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Background/Aims: Studies on elective switching to the subcutaneous (SC) formulation of infliximab revealed comparable efficacy and safety and higher infliximab level than those exhibited by intravenous (IV) infliximab. However, no studies have reported on the effectiveness of SC switching in ulcerative colitis (UC) patients who experienced IV infliximab failure during maintenance treatment. Methods: This retrospective study included UC patients who had been switched to SC infliximab because of IV infliximab failure, between January 2021 and January 2023. Group A was defined as having clinically and biochemically active UC (secondary loss of response), and group B consisted of patients with stable symptoms but biochemically active UC. Results: Twenty-three patients met the inclusion criteria: 15 in group A and eight in group B. The serum infliximab levels significantly increased after SC switching in both groups. The electively switched group also exhibited increased infliximab levels after SC switching. Patients in group A showed improved partial Mayo score with a significant decrease in fecal calprotectin and C-reactive protein after switching. In group B, the fecal calprotectin level significantly decreased without clinical relapse after switching. A high proportion of patients (≥80%) in both groups achieved clinical and/or biochemical responses at the last follow-up. During the follow-up period, only two patients in group A discontinued SC infliximab, and only one complained of severe injection site reaction. Conclusion : s: In UC patients who experience IV infliximab failure during maintenance treatment, switching to SC infliximab may be a promising option because of better efficacy and safety.

Functional constipation is a common clinical diagnosis that affects approximately 14% of the world’s population. Non-pharmacological therapies often represent the initial steps in management and may include lifestyle adjustments or changes such as physical activity and diet. Pharmacological options have been used when the non-pharmacological approach has been ineffective. Biofeedback therapy, surgery, sacral nerve stimulation, botulinum toxin injection, and vibrating capsules can be considered in scenarios where the laxatives are ineffective. Biofeedback therapy is highly effective and safe in treating dyssynergic defecation, which affects more than half of patients with chronic constipation. This paper overviews non-pharmacological therapies for functional constipation.

Polytetrafluoroethylene (PTFE) grafts are artificial vascular grafts commonly utilized for reconstructing the middle hepatic vein during living donor liver transplantation. In this report, we present three cases of expanded PTFE (ePTFE) graft migration into the gastrointestinal tract. These migrations were incidentally discovered and later migrated grafts were successfully removed endoscopically. The first case involved a patient presenting with epigastric discomfort, with a migrated ePTFE graft observed in the duodenal lumen during esophagogastroduodenoscopy (EGD). In the second case, a patient who visited the emergency room with hematochezia was found to have a migrated ePTFE graft in the colonic lumen on colonoscopy. The third case involved a patient undergoing regular EGD after endoscopic submucosal dissection for early gastric cancer; graft migration into the duodenal lumen was documented over time through sequential surveillance EGDs. The graft was endoscopically removed after complete migration. Contrary to previous reports, the three cases presented here did not exhibit serious clinical symptoms, and they were successfully treated through endoscopic foreign body removal without complications. We believe these occasions were possible due to the slow migration of the graft and the concurrent spontaneous closure of the fistula tract.

Background/Aims This study aimed to compare the safety of the double-guidewire technique (DGT) with that of the conventional single-guidewire technique (SGT) in real-world situations. Methods A total of 240 patients with naïve papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Daegu Catholic University Medical Center between January 2021 and December 2021 were included. The primary outcome was the rate of post-ERCP pancreatitis (PEP) in the SGT and DGT groups. Results A total of 163 patients (67.9%) belonged to the SGT group, and 77 (32.1%) belonged to the DGT group. The rates of successful biliary cannulation were 95.7% and 83.1% in the SGT and DGT groups, respectively (p=0.002). In the study group, PEP occurred in 14 patients (5.8%). The PEP rates were not significantly different between the SGT and DGT groups (4.3% vs. 9.1%, p=0.150). In the multivariate analysis, the age of

Background/Aims: Increasing resistance to clarithromycin (CAM) of Helicobacter pylori (H. pylori) is one of the main causes of recent decrease in eradication rate of standard triple therapy. The aim of this study was to evaluate the usefulness of 7-day tailored therapy based on the existence of CAM resistance. Methods: From January 2017 to May 2022, a total of 481 consecutive patients with H. pylori infection were recruited in Daegu Catholic University Medical Center. Treatment regimen was selected based on the result of CAM resistance test. Patients with CAM resistance (R group) were treated with bismuth-based quadruple therapy for 7 days. Patients without CAM resistance (S group) were treated with standard triple therapy for 7 days. Results: The overall H. pylori eradication rate was 89.4% (379 of 424) by per-protocol (PP) analysis. Patients with CAM resistance mutation included 166 patients (34.5%). The eradication rates of each group were 88.8% (135 of 152) and 89.7% (244 of 272) by PP analysis, for R and S group respectively. By intention-to-treat (ITT) analysis, the eradication rates were 81.3% (135 of 166) and 77.5% (244 of 315) for R and S group. CAM resistance was identified with a dual-priming oligonucleotide-based multiplex PCR. Conclusions: In spite of this high CAM resistance (34.5%), the eradication rate of 7-day tailored therapy based on the existence of CAM resistance was 89.4%. The 7-day tailored therapy based on CAM resistance could be an acceptable treatment selection strategy for H. pylori eradication.

Background/Aims: This study evaluated the incidence of venous thromboembolism (VTE) in patients with advanced pancreatic ductal adenocarcinoma (PDAC) at the authors’ institution and analyzed the risk factors associated with VTE and the overall survival (OS). Methods: One hundred and seventy patients with locally advanced or metastatic PDAC who received palliative chemotherapy at Daegu Catholic University Medical Center from January 2011 to December 2020 were included. Results: During a median follow-up period of 341 days, 24 patients (14.1%) developed VTE. Cumulative incidence values of VTE were 4.7% (95% confidence interval [CI], 2.39-9.22) at 90 days, 9.9% (95% CI, 6.14-15.59) at 180 days, and 16.9% (95% CI, 11.50-24.36) at 360 days. Multivariate analysis showed that a carbohydrate antigen 19-9 (CA 19-9) level over 1,000 U/mL (hazard ratio [HR], 2.666; 95% CI, 1.112-6.389; p=0.028) and a history of alcohol consumption (HR, 0.327; 95% CI, 0.109-0.981; p=0.046) were significant factors associated with VTE. Patients with VTE showed a shorter median survival (347 days vs. 556 days; p=0.041) than those without VTE. Multivariate analysis revealed VTE (HR, 1.850; 95% CI, 1.049-3.263; p=0.033) and CA 19-9 level over 1,000 U/mL (HR, 1.843; 95% CI, 1.113-3.052; p=0.017) to be significant risk factors associated with OS. Conclusions: The cumulative incidence of VTE in patients with advanced PDAC was 16.9% at 360 days. While a history of alcohol consumption was a protective factor, a high CA19-9 level was a risk factor for VTE. In addition, the occurrence of VTE was associated with poor prognosis.

Purpose: This study aimed to evaluate the safety of biologics and small molecules for the treatment of inflammatory bowel diseases (IBD) in patients receiving antirejection therapies after organ transplants. Materials and Methods: We reviewed the medical records of patients with IBD who received organ transplants at the Asan Medical Center between January 1989 and December 2021. We compared the parameters of patients receiving biologics or small molecules to those of patients without those therapies. Results: This study included a total of 53 patients (ulcerative colitis, 41; Crohn’s disease, 6; and gastrointestinal Behçet’s disease, 6). Among them, 15 patients were receiving biologics or small molecules and 38 were not. During a mean follow-up of 119 months, the proportion of patients experiencing severe infections was significantly higher in those treated with biologics or small molecules than in those not treated. However, other safety outcomes (e.g., malignancies, adverse events, including organizing pneumonia or hepatic failure, and death) were not different between the two groups. Kaplan–Meier curve analysis revealed no significant difference in the safety outcome rate related to the use of biologics or small molecules. During follow-up, eight patients underwent bowel resections for IBD. The rate of bowel resection was not different between the two groups. Conclusion: The use of biologics or small molecules for patients with IBD who received organ transplants did not show a significant difference in safety outcomes. However, the possibility of severe infections must be considered. [ABSTRACT FROM AUTHOR]

Background/Aims Video capsule endoscopy is rarely used to diagnose Crohn’s disease in patients with negative ileocolonoscopy or cross-sectional image findings. We evaluated clinical characteristics and long-term outcomes of these rare cases. Methods This multicenter study included patients with Crohn’s disease from three tertiary hospitals from January 2007 to October 2022. Patients with normal findings on ileocolonoscopy and CT/MR enterography but had ulcerations at the small bowel detected by video capsule endoscopy were included. The controls were patients with abnormal findings on endoscopy or CT/MR enterography. Controls were case-matched in a ratio of 3:1 for sex, calendar year of diagnosis, and age at diagnosis. Results Among 3,752 patients, 24 (0.6%) were diagnosed with Crohn’s disease using video capsule endoscopy findings. The disease location (p<0.001) and behavior at diagnosis (p=0.013) of the cases significantly differed from that of controls. The perianal fistula modifier (25.0% vs. 33.3%, p=0.446) did not differ significantly between the two groups. Initial disease activity and C-reactive protein and fecal calprotectin levels were significantly lower in cases versus controls. The median Lewis score was 838 [interquartile range 393 –1803]. Over 10 years of follow-up, the cases showed significantly lower cumulative risk of complicated behavior, biologics use, Crohn’s disease-related hospitalization, and surgeries (log-rank test p<0.05). Conclusion Patients with Crohn’s disease whose lesions were observed only by video capsule endoscopy were rare and exhibit different clinical characteristics and a more favorable long-term disease course compared to those who were conventionally diagnosed. [ABSTRACT FROM AUTHOR]

Background/Aims Colonoscopy in elderly patients, particularly those aged 80 and above, raises concerns about safety and effectiveness. This study evaluates the diagnostic results and safety of colonoscopy in patients aged 80 and older. Methods This retrospective cohort study was conducted at Daegu Catholic University Medical Center from January 2013 to December 2023. A total of 446 patients aged 80 and older who underwent colonoscopy for screening or mild abdominal discomfort were included. Patients were excluded if their colonoscopy was performed due to anemia, gastrointestinal bleeding, positive fecal occult blood tests, elevated tumor markers, or for follow-up after polypectomy or surgery. The patients were divided into two groups: 80-84 years and >85 years. Results Of the detected adenomas, 230 cases (51.6%) were low-grade, and 14 cases (3.1%) were advanced adenomas (high-grade dysplasia and adenocarcinoma). Among the patients with advanced adenomas, 7 underwent surgery, 3 had endoscopic resection, and 1 received radiation therapy. Most patients (85.9%) had the procedure under conscious sedation. The overall cecal intubation success rate was 97.5%. Two complications, both involving bleeding after endoscopic mucosal resection, resulted in a complication rate of 0.4%. There were no significant differences between the two age groups in adenoma detection rates, conscious sedation, cecal intubation success, or complication rates (all p-values > 0.05). Conclusion Colonoscopy is both safe and effective for patients aged 80 and older, with a high cecal intubation success rate and a low complication rate, even for those over 85 years old. These findings support the continued use of colonoscopy in elderly patients, including those over 85. [ABSTRACT FROM AUTHOR]

Background/Aims The optimal sequence for same-day bidirectional endoscopy remains controversial. This study aims to further investigate the impact of procedure sequence on cecum insertion time, with a particular focus on differences between experts (≥10 years) and trainees (<1 year). We hypothesized that abdominal gas insufflation from esophagogastroduodenoscopy (EGD) could impact colonoscopy (CF), specifically prolonging cecal insertion time in trainees. Methods This retrospective cohort study was conducted at Daegu Catholic University Medical Center from March 2023 to February 2024. A total of 1095 CF cases were included, with 655 performed by experts and 440 by trainees. Among the expert cases, 269 followed EGD first, and 386 followed CF first. In the trainee group, 236 followed EGD first, and 204 followed CF first. Cecum insertion times were compared between these groups. Results In the expert group, the cecum insertion time was 8.6 minutes for the EGD-first group and 8.0 minutes for the CF-first group, indicating no significant difference (p=0.127). In the trainee group, the cecum insertion time was 13.8 minutes for the EGD-first group and 12.2 minutes for the CF-first group, showing a statistically significant difference (p=0.011). Conclusion This study demonstrates a significant difference in cecum insertion times between the EGD-first and CF-first procedures in the trainee group but not in the expert group. These findings suggest that performing EGD before CF can increase cecum insertion time for trainees, highlighting the need for protocol considerations in training programs. No significant impact was observed for experienced practitioners. [ABSTRACT FROM AUTHOR]

Background/Aims The study investigated the incidence, risk factors, and clinical outcomes of chronic antibiotic-refractory pouchitis (CARP) in Korean patients with ulcerative colitis (UC). Methods This single-center retrospective study included patients with UC who underwent total proctocolectomy with ileal pouch-anal anastomosis (IPAA) at the Asan Medical Center in Korea between January 1987 and December 2022. Primary outcomes were endoscopic remission and pouch failure. Cox’s proportional hazard model was used to identify risk factors of CARP. Results A total of 232 patients were analyzed. The most common cause of surgery was steroid refractoriness (50.9%), followed by dysplasia/colorectal cancer (26.7%). Among 74 patients (31.9%) with chronic pouchitis (CP), 31 (13.4%) had CARP, and 43 (18.5%) had chronic antibiotic-dependent pouchitis (CADP). The most frequent endoscopic phenotype was focal inflammation of the pouch (CP, 47.3%; CARP, 35.5%; CADP, 55.8%). Patients with CARP were less likely to have concomitant probiotics compared with CADP (29.0% vs 72.1%; p<0.01). The endoscopic remission rate in CP, CARP, and CADP was 14.9%, 9.7%, and 18.6%, respectively. The pouch failure rate in CP, CARP, and CADP was 13.5%, 16.1%, and 11.6%, respectively. Current smoking status (adjusted Hazard Ratio [aHR] 2.96; 95% confidence interval [CI] 1.27–6.90; p=0.01) and previous use of biologics/small molecules (aHR 2.40; 95% CI 1.05–5.53; p=0.04) were significantly associated with CARP development. Conclusion Current smoker and previous user of biologics/small molecules in UC patients who underwent IPAA had a higher risk of CARP. Concomitant use of probiotics was less likely to be associated with developing CARP. [ABSTRACT FROM AUTHOR]