, Aida Habtezion; Intest Res 2023;21(3):295-305. Published online May 31, 2023; DOI: https://doi.org/10.5217/ir.2023.00029

Abstract PDF PubReader ePub

Inflammatory bowel disease (IBD), comprising Crohn’s disease and ulcerative colitis, is a lifelong disease that manifests with chronic intestinal inflammation, sequential fibrosis, and an increased risk of colitis-associated colon cancer (CAC). The combined effects of genetic, immunological, environmental, and microbial factors render it difficult to determine the specific mechanism underlying the induction and perpetuation of IBD. Various animal models of IBD have contributed enormously to the understanding of IBD pathogenesis in terms of genomics, transcriptomics, proteomics, microbiome, and drug development of novel therapeutics. Although comprehensive research on IBD has been enabled by advanced technologies, such as genetically engineered models, there is a great need to develop relevant in vivo models of colitis and fibrosis. Here, we review 4 categories of animal models of acute and chronic intestinal inflammation, fibrosis, and CAC: chemically induced, genetically engineered, T cell transfer, and spontaneous gene mutation models.

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Lactobacillus paracasei Jlus66 relieves DSS-induced ulcerative colitis in a murine model by maintaining intestinal barrier integrity, inhibiting inflammation, and improving intestinal microbiota structure
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Predictors of histologic remission in patients with biologic-naïve, moderate-to-severe ulcerative colitis treated with first-line biologic agents and small-molecule drugs: a single-center, retrospective cohort study
Kijae Jo, Kwang Woo Kim, Hyun Jung Lee, Jong Pil Im, Joo Sung Kim, Seong-Joon Koh
Intestinal Research.2024;[Epub] CrossRef
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Haitao Zheng, Xiaoli Ping, Ruizi Wu, Cen Lei, Huijia Mao, Yanni Pan, Yongpeng He, Xin Zhao
International Journal of Pharmacology.2024; 20(5): 817. CrossRef
Inhibition of myeloperoxidase by food-derived peptides: A review of current research and future prospects
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Orazio Palmieri, Fabrizio Bossa, Stefano Castellana, Tiziana Latiano, Sonia Carparelli, Giuseppina Martino, Manuel Mangoni, Giuseppe Corritore, Marianna Nardella, Maria Guerra, Giuseppe Biscaglia, Francesco Perri, Tommaso Mazza, Anna Latiano
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Protective effect of freeze-dried extract of Persicaria bistorta Samp. on acetic acid-induced colitis model in rats: Involvement of nitric oxide and opioid system
Niusha Esmaealzadeh, Amirhossein Abdolghaffari, Maryam Baeeri, Maede Hasanpour, Mehrdad Iranshahi, Cristina Santarcangelo, Mahdi Gholami, Roodabeh Bahramsoltani
Inflammopharmacology.2024;[Epub] CrossRef
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Marisa O Pacheco, Isabelle K Gerzenshtein, Whitney L Stoppel, Carlos M Rinaldi‐Ramos
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Inflammatory Bowel Diseases.2024;[Epub] CrossRef
Immunomodulatory Effects of a Probiotic Mixture: Alleviating Colitis in a Mouse Model through Modulation of Cell Activation Markers and the Gut Microbiota
Hye-Myung Ryu, S. M. Shamsul Islam, Bushra Riaz, Hasan M. Sayeed, Bunsoon Choi, Seonghyang Sohn
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Original Articles

Infection

Comparative outcomes of acute colonic diverticulitis in immunocompromised versus immunocompetent patients: a systematic review and meta-analysis: Jae Gon Lee, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Shin Hee Lee, Myung-Won You, Seong-Eun Kim; Intest Res 2023;21(4):481-492. Published online May 31, 2023; DOI: https://doi.org/10.5217/ir.2023.00005

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Immunocompromised patients with acute colonic diverticulitis are at high risk for complications and failure of non-surgical treatment. However, evidence on the comparative outcomes of immunocompromised and immunocompetent patients with diverticulitis is lacking. This systematic review and meta-analysis investigated the outcomes of medical treatment in immunocompromised and immunocompetent patients with diverticulitis.
Methods
A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library. Studies comparing the clinical outcomes of immunocompromised and immunocompetent patients with diverticulitis were included.
Results
A total of 10 studies with 1,946,461 subjects were included in the quantitative synthesis. The risk of emergency surgery and postoperative mortality after emergency surgery was significantly higher in immunocompromised patients than in immunocompetent patients with diverticulitis (risk ratio [RR], 1.76; 95% confidence interval [CI], 1.31–2.38 and RR, 3.05; 95% CI, 1.70–5.45, respectively). Overall risk of complications associated with diverticulitis was non-significantly higher in immunocompromised than in immunocompetent patients (RR, 1.24; 95% CI, 0.95–1.63). Overall mortality irrespective of surgery was significantly higher in immunocompromised than in immunocompetent patients with diverticulitis (RR, 3.65; 95% CI, 1.73–7.69). By contrast, postoperative mortality after elective surgery was not significantly different between immunocompromised and immunocompetent patients with diverticulitis. In subgroup analysis, the risk of emergency surgery and recurrence was significantly higher in immunocompromised patients with complicated diverticulitis, whereas no significant difference was shown in mild disease.
Conclusions
Immunocompromised patients with diverticulitis should be given the best medical treatment with multidisciplinary approach because they had increased risks of surgery, postoperative morbidity, and mortality than immunocompetent patients.

Citations

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Not all acute colonic diverticulitis follows the same course: a potential risk for immunocompromised individuals
Yehyun Park
Intestinal Research.2023; 21(4): 415. CrossRef

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1 Crossref

Colorectal neoplasia

Clinical characteristics and risk factors related to polyposis recurrence and advanced neoplasm development among patients with non-hereditary colorectal polyposis: Jihun Jang, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim; Intest Res 2023;21(4):510-517. Published online May 31, 2023; DOI: https://doi.org/10.5217/ir.2022.00139

Abstract PDF PubReader ePub

Background/Aims
Patients with more than 10 cumulative polyps might involve a greater genetic risk of colorectal neoplasia development. However, few studies have investigated the risk factors of polyposis recurrence and development of advanced neoplasms among patients with non-hereditary colorectal polyposis.
Methods
This study included patients (n=855) with 10 or more cumulative polyps diagnosed at Severance Hospital from January 2012 to September 2021. Patients with known genetic mutations related to polyposis, known hereditary polyposis syndromes, insufficient information, total colectomy, and less than 3 years of follow-up were excluded. Finally, 169 patients were included for analysis. We collected clinical data, including colonoscopy surveillance results, and performed Cox regression analyses of risk factors for polyposis recurrence and advanced neoplasm development.
Results
The 169 patients were predominantly male (84.02%), with a mean age of 64.19±9.92 years. The mean number of adenomas on index colonoscopy was 15.33±8.47. Multivariable analysis revealed history of cancer except colon cancer (hazard ratio [HR], 2.23; 95% confidence interval [CI], 1.23–4.01), current smoking (HR, 2.39; 95% CI, 1.17–4.87), and detection of many polyps (≥15) on index colonoscopy (HR, 2.05; 95% CI, 1.21–3.50) were significant risk factors for recurrence of polyposis. We found no statistically significant risk factors for advanced neoplasm development during surveillance among our cohort.
Conclusions
The presence of many polyps (≥15) on index colonoscopy, history of cancer except colon cancer, and current smoking state were significant risk factors for polyposis recurrence among patients with non-hereditary colorectal polyposis.

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Screening and surveillance for hereditary colorectal cancer
Hee Man Kim, Tae Il Kim
Intestinal Research.2024; 22(2): 119. CrossRef

2,156 View
303 Download
1 Web of Science
1 Crossref

Review

Cancer

Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition: Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo Young Cho, Moon Sung Lee, Oh Young Lee, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases; Intest Res 2023;21(1):20-42. Published online January 31, 2023; DOI: https://doi.org/10.5217/ir.2022.00096

Abstract PDF Supplementary Material PubReader ePub

Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: adenoma ≥10 mm in size; 3 to 5 (or more) adenomas; tubulovillous or villous adenoma; adenoma containing high-grade dysplasia; traditional serrated adenoma; sessile serrated lesion containing any grade of dysplasia; serrated polyp of at least 10 mm in size; and 3 to 5 (or more) sessile serrated lesions. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

Citations

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The histologic features, molecular features, detection and management of serrated polyps: a review
Jin-Dong Wang, Guo-Shuai Xu, Xin-Long Hu, Wen-Qiang Li, Nan Yao, Fu-Zhou Han, Yin Zhang, Jun Qu
Frontiers in Oncology.2024;[Epub] CrossRef
Screening and surveillance for hereditary colorectal cancer
Hee Man Kim, Tae Il Kim
Intestinal Research.2024; 22(2): 119. CrossRef
Prediction of Lymph Node Metastasis in T1 Colorectal Cancer Using Artificial Intelligence with Hematoxylin and Eosin-Stained Whole-Slide-Images of Endoscopic and Surgical Resection Specimens
Joo Hye Song, Eun Ran Kim, Yiyu Hong, Insuk Sohn, Soomin Ahn, Seok-Hyung Kim, Kee-Taek Jang
Cancers.2024; 16(10): 1900. CrossRef
Strategies to improve screening colonoscopy quality for the prevention of colorectal cancer
Joo Hye Song, Eun Ran Kim
The Korean Journal of Internal Medicine.2024; 39(4): 547. CrossRef
Efficacy of Oral Sulfate Tablet and 2 L-Polyethylene Glycol with Ascorbic Acid for Bowel Preparation: A Prospective Randomized KASID Multicenter Trial
Yunho Jung, Hyun Gun Kim, Dong-Hoon Yang, Hyoun Woo Kang, Jae Jun Park, Dong Hoon Baek, Jaeyoung Chun, Tae-Geun Gweon, Hyeon Jeong Goong, Min Seob Kwak, Hyun Jung Lee, Soo-Kyung Park, Jong Hoon Lee
Journal of Korean Medical Science.2024;[Epub] CrossRef
Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revision
Su Young Kim
The Korean Journal of Medicine.2023; 98(3): 102. CrossRef
Clinical characteristics and risk factors related to polyposis recurrence and advanced neoplasm development among patients with non-hereditary colorectal polyposis
Jihun Jang, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim
Intestinal Research.2023; 21(4): 510. CrossRef
Summary and comparison of recently updated post-polypectomy surveillance guidelines
Yoon Suk Jung
Intestinal Research.2023; 21(4): 443. CrossRef
Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
Yong Soo Kwon, Su Young Kim
Journal of the Korean Medical Association.2023; 66(11): 652. CrossRef

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Original Article

Miscellaneous

Characteristics and usefulness of transabdominal ultrasonography in immune-mediated colitis: Kensuke Sakurai, Takehiko Katsurada, Mutsumi Nishida, Satomi Omotehara, Shinya Fukushima, Shinsuke Otagiri, Kazunori Nagashima, Reizo Onishi, Ryo Takagi, Yoshito Komatsu, Naoya Sakamoto; Intest Res 2023;21(1):126-136. Published online July 22, 2022; DOI: https://doi.org/10.5217/ir.2021.00166

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
The usefulness of ultrasonography (US) in diseases of the gastrointestinal tract has been reported recently. This prospective study aimed to determine the features of US findings in immune-mediated colitis (IMC), an adverse event induced by immune checkpoint inhibitor, and examine the correlation between US findings, colonoscopy (CS) findings, and severity of colitis.
Methods
We studied patients examined using CS and US upon suspicion of IMC in Hokkaido University Hospital between April 2018 and February 2021. Endoscopic findings of IMC were assessed using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). The severity of US findings in IMC was evaluated using US grade, which is the ultrasonographic grading scale in ulcerative colitis. Bowel wall thickness and the intensity of the color Doppler signal were also analyzed. Severity of colitis was evaluated using Common Terminology Criteria for Adverse Events (CTCAE) grade version 5.
Results
Fourteen patients with IMC were enrolled. The US findings were bowel wall thickening, loss of stratification, ulceration and increased blood flow signal. The US grade was moderately correlated with the UCEIS (r=0.687, p=0.009) and CTCAE grade (r=0.628, p=0.035). Bowel wall thickness and UCEIS (r=0.628, p=0.020), as well as color Doppler signal grade and CTCAE grade (r=0.724, p=0.008), were significantly correlated.
Conclusions
US findings in IMC were mainly similar to those of ulcerative colitis, but there were some findings that were characteristic only of IMC. Significant correlation was found between US findings, CS findings, and severity of colitis. Hence, US could be useful for the evaluation of IMC.

Citations

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Response
Malek Shatila, Yinghong Wang
Gastrointestinal Endoscopy.2024; 100(2): 349. CrossRef
Ultrasound's echo in the endoscopic realm: navigating checkpoint colitis
Steven Nicolaides, Zaid Ardalan, Alex Boussioutas
Gastrointestinal Endoscopy.2024; 100(2): 349. CrossRef
Gut microbiome on immune checkpoint inhibitor therapy and consequent immune-related colitis: a review
Sung Wook Hwang, Min Kyu Kim, Mi-Na Kweon
Intestinal Research.2023; 21(4): 433. CrossRef

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Perspective

IBD

Endoscopy for assessment of mucosal healing in ulcerative colitis: time bound or response guided?: Ajit Sood, Ramit Mahajan, Arshdeep Singh, Vandana Midha, Varun Mehta; Intest Res 2022;20(3):297-302. Published online February 8, 2022; DOI: https://doi.org/10.5217/ir.2021.00099

Abstract PDF PubReader ePub

The timing of colonoscopy in patients with active ulcerative colitis (UC) lacks coherence. The published guidelines and recommendations advocate time-bound colonoscopy in patients with active UC to assess for mucosal healing. However, the practice of performing colonoscopies at fixed time frames lacks reasoning. The time to achieve mucosal healing in UC is not uniform across the patient populations and is influenced by the disease severity and efficacy and time to therapeutic response of the drugs being used. Additionally, with the availability of sensitive noninvasive inflammatory biomarkers such as fecal calprotectin, that parallel the disease activity and correlate with mucosal healing, the notion of performing colonoscopy at fixed intervals sounds unjustifiable. The authors express their view that a response-guided colonoscopy (driven by normalization of clinical symptoms and inflammatory biomarkers), rather than a time-bound colonoscopy, would be more logical, apart from being cost-effective and patient-friendly.

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Ji Eun Kim
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Seung Bum Lee, Hyun-Ki Kim, Sang Hyuk Park, Ji-Hun Lim, Sang Hyoung Park
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Hyoun Woo Kang
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Hsu-Heng Yen, Jia-Feng Wu, Horng-Yuan Wang, Ting-An Chang, Chung-Hsin Chang, Chen-Wang Chang, Te-Hsin Chao, Jen-Wei Chou, Yenn-Hwei Chou, Chiao-Hsiung Chuang, Wen-Hung Hsu, Tzu-Chi Hsu, Tien-Yu Huang, Tsung-I Hung, Puo-Hsien Le, Chun-Che Lin, Chun-Chi Lin
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Histologic improvement predicts endoscopic remission in patients with ulcerative colitis
Ji Eun Kim, Minjee Kim, Min-Ji Kim, Eun Ran Kim, Sung Noh Hong, Dong Kyung Chang, Sang Yun Ha, Young-Ho Kim
Scientific Reports.2024;[Epub] CrossRef
Practical management of mild-to-moderate ulcerative colitis: an international expert consensus
Ferdinando D’Amico, Fernando Magro, Axel Dignass, Sameer Al Awadhi, Ana Gutierrez Casbas, Natália Sousa Freitas Queiroz, Grażyna Rydzewska, Byong Duk Ye, Zhihua Ran, Ailsa Hart, Vipul Jairath, Gionata Fiorino, Laurent Peyrin-Biroulet, Silvio Danese
Expert Review of Gastroenterology & Hepatology.2024; 18(8): 421. CrossRef
Comparison of Two Types of 1-L Polyethylene Glycol-ascorbic Acid as Colonoscopic Bowel Preparation: A Prospective Randomized Study
Suh Hyun Choi, Won Eui Yoon, Seung Hyuk Kim, Hee Jun Myung, Seo Hyun Kim, Soon Oh So, Se Hun Kim, Hyun Mi Lee, Yeoun Jung Oh, Jeong Seop Moon, Tae Yeong Park, You Sun Kim
The Korean Journal of Gastroenterology.2022; 80(2): 85. CrossRef

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Original Articles

IBD

Fecal microbiota transplantation for induction of remission, maintenance and rescue in patients with corticosteroid-dependent ulcerative colitis: a long-term follow-up real-world cohort study: Avnish Kumar Seth, Priti Jain; Intest Res 2022;20(2):251-259. Published online February 8, 2022; DOI: https://doi.org/10.5217/ir.2021.00069

Abstract PDF PubReader ePub

Background/Aims
To study role of fecal microbiota transplantation (FMT) in induction, maintenance, and rescue in patients with corticosteroid-dependent ulcerative colitis (CDUC).
Methods
Patients with active CDUC received 3 fortnightly sessions of colonoscopic induction FMT (iFMT) in addition to standard of care. In patients who achieved clinical remission (CR) or response, prednisolone was tapered from week 4 and azathioprine from week 12. Responders were advised maintenance FMT (mFMT) every 6 months. Those with relapse were offered rescue FMT (rFMT), and low dose prednisolone was added if there was no improvement in 2 weeks.
Results
All 27 patients enrolled completed iFMT and were followed up for 39 months (range, 9–71 months). The mean Mayo score decreased from 6.4±2.5 at baseline to 2.6±3.7 at week 4, 2.6±3.4 at week 12, and 2.8±3.8 at week 24 (P<0.05). Corticosteroid-free CR and clinical response at week 12 were seen in 13 patients (48%) and 1 patient (3.7%), respectively. Corticosteroid and azathioprine-free CR at week 24 was seen in 13 patients (48%) and in them histological response was seen in 2 patients (15.2%) at week 4, 5 patients (38.4%) at week 12, and 10 patients (76.9%) at week 24. First relapse was seen in 10 of 13 responders (76.9%) at a median of 14.8 months (range, 6–34 months) after iFMT and was less frequent in patients on mFMT. Relapse was treated successfully with rFMT alone in 4 patients (40%) and rFMT with low dose steroids in 5 patients (50%).
Conclusions
iFMT, mFMT, and rFMT may have a role in treatment of selected patients with CDUC.

Citations

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IBD

Factors associated with anti-tumor necrosis factor effectiveness to prevent postoperative recurrence in Crohn’s disease: Anthony Buisson, Lisa Cannon, Konstantin Umanskiy, Roger D. Hurst, Neil H. Hyman, Atsushi Sakuraba, Joel Pekow, Sushila Dalal, Russell D. Cohen, Bruno Pereira, David T. Rubin; Intest Res 2022;20(3):303-312. Published online August 4, 2021; DOI: https://doi.org/10.5217/ir.2021.00018

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
We assessed the effectiveness of anti-TNF agents and its associated factors to prevent endoscopic and clinical postoperative recurrence (POR) in Crohn’s disease (CD).
Methods
From a prospectively-maintained database, we retrieved 316 CD patients who underwent intestinal resection (2011–2017). Endoscopic (Rutgeerts index ≥ i2 at 6 months) and clinical (recurrence of symptoms leading to hospitalization or therapeutic escalation) POR were assessed.
Results
In 117 anti-TNF-naïve patients, anti-TNF therapy was more effective than immunosuppressive agents (odds ratio [OR], 8.8; 95% confidence interval [CI], 1.8–43.9; P= 0.008) and no medication/5-aminosalicylates (OR, 5.2; 95% CI, 1.0–27.9; P= 0.05) to prevent endoscopic POR. In 199 patients exposed to anti-TNF prior to the surgery, combination with anti-TNF and immunosuppressive agents was more effective than anti-TNF monotherapy (OR, 2.32; 95% CI, 1.02–5.31; P= 0.046) to prevent endoscopic POR. Primary failure to anti-TNF agent prior to surgery was predictive of anti-TNF failure to prevent endoscopic POR (OR, 2.41; 95% CI, 1.10–5.32; P= 0.03). When endoscopic POR despite anti-TNF prophylactic medication (n = 55), optimizing anti-TNF and adding an immunosuppressive drug was the most effective option to prevent clinical POR (hazard ratio, 7.38; 95% CI, 1.54–35.30; P= 0.012). Anti-TNF therapy was the best option to prevent clinical POR (hazard ratio, 3.10; 95% CI, 1.09–8.83; P= 0.034) in patients with endoscopic POR who did not receive any biologic to prevent endoscopic POR (n = 55).
Conclusions
Anti-TNF was the most effective medication to prevent endoscopic and clinical POR. Combination with anti-TNF and immunosuppressive agents should be considered in patients previously exposed to anti-TNF.

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Eline M. L. van der Does de Willebois, Vittoria Bellato, Marjolijn Duijvestein, Susan van Dieren, Silvio Danese, Pierpaolo Sileri, Christianne J. Buskens, Andrea Vignali, Willem A. Bemelman
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Michiel T. J. Bak, Karlijn Demers, Nassim Hammoudi, Matthieu Allez, Mark S. Silverberg, Gwenny M. Fuhler, Kaushal Parikh, Marieke J. Pierik, Laurents P. S. Stassen, C. Janneke van der Woude, Michail Doukas, Oddeke van Ruler, Annemarie C. de Vries
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Review

Microbiota

The role of microbiome in colorectal carcinogenesis and its clinical potential as a target for cancer treatment: Sang Hoon Kim, Yun Jeong Lim; Intest Res 2022;20(1):31-42. Published online May 21, 2021; DOI: https://doi.org/10.5217/ir.2021.00034

Abstract PDF PubReader ePub

The role of gut microbiome-intestinal immune complex in the development of colorectal cancer and its progression is well recognized. Accordingly, certain microbial strains tend to colonize or vanish in patients with colorectal cancer. Probiotics, prebiotics, and synbiotics are expected to exhibit both anti-tumor effects and chemopreventive effects during cancer treatment through mechanisms such as xenometabolism, immune interactions, and altered eco-community. Microbial modulation can also be safely used to prevent complications during peri-operational periods of colorectal surgery. A deeper understanding of the role of intestinal microbiota as a target for colorectal cancer treatment will lead the way to a better prognosis for colorectal cancer patients.

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Original Articles

Colorectal neoplasia

Postgastrectomy gastric cancer patients are at high risk for colorectal neoplasia: a case control study: Tae-Geun Gweon, Kyu-Tae Yoon, Chang Hyun Kim, Jin-Jo Kim; Intest Res 2021;19(2):239-246. Published online November 13, 2020; DOI: https://doi.org/10.5217/ir.2020.00009

Abstract PDF PubReader ePub

Background/Aims
Several studies have shown that colorectal neoplasms (CRN) including colorectal cancer (CRC) may be prevalent in patients with gastric cancer. However, in most of these studies, colonoscopy to investigate the prevalence of CRN was performed prior to surgery. We aimed to investigate whether CRN was more prevalent in postgastrectomy gastric cancer patients than in healthy individuals.
Methods
We reviewed the medical records of those patients within a cohort of gastric cancer patients with gastrectomy who underwent colonoscopy between 2016 and 2017. Controls age- and sex-matched with gastric cancer patients at a 2:1 ratio were identified among those who underwent colonoscopy at a health-promotion center. The frequencies of CRN, advanced CRN (ACRN), and CRC among patients with gastrectomy were compared with those in the control subjects. A total of 744 individuals (gastric cancer, 248; control, 496) were included.
Results
The rates of CRN and ACRN in the gastric cancer group were higher than those in the healthy individuals (CRN, 47.6% vs. 34.7%, P< 0.001; ACRN, 16.9% vs. 10.9%, P= 0.020). The rate of CRC was comparable between the 2 groups (2.0% vs. 0.6%, P= 0.125). Multivariate analysis identified previous gastrectomy for gastric cancer and male sex as significant risk factors for (A)CRN.
Conclusions
CRN and ACRN were more prevalent in patients who underwent surgery for gastric cancer than in the control group. Regular surveillance colonoscopy at appropriate intervals is indicated after gastrectomy.

Citations

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Effect of bowel preparation completion time on bowel cleansing efficacy: Prospective randomized controlled trial of different bowel preparation completion times precolonoscopy
Hye Min Kim, Hyo Suk Kim, Young Eun An, Jae Hyuck Chang, Tae Ho Kim, Chang Whan Kim, Tae‐Geun Gweon
Digestive Endoscopy.2024;[Epub] CrossRef
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Young-Jo Wi, Soo-Young Na
The Korean Journal of Gastroenterology.2023; 82(2): 47. CrossRef
Comparison of 2 L Polyethylene Glycol Plus Ascorbic Acid and 4 L Polyethylene Glycol in Elderly Patients Aged 60–79: A Prospective Randomized Study
Sung Hoon Jung, Chul-Hyun Lim, Tae-Geun Gweon, Jinsu Kim, Jung Hwan Oh, Kyu-Tae Yoon, Jee Young An, Jeong‑Seon Ji, Hwang Choi
Digestive Diseases and Sciences.2022; 67(10): 4841. CrossRef
Colonoscopy Insertion in Patients with Gastrectomy: Does Position Impact Cecal Intubation Time?
Jae Hyun Kim, Youn Jung Choi, Hye Jung Kwon, Gyu Man Oh, Kyoungwon Jung, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park
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Seong-Jung Kim, Jun Lee, Dae Youb Baek, Jun Hyung Lee, Ran Hong
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American Journal of Gastroenterology.2022; 117(11): 1877. CrossRef

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Endoscopy

Effect of gut microbiome on minor complications after a colonoscopy: Jae Hyun Kim, Youn Jung Choi, Hye Jung Kwon, Kyoungwon Jung, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park; Intest Res 2021;19(3):341-348. Published online November 10, 2020; DOI: https://doi.org/10.5217/ir.2020.00057

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Minor complications that might occur after colonoscopy, including abdominal discomfort, bloating, diarrhea, and constipation, could a barrier for patients to undergo a screening colonoscopy. In this study, we aimed to identify the effect of gut microbial diversity and composition on minor complications after colonoscopy.
Methods
A total of 24 healthy subjects provided their stools before bowel preparation and on the 7th and 28th day after colonoscopy. On the 7th day after colonoscopy, the presence of minor complications was investigated using a questionnaire. We divided patients into 2 groups, the no complication group and complications group. The fecal microbial diversity, distribution, and composition were then compared between the groups.
Results
Five of the 24 subjects reported that they had undergone minor complications after colonoscopy. Most of the symptoms were mild and self-limited, but 1 patient needed medication. Interestingly, the Firmicutes/Bacteroidetes ratio of the initial stool samples before bowel preparation in the complication group was significantly higher than that in no complication group. After bowel preparation, the Firmicutes/Bacteroidetes ratio of the complication group decreased, but not in the no complication group. The microbial diversity of the no complication group decreased after bowel preparation, but not in the complication group.
Conclusions
The gut microbial composition and diversity before and after bowel preparation could be considered as one of the causes of minor complications after colonoscopy. Further studies are needed to delineate the role of gut microbiota in the occurrence of minor complications after colonoscopy.

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Amelia J. McGuinness, Martin O’Hely, Douglas Stupart, David Watters, Samantha L. Dawson, Christopher Hair, Michael Berk, Mohammadreza Mohebbi, Amy Loughman, Glenn Guest, Felice N. Jacka
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Benefits of Probiotic Pretreatment on the Gut Microbiota and Minor Complications after Bowel Preparation for Colonoscopy: A Randomized Double-Blind, Placebo-Controlled Pilot Trial
Dooheon Son, Youn Jung Choi, Min Young Son, Won Moon, Seun Ja Park, Sanghyun Lim, Jae Hyun Kim
Nutrients.2023; 15(5): 1141. CrossRef
Key determinants of success in fecal microbiota transplantation: From microbiome to clinic
Serena Porcari, Nicolas Benech, Mireia Valles-Colomer, Nicola Segata, Antonio Gasbarrini, Giovanni Cammarota, Harry Sokol, Gianluca Ianiro
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Adam Zaczek, Robert Pudlo
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Xue Yang, Wen-Bo Xiu, Jin-Xia Wang, Liang-Ping Li, Chong He, Cai-Ping Gao
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Milena Di Leo, Andrea Iannone, Monica Arena, Giuseppe Losurdo, Maria Angela Palamara, Giuseppe Iabichino, Pierluigi Consolo, Maria Rendina, Carmelo Luigiano, Alfredo Di Leo
World Journal of Gastroenterology.2021; 27(45): 7748. CrossRef

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Review

Cancer

Two intertwined compartments coexisting in sporadic conventional colon adenomas: Carlos A. Rubio; Intest Res 2021;19(1):12-20. Published online February 24, 2020; DOI: https://doi.org/10.5217/ir.2019.00133

Abstract PDF PubReader ePub

Sporadic conventional colon adenomas are microscopically built of 2 intertwined compartments: one on top, harboring the dysplastic tissue that defines their histo-biomolecular attributes, and the other below, composed of non-dysplastic crypts with corrupted shapes (CCS). The CCS of 306 colon adenomas revealed asymmetric, haphazardly-distributed proliferating cell-domains (PC). In contrast, the PC-domains in normal controls were symmetric, being limited to the lower thirds of the crypts. In 28% out of 501 sporadic conventional adenomas, foci of p53-upregulated dysplastic tissue were found. The CCS in 30% of 108 sporadic adenomas showed p53-upregulated single cells, suggesting mounting somatic mutations. No p53-upregulated cells were found in the crypts of controls. In polypoid adenomas, the mucosa of the stalk without dysplastic tissue on top disclosed CCS with asymmetrical PC-domains and single p53-upregulated cells. The latter observations suggested that CCS had developed prior to and not after the growth of the dysplastic tissue on top. CCS were also found below colon adenomas in carcinogen-treated rats. It is concluded that the 2 intertwined histo-biological compartments of sporadic conventional colon adenomas are probably interdependent components. These findings may open new directions aimed to uncover the link between the normal colonic mucosa and the histogenesis of, conventional adenomas.

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Calcium, Vitamin D, and Colorectal Cancer
Young-Jo Wi, Soo-Young Na
The Korean Journal of Gastroenterology.2023; 82(2): 47. CrossRef
Gut Microbiome and Colorectal Cancer
Tae-Geun Gweon
The Korean Journal of Gastroenterology.2023; 82(2): 56. CrossRef
Summary and comparison of recently updated post-polypectomy surveillance guidelines
Yoon Suk Jung
Intestinal Research.2023; 21(4): 443. CrossRef
Asymmetric crypt fission in colectomy specimens in patients with ulcerative colitis
Carlos A Rubio, Peter T Schmidt
Journal of Clinical Pathology.2020; : jclinpath-2020-206694. CrossRef

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Original Articles

Colorectal neoplasia

Microvascular density under magnifying narrow-band imaging endoscopy in colorectal epithelial neoplasms: Takahiro Gonai, Keisuke Kawasaki, Shotaro Nakamura, Shunichi Yanai, Risaburo Akasaka, Kunihiko Sato, Yousuke Toya, Kensuke Asakura, Jun Urushikubo, Yasuko Fujita, Makoto Eizuka, Noriyuki Uesugi, Tamotsu Sugai, Takayuki Matsumoto; Intest Res 2020;18(1):107-114. Published online November 4, 2019; DOI: https://doi.org/10.5217/ir.2019.00061

Abstract PDF PubReader ePub

Background/Aims
Magnifying endoscopic classification systems, such as the Japan narrow-band imaging (NBI) Expert Team (JNET) classification, have been widely used for predicting the histologic diagnosis and invasion depth of colorectal epithelial tumors. However, disagreement exists among observers regarding magnifying endoscopic diagnosis, because these classification systems are subjective. We herein investigated the utility of endoscopic microvascular density (eMVD) calculated from magnifying NBI endoscopic images in colorectal tumors.
Methods
We reviewed magnifying NBI endoscopic images from 169 colorectal epithelial tumors (97 adenomas, 72 carcinomas/high-grade dysplasias) resected endoscopically or surgically. The eMVD on magnifying NBI endoscopic images was evaluated using image-editing software, and relationships between eMVD and clinical, endoscopic, and pathological findings were retrospectively analyzed.
Results
The eMVD in carcinomas (0.152 ± 0.079) was significantly higher than that in adenomas (0.119 ± 0.059, P< 0.05). The best cutoff value for distinguishing carcinoma from adenoma was 0.133. Sensitivity, specificity, and accuracy were 56.9%, 67.0%, and 62.7%, respectively. In addition, JNET type 2B tumors showed significantly higher eMVD (0.162 ± 0.079) compared to type 2A tumors (0.111 ± 0.050, P< 0.05).
Conclusions
The eMVD as determined by magnifying NBI endoscopy is considered to be a possible objective indicator for differentiating colorectal carcinomas from adenomas.

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Zugang Yin, Chenhui Yao, Limin Zhang, Shaohua Qi
Frontiers in Medicine.2023;[Epub] 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
A review on self-healing featured soft robotics
Md. Ariful Islam, Labanya Talukder, Md. Firoj Al, Subrata K. Sarker, S. M. Muyeen, Prangon Das, Md. Mehedi Hasan, Sajal K. Das, Md. Manirul Islam, Md. Robiul Islam, Sumaya Ishrat Moyeen, Faisal R. Badal, Md. Hafiz Ahamed, Sarafat Hussain Abhi
Frontiers in Robotics and AI.2023;[Epub] CrossRef
Emergence of a New Optical Marker for Colorectal Neoplasms: To What Extent Should We Accept It?
Han Hee Lee
Clinical Endoscopy.2022; 55(2): 315. CrossRef
Endoscopic diagnosis and treatment of early colorectal cancer
Seung Wook Hong, Jeong-Sik Byeon
Intestinal Research.2022; 20(3): 281. 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
Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
Ji Young Chang
Clinical Endoscopy.2022; 55(5): 699. CrossRef
Response to Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
Istvan Racz, Andras Horvath, Zoltán Horvath
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Photoacoustic endoscopy: A progress review
Heng Guo, Ying Li, Weizhi Qi, Lei Xi
Journal of Biophotonics.2020;[Epub] CrossRef
Diagnostic efficacy of the Japan Narrow-band-imaging Expert Team and Pit pattern classifications for colorectal lesions: A meta-analysis
Yu Zhang, Hui-Yan Chen, Xiao-Lu Zhou, Wen-Sheng Pan, Xin-Xin Zhou, Hang-Hai Pan
World Journal of Gastroenterology.2020; 26(40): 6279. CrossRef

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Miscellaneous

Primary epiploic appendagitis: compared with diverticulitis and focused on obesity and recurrence: Youn I Choi, Hyun Sun Woo, Jun-Won Chung, Young Sup Shim, Kwang An Kwon, Kyoung Oh Kim, Yoon Jae Kim, Dong Kyun Park; Intest Res 2019;17(4):554-560. Published online October 14, 2019; DOI: https://doi.org/10.5217/ir.2018.00148

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Background/Aims
There is limited data to compare the clinical characteristics and recurrence rates between left-sided primary epiploic appendagitis (PEA) versus left-sided acute colonic diverticulitis (ACD), and right-sided PEA versus right-sided ACD, respectively.
Methods
We retrospectively reviewed the medical records and radiologic images of the patients who presented with left-sided or right-sided acute abdominal pain and had computer tomography performed at the time of presentation showing radiological signs of PEA or ACD between January 2004 and December 2014. We compared the clinical characteristics of left PEA versus left ACD and right PEA versus right ACD, respectively.
Results
Fifty-six patients (left:right = 27:29) and 308 patients (left:right = 24:284) were diagnosed with symptomatic PEA and ACD, respectively. Left-sided PEA were statistically significantly younger (50.2 ± 15.4 years vs. 62.1 ± 15.8 years, P= 0.009), more obese (body mass index [BMI]: 26.3 ± 2.9 kg/m2 vs. 22.3 ± 3.1 kg/m2 , P< 0.001), and had more tendencies with normal or mildly elevated high-sensitivity C-reactive protein (hsCRP) (1.2 ± 1.3 mg/dL vs. 8.4 ± 7.9 mg/dL, P< 0.001) than patients with left-sided ACD. The discriminative function of age, BMI and CRP between left-sided PEA versus left-sided ACD was 0.71 (cutoff: age ≤ 59 years, sensitivity of 66.7%, specificity of 77.8%), 0.83 (cutoff: BMI > 24.5 kg/m2 , sensitivity of 80.0%, specificity of 80.0%) and 0.80 (cutoff: CRP < 1.8 mg/dL, sensitivity of 72.2%, specificity of 85.7%).
Conclusions
If patients with left lower quadrant abdominal pain are less than 60 years, obese (BMI > 24.5 kg/m2 ) with or without normal to mild elevated CRP levels (CRP < 1.8 mg/dL), it might be necessary for clinicians to suspect the diagnosis of PEA rather than ACD.

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Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases
Ayman El‐Menyar, Syed G. A. Naqvi, Omer Al‐Yahri, Abdelaziz MA Abusal, Abdulwahhab Al‐Shaikhli, Sadia Sajid, Husham Abdelrahman, Ahmad G. Kloub, Muhamed Ibnas, Rifat Latifi, Yasser M. R. Toble, Hassan Al‐Thani
World Journal of Surgery.2024; 48(6): 1363. CrossRef
Epiploic Adipose Tissue (EPAT) in Obese Individuals Promotes Colonic Tumorigenesis: A Novel Model for EPAT-Dependent Colorectal Cancer Progression
Rida Iftikhar, Patricia Snarski, Angelle N. King, Jenisha Ghimire, Emmanuelle Ruiz, Frank Lau, Suzana D. Savkovic
Cancers.2023; 15(3): 977. CrossRef
Recurrencia en pacientes con apendagitis epiploica: un reporte de caso
Mía Alejandra Gómez Corrales, Fabian Andrés Chávez Ecos, Jackeline Alexandra Espinoza Utani, Carlos Alberto Dávila Hernández
Revista colombiana de Gastroenterología.2023; 38(1): 94. CrossRef

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Case Report

Colorectal neoplasia

Primary malignant melanoma without melanosis of the colon: Nam Hee Yi, Sang Heon Lee, Sang Heon Lee, Ji Hyun Kim, Sam Ryong Jee, Sang Yong Seol; Intest Res 2019;17(4):561-564. Published online August 5, 2019; DOI: https://doi.org/10.5217/ir.2019.00020

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Primary malignant melanoma (PMM) of the gastrointestinal tract is rare. Reported cases of PMM of the lower gastrointestinal tract typically describe anal and rectal involvement rather than colonic lesions. This report describes a rare case of a 50-year-old woman with PMM originating in the colon. The patient presented to Inje University Busan Paik Hospital with a 3-day history of blood-tinged stools. She underwent colonoscopy for a diagnosis of hematochezia. The colonoscopic examination revealed a large-sized semi-pedunculated sigmoid colon polyp with a reddish-colored mucosal surface. Endoscopic mucosal resection was performed, and the final histopathological findings were consistent with a diagnosis of malignant melanoma. Systemic work-up was performed for assessment of metastasis and to identify the primary tumor considering the high metastatic rate of gastrointestinal malignant melanoma; however, no other malignant lesion was detected. Thus, she was diagnosed with colonic PMM. She underwent laparoscopic low anterior resection and lymph node dissection and has been recurrence-free for > 2 years.

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Malignant primary melanoma of the colon: a case report
Claire K Foley, Marybeth S Hughes, Charles T Hehman
Journal of Surgical Case Reports.2023;[Epub] CrossRef

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Original Articles

Colorectal neoplasia

Clinical outcomes of positive resection margin after endoscopic mucosal resection of early colon cancers: Junseok Park, Hyun Gun Kim, Shin Ok Jeong, Hoon gil Jo, Hyo Yeop Song, Jeeyeon Kim, Seri Ryu, Youngyun Cho, Hyun Jin Youn, Seong Ran Jeon, Jin-Oh Kim, Bong Min Ko, Yoon Mi Jeen, So-Young Jin; Intest Res 2019;17(4):516-526. Published online May 31, 2019; DOI: https://doi.org/10.5217/ir.2018.00169

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Background/Aims
When determining the subsequent management after endoscopic resection of the early colon cancer (ECC), various factors including the margin status should be considered. This study assessed the subsequent management and outcomes of ECCs according to margin status.
Methods
We examined the data of 223 ECCs treated by endoscopic mucosal resection (EMR) from 215 patients during 2004 to 2014, and all patients were followed-up at least for 2 years.
Results
According to histological analyses, the margin statuses of all lesions after EMR were as follows: 138 cases (61.9%) were negative, 65 cases (29.1%) were positive for dysplastic cells on the resection margins, and 20 cases (8.9%) were uncertain. The decision regarding subsequent management was affected not only by pathologic outcomes but also by the endoscopist’s opinion on whether complete resection was obtained. Surgery was preferred if the lesion extended to the submucosa (odds ratio [OR], 25.46; 95% confidence interval [CI], 7.09–91.42), the endoscopic resection was presumed incomplete (OR, 15.55; 95% CI, 4.28–56.56), or the lymph system was invaded (OR, 13.69; 95% CI, 1.76–106.57). Fourteen patients (6.2%) had residual or recurrent malignancies at the site of the previous ECC resection and were significantly associated with presumed incomplete endoscopic resection (OR, 4.59; 95% CI, 1.21–17.39) and submucosal invasion (OR, 5.14; 95% CI, 1.18–22.34).
Conclusions
Subsequent surgery was associated with submucosa invasion, lymphatic invasion, and cancer-positive margins. Presumed completeness of the resection may be helpful for guiding the subsequent management of patients who undergo endoscopic resection of ECC.

Citations

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Long-term outcomes after endoscopic versus surgical resection of T1 colorectal carcinoma
Hyun Jin Bae, Hoyeon Ju, Han Hee Lee, Jinsu Kim, Bo-In Lee, Sung Hak Lee, Daeyoun David Won, Yoon Suk Lee, In Kyu Lee, Young-Seok Cho
Surgical Endoscopy.2023; 37(2): 1231. CrossRef
Emergence of a New Optical Marker for Colorectal Neoplasms: To What Extent Should We Accept It?
Han Hee Lee
Clinical Endoscopy.2022; 55(2): 315. CrossRef
Comparison of long-term recurrence-free survival between primary surgery and endoscopic resection followed by secondary surgery in T1 colorectal cancer
Eun Hye Oh, Nayoung Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Chang Sik Yu, Jin Cheon Kim, Jeong-Sik Byeon
Gastrointestinal Endoscopy.2021; 94(2): 394. CrossRef
Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery
Yun Sik Choi, Wan Soo Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon
Intestinal Research.2020; 18(1): 96. CrossRef

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4 Crossref

Endoscopy

Clinical comparison of low-volume agents (oral sulfate solution and sodium picosulfate with magnesium citrate) for bowel preparation: the EASE study: Jeeyeon Kim, Hyun Gun Kim, Kyeong Ok Kim, Hyung Wook Kim, Jongha Park, Jeong-Sik Byeon, Sung-Wook Hwang, Hyun Deok Shin, Jeong Eun Shin, Hyo-Joon Yang, Hyun Seok Lee, Yunho Jung, Young-Seok Cho, Young Eun Joo, Dae-Seong Myung, Kyu Chan Huh, Eu Mi Ahn; Intest Res 2019;17(3):413-418. Published online April 8, 2019; DOI: https://doi.org/10.5217/ir.2018.00156

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Background/Aims
This study compared the efficacy, compliance, and safety of bowel preparation between sodium picosulfate with magnesium citrate (SPMC) and oral sulfate solution (OSS).
Methods
A prospective randomized multicenter study was performed. Split preparation methods were performed in both groups; the SPMC group, 2 sachets on the day before, and 1 sachet on the day of the procedure, the OSS group, half of the OSS with 1 L of water on both the day before and the day of the procedure. The adenoma detection rate (ADR), adequacy of bowel preparation using the Boston Bowel Preparation Scale (BBPS) score, patient satisfaction on a visual analog scale (VAS), and safety were compared between the 2 groups.
Results
This study analyzed 229 patients (121 in the SPMC group and 108 in the OSS group). ADR showed no differences between 2 groups (51.7% vs. 41.7%, P> 0.05). The mean total BBPS score (7.95 vs. 8.11, P> 0.05) and adequate bowel preparation rate (94.9% vs. 96.3%, P> 0.05) were similar between the 2 groups. The mean VAS score for taste (7.62 vs. 6.87, P=0.006) was significantly higher in the SPMC group than in the OSS group. There were no significant differences in any other safety variables between the 2 groups except nausea symptom (36.1% vs. 20.3%, P=0.008).
Conclusions
Bowel preparation for colonoscopy using low volume OSS and SPMC yielded similar ADRs and levels of efficacy. SPMC had higher levels of satisfaction for taste and feeling than did OSS.

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Comments on Oral Sulfate Solution Is as Effective as Polyethylene Glycol with Ascorbic Acid in a Split Method for Bowel Preparation in Patients with Inactive Ulcerative Colitis: A Randomized, Multicenter, and Single-Blind Clinical Trial
Ji Eun Kim
Gut and Liver.2024; 18(1): 192. CrossRef
Oral Sulfate Solution Is as Effective as Polyethylene Glycol with Ascorbic Acid in a Split Method for Bowel Preparation in Patients with Inactive Ulcerative Colitis: A Randomized, Multicenter, and Single-Blind Clinical Trial
Ji Min Lee, Kang-Moon Lee, Ho Suk Kang, Ja Seol Koo, Hyun Seok Lee, Seok-Hoo Jeong, Jung Ho Kim, Dae Bum Kim
Gut and Liver.2023; 17(4): 591. CrossRef
Quality indicators in colonoscopy: the chasm between ideal and reality
Su Bee Park, Jae Myung Cha
Clinical Endoscopy.2022; 55(3): 332. CrossRef
Comparison of the efficacy and safety between oral sulfate tablet and polyethylene glycol for bowel preparation before colonoscopy according to age
Jae Hyun Kim, Yong Eun Park, Tae Oh Kim, Jongha Park, Gyu Man Oh, Won Moon, Seun Ja Park
Medicine.2022; 101(27): e29884. CrossRef
Efficacy, safety and tolerability of oral sulphate tablet for bowel preparation in patients with inflammatory bowel disease: A multicentre randomized controlled study
Kyeong Ok Kim, Eun Young Kim, Yoo Jin Lee, Hyun Seok Lee, Eun Soo Kim, Yun Jin Chung, Byung Ik Jang, Sung Kook Kim, Chang Heon Yang
Journal of Crohn's and Colitis.2022; 16(11): 1706. CrossRef
Comparison of Two Types of 1-L Polyethylene Glycol-ascorbic Acid as Colonoscopic Bowel Preparation: A Prospective Randomized Study
Suh Hyun Choi, Won Eui Yoon, Seung Hyuk Kim, Hee Jun Myung, Seo Hyun Kim, Soon Oh So, Se Hun Kim, Hyun Mi Lee, Yeoun Jung Oh, Jeong Seop Moon, Tae Yeong Park, You Sun Kim
The Korean Journal of Gastroenterology.2022; 80(2): 85. CrossRef
Correlation between Surrogate Quality Indicators for Adenoma Detection Rate and Adenoma Miss Rate in Qualified Colonoscopy, CORE Study: KASID Multicenter Study
Jae Hee Han, Hyun Gun Kim, Eu Mi Ahn, Suyeon Park, Seong Ran Jeon, Jae Myung Cha, Min Seob Kwak, Yunho Jung, Jeong Eun Shin, Hyun Deok Shin, Young-Seok Cho
Gut and Liver.2022; 16(5): 716. CrossRef
How to Choose the Optimal Bowel Preparation Regimen for Colonoscopy
Ji Eun Na, Eun Ran Kim
The Ewha Medical Journal.2021; 44(4): 122. CrossRef
Optimal Laxatives for Oral Colonoscopy Bowel Preparation: from High-volume to Novel Low-volume Solutions
Soo-Young Na, Won Moon
The Korean Journal of Gastroenterology.2020; 75(2): 65. CrossRef
No inferioridad entre dos agentes de bajo volumen (Picosulfato de Sodio/Citrato de Magnesio vs. Sulfato de Sodio/Potasio/Magnesio) en la preparación de colon para procedimientos diagnósticos: estudio observacional
Erika D. Pérez-Riveros, Margarita Rey R., Belén Mendoza De Molano, Juan Carlos Robayo, Jaime Solano Mariño, Rafael García Duperly, Andrés Gómez, Renzo Pinto Carta, Gerardo Ardila, Jose De la Hoz-Valle, Fernando Sierra-Arango
Revista Colombiana de Gastroenterología.2020; 35(4): 436. CrossRef

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Endoscopy

Clinicopathological feature and treatment outcome of patients with colorectal laterally spreading tumors treated by endoscopic submucosal dissection: Young-Hoon Jeong, Jun Lee, Sang-Wook Kim, Geom-Seog Seo, Hyun-Soo Kim, Young-Eun Joo; Intest Res 2019;17(1):127-134. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00075

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Background/Aims
Endoscopic submucosal dissection (ESD) is an advanced technique that can be used to treat precancerous and early colorectal neoplasms by facilitating en bloc resection regardless of tumor size. In our study, we investigated the clinicopathological feature and the treatment outcome of patients with colorectal laterally spreading tumors (LSTs) that were treated by ESD.
Methods
The study enrolled all of 210 patients with colorectal LSTs who underwent ESD. Clinical outcomes were analyzed by retrospectively reviewing medical records.
Results
A cancerous pit pattern (Vi/Vn) was more common in pseudo-depressed (PD) subtype than in flat elevated (FE) subtype. The incidence of adenocarcinoma in the PD subtype and nodular mixed (NM) subtypes was significantly higher than in the homogenous (HG) subtype and FE subtype. The en bloc and R0 resection rates were 89.0% and 85.7%, respectively. The bleeding and perforation rates were 5.2% and 1.9%, respectively. The mean procedure time was much longer in the PD subtype than in the FE subtype. The en bloc resection rate was significantly higher in the NM subtype than in the HG subtype. However, there were no statistically significant differences in mean procedure time, en bloc resection rate, R0 resection rate, bleeding rate, or perforation rate between LST-granular and LST-nongranular types.
Conclusions
These results indicate that ESD is acceptable for treating colorectal LSTs concerning en bloc resection, curative resection, and risk of complications. Careful consideration is required for complete resection of the PD subtype and NM subtype because of their higher malignant potential.

Citations

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Risk factors for unsuccessful colorectal endoscopic submucosal dissection: A systematic review and meta-analysis
Feng Gu, Wei Jiang, Jingyi Zhu, Lei Ma, Boyuan He, Huihong Zhai
Digestive and Liver Disease.2024; 56(8): 1288. CrossRef
Prognosis and risk factors of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum. Large cohort study
Seong-Jung Kim, Su Young Kim, Jun Lee
Surgical Endoscopy.2022; 36(8): 6243. CrossRef
Blue laser imaging combined with JNET (Japan NBI Expert Team) classification for pathological prediction of colorectal laterally spreading tumors
Si-lin Huang, Wen-xin Tan, Qun Peng, Wen-hua Zhang, Hai-tao Qing, Qiang Zhang, Jun Wu, Liang-dou Lin, Zhi-bin Lu, Yu Chen, Wei-guang Qiao
Surgical Endoscopy.2021; 35(10): 5430. CrossRef
Comparison of long-term recurrence-free survival between primary surgery and endoscopic resection followed by secondary surgery in T1 colorectal cancer
Eun Hye Oh, Nayoung Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Chang Sik Yu, Jin Cheon Kim, Jeong-Sik Byeon
Gastrointestinal Endoscopy.2021; 94(2): 394. CrossRef
Second-look endoscopy findings after endoscopic submucosal dissection for colorectal epithelial neoplasms
Soo-kyung Park, Hyeon Jeong Goong, Bong Min Ko, Haewon Kim, Hyo Sun Seok, Moon Sung Lee
The Korean Journal of Internal Medicine.2021; 36(5): 1063. CrossRef

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200 Download
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Endoscopy

The current capacity and quality of colonoscopy in Korea: Jae Ho Choi, Jae Myung Cha, Jin Young Yoon, Min Seob Kwak, Jung Won Jeon, Hyun Phil Shin; Intest Res 2019;17(1):119-126. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00060

Abstract PDF PubReader ePub

Background/Aims
Little is known for the capacity and quality of colonoscopy, and adherence to colonoscopy surveillance guidelines in Korea. This study aimed to investigate the present and potential colonoscopic capacity, colonoscopic quality, and adherence to colonoscopy surveillance guidelines in Korea.
Methods
We surveyed representative endoscopists of 72 endoscopy units from June to August 2015, using a 36-item questionnaire regarding colonoscopic capacity, quality, and adherence to colonoscopy surveillance guidelines of each hospitals.
Results
Among the 62 respondents who answered the questionnaire, 51 respondents were analyzed after exclusion of 11 incomplete answers. Only 1 of 3 of endoscopy units can afford to perform additional colonoscopies in addition to current practice, and the potential maximum number of colonoscopies per week was only 42. The quality of colonoscopy was variable as reporting of quality indicators of colonoscopy were considerably variable (29.4%–94.1%) between endoscopy units. Furthermore, there are substantial gaps in the adherence to colonoscopy surveillance guidelines, as concordance rate for guideline recommendation was less than 50% in most scenarios.
Conclusions
The potential capacity and quality of colonoscopy in Korea was suboptimal. Considering suboptimal reporting of colonoscopic quality indicators and low adherence rate for colonoscopy surveillance guidelines, quality improvement of colonoscopy should be underlined in Korea.

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Trends in colorectal cancer incidence according to an increase in the number of colonoscopy cases in Korea
Ga Hee Kim, Yeong Chan Lee, Tae Jun Kim, Sung Noh Hong, Dong Kyung Chang, Young-Ho Kim, Dong-Hoon Yang, Chang Mo Moon, Kyunga Kim, Hyun Gun Kim, Eun-Ran Kim
World Journal of Gastrointestinal Oncology.2024; 16(1): 51. CrossRef
Factors Affecting Adherence to National Colorectal Cancer Screening: A 12-Year Longitudinal Study Using Multi-Institutional Pooled Data in Korea
Dae Sung Kim, Jeeyoung Hong, Kihyun Ryu, Sang Hyuk Lee, Hwanhyi Cho, Jehyeong Yu, Jieun Lee, Jong-Yeup Kim
Journal of Korean Medical Science.2024;[Epub] CrossRef
Strategies to improve screening colonoscopy quality for the prevention of colorectal cancer
Joo Hye Song, Eun Ran Kim
The Korean Journal of Internal Medicine.2024; 39(4): 547. CrossRef
Faecal immunochemical tests can improve colonoscopy triage in patients with iron deficiency: A systematic review and meta-analysis
Jennifer Pham, Geraldine Laven-Law, Erin L. Symonds, Molla M. Wassie, Charles Cock, Jean M. Winter
Critical Reviews in Oncology/Hematology.2024; 201: 104439. CrossRef
Comparison of Synergistic Sedation with Midazolam and Propofol Versus Midazolam and Pethidine in Colonoscopies: A Prospective, Randomized Controlled Study
Jae Woong Lim, Min Jae Kim, Gang Han Lee, Dae Sol Kim, Sang Hyuk Jung, Yu Yeon Kim, Jin Won Kim, Yohan Lee, Hyun Soo Kim, Seon Young Park, Dong Hyun Kim
Chonnam Medical Journal.2024; 60(3): 192. CrossRef
Overview of the National Cancer Screening Program for Colorectal Cancer in Korea over 14 Years (2004-2017)
Bomi Park, Eun Young Her, Kyeongmin Lee, Fatima Nari, Jae Kwan Jun, Kui Son Choi, Mina Suh
Cancer Research and Treatment.2023; 55(3): 910. CrossRef
Sessile serrated lesions in patients with adenoma on index colonoscopy do not increase metachronous advanced adenoma risk
Seung Wook Hong, Jeongseok Kim, Ji Young Lee, Jong‐Soo Lee, Hye‐Sook Chang, Hye Won Park, Gwang‐Un Kim, Jiyoung Yoon, Byong Duk Ye, Jeong‐Sik Byeon, Seung‐Jae Myung, Suk‐Kyun Yang, Jaewon Choe, Dong‐Hoon Yang
Digestive Endoscopy.2022; 34(4): 850. CrossRef
Efficacy and safety of split-dose bowel preparation with 1 L polyethylene glycol and ascorbate compared with 2 L polyethylene glycol and ascorbate in a Korean population: a phase IV, multicenter, randomized, endoscopist-blinded study
Sung Noh Hong, Chang Kyun Lee, Jong Pil Im, Chang Hwan Choi, Jeong-Sik Byeon, Young-Seok Cho, Sung-Ae Jung, Tae Il Kim, Yoon Tae Jeen
Gastrointestinal Endoscopy.2022; 95(3): 500. CrossRef
Effect of colorectal cancer screening on long‐term survival of colorectal cancer patients: Results of the Korea National Cancer Screening Program
Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kyu‐Won Jung, Kui Son Choi
International Journal of Cancer.2022; 150(12): 1958. CrossRef
A Study on Differences between Professional Endoscopists and Gastroenterologists in Endoscopic Detection and Standard Pathological Biopsy of Inflammatory Bowel Diseases
Dong Yang, Yuqin Li, Haibo Sun, Chuan He, Geng Chen, Zhuo Zhao, Tongyu Tang, Amosy M'Koma
Gastroenterology Research and Practice.2022; 2022: 1. CrossRef
Risk of Metachronous Colorectal Advanced Neoplasia and Cancer in Patients With 3–4 Nonadvanced Adenomas at Index Colonoscopy: A Systematic Review and Meta-Analysis
Suyeon Park, Seong Ran Jeon, Hyun Gun Kim, Yunho Jung, Min-Seob Kwak, Su Young Kim, Jong Wook Kim, Seung-Joo Nam, Eun Hye Oh, Seon-Young Park, Soo-Kyung Park, Jeong-Sik Byeon, Sun-Jin Boo, Dong Hoon Baek, Soon Man Yoon, Jaeyoung Chun, Jooyoung Lee, Miyoun
American Journal of Gastroenterology.2022; 117(4): 588. CrossRef
The Influence of Face Shields on the Quality of Colonoscopy in the Era of the COVID-19 Pandemic
Jin Wook Lee, Hyo Jeong Lee, Dae Sung Kim, Jiyoung Yoon, Seung Wook Hong, Ha Won Hwang, Jong-Soo Lee, Gwang-Un Kim, Sinwon Lee, Jaewon Choe, Jin Hwa Park, Dong-Hoon Yang, Jeong-Sik Byeon
Gut and Liver.2022; 16(3): 404. CrossRef
Quality indicators in colonoscopy: the chasm between ideal and reality
Su Bee Park, Jae Myung Cha
Clinical Endoscopy.2022; 55(3): 332. CrossRef
Intentions to undergo primary screening with colonoscopy under the National Cancer Screening Program in Korea
Kyeongmin Lee, Haejoo Seo, Sunho Choe, Seung-Yong Jeong, Ji Won Park, Mina Suh, Aesun Shin, Kui Son Choi, Filipe Prazeres
PLOS ONE.2021; 16(2): e0247252. CrossRef
Colonoscopy quality in community hospitals and nonhospital facilities in Korea
Jae Gon Lee, Dong Soo Han, Young-Eun Joo, Dae-Seong Myung, Dong Il Park, Seul Ki Kim, Yunho Jung, Won Hyun Lee, Eun Soo Kim, Joon Seok Yoon, Chang Soo Eun
The Korean Journal of Internal Medicine.2021; 36(Suppl 1): S35. CrossRef
Real-World National Colonoscopy Volume in Korea: A Nationwide Population-Based Study over 12 Years
Jae Myung Cha, Min Seob Kwak, Hyun-Soo Kim, Su Young Kim, Sohee Park, Geun U Park, Jung Kuk Lee, Soo Jin Kim, Hun Hee Lee, Joo Sung Kim, Won Ho Kim
Gut and Liver.2020; 14(3): 338. CrossRef

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Colorectal neoplasia

Rates of metachronous adenoma after curative resection for left-sided or right-sided colon cancer: Yuk Fai Lam, Wai Kay Seto, Teresa Tong, Ka Shing Cheung, Oswens Lo, Ivan FN Hung, Wai Lun Law, Wai K Leung; Intest Res 2018;16(4):619-627. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00013

Abstract PDF PubReader ePub

Background/Aims
We determined the rates of metachronous colorectal neoplasm in colorectal cancer (CRC) patients after resection for right (R)-sided or left (L)-sided cancer.
Methods
Consecutive CRC patients who had undergone surgical resection for curative intent in our hospital between 2001 and 2004 were identified. R-sided colonic cancers refer to cancer proximal to splenic flexure whereas L-sided cancers include rectal cancers. Patients were included only if they had a clearing colonoscopy performed either before or within 6 months after the operation. Findings of surveillance colonoscopy performed up to 5 years after colonic resection were included in the analysis.
Results
Eight hundred and sixty-three CRC patients underwent curative surgical resection during the study period. Three hundred and twenty-seven patients (107 R-sided and 220 L-sided) fulfilled the inclusion criteria and had at least 1 postoperative surveillance colonoscopy performed. The proportion of patients who had polyp and adenoma on surveillance colonoscopy was significantly higher among patients with L-sided than R-sided cancers (polyps: 30.9% vs. 19.6%, P=0.03; adenomas: 25.5% vs. 13.1%, P=0.01). The mean number of adenoma per patient on surveillance colonoscopy was also higher for patients with L-sided than R-sided tumors (0.52; 95% confidence interval [CI], 0.37–0.68 vs. 0.22; 95% CI, 0.08–0.35; P<0.01). Multivariate analysis showed that L-sided cancers, age, male gender and longer follow-up were independent predictors of adenoma detection on surveillance colonoscopy.
Conclusions
Patients with Lsided cancer had a higher rate of metachronous polyps and adenoma than those with R-sided cancer on surveillance colonoscopy.

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The absolute number of small and diminutive adenomas with high-grade dysplasia is substantially higher compared with large adenomas: a retrospective pooled study
Jiancheng Zhang, Huajun Sun, Fei Xiong, Shan Lei, Guanyu Zhou, Xun Xiao, Lin Liu, Pu Wang
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A survey of current practices in post-polypectomy surveillance in Korea
Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Eun Ran Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoo
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Delineation of gastrointestinal tumors biopsies using a fluorescence lifetime imaging optical fiber probe
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Miscellaneous

Risk factors for severity of colonic diverticular hemorrhage: Ken Kinjo, Toshiyuki Matsui, Takashi Hisabe, Hiroshi Ishihara, Toshiki Kojima, Kenta Chuman, Shigeyoshi Yasukawa, Tsuyoshi Beppu, Akihiro Koga, Satoshi Ishikawa, Masahiro Kishi, Noritaka Takatsu, Fumihito Hirai, Kenshi Yao, Toshiharu Ueki, Masakazu Washio; Intest Res 2018;16(3):458-466. Published online July 27, 2018; DOI: https://doi.org/10.5217/ir.2018.16.3.458

Abstract PDF PubReader ePub

Background/Aims

Colonic diverticular hemorrhage (DH) was a rare disease until the 1990s, and its incidence has increased rapidly since 2000 in Japan. In recent years, colonic DH has been the most frequent cause of lower gastrointestinal bleeding (LGIB). Nearly all cases of DH are mild, with the bleeding often stopping spontaneously. Some cases, however, require surgery or arterial embolization. In this study, using a cohort at Fukuoka University Chikushi Hospital, we investigated factors associated with severe colonic DH.

Methods

Among patients with LGIB who underwent colonoscopy at our hospital between 1995 and 2013, DH was identified in 273 patients. Among them, 62 patients (22.7%) were defined as having severe colonic DH according to recurrence of bleeding in a short period, and/or the necessity of transfusion, arterial embolization, or surgery. We then evaluated risk factors for severe DH among DH patients in this retrospective cohort.

Results

Among the 273 patients with DH, use of non-steroidal anti-inflammatory drugs (NSAIDs) (odds ratio [OR], 2.801; 95% confidence interval [CI], 1.164–6.742), Charlson Risk Index (CRI) ≥2 (OR, 3.336; 95% CI, 1.154–7.353), right-sided colonic DH (OR, 3.873; 95% CI, 1.554–9.653), and symptoms of cerebral hypoperfusion (such as light-headedness, dizziness, or syncope) (OR, 2.926; 95% CI, 1.310–6.535) showed an increased risk of severe DH even after controlling for other factors.

Conclusions

Severe DH occurred in 23% of DH patients, and NSAID use, CRI ≥2, right-sided colonic DH, and symptoms of cerebral hypoperfusion are suggested to be predictors of severe DH.

Citations

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Clinical Factors Associated with Severity of Colonic Diverticular Bleeding and Impact of Bleeding Site
Hirohito Amano, Takatsugu Yamamoto, Ken Ikusaka, Naoaki Aoki, Miyoko Sakurai, Taku Honda, Kyohei Maruyama, Hitoshi Aoyagi, Akari Isono, Koichiro Abe, Yoshinari Asaoka, Shinya Kodashima, Atsushi Tanaka
Journal of Clinical Medicine.2023; 12(5): 1826. CrossRef
Effectiveness and Safety of Endoscopic Submucosal Dissection for Colorectal Neoplasm in Patients with High Charlson Comorbidity Index Score: A HASID Multicenter Study
Dong-Hyun Kim, Yong-Wook Jung, Byung-Chul Jin, Hyung-Hoon Oh, Hyo-Yeop Song, Seong-Jung Kim, Dae-Seong Myung, Sang-Wook Kim, Jun Lee, Geom-Seog Seo, Young-Eun Joo, Hyun-Soo Kim
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Hye-Su You, Dong Hyun Kim, Seo-Yeon Cho, Seon-Young Park, Chang Hwan Park, Hyun-Soo Kim, Sung Kyu Choi
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Construction of a Model for Predicting the Severity of Diverticular Bleeding in an Elderly Population
Tomoyuki Okada, Tsuyoshi Mikamo, Ayana Nakashima, Atsushi Yanagitani, Kiwamu Tanaka, Hajime Isomoto
Internal Medicine.2022; 61(15): 2247. CrossRef
Diagnosis and Treatment of Colonic Diverticular Disease
You Sun Kim
The Korean Journal of Gastroenterology.2022; 79(6): 233. CrossRef
Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
Marcello Covino, Valerio Papa, Antonio Tursi, Benedetta Simeoni, Loris Riccardo Lopetuso, Lorenzo Maria Vetrone, Francesco Franceschi, Gianludovico Rapaccini, Antonio Gasbarrini, Alfredo Papa
Journal of Personalized Medicine.2021; 11(2): 80. CrossRef
Risk of Rebleeding in Patients with Small Bowel Vascular Lesions
Akira Harada, Takehiro Torisu, Shin Fujioka, Yuichiro Yoshida, Yasuharu Okamoto, Yuta Fuyuno, Atsushi Hirano, Junji Umeno, Kumiko Torisu, Tomohiko Moriyama, Motohiro Esaki, Takanari Kitazono
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Vegetarianism as a protective factor for asymptomatic colonic diverticulosis in Asians: a retrospective cross-sectional and case-control study
Jihun Bong, Hyoun Woo Kang, Hyeki Cho, Ji Hyung Nam, Dong Kee Jang, Jae Hak Kim, Jun Kyu Lee, Yun Jeong Lim, Moon-Soo Koh, Jin Ho Lee
Intestinal Research.2020; 18(1): 121. CrossRef

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Endoscopy

Difficult colonoscopy: air, carbon dioxide, or water insufflation?: Alisha Chaubal, Vikas Pandey, Ruchir Patel, Prateik Poddar, Aniruddha Phadke, Meghraj Ingle, Prabha Sawant; Intest Res 2018;16(2):299-305. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.299

Abstract PDF Supplementary Material PubReader ePub

Background/Aims

This study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation).

Methods

Patients with body mass index (BMI) less than 18 kg/m² or more than 30 kg/m², or who had undergone previous abdominal or pelvic surgeries were randomized to air, carbon dioxide, or water insufflation during colonoscopy. The primary endpoint was cecal intubation with mild pain (less than 5 on visual analogue scale [VAS]), without use of sedation.

Results

The primary end point was achieved in 32.7%, 43.8%, and 84.9% of cases with air, carbon dioxide and water insufflation (P<0.001). The mean pain scores were 5.17, 4.72, and 3.93 on the VAS for air, carbon dioxide, and water insufflation (P<0.001). The cecal intubation rate or procedure time did not differ significantly between the 3 groups.

Conclusions

Water insufflation was superior to air or carbon dioxide for pain tolerance. This was seen in the subgroups with BMI <18 kg/m² and the post-surgical group, but not in the group with BMI >30 kg/m².

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Xiaomeng Jiang, Runqing Wang, Haibo Sun, Faming Zhang
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Causes of intraprocedural discomfort in colonoscopy: a review and practical tips
Jabed F. Ahmed, Ara Darzi, Lakshmana Ayaru, Nisha Patel
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Zhifan Teng, Jianhua Liu, Hongbo Sun, Quanyue Liu, Yujia Zhai, Qiuliang Wang
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Salman Mahmood, Sebastian Schostek, Marc O. Schurr, Jacob Bergsland, Ilangko Balasingham, Erik Fosse
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Magnetic endoscopic imaging as a rational investment for specific colonoscopies: a systematic review and meta-analysis
Xiangzhou Tan, Weimin Yang, Doerte Wichmann, Changhao Huang, Benedikt Mothes, K.E. Grund, Zhikang Chen, Zihua Chen
Expert Review of Gastroenterology & Hepatology.2021; 15(4): 447. CrossRef
Screening colonoscopy: The present and the future
Chelsea V Hayman, Dinesh Vyas
World Journal of Gastroenterology.2021; 27(3): 233. CrossRef
Transparent cap‐assisted, water‐exchange colonoscopy in previous incomplete difficult colonoscopy patients: A retrospective study
Lien‐Fu Lin, Pi‐Teh Huang
Advances in Digestive Medicine.2020; 7(3): 118. CrossRef
Can water insufflation and carbon dioxide overcome the difficulties of colonoscope insertion?
Choong-Kyun Noh, Kee Myung Lee
Intestinal Research.2018; 16(2): 166. CrossRef

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Endoscopy

Prospective analysis of factors associated with inadequate bowel preparation for colonoscopy in actual clinical practice: Dae Hyung Woo, Kyeong Ok Kim, Da Eun Jeong, Yoon Jeong Nam, Si Hyung Lee, Byung Ik Jang, Tae Nyeun Kim; Intest Res 2018;16(2):293-298. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.293

Abstract PDF PubReader ePub

Background/Aims

Inadequate bowel preparation can result in prolonged procedure time and increased missed lesion and complication rates. This prospective study aimed to evaluate bowel preparation quality and identify the predictive factors for inadequate bowel preparation in actual clinical practice.

Methods

We included 399 patients who underwent colonoscopy between June 2015 and July 2016. Using the Aronchick bowel preparation scale, we defined a score ≤2 as adequate preparation and a score >2 as inadequate preparation.

Results

Mean patient age was 58.38±12.97 years; 60.6% were male. Indications for colonoscopy included screening (69.7%) and surveillance after polyp removal (21.3%). A split-dose regimen was prescribed to 55.4% of patients. The inadequate bowel preparation rate was 28.1%. Overall, the median time between the last bowel preparation agent dose and start of colonoscopy was 5.0 hours (range, 1.5–16.0 hours); that of the adequate group was 5.0 hours (range, 1.5–16.0 hours); and that of the inadequate group was 5 hours (range, 2–23 hours). The mean bowel preparation scale score of the ascending colon (1.94±0.25) was significantly higher than that of other colon segments. On multivariate analysis, elderly age, history of cerebrovascular disease, history of gastrectomy or appendectomy, and total preparation solution uptake <2 L were the independent predictors of inadequate bowel preparation.

Conclusions

The inadequate bowel preparation rate was 28.1%. Risk factors included elderly age and history of cerebrovascular disease or abdominal surgery. Patients with these risk factors require special care and education.

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Wen‐Feng Hsu, Han‐Mo Chiu
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Jahanbakhsh Amirarsalani, Leyla Alilu, Masoumeh Hemmati-Maslakpak, Javad Rasouli
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Qi Wang, Kexin Shen, Bingyuan Fei, Hai Luo, Ruiqi Li, Zeming Wang, Mengqiang Wei, Zhongshi Xie
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Jacob E. Kurlander, Akbar K. Waljee, Stacy B. Menees, Rachel Lipson, Alex N. Kokaly, Andrew J. Read, Karmel S. Shehadeh, Amy Cohn, Sameer D. Saini
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Su Bee Park, Jae Myung Cha
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Kyeong Ok Kim, Eun Young Kim, Yoo Jin Lee, Hyun Seok Lee, Eun Soo Kim, Yun Jin Chung, Byung Ik Jang, Sung Kook Kim, Chang Heon Yang
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Comparison of Two Types of 1-L Polyethylene Glycol-ascorbic Acid as Colonoscopic Bowel Preparation: A Prospective Randomized Study
Suh Hyun Choi, Won Eui Yoon, Seung Hyuk Kim, Hee Jun Myung, Seo Hyun Kim, Soon Oh So, Se Hun Kim, Hyun Mi Lee, Yeoun Jung Oh, Jeong Seop Moon, Tae Yeong Park, You Sun Kim
The Korean Journal of Gastroenterology.2022; 80(2): 85. CrossRef
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Shashank Sarvepalli, Ari Garber, Carol A. Burke, Niyati Gupta, Mounir Ibrahim, John McMichael, Gareth Morris-Stiff, Amit Bhatt, John Vargo, Maged Rizk, Michael B. Rothberg
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Chen-Shuan Chung, Chih-Ming Lin, Ming-Shu Chen
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Ji Eun Na, Eun Ran Kim
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Yohan Lee, Haejung Lee
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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
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Sun Hwa Kim, Eun Ran Kim, Kyunga Kim, Tae Jun Kim, Sung Noh Hong, Dong Kyung Chang, Young‐Ho Kim
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Review

Endoscopy

Quality is the key for emerging issues of population-based colonoscopy screening: Jin Young Yoon, Jae Myung Cha, Yoon Tae Jeen; Intest Res 2018;16(1):48-54. Published online January 18, 2018; DOI: https://doi.org/10.5217/ir.2018.16.1.48

Abstract PDF PubReader ePub

Colonoscopy is currently regarded as the gold standard and preferred method of screening for colorectal cancer (CRC). However, the benefit of colonoscopy screening may be blunted by low participation rates in population-based screening programs. Harmful effects of population-based colonoscopy screening may include complications induced by colonoscopy itself and by sedation, psychosocial distress, potential over-diagnosis, and socioeconomic burden. In addition, harmful effects of colonoscopy may increase with age and comorbidities. As the risk of adverse events in population-based colonoscopy screening may offset the benefit, the adverse events should be managed and monitored. To adopt population-based colonoscopy screening, consensus on the risks and benefits should be developed, focusing on potential harm, patient preference, socioeconomic considerations, and quality improvement of colonoscopy, as well as efficacy for CRC prevention. As suboptimal colonoscopy quality is a major pitfall of population-based screening, adequate training and regulation of screening colonoscopists should be the first step in minimizing variations in quality. Gastroenterologists should promote quality improvement, auditing, and training for colonoscopy in a population-based screening program.

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Stefanie BREZINA, Gernot LEEB, Andreas BAIERL, Evelyn GRÄF, Monika HACKL, Philipp HOFER, Harald LANG, Michaela KLEIN, Karl MACH, Remy SCHWARZER, Wilhelm WLASSITS, Andreas PÜSPÖK, Andrea GSUR
BMC Gastroenterology.2024;[Epub] CrossRef
Strategies to improve screening colonoscopy quality for the prevention of colorectal cancer
Joo Hye Song, Eun Ran Kim
The Korean Journal of Internal Medicine.2024; 39(4): 547. CrossRef
The adult large bowel: describing environment morphology for effective biomedical device development
Joseph C Norton, James W Martin, Conchubhair Winters, Bruno Scaglioni, Keith L Obstein, Venkataraman Subramanian, Pietro Valdastri
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Dong Seok Lee, Jeong-Seon Ji, Tae-Geun Gweon, Myeongsook Seo, Hwang Choi
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Tae-Geun Gweon, Kang-Moon Lee, Seung-Woo Lee, Dae Bum Kim, Jeong-Seon Ji, Ji Min Lee, Woo Chul Chung, Chang-Nyol Paik, Hwang Choi
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Tae-Geun Gweon, Seung-Woo Lee, Jeong-Seon Ji, Jeong Rok Lee, Joon Sung Kim, Byung-Wook Kim, Hwang Choi
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Original Articles

Endoscopy

Three-year colonoscopy surveillance after polypectomy in Korea: a Korean Association for the Study of Intestinal Diseases (KASID) multicenter prospective study: Won Seok Choi, Dong Soo Han, Chang Soo Eun, Dong Il Park, Jeong-Sik Byeon, Dong-Hoon Yang, Sung-Ae Jung, Sang Kil Lee, Sung Pil Hong, Cheol Hee Park, Suck-Ho Lee, Jeong-Seon Ji, Sung Jae Shin, Bora Keum, Hyun Soo Kim, Jung Hye Choi, Sin-Ho Jung; Intest Res 2018;16(1):126-133. Published online January 18, 2018; DOI: https://doi.org/10.5217/ir.2018.16.1.126

Abstract PDF PubReader ePub

Background/Aims

Colonoscopic surveillance is currently recommended after polypectomy owing to the risk of newly developed colonic neoplasia. However, few studies have investigated colonoscopy surveillance in Asia. This multicenter and prospective study was undertaken to assess the incidence of advanced adenoma based on baseline adenoma findings at 3 years after colonoscopic polypectomy.

Methods

A total of 1,323 patients undergoing colonoscopic polypectomy were prospectively assigned to 3-year colonoscopy surveillance at 11 tertiary endoscopic centers. Relative risks for advanced adenoma after 3 years were calculated according to baseline adenoma characteristics.

Results

Among 1,323 patients enrolled, 387 patients (29.3%) were followed up, and the mean follow-up interval was 31.0±9.8 months. The percentage of patients with advanced adenoma on baseline colonoscopy was higher in the surveillance group compared to the non-surveillance group (34.4% vs. 25.7%). Advanced adenoma recurrence was observed in 17 patients (4.4%) at follow-up. The risk of advanced adenoma recurrence was 2 times greater in patients with baseline advanced adenoma than in those with baseline non-advanced adenoma, though the difference was not statistically significant (6.8% [9/133] vs. 3.1% [8/254], P=0.09). Advanced adenoma recurrence was observed only in males and in subjects aged ≥50 years. In contrast, adenoma recurrence was observed in 187 patients (48.3%) at follow-up. Male sex, older age (≥50 years), and multiple adenomas (≥3) at baseline were independent risk factors for adenoma recurrence.

Conclusions

A colonoscopy surveillance interval of 3 years in patients with baseline advanced adenoma can be considered appropriate.

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Woohyuk Jung, Gyu Man Oh, Jae Hyun Kim, Youn Jung Choi, Min Young Son, Kyoungwon Jung, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park
Medicine.2023; 102(19): e33728. CrossRef
Comparison of the efficacy and safety between oral sulfate tablet and polyethylene glycol for bowel preparation before colonoscopy according to age
Jae Hyun Kim, Yong Eun Park, Tae Oh Kim, Jongha Park, Gyu Man Oh, Won Moon, Seun Ja Park
Medicine.2022; 101(27): e29884. CrossRef
Optimization of the surveillance strategy in patients with colorectal adenomas: A combination of clinical parameters and index colonoscopy findings
Chan Hyuk Park, Yoon Suk Jung, Nam Hee Kim, Jung Ho Park, Dong Il Park, Chong Il Sohn
Journal of Gastroenterology and Hepatology.2021; 36(4): 974. CrossRef
Postgastrectomy gastric cancer patients are at high risk for colorectal neoplasia: a case control study
Tae-Geun Gweon, Kyu-Tae Yoon, Chang Hyun Kim, Jin-Jo Kim
Intestinal Research.2021; 19(2): 239. CrossRef
Risk of developing metachronous advanced colorectal neoplasia after resection of low-risk diminutive versus small adenomas
Nam Hee Kim, Yoon Suk Jung, Jung Ho Park, Dong Il Park, Chong Il Sohn
Gastrointestinal Endoscopy.2020; 91(3): 622. CrossRef
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Jian Dong, Minman Wu, Jiarong Miao, Rana Sami Ullah Khan, Tao Zhi, Tianmei Zhang, Xue Li, Yashi Peng, Gang Yang, Qiong Nan
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Yoon Suk Jung, Tae Jun Kim, Eunwoo Nam, Chan Hyuk Park
Gastrointestinal Endoscopy.2020; 92(3): 692. CrossRef
Appropriate Surveillance Interval after Colonoscopic Polypectomy in Patients Younger than 50 Years
Yoon Suk Jung, Nam Hee Kim, Jung Ho Park, Dong Il Park, Chong Il Sohn
Journal of Korean Medical Science.2019;[Epub] CrossRef
Impact of obesity and metabolic abnormalities on the risk of metachronous colorectal neoplasia after polypectomy in men
Nam Hee Kim, Yoon Suk Jung, Jung Ho Park, Dong Il Park, Chong Il Sohn
Journal of Gastroenterology and Hepatology.2019; 34(9): 1504. CrossRef
What Is Appropriate Upper Endoscopic Interval Among Dyspeptic Patients With Previously Normal Endoscopy? A Multicenter Study With Bayesian Change Point Analysis
Jong Wook Kim, Kee Wook Jung, Joong Goo Kwon, Jung Bok Lee, Jong Kyu Park, Ki Bae Bang, Chung Hyun Tae, Jung Hwan Oh
Journal of Neurogastroenterology and Motility.2019; 25(4): 544. CrossRef
Risk of Developing Metachronous Advanced Colorectal Neoplasia After Polypectomy in Patients With Multiple Diminutive or Small Adenomas
Nam Hee Kim, Yoon Suk Jung, Mi Yeon Lee, Jung Ho Park, Dong Il Park, Chong Il Sohn
American Journal of Gastroenterology.2019; 114(10): 1657. CrossRef

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High C-reactive protein level is associated with high-risk adenoma: Hyae Min Lee, Jae Myung Cha, Jung Lok Lee, Jung Won Jeon, Hyun Phil Shin, Kwang Ro Joo, Jin Young Yoon, Joung Il Lee; Intest Res 2017;15(4):511-517. Published online October 23, 2017; DOI: https://doi.org/10.5217/ir.2017.15.4.511

Abstract PDF PubReader ePub

Background/Aims

There is substantial evidence supporting a role of inflammation in the pathogenesis of colorectal cancer; however, little is known about the association between serum C-reactive protein (CRP) and the risk of colorectal adenoma. This study was conducted to investigate the association between serum CRP and colorectal adenoma risk.

Methods

A retrospective cross-sectional study was performed on first-time screening colonoscopies in asymptomatic subjects who also had their serum CRP level measured during a routine health check-up between September 2006 and September 2009 in Korea. Serum CRP level was compared between high-risk and low-risk adenoma groups and independent predictors of high-risk adenoma were analyzed using multivariate regression analysis.

Results

Among the 3,309 eligible patients, the high-risk adenoma group had higher serum CRP levels than the low-risk adenoma group (P=0.000). In addition, patients with a high-risk adenoma were more frequently included in the high CRP group than in the low CRP group (8.6% vs. 4.0%, P<0.001). The prevalence of high-risk adenoma was 3.5 times higher in the highest quartile of CRP level (P=0.000) compared with that in the lowest quartile. In logistic regression analysis, a higher quartile CRP level was found to be an independent risk factor for high-risk adenoma (odds ratio, 1.8; 95% confidence interval, 1.3–2.5; P=0.000).

Conclusions

High CRP level is associated with high-risk adenoma in both men and women. Our data may support the association between chronic inflammation and colorectal neoplasia, which warrants further investigation.

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Local recurrence and subsequent endoscopic treatment after endoscopic piecemeal mucosal resection with or without precutting in the colorectum: Myeongsook Seo, Eun Mi Song, Gwang Un Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Kyung-Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon; Intest Res 2017;15(4):502-510. Published online October 23, 2017; DOI: https://doi.org/10.5217/ir.2017.15.4.502

Abstract PDF PubReader ePub

Background/Aims

Precutting before endoscopic piecemeal mucosal resection (EPMR) may increase colorectal polyp resection effectiveness. We aimed to identify risk factors for recurrence after conventional EPMR (CEPMR) and precut EPMR (PEPMR) and investigated endoscopic treatment outcomes for recurrent cases.

Methods

The medical records of patients with colorectal polyps treated by EPMR were analyzed. Patients without follow-up surveillance colonoscopies were excluded.

Results

Among 359 lesions, the local recurrence rate on the first surveillance colonoscopy was 5.8% (18/312) and 6.4% (3/47) after CEPMR and PEPMR, respectively. Among lesions without recurrence at the first surveillance colonoscopy, the rates of late recurrence on subsequent surveillance colonoscopy were 3.9% (6/152) and 0% after CEPMR and PEPMR, respectively. Larger tumor size was the only independent risk factor for recurrence (odds ratio, 7.93; 95% confidence interval, 1.95–32.30; P<0.001). Endoscopic treatment was performed for all 27 recurrences. A combination of ≥2 endoscopic treatment modalities was used in 19 of 27 recurrences (70.4%). Surveillance colonoscopies were performed in 20 of 27 recurrences after endoscopic treatment. One (5.0%) had a re-recurrence and was treated by surgical resection because recurrence occurred at the appendiceal orifice. Nineteen of 20 lesions (95.0%) could be cured endoscopically, although 3 of the 19 showed second or third recurrences and were treated by repeat endoscopic resection.

Conclusions

The local recurrence rates after CEPMR and PEPMR were similar. Larger tumor size was an independent risk factor for local recurrence after EPMR. Endoscopic treatment of recurrences resulted in high cure rates, although combination methods were necessary in many cases.

Citations

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Yun Sik Choi, Wan Soo Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon
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Viveksandeep Thoguluva Chandrasekar, Muhammad Aziz, Harsh K. Patel, Naaz Sidhu, Abhiram Duvvuri, ChandraShekhar Dasari, Kevin F. Kennedy, Ashwini Ashwath, Marco Spadaccini, Madhav Desai, Ramprasad Jegadeesan, Anjana Sathyamurthy, Prashanth Vennalaganti, D
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Gastrointestinal Endoscopy.2020; 91(6): 1343. CrossRef

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