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Background/Aims: Accurately diagnosing diffuse gastric wall thickening is challenging. Hypertrophic gastritis (HG), while benign, mimics the morphology of Borrmann type 4 advanced gastric cancer (AGC B-4). We compared the features of endoscopy and endoscopic ultrasonography (EUS) between them. Methods: We retrospectively reviewed patients who underwent EUS for gastric wall thickening between 2000 and 2021, selecting HG and pathologically confirmed advanced gastric cancer cases. Ulceration and antral wall thickening were determined via endoscopy, while EUS assessed the 5-layered gastric wall structure, measuring the proper muscle (PM) layer and total wall thickness. Results: Male dominance was observed in AGC B-4, and the hemoglobin and albumin levels were significantly lower. The rate of antral wall thickening and presence of ulceration were significantly higher in AGC B-4 cases. Destruction of the PM layers was observed only in AGC B-4 cases, and the PM was significantly thicker in AGC B-4 cases. Forceps biopsy had an excellent success rate in ulcer-present AGC B-4 cases, but only a 42.6% success rate was observed for cases without ulcers, necessitating additional diagnostic modalities. A PM thickness of 2.39 mm distinguished between AGC B-4 and HG effectively. The multivariable analysis showed that a thickened PM layer and the presence of ulceration were significant risk factors for the diagnosis of AGC B-4. Conclusions: Endoscopic findings of a thickened gastric wall, including antral involvement, and presence of ulcer were significant risk factors for the diagnosis of AGC B-4. EUS findings of destroyed wall layers and a thickened PM of >2.39 mm were the key points of differentiation between HG and AGC B-4. [ABSTRACT FROM AUTHOR]

Background/Aims: Although an association between achalasia and esophageal cancer has been reported, whether achalasia confers a substantial increase in mortality is unknown. Moreover, the causes of death related to achalasia have not been investigated. We performed this nationwide, population-based cohort study on achalasia because no such study has been performed since the introduction of high-resolution manometry in 2008. Methods: This study was performed using data extracted from the Korean National Health Insurance Service database, covering a 9-year period from 2009 to 2017. Control participants without a diagnostic code for achalasia were randomly selected and matched by sex and birth year at a case-to-control ratio of 1:4. Data on the cause of death from Statistics Korea were also analyzed. Results: The overall incidence of achalasia was 0.68 per 100,000 person-years, and the prevalence was 6.46 per 100,000 population. Patients with achalasia (n=3,063) had significantly higher adjusted hazard ratio (aHR) for esophageal cancer (aHR, 3.40; 95% confidence interval [CI], 1.25 to 9.22; p=0.017), pneumonia (aHR, 2.30; 95% CI, 1.89 to 2.81; p<0.001), aspiration pneumonia (aHR, 3.92; 95% CI, 2.38 to 6.48; p<0.001), and mortality (aHR, 1.68; 95% CI, 1.44 to 1.94; p<0.001). Esophageal cancer carried the highest mortality risk (aHR, 8.82; 95% CI, 2.35 to 33.16; p=0.001), while pneumonia had the highest non-cancer mortality risk (aHR, 2.28; 95% CI, 1.31 to 3.96; p=0.004). Conclusions: In this nationwide study, achalasia was associated with increased risk of mortality. Esophageal cancer and pneumonia were the most common comorbidities and the major causes of death in patients with achalasia. [ABSTRACT FROM AUTHOR]

Background/Aims: Real-time polymerase chain reaction (RT-PCR) is a fast and simple method for the simultaneous detection of clarithromycin (CLR) resistance and Helicobacter pylori. We evaluated the effectiveness of RT-PCR compared to that of the rapid urease test (RUT) and assessed its value in verifying CLR resistance. Methods: A total of 70 specimens with confirmed H. pylori infection in culture were enrolled and analyzed in this prospective study. All specimens were subjected to RT-PCR assay using fluorescence melting peak signals to detect H. pylori infection and CLR resistances caused by either A2142G or A2143G mutations in the 23S ribosomal RNA gene (23S rRNA). The results were compared to those of RUT and antimicrobial susceptibility culturing tests to investigate the efficacy of RT-PCR. Results: Among the 70 specimens analyzed, the positivity rate was 97.1% (68/70) with RT-PCR and 82.9% (58/70) with RUT. CLR resistance (minimum inhibitory concentration >1.0 μg/mL) was confirmed in 18.6% (13/70), and fluorescence melting curve analysis showed that 84.6% (11/13) had point mutations in 23S rRNA. Ten specimens had only A2143G mutation, and one specimen contained both A2142G and A2143G mutations. Conclusions: RT-PCR assay was found to be more efficient than RUT in detecting H. pylori infection and could effectively verify CLR resistance compared to the antimicrobial susceptibility culturing test. Considering the high sensitivity and accessibility of RT-PCR method, it could be used to easily detect CLR-resistant H. pylori, thus helping clinicians select suitable treatment regimen and improve the eradication rate. [ABSTRACT FROM AUTHOR]

Background/Aims The liver and small bowel are known to be closely interrelated. In addition, the expression of tight junction proteins (TJPs) is suggested to be associated with the development of non-alcoholic fatty liver disease (NAFLD). This study aimed to investigate the effects of age and sex on the hepatic steatosis and the small bowel inflammation induced by the high fructose, high fat diet (HFHFD) in rats. Methods 6-week-old male and female rats, along with 2-year-old, were used. The HFHFD groups were provided with the high fat diet (60% kcal from fat) and high fructose water (20%). After 8 weeks, both liver and small intestinal tissues were evaluated by histological analysis. TJP expression in the jejunum mucosa was analyzed by qRT-PCR. Results The histological inflammation scores of old control groups in small bowel were higher than those of young control groups regardless of sex, particularly in the jejunum (Table). The jejunum villus/crypt ratio of 6-week-old rats significantly decreased only among male HFHFD group (Table). In contrast, in the 2-year-old rats, the villus/crypt ratio resulted in a reduction only among female HFHFD group. The hepatic steatosis were significantly higher in the both age of male HFHFD groups and only old female HFHFD (Table). The mRNA expression of claudin-2 significantly elevated in female HFHFD (Table). Conclusion HFHFD induced inflammation of small bowel and hepatic steatosis, especially in old rats, suggesting that NAFLD might be related with damage of small bowel brush border membrane. The upregulated gene expression of claudin-2 in the aged female rats suggests a potential role of TJPs in provoking NAFLD in postmenopausal females. [ABSTRACT FROM AUTHOR]

Background/Aims Self-expanding metal stents (SEMS) are effective for symptom palliation in patients with esophageal obstruction. However, their placement can lead to adverse events such as stent migration and restenosis. A novel fully covered SEMS (FCSEMS) with antimigration properties has been developed to address these issues. This study aimed to evaluate the feasibility and safety of this novel stent in treating malignant esophageal obstruction. Methods This prospective pilot study enrolled patients with malignant esophageal obstruction treated with the novel stent at a tertiary referral center. Primary outcomes included technical and clinical efficacy, whereas secondary outcomes were adverse events. Treatment outcomes were compared between the novel stent and historical control groups. Results A total of 137 patients, including 32 in the novel stent group and 105 in the historical control group, were finally analyzed. In the novel stent group, technical and clinical success was achieved in 100% and 96.9% of the patients, respectively. No stent placement-related events, such as bleeding or perforation, were observed. Although no significant differences in adverse events were found, the novel stent group had a lower migration rate than the historical control group (9.4% vs. 14.3%, p=0.565). Median stent patency was comparable between both groups (70.5 vs. 43.0 days, p=0.185). Conclusion The novel multisegmented FCSEMS demonstrated high technical and clinical efficacy with a low migration rate, offering a promising treatment option for malignant esophageal obstruction. Further studies with larger samples are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background/Aims: Epstein-Barr virus (EBV) and Helicobacter pylori (HP) coinfection may synergistically induce severe inflammatory responses in the stomach tissue, increasing the risk of developing gastric cancer. We aimed to analyze the effect of EBV and HP coinfection on the clinicopathologic features and prognosis of gastric cancer, as well as to evaluate the role of EBV infection in non-gastric carcinoma with lymphoid stroma (non-GCLS). Methods: Overall, 956 patients who underwent surgery for gastric cancer between September 2014 and August 2015 were eligible and divided into groups, according to GCLS morphology, EBV infection, and HP infection. Clinicopathologic characteristics and oncologic outcomes were analyzed retrospectively. Results: EBV and HP coinfection was significantly associated with male sex, proximal location, GCLS morphology, and equivocal p53 expression (p<0.001). Multivariate analysis revealed that EBV infection alone (hazard ratio [HR], 0.362; 95% CI, 0.131 to 0.996; p=0.049) and lower third location (HR, 0.624; 95% CI, 0.413 to 0.943; p=0.025) were inversely correlated with overall survival. During median follow-up period of 72 months, overall survival rate was not significantly different between the EBV and HP coinfection group and others (97.6% vs 86.8%, log-rank p=0.144). In non-GCLS patients (n=920), overall survival rate was not significantly different between the EBV infection group and others (96.9% vs 86.4%, log-rank p=0.126). Conclusions: EBV and HP coinfection is not an independent prognostic factor for gastric cancer. EBV infection status, regardless of HP infection, affects the clinicopathologic features of all types of gastric cancer. However, it does not lead to a significant difference in overall survival of nonGCLS patients. [ABSTRACT FROM AUTHOR]

Background/Aims: Postprocedural bleeding is known to be relatively low after argon plasma coagulation (APC) for gastric neoplasms; however, there are few studies proving the effect of antithrombotic agents. This study aimed to analyze the incidence of delayed bleeding (DB) based on antithrombotic agents administered and to identify the risk factors for DB in APC for gastric tumors. Methods: A total of 785 patients with 824 lesions underwent APC for single gastric neoplasm between January 2011 and January 2018. After exclusion, 719 and 102 lesions were classified as belonging to the non-antithrombotics (non-AT) and AT groups, respectively. The clinical outcomes were compared between the two groups, and we determined the risk factors for DB in gastric APC. Results: Of the total 821 cases, DB occurred in 20 cases (2.4%): 17 cases in the non-AT group and three cases in the AT group (2.4% vs 2.9%, p=0.728). Multivariate analysis of the risk factors for DB confirmed the following significant, independent risk factors: male sex (odds ratio, 7.66; 95% confidence interval, 1.02 to 57.69; p=0.048) and chronic kidney disease (odds ratio, 4.51; 95% confidence interval, 1.57 to 13.02; p=0.005). Thromboembolic events and perforation were not observed in all patients regardless of whether they took AT agents. Conclusions: AT therapy is acceptably safe in gastric APC because it does not significantly increase the incidence of DB. However, patients with chronic kidney disease or male sex need to receive careful follow-up on the incidence of post-APC bleeding. [ABSTRACT FROM AUTHOR]

Background/Aims: Data regarding the prognosis of early esophageal cancer are lacking. This study investigated the long-term outcomes and factors affecting the survival of patients with mucosal esophageal squamous cell carcinoma (T1aESCC). Methods: We analyzed the clinical and tumor-specific parameters of 263 patients who received surgical resection (SR; n=63) or endoscopic resection (ER; n=200) for T1aESCC. Underlying comorbidities were scored using the Charlson comorbidity index (CCI). Overall survival (OS) was the primary outcome, and multivariate regression analysis was performed to predict factors for OS. Results: Of the study patients (age, 64.5±8.0 years), the CCI was 1.0±1.4 in the ER group and 0.6±0.9 in the SR group (p=0.107). The 5-year OS rate during follow-up (54.4±20.4 months) was 85.7% (ER group, 86.8%; SR group, 82.4%; p=0.631). The cumulative 5-year incidence of esophageal cancer recurrence was 10.5% in the ER group (vs 0% in the SR group). The overall mortality rate was 12.9% (ER group, 12.0%; SR group, 15.9%; p=0.399). The most common cause of mortality was second primary cancers in the ER group (75%) and organ dysfunction or postoperative complications in the SR group (70%). According to multivariate analysis, only CCI was significantly associated with OS (p<0.001). The 5-year OS rate in patients with a CCI >2 and in those with a CCI ≤2 was 60.2% and 88.2%, respectively (p<0.001). The treatment method (ER vs SR) was not a significant affecting factor (p=0.238). Conclusions: The long-term prognosis of patients with T1aESCC was significantly associated with underlying comorbidities. [ABSTRACT FROM AUTHOR]

The effects of 17β-estradiol (E2) were evaluated in ICR male mice 4 weeks after AOM/DSS treatment. Histological damage was scored by hematoxylin and eosin staining and the levels of the colonic mucosal cytokine myeloperoxidase (MPO) were assessed by enzyme-linked immunosorbent assay (ELISA). To evaluate the effects of E2 on intestinal permeability, tight junctions, and inflammation, we performed quantitative real-time polymerase chain reaction and Western blot analysis. Furthermore, the expression levels of mucin 2 (MUC2) and mucin 4 (MUC4) were measured as target genes for intestinal permeability, whereas zonula occludens 1 (ZO-1), occludin (OCLN), and claudin 4 (CLDN4) served as target genes for the tight junctions. Results: The colitis-mediated induced damage score and MPO activity were reduced by E2 treatment (p<0.05). In addition, the mRNA expression levels of intestinal barrier-related molecules (i.e., MUC2, ZO-1, OCLN, and CLDN4) were decreased by AOM/DSS-treatment; furthermore, this inhibition was rescued by E2 supplementation. The mRNA and protein expression of inflammation-related genes (i.e., KLF4, NF-κB, iNOS, and COX-2) was increased by AOM/DSS-treatment and ameliorated by E2. Conclusions: E2 acts through the estrogen receptor β signaling pathway to elicit anti-inflammatory effects on intestinal barrier by inducing the expression of MUC2 and tight junction molecules and inhibiting pro-inflammatory cytokines. [ABSTRACT FROM AUTHOR]

Background/Aims: We aimed to investigate whether the current indications for curative endoscopic resection (ER) of gastric cancer (GC) can be applied to GC caused by adenoma. Additionally, we attempted to identify factors predictive of lesions subsequently found in addition to the expanded indications for ER. Methods: We retrospectively analyzed 342 patients diagnosed with GC caused by adenoma who underwent ER at a single tertiary center between February 2011 and December 2014. The gross whole tumor size was measured using the endoscopically resected specimen. The microscopic whole tumor size was measured using mapping paper. The estimated cancer size was calculated using the microscopic whole tumor size and the square root of the carcinoma component. Results: A gross whole tumor size ≥3 cm, carcinoma component ≥35%, and gross ulceration were predictive of lesions other than the expanded indications for ER. The overall rate of lymph node metastasis was 0.3% (1/327), which only occurred in one patient with a lesion other than the expanded indications (4.5%, 1/22). Conclusions: The current indications for curative ER in GC can be applied to GC caused by adenoma. In cases suspected of having lesions other than the expanded indications, patients should be cautiously selected for ER to reduce the risk of an inappropriate procedure. [ABSTRACT FROM AUTHOR]

Background/Aims: We used three-dimensional (3D) printing technology to create a new biopsy simulator for the stomach and investigated its efficacy and realism in endoscopic biopsy training. Methods: A novel stomach biopsy simulator, with 10 biopsy sites, was produced using a 3D printer. We enrolled 26 participants, including 10 residents, six firstyear fellows, five second-year fellows, and five faculty members. We recorded and reviewed five training sessions and evaluated the simulator with questionnaires using a 7-point Likert scale. Results: The mean completion time (seconds) was 244.8±11.5 for the residents, 107.9±33.4 for the firstyear fellows, 106.8±20.1 for the second-year fellows, and 103.8±19.2 for the faculty members. The completion time became shorter with repetition and was significantly lower for residents by the fifth trial (first trial, 347.0±159.5; fifth trial, 169.6±57.7; p=0.007). The faculty members strongly agreed that the simulator realistically reflected endoscopic handling and was reasonable for endoscopic training (scores of 6.2±0.8 and 6.4±0.9, respectively). Importantly, experienced endoscopists reported that the difficulty levels of the 10 biopsy sites in the simulator were a realistic match for the actual stomach. Conclusions: This endoscopic biopsy simulator created using a 3D printer is a realistic and useful method to improve the biopsy skills of trainee endoscopists. [ABSTRACT FROM AUTHOR]

Background/Aims: We developed a new endoscopic biopsy training simulator and determined its efficacy for improving the endoscopic biopsy skills of beginners. Methods: This biopsy simulator, which presents seven biopsy sites, was constructed using readily available materials. We enrolled 40 participants: 14 residents, 11 first-year clinical fellows, 10 second-year clinical fellows, and five staff members. We recorded the simulation completion time for all participants, and then simulator performance was assessed via a questionnaire using the 7-point Likert scale. Results: The mean times for completing the five trials were 417.7±138.8, 145.2±31.5, 112.7±21.9, and 90.5±20.0 seconds for the residents, first-year clinical fellows, second-year clinical fellows, and staff members, respectively. Endoscopists with less experience reported that they found this simulator more useful for improving their biopsy technique (6.8±0.4 in the resident group and 5.7±1.0 in the first-year clinical fellow group). The realism score of the simulator for endoscopic handling was 6.4±0.5 in the staff group. Conclusions: This new, easy-to-manufacture endoscopic biopsy simulator is useful for biopsy training for beginner endoscopists and shows good efficacy and realism. [ABSTRACT FROM AUTHOR]

Background/Aims: We investigated the effectiveness of Helicobacter pylori eradication therapy for gastric mucosaassociated lymphoid tissue (MALT) lymphoma regardless of the H. pylori infection status or disease stage. Methods: From November 1995 to September 2014, 345 subjects who were diagnosed with gastric MALT lymphoma and had received eradication therapy as their first-line treatment were eligible for inclusion in this study. A retrospective review was performed using the medical records. Results: Of the 345 patients, H. pylori infection was detected in 317 patients (91.9%). The complete remission (CR) rate after eradication therapy was 82.3%, which was higher in H. pylori -positive patients than in H. pylori-negative patients (84.5% vs 57.1%, p=0.001). CR rates after eradication did not present significant differences between stages, and the CR rate was 83.3% for stage IE1 and 74.4% for stage IE2 or above (p=0.167). The overall CR rate was 87.2% after additional treatment, and neither H. pylori infection status nor stage showed differences according to the treatment response. Conclusions: Eradication therapy led to CR in 57.1% of H. pylori-negative patients and in 74.4% of patients with stage IE2 or above. Eradication therapy is worthwhile as an initial treatment for gastric MALT lymphoma regardless of the H. pylori infection status and stage. [ABSTRACT FROM AUTHOR]

Background/Aims: The efficacy of surveillance for esophageal squamous cell neoplasia (ESCN) in patients with head and neck squamous cell carcinoma (HNSCC) remains controversial. Our study aimed to provide clinical data concerning the necessity of surveillance for detecting early ESCN in patients with HNSCC. Methods: We retrospectively reviewed the data from 714 patients who were pathologically confirmed as having HNSCC (n=236 oral cavity cancers, 137 oropharyngeal cancers, 87 hypopharyngeal cancers, and 254 laryngeal cancers). Results: Of 714 patients, during a median follow-up of 31 months, 48 ESCNs (37 synchronous and 11 metachronous) were detected in 36 patients (5%). Fifteen synchronous lesions (40.3%) were early ESCN, whereas nine metachronous lesions (81.8%) were early ESCN. The 3-year survival rates of HNSCC only and HNSCC combined with ESCN were 71.2% and 48.2%, respectively (p<0.001). Among 36 patients with ESCN, the 3-year survival rates for early and advanced ESCN were 77.7% and 21.7%, respectively (p=0.01). In the multivariate analysis, alcohol consumption and hypopharyngeal cancer were significant factors associated with the development of ESCN. Conclusions: HNSCC patients with early ESCN were similar in prognosis with patients without ESCN, in contrast to patients with advanced ESCN. Therefore, surveillance for the early detection of ESCN in patients with HNSCC, especially in alcohol drinkers and those with hypopharyngeal cancer, is warranted. [ABSTRACT FROM AUTHOR]

Background/Aims We aimed to develop endoscopic scoring system to evaluate atrophic gastritis and intestinal metaplasia using narrowing band imaging (NBI) and magnification view and to compare endoscopic scores with operative link for gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM). Methods Total 28 patients underwent diagnostic esophagogastroduodenoscopy were enrolled and endoscopic scoring using NBI and magnification view were performed. Four areas (the lesser and greater curvatures of the antrum and the lesser and greater curvature side of the body) were observed and biopsies were taken. Degree of atrophy was scored from 0 to 2 according to Kimura-Takemoto classification (0, C0-2; 1, C3-O1; 2, O2-3). Degree of metaplasia was scored from 0 to 3 (0, no metaplasia; 1, metaplasia at antrum; 2, metaplasia at body; +1, 1/2 >observed filed). Endoscopic scores were compared to OLGA and OLGIM staging. Results Correlation coefficients for atrophy between endoscopic and histologic scores 0.85 (95% confidence interval [CI], 0.70 to 0.93; p<0.001) and those for metaplasia was 0.74 (95% CI, 0.85 to 0.87; p<0.001). For atrophic gastritis, endoscopic score >1 correlated OLGA Stage III and IV with a sensitivity, specificity, positive predictive value, and negative predictive value of 92%, 88%, 86% and 93%, respectively and for metaplasia, endoscopic score >1 correlated high OLGIM Stage III and IV with those values of 78%, 100%, 100% and 73%, respectively. Conclusions Endoscopic scoring for gastric atrophy and intestinal metaplasia using NBI-magnification view seems to correlate well with histologic staging. [ABSTRACT FROM AUTHOR]

Background/Aims Benign esophageal stricture has been treated with endoscopic methods; and balloon dilation (BD) is common modality for treating stricture. However, recurrent refractory esophageal stricture after balloon dilatation have been reported and it impairs quality of life of patients. The aim of this study was to evaluate efficacy and safety of endoscopic incisional therapy (EIT) compared to BD for anastomotic stricture after total gastrectomy. Methods Subjects who underwent EIT or BD as a first treatment for esophagojejunostomy anastomotic stricture after total gastrectomy between January 2010 and December 2017 were eligible. The medical records were retrospectively reviewed and clinical characteristics were investigated. Stricture was defined as an inability to pass a conventional endoscope. The stricture area was incised under direct vision with the nano-insulated-tip knife in a radial fashion parallel to the longitudinal axis of the esophagus. Results Twenty-one patients presented benign anastomotic stricture after total gastrectomy. BD group included 12 patients and EIT group included nine patients who underwent EIT with or without BD. Among the nine patients in EIT group, three patients received additional BD immediately after EIT. Re-stricture rate showed significant difference between BD group and EIT group (41.7% vs 0%, p=0.045). Between two groups, there were no significant differences in procedure time, interval from surgery to first stricture, hospitalization period, and complication rates. One patient developed microperforation during BD and clipping was done to the site without undergoing surgical intervention. Conclusions EIT is a feasible, safe and effective treatment modality compared to BD for esophagojejunostomy anastomotic stricture after total gastrectomy showing significant lower re-stricture rate. [ABSTRACT FROM AUTHOR]

Background/Aims Endoscopic surveillance after total gastrectomy (TG) for gastric cancer is routinely performed for detecting tumor recurrence or adverse effects of surgery. But, there were only a few reports for clinical benefits of endoscopic surveillance. We investigated the necessity for endoscopic surveillance after TG for gastric cancer. Methods We enrolled 388 patients with early gastric cancer and 461 with advanced gastric cancer who underwent TG with R0 resection for gastric cancer between 2011 and 2012, and received regular surveillance programs after TG including endoscopy and abdominopelvic computed tomography (CT) with contrast. Results Median follow-up period of abdominopelvic CT was 52± 22.5 months and endoscopy was 53.4 23.4 months. Tumor recurrence occurred in 167 patients (19.6%). Of 167 patients, only locoregional recurrence was observed in five patients (2.9%). All only locoregional recurrence was detected by both endoscopy and abdominopelvic CT. Of detectable postoperative adverse effects by endoscopic or radiologic studies, benign stricture in the anastomotic site was observed by endoscopy in only three patients. Conclusions Endoscopic surveillance after TG with R0 resection for gastric cancer is a limited role for the oncologic outcome or postoperative adverse effects. [ABSTRACT FROM AUTHOR]

Background/Aims Endoscopic resection (ER) can be applied for small gastric SETs. Gastrointestinal stromal tumors (GISTs) can be diagnosed pathologically after resection. Initially we used endoscopic submucosal dissection (ESD). Submucosal tunneling endoscopic resection (STER) was introduced for overcoming limitations of ESD. However, STER was very difficult to apply for gastric lesions. We developed new ER method, clip-assisted surgical endoscopy (CASE, Jung's method). In this study, we evaluate the feasibility of ER for GISTs and compared three ER methods. Methods Medical records of 53 patients who diagnosed GISTs after ER for SETs from 2005 to 2019 were reviewed retrospectively. Average age was 60.0±10.6 years. ESD, STER and CASE were performed for 23, 5, and 25 patients, respectively. Clinical characteristics, procedure times, and outcomes of each endoscopic technique were analyzed. Results Average pathological size of GIST was 2.1 cm. The 94.3% proved to be very low risk of malignant potential. Location of SETs were different; ESD applied mainly for body lesions, STER tried for fundus lesions, CASE also mainly for fundus and high body lesions. Overall R0 and R1 resection rate was 62.3%, and 35.8%. There are 34 patients who had complications after the procedure (21 micro-perforation, 12 macro-perforation, one bleeding), but perforation would be a part of ER procedure for SETs. In ESD, some macro- perforations were a reason for surgical conversion. Four patients (two, ESD; one, STER; one, CASE) underwent surgical conversion during ER. STER had the longest procedure time (50.3, 95.2, 40.7 minutes, p=0.018). After development of CASE, we can reduce procedure time and on-site surgical conversion. R0 resection rate was highest in CASE. No R1 resected patients were recurred so far. Conclusions ER seems to be safe and effective therapeutic options for small gastric GISTs. Using CASE (Jung's method), ER would be more comfortable especially in the fundus lesions. [ABSTRACT FROM AUTHOR]

Background/Aims Gastro-esophageal reflux disease questionnaire (GerdQ) has been developed for diagnosis of gastro-esophageal reflux disease (GERD). Recently published Lyon GERD consensus defines parameters on esophageal testing that conclusively establish the presence of GERD. However, Lyon GERD consensus criteria was not validated in Asian population. Therefore, we aimed to validate the Lyon GERD consensus criteria using GerdQ. Methods Patients with suggestive GERD symptoms were enrolled in the study. They underwent pH monitoring, upper endoscopy and asked to GerdQ between January 2018 and July 2019. Patients previously treated with surgical or endoscopic treatment were excluded. The results of pH monitoring and endoscopic grade of esophagitis were analyzed according to the Lyon consensus criteria. Results A total of 181 patients (male:female, 71:110; median age, 57 years) were included and 114 patients (63.0%) had GerdQ score over 8. On the pH monitoring, 13.8% of patients had acid exposure time (AET) over 6%, 7.2% had AET 4% to 6%. On endoscopic finding, 0.6% patients had grade C or D esophagitis; 13.2% had grade A or B esophagitis; and 1.1% had Barrett's esophagus. By Lyon consensus, 26 patients (14.4%) were classified as conclusive evidence of GERD, 102 patients (56.3%) were against GERD, 50 patients (27.6%) were borderline or inconclusive, and three patients (1.7%) were adjunctive or supportive. The GerdQ was not correlated with Lyon consensus criteria (rho=-0.050, p=0.507) but positively correlated with endoscopic esophagitis grade (rho=0.236, p=0.001). Conclusions Despite high rate of GerdQ over 8, proportion of conclusive evidence of GERD and higher grade of reflux esophagitis were low. GerdQ and Lyon consensus criteria showed poor correlation to each other. The development of criteria suitable for Korea's situation is warranted. [ABSTRACT FROM AUTHOR]