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To prevent colorectal cancer, high-quality colonoscopy is advocated, undertaken by endoscopists with high adenoma detection rates (ADRs). Despite reports that various factors may impact ADRs, the significance of such factors is still unclear. The analysis was aimed at quality-oriented interventions for boosting ADRs. Study enrollees were adults subjected to screening colonoscopy between September 2013 and August 2016 at the Gangnam Center of Seoul National University Hospital Healthcare System. The investigation entailed six periods (P1–6) of 6 months each, during which serial multidirectional quality improvement efforts were instituted. In particular, we sought to further educate endoscopists, provide feedback on individual ADRs, and introduce a split-dose regimen, gauging results via the Boston Bowel Preparation Score. Changes in polyp detection rates (PDRs) and ADRs were then analyzed. A total of 13,430 colonoscopies were undertaken by 15 experienced endoscopists. Overall, the ADR increased from 45.6% (P1) to 48.2% (P6, p

Endoplasmic reticulum (ER) stress has been implicated in the development of nonalcoholic steatohepatitis. A methionine–choline-deficient (MCD) diet induces robust ER stress response and steatohepatitis, but the effects of ER stress modulation on the course of steatohepatitis remain uncertain. The present study evaluated whether reducing ER stress using the chemical chaperone tauroursodeoxycholic acid (TUDCA) could limit hepatocyte lipoapoptosis and progression of MCD diet-induced steatohepatitis. HuH7 cells stably transfected with sodium taurocholate cotransporting polypeptide (HuH-Ntcp cells) and palmitate (PA) were used. Experimental steatohepatitis was induced in male C57BL/6 mice using an MCD diet, and three different doses of TUDCA (500, or 1,000 mg/kg, once daily; or 500 mg/kg twice daily) were administered by gavage from the start of the MCD diet regimen or after 4 weeks. TUDCA reduced PA-induced ER stress as manifested by decreased eIF2α phosphorylation, XBP1 splicing and expression of BiP, ATF4, and CHOP in HuH-Ntcp cells. TUDCA also decreased PA-induced JNK phosphorylation, Puma up-regulation and Bax activation, which in turn suppressed caspase-dependent hepatocyte lipoapoptosis. Mice given TUDCA did not show a significant decrease in the intrahepatic triglyceride contents and steatosis. However, TUDCA treatment significantly reduced hepatic damage compared to controls for both early and late treatment groups. TUDCA treatment reduced the expression of ER stress markers and pro-apoptotic proteins, leading to decreased apoptosis and oxidative stress. Finally, TUDCA reduced histological fibrosis along with the down-regulation of pro-fibrotic gene expression in both early and late treatment groups. These results show that TUDCA attenuates the progression of MCD diet-induced steatohepatitis by reducing ER stress.

The selection of a high-risk group of gastric cancer is important. This study was performed to compare the efficacy of non-invasive gastric cancer screening through the measurement of pepsinogen (PG) I/II ratio and endoscopic screening using histologic criteria (Meining’s risk index for gastric cancer) in Korean patients. Included in the study were 460 gastric cancer patients and 460 control cases who underwent upper endoscopy between June 2003 and July 2008 at Seoul National University Bundang Hospital. Serum PG I/II ratio and histologic characteristics were evaluated for each participant. Multivariate logistic regression was performed to compare the predictive power for gastric cancer of both the PG II/I ratio (the inverse form of PG I/II ratio) and the histologic gastric cancer risk index. A higher PG II/I ratio was significantly associated with a higher risk for gastric cancer (odds ratio of highest quartile for cancer vs. lowest quartile, 3.51; 95% confidence interval, 2.29–5.36) in the multivariate logistic model. The validity (in terms of calibration and discrimination) of the PG-including multivariate logistic model was comparable to the histologic gastric cancer risk index model. The results were similar regardless of the staging of the cancer, Lauren’s histologic classification, and the location of the cancer. These results suggest that non-invasive measurement of serum PG I/II ratio is as effective as Meining’s histologic gastric cancer risk index in predicting gastric cancer occurrence.

The clinical features and prognosis of hepatocellular carcinoma (HCC) with peritoneal metastasis have not been fully evaluated. This study aimed to investigate the risk factors, clinical features, and prognosis of HCC with peritoneal metastasis. Patients who were diagnosed as HCC with peritoneal metastasis and the same number of randomly selected, risk factor-matched HCC controls without peritoneal metastasis were included. The risk factors and overall survival were compared between peritoneal metastasis-positive and -negative groups after adjustment of other variables. HCC rupture was an independent risk factor for peritoneal metastasis in HCC patients (P = 0.008). When the risk factors (age, sex, Child-Pugh score, and intrahepatic tumor stage) were matched, peritoneal metastasis failed to independently affect overall survival (P = 0.511). In the peritoneal metastasis-positive group, advanced Child-Pugh class [hazard ratio (HR), 1.99; 95% confidence interval (CI), 1.07–3.72; P = 0.030] and progressive intrahepatic HCC status (HR, 19.04; 95% CI, 2.55–142.13; P = 0.004) were independent risk factors for early death. Complications such as ileus, bleeding, and hydronephrosis due to rectovesical mass were reported in 1.5–7.4% in the peritoneal metastasis-positive group. Peritoneal metastasis was not found to be an independent prognostic factor of HCC, and among HCC patients with peritoneal metastasis, those with advanced Child-Pugh class and with uncontrolled intrahepatic HCC showed poor survival. Therefore, the maintenance of favorable hepatic function and control of intrahepatic HCC should still be emphasized in HCC patients with peritoneal metastasis.