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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: Few studies have investigated the long-term outcomes of endoscopic resection for early gastric cancer (EGC) in very elderly patients. The aim of this study was to determine the appropriate treatment strategy and identify the risk factors for mortality in these patients. Methods: Patients with EGC who underwent endoscopic resection from 2006 to 2017 were identified using National Health Insurance Data and divided into three age groups: very elderly (≥85 years), elderly (65 to 84 years), and non-elderly (≤64 years). Their long- and short-term outcomes were compared in the three age groups, and the survival in the groups was compared with that in the control group, matched by age and sex. We also evaluated the risk factors for long- and short-term outcomes. Results: A total of 8,426 patients were included in our study: 118 very elderly, 4,583 elderly, and 3,725 non-elderly. The overall survival and cancer-specific survival rates were significantly lower in the very elderly group than in the elderly and the non-elderly groups. Congestive heart failure was negatively associated with cancer-specific survival. A significantly decreased risk for mortality was observed in all groups (p<0.001). The very elderly group had significantly higher readmission and mortality rates within 3 months of endoscopic resection than the non-elderly and elderly groups. Furthermore, the cerebrovascular disease was associated with mortality within 3 months after endoscopic resection. Conclusions: Endoscopic resection for EGC can be helpful for very elderly patients, and it may play a role in achieving overall survival comparable to that of the control group. [ABSTRACT FROM AUTHOR]

Background/Aims: The treatment goal of ulcerative colitis (UC) has been changed to achieve endoscopic remission (ER). However, there is insufficient clinical evidence to determine whether a step-up treatment should be performed to achieve ER in clinical remission (CR) without ER, and there are inadequate data on the need to consider the distribution and severity of residual inflammation. This retrospective study aimed to evaluate the prognostic significance of the distribution and severity of residual inflammation in UC patients in CR. Methods: A total of 131 UC patients in CR who underwent endoscopic evaluation for more than three times between January 2000 and December 2018 were reviewed. The patients were allocated by the endoscopic healing state and the distribution of inflammation to ER (n=31, 23.7%), residual nonrectal inflammation with patchy distribution (NRI) (n=17, 13.0%) or residual rectal involvement with continuous or patchy distribution (RI) (n=83, 63.3%) groups. We reviewed clinical characteristics, endoscopic findings, and factors associated with poor outcome-free survival (PFS). Results: In UC patients in CR, PFS was significantly higher in the ER and NRI groups than in the RI group (p=0.003). Patients in the ER and NRI groups had similar PFS (p=0.647). Cox proportional hazard model showed only RI (hazard ratio, 5.76; p=0.027) was associated with a higher risk of poor outcome. Conclusions: We suggest that escalation of treatment modalities may be selectively performed in consideration of the residual mucosal inflammation pattern, even if ER has not been achieved, in UC patients with CR. [ABSTRACT FROM AUTHOR]

Background/Aims: The quality of bowel preparation is important for optimal colonoscopy. It is influenced by medical and personal factors. We aimed to evaluate the effect of bowel habit on the quality of bowel preparation and to identify predictors of inadequate bowel preparation among bowel habit factors. Methods: From June 2017 to September 2017, 90 volunteers were enrolled in this study. Each participant answered a questionnaire consisting of multiple questions about personal bowel habits, including stool form, frequency of bowel movements per week, duration, and degree of straining for bowel movement. Then, all volunteers underwent colonoscopic exam. Eleven endoscopists performed colonoscopies and used the Boston Bowel Preparation Scale (BBPS) as the index for bowel preparation. Two expert endoscopists simultaneously reviewed all colonoscopic images to confirm the final BBPS. Univariate and multivariate logistic regression analyses were performed to verify the correlation between bowel preparation adequacy and bowel habit. Results: Among the 90 participants, 20 (22.2%) had inadequate bowel preparation (total BBPS ≤6 or any segmental BBPS ≤1). In univariate analysis, infrequent bowel movement (0-2/week) (odds ratio [OR], 12.60; 95% confidence interval [CI], 1.22 to 129, p=0.03) and moderate straining (more than 1/4 of defecations) (OR, 4.40; 95% CI, 1.44 to 13.39; p=0.01) were significantly associated with inadequate bowel preparation. However, only moderate straining was significantly associated with inadequate bowel preparation in multivariate analysis (OR, 3.99; 95% CI, 1.26 to 12.65; p=0.02). Conclusions: Straining is a significant predictor for inadequate bowel preparation. For patients with straining during bowel movements, an intensified preparation regimen should be considered. [ABSTRACT FROM AUTHOR]

Background/Aims: Studies concerning the efficacy and safety of single-balloon enteroscopy (SBE) compared with that of double-balloon enteroscopy (DBE) often appear to be conflicting. However, previous studies were performed by endoscopists who were less experienced in SBE compared with DBE. Methods: We performed a retrospective analysis of SBE and DBE data performed by a single enteroscopist, with expertise in SBE, using a prospective balloon-assisted enteroscopy registry from 2013 to 2015. Furthermore, we performed a comprehensive literature search and meta-analysis of available studies, including the current study, to clarify the efficacy and safety of SBE versus DBE. Results: A total of 65 procedures in 44 patients with SBE and 74 procedures in 69 patients with DBE were analyzed. There were no significant differences in diagnostic yield (61.1% vs 77.3%, respectively, p=0.397), therapeutic yield (39.1% vs 31.8%, respectively, p=0.548), and complication rate (4.4% vs 2.3%, p=1.000). In the meta-analysis, which included four randomized controlled trials and three observational studies, there were no significant differences in the pooled relative risk and odds ratio for diagnostic and therapeutic yield and complications of SBE compared with those of DBE. Conclusions: The performance of SBE appears to be similar to that of DBE in terms of diagnostic and therapeutic yield and complications. [ABSTRACT FROM AUTHOR]

Background/Aims Helicobacter pylori infection may be associated with extra-digestive diseases such as coronary artery disease, nonalcoholic fatty liver disease and autoimmune disease. Many studies used serological tests to diagnose of H. pylori infection, but these methods detected past and current infection. The aim of this study was to determine the correlation between current infection of H. pylori and autoimmune thyroid disease. Methods A retrospective, cross-sectional study was conducted with those who received screening esophagogastroduodenoscopy between January 1, 2010 and December 31, 2018. The subjects were categorized into two groups that were H. pylori infected group and no H. pylori infected group. Anti-thyroid peroxidase (anti-TPO) antibody was compared as the primary outcome between two groups. Also, thyroid-stimulating hormone, free thyroxine, rheumatoid factor (RF) levels and thyroid function were compared. Results A total of 43,321 subjects were included in the analysis. The number of H. pylori positive subjects was 15,927 and H. pylori negative was 27,394. Anti-TPO antibodies positive rate of H. pylori positive group was 8.27% (n=1,317) and H. pylori negative group was 9.47% (n=2,595) in the univariate analysis (p<0.0001). In the multivariate analysis, the positive rate of anti-TPO antibody in the H. pylori positive group was significantly lower (odds ratio, 0.877; 95% confidence limits, 0.818 to 0.941; Pr >chi-square 0.0002) than in the H. pylori negative group and RF positive rate in the H. pylori positive group was significantly lower (odds ratio, 0.898; 95% confidence limits, 0.74 to 0.86; Pr >chi-square <0.0001) than in the H. pylori negative group when age, sex and body mass index were adjusted as covariates. Conclusions Current H. pylori infection had a statistically significant effect on the positive rate of anti-TPO antibody and RF inversely. [ABSTRACT FROM AUTHOR]

Background/Aims Proton-pump inhibitor (PPI) use alters small intestinal bacterial overgrowth and may induce increased portal endotoxins and increase the risk of fatty liver disease, but the association of PPI use with the risk of fatty liver disease has been controversial. Therefore, we evaluated the prospective association between PPI use and the incidence of fatty liver. Methods Cohort study conducted using the Korean National Health Insurance Service-National Sample Cohort, a nationwide population-based representative sample followed-up from January 1, 2003 to December 31, 2013. PPI use was identified from treatment claims and considered as a time-varying variable. Incident fatty liver disease was identified from outpatient visit claims (ICD-10 diagnosis codes K76.0 or K70.0). Results The age-, sex-, body mass index, residential area-, and income percentiles-adjusted hazard ratio (HR) for incident cholangitis comparing use versus no use of PPI was 1.41 (95% confidence interval [CI], 1.33 to 1.49). The association persisted after further adjustment for smoking, alcohol habit, Charlson comorbidity index score, and year of screening exam (HR, 1.35; 95% CI, 1.28 to 1.43). Conclusions In this large cohort, PPI use was associated with an increased risk of fatty liver. Physicians prescribe PPI should consider fatty liver as a potential complication of PPI use. [ABSTRACT FROM AUTHOR]

Background/Aims Obesity is an established risk factor of erosive esophagitis and metabolic unhealthiness has been implicated in the pathogenesis of erosive esophagitis. Yet, the risk of erosive esophagitis among obese individuals without obesity-related metabolic unhealthiness, a condition referred to as metabolically healthy obese (MHO), remains unclear. We examined the association between body mass index (BMI) categories and the development of erosive esophagitis in a cohort of metabolically healthy individuals. Methods We conducted a cohort study of 14,725 asymptomatic adults free of erosive esophagitis and metabolic abnormalities, who underwent repeated health check-ups including screening endoscopy. A metabolically healthy state was defined as having no metabolic syndrome components and a homeostasis model assessment of insulin resistance <2.5. The presence of erosive esophagitis was determined using endoscopy. Results During 81,385.2 person-years of follow-up, 1,865 participants developed erosive esophagitis (incidence rate, 22.9 per 1,000 person-years). The multivariable adjusted hazard ratios (95% confidence intervals) for incident erosive esophagitis comparing overweight (BMI, 23.0-24.9 kg/m2) and obese (≥25 kg/m2) with normal-weight participants (18.5-22.9 kg/m2) were 1.12 (1.00-1.25 kg/m2) and 1.29 (1.14-1.47 kg/m2), respectively. In dose-response analyses, increasing BMI also showed positive association with overall and LA-B grade or higher. The association persisted in MHO individuals without central obesity. The association between waist circumference categories and the development of erosive esophagitis was also evident. Conclusions In a large cohort of strictly defined metabolically healthy men and women, the MHO phenotype was associated with an increased incidence of erosive esophagitis, providing evidence that the MHO phenotype is not protective from gastroesophageal reflux disease. [ABSTRACT FROM AUTHOR]

Background/Aims Previous studies have suggested a link between Helicobacter pylori infection and dyslipidemia, yet large-scale longitudinal studies have not elucidated this association. Therefore, we assessed the longitudinal effects of both H. pylori infection and eradication on lipid profiles in a large cohort of asymptomatic men and women. Methods This cohort study included 18,621 adults without dyslipidemia at baseline, who participated in a repeated, regular health screening examination, which included upper gastrointestinal endoscopy, between January 2009 and December 2018. The primary outcome was incident dyslipidemia at follow-up. Results During the 52,992 person-years follow-up, participants with persistent H. pylori infection had a higher incidence rate (177 per 1,000 person-years) of dyslipidemia than those whose infections had been successfully eradicated (158.2 per 1,000 person-years) and those who were uninfected (157.6 per 1,000 person-years). In a multivariable model adjusted for age, sex, body mass index, smoking status, alcohol intake, and baseline levels of low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglyceride, the H. pylori eradication group was associated with a lower risk of dyslipidemia than the persistent group (hazard ratio, 0.89; 95% confidence interval, 0.82 to 0.96; p=0.005). The risk of dyslipidemia in the eradication group was similar to that of participants uninfected with H. pylori (p=0.245). Conclusions Persistent H. pylori infection was significantly associated with the risk of dyslipidemia. H. pylori infection may play a pathophysiologic role in the development of dyslipidemia and H. pylori eradication might decrease the risk of dyslipidemia. [ABSTRACT FROM AUTHOR]

Background/Aims The advancement of therapeutic agent has made it possible to achieve endoscopic remission in inflammatory bowel disease. Consequently, the treatment goal of ulcerative colitis (UC) also has been changed to achieve endoscopic remission (ER). However, there was insufficient clinical evidence to whether a step-up treatment should be performed to achieve ER in clinical remission (CR) without ER. And there is inadequate data on the need to consider the distribution and severity of residual inflammation in UC. This retrospective study aimed to evaluate the prognostic significance (such as step-up therapy, hospitalization, and colectomy) of the distribution and severity of residual inflammation in UC patients with CR. Methods A total of 134 UC patients who underwent endoscopic evaluation in CR and underwent colonoscopy more than three times between January 2000 and December 2018 were retrospectively reviewed. Patients were allocated by endoscopic healing state and distribution of inflammation to an ER (n=33, 24.6%), patch distribution (n=17, 12.7%) or rectal involvement (n=84, 62.7%). We reviewed patient's characteristics, endoscopic findings and ascertain poor outcome-free survival (PFS) until June 2019. Results In UC patient with CR, the PFS was significantly better in ER and patch distribution (p=0.003). ER and patch distribution had similar PFS (p=0.683). The baseline clinical characteristics of the patch distribution and rectal involvement were not significantly different except for the pattern of residual inflammation (p<0.001). Multivariable analysis showed that ER and patch distribution was a good prognostic factor of PFS for UC with CR (hazard ratio, 0.11; p=0.035). Conclusions There was no statistically significant difference in the PFS between ER and patch distribution in the CR state of UC patients. Therefore, we propose selective escalation of treatment modality in CR patients, even if they do not reach ER. [ABSTRACT FROM AUTHOR]