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Background: Valid and reliable methods for measurement of lesion sizes during endoscopy have not been established., Methods: We developed a novel software program (ENDOVER; Poinbionics, Seoul, Republic of Korea) to measure lesions sizes and assessed its validity and reliability. To validate the program, we measured standard coin sizes and estimated measurement errors. To assess program reliability, 32 pictures of endoscopically resected specimens were used to measure tissue sizes six times in a 24-h interval by two examiners. Intraclass correlation coefficients (ICCs) were used to assess intraobserver and interobserver agreements. Agreement between the program and pathological measurements was assessed by absolute differences., Results: The nominal standard sizes of 10-won, 100-won, and 500-won coins were 18.0, 24.0, and 26.5 mm, and the calculated sizes were 18.09, 24.48, and 26.31 mm, respectively. ICCs of the long and short diameters were, respectively, 0.92 [95% confidence interval (CI) 0.87-0.95] and 0.93 (CI 0.89-0.96) for examiner 1 and 0.88 (CI 0.81-0.93) and 0.92 (CI 0.87-0.95) for examiner 2. Interobserver ICCs of the long and short diameters were 0.97 (CI 0.94-0.99) and 0.97 (CI 0.94-0.99), respectively. The mean absolute differences between the program and pathological measurements were 4.4 and 4.7 mm for the long and short diameters, respectively., Conclusions: Our findings indicate that the novel measurement program is a valid and reliable method for estimation of lesion sizes from endoscopic findings during and after examination.

Background: Endoscopic resection (ER) is a widely accepted treatment for patients with early gastric cancer (EGC) with no lymph node metastasis. Occasionally, however, additional surgery is needed due to an incomplete resection. The purpose of this study was to detect clinical factors which might identify patients at greater risk of additional surgery after ER and to suggest an alternative treatment strategy for these patients.Methods: This study retrospectively analyzed 350 patients with gastric cancer who underwent radical gastrectomy and lymphadenectomy after ER in a single institution between July 2004 and July 2014. Risk factors for incomplete resection were identified using binary logistic multiple regression tests and a classification and regression tree analysis.Results: Residual cancer cells were found in the remnant stomach or lymph node in 96 patients (27.4%). In multivariate analysis, lymphovascular invasion (p < 0.001, odds ratio [OR] 5.619) and depth of invasion greater than the second submucosal layer (SM2) (p < 0.01, OR 3.224) were independent risk factors for lymph node metastasis. Positive resection margin (p < 0.001, OR 7.565), depth of invasion to mucosa (M) and the first submucosal layer (SM1) (p < 0.001, OR 4.219), and size over 3 cm (p < 0.029, OR 2.306) were significant risk factors for residual tumor in the remnant stomach. Of 106 patients who had invasion of the M or SM1 without lymphatic invasion at the time of ER, residual cancer was found in 53 patients. Of these 53 patients, 50 (94.3%) had residual cancer in the mucosal layer and only one had lymph node metastasis.Conclusion: In patients with EGC with M or SM1 invasion without lymphovascular invasion at the time of ER, who had an incomplete resection, additional endoscopic treatment or close monitoring can be performed instead of additional surgery, especially in patients who are unable to tolerate gastrectomy, for example elderly patients or those with comorbidities. [ABSTRACT FROM AUTHOR]

Background: The incidence of metachronous lesions after endoscopic resection (ER) of high-grade dysplasia (HGD) has not been evaluated, and optimal surveillance strategy remains vague. This study aimed to evaluate the incidence and characteristics of metachronous tumors including HGD and early gastric cancer (EGC) arising after ER.Patients: The medical records of 2779 patients with 2981 lesions (445 patients with HGD and 2334 patients with EGC) who underwent ER and surveillance endoscopy at Asan Medical Center between April 1999 and December 2011 were retrospectively reviewed, and clinicopathological features of metachronous tumors were analyzed.Results: Ninety-six metachronous lesions (17 HGD and 79 EGC) occurred in 92 patients during median 42 months of follow-up period (range 26-58 months). The 5-year and 10-year overall cumulative incidences of metachronous tumors were 4.6 and 10.5 %, respectively, and were on steady rise up to 10 years. The 5- and 10-year cumulative incidences of metachronous lesions were 4.1 and 8.4 % in HGD group and 4.7 and 11.3 % in EGC group (P = 0.578), respectively. The size of metachronous tumors was significantly smaller than initial lesion (2.3 vs. 1.9 cm, P = 0.039). Lower third of the stomach was most frequent site for both initial and metachronous lesions (77.1 and 70.8 %, respectively) and age was the significant predicting factor for metachronous tumors.Conclusions: Cumulative incidence of metachronous tumors after ER of HGD was comparable to the incidence after ER of EGC. Surveillance endoscopy can be considered at least for 10 years, with special attention on the lower third of the stomach. [ABSTRACT FROM AUTHOR]

OBJECTIVES: There is limited data on whether scoring systems can be used to predict clinical outcomes in patients with upper gastrointestinal bleeding due to Mallory-Weiss syndrome (MWS). We aimed to evaluate whether the Glasgow-Blatchford score (GBS) could be effective in predicting clinical outcomes of bleeding MWS and to investigate the predictive ability of the Forrest classification for rebleeding and assess the effective endoscopic modalities for bleeding control in MWS. METHODS: From January 2004 to December 2012 168 patients were diagnosed with MWS in the Asan Medical Center Emergency Department. We analyzed their clinical outcomes, including endoscopic treatment, transfusion and admission as well as the rates of rebleeding and mortality using GBS and the Forrest classification, retrospectively. RESULTS: Endoscopic treatment was applied to ‡ patients. The GBS was significantly higher in patients treated with endoscopic therapy than in the conservative treatment group (6.8 ± 3.7 vs 5.1 ± 4.7, P=0.011). In patients with a GBS of >6 the rates of endoscopic treatment and rebleeding and the need for transfusion and admission were significantly higher (all P <0.05). The Forrest classification was able to predict recurrent bleeding (area under the receiver operating characteristic curve 0.723, 95% confidence interval 0.609- 0.836, P = 0.025). Hemoclip-based therapy and band ligation achieved higher success rates than did injection therapy alone in preventing rebleeding (96.4%, 88.9% and 71.4%, P=0.013). CONCLUSION: In MWS, GBS might be useful for predicting clinical outcomes and the Forrest classification in predicting recurrent bleeding. [ABSTRACT FROM AUTHOR]