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Background: Biopsy needles have recently been developed to obtain both cytological and histological specimens during endoscopic ultrasound (EUS). We conducted this study to compare 22-gauge (G) fine needle aspiration (FNA) needles, which have been the most frequently used, and new 25G fine needle biopsy (FNB) needles for EUS-guided sampling of solid pancreatic masses.Methods: We conducted a retrospective cohort study of all EUS-guided sampling performed between June 2010 and October 2013. During the study period, 76 patients with pancreatic masses underwent EUS-guided sampling with a 22G FNA needle (n = 38) or a 25G FNB needle (n = 38) for diagnosis. An on-site cytopathologist was not present during the procedure. Technical success, the number of needle passes, cytological diagnostic accuracy, cytological sample quality (conventional smear and liquid-based preparation), histological diagnostic accuracy, and complications were reviewed and compared.Results: There were no significant differences in technical success (100% for both), the mean number of needle passes (5.05 vs. 5.55, P = 0.132), or complications (0% for both) between the 22G FNA group and the 25G FNB group. The 22G FNA and 25G FNB groups exhibited comparable outcomes with respect to cytological diagnostic accuracy (97.4% vs. 89.5%, P = 0.358) and histological diagnostic accuracy (34.2% vs. 52.6%, P = 0.105). In the cytological sample quality analysis, the 25G FNB group exhibited higher scores for the amount of diagnostic cellular material present (22G FNA: 0.92 vs. 25G FNB: 1.32, P = 0.030) and the retention of appropriate architecture (22G FNA: 0.97 vs. 25G FNB: 1.42, P = 0.010) in the liquid-based preparation. The 25G FNB group showed a better histological diagnostic yield for specific tumor discrimination compared with the 22G FNA group (60 % vs. 32.4%, P = 0.018).Conclusions: Use of the 25G FNB needle was technically feasible, safe, efficient, and comparable to use of the standard 22G FNA needle in patients with solid pancreatic masses in the absence of an on-site cytopathologist. The cytological sample quality in the liquid-based preparation and the histological diagnostic yield for specific tumor discrimination of EUS-guided sampling using a 25G FNB needle were significantly higher than those using a 22G FNA needle. [ABSTRACT FROM AUTHOR]

Background and study aims: Endoscopists sometimes face paradoxical cases in which the endoscopic submucosal dissection (ESD) specimen reveals a non-neoplastic pathology result. The aims of the study were to determine the reasons for such results, and to compare the endoscopic characteristics of non-neoplastic and conventional neoplastic pathology groups after ESD. Patients and methods: A total of 1186 gastric ESDs performed between February 2005 and December 2011 were retrospectively reviewed. The ESD specimens included 52 (4.4 %) that were confirmed as negative or indefinite for neoplasia. Patient characteristics and endoscopic and pathological data were reviewed and compared. Results: Non-neoplastic pathology after ESD was due to complete removal of the lesion at biopsy in 45 cases (86.5 %), pathology overestimation in 5 (9.6 %), and incorrect localization of the original tumor with subsequent ESD performed at the wrong site in 2 (3.8 %). The mean length and surface area of the non-neoplastic lesions were 9.2±2.6mm and 49.6±23.6mm2, respectively. Mean sampling ratios were 3.0±1.5mm/fragment and 16.3±10.0mm2/fragment. Compared with 1134 cases confirmed as neoplastic on the final ESD specimen, non-neoplastic cases showed a significantly smaller tumor size and surface area, and lower sampling ratios in a logistic regression analysis adjusted for potential confounders (P<0.001 for all). Conclusions: Complete lesion removal by biopsy, pathology overestimation, and incorrect localization of the original tumor with subsequent ESD at the wrong site were the main reasons for nonneoplastic results after ESD. Small tumor size and surface area, and low sampling ratios were associated with non-neoplastic pathology results after ESD. [ABSTRACT FROM AUTHOR]

Background A conformable self-expandable metallic stent was developed to overcome the limitation of previous self-expandable metallic stents. The aim of this study was to evaluate outcomes after placement of conformable covered and uncovered self-expandable metallic stents for palliation of malignant gastroduodenal obstruction. Methods A single-blind, randomized, parallel-group, prospective study were conducted in 4 medical centres between March 2009 and July 2012. 134 patients with unresectable malignant gastroduodenal obstruction were assigned to a covered double-layered (n=66) or uncovered unfixed-cell braided (n=68) stent placement group. Primary analysis was performed to compare re-intervention rates between two groups. Results 120 patients were analysed (59 in the covered group and 61 in the uncovered group). Overall rates of re-intervention were not significantly different between the two groups: 13/59 (22.0%) in the covered group vs. 13/61 (21.3%) in the uncovered group, p=0.999. Stent migration was more frequent in the covered group than in the uncovered group (p=0.003). The tumour ingrowth rate was higher in the uncovered group than in the covered group (p=0.016). Conclusions The rates of re-intervention did not significantly differ between the two stents. Conformable covered double-layered and uncovered unfixed-cell braided stents were associated with different patterns of stent malfunction. [ABSTRACT FROM AUTHOR]

Background/Aims: In patients with occlusive colorectal cancers, a complete preoperative evaluation of the colon proximal to the obstruction is often impossible. We aimed to evaluate the feasibility of preoperative colonoscopy after stent placement and to determine whether the success rate of colonoscopy differs between covered and uncovered stents. Methods: Seventy-three patients with malignant colorectal obstruction were enrolled prospectively. In patients with a resectable cancer, a preoperative colonoscopy was performed after insertion of a self-expandable metal stent (SEMS). The success rate of complete preoperative colonoscopy was compared between covered and uncovered stents. Results: Forty-five of 73 patients who underwent stent placement had a resectable cancer (61.6%). A complete preoperative colonoscopy was possible in 40 of 45 patients (88.9%). The success rate of complete preoperative colonoscopy was significantly lower in the covered-stent group when the obstructing mass lesion was located in the sigmoid colon (p=0.024). Synchronous cancer was detected in one patient (2.2%). Stent migration was observed in four patients with a covered stent. Conclusions: A preoperative complete colonoscopy after SEMS placement was feasible and safe in most patients with malignant colorectal obstruction. Uncovered stents seem to have more advantages than covered stents in preoperative colonoscopy proximal to the obstruction. [ABSTRACT FROM AUTHOR]

Background: Endoscopic sphincterotomy (EST) combined with large-balloon dilation (LBD) has been proposed as an alternative to manage large bile duct stones. However, recent reports indicate that LBD without EST may be safe and effective in this setting. Methods: One hundred thirty-one patients with large common bile duct (CBD) stones 12 mm in size or larger underwent LBD alone (n = 62) or EST plus LBD (n = 69) for lithotripsy. The therapeutic outcome and complications were reviewed and compared. Results: There were no differences between the two groups with regard to age, size and number of stones, or bile duct diameter. The LBD alone group (mean age, 70.4 years) and the EST plus LBD group (mean age, 68.2 years) had similar outcomes in terms of overall successful stone removal (96.8% vs. 95.7%, P = 0.738) and complete stone removal without the need for mechanical lithotripsy (80.6% vs. 73.9%, P = 0.360). Complications in the LBD alone and EST plus LBD groups were as follows: pancreatitis (6.5% vs. 4.3%, P = 0.593), impaction of basket and stone (0% vs. 1.4%, P = 0.341), and perforation (0% vs. 1.4%, P = 0.341). Conclusions: LBD alone may be a simple, safe, and effective alternative to EST plus LBD in relatively aged patients with large CBD stones, and it can simplify the procedure compared with EST plus LBD. [ABSTRACT FROM AUTHOR]

Background/Aims Guanine nucleotide binding protein (G-protein) beta polypeptide 3 (GNB3) C825T polymorphism alters intracellular signal transduction, which may lead to motor or sensory abnormalities of the gastrointestinal tract. The aim of the present study was to evaluate the association of the GNB3 C825T polymorphism with susceptibility to overlap syndrome of functional dyspepsia (FD) and irritable bowel syndrome (IBS) in a Korean population. Methods One hundred sixty-seven patients with FD alone, 60 patients with IBS alone, 85 patients with the overlap of FD and IBS, and 434 asymptomatic healthy subjects participated in the study. Genotyping for GNB3 C825T polymorphism was performed using their blood samples. Results No association of GNB3 genotypes in patients with FD alone, IBS alone or overlap phenotype, when compared to genotypes in controls, was detected. The frequency of CT and TT genotypes relative to the CC genotype for the phenotypes of FD alone, IBS alone and the coexistence of FD and IBS did not significantly differ. Comparison of the TT genotype with the CC/CT genotype showed no significant association for each phenotype group. Conclusions There is no apparent association of the GNB3 C825T polymorphism with the susceptibility to FD, IBS or the overlap of FD and IBS. Larger-scale studies and further investigation on other candidate genes are required. [ABSTRACT FROM AUTHOR]

Gastric adenoma with low-grade dysplasia (LGD) is a less progressive disease than with high-grade dysplasia; nevertheless, a certain portion of lesions can progress. The purpose of this study was to evaluate the effectiveness of argon plasma coagulation (APC) with submucosa saline injections (APC-SSI) for gastric adenoma with LGD on an outpatient department (OPD) basis. We included 57 patients with 64 lesions of gastric adenoma with LGD. Endoscopic type was flat elevated in 58 lesions and central depressed in 6 lesions. Normal saline was injected into the submucosa under the lesion before APC. APC was performed to the lesion and its surrounding mucosa. After treatment, patients underwent regular endoscopy follow-ups. One case each of pneumoperitoneum and Mallory-Weiss tearing occurred and could be managed with conservative care. One case of overt bleeding occurred after 2 weeks and was treated with APC. After 19.5 months of follow-up, four residual adenomas (6.3%) were found and treated with additional APC-SSI. Fourteen metachronous lesions were noted in eight patients (14.0%). Twelve lesions were adenoma with LGD and two lesions were intramucosal adenocarcinoma. APC-SSI is an effective and safe treatment modality for gastric adenoma with LGD on an OPD basis and it is recommended for patients with risk factors of endoscopic mucosal resection (EMR). After treatment of gastric adenoma, meticulous follow-up endoscopy is recommended for detection of metachronous lesions. [ABSTRACT FROM AUTHOR]

Background/Aims Although the long-term administration of proton pump inhibitors (PPIs) has been proven to induce the changes of gut microbiota, study about the short-term effect of PPIs is lacking. We aimed to verify the influence of 8 weeks of PPI treatment on the gut microbiome. Methods Patients who were given 8 weeks of Ilaprazole (20 mg, once daily PO) in the treatment of gastroesophageal reflux diseases were prospectively enrolled in our study. Enrolled subjects were educated to avoid changes in eating habits and other medications. The fecal samples were collected for microbiome analysis before and right after PPI administration. The microbial 16S rDNA of the fecal sample was collected, amplified and analyzed by the polymerase chain reaction method and sequenced using the Illumina MiSeq® System. Microbial information was obtained using the NCBI 16S database and we analyzed the variety of species and the variation of the microbiota. Results Nine patients were finally analyzed in our study. There was no significant change in species diversity when compared before and after PPI administration. The results of classifying gut microbiota in the colony as genus showed increases in Streptococcus, Agathobaculum, and Murimonas. As for species, eight species were significantly increased (such as Streptococcus), and one species, Sutterella wadsworthensis was decreased after PPI administration. When gut microbiota was classified as genus and species, 12 genus and 28 species showed statistical differences in their composition fraction. Conclusions The short-term (8 weeks) administration of Ilaprazole were found to affect the abundance and composition ratio of gut microbiome at the level of a strain, although there was no significant change in the cluster diversity of gut microbiome. [ABSTRACT FROM AUTHOR]

Background/Aims There are no standard guidelines regarding the time interval from the diagnosis of gastric neoplasms to endoscopic submucosal dissection (ESD). This study was aimed to evaluate the association between the time interval from the diagnosis to ESD and success of complete resection for high-grade dysplasia (HGD) and early gastric cancers (EGCs). Methods A total of 1,728 patients who underwent ESD for HGD or EGC from January 2005 to March 2019 were enrolled. The time intervals from the diagnosis to ESD were analyzed as continuous variables. A multivariable logistic regression analysis was performed to evaluate the influence of the time interval on success of complete resection. Results Of the 1,728 enrolled patients, 568 (32.9%) and 1,160 (67.1%) patients were diagnosed with HGD and EGC, respectively. The complete resection rate is 91.1% (1,572 patients) and the mean time interval for all patients was 36.30 (±19.17) days. There was significant difference in the mean waiting time between two groups divided by referral center (our center vs other center: 29.4±14.5 vs 40.4±20.4, p<0.001). However, the success rate of complete resection was not different between two groups (p>0.05). The time interval does not significantly influence the incidence of complete resection (adjusted odds ratio, 0.995; 95% confidence interval, 0.985 to 1.004; p=0.326). Conclusions A longer time interval from the diagnosis to ESD was not associated with incomplete resection. These results could help establish endoscopic treatment guidelines for gastric neoplasms and aid both patients and endoscopists. [ABSTRACT FROM AUTHOR]