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To investigate the efficacy of amitriptyline with proton pump inhibitor (PPI) for the treatment of functional chest pain (FCP).This was a randomized, open-label trial investigating the addition of low dose amitriptyline (10 mg at bedtime) to a conventional dose of rabeprazole (20 mg/d) (group A, n = 20) vs a double-dose of rabeprazole (20 mg twice daily) (group B, n = 20) for patients with FCP whose symptoms were refractory to PPI. The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with50% improvement in their symptom score.The between-group difference in global symptom scores was statistically significant during the last week of treatment (overall mean difference; 3.75 ± 0.31 vs 4.35 ± 0.29, the between-group difference; P0.001). Furthermore, 70.6% of patients in group A had their symptoms improve by50%, whereas only 26.3% of patients in group B had a similar treatment response (70.6% vs 26.3%, P = 0.008). Specifically, patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B (52.37 ± 17.00 vs 41.32 ± 12.34, P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84, P = 0.01, respectively).Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.

We fabricated a novel in-line conductive atomic force microscopy (C-AFM), which can analyze the resistive failures and examine process variance with an exact-positioning capability across the whole wafer scale in in-line DRAM fabrication process. Using this in-line C-AFM, we introduced a new, non-destructive diagnosis for resistive failure in mobile DRAM structures. Specially, we focused on the self-aligned contact (SAC) process, because the failure of the SAC process is one of the dominant factors that induces the degradation of yield performance, and is a physically invisible defect. We successfully suggested the accurate pass mark for resistive-failure screening in the fabrication of SAC structures and established that the cause of SAC failures is the bottom silicon oxide layer. Through the accurate pass mark for the SAC process configured by the in-line C-AFM analyses, we secured a good potential method for preventing the yield loss caused by failures in DRAM fabrication.

Purpose: Additional gastrectomy is needed after endoscopic resection for early gastric cancer when pathology confirms any possibility of lymph node metastasis or margin involvement. No studies depicted the optimal type of surgery to apply in these patients. We compared the short-term and long-term outcomes of laparoscopic gastrectomy with those of open gastrectomy after endoscopic resection to identify the optimal type of surgery. Materials and Methods: From 2003 to 2010, 110 consecutive patients who underwent gastrectomy with lymphadenectomy either by laparoscopic (n=74) or by open (n=36) for gastric cancer after endoscopic resection were retrospectively analyzed. Postoperative and oncological outcomes were compared according to types of surgical approach. Results: Clinicopathological characteristics were comparable between the two groups. Laparoscopic group showed significantly shorter time to gas passing and soft diet and hospital day than open group while operation time and rate of postoperative complications were comparable between the two groups. All specimens had negative margins regardless of types of approach. Mean number of retrieved lymph nodes did not differ significantly between the two groups. During the median follow-up of 47 months, there were no statistical differences in recurrence rate (1.4% for laparoscopic and 5.6% for open, P=0.25) and in overall (P=0.22) and disease-free survival (P=0.19) between the two groups. Type of approach was not an independent risk factor for recurrence and survival. Conclusions: Laparoscopic gastrectomy after endoscopic resection showed comparable oncologic outcomes to open approach while maintaining benefits of minimally invasive surgery. Thus, laparoscopic gastrectomy can be a treatment of choice for patients previously treated by endoscopic resection.

The Korean Society of Gastrointestinal Endoscopy (KSGE) has been hosting the International Digestive Endoscopy Network (IDEN) since 2011. IDEN 2016 was held at the Grand Hilton Hotel, Seoul, Korea, from June 24 to 26, 2016. The KSGE collaborated with the American Society for Gastrointestinal Endoscopy (ASGE) in hosting the KSGE-ASGE joint sessions in the conference.

Background Several pro-inflammatory cytokines such as TNF-α, IL-1, IL-6, IL-8 and IL-15 are known to be critical in synovial inflammatory process in RA and successful results have been obtained in RA treatment with targeting pro-inflammatory cytokines including TNF-α, IL-1 and IL-6. Objectives This study sought to investigate the role of IL-33 and IL-6 in RA patients receiving IL-6 receptor inhibition therapy. Methods We analyzed the association of the IL-33 and IL-6 level with disease activity and serologic features in 83 patients with RA. We also measured the serum level of IL-33 and IL-6 before and after the administration of tocilizumab for 24 weeks in 40 patients. Results Serum IL-33 level showed significant correlation with RF (rho =0.660, p Serum IL-33 level significantly decreased after 24 weeks of IL-6 receptor inhibition in patients with RA (p Serum IL-6 levels were not significantly changed after 24 weeks of IL-6 receptor inhibition therapy (median 7.1 to 8.9 pg/mL, p=0.503). Changes of IL-6 levels were insignificant both in ACR20 responders and non-responders after 24 weeks of IL-6 receptor inhibition therapy. Baseline IL-6 levels were not different between ACR20 responders and non-responders. Conclusions The use of IL-6 receptor inhibitor decreased the serum level of IL-33 and this effect seems to be led by the responder group. IL-33 could be a useful indicator to monitor the response in IL-6 receptor inhibition therapy. Disclosure of Interest None declared

Background Endoscopic submucosal dissection (ESD) is accepted as a standard treatment in patients with early gastric cancer (EGC) who have a negligible risk of lymph node metastasis. The aim of this study was to compare the short-term and long-term outcomes between ESD and surgery in patients with EGC that fulfilled the expanded indication of ESD on their final pathologic report.

145 Background: We tried to analyze and deduce a treatment guideline after endoscopic resection of superficial esophageal squamous cell carcinoma in a retrospective analysis. Methods: Medical records of 37 patients who had been treated by endoscopic resection during a 6-year period in single institution were retrospectively analyzed. Results: Mean tumor size was 11.5±5.5 mm (range 3-31). Thirty-one lesions (83.8%) were treated by endoscopic submucosal dissection and 6 lesions by endoscopic mucosal resection (16.2%). En bloc resection rate and complete resection rate was 91.9% and 81.8%, respectively. The tumor invasion depth was diagnosed as epithelium: 5(13.5%), lamina propria mucosa: 12 (32.4%), muscularis mucosa: 10 (27.0%), submucosa: 10 (27.0%) respectively. The lymphovascular invasion was 3 lesions (8.1%). The rates of adverse events were 13.5% including 3 cases (8.1%) of perforation. Ten patients of the invasion depth as muscularis mucosa and submucosa received additional treatments including 6 patients of esophagectomy, 3 patients with radiotherapy and 1 patient with chemoradiotherapy. One patient of lamina propria received radiotherapy due to resection margin positive. The median follow-up duration was 22 month (range, 4-79) and there was no recurrence or metastasis during follow-up. Conclusions: We propose that adequate tailored management strategy after endoscopic resection of superficial esophageal squamous cell carcinoma may provide the favorable clinical results in outcome in treating early stage esophageal carcinoma.

Background/Aims: This study sought to characterize the current sedation practices of Korean endoscopists in real- world settings. Methods: All active members of the Korean Society of Gastrointestinal Endoscopy were invited to com- plete an anonymous 35-item questionnaire. Results: The overall response rate was 22.7% (1,332/5,860). Propofol- based sedation was the dominant method used in both elec- tive esophagogastroduodenoscopy (55.6%) and colonoscopy (52.6%). The mean satisfaction score for propofol-based sedation was significantly higher than that for standard seda- tion in both examinations (all p

Endoscopic submucosal dissection (ESD) has been widely used to treat early gastric cancer (EGC) with expanded indications.1,2 The expanded indications for ESD proposed by Gotoda3 consist of four categories based on a combination of multiple tumor characteristics including tumor differentiation, depth of tumor invasion, tumor size, presence of ulcers, and presence of lymphovascular invasion. However, predicting whether a tumor fulfills the indication criteria by using endoscopy with biopsy alone is difficult.1 When a tumor resected through ESD does not meet the ESD indication criteria, subsequent surgery should be performed because of the possibility of lymph node metastasis. However, some patients with EGC undergo unnecessary surgery even when the lesion meets the ESD indication criteria. To solve this problem, endoscopic ultrasonography (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.4,5 However, the ability of EUS to distinguish mucosal cancer from submucosal cancer remains in doubt.6 This doubt is concerning because the therapeutic decision between ESD and surgery for EGC with a differentiated histology might primarily depend on the presence of the submucosal invasion of the tumor. If EUS does not decrease the proportion of additional treatments after ESD, or that of unnecessary surgery, then there is no need to perform EUS before EGC. A recent study by Lee et al.,7 published in Gut and Liver, has approached this issue directly. In that study, EUS did not increase the likelihood of selecting the appropriate treatment for EGC with a differentiated histology. The appropriate treatment selection rates were 75.3% and 71.5% for the endoscopy- and EUS-based approaches, respectively, and these rates were not significantly different. In the case of endoscopically presumed mucosal cancer, however, an EUS-based treatment approach was inferior to its endoscopy-based counterpart. The authors demonstrated the nonrequirement for EUS by using a hypothetical treatment algorithm. Performing EUS routinely before treatment may not be necessary in patients with EGC. However, certain issues remain to be discussed. All patients with EGC undergo endoscopic examination regardless of whether they undergo EUS examination. No endoscopist should ignore the endoscopic findings during selection of the treatment plan. Therefore, therapeutic decision-making on the basis of EUS alone is unrealistic. Furthermore, a treatment plan based on endoscopy with EUS might be more clinically meaningful than a treatment plan based on EUS alone. Lee et al.7 have reported that seven of 45 patients (8.3%) with endoscopically presumed submucosal cancer successfully underwent ESD after an EUS-based treatment plan. In contrast, only one patient (1.2%) with endoscopically presumed submucosal cancer needed surgery after ESD after an EUS-based treatment plan. Although this finding was not significant, it suggests that EUS may play a supporting role in conventional endoscopy. Here, we suggest an algorithm for determining the depth of tumor invasion by using both endoscopy and EUS in patients with EGC with a differentiated histology (Fig. 1). Using this algorithm, EUS is necessary only when EGC is estimated to be beyond the absolute indication for ESD upon conventional endoscopy. When the tumor appears to be confined to the mucosa upon EUS, ESD is recommended as the initial treatment method even when the lesion appears to be beyond the absolute indication for ESD upon conventional endoscopy. This algorithm emphasizes the supporting role of EUS in minimizing the number of patients who undergo unnecessary surgery. We hope that the supporting role of EUS will be proven through future studies. Fig. 1 An algorithm for making designing a treatment plan in for patients with early gastric cancer (EGC) with a differentiated histology. Another discussion point is the variation in the gastric cancer population. In Korea and Japan, early-stage gastric cancer, especially mucosal cancer, is more prevalent than advanced gastric cancer.1,8–10 Lee et al.7 have shown that the sensitivity for predicting mucosal cancer is higher for the diagnosis based on endoscopy (endoscopy, 83.2% vs EUS, 66.9%), whereas the specificity for predicting mucosal cancer is higher for the diagnosis based on EUS (endoscopy, 56.5% vs EUS, 86.8%). Given that the overall accuracy of a diagnostic tool with a high sensitivity and low specificity increases as the incidence or prevalence increases, an endoscopy-based treatment plan should be favored over an EUS-based treatment plan in Korea and Japan. However, in Western countries where mucosal cancer is less prevalent, EUS might play a larger role in planning the treatment strategy. If mucosal cancer is extremely rare among EGCs, then the relatively low specificity of endoscopy might significantly increase the performance of unnecessary ESD procedures under a treatment plan based on endoscopy alone. Lee et al.7 have described the clinical role that EUS plays in choosing between ESD and surgery for patients with EGC. Routine EUS examination for therapeutic decision making may no longer be necessary. However, EUS might be an optional diagnostic modality because of its discriminatory ability in endoscopically presumed submucosal cancer. In addition, the relatively higher specificity of EUS compared with endoscopy should be considered when discussing the accuracy of EUS for predicting mucosal cancer because this accuracy depends on the incidence of mucosal cancer.

Background/Aims: The clinicopathologic features of gastric cancer in young patients are different from those of older patients. However, endoscopic submucosal dissection (ESD) is performed regardless of age. The purpose of this study was to characterize younger patients (≤40 years) who underwent ESD for early gastric cancer (EGC) and analyze the results of ESD. Materials and Methods: From January 2006 to June 2014, 55 patients aged 40 years or younger with newly diagnosed EGC under- went ESD at two tertiary hospitals. The clinicopathologic features of EGC and clinical outcomes of ESD in these young patients were reviewed retrospectively. Results: A total 55 patients with 57 EGC lesions underwent ESD. Female sex, superficial flat or depressed lesions, and un- differentiated histology were more common in younger patients than in older patients in our institutional ESD cohort. The en bloc resection rate was 92.7% and the complete resection rate was 94.5%. Although there was a high proportion of undifferentiated can- cer in the younger patient group, the curative resection rate was 72.7%. Among 15 patients with non-curative resection, 4 patients underwent additional surgery and 1 patient underwent argon plasma coagulation at the ESD ulcer margin. Eight patients were placed under close surveillance without additional treatment, and no recurrent tumors developed, with a median follow-up period of 37.2±23.6 months. Conclusions: Younger EGC patients who underwent ESD showed the typical characteristics seen in younger patients with gastric cancer. ESD in younger EGC patients showed comparable outcomes to those in patients with undifferentiated EGC in general. (Korean J Helicobacter Up Gastrointest Res 2016;16:139-146)

There are heterogeneous subgroups among those with heartburn, and data on these individuals are relatively scant. We aimed to evaluate the effect of acid challenge on the segmental contractions of esophageal smooth muscle in endoscopy-negative patients with normal esophageal acid exposure.High-resolution esophageal manometry (HRM) was performed on 30 endoscopy-negative patients with heartburn accompanied by normal esophageal acid exposure using 10 water swallows followed by 10 acidic pomegranate juice swallows. Patients were classified into functional heartburn (FH) and hypersensitive esophagus (HE) groups based on the results of 24-hr impedance pH testing. HRM topographic plots were analyzed and maximal wave amplitude and pressure volumes were measured for proximal and distal smooth muscle segments.The pressure volume of the distal smooth muscle segment in the HE group measured during acidic swallows was higher than during water swallows (2224.1 ± 68.2 mmHg/cm per s versus 2105.6 ± 66.4 mmHg/cm per s, P = 0.027). A prominent shift in the pressure volume to the distal smooth muscle segment was observed in the HE group compared with the FH group (segmental ratio: 2.72 ± 0.08 versus 2.39 ± 0.07, P = 0.005). Manometric measurements during acidic swallows revealed that this shift was augmented in the HE group. The optimal ratio of pomegranate juice swallowing for discrimination of FH from HE was 2.82, with a sensitivity of 88.9% and a specificity of 100%.Hypercontractile response of distal smooth muscle segment to acid swallowing was more prominent in the HE group than the FH group.

Same-day bidirectional endoscopy is commonly performed in clinical practice. However, the optimal sequence of procedures for same-day bidirectional endoscopy has not been established. The purpose of this study was to compare colonoscopy performance and quality between patients who underwent colonoscopy before or after esophagogastroduodenoscopy (EGD). A total of 1,103 patients were prospectively randomized into either the EGD–colonoscopy or colonoscopy–EGD sequence groups. Three patients who had incomplete cecal intubation due to structural obstruction were excluded from the analysis. During colonoscopy, colonoscopic parameters including difficult cecal intubation (cecal intubation failure and prolonged insertion), insertion time, and adenoma detection rate were measured. Out of 1,100 patients, 524 patients without sedation completed a questionnaire designed to assess subjective discomfort experienced. The colonoscopy completion rate was 99.5 %, and the rate of difficult cecal intubation was 14.5 %. The time from insertion to reaching the cecum (minutes:seconds, 06:32 ± 04:26 vs. 06:40 ± 04:09, p = 0.649), difficult cecal intubation ratio (76 of 550 vs. 83 of 550, p = 0.593), and colonoscopic adenoma detection rate (29.8 vs. 25.5 %, p = 0.106) did not differ between the groups. On multivariate analysis, difficulty with cecal intubation increased specifically in women, in patients aged 55 years and over, in patients with poor bowel preparation, and in patients who had undergone previous abdominal surgery. Subjective discomfort after EGD was higher in the colonoscopy–EGD sequence group. The procedural sequence did not affect colonoscopy performance and quality in same-day bidirectional endoscopy, and factors such as old age, female gender, poor bowel preparation, and previous abdominal surgery were confirmed to adversely affect colonoscopy. In addition, the EGD–colonoscopy sequence induced less subjective discomfort during EGD.

Endoscopic forceps biopsy is a fundamental modality for the histologic diagnosis of gastric neoplasms. However, the pathologic findings are not always concordant with the endoscopic interpretations. Currently, repeat endoscopic biopsy is the only way to manage lesion of indefinite pathology such as Category 2 according to the revised Vienna classification. We aimed to elucidate the role of endoscopic submucosal dissection (ESD) in clarifying the final pathologic diagnosis.Among the 2304 gastric ESD cases, a total of consecutive 30 patients with 31 lesions (1.3%) that had a forceps biopsy with indefinite pathology discrepant from the endoscopic findings underwent endoscopic submucosal dissection (ESD) for confirmative diagnosis and treatment.The final pathologic diagnoses of the ESD specimens were as follows: low-grade dysplasia in 3 patients (9.7%); high-grade dysplasia in 2 patients (6.5%); adenocarcinoma in 15 patients (48.4%); and a benign lesion in 11 patients (35.5%). Cases with adenocarcinoma included nine well-differentiated lesions, four moderately differentiated lesions, and two lesions with signet ring cell carcinoma. The complete en bloc resection rate for neoplastic lesions was 95.0%, and the incidence rates of ESD-related bleeding and perforation were 5.0% and 5.0%, respectively.ESD can be considered an effective and safe alternative therapeutic and diagnostic tool for gastric lesions in cases where the forceps biopsy pathology is discrepant from the endoscopic findings. The overall final neoplastic diagnosis rate after ESD was 64.5%, and ESD should be performed for lesions with red coloration and friability.

There are no data on how metabolic syndrome (MetS) affects the prevalence of synchronous colorectal neoplasm (CRN) in gastric neoplasm (GN) patients. The aim of this study was to investigate a model for risk stratification for colorectal screening by evaluating the clinical characteristics of synchronous CRN in GN patients classified according to the presence of MetS.A cross-sectional, case-control study of 492 patients (368 males and 124 females) with GN, and 492 age-matched healthy controls undergoing simultaneous upper endoscopy and colonoscopy, was conducted.The GN group involved 446 patients without MetS, and 46 patients with MetS. In total, 177 (39.7%) and 28 (60.9%) synchronous CRN were detected in GN patients without MetS and with MetS, respectively (P=0.006). A total of 143 (34.7%) synchronous colorectal adenomas were detected in GN patients without MetS, whereas 17 (48.6%) were detected in GN patients with MetS (P=0.101), as well as more synchronous colorectal cancers (11.2% vs 37.9%, P0.001). A multivariate logistic regression analysis revealed that the presence of GN (OR=1.54, 95% CI: 1.18-2.00, P=0.001) and the presence of MetS (odds ratio=1.82, 95% confidence interval: 1.19-2.78, P=0.006) were significant independent risk factors associated with the prevalence of CRN. The frequency of synchronous CRN in GN patients with MetS was 1.96 times greater than that in the GN group without MetS.The risk of synchronous CRN is significantly increased by the presence of GN, especially in MetS patients. Screening for synchronous CRN is highly recommended for GN patients with MetS.

Technical limitations of conventional endoscopes and delivery systems frequently hamper palliative endoscopic placement of self-expandable metal stents for malignant small bowel obstruction. This study examined feasibility of the double balloon enteroscope-guided withdrawal-reinsertion method as a rescue procedure in patients with failed palliative stent placement for malignant small bowel obstruction.We enrolled 19 consecutive patients with small bowel obstruction due to metastatic gastric (n = 15) or colorectal cancer (n = 2), or primary small bowel carcinoma (n = 2), in whom previous attempts to place self-expandable metal stents using conventional endoscopy had failed. Ten patients had undergone previous gastric surgery. After passing a guide-wire using an enteroscope with or without the double-balloon method, the enteroscope was withdrawn. A conventional endoscope was re-inserted along the guide-wire, and through-the-scope self-expandable metal stent placement was performed.Obstruction sites were efferent jejunal loop, proximal jejunum, and third duodenal portion. Technical success was achieved with 94.7% (18/19) of stents, and clinical success occurred with 84.2% (16/19) of patients. The gastric outlet obstruction score (pre-procedure: 0.68 ± 0.58) increased by one week (2.05 ± 0.52, P0.001). Stent migration and restenosis occurred in two (10.5%) and four (21.1%) of 19 stents, respectively. Median stent patency duration was 67 days and median survival was 93 days; these did not differ significantly by palliative chemotherapy (P = 0.76 and 0.67, respectively).The double-balloon enteroscopy-guided method followed by conventional endoscopic self-expandable metal stent delivery was effective for rescue palliation of malignant small bowel obstruction.

High-dose proton pump inhibitor (PPI) treatment leads to relatively little symptomatic improvement in patients with functional chest pain (FCP). This study was to evaluate the use of smooth muscle segmental changes in esophageal contraction as measured by topographical plots of high resolution manometry (HRM) as predictive factors of the response to high-dose PPI treatment in FCP patients.Thirty patients diagnosed with FCP were treated with rabeprazole 20 mg twice daily for 2 weeks and classified as positive and negative responders based on symptom intensity score. HRM topographical plots were analyzed for segment lengths, maximal wave amplitudes, and pressure volumes of the proximal and distal smooth muscle segments.A positive response was observed in 23.3% of the patients. While the pressure volume of the proximal segment was significantly higher in the positive responders than the negative responders (900.4 ± 91.5 mm Hg/cm per s vs. 780.5 ± 133.3 mm Hg/cm per s, P = 0.017), the pressure volume of the distal segment was significantly lower in the positive responders (1914.0 ± 159.8 mm Hg/cm per s vs. 2140.5 ± 276.2 mm Hg/cm per s, P = 0.014). A prominent shifting in pressure volume to the distal segment was observed in the negative responders compared with the positive responders (segmental ratio of pressure volume (SRPV): 2.9 ± 0.5 vs. 2.1 ± 0.1, P0.001), and 2.39 was found to be the SRPV that best differentiated positive and negative responders.A low SRPV was associated with a positive response to high-dose PPI treatment in patients with FCP.

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

Pretreatment identification of the sentinel lymph nodes (SLNs) in gastric cancer patients may have great advantages for minimally invasive treatment. No reliable method for the detection of SLNs during the pretreatment period in gastric cancer has been established. The aim of this study was to determine whether computed tomographic (CT) lymphography using nanoscale iodized oil emulsion via endoscopic submucosal injection can visualize LNs. Five dogs underwent CT lymphography after endoscopic submucosal injection of 2 ml of a nanoscale iodized oil emulsion. CT images were taken before and 30, 90, and 210 min after contrast injection. Intraoperative SLN detection was performed using endoscopically injected indocyanine green lymphography for comparison. Computed tomographic lymphography with nanoscale iodized oil emulsion enabled the visualization of 19 enhanced LNs (mean = 3.8/dog, range = 3–6) with a 100% SLN detection rate. The locations of the SLNs were the lesser curvature (n = 7), greater curvature (n = 1), infrapyloric (n = 3), and left gastric (n = 8) areas. Contrast enhancement of SLNs continuously increased and peaked after 210 min at 142.4 ± 42.3 HU. No green LNs were visualized in the three locations that were detected by CT lymphography. However, no additional LNs were visualized using the dye method. The concordance rate based on the LNs between the SLNs on CT lymphography and the green LNs using the ICG method was 84% (16/19), whereas the concordance rate of the stations identified by CT lymphography and the dye method was 78.6% (11/14). Computed tomographic lymphography using nanoscale iodized oil emulsion is a promising tool for preoperative SLN detection for early gastric cancer if the biological safety of the nanoscale iodized oil emulsion can be established.

The purpose of this study was to investigate the beneficial effects of endogenous and exogenous melatonin on functional recovery in an animal model of spinal cord injury (SCI). Eight-week-old male Sprague-Dawley (SD, 250-260 g) rats were used for contusion SCI surgery. All experimental groups were maintained under one of the following conditions: 12/12-hr light/dark (L/D) or 24:0-hr constant light (LL). Melatonin (10 mg/kg) was injected subcutaneously for 4 wk, twice daily (07:00, 19:00). Locomotor recovery, inducible nitric oxide synthase (iNOS), glial fibrillary acidic protein gene expression, and muscle atrophy-related genes, including muscle atrophy F-box (MAFbx) and muscle-specific ring-finger protein 1 (MuRF1) gene expression were evaluated. Furthermore, autophagic signaling such as Beclin-1 and LC3 protein expression was examined in the spinal cord and in skeletal muscle. The melatonin treatment resulted in increased hind-limb motor function and decreased iNOS mRNA expression in the L/D condition compared with the LL condition (P0.05), indicating that endogenous melatonin had neuroprotective effects. Furthermore, the MAFbx, MuRF1 mRNA level, and converted LC3 II protein expression were decreased in the melatonin-treated SCI groups under the LL (P0.05), possibly in response to the exogenous melatonin treatment. Therefore, it seems that both endogenous and exogenous melatonin contribute to neural recovery and to the prevention of skeletal muscle atrophy, promoting functional recovery after SCI. Finally, this study supports the benefit of endogenous melatonin and use of exogenous melatonin as a therapeutic intervention for SCI.

A rapid, simple and sensitive liquid chromatography–tandem mass spectrometry (LC/MS/MS) was developed for the determination of an antiepileptic drug, lacosamide, in rat plasma. The method involves the addition of acetonitrile and internal standard solution to plasma samples, followed by centrifugation. An aliquot of the supernatant was diluted with water and directly injected into the LC/MS/MS system. The separations were performed on column packed with octadecylsilica (5 µm, 2.0 × 50 mm) with 0.1% formic acid and acetonitrile as mobile phase, and the detection was performed on tandem mass spectrometry by the multiple-reaction monitoring via an electrospray ionization source. The standard curve was linear over the concentration range from 0.3 to 1000 ng/mL. The lower limit of quantification was 0.3 ng/mL using 50 μL of rat plasma sample. The intra- and inter-assay precision and accuracy were found to be less than 11.7 and 8.8%, respectively. The developed analytical method was successfully applied to the pharmacokinetic study of lacosamide in rats. Copyright © 2011 John Wiley & Sons, Ltd.

The multifocality rate of EGC ranges from 4 to 20%, but there are few data regarding both lymph node metastasis and feasibility of the endoscopic treatment. We investigated the risk of lymph node metastasis with the purpose to evaluate the potential for endoscopic treatment in patients with multifocal EGC. We retrospectively reviewed the medical records of patients who underwent radical gastrectomy to treat EGC between January 2001 and December 2007 at Severance Hospital, Seoul, Korea. Synchronous multifocal EGC was defined as EGC having two or more malignant foci, whereas solitary EGC was defined as EGC having single focus. Of 1,693 patients, 55 (3.2%) were diagnosed with synchronous multifocal EGC. The rates of lymph node metastasis were 12.7% in synchronous multifocal EGC and 10% in solitary EGC. In the multivariate analysis, synchronous multifocal EGC was not associated with lymph node metastasis (odds ratio, 1.1; 95% confidence interval, 0.4–2.7) compared with solitary EGC. In a subgroup analysis of 55 patients with synchronous multifocal EGC, older age (≥65 years) and lymphovascular invasion were associated with lymph node metastasis. In synchronous multifocal EGC, none of the cases had lymph node metastasis in major and minor lesions representing mucosal cancer without lymphovascular invasion. Synchronous multifocality of EGC does not increase the risk of lymph node metastasis compared with solitary EGC. Therefore, endoscopic treatment can be planned when major and minor lesions are predicted to represent mucosal cancer without lymphovascular invasion.

Over the last decade, a growing number of non-coding transcripts have been found to have roles in gene regulation and RNA processing. The most well known small non-coding RNAs (ncRNAs) are the microRNAs (miRNAs), but the network of long and short non-coding transcripts is complex and is likely to contain as yet unidentified classes of molecules that form transcriptional regulatory networks. miRNAs and some other ncRNAs have been found to be involved in human tumorigenesis, revealing a new layer in the molecular architecture of cancer. Gene expression studies have shown that hundreds of miRNAs are deregulated in cancer cells, and functional studies have clarified that miRNAs are involved in all the molecular and biologic processes that drive tumorigenesis. Here, we summarize the recent advances in understanding miRNAs' and other ncRNAs' involvement in cancer and illustrate how this knowledge may be useful in medical practice. New diagnostic classifiers based on miRNAs will soon be available for medical practitioners, and even more importantly, miRNAs may become novel anti-cancer therapies.

Various endoscopic submucosal dissection (ESD)-related complications, such as perforation or bleeding, occur frequently. However, the clinical course of coagulation syndrome (CS) after ESD is not known. The aim of this study was to clarify the clinical outcomes and predictive factors of CS after ESD for early gastric lesions.ESD procedures were performed in the typical sequence (marking, incision, and submucosal dissection). Four hundred and ninety-five patients with early gastric neoplasms were classified into two groups based on their clinical course after ESD: one group with post-ESD CS and the other with a normal clinical course. The clinical outcomes of the CS group were analyzed, and various clinical and pathological factors related to post-ESD CS were investigated using univariate and multivariate analyses.Coagulation syndrome occurred after ESD in 35 patients. In the CS group, the median period of inflammatory symptoms was 23.7 ± 12.0 h, and no blood cultures showed bacteremia. Multivariate analysis demonstrated that a tumor size of more than 1.5 cm [odds ratio (OR) 5.99, P 0.001], tumor location in the middle third of the stomach (OR 2.84, P = 0.005), and a procedural time longer than 45 min (OR 2.71, P = 0.033) were independent risk factors for this complication. All patients with CS presented with a favorable outcome, irrespective of antibiotic treatment.This study suggests that CS occurs with an incidence of 7.1% after ESD for gastric lesions, and the factors associated with post-ESD CS include tumor size and location, and procedural duration.

Colorectal polyps can be missed even during a meticulous colonoscopy by an experienced colonoscopist. The aim of this study was to investigate patient-, procedure-, and polyp-related factors affecting the miss rate of polyps on colonoscopy.From March 2001 to February 2006, a total of 285 patients undergoing screening colonoscopy followed within 2 months by colonoscopy for polypectomy were enrolled. The main outcome measurements were factors associated with miss rates of polyp and the conditions for reducing missed polyps on colonoscopy.From the 285 colonoscopy pairs, a total of 1326 polyps were found. Overall, 350 of the 1326 polyps were missed (26.4%). Among those, 59 polyps (4.4%) were only seen on the first colonoscopy and 291 polyps (21.9%) were found only at the second colonoscopy. Patient-related factors were male sex (Odds Ratio (OR) 2.11, 95% Confidence Interval (CI) 1.21-3.70) and older age (OR 2.51, 95% CI 1.48-4.30). Procedure-related factors were colonoscopy by clinical fellows (OR 2.20, 95% CI 1.02-4.84) and delayed insertion time (OR 4.10, 95% CI 2.14-7.86). Polyp-related factors were more than four numbers of polyps (OR 4.48, 95% CI 1.91-10.5). However, a large polyp was less frequently missed on colonoscopy (OR 0.10, 95% CI 0.05-0.19).In usual clinical practice, colon polyps were frequently missed on colonoscopy. Comprehensive analysis of patient should be required to reduce the miss rates.

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. 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. 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. 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.

This study investigates the combined effect of absorption enhancers and electrical assistance on transbuccal salmon calcitonin (sCT) delivery, using fresh swine buccal tissue. We placed 200 IU (40 μg/mL) of each sCT formulation--containing various concentrations of ethanol, N-acetyl-L-cysteine (NAC), and sodium deoxyglycocholate (SDGC)--onto the donor part of a Franz diffusion cell. Then, 0.5 mA/cm(2) of fixed anodal current was applied alone or combined with chemical enhancers. The amount of permeated sCT was analyzed using an ELISA kit, and biophysical changes of the buccal mucosa were investigated using FT-IR spectroscopy, and hematoxylin-eosin staining methods were used to evaluate histological alteration of the buccal tissues. The flux (J(s)) of sCT increased with the addition of absorption enhancer groups, but it was significantly enhanced by the application of anodal iontophoresis (ITP). FT-IR study revealed that all groups caused an increase in lipid fluidity but only the groups containing SDGC showed statistically significant difference. Although the histological data of SDGC groups showed a possibility for tissue damage, the present enhancing methods appear to be safe. In conclusion, the combination of absorption enhancers and electrical assistance is a potential strategy for the enhancement of transbuccal sCT delivery.

The title compounds were synthesized and characterized. The vibrational frequencies of (Me 3 Si) 3 SiX (X  H, Cl, OH, OD, Me, OMe, SiMe 3 ) were determined by means of IR and Raman spectroscopy. Based on our AM1 semiempirical calculation and the literature group frequencies of CH 3 , Me 3 Si, SiSi 3 , SiX (X  H, Cl, OH, OD, CH 3 , OCH 3 ) have been assigned. The intensities of the Raman lines of the stretching vibrations of (Me 3 Si) 3 SiX (X  Cl, OH, OMe) and (Me 3 Si) 3 SiOH are very low compared with those of the IR lines. This indicates that the bonds have a strong ionic nature.

Objective: To evaluate the clinical usefulness of positive oral contrast computed tomography (CT) for the detection of leakage and its relationship with the immediate postoperative outcome after gastrectomy for gastric cancer. Methods: A total of 210 patients with a clinical suspicion of leakage after gastrectomy for gastric cancer underwent a positive oral contrast CT. Two radiologists retrospectively reviewed the CT images, recorded the presence of extraluminal contrast leakage, and graded the amount of leaked contrast. The rate of postoperative intervention treatment, the length of postoperative hospital stay, and mortality rates were correlated with the presence and grades of leakage. Matching accuracy between CT and other diagnostic studies in detection of leakage was also evaluated. Results: There were 162 patients without extraluminal contrast leakage (77.1%), 13 with grade 1 leakage (6.2%), 19 with grade 2 (9.0%), and 16 with grade 3 (7.6%). Postoperative intervention rate, hospital stay, and mortality were significantly higher in patients with extraluminal contrast than those in patients without extraluminal contrast (P < 0.05). Postoperative hospital stays increased as the leakage grades increased (P = 0.0008). The matching accuracy between CT and other studies was 82.1% (n = 32/39). Conclusions: Positive oral contrast CT can be a reliable tool for diagnosing postoperative leakage that requires further intervention after gastrectomy in gastric cancer patients, and the immediate postoperative outcome may be related with the grade of leaked contrast on CT.

BACKGROUND AND STUDY AIMS: Controversy persists around the treatment of gastric low-grade dysplasia (LGD). The aim of this study was to investigate possible indications for the endoscopic resection of gastric LGD through analysis of the histologic discrepancies between specimens of gastric LGD obtained by forceps biopsy and by endoscopic mucosal resection (EMR), and of their clinicopathologic characteristics. PATIENTS AND METHODS: The study involved 293 gastric LGD that were histologically proven on the basis of forceps biopsy in Severance Hospital between January 2004 and December 2007. Twenty cases were regularly followed up, and the remaining 273 were resected by EMR. We performed univariate and multivariate analyses of clinical and endoscopic characteristics including lesion size, number of biopsy fragments, and endoscopic appearance, in order to analyze the factors affecting histologic discrepancies. RESULTS: Of the 273 lesions resected by EMR, 207 (75.8 %) showed concordant histology, whereas for 51 (18.7 %) the histology was upgraded after endoscopic resection. Lesion size, absence of whitish discoloration, and the presence of spontaneous bleeding were found by univariate analysis to be statistically significant factors predicting an upgraded histology after EMR ( P = 0.026, P < 0.001, and P = 0.025, respectively). Multivariate analysis also showed absence of whitish discoloration to be a statistically significant factor influencing histologic discrepancies ( P = 0.001, odds ratio 5.29, 95 % confidence interval 1.95 - 14.37). Perforation and bleeding rates associated with EMR for LGD were 0.7 % and 6.2 %, respectively. Twenty patients who did not undergo EMR were followed up for a mean of 22 months, and 3 were revealed to have adenocarcinoma and 1 high-grade dysplasia on the latest histologic exam. CONCLUSIONS: We should consider endoscopic resection for gastric LGD that are 2 cm or more in size and do not have whitish discoloration.

The purpose was to evaluate the diagnostic role of contrast-enhanced CT colonography (CTC) for follow-up of colorectal cancer screening after curative gastrectomy in patients with gastric adenocarcinomas.Contrast-enhanced CTC was performed as a substitute for routine follow-up CT for the detection of recurrent lesions in 700 consecutive patients who underwent curative surgery for gastric adenocarcinomas. Prospectively, patients with polyps measuring 6 mm or larger on CTC were referred for optical colonoscopy. Clinical and radiologic follow-up with respect to detection of polyp and recurrent lesion was retrospectively assessed.Colorectal polyps measuring 6 mm or larger were identified by CTC in 104 (14.9%) of the 700 patients. Optical colonoscopy was recommended to these patients and was performed in 72 cases. True positive lesions were identified in 62 of the 72 patients (per-patient positive predictive value: 86.1%). The diagnostic yield for primary colonic malignancies was 1.6% (11/700). Recurrent lesions of gastric cancer were also detected in eight patients (1.1%).In patients who undergo gastrectomy due to gastric adenocarcinoma, contrast-enhanced CTC may offer a unique advantage by allowing simultaneous colorectal cancer screening in addition to its routine role of detecting recurrent lesions during follow-up.

Same-day bidirectional endoscopy including esophagogastroduodenoscopy (EGD) and colonoscopy is routinely performed to evaluate anemia and gastrointestinal bleeding, as well as to conduct cancer surveillance. Numerous questions have been raised regarding the most appropriate procedural sequence and the resulting potential procedure interactions. We compared the quality and feasibility of performing EGD and colonoscopy without sedation in patients subjected to EGD-colonoscopy (Group I) or colonoscopy-EGD (Group II) sequences.A total of 80 patients were prospectively randomized into two groups (40:40). All EGD examinations were recorded on videotape, and the quality of 18 EGD steps was assessed by three endoscopists. In addition, we analyzed the colonoscopic parameters and subjective discomfort scores of patients.Group I displayed significantly superior quality for retroflexion-related steps (P11-13; all median of Group I vs Group II = 2:3; P0.01), visualization of the angular fold (P10; Group I vs Group II = 2:3; P = 0.048), and general assessment of the stomach (P17; Group I vs Group II = 2:3; P = 0.008) and upper GI tract (P15; Group I vs Group II = 2:3; P = 0.047). Colonoscopic insertion time, total time, and prolonged insertion ratio did not differ between the two groups. Questionnaire responses indicated that EGD was perceived to be more stressful in Group II sequence.The quality of EGD steps is influenced by the sequence of bidirectional endoscopy. EGD is perceived to be more stressful to patients when preceded by colonoscopy. Therefore, EGD followed by colonoscopy may be the preferable procedural sequence for same-day bidirectional endoscopy.

Intestinal Behcet's disease (BD) is challenging to diagnose, especially if the patient presents with typical colonoscopic findings of intestinal BD without systemic manifestations of BD. We performed this study to evaluate the systemic manifestations of BD in patients with typical colonoscopic findings of intestinal BD at the time of initial presentation and to identity the chronologic changes of these features during an extended follow-up period. One hundred twenty-six consecutive patients who showed typical colonoscopic findings of intestinal BD at a single institution in Korea were enrolled. Clinical and endoscopic data were collected from a medical database and using a written questionnaire. Parameters including demographic characteristics and the subset type of BD at the initial and endpoints of the follow-up were analyzed. The mean follow-up period was 63.9 ± 50.9 months. The number of cases that satisfied the International Study Group for Behcet’s Disease criteria at initial diagnosis, 19.0%, increased to 53.2% by the end of follow-up. When the Japanese criteria were used for classification, the proportion of complete and incomplete type BD increased (2.4% and 26.2% to 18.3% and 49.2%, respectively), while that of suspected and not-satisfied subtype BD decreased (22.2% and 49.2% to 19.0% and 13.5%, respectively) during the follow-up period. Our data suggest that patients who lack the systemic manifestations of BD could be included in the category of intestinal BD when typical intestinal lesion is identified, indicating that close examination and early treatment should be considered in such patients.

Background The aim of this study was to investigate the antiinflammatory effects of Bifidobacterium lactis on intestinal epithelial cells (IECs) and on experimental acute murine colitis and its tumor prevention effects on colitis-associated cancer (CAC) in mice. Methods Human HT-29 cells were stimulated with IL-1beta, lipopolysaccharides, or tumor necrosis factor-alpha with and without B. lactis, and the effects of B. lactis on nuclear factor kappa B (NF-kappaB) signaling in IEC were examined. For in vivo study, dextran sulfate sodium (DSS)-treated mice were fed with and without B. lactis. Finally, we induced colonic tumors in mice by azoxymethane (AOM) and DSS and evaluated the effects of B. lactis on tumor growth. Results B. lactis significantly suppressed NF-kappaB activation, including NF-kappaB-binding activity and NF-kappaB-dependent reporter gene expression in a dose-dependent manner, and suppressed IkappaB-alpha degradation, which correlated with the downregulation of NF-kappaB-dependent gene products. Moreover, B. lactis suppressed the development of acute colitis in mice. Compared with the DSS group, the severity of DSS-induced colitis as assessed by disease activity index, colon length, and histological score was reduced in the B. lactis-treated group. In the CAC model, the mean number and size of tumors in the B. lactis-treated group were significantly lower than those in the AOM group. Conclusions Our data demonstrate that B. lactis inhibits NF-kappaB and NF-kappaB-regulated genes in IEC and prevents acute colitis and CAC in mice. These results suggest that B. lactis could be a potential preventive agent for CAC as well as a therapeutic agent for inflammatory bowel disease.

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 IKKalpha 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.

The title compounds were synthesized and characterized. The vibrational frequencies of (Me 3 Si) 3 SiX (X  H, Cl, OH, OD, Me, OMe, SiMe 3 ) were determined by means of IR and Raman spectroscopy. Based on our AM1 semiempirical calculation and the literature group frequencies of CH 3 , Me 3 Si, SiSi 3 , SiX (X  H, Cl, OH, OD, CH 3 , OCH 3 ) have been assigned. The intensities of the Raman lines of the stretching vibrations of (Me 3 Si) 3 SiX (X  Cl, OH, OMe) and (Me 3 Si) 3 SiOH are very low compared with those of the IR lines. This indicates that the bonds have a strong ionic nature.

Intestinal Behcet’s disease (BD) is a chronic inflammatory bowel disease, as are Crohn’s disease (CD) and ulcerative colitis (UC). But unlike CD and UC, serologic markers for intestinal BD are not well known. Recently, anti-α-enolase antibody (AAEA) has been detected in sera from BD patients. The aim of this study was to evaluate the prevalence of AAEA in intestinal BD and its clinical correlations. The study sample included 80 patients with intestinal BD and 23 healthy controls. IgM AAEA was detected by ELISA. The positivity of IgM AAEA was defined as an optical density greater than three standard deviations above the mean of the control sera. Other parameters, such as demographic information, subtype of BD, colonoscopic findings, disease severity and treatment modality, were analyzed retrospectively. The prevalence of IgM AAEA was 67.5% in intestinal BD and 0% in the control group. The positivity rate of IgM AAEA was higher in complete or incomplete BD than in suspected BD (77.5% vs. 51.6%, P = 0.016). The mean HBI score was higher in antibody positive patients than in antibody negative patients (5.60 vs. 4.61, P = 0.003). The cumulative probability of steroid use for aggravation of intestinal and extra-intestinal symptoms was higher in antibody positive patients than in antibody negative patients (P = 0.012). The number of patients with systemic involvement was higher in the AAEA positive group than in the negative group. Monitoring IgM AAEA may be helpful for diagnosis of intestinal BD and could be used to predict clinical course and disease severity.

In colonoscopy examination, luminal visibility is frequently limited due to intraluminal bubbles. In present study was evaluated factors affecting bubble formation and the effects of simethicone in preventing bubble formation during colonoscopy.Consecutive patients (n=164) who received polyethylene glycol or sodium phosphate for bowel preparation were prospectively enrolled. Before colonoscopy, 57 patients took 80 mg simethicone after ingestion of bowel preparation solution and 107 did not to determine whether simethicone decreased bubble formation. Intraluminal gas bubbles were assessed and graded as follows: 0, minimal or none; 1, covering less than half the lumen; 2, covering at least half the lumen or the entire circumference. Grade 2 bubbles were regarded as significant, limiting visibility.Sodium phosphate preparation tended to have more bubbles than the polyethylene glycol. Significant bubbles were more likely to occur in males than females (p = 0.020). Significant bubbles were noted in 34.6% of patients without simethicone and 7% of patients with simethicone. Simethicone significantly lowered the incidence of bubbles during colonoscopy when given after a preparation solution (p0.05),The present study findings indicate that taking simethicone after an oral polyethylene glycol or sodium phosphate preparation can improve colonic visibility by diminishing colonic bubbles.

Several reports have suggested a trend of right-side shift of colorectal cancer; however, there were only a few studies on the chronologic changes in the distribution of adenomatous polyps. We aimed to study the changes in the distribution of colorectal adenomatous polyps over the past ten years.We reviewed medical records of patients who underwent a colonoscopy at Yonsei University Severance Hospital, Seoul, Korea between January 1996 and December 2005. Patients who had an adenomatous polyp with a diameter of at least 5mm were included. Of these, patients with a history of colon resection, colorectal cancer, colorectal polyp, inflammatory bowel disease, HNPCC, or familial adenomatous polyposis were excluded.A total of 2,498 patients and 4,591 adenomatous polyps were included in this study. Analysis with respect to number of patients showed significant increases in the proportion of patients with adenomatous polyp on the proximal colon, from 48.5% to 66.3% (p0.001). Analysis with respect to number of polyps revealed that the proportion of adenomatous polyps on the proximal colon significantly increased from 48.9% to 62.3% (p0.001).The proportion of adenomatous polyp on the proximal colon significantly increased over the past 10 years.