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Background/Aims: This study aimed to review the indications, methods, cooperation, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG). Methods: Questionnaires were sent to 200 hospitals, of which 62 returned their questionnaires, with a response rate of approximately 30%. Descriptive statistics were calculated to analyze the responses to the questionnaires. Results: In 2019, a total of 1,052 PEGs were performed in 1,017 patients at 62 hospitals. The main group who underwent PEG was older adult patients with brain disease, particularly stroke. Nutritional supply was an important purpose of the PEG procedure. “The pull method” was the most commonly used for initial PEG insertion. The complications related to PEG were mostly mild, with leakage being the most common. Patients who underwent PEG procedures were primarily educated regarding the post-procedure management and complications related to PEG. Preoperative meetings were skipped at >50% of the institutions. Regarding the cooperation between the nutrition support team (NST) and the physician performing PEG, few endoscopists answered that they cooperated with NST before and after PEG. Moreover, the rate of NST certification obtained by physicians performing PEG and the frequency of attendance at NST-related conferences were relatively low. Conclusions: This study shows a similar trend to that found in the previous PEG guidelines. However, it covers new aspects, including team-based work for PEG procedure, nutrition support, and education for patients and guardians. Therefore, each medical institution needs to select an appropriate method considering the medical environment and doctor’s abilities. [ABSTRACT FROM AUTHOR]

Background/Aims: Some cases of gastric low-grade dysplasia (LGD) and high-grade dysplasia (HGD) on forceps biopsy (FB) are diagnosed as gastric cancer (GC) after endoscopic resection (ER). This study aims to evaluate the clinical outcomes of ER for gastric LGD and HGD on pretreatment FB and to identify the factors that predict pathologic upstaging to GC. Methods: Patients who underwent ER for LGD and HGD on pretreatment FB from March 2005 to February 2018 in 14 hospitals in South Korea were enrolled, and the patients' medical records were reviewed retrospectively. Results: This study included 2,150 cases of LGD and 1,534 cases of HGD diagnosed by pretreatment FB. In total, 589 of 2,150 LGDs (27.4%) were diagnosed as GC after ER. Helicobacter pylori infection, smoking history, tumor location in the lower third of the stomach, tumor size >10 mm, depressed lesion, and ulceration significantly predicted GC. A total of 1,115 out of 1,534 HGDs (72.7%) were diagnosed with GC after ER. Previous history of GC, H. pylori infection, smoking history, tumor location in the lower third of the stomach, tumor size >10 mm, depressed lesion, and ulceration were significantly associated with GC. As the number of risk factors predicting GC increased in both LGD and HGD on pretreatment FB, the rate of upstaging to GC after ER increased. Conclusions: A substantial proportion of LGDs and HGDs on pretreatment FB were diagnosed as GC after ER. Accurate ER procedures such as endoscopic submucosal dissection should be recommended in cases of LGD and HGD with factors predicting pathologic upstaging to GC. [ABSTRACT FROM AUTHOR]

Background/Aims: Knowledge regarding the quality metrics of fecal immunochemical test (FIT)-based colorectal cancer screening programs is limited. The aim of this study was to investigate the performance and quality metrics of a FITbased screening program. Methods: In our screening program, asymptomatic subjects aged ≥50 years underwent an annual FIT, and subjects with positive FIT results underwent a subsequent colonoscopy. The performance of the FIT and colonoscopy was analyzed in individuals with a positive FIT who completed the program between 2009 and 2015 at a university hospital. Results: Among the 51,439 screened participants, 75.1% completed the FIT. The positive rate was 1.1%, and the colonoscopy completion rate in these patients was 68.6%. The positive predictive values of cancer and advanced neoplasia were 5.5% and 19.1%, respectively. The adenoma detection rate in the patients who underwent colonoscopy after a positive FIT was 48.2% (60.0% for men and 33.6% for women). The group with the highest tertile quantitative FIT level showed a significantly higher detection rate of advanced neoplasia than the group with the lowest tertile (odds ratio, 2.6; 95% confidence interval, 1.4 to 5.1; p<0.001). Conclusions: The quality metrics used in the United States and Europe may be directly introduced to other countries, including Korea. However, the optimal quality metrics should be established in each country. [ABSTRACT FROM AUTHOR]

Background/Aims The human gut microbiota serves as an important component in the pathogenesis of Crohn's disease (CD) that promote host-microbe imbalances leading to perturbed intestinal and immune homeostasis. In this study, we aimed to assess the potential clinical usefulness of using the colonic tissue microbiome by which biomarkers for upper gastrointestinal (UGI) involvement of CD could be obtained. Methods We analyzed colonic tissue samples from 26 patients with CD, including 13 with and 13 without UGI involvement at diagnosis from the Inflammatory Bowel Disease Multi-Omics Database. Metagenomic analysis of the V3-V4 region of the 16S ribosomal RNA gene was performed using QIIME1, DiTaxa and linear discriminant analysis effect size (LEfSe) method. Results Non-metric multidimensional scaling using Bray-Curtis distances revealed a complex pattern of community structures. There were no statistically significant differences in the community richness estimator (Chao) and the diversity estimator (Shannon index) between the CD patients with and without UGI involvement. The overall abundance of the genus Bacteroides was significantly increased in the patients with UGI involvement compared with those without UGI involvement. Taxa predicted by DiTaxa had the species Ruminococcus torques as significantly associated with UGI involvement, which was confirmed based on the LEfSe analysis (p=0.025). Conclusions These finding suggest that the species Ruminococcus torques might serve as a novel potential biomarker for UGI involvement of CD and its correlations in abundance with a range of bacterial species. The mechanisms of interactions between hosts and Ruminococcus torques should be further investigated. [ABSTRACT FROM AUTHOR]

Background/Aims Population screening for colorectal cancer (CRC) is expected to increase the number of early stage tumor. The identification of simplified prediction model for lymph node metastasis (LNM) for early CRC is urgently needed to determine the treatment and follow-up strategies. This study aims to develop an accurate prediction model for the LNM in early CRC. Methods We used data from the 2004 to 2016 Surveillance, Epidemiology, and End Results database to develop and validate the prediction models for LNM. Six models, namely, neural network, naïve-Bayesian, Support vector machines, logistic regression, decision tree, and random forest (RF) models were assessed. Results A total of 32,725 patients with a diagnosis of early CRC (Tis and T1) were analyzed in the study. The model included eight independent prognostic variables, including age at diagnosis, sex, race, primary site, histologic type, tumor grade, tumor size, and tumor depth. LNM was significantly more frequently in patients with larger tumor, in elderly patients, and in patients with more poorly differentiated tumor. The RF algorithm had the best predictive performance in comparison to the other methods, achieving an accuracy of 94.7%, a sensitivity of 71.4%, a specificity of 92.2%, and an area under the curve of 0.90. Conclusions Our data show that the age at diagnosis is the most important feature in predicting LNM of early CRC in the RF model. We established a simplified reproducible predictive model for LNM in early CRC that could be used to guide treatment decisions. [ABSTRACT FROM AUTHOR]