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Background The optimal interval between endoscopic examinations for detecting early gastric neoplasms, including gastric adenomas, has not previously been studied. Objective To clarify the optimal interval between endoscopic examinations for the early diagnosis of both gastric cancers and adenomas. Design Retrospective study. Setting University-affiliated tertiary-care hospital, Seoul, Korea. Patients Patients who were treated for gastric neoplasms between January 2008 and August 2013. Interventions Questionnaire survey for interval between the penultimate endoscopy and diagnosis of a gastric neoplasm. A total of 846 patients were divided into 5 groups according to the interval between endoscopic examinations. Main Outcome Measurements The proportion of gastric neoplasms treated with endoscopic submucosal dissection and the proportion of advanced gastric cancers according to the interval between endoscopic examinations. Results In total, 197, 430, and 219 patients were diagnosed with gastric adenoma, early gastric cancer, and advanced gastric cancer, respectively. In multivariate analysis, the proportion of gastric neoplasms treated with endoscopic submucosal dissection was significantly higher in the ≤12 months, 12 to 24 months, and 24 to 36 months endoscopy interval groups than in the no endoscopy within 5 years group (all P < .001). In addition, the proportion of advanced gastric cancers was significantly lower in the ≤12 months and 12 to 24 months endoscopy interval groups than in the no endoscopy within 5 years group (all P < .001). Limitations Retrospective study and recall bias. Conclusion Annual endoscopy cannot facilitate the detection of endoscopically treatable gastric neoplasms compared with biennial or triennial endoscopy. We recommend biennial endoscopic screening for gastric neoplasms in order to increase the proportion of lesions discovered while they are still endoscopically treatable and to reduce the number of lesions that progress to advanced gastric cancer. [ABSTRACT FROM AUTHOR]

Background/Aims: The aim of this study was to evaluate the outcome of endoscopic dilation for benign anastomotic stricture after radical gastrectomy in gastric cancer patients. Methods: Gastric cancer patients who underwent endo- scopic balloon dilation for benign anastomosis stricture after radical gastrectomy during a 6-year period were reviewed retrospectively. Results: Twenty-one patients developed benign strictures at the site of anastomosis. The majority of strictures occurred within 1 year after surgery (95.2%). The median duration to stenosis after surgery was 1.70 months (range, 0.17 to 23.97 months). The success rate of the first endoscopic dilation was 61.9%. Between the restenosis group (n=8) and the no restenosis group (n=13), there were no significant differences in the body mass index (22.82 kg/ m 2 vs 22.46 kg/m 2 ), interval to symptom onset (73.9 days vs 109.3 days), interval to treatment (84.6 days vs 115.6 days), maximal balloon diameter (14.12 mm vs 15.62 mm), number of balloon dilation sessions (1.75 vs 1.31), location of gastric cancer or type of surgery. One patient required surgery because of stricture refractory to repeated dilation. Conclusions: Endoscopic dilation is a highly effective treatment for benign anastomotic strictures after radical gastrectomy for gastric cancer and should be considered a primary intervention prior to proceeding with surgical revision. [ABSTRACT FROM AUTHOR]

Background/Aims: Solid organ transplant recipients fre-quently report gastrointestinal symptoms, especially heart-burn or dyspepsia. However, the prevalence of endoscopic erosive esophagitis (EE) and associated risk factors after transplantation are unknown. The aim of this study was to determine whether there was a high incidence of endoscopic findings of EE in solid organ transplant recipients. Methods: This retrospective case-control study included 256 of 3,152 solid organ transplant recipients who underwent sequential screening upper endoscopic examinations and an equal number of controls. Results: Forty-four (17.2%) and 16 (6.2%) cases of EE were detected in the solid organ transplant and control groups, respectively (p<0.001). In the multivariate analysis, transplantation was significantly associated with EE (odds ratio [OR], 6.48; 95% confidence interval, 2.74 to 15.35). Factors such as old age (OR, 1.17), the presence of a hiatal hernia (OR, 5.84), an increased duration of immuno-suppression (OR, 1.07), and the maintenance administration of mycophenolate mofetil (OR, 4.13) were independently associated with the occurrence of EE in the solid organ transplant recipients. Conclusions: A significant increase in the incidence of endoscopically detected EE was observed in solid organ transplant recipients. This increased incidence was associated with the type and duration of the immuno-suppressive therapy. [ABSTRACT FROM AUTHOR]

The article offers information on a study that hypothesized that melatonin combined with exercise is beneficial to cerebral ischemia/reperfusion. The study reveals that rats receiving melatonin combined with exercise had reduced neural loss in the primary motor cortex. It shows the association between excessive intervention with melatonin, exercise or their combination and negative effects on ischemia/reperfusion-induced brain damage.

Background: Recently, endoscopic submucosal dissection has been carefully applied in early gastric cancer (EGC) with undifferentiated type. However, there are no individual guidelines for endoscopic treatment of EGCs with poorly differentiated tubular adenocarcinoma or signet ring cell carcinoma. The aim of this study was to investigate and compare the clinicopathologic features of these two types of EGC to guide the application of endoscopic treatment. Methods: Patients to undergo radical gastrectomy for the treatment of EGC were selected for inclusion in this study. Histology was classified according to the Japanese Gastric Cancer Association. Between January 2005 and December 2008, 288 patients with poorly differentiated EGC and 419 patients with signet ring cell EGC were enrolled. Their medical records were reviewed retrospectively. Results: Compared with signet ring cell EGC, poorly differentiated EGC had higher rates of male gender, old age (≥45 years), large tumor length (>20 mm), ulcer, submucosal invasion, lymphovascular invasion, and lymph node metastasis. In the multivariate analyses, poorly differentiated EGC was significantly associated with ulcer (odds ratio [OR]: 2.4, 95% confidence interval [CI]: 1.5-3.8), submucosal invasion (OR: 3.6, 95% CI: 2.6-5.1) and lymphovascular invasion (OR: 2.0, 95% CI: 1.1-3.6) with a reference of signet ring cell EGC. The independent risk factors for lymph node metastasis were large tumor length, submucosal invasion, and lymphovascular invasion in both types of EGC. Young age was an independent risk factor of lymph node metastasis only in poorly differentiated EGC. Conclusions: Poorly differentiated EGC has clinicopathologic features that are less favorable to endoscopic treatment than are those of signet ring cell EGC. Therefore, these two types of EGC should be approached separately, not as a united type of undifferentiated histology, during the planning of endoscopic treatment. [ABSTRACT FROM AUTHOR]

Objective To develop and validate a clinical risk score predictive of risk for colorectal advanced neoplasia for Asia. Methods A prospective, cross-sectional and multicentre study was carried out in tertiary hospitals in 11 Asian cities. The subjects comprise 2752 asymptomatic patients undergoing screening colonoscopy. From a development set of 860 asymptomatic subjects undergoing screening colonoscopy, multiple logistic regression was applied to identify significant risk factors for advanced colorectal neoplasia defined as invasive carcinoma or advanced adenoma. The ORs for significant risk factors were utilised to develop a risk score ranging from 0 to 7 (Asia-Pacific Colorectal Screening (APCS) score). Three tiers of risk were arbitrarily defined: 0-1 'average risk' (AR); 2-3 'moderate risk' (MR); and 4-7 'high risk' (HR). Subjects undergoing screening colonoscopy between July 2006 and December 2007 were prospectively enrolled to form an independent validation group. Each subject had a personal APCS score calculated by summing the points attributed from the presence of risk factors in the individuals. The performance of the APCS score in predicting risk of advanced neoplasia was evaluated. Results There were 860 subjects in the derivation set and 1892 subjects in the validation set, with a baseline prevalence of advanced neoplasia of 4.5% and 3%, respectively. Applying the APCS stratification in the validation set, 559 subjects (29.5%) were in the AR tier, 966 subjects (51.1%) in the MR tier and 367 (19.4%) subjects in the HR tier. The prevalence of advanced neoplasia in the AR, MR and HR groups was 1.3, 3.2 and 5.2%, respectively. The subjects in the MR and HR tiers had 2.6-fold (95% CI 1.1 to 6.0) and 4.3-fold (95% CI 1.8 to 10.3) increased prevalence of advanced neoplasia, respectively, than those in the AR tier. Conclusions The APCS score based on age, gender, family history and smoking is useful in selecting asymptomatic Asian subjects for priority of colorectal screening. [ABSTRACT FROM AUTHOR]

Background Endoscopic resection is widely accepted as the primary treatment for early gastric cancer (EGC) without lymph node metastasis. A new and refined technique, endoscopic submucosal dissection (ESD), may prove to be more effective; however, incomplete resection and local recurrence present ongoing concerns. We sought to determine the clinicopathological features associated with local recurrence in patients with EGC following endoscopic resection. Methods We enrolled in this study 239 EGC patients treated by endoscopic resection between January 2002 and January 2008. Results Fifty EGC lesions were treated by conventional endoscopic mucosal resection (EMR group) and 189 EGC lesions were treated by ESD (ESD group). During the follow-up period (mean = 30.3 months), the rates for en bloc resection and complete resection (defined as en bloc resection with negative resection margin) were 64% (32/ 50) and 60% (30/50), respectively, in the EMR group, and 86.8% (164/189) and 79.9% (151/189), respectively, in the ESD group. We observed seven local recurrences in the ESD group, though only one with complete resection by ESD had a local recurrence. The EMR group showed a significantly higher recurrence rate than did the ESD group (18% vs. 3.7%, respectively, p < 0.001). Incomplete resection significantly increased local recurrence risk, and larger tumor size and use of EMR increased the risk for incomplete resection. Most lesions (3/4) treated with additional argon plasma coagulation for an initial recurrence had recurred again. Conclusions Despite the potential advantages in treating EGC with ESD, a risk for local recurrence remains. All patients treated with EMR, even with curative resection, and those with incomplete resection after ESD require conscientious surveillance for local recurrence. Furthermore, a large prospective study will be required to determine the best treatment modality for local recurrence. [ABSTRACT FROM AUTHOR]

Nitric oxide (NO) may aggravate neuronal damage after spinal cord injury (SCI). We hypothesized that NO produced by inducible nitric oxide synthase (iNOS) accelerates secondary damage to spinal tissue, which may be reversed by the neuroprotectant, melatonin. This study investigated the effects of combination therapy with melatonin (10 mg/kg) and exercise (10 m/min) on recovery from SCI caused by contusion. We examined locomotor recovery, iNOS gene expression, autophagic and apoptotic signaling, including Beclin-1, LC3, p53 and IKKα protein expression and histological alterations in the ventral horn of the spinal cord. Melatonin in combination with exercise resulted in significantly increased hindlimb movement ( P < 0.05), a reduced level of iNOS mRNA ( P < 0.05) and more motor neurons in the ventral horn, versus control SCI and SCI plus exercise alone, with no effect on the other signaling molecules examined. This study shows that combined therapy with melatonin and exercise reduces the degree of secondary damage associated with SCI in rats and supports the possible use of melatonin in combination with exercise to reduce the side effects related to exercise-induced fatigue and impairment. [ABSTRACT FROM AUTHOR]

Background: Endoscopic resection (endoscopic mucosal resection, EMR, and endoscopic submucosal dissection, ESD) has been accepted worldwide as a less invasive standard treatment for early gastric cancer (EGC). However, the risk of synchronous and metachronous gastric cancer developing in the post-endoscopic resection patient has become a major problem. We investigated the incidence and characteristics of synchronous and metachronous multiple gastric cancers in a retrospective study of patients with EGC after endoscopic resection. Patients and Methods: We studied the clinicopathological features of 235 patients with EGC who had undergone endoscopic resection and were periodically followed up using endoscopic examinations (181 with a single lesion, 34 synchronous multiple lesions, and 20 metachronous multiple lesions). Results: The overall incidence of synchronous and metachronous multiple gastric cancer was 14.5 and 8.5%, respectively, during a follow-up of 12–77 (median 26.5) months. Undifferentiated histology of the primary lesion was related to the occurrence of synchronous gastric cancer (p < 0.001). Undifferentiated histology and upper location of the primary lesion were correlated with the occurrence of metachronous gastric cancer (p = 0.002, 0.001). Most synchronous and metachronous lesions were well to moderately differentiated (82.4 and 80.0%); however, the proportion with undifferentiated histology (including poorly differentiated carcinoma and signet ring cell carcinoma) in synchronous and metachronous gastric cancer was significantly higher than in single gastric cancer (p = 0.008). Conclusions: Undifferentiated histology of EGC may predict the occurrence of synchronous and metachronous lesions after endoscopic resection. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article discusses the role of endoscopic ultrasonography (EUS) in detecting early gastric cancer (EGC). The EUS has been performed to increase the accuracy of predicting the depth of tumor invasion. Meta-analyses have shown the high sensitivity and specificity of EUS in predicting the T stage of gastric cancer. J. Y. Lee and colleagues have described the clinical role that EUS plays in choosing between endoscopic submucosal dissection (ESD) and surgery for patients with EGC.

Malignant obstruction develops frequently in advanced gastric cancer. Although it is primarily the gastric outlet that is obstructed, there are occasional reports of colonic obstruction. Treating intestinal obstruction usually requires emergency surgery or stent insertion. There are several kinds of complications with stent insertion, such as bowel perforation, stent migration, bleeding, abdominal pain and reobstruction. Nevertheless, endoscopic stent insertion could be a better treatment than emergency surgery in cases of malignant bowel obstruction in cancer patients with poor performance status. We report a case of advanced gastric cancer with carcinomatosis in which a recurrent colonic stent was inserted at the same site because of cancer growth into the stent. The patient maintained a good condition for chemotherapy, thus improving their chances for survival. [ABSTRACT FROM AUTHOR]

Background and Aim: It remains unclear whether Helicobacter pylori eradication therapy affects the healing rate of iatrogenic ulcers following endoscopic mucosal resection (EMR) for gastric tumors. The aim of our study was to prospectively evaluate the effect of H. pylori eradication therapy on gastric ulcer healing after EMR. Methods: After EMR, patients were randomly assigned to either the H. pylori eradication group (Hp group) (lansoprazole 30 mg, amoxicillin 1000 mg, and clarithromycin 500 mg, twice a day for 7 days) or the noneradication group (proton pump inhibitor, PPI group) (lansoprazole 30 mg, twice a day for 7 days). Four weeks after EMR, the ulcer stages and size were compared between the two groups. Moreover, ulcer-related symptoms, bleeding rates, adverse effects, and drug compliance were compared. Results: A total of 64 patients were enrolled. Of these, 17 patients were excluded from the study. The two groups were comparable in terms of baseline clinicopathologic characteristics. Four weeks after EMR, the two groups did not differ with respect to ulcer stage ( p = .475) or ulcer-related symptoms ( p = .399). However, the ulcer reduction ratio was significantly higher in the Hp group (0.028 ± 0.024 vs. 0.065 ± 0.055, p < .05). No differences were observed between the two groups with regard to drug compliance, adverse drug event rates, or bleeding rates. Conclusions: Our results suggest that H. pylori eradication therapy might improve the ulcer healing rate after EMR. [ABSTRACT FROM AUTHOR]

Colonic inflammatory fibroid polyp (IFP) is an uncommon benign polypoid lesion, which is composed of fibroblasts, numerous small vessels and edematous connective tissue with marked eosinophilic inflammatory cell infiltration. This condition is frequently detected in the stomach and small intestine, but uncommon in the colon. Although IFP is a benign lesion, surgical resections are performed in most colonic cases because the polyps are usually too large to resect endoscopically. Only three patients underwent endoscopic polypectomy in our literature reviews. Here, we present a case of IFP in the descending colon successful endoscopically resected using a novel technique of trapping its stalk with an endoloop, forming the stalk into an omega shape, and then dissecting the stalk with a needle knife. [ABSTRACT FROM AUTHOR]

Background/Aims: Serrated polyps have emerged as important evidence supporting the serrated polyp-neoplasia pathway in colorectal carcinogenesis, an alternate to the classical adenoma-carcinoma sequence. However, there is confusion over the diagnostic criteria for serrated polyps including traditional serrated adenoma (TSA) and sessile serrated adenoma (SSA). In addition, clinical and pathologic characteristics of each are largely unknown and need further exploration. Methods: The 753 polyps that were previously diagnosed as serrated adenoma (SA) from 14 tertiary care university hospitals in Korea between 2003 and 2005 were evaluated for the clinicopathologic findings of TSA and SSA. Results: Among 753 cases, 420 (55.8%) were reclassified as TSA and 56 (7.4%) as SSA. Among the pathologic parameters, crypt branching, crypt dilatation, and horizontal crypts were more frequent in SSA than in TSA (p < 0.001). SSA was larger than TSA (12.6 ± 7.3 vs. 9.8 ± 6.9 mm, p = 0.005), was more likely to be flat type (p = 0.006), and was more frequently located in the proximal colorectum (p = 0.012). There were no significant differences in age, sex, and body mass index between TSA and SSA. Conclusions: Locationand endoscopic features of the polyps with abnormal crypt morphology in histologic findings could be helpful for the diagnosis and classification of SAs. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The da Vinci system is a newly developed device for colorectal surgery, therefore experience of its use for rectal cancer surgery is limited and there are no reports describing the use of four robotic arms with this system. The aim of this study is to evaluate the safety and feasibility of the four-arm da Vinci system for total mesorectal excision in rectal cancer patients. Clinicopathologic data were prospectively collected on nine patients who underwent robotic total mesorectal excision using four robotic arms for the treatment of mid or low rectal cancer between November 2006 and Febuary 2007. Patient demographics, perioperative clinical outcomes, and pathology results with macroscopic grading (complete, nearly complete, incomplete) were evaluated. nine patients with mid or low rectal cancer underwent robotic total mesorectal excison using four robotic arms without serious complications. The mean length of hospital stay was 7.4 ± 1.3 days (range 5.0–10.0 days) and the mean operating time was 220.8 ± 49.4 min (range 153–315 min). Macroscopic grading of the specimen was complete in eight patients and nearly complete in one patient. There were no cases of conversion. In the present study, we accomplished nine robot-assisted rectal resections safely and effectively. [ABSTRACT FROM AUTHOR]

Tylosin polyketide synthase (Tyl PKS) was heterologously expressed in an engineered strain of Streptomyces venezuelae bearing a deletion of pikromycin PKS gene cluster using two compatible low-copy plasmids, each under the control of a pikAI promoter. The mutant strain produced 0.5 mg/l of the 16-membered ring macrolactone, tylactone, after a 4-day culture, which is a considerably reduced culture period to reach the maximum production level compared to other Streptomyces hosts. To improve the production level of tylactone, several precursors for ethylmalonyl-CoA were fed to the growing medium, leading to a 2.8-fold improvement (1.4 mg/ml); however, switching the pikAI promoter to an actI promoter had no observable effect. In addition, a small amount of desosamine-glycosylated tylactone was detected from the extract of the mutant strain, revealing that the native glycosyltransferase DesVII displayed relaxed substrate specificity in accepting the 16-membered ring macrolactone to produce the glycosylated tylactone. These results demonstrate a successful attempt for a heterologous expression of Tyl PKS in S. venezuelae and introduce S. venezuelae as a rapid heterologous expression system for the production of secondary metabolites. [ABSTRACT FROM AUTHOR]

Large volume paracentesis (LVP) with plasma volume expansion has been used for tense or refractory ascites. However, still in question is whether it is safe and effective for the treatment of spontaneous bacterial peritonitis (SBP). We addressed this issue and conducted a study to assess safety and long-term outcome of LVP in cirrhotic patients with SBP. Forty-two randomly assigned cirrhotic patients with SBP were classified into two groups; Group 1 included 21 patients who were treated with LVP and intravenous albumin; and Group 2 included 21 patients who were treated with diuretics and intravenous albumin. The overall cumulative survival rate was poor in patients with SBP (42.5% and 22.5% at 6 and 12 months, respectively). At 7 days after treatment, the blood tests were similar between the two groups. In the ascitic fluid, the white blood cell counts decreased significantly and the protein concentrations tended to increase in both groups. In-hospital days, resolution rate of SBP, and in-hospital mortality rate were similar between the two groups. Although complication rates tended to be slightly higher in Group 1, long-term cumulative survivals were similar between Group 1 and Group 2. LVP was effective in removing abdominal discomfort in patients with tense ascites without serious complication. LVP with intravenous albumin was as effective as diuretics with intravenous albumin for the treatment of SBP with similar mortality. LVP with intravenous albumin might be feasible for the treatment of tense or refractory ascites in cirrhotic patients with SBP. [ABSTRACT FROM AUTHOR]

The article reports on issues including Gastric cancer, which is the third most common cause of cancer related deaths in both sexes worldwide and it is mentioned that Helicobacter pylori infection is the greatest known risk factor for the development of gastric cancer. Screening and treatment of H. pylori is an important strategy for the prevention of gastric cancer. The results of survey conducted on patients with gastric cancer are discussed.

In this article, the author discusses gastric mucosa-associated lymphoid tissue lymphoma and Helicobacter pylori infection. Topics discussed include evaluation of the clinical characteristics, management, and prognosis of patients, role of endoscopic ultrasound on the preoperative T staging and increased plasmacytic differentiation in gastric mucosa-associated lymphoid tissue lymphomas.

Background/Aims Esophageal squamous cell carcinoma (ESCC) display a very poor clinical outcome in 5-year survival rate. Although long non-coding RNAs (lncRNAs) exert critical roles in cancer development, the promising biomarkers and therapeutic target candidates of ESCC-expressed lncRNAs has not been comprehensively examined. Methods High-throughput RNA sequencing were performed from paired nontumor and tumor samples of Korean ESCC patients. Highly expressed lncRNA in ESCC (HERES), was experimentally tested with cell proliferation, colony formation, invasion and migration assays following siRNA-treatment against HERES in ESCC cell lines. To identify downstream targets of HERES, the expression and DNA methylation changes of cancer-related genes, NanoString, ChIP-qPCR, MS-PCR, RNA immunoprecipitation assay and RNA fluorescence in situ hybridization were used. KYSE-30 cells were injected into nude mice, respectively, and the xenograft tumors were generated to verify the effect of HERES in tumor progression. Results We identified 113 commonly dysregulated lncRNAs in the Korean, Chinese, and TCGA ESCC cohorts, 20 of which were novel lncRNA genes. Six lncRNAs were significantly associated with the clinical outcomes of ESCC patients: two (RP11-1L12.3 and HERES) showed a positive hazard ratio while others (RP11-114H23.1, RP11-114H23.2, CTD-2319I12.1, and LINC00330) showed a negative hazard ratio. The reduction of HERES, which is most significantly upregulated in ESCC, repressed cell proliferation, migration, invasion and colony formation in ESCC cell lines and tumor growth in xenograft models. HERES appeared to simultaneously regulate CACNA2D3, SFRP2 and CXXC4 to activate Wnt signaling pathways through a chromatin remodeler, EZH2. Conclusions These results suggest that HERES holds a substantial potential to be developed as not only a biomarker and a therapeutic target to cure ESCC and probably other squamous-type cancers caused by defective Wnt signaling pathway. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 73-year-old man with esophageal cancer who underwent concurrent chemoradiotherapy (CCRT). Topics discussed include the patient developing lesions after CCRT, placing of hemoclips to prevent development of stricture and esophageal stenosis occurring after endoscopic submucosal dissection (ESD).

Background/Aims Prokinetics can be used for treating patients with gastroesophageal reflux disease (GERD), who exhibit suboptimal response to proton pump inhibitor (PPI) treatment. We conducted a systematic review to assess the potential benefits of combination treatment with PPI plus prokinetics in GERD. Methods We searched PubMed, the Cochrane Library, and EMBASE for publications regarding randomized controlled trials comparing combination treatment of PPI plus prokinetics to PPI monotherapy with respect to global symptom improvement in GERD (until February 2020). The primary outcome was an absence or global symptom improvement in GERD. Adverse events and quality of life (QoL) scores were evaluated as secondary outcomes using a random effects model. Quality of evidence was rated using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results This meta-analysis included 16 studies involving 1446 participants (719 in the PPI plus prokinetics group and 727 in the PPI monotherapy group). The PPI plus prokinetics treatment resulted in a significant reduction in global symptoms of GERD regardless of the prokinetic type, refractoriness, and ethnicity. Additionally, treatment with PPI plus prokinetics for at least 4 weeks was found to be more beneficial than PPI monotherapy with respect to global symptom improvement. However, the QoL scores were not improved with PPI plus prokinetics treatment. Adverse events observed in response to PPI plus prokinetics treatment did not differ from those observed with PPI monotherapy. Conclusions Combination of prokinetics with PPI treatment is more effective than PPI alone in GERD patients. Further high-quality trials with large sample sizes are needed to verify the effects based on prokinetic type. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 54-year-old woman who was admitted to the hospital's gastroenterology department for experiencing 2 weeks of vomiting after an esophagectomy surgery. The patient's esophagectomy has revealed a marked delay in passage of contrast through the gastroscope and pylorus and an endoscopic balloon dilation was performed. The article also discusses the method of endoscopic pyloromyotomy for postesophagectomy.

The article offers information on the International Digestive Endoscopy Network (IDEN) 2016 hosted by Korean Society of Gastrointestinal Endoscopy (KSGE) in Seoul, Korea from June 24-26, 2016 on the advances in the field of upper gastrointestinal (GI) and pancreatobiliary endoscopy.

A letter to the editor is presented that discusses the robotic total mesorectal excision (TME) and robotic total abdominal hysterectomy (TAH) in a patient with rectal cancer and uterine myoma.

A letter to the editor is presented in response to the article about restorative proctocolectomy by Yong Taek Ko, Nam Kyu Kim and Byung So Min.

A letter to the editor is presented in response to an article related to clear cell adenocarcinoma of the sigmoid colon.

Purpose: Gastric cancer (GC) is among the most prevalent and fatal cancers worldwide. National cancer screening programs in countries with high incidences of this disease provide medical aid beneficiaries with free-of-charge screening involving upper endoscopy to detect early-stage GC. However, the coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions to routine healthcare access. Thus, this study aimed to assess the impact of COVID-19 on the diagnosis, overall incidence, and stage distribution of GC. Materials and Methods: We identified patients in our hospital cancer registry who were diagnosed with GC between January 2018 and December 2021 and compared the cancer stage at diagnosis before and during the COVID-19 pandemic. Subgroup analyses were conducted according to age and sex. The years 2018 and 2019 were defined as the “before COVID” period, and the years 2020 and 2021 as the “during COVID” period. Results: Overall, 10,875 patients were evaluated; 6,535 and 4,340 patients were diagnosed before and during the COVID-19 period, respectively. The number of diagnoses was lower during the COVID-19 pandemic (189 patients/month vs. 264 patients/month) than before it. Notably, the proportion of patients with stages 3 or 4 GC in 2021 was higher among men and patients aged ≥40 years. Conclusions: During the COVID-19 pandemic, the overall number of GC diagnoses decreased significantly in a single institute. Moreover, GCs were in more advanced stages at the time of diagnosis. Further studies are required to elucidate the relationship between the COVID-19 pandemic and the delay in the detection of GC worldwide. [ABSTRACT FROM AUTHOR]

Melatonin (N-acetyl-5-methoxytryptamine) was long thought to be a neurohormone found exclusively in vertebrates. However, the finding of melatonin in photosynthesizing organisms prompted research on this compound in order taxa, opening up a new field of knowledge. So far, melatonin has been detected in bacteria, protozoans, algae, plants, fungi and invertebrates. Here we performed to address the cellular mechanism of melatonin in the cell division and differentiation of fibroblast, prior to application of grape extract which is a putative potential candidate of melatonin-enriched edible plant. In addition, melatonin significantly increased the expression level of clock genes (clock, bmall, per 1/2, and cryl), which were considered as important regulating factors in cell cycle machinery. [ABSTRACT FROM AUTHOR]

Background/Aims Patients with gastroesophageal reflux disease (GERD) frequently experience nighttime heartburn and sleep disturbance. Tegoprazan is a new potassium-competitive acid blocker that can rapidly block acid secretion. This study aims to evaluate the efficacy of tegoprazan compared with esomeprazole in relieving nighttime heartburn and sleep disturbances. Methods Patients with erosive esophagitis, nighttime heartburn, and sleep disturbances were randomized to receive tegoprazan 50 mg or esomeprazole 40 mg for 2 weeks. The primary endpoint was time to first nighttime heartburn-free interval. The percentage of nighttime heartburn-free days was also compared between the 2 groups. Results A total of 46 patients were enrolled in this study. Time to the first nighttime heartburn-free interval was shorter with tegoprazan than with esomeprazole but the difference was not statistically significant (1.5 days vs 3 days, P = 0.151). The percentage of nighttime heartburn-free days was higher in the tegoprazan group but the difference was insignificant (57.8% vs 43.1%, P = 0.107). Adverse events occurred in 2 patients. They were mild in severity. Conclusions Tegoprazan may induce faster relief of nighttime heartburn symptoms and may improve sleep disorders associated with nighttime heartburn. Further large-scale studies are required to validate our findings. [ABSTRACT FROM AUTHOR]

Gastric adenoma (dysplasia) is a precursor for gastric cancer and is closely associated with intestinal type gastric cancer. Thus, accurate diagnosis and proper management of gastric adenoma are extremely critical for preventing gastric cancer. The revised Vienna and World Health Organization classifications have categorized gastric adenomas into two types: high-grade and low-grade dysplasia. High-grade dysplasia requires endoscopic resection due to synchronous carcinoma or the high risk of progression to carcinoma. Although the treatment for low-grade dysplasia remains controversial, endoscopic resection is also recommended due to the potential of progression to carcinomas and the unrevealed histologic discrepancies between forceps biopsy and endoscopic specimens. According to the Lauren classification, gastric cancer is categorized into three histologic types: intestinal, diffuse, and mixed types. Intestinal and diffuse types show a distinct difference in their clinical and epidemiological features. The intestinal type, in its pathogenesis, follows the cascade of non-atrophic gastritis, atrophic gastritis, intestinal metaplasia, adenoma, and intramucosal neoplasia (correa cascade). It tends to appear in older ages than diffuse type and show some predominance in the distal portion of the stomach. It is more common in males and is often associated with environmental factors. In this review, the current knowledge of gastric adenoma and intestinal type gastric cancer, together with relevant diagnostic and therapeutic strategies, is discussed.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the "proven GERD" with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett's mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis. Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) is a condition that develops when reflux of stomach contents causes troublesome symptoms and/or complications. The prevalence of GERD is increasing worldwide and in Asia-Pacific. The latest Korean guidelines for GERD were published in 2012, and several international guidelines and consensus statements for the management of GERD have also been recently published. Here, we review these guidelines and consensus statements in order to provide a better understanding of the diagnosis and treatment of GERD.

Gastric cancer remains a big problem in terms of incidence or mortality; various mechanisms to explain its development and progression have been studied. Recently, long non-coding RNAs (lncRNAs) have been spotlighted in the epigenetic mechanism of cancer development. Although lncRNAs have been consistently reported to be involved in the development and progression of various cancers, there is still a lot more to be studied about them. In this article, we would like to introduce lncRNAs related to gastric cancer in order to encourage gastroenterologists to study them.

Background/Aims: Endoscopic vacuum-assisted closure (EVAC) has been attempted as new nonsurgical treatment for anastomotic leakage. We aimed to evaluate the clinical outcomes of EVAC and compare its efficacy with the self-expandable metallic stent (SEMS) for postgastrectomy leakage. Methods: Between January 2007 and February 2018, 39 patients underwent endoscopic treatment for anastomotic leakage after gastric cancer surgery. Of them, 28 patients were treated with SEMS, seven with EVAC after SEMS failure, and four with EVAC. We retrospectively compared the clinical characteristics and therapeutic outcomes between EVAC (n=11) and SEMS (n=28). Results: The median followup duration was 17 months (interquartile range, 9 to 26 months) in both groups. In comparison of clinical characteristics between two groups, only the median size of the leak was larger in the EVAC group than in the SEMS group (2.1 cm vs 1.0 cm; p<0.001). All EVAC cases healed successfully; however, two cases (7.1%) failed to heal in the SEMS group. Anastomotic stricture occurred one case (9.1%) in EVAC and four cases (14.3%) in SEMS within 1 year after endoscopic treatment. The median treatment duration of EVAC was shorter than that of SEMS (15 days vs 36 days; p<0.001). Median weight loss after therapy was similar in both groups (8.0 kg in EVAC vs 9.0 kg in SEMS; p=0.356). Conclusions: EVAC can be effective endoscopic treatment for postgastrectomy anastomotic leakage. Substantial leakage could be an important clinical factor for considering EVAC as a treatment option. Large randomized controlled trials are needed to confirm the efficacy of EVAC. [ABSTRACT FROM AUTHOR]

Background/Aims: Bicarbonate-containing alginate formulations are reported to be effective for controlling reflux symptoms. However, the efficacy of Lamina G alginate without gas production has not been reported. The aim is to evaluate the efficacy of a non-bicarbonate alginate in individuals with reflux symptoms without reflux esophagitis. Methods: Participants who had experienced heartburn or regurgitation for 7 consecutive days were randomized to one of the following treatment groups: proton pump inhibitors (PPI) plus alginate (combination) or PPI plus placebo (PPI only). In addition, as a reference group, patients received placebo plus alginate (alginate only). The primary endpoint compared the percentage of patients with complete resolution of symptoms for the final 7 days of the treatment. Secondary endpoints compared changes in symptom score, symptom-free days during the treatment period, the Reflux Disease Questionnaire, Patient Assessment of Upper Gastrointestinal Disorders (PAGI)- Quality of Life and PAGI-Symptoms Severity Index scores, the investigator's assessment of symptoms, and incidence of adverse events. Results: Complete resolution of heartburn or regurgitation was not significantly different between the combination and PPI only groups (58.7% vs 57.5%, p=0.903). The secondary endpoints were not significantly different between the two groups. Complete resolution of heartburn or regurgitation, did not differ between the alginate only reference group and the PPI only group (75.0% vs 57.5%, p=0.146). Conclusions: The addition of non-bicarbonate alginate to PPI was no more effective than PPI alone in controlling reflux symptoms. [ABSTRACT FROM AUTHOR]

Background/Aims: Gastric cancer is one of the most common malignant tumors worldwide with poor prognosis due to a lack of effective treatment modalities. Recent research showed that a long noncoding RNA named N-BLR modulates the epithelial-to-mesenchymal transition (EMT) process in colorectal cancer. However, the biological role of N-BLR in gastric cancer still remains to be explored. The aim of this study was to investigate the possibility of N-BLR as an EMT modulator in gastric cancer. Methods: The expression of NBLR was measured by quantitative polymerase chain reaction in fresh gastric cancer tissue, paired adjacent normal tissues and cell lines. Fresh gastric tissues, paired samples obtained by surgery and clinical data were collected prospectively. Knockdown of N-BLR was induced by small interfering RNA (siRNAs). Cell number and viability were assessed after treatment with siRNAs. The ability of N-BLR to promote metastasis was measured using migration and invasion assays. Additionally, an inverse correlation between N-BLR and miR- 200c was measured by TaqMan microRNA assays. Western blotting was performed to detect EMT and apoptosis markers upon knockdown of N-BLR. Results: N-BLR expression was significantly elevated in gastric cancer cell lines and tissues compared to that in a normal gastric cell line and adjacent normal tissues (p<0.01). Two different siRNAs significantly reduced cell proliferation of gastric cancer cells compared to the siCT. siRNAs for N-BLR significantly suppressed migration and invasion in AGS and MKN28 cells. N-BLR expression was inversely correlated with miR-200c, which is known to regulate EMT. Conclusions: In this study, we confirmed NBLR as a regulator of the EMT process in gastric cancer. [ABSTRACT FROM AUTHOR]

Background/Aims: Endoscopic resection is a standard treatment for stage T1a esophageal cancer, with esophagec-tomy or radical radiation therapy (RT) performed for stage T1b lesions. This study aimed to compare treatment out-comes of each modality for clinical stage T1 esophageal can-cer. Methods: In total, 179 patients with clinical T1N0M0-stage esophageal cancer treated from 2006 to 2016 were retrospectively evaluated. Sixty-two patients with clinical T1a-stage cancer underwent endoscopic resection. Among 117 patients with clinical T1b-stage cancer, 82 underwent esoph-agectomy, and 35 received chemoradiotherapy or RT. We compared overall survival (OS) and recurrence-free survival (RFS) rates for each treatment modality. Results: The medi-an follow-up time was 32 months (range, 1 to 120 months). The 5-year OS and RFS rates for patients with stage T1a cancer receiving endoscopic resection were 100% and 85%, respectively. For patients with stage T1b, the 5-year OS and RFS rates were 78% and 77%, respectively, for the esopha-gectomy group; 80% and 44%, respectively, for the RT alone group; and 96% and 80%, respectively, for the chemoradia-tion group. The esophagectomy group showed significantly higher RFS than the RT alone group (p=0.04). There was no significant difference in RFS between the esophagectomy and chemoradiation groups (p=0.922). Grade 4 or higher treatment-related complications occurred in four patients who underwent esophagectomy. Conclusions: Endoscopic resection appeared to be an adequate treatment for patients with T1a-stage esophageal cancer. The multidisciplinary approach involving chemoradiation was comparable to esophagectomy in terms of survival outcome without serious complications for T1b-stage esophageal cancer. [ABSTRACT FROM AUTHOR]

Background/Aims: Recently, increased body weight has been found to be associated with an increasing risk of several cancers, including gastric cancer. The true pathogenic role of hyperglycemia in the development of gastric cancer remains unclear as hyperglycemia and its associated conditions may work as carcinogenic factors. The goal of this study was to clarify the factors associated with early gastric cancer and evaluate a homeostasis model assessment of the insulin resistance (HOMA-IR) index, fasting glucose, and lipid profile as predictors of early gastric cancer. Methods: A total of 63 patients with early gastric cancer between November 2012 and March 2013 were included. Preoperative serum lipid profile levels and serum fasting glucose were examined prospectively in patients with early gastric cancer. The same number of controls were evaluated and matched to the early gastric cancer group for age and gender. We performed multivariate logistic regression analysis to identify independent risk factors for early gastric cancer. Results: Univariate analysis showed that risk for early gastric cancer was associated with diastolic blood pressure (BP), total cholesterol, fasting glucose, and HOMA-IR. In the multivariate-adjusted model, higher total cholesterol, fasting glucose, body mass index, and diastolic BP were strongly associated with an increased risk of early gastric cancer. Conclusions: Hyperglycemia, a lower high-density lipoprotein cholesterol level, and a low HOMA-IR level appear to be associated with early gastric cancer risk. [ABSTRACT FROM AUTHOR]