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Epidemiologic and clinical data suggest that Helicobacter pylori infection is a contributing factor in the progression of atherosclerosis. However, the specific cardiovascular disease risk factors associated with H. pylori remain unclear. We performed a cross-sectional study of 37,263 consecutive healthy subjects who underwent a routine health check-up. In multivariable log Poisson regression models adjusted for potential confounders, the associations of H. pylori seropositivity with higher LDL-C (relative risk [RR], 1.21; 95% confidence interval [CI], 1.12–1.30) and lower HDL-C level (RR, 1.10; 95% CI, 1.01–1.18) were significant and independent. In multiple linear regression analyses, H. pylori infection was significantly associated with higher total cholesterol level (coefficient = 2.114, P P P P = 0.001). In contrast, H. pylori infection was not associated with obesity-related parameters (body mass index, waist circumference), glucose tolerance (fasting glucose, glycated hemoglobin), and systolic blood pressure. We found that H. pylori infection was significantly and independently associated with dyslipidemia, but not with other cardiometabolic risk factors, after adjusting for potential risk factors of atherosclerosis.

The aim of the study was to develop a reliable and easy-to-use risk-scoring system (RSS) to predict lymph-node metastasis (LNM) and determine the feasibility of endoscopic submucosal dissection for mucosa-confined signet ring cell carcinomas (SRCs).Fewer LNM and better survival rates have been reported for early gastric SRCs compared with other undifferentiated early gastric cancers (EGCs).Data from 1544 patients with mucosa-confined SRCs were reviewed. Stepwise logistic regression analysis determined the independent predictors of LNM. Risk scores were based on the final predictive factors for LNM, and performance was internally validated using a split-sample approach. External validation was also performed in an independent dataset (n = 208) to assess the discriminatory power of the RSS.The overall LNM incidence was 3.8% (57/1544). Three risk factors (tumor size ≥1.7 cm, tumors of elevated type, and lymphatic-vascular involvement) were significantly associated with LNM. These factors were incorporated into the RSS, and were assigned scores ranging from 0 to 4. The area under the receiver-operating characteristic curve for predicting LNM after internal and external validation was 0.68 (95% confidence interval, 0.0793-0.2865) and 0.686 (95% confidence interval, 0.618-0.748), respectively. A score of 2 points was the optimal cut-off value for LNM prediction, and the overall diagnostic accuracy was 96%. LNM were found in 2.9% and 23.8% of the low and high-risk groups of the RSS, respectively.A RSS may help to predict LNM and evaluate endoscopic submucosal dissection feasibility in patients with intramucosal SRC.

// Jae-Han Kim 1 , Sung Hyeon Lee 2 , Sookyung Choi 2 , Unyong Kim 3 , In Seok Yeo 4 , Su Hee Kim 2 , Myung Jin Oh 3 , Hantae Moon 3 , Jua Lee 3 , Seunghyup Jeong 3 , Min Gew Choi 5 , Jun Ho Lee 5 , Tae Sung Sohn 5 , Jae Moon Bae 5 , Sung Kim 5 , Yang Won Min 5 , Hyuk Lee 5 , Jun Haeng Lee 5 , Poong-Lyul Rhee 5 , Jae J. Kim 5 , Su Jin Lee 5 , Seung Tae Kim 5 , Jeeyun Lee 5 , Se Hoon Park 5 , Joon Oh Park 5 , Young Suk Park 5 , Ho Yeong Lim 5 , Won Ki Kang 5 , Hyun Joo An 3 , Jung Hoe Kim 4 1 Department of Food and Nutrition, Chungnam National University, Yuseong-Gu, Deajeon, Korea 2 GLYCAN Co., Ltd., Healthcare Innovation Park, Bundang-Gu, Seongnam, Korea 3 Graduate School of Analytical Science and Technology, Chungnam National University, Yuseong-Gu, Deajeon, Korea 4 Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Yuseong-Gu, Daejeon, Korea 5 Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Correspondence to: Se Hoon Park, email: hematoma@skku.edu Keywords: stomach neoplasm, haptoglobin, N-glycan, glycoprotein, biomarker Received: October 05, 2016 Accepted: December 21, 2016 Published: December 29, 2016 ABSTRACT Based on our previous studies, differential analysis of N-glycan expression bound on serum haptoglobin reveals the quantitative variation on gastric cancer patients. In this prospective case-control study, we explore the clinically relevant glycan markers for gastric cancer diagnosis. Serum samples were collected from patients with gastric cancer ( n = 44) and healthy control ( n = 44). N-glycans alteration was monitored by intact analysis of Hp using liquid chromatography–mass spectrometry followed by immunoaffinity purification with the serum samples. Intensity and frequency markers were defined depending on the mass spectrometry data analysis. Multiple markers were found with high diagnostic efficacy. As intensity markers ( I -marker), six markers were discovered with the AUC > 0.8. The high efficiency markers exhibited AUC of 0.93 with a specificity of 86% when the sensitivity was set to 95%. We additionally established frequency marker ( f -marker) panels based on the tendency of high N-glycan expression. The AUC to conclude patients and control group were 0.82 and 0.79, respectively. This study suggested that N-glycan variation of serum haptoglobin were associated with patients with gastric cancer and might be a promising marker for the cancer screening.

The present study aimed to assess the real impact of proton pump inhibitor (PPI) use on incidence of recurrent spontaneous bacterial peritonitis (SBP) in a homogenous population composed of cirrhotic patients with a previous SBP where differences related with SBP incidence between PPI users and non-users are less likely to exist.This retrospective cohort study enrolled 307 cirrhotic patients taking diuretics for ascites control and had a previous SBP. Patients who took any PPI for at least 1 week prior to a second SBP were included in the PPI group. The incidence of a second SBP was a primary outcome and was compared between PPI group and non-PPI group before and after propensity score matching. Risk factors for a second SBP were investigated by multivariate analysis.Second SBP occurred in 17 patients (29.3%) during mean 52.1 ± 5.2 months of PPI group and in 60 patients (24.1%) during mean 61.9 ± 4.8 months of non-PPI group, which did not differ (P = .185). In the matched cohort, second SBP similarly occurred in both groups [29.3% of PPI group vs 26.8% of non-PPI group (P = .271)]. According to the multivariate analysis, Child-Pugh score was the only significant risk factor for a second SBP (hazard ratio 1.68, 95% confidence interval, 1.13-2.50, P = .001). Isolated bacteria and clinical outcomes such as of mortality, presence of sepsis, and hospital stay did not differ between the two groups in the matched cohort.Proton pump inhibitor use is not a risk factor for recurrent SBP in cirrhotic patients.

BACKGROUND AND AIM:Endoscopic submucosal dissection (ESD) for undifferentiated type early gastric cancer is regarded as an investigational treatment. Few studies have tried to identify the risk factors that predict lymph-node metastasis (LNM) in intramucosal poorly differentiated adenocarcinomas (PDC). This study was designed to develop a risk scoring system (RSS) for predicting LNM in intramucosal PDC. METHODS:From January 2002 to July 2015, patients diagnosed with mucosa-confined PDC, among those who underwent curative gastrectomy with lymph node dissection were reviewed. A risk model based on independent predicting factors of LNM was developed, and its performance was internally validated using a split sample approach. RESULTS:Overall, LNM was observed in 5.2% (61) of 1169 patients. Four risk factors [Female sex, tumor size ≥ 3.2 cm, muscularis mucosa (M3) invasion, and lymphatic-vascular involvement] were significantly associated with LNM, which were incorporated into the RSS. The area under the receiver operating characteristic curve for predicting LNM after internal validation was 0.69 [95% confidence interval (CI), 0.59-0.79]. A total score of 2 points corresponded to the optimal RSS threshold with a discrimination of 0.75 (95% CI 0.69-0.81). The LNM rates were 1.6% for low risk (

Background and Aims Differentiated minute submucosal cancers measuring ≤3 cm that exhibit no lymphovascular invasion are considered eligible for endoscopic resection; however, the ≤3-cm criterion remains debatable. The aim of this study was to verify the optimal tumor size cutoff for endoscopic resection eligibility, and to determine whether 2-dimensional tumor size measurement would be more accurate for this purpose. Methods The clinicopathologic data for 574 patients undergoing curative surgery for differentiated minute submucosal cancer were reviewed retrospectively. A receiver operating curve analysis and bootstrapped samples were used to identify the optimal cutoff values for predicting lymph node (LN) metastasis. Results Four hundred fourteen patients were eligible for the study. LN metastasis accompanied 2.5% of differentiated minute submucosal cancers that were ≤3 cm in size and lacked lymphovascular invasion. There was no lymph node metastasis in the tumors with 1-dimensional sizes ≤1.0 cm and 2-dimensional sizes ≤1.0 cm 2 . When 10,000 bootstrapped data were used, optimal cutoff values were 2.9 cm (LN metastasis: 2.1%) and 8.3 cm 2 (LN metastasis: 2.5% incidence) for 1- and 2-dimensional tumor size, respectively. Although the area under the curve was 0.611 ( P = .046) for 2-dimensional size, specificity and accuracy were greater for the dichotomized 2-dimensional measure than for the dichotomized 1-dimensional measure ( P Conclusions One- and 2-dimensional cutoff values of 2.9 cm and 8.3 cm 2 might be suitable for patients at high risk of postoperative morbidity and mortality. Two-dimensional tumor size is an acceptable measurement method for estimating the risk of LN metastasis.

Erosive esophagitis is a major risk factor for Barrett esophagus and esophageal adenocarcinoma. Information regarding the putative risk factors for developing erosive esophagitis is considerably heterogeneous; thus, a risk model is required to clinically predict the incidence of erosive esophagitis. This study was to derive and validate a predictive model for the incidence of developing erosive esophagitis after negative index endoscopy in a population subjected to routine health check-ups. This retrospective cohort study of health check-ups included 11,535 patients who underwent repeated screening endoscopy after >3 years from a negative index endoscopy. We used logistic regression analysis to predict the incidence of erosive esophagitis, and a Simple Prediction of Erosive Esophagitis Development score for risk assessment was developed and internally validated using the split-sample approach. The development and validation cohorts included 5765 patients (675 with erosive esophagitis [11.7%]) and 5770 patients (670 with erosive esophagitis [11.6%]), respectively. The final model included sex, smoking behavior, body mass index, hypertension, and the triglyceride level as variables. This model predicted 667 cases of erosive esophagitis, yielding an expected-to-observed ratio of 1.00 (95% confidence interval [CI], 0.92–1.07). A simplified 5-item risk scoring system based on coefficients was developed, with a risk of erosive esophagitis of 6.2% (95% CI, 5.2–7.1) for the low-risk group (score ≤2), 15.1% (95% CI, 13.5–16.6) for the intermediate-risk group (score ≤3, 4), and 18.2% (95% CI, 15.2–21.3) for the high-risk group (score ≥5). The discriminative performance of the risk-prediction score was consistent in the derivation cohort and validation cohort (c-statistics 0.68 and 0.64, respectively); the calibration was good (Brier score 0.099 and 0.1, respectively). In conclusion, a simple risk-scoring model using putative risk factors can predict the future incidence of developing erosive esophagitis in asymptomatic populations.

Summary Background/Aims Proximal serrated polyp (SP) is one of potential explanations for the failure of colonoscopy to prevent all interval cancers. The aims of our study were to determine the prevalence of proximal SP in Korea and to investigate clinical factors associated with the proximal SP detection in average-risk people undergoing screening colonoscopy. Methods We re-analyzed the data of the previous prospective study which included asymptomatic, average-risk people over 45 years of age who underwent screening colonoscopy from four tertiary medical centers in South Korea between December 2007 and November 2008 to compare guaiac-based and quantitative immunochemical fecal occult blood tests. SPs included hyperplastic polyps, sessile serrated adenomas, and traditional serrated adenomas. Results A total of 926 subjects were analyzed. Of these, 454 subjects (49.0%) and 356 (38.4%) had a total of 859 polyps and 709 adenomas, respectively. One hundred and ten subjects (11.9%) had a total of 150 SPs and 49 (5.3%) had a total of 60 proximal SPs. In comparison between subjects with and without proximal SP, there were no differences with respect to procedure-related variables including endoscopic training, day of week, time of day, and elapsed time as well as demographic features such as age and sex. Conclusions In average-risk people underwent screening colonoscopy, the prevalence of proximal SP was 5.3% in Korea. There were no significant clinical factors associated with the proximal SP detection.

Background and study aims: Transanal endoscopic microsurgery (TEM) has been shown to be highly effective for early rectal cancer, and endoscopic submucosal dissection (ESD) has been introduced to treat noninvasive colorectal neoplasia. The aim of this study was to compare the outcomes of ESD and TEM for superficial early rectal cancer. Patients and methods: We retrospectively analyzed 63 patients with nonpolypoid rectal high grade dysplasia or submucosa-invading cancer who were treated with ESD or TEM, and compared clinical outcomes and safety between the treatment groups. Results: 30 patients underwent ESD and 33 underwent TEM. For ESD compared with TEM, en bloc resection rates were 96.7 % vs. 100 % (P = 0.476) and R0 resection rates were 96.7 % vs. 97.0 % (P = 1.000). There were no cases of local recurrence or distant metastasis in either group. Antibiotics were required in 11 patients (36.7 %) in the ESD group and 33 (100 %) in the TEM group (P Conclusions: Both ESD and TEM are effective and oncologically safe for treating nonpolypoid rectal high grade dysplasia and submucosa-invading cancers. ESD has the additional advantages of minimal invasiveness and avoidance of anesthesia. Therefore, ESD could be recommended as a treatment option for superficial early rectal cancers.

Extremely well-differentiated tubular adenocar- cinomas (EWDAs) of the stomach are character- ized by surface maturation and their mimicking of intestinal metaplasia. Endoscopically, intramu- cosal EWDAs are frequently ill defined with indis- tinct borders due to the pallor of the neoplastic mucosa and the lack of contrast against the back- ground atrophic and metaplastic mucosa. We evaluated the effectiveness of endoscopic resec- tion for EWDAs after endoscopic submucosal dis- section (ESD). Among 872 patients with early gastric cancer, 17 EWDAs were identified (1.9%). Endoscopically, the flat or depressed type was significantly more common among EWDAs (88.2%) than among early gastric cancers of other histologies (37.8%; P

Summary The aim of this study was to determine the correlation between microsatellite instability (MSI) and young age in patients with advanced colorectal adenomas. We retrospectively analyzed young patients (≤ 40 years of age) with advanced adenomas (n = 84) between January 1996 and December 2006. We randomly selected the control group as patients ≥ 50 years of age with advanced adenomas (n = 84) during the same time period. Of these patients, the MSI test and MLH1 immunohistochemistry were performed in the available tissue samples from patients with advanced adenomas. The number of patients who had the two tests was 52 in the young group and 49 in the old group. The monomorphic nature of the BAT26 panel for MSI analysis was used without comparison of normal tissue. MSI was detected in three young patients (n = 52) and none of the old patients (n = 49). There was no statistical difference between the two groups (P = 0.243). All three young patients with MSI had a strong family history of colorectal cancer. MSI analysis was not a useful method of screening for HNPCC in young patients with advanced colorectal adenoma, at least in cases without a family history of colorectal cancer.

The influence of body mass index (BMI) on the outcome of patients with colorectal cancer (CRC) is largely unknown, particularly in an Asian population. Therefore, we investigated the influence of BMI on survival of patients who underwent surgical treatment for CRC in Korean population. This prospective cohort study included CRC patients who underwent surgery between June 2003 and May 2005. Study participants were divided into two BMI groups: normal weight (

Appropriate surveillance intervals are important to ensure that the benefits of surveillance are not offset by harm. This study aimed to determine the factors associated with nonadherence to recommended colonoscopic surveillance intervals. The study enrolled 296 patients who underwent screening colonoscopy. The colonoscopies were performed by four endoscopists in the first or second year of fellowship. After each procedure, the endoscopists responded to a questionnaire that elicited information on the degree of concern for missed polyps (using a visual analog scale [VAS]), colonoscopic technical factors, and surveillance intervals. Of the 296 patients, 105 (36%) were adherent and 191 (64%) and were nonadherent to the guidelines. There were no differences in insertion time, withdrawal time, or polyp detection rate between the adherence and nonadherence groups. The endoscopy at cecal intubation was longer in the nonadherence group than in the adherence group (P = 0.013). The proportion of patients with poor bowel preparation was higher in the nonadherence group than in the adherence group (P = 0.011). The endoscopist’s concern for missed polyps was greater in the nonadherence group than in the adherence group (P

Summary Background/aim Non-alcoholic fatty liver disease (NAFLD) is associated with multiple adenomatous polyps and advanced neoplasm. This study aims to investigate the influence of NAFLD on the tumor characteristics and prognosis in patients with colorectal cancer (CRC). Methods We analyzed 227 patients who were first diagnosed with CRC and underwent abdominal ultrasonography within six months prior to diagnosis at Samsung Medical Center between 2000 and 2005. Results Of the study population, 26.0% were diagnosed with NAFLD. Upon baseline comparison, CRC patients with NAFLD had higher BMI and ALT values than CRC patients without NAFLD (25.3 ± 2.7 vs. 22.6 ± 3.0, P = 0.000 and 26.6 ± 17.4 vs. 21.2 ± 14.0, P = 0.018, respectively). Additionally, CRC patients with NAFLD were diagnosed earlier than CRC patients without NAFLD (P = 0.004). However, there were no significant differences between two groups with regard to location and differentiation of tumors, CEA or numbers of synchronous adenoma and advanced adenoma. The cumulative 1-, 3-, and 5-year survival rates in CRC patients with NAFLD were 98.3%, 89.8%, and 86.4%, respectively, which were higher but statistically not significant than 90.4%, 79.6%, and 74.8%, respectively, in CRC patients without NAFLD (P = 0.079). During follow-up, freedom from recurrence was similarly observed in CRC patients with and without NAFLD (89.8% and 87.3%, respectively, P = 0.614). Conclusions The results of this study suggest that the presence of NAFLD does not influence on the prognosis in CRC patients, especially with respect to disease recurrence during follow-up.

Background/Aims When undergoing endoscopic submucosal dissection (ESD), patients with liver cirrhosis (LC) may suffer from a high risk of bleeding, bacteremia and tissue vulnerability. There have been few reports evaluating the efficacy and safety of ESD in patients with LC. Methods From January 2004 to March 2010, 23 patients with LC (cirrhosis group) underwent ESD for superficial gastric neoplastic lesions. The number of patients with a liver function in the Child-Pugh classes A and B were 20 and 3, respectively. The clinical outcomes and complications were compared with 69 patients without LC (control group) that were matched for age and sex. Results The en bloc resection, R0 resection and en bloc plus R0 resection rates of the cirrhosis group were 82.6%, 91.3%, and 82.6%, respectively, and did not show significant differences from the rates of the control group. No local recurrence was found in either group during the follow-up period. The procedure length of time (41.0 vs 39.0 minutes), rate of bleeding (4.3% vs 7.2%) and rate of perforation (0.0% vs 1.4%) in the cirrhosis group were also comparable to the results from the control group. Conclusions ESD was safely performed in patients with LC, and satisfactory outcomes were achieved with high en bloc and R0 resection rates for superficial gastric neoplastic lesions.

Background/Aims: Gastric glomus tumors are extremely rare, and presurgical confirmation is often impossible. The identification of clinical and radiologic characteristics of this tumor type is important for preoperative diagnosis and treatment planning. Methods: In this study, we analyzed 10 cases of gastric glomus tumors resected at a single institute over 9 years. Results: Eight of the patients were men and 2 were women, with a mean age of 49 years. Five patients presented with abdominal discomfort or pain, 1 presented with anemia, and the remaining 4 cases were found incidentally during endoscopic examinations. The most common location of the tumor was the antrum (n=7), followed by the low (n=2) and high body (n=1). Although the endoscopic ultrasonography fi ndings were variable, contrast-enhanced computed tomography generally showed a strong homogeneous enhancement. The resected tumors were well-demarcated solid masses with sizes ranging from 1.0 to 3.6 cm. Microscopically, the masses were composed of abundant vascular channels with clusters of uniform and round glomus cells. There was no evidence of recurrence after complete surgical resection. Conclusions: Gastric glomus tumors are unusual, distinct lesions that should be considered in the differential diagnosis of a gastric submucosal mass. Unlike their deep soft tissue counterparts, most glomus tumors in the stomach are benign. (Gut Liver 2012;6:52-57)

Gastric cancer is the most common cancer worldwide. The proportion of early gastric cancer (EGC) cases at diagnosis has increased because of the use of mass screening endoscopy in older adults. Endoscopic mucosal resection has become the standard treatment for EGC in cases with standard indications because of its low risk of lymph node metastasis. A new endoscopic method, endoscopic submucosal dissection, has recently become available. This method allows en bloc resection without limitation of the size of the lesion. The goal of this article is to review the history and methods of endoscopic treatment with EGC, the conventional and extended indications, the therapeutic outcomes, and the complication rates.

Our aim was to investigate the incidence of tumor recurrence in cases in which there was a discrepancy in the diagnosis of complete resection by pathologists and colonoscopists, especially in the lateral resection margin.We reviewed 245 patients with colorectal tumors that were treated by endoscopic submucosal dissection (ESD) between March 2006 and June 2011. We evaluated the recurrence rate in cases judged as pathologically incomplete resection despite endoscopically complete resection.Of the 24 cases with tumor cells on the lateral resection margin, the histologies of the colorectal tumors were found to be tubular adenoma (TA) with low-grade dysplasia (n = 19), TA with high-grade dysplasia (n = 3) and differentiated adenocarcinoma (n = 2). No tumor recurrence was observed in 22 patients after ESD. Four patients did not receive surveillance colonoscopy. The median tumor size was 28 mm (12-35) and the median follow-up period was 19 months (5-42).This retrospective analysis was limited by a short follow-up period. However, surveillance colonoscopy could be attempted without additional ESD in those cases in which incomplete resection on the lateral margin was judged pathologically, if endoscopic complete resection was grossly achieved.

Non-technical summary What is known about gastric electrophysiology and used in motility clinics throughout the world is mostly deduced from animal studies and extracellular recordings from human patients. Extracellular recording from gastrointestinal muscles, however, is prone to extensive motion artifact, and it is not clear that animal models can be translated directly to human physiology. Therefore, we have performed a detailed analysis of electrical activity from carefully mapped specimens of gastric muscle removed from humans during surgery for gastric cancers. Our data show several important differences in electrical activity recorded with intracellular microelectrodes and accepted gastric electrophysiological dogma. We observed ongoing electrical slow wave activity in the gastric fundus; we also found no evidence for a slow wave frequency gradient. Muscles from all regions through the thickness of the muscularis demonstrated intrinsic pacemaker activity, and this corresponded with the widespread distribution of pacemaker cells.

Background/Aims Propofol induced sedation with bispectral index (BIS) monitoring has been reported to lead to higher satisfaction in patients and endoscopists during endoscopic submucosal dissection (ESD) procedures. There are no data, however, regarding the efficacy of midazolam and meperidine (M/M) induced sedation with BIS monitoring during ESD. The purpose of this study was to evaluate whether M/M induced sedation with BIS monitoring could improve satisfaction and reduce the dose of M/M required during ESD. Methods Between September 2009 and January 2010, 56 patients were prospectively enrolled and randomly assigned to a BIS group (n=28) and a non-BIS group (n=28). Patient and endoscopist satisfaction scores were assessed using the visual analog scale (0 to 100) following the ESD. Results The mean satisfaction scores did not significantly differ between the BIS and non-BIS groups (92.3±16.3 vs 93.3±15.5, p=0.53) or endoscopists (83.1±15.4 vs 80.0±16.7, p=0.52). Although the mean meperidine dose did not differ (62.5±27.6 vs 51.0±17.3, p=0.18) between the two groups, the mean dose of midazolam in the non-BIS group was lower than in the BIS group (6.8±2.0 vs 5.4±2.1, p=0.01). Conclusions BIS monitoring during ESD did not increase the satisfaction of endoscopists or patients and did not lead to an M/M dose reduction. These results demonstrate that BIS monitoring provides no additional benefit to M/M induced sedation during ESD.

The incidence of colorectal adenomas and advanced neoplasia in the transplant population has not been well characterized. The aim of this study was to determine whether or not there was an increased incidence of colorectal adenomas and advanced neoplasia in solid organ transplantation (SOT) recipients compared with an average-risk population. We reviewed 360 patients with solid organ transplants who underwent colonoscopy between February 1995 and July 2008, and 360 age- and gender-matched patients in an average-risk population. The mean duration from transplantation to colonoscopy in the SOT group was 40.4 ± 34.0 months. Ninety-three (25.8%) adenomas were detected in the SOT group, while 98 (27.2%) adenomas were detected in the control group (p = 0.763). There was a statistically significant difference (p < 0.0001) in the number of patients with advanced neoplasia in the SOT group (24 patients [6.7%]) compared with the control group (3 patients [0.8%]). The independent risk factors of advanced neoplasia were old age (odds ratio [OR], 1.067; 95% CI, 1.019-1.118) and transplantation (OR, 6.069; 95% CI, 1.455-25.314). In summary, there was a significant increase in the incidence of advanced colorectal neoplasia in SOT recipients. The reason for this finding is unclear, and studies with a larger number of patients are needed to further evaluate this group.

Background/Aims: Early gastric cancer (EGC) can be treated by endoscopic resection, which results in an excellent prognosis. Optimal screening intervals considering risk factors for gastric cancer have not been established. The aim of this study was to determine the maximum gastric cancer screening interval in terms of long-term survival. Methods: Curative resection was performed in 561 patients with gastric cancer who had completed a questionnaire on their previous history of screening tests and risk factors. The association between EGC detection rate and previous screening history was evaluated, and 5-year disease-free survival rates were compared between various screening intervals. Results: Multivariate analysis showed that intestinal metaplasia [hazard ratio (HR) 9.690, 95% confidence interval (CI) 5.896–15.927] and previous screening history (HR 0.077, 95% CI 0.048–0.125) were independent factors associated with advanced gastric cancer. In patients without intestinal metaplasia, there was no significant difference in the extent of gastric cancer progression and the 5-year disease-free survival rate between groups with screening intervals of less than 3 years. In patients with intestinal metaplasia, the cutoff screening interval for detection of EGC and disease-free survival was 2 years. Conclusion: The optimum screening interval for disease-free survival for gastric cancer in a normal population is 3 years, but a screening interval of 2 years should be used for patients with intestinal metaplasia in Korea.

Background/Aims The incidence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study was to evaluate the relationship between GERD symptoms and dietary factors in Korea. Methods From January 2007 to April 2008, 162 subjects were enrolled (81 in GERD group and 81 in control group). They were asked to complete the questionnaires about GERD symptoms and dietary habits. The symptom severity score was recorded by visual analogue scale. Results Subjects with overweight or obesity had an increased risk for GERD (OR, 2.52; 95% CI, 1.18-5.39). Irregular dietary intake was one of the risk factors for GERD (OR, 2.33; 95% CI, 1.11-4.89). Acid regurgitation was the most suffering (2.85 ± 2.95 by visual analogue scale) and frequent reflux-related symptom (57.5%) in GERD. Noodles (OR, 1.22; 95% CI, 1.12-1.34), spicy foods (OR, 1.09; 95% CI, 1.02-1.16), fatty meals (OR, 1.20; 95% CI, 1.09-1.33), sweets (OR, 1.42; 95% CI, 1.00-2.02), alcohol (OR, 1.16; 95% CI, 1.03-1.31), breads (OR, 1.17; 95% CI, 1.01-1.34), carbonated drinks (OR, 1.69; 95% CI, 1.04-2.74) and caffeinated drinks (OR,1.41; 95% CI, 1.15-1.73) were associated with symptom aggravation in GERD. Among the investigated noodles, ramen (instant noodle) caused reflux-related symptoms most frequently (52.4%). Conclusions We found that noodles, spicy foods, fatty meals, sweets, alcohol, breads, carbonated drinks and caffeinated drinks were associated with reflux-related symptoms.

Background and Aim: Pathological bolus exposure is defined in the present study as cases in which all reflux percentage times are above 1.4% of the total reflux number, as revealed by impedance–pH monitoring. The role of pathological bolus exposure in the pathogenesis of non-cardiac chest pain (NCCP) is poorly known. We aimed to classify and characterize NCCP using combined impedance–pH monitoring. Methods: Seventy-five consecutive patients with NCCP were prospectively enrolled from January 2006 to October 2008. All the patients underwent upper endoscopy, esophageal manometry, and 24-h multichannel intraluminal impedance (MII)–pH metering. Results: Sixteen patients (21.3%) had esophageal erosion upon endoscopy. Upon esophageal manometry, 37 patients (49.3%) had esophageal dysmotility. When the patients were classified based on MII–pH metering, 16 (21.3%) showed pathological acid exposure, and 40 (53.3%) showed pathological bolus exposure. The DeMeester score of patients with pathological acid exposure was higher than that of patients with pathological bolus exposure (P = 0.002). There was no significant difference in age, sex, typical esophageal symptoms, presence of esophageal erosion, esophageal dysmotility, improvement with proton pump inhibitor medication, symptom index ≥50%, percentage of time clearance pH below 4 ≥4%, and all reflux time ≥1.4% in the fasting period between the two groups. When the patients were divided into gastroesophageal reflux disease (GERD)-related NCCP and non-GERD-related NCCP groups based on MII–pH metering and upper endoscopy, there was no difference between the two groups. Conclusions: Combined impedance–pH monitoring improves the detection and characterization of NCCP. This study suggests that pathological bolus exposure plays a major role in eliciting NCCP.

Background/Aims: Many studies have suggested that hyperplastic polyps (HPs) are associated with adenomas and even malignancy. We investigated whether or not HPs are associated with the presence of synchronous advanced colorectal neoplasms as a function of their size and location. Methods: A total of 2,482 asymptomatic patients who underwent screening colonoscopies were classified into the following two groups: cases with advanced neoplasms and controls without advanced neoplasms. The proximal colon was defined as all segments proximal to the splenic flexure. We defined diminutive HPs as Results: The median age of the patients was 51 years. 76.8% (n = 1,909) of the patients were males. 82 patients (3.3%) had at least one advanced neoplasm. Based on multivariate analysis, the independent risk factors for advanced neoplasms were old age (OR = 2.81), male gender (OR = 2.92), non-advanced adenomas (OR = 3.57), and non-diminutive HPs (OR = 4.75, p = 0.000). Having at least one non-diminutive HP in either the proximal or distal colon was associated with an increased risk of advanced neoplasm, with no statistically significant difference (proximal vs. distal colon, OR = 5.95 vs. 5.36). Conclusions: These results suggest that non-diminutive HPs are important markers of advanced colorectal neoplasms regardless of location.

†† † † † , † † ‡ ‡ † ‡ Background/Aims: Endoscopic submucosal dissection (ESD), a new and potentially curative method for treating gastrointestinal neoplasms, may have longer procedure time and the risk of complications when compared to conventional endoscopic mucosal resection. This study evaluated the efficacy and safety of ESD in patients with comorbid diseases. Methods: The outcomes of 337 patients who underwent ESD for early gastric cancer at Samsung Medical Center from April 2003 to December 2006 were analyzed retrospectively. The Charlson comorbidity scale was used to divide the patients into low-risk (no risk factor) and high-risk (at least one risk factor) groups. The outcomes and complications were compared between the high-and low- risk groups. Results: The low- and high-risk groups comprised 240 and 97 patients with mean ages of 61.1 and 64.7 years, respectively (p=0.002). Tumor location, tumor size, depth of invasion, procedure duration, and rates of en bloc resection, complete resection, complication, and recurrence did not differ significantly between the two groups (p＞0.05). Conclusions: ESD may be a safe and effective treatment for early gastric cancer in patients with comorbid diseases. (Gut Liver 2010;4:186191)

Efficacy and Tolerability of Split-Dose Magnesium Citrate: Low-Volume (2 Liters) Polyethylene Glycol vs. Single- or Split-Dose Polyethylene Glycol Bowel Preparation for Morning Colonoscopy

We investigated the clinical usefulness of HbA1c in screening an average-risk group50 years of age who need colonoscopy for colorectal cancer (CRC) screening.Eight hundred nineteen asymptomatic males who underwent colonoscopy for CRC screening with blood chemistries between January 2006 and December 2006 were enrolled. The ages of the subjects ranged from 40 to 59.Subjects in their 50 s had significantly more adenomatous polyps than subjects in their 40 s (32.7% vs. 26.0%, p0.05). The incidence of adenomatous polyp increased with increasing quartiles of HbA1C as follows: first quartile (19.9%, HbA1c 4.0-5.0), second quartile (27.8%, HbA1c 5.1-5.3), third quartile (32.7%, HbA1c 5.4-5.5), and fourth quartile (34.9%, HbA1c = 5.6-8.8)(p = 0.008). When combining quartile of HbA1c and age (40 s vs. 50 s) according to HbA1C levels, the odds ratio for adenomatous polyp in subjects in their 40 s with HbA1c5.4% was significantly lower than that in subjects in their 50 s. However, the odds ratio for adenomatous polyp in subjects in their 40 s with HbA1cor =5.4% was similar to that in subjects in their 50 s with average risk for CRC.An elevated HbA1c may be useful as a clinical predictor of adenomatous polyps in male subjects50 years of age who have average risk for CRC.

Background and Aim: Patients with achalasia have a thicker muscularis propria compared to normal patients. Because pneumatic balloon dilatation (PD) is an effective treatment for achalasia, the changes in the esophageal muscles after PD may predict treatment outcomes, if muscular change is of primary importance. In the present study, we aimed to observe the changes in esophageal muscle thickness following PD and assessed whether symptom relapse can be predicted on the basis of the esophageal muscle cross-sectional area (CSA), as measured by high-frequency intraluminal ultrasound (HFIUS). Methods: Fifteen patients treated by PD were studied and followed up for a median of 3.6 years. An HFIUS was done before PD and 6 months after PD. The esophageal muscle CSA measured at the lower esophageal sphincter (LES), and 3 and 6 cm above the LES, was used to see whether any association was present between symptom recurrence and the esophageal muscle CSA. Results: A single PD resulted in a 2-year remission rate of 66%. A significance variance in change (−65%–248%) was noticed in the muscle CSA after PD. The predilation muscle CSA, post-dilation muscle CSA, and change in the muscle CSA after PD was not associated with symptom recurrence. Conclusion: Our findings suggest that measuring the muscle CSA does not help to predict treatment outcome. Muscular changes in achalasia might be just reactive changes.

Background /Aims: Epidemiologic and clinical data indicate that allergies may be associated with reduced risks for several cancers; however, to date, only a few studies have examined the associations between allergies and gastric cancer. This study aimed to examine the associations between allergies and gastric cancer using a large population-based dataset. Methods : This cross-sectional study obtained data from the Korea National Health and Nutrition Examination Survey between 2010 and 2014, involving a total of 24,089 participants. The associations between allergies and gastric cancer were analyzed using univariable and multivariable logistic regression analyses with complex sampling, while adjusting for confounding factors that included age, sex, body mass index, smoking status, alcohol intake, and level of education. Results : Multivariable logistic regression analyses that were adjusted for the potential confounders determined that a history of allergic diseases tended to be associated with reduced risk of gastric cancer; however, this relationship was not statistically significant (any allergy: odds ratio [OR], 0.62; 95% confidence interval [CI], 0.34-1.12; atopic dermatitis: OR, 0.34; 95% CI, 0.50-1.72; allergic rhinitis: OR, 0.71; 95% CI, 0.34-1.46; asthma: OR, 0.44; 95% CI, 0.15-1.29). Multivariable analysis showed that a history of atopic dermatitis was associated with reduced risk of gastric cancer in men (OR, 0.16; 95% CI, 0.03-0.75). Conclusions: This findings of this study suggest that individuals with allergies tend to have a reduced risk of gastric cancer, without a statistically significant association. Furthermore, atopic dermatitis was associated with reduced risk of gastric cancer, particularly in men.

Distal microsatellite instability (MSI)-high colorectal cancers (CRCs) have been investigated by few studies and are generally regarded as having similar features to proximal MSI-high CRCs. In the present study, we aimed to elucidate whether distal sporadic MSI-high CRCs displayed distinguished clinicopathological and molecular features from proximal MSI-high CRCs.All patients who underwent their first surgical resections for stage I-IV sporadic CRCs between August 2003 and August 2006 were initially considered for enrollment, and their MSI data were prospectively collected. Among them, 135 patients with MSI-high CRCs (86 proximal and 49 distal CRCs) were finally identified. The clinicopathological and molecular characteristics, and prognosis of these cases with MSI-high CRCs were reviewed and compared according to tumor site (proximal versus distal).Distal MSI-high CRCs showed significantly more frequent association with younger age, male gender, differentiated histology, small tumor size, distant metastasis, stability in BAT25 and BAT26, and hMLH1 expression on immunohistochemical staining as compared with proximal MSI-high CRCs. In addition, distal MSI-high CRCs demonstrated significantly worse 3-year overall and disease-free survival rates than proximal MSI-high CRCs (87.0% versus 97.4%; 81.6% versus 95.9%). For stage III-IV CRCs, distal MSI-high CRCs also showed significantly worse 3-year overall and disease-free survival rates than proximal MSI-high CRCs (72.2% vs. 90.5%; 58.3% vs. 94.4%).These results indicated that distal sporadic MSI-high CRCs formed a distinct subgroup with distinguished clinicopathological and molecular features from proximal MSI-high CRCs. In addition, this study demonstrated that distal MSI-high CRCs had worse prognosis than proximal MSI-high CRCs.

Colonic spasm, a relatively common problem during colonoscopy, may interfere with intubation and examination. This study was conducted to compare the effect of warm water consumption before unsedated colonoscopy on the incidence of spasm, pain, and technical difficulties. In addition, we studied the associations between attributes of patients and the degree of pain experienced by them during procedures undertaken after warm water consumption.A prospective, randomized, controlled, and investigator-blinded study was conducted in which three groups of patients underwent unsedated colonoscopies. Those randomized to group A (n=64) were instructed to drink 2 l of warm water and 90 ml of sodium phosphate (NaP) solution before colonoscopy. For comparison, those randomized to groups B (n=64) and C (n=64) were instructed to drink 2 l of cold water and 90 ml of NaP solution, or 90 ml of NaP solution without any additional water, respectively. Patient demographics, procedure-related factors, and degree of spasm, pain, and technical difficulty were assessed.Ileal intubation and withdrawal times were significantly shorter for group A than for groups B and C (P0.001 and P0.001, respectively). There was no significant difference between groups in the degree of spasm reported by the endoscopist. The level of pain at the sigmoid colon and splenic flexure during colonoscopy was lower for group A than for groups B and C on both advancement and withdrawal of the colonoscope (P0.001 and P0.001, respectively). The level of discomfort 2 h after the completion of endoscopy was lower for group A than for the other groups. (P=0.001). A subgroup analysis showed that warm water consumption was especially beneficial for patients40 years of age and for those with irritable bowel syndrome. A multivariate analysis showed that warm water consumption before colonoscopy (odds ratio (OR) 0.22; 95% confidence interval (CI): 0.09-0.48 vs. the cold water group and OR 0.34; 95% CI: 0.16-0.73 vs. the no water group) was an independent factor for the reduction of pain during colonoscopy.The intake of warm water before unsedated colonoscopy reduces procedure-related pain and technical difficulty, especially in patients who are young or have irritable bowel syndrome, even though it does not improve the frequency of visible spasmodic events.

Background/Aims Although gastric hyperplastic polyps are usually considered as benign lesions, a low risk of carcinomatous conversion is currently recognized. We aimed to identify the characteristics of hyperplastic polyps undergoing neoplastic transformation. Methods A total of 269 gastric hyperplastic polyps from 216 patients removed by endoscopic polypectomy (EP) or surgical resection were enrolled in this study, and their endoscopic pictures and pathology slides were reviewed. Results Neoplastic transformation was detected on forceps biopsy specimen in 11 cases. However, the pathology findings from the EP or surgical specimen revealed neoplastic transformation in 14 cases (5.2%; 4 with dysplasia and 10 with adenocarcinoma). No significant difference was found between hyperplastic polyps with and without neoplastic transformation in age, sex, location, number of polyps or gross appearance. However, neoplastic transformations were more frequently found in gastric hyperplastic polyps >1 cm than in polyps ≤1 cm (12 of 143; 8.4% vs. 2 of 126; 1.6%) (p=0.013). Conclusions Neoplastic transformations were more frequently found in gastric hyperplastic polyps >1 cm. Therefore, EP should be considered for gastric hyperplastic polyps >1 cm for the accurate diagnosis and definitive treatment.

Gastroesophageal reflux is a commonly encountered condition, but detailed data on reflux symptoms in Asian countries are lacking.To evaluate the prevalence and to document the clinical spectrum of endoscopic reflux esophagitis (RE).A total 25,536 subjects underwent an upper gastrointestinal endoscopic examination as part of a health check, and completed a gastroesophageal reflux questionnaire. Endoscopic findings classified according to the Los Angeles (LA) classification and the data from gastroesophageal reflux questionnaire were analyzed.On the basis of endoscopic findings, 2019 subjects (7.91%) were found to have RE: 5.87% in LA-A; 1.84% in LA-B; 0.18% in LA-C; and 0.02% in LA-D. Heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough, and epigastric soreness were found to be associated with RE (P0.05). Heartburn, acid regurgitation, and epigastric soreness were more frequent in LA-B than in LA-A (P0.05). Epigastric soreness was most bothersome in LA-A and LA-B, and acid regurgitation was most bothersome in LA-C and LA-D (P0.01). Heartburn, hoarseness, and globus sensation were more frequent in men with RE, and acid regurgitation was most common in women.The prevalence of RE was found to be 7.91% in Korea, and the profiles of reflux symptoms were found to depend on grade of RE and sex.

Background The biologic significance of low-level microsatellite instability (MSI) in colorectal cancers (CRCs) remains unclear. This study aimed to elucidate whether sporadic MSI-low CRCs in Korea displayed distinguished clinicopathological characteristics from microsatellite stable (MSS) and MSI-high CRCs. Methods We consecutively enrolled 657 patients who underwent their first surgical resections for stage I–IV sporadic CRCs and compared their clinicopathological features and prognosis after resection according to MSI status (574 MSS, 30 MSI-low and 53 MSI-high CRCs). Results When compared with MSS CRCs, MSI-low CRCs showed significantly more frequent association with poorly differentiated histology, mucinous carcinoma, and large tumour size. In addition, MSI-low CRCs demonstrated significantly less frequent lymph node metastasis and advanced tumour stage than MSS CRCs. When compared with MSI-high CRCs, MSI-low CRCs were significantly more frequently located in distal colon. Three-year overall and disease-free survival rates of MSS, MSI-low and MSI-high CRCs were 83.5%, 90.0% and 91.7% and 82.0%, 89.1% and 87.5%, respectively and neither demonstrated significant difference between three groups. Conclusions These results indicated that sporadic MSI-low CRCs in Korea displayed distinguished clinicopathological features and might form a distinct subgroup especially from MSS CRCs. Further large studies are required to evaluate the impact of MSI-low status on prognosis. J. Surg. Oncol. 2009;99:351–355. © 2009 Wiley-Liss, Inc.

Background 5-Aminosalicylic acid lacks the well-known side effects associated with the long-term use of non-steroidal anti-inflammatory drugs. We investigated anti-carcinogenic mechanisms of 5-aminosalicylic acid on a colon cancer cell line. Methods MTT analysis was performed for various colon cancer cell lines. The expression of NF-κB and metalloproteinases was examined in either HT-29 cells treated with IL-1β and/or 5-aminosalicylic acid. Matrigel assay was used to evaluate invasive potential of HT-29 cells. Analysis of a cDNA microarray containing 8700 genes was performed to identify the alteration of gene expression in response to treatment to 5-aminosalicylic acid. Results The use of MTT analysis showed that 5-aminosalicylic acid suppressed the growth of HT-29 cells. The activity of NF-κB was also decreased by combined-treatment with IL-1β and 5-aminosalicylic acid. The use of an ELISA and zymography demonstrated that MMP-2 and MMP-9 enzyme activity were decreased in HT-29 cells by treatment with various concentration of 5-aminosalicylic acid. A matrigel analysis demonstrated that 5-aminosalicylic acid treatment on HT-29 significantly inhibited the invasiveness of the cells. In cDNA microarray, 163 genes following 5-aminosalicylic acid exposure showed altered expression. Conclusions This study indicated that 5-aminosalicylic acid suppresses the growth of human colon cancer cells and is able to inhibit MMPs expression via NF-κB mediated cell signals and invasiveness.

Aim This prospective cohort study aimed to evaluate the etiology of elevated CA 19-9 levels and to present appropriate guidelines for the asymptomatic patients. Methods Between January 2004 and March 2007, we enrolled consecutive asymptomatic patients who had elevated CA 19-9 levels >37 U/mL. To evaluate the etiology, the CA 19-9 level was rechecked and further studies were carried out. If the CA 19-9 level decreased to the normal range, or if it showed a decreasing trend, then it was monitored annually. Yet, if the CA 19-9 level showed an increasing trend, then the level was monitored at intervals of 1, 3, and 6 months until no evidence of malignancy was proven. Results Of the 62,976 patients, 501 (0.8%) subjects showed an elevated CA 19-9 level. This prospective analysis was conducted on 353 subjects (70.5%) who were followed up for at least 6 months. Ten patients (2.8%) were diagnosed with malignancies. There were 97 patients (27.5%) with benign diseases and 246 patients (69.7%) were deemed non-specific. Conclusions CA 19-9 should not be used as a screening tool. In the case of a persistently elevated CA 19-9 level, further work-up for determining the etiology should be done.

Idiopathic megacolon with bowel dilatation only proximal to the splenic flexure is an uncommon and poorly characterized disease. This study aimed to identify the characteristics of idiopathic proximal hemimegacolon. Five patients (2 males and 3 females) were diagnosed to have idiopathic proximal hemimegacolon and their radiologic, clinical, and physiological characteristics were reviewed. Hirschsprung’s disease and other known causes of bowel dilatation were excluded by the presence of rectoanal inhibitory reflex and reviewing medical records. Mean age at diagnosis and symptom onset were 50.4 years and 47.2 years, respectively. Four patients presented with constipation, and all five patients showed abdominal distention and abdominal pain. Four patients were successfully treated and maintained only with laxatives and prokinetics without enema. Only one patient underwent surgery for intractable constipation. Mean maximal diameters of each segment of colons measured by computed tomography were 57.5 mm, 69.3 mm, 73.0 mm, 33.3 mm, 24.0 mm, and 27.3 mm for cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum, respectively. Colon transit time was delayed in four patients with mean value of 90.0 h. These results indicated that patients with idiopathic proximal hemimegacolon may be treated successfully only with medical therapy in most cases.

To achieve en bloc resection for large lesions, endoscopic mucosal resection after circumferential precutting and endoscopic submucosal dissection techniques have been developed.To compare endoscopic submucosal dissection with endoscopic mucosal resection after circumferential precutting in terms of the clinical efficacy and safety.346 consecutive patients underwent their first endoscopic mucosal resection after circumferential precutting (103 patients) or endoscopic submucosal dissection (243 patients) for early gastric cancer and their clinical outcomes were compared.For early gastric canceror=20mm endoscopic submucosal dissection group demonstrated significantly higher en bloc resection and en bloc plus R0 resection rate compared with endoscopic mucosal resection after circumferential precutting group. For early gastric cancer with size of 10-19 mm, endoscopic submucosal dissection group also showed significantly higher en bloc resection rate. For early gastric cancer20mm, however, en bloc plus R0 resection rate for endoscopic mucosal resection after circumferential precutting group was comparable to that for endoscopic submucosal dissection group. In case of R0 resection of intramucosal differentiated cancer, neither group showed local recurrence during the median 29 and 17 months of follow-up. Two groups did not show significant difference in the bleeding or perforation rates.For early gastric cancer20mm endoscopic mucosal resection after circumferential precutting may be considered as an alternative choice to endoscopic submucosal dissection. However, for early gastric canceror=20mm endoscopic submucosal dissection should be considered as the first choice for treating early gastric cancer.

Background Ineffective esophageal motility (IEM) is characterized by frequent hypotensive or failed peristaltic contractions; its pathophysiology is controversial. Objective To evaluate whether patients with IEM because of GERD would differ from patients with other etiologies of IEM on the basis of esophageal-muscle thickness measured by high-frequency intraluminal US (HFIUS). Design Single-center prospective study. Setting Academic medical center; from January 2004 to June 2005. Subjects A total of 46 patients who were newly diagnosed with IEM were classified into 2 groups: GERD-related IEM (group I, n=26) and non-GERD–related IEM (group II, n=20) on the basis of the presence of reflux esophagitis and/or pathologic acid exposure by 24-hour esophageal pH monitoring. In addition, 16 asymptomatic healthy volunteers with no reflux esophagitis, normal manometric finding, and normal level of acid exposure were included as controls. Main Outcome Measurements We compared the clinical characteristics, including a predominant principal esophageal symptom and the results from HFIUS among the control, GERD-related IEM (group I), and non-GERD–related IEM (group II) groups. Results The proportion of typical reflux symptom as a predominant symptom was higher in group I (66%) than in group II (25%). Muscle thickness was greater in group II than in group I and the control group during both the baseline rest period and the peak of contraction period at all levels of the middle of the lower esophageal sphincter (LES), and 3 cm and 9 cm above the LES (respectively) ( P Limitation The limitation was the small sample size. Conclusions Patients with non-GERD–related IEM had increased muscle thickness on HFIUS compared with patients with GERD-related IEM and the controls. Based on this study, IEM is not necessarily indicative of GERD.

Background During an EMR or endoscopic submucosal dissection (ESD) for colorectal tumors, an injection needle catheter is passed through the contaminated endoscopic channel and may directly inoculate bacteria into the blood stream during submucosal injection. In addition, extensively exposed submucosa, especially with an ESD, directly contacts colonic luminal bacteria after the procedure, which may increase the risk of bacteremia. However, the incidence of bacteremia after an EMR or ESD for colorectal tumors has not been reported. Objective To evaluate the frequency of bacteremia associated with an EMR or ESD for colon lesions. Design A prospective study. Patients A total of 40 patients who underwent a conventional EMR (n = 30), an EMR after circumferential pre-cutting (n = 3), or ESD (n = 7) for colorectal tumors. Interventions and Main Outcome Measurements Blood cultures were obtained immediately before, 5 minutes after, and 30 minutes after the procedure. Patients were closely monitored for 24 hours after the procedure to detect the development of infectious complications. Results Blood cultures at baseline and 5 minutes after the procedure were all negative. However, a blood culture at 30 minutes after the procedure showed a positive result in 1 of 40 patients (2.5%). This patient underwent a conventional EMR, and the isolated microorganism was coagulase-negative Staphylococcus, which might be regarded as a contaminant. None of the 40 patients showed any signs or symptoms associated with infection. Limitation The small sample size. Conclusions An EMR, or even an ESD, for colon lesions may be considered a low-risk procedure for infectious complications that does not warrant prophylactic administration of antibiotics.

Background and Aim: To perform endoscopic mucosal resection (EMR) for T1 esophageal cancer, it is essential to estimate the lymph node status exactly. In order to evaluate the feasibility of EMR for esophageal cancers, we evaluated the clinicopathological features of T1 esophageal squamous carcinomas with an emphasis on the risk factors and distribution patterns of lymph node metastasis. Methods: From 1994 to 2006, a total of 200 patients with T1 esophageal carcinoma were treated surgically in our institution. Among them, clinicopathological features were evaluated for 197 consecutive patients with T1 squamous cell carcinoma. Results: The frequency of lymph node involvement was 6.25% (4/64) in mucosal cancers and 29.3% (39/133) in submucosal cancers (P

The aims of this study are to evaluate and compare the accuracies of isotropic multi-detector row CT (MDCT) including multiplanar reconstruction (MPR) images for preoperative staging of endoscopically diagnosed early gastric cancer (eEGC) and advanced gastric cancer (eAGC). One hundred and five patients with endoscopically proven gastric cancer underwent isotropic MDCT. Three independent radiologists evaluated T and N staging both on transverse images only and on three orthogonal MPR images. The staging of each tumor was surgico-pathologically confirmed. The receiver operating characteristic (ROC) analysis and the Wilcoxon signed ranked test were used for statistical analyses. In 30 eAGCs, the accuracies for T and N staging with MPR imaging were better than those with transverse imaging (each P

Probiotic bacteria exhibit a variety of properties, which are unique to a particular strain. Lactobacillus acidophilus-SDC 2012, 2013 are new strains isolated from Korean infants' feces. The potential utility of Lactobacillus acidophilus-SDC 2012, 2013 in irritable bowel syndrome (IBS) was studied. Forty IBS patients were randomized into a placebo (n = 20) and probiotics group (n = 20). Four weeks of treatment with L. acidophilus-SDC 2012, 2013 was associated with a reduced score for abdominal pain or discomfort compared to the baseline (P = 0.011). The percent reduction in abdominal pain or discomfort exceeded the placebo scores by more than 20% (23.8 and 0.2% for probiotics and placebo, respectively, P = 0.003). There was a significant difference in the proportion of responders between the probiotics and placebo groups (P = 0.011). There was no drop out or adverse events for either group during the study period. Lactobacillus acidophilus-SDC 2012, 2013 appeared to have a beneficial effect in patients with IBS. Further studies are warranted.

Background: Products of cyclin-dependent kinase inhibitor p16INK4Aand mitotic arrest defective protein 2 (MAD2) genesare key regulator proteins at the G1 restriction point and mitotic checkpoint of the cell cycle. The objective of this study was to investigate the role of promoter methylation of p16INK4A and MAD2 genes in gastric marginal-zone B-cell lymphoma (MZBCL). Materials and Methods: Gastric biopsies from 40 patients were analyzed by methylation-specific polymerase chain reaction, and the methylation status was compared with the results of BCL10 expression and t(11;18)(q21;q21) translocation. Results and Conclusion:p16INK4A was methylated in 30 of 40 MZBCLs (75%). The lymphomas with p16INK4A methylation tended to be negative for t(11;18)(q21;q21) (p = 0.011). MAD2 gene was methylated in 23 of 38 MZBCLs (61%). Lymphomas with MAD2 gene methylation more frequently expressed BCL10 (p = 0.037). These methylation profiles suggest that p16INK4A and MAD2 gene may play a role in the pathogenesis of MZBCL via different pathways; MAD2 gene is Helicobacter pylori independent with a close association with BCL10 while p16INK4A is H. pylori dependent with an inverse correlation with the t(11;18)(q21;q21) translocation.