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Background/aims Peritoneal micrometastasis is known to play an important role in the recurrence of gastric cancer. However, its effects remain equivocal. Herein, we examine the messenger RNA (mRNA) as tumor markers, carcinoembryonic antigen (CEA), and cytokeratin 20 (CK20), in peritoneal washing fluid. Moreover, we evaluate whether these results could predict the recurrence of gastric cancer following curative resection. Methods We prospectively enrolled 132 patients with gastric cancers, who had received an operation, between January 2010 and January 2013. The peritoneal lavage fluid was collected at the operation field and semi-quantitative PCR was performed using the primers for CEA and CK20. We excluded patients with stage IA (n=28) early gastric cancer, positive cytologic examination of peritoneal washings (n=7), and those who were lost during follow up (n=18). Results A total of 79 patients with gastric cancers were enrolled, and the mean follow-up period was 39.95±19.25 months (range, 5-72 months). According to the multivariate analysis, T4 stage at the initial diagnosis was significantly associated with recurrence. All cases of recurrence were CEA positive and 6 cases were CK20 positive. The positive and negative predictive values of CEA were 32.0% and 100%, respectively, whereas those of CK20 were 37.5% and 71.4%, respectively. Disease free survival of CK20-negative cases was 36.17±20.28 months and that of CK20-positive cases was 32.06±22.95 months (p=0.39). Conclusions It is unlikely that the real time polymerase chain reaction results of mRNA for CEA and CK20 in peritoneal washing fluid can predict recurrence. However, negative results can convince surgeons to perform curative R0 resection.

OBJECTIVE Recurrent attacks after acute gallstone pancreatitis (GSP) are a substantial problem with associated morbidity and mortality. The recommended therapies for recurrent attacks are cholecystectomy and endoscopic sphincterotomy (EST). This study aimed to evaluate the long-term results of cholecystectomy and EST after clinical improvement of GSP. METHODS A consecutive series of patients who were admitted with GSP between January 2003 to December 2014 were analyzed. Patients were categorized into three treatment subgroups: cholecystectomy (n = 53), EST (n = 51), and conservative care (n = 67). RESULTS A total of 171 patients were enrolled. The mean follow-up period was 58 months (range 6-125months). The pancreatitis-induced in-hospital mortality rate was 1.5%. The cholecystectomy and EST groups had a significantly lower frequency of recurrent pancreatitis than the conservative care group (P< 0.01). For recurrent pancreatitis, there was no significant difference between the cholecystectomy with and without EST subgroups (P = 0.38). With respect to total recurrent biliary events, the cholecystectomy group was superior to the EST-only group (P < 0.01). In patients receiving definitive treatment (cholecystectomy with or without EST), presence of common bile duct (CBD) stone was an independent risk factor for recurrent biliary events (P < 0.01). CONCLUSIONS In long-term follow-up of GSP, cholecystectomy can offer better protection against recurrent biliary events than EST only. Presence of CBD stone at time of definitive therapy might be a risk factor for recurrent biliary events. Copyright © 2016 John Wiley & Sons, Ltd.

Acute pancreatitis (AP) ranges from a mild and self-limiting disease to a fulminant illness with significant morbidity and mortality. Severe acute pancreatitis (SAP) is defined as persistent organ failure lasting for 48 h. We aimed to determine the factors that predict survival and mortality in patients with SAP.We reviewed a consecutive series of patients who were admitted with acute pancreatitis between January 2003 and January 2013. A total of 1213 cases involving 660 patients were evaluated, and 68 cases with SAP were selected for the study. Patients were graded based on the Computer Tomography Severity Index (CTSI), the bedside index for severity (BISAP), and Ranson's criteria.The frequency of SAP was 5.6% (68/1213 cases). Among these patients, 17 died due to pancreatitis-induced causes. We compared several factors between the survivor (n = 51) and non-survivor (n = 17) groups. On multivariate analysis, there were significant differences in the incidence of diabetes mellitus (p = .04), Ranson score (p = .03), bacteremia (p = .05) and body mass index (BMI) (p = .02) between the survivor and non-survivor groups.Bacteremia, high Ranson score, DM, and lower BMI were closely associated with mortality in patients with SAP. When patients with SAP show evidence of bacteremia or diabetes, aggressive treatment is necessary. For the prediction of disease mortality, the Ranson score might be a useful tool in SAP.

Recurrent attacks after acute gallstone pancreatitis (GSP) are substantial problems, together with associated morbidity and mortality. The recommended therapies for recurrent attacks are cholecystectomy and endoscopic sphincterotomy (EST). This study aimed to evaluate the long-term results of cholecystectomy and EST after clinical improvement of GSP.A consecutive series of patients who were admitted with GSP from January 2003 to December 2014 were analyzed. Patients were categorized into three treatment subgroups: cholecystectomy (n = 53), EST (n = 51) and conservative care (n = 67).A total of 171 patients were enrolled. The mean follow-up period was 58 months (range 6-125 months). The pancreatitis-induced in-hospital mortality rate was 1.5%. The cholecystectomy and EST groups had a significantly lower frequency of recurrent pancreatitis than the conservative care group (P0.01). For recurrent pancreatitis, there was no significant difference between the cholecystectomy with and without EST subgroups. With respect to total recurrent biliary events, the cholecystectomy group was superior to the EST only group (P0.01). In patients receiving definitive treatment (cholecystectomy with or without EST), the presence of common bile duct (CBD) stone was an independent risk factor for recurrent biliary events (P0.01).In the long-term follow up of GSP, cholecystectomy can offer better protection against recurrent biliary events than EST only. The presence of CBD stones at time of definitive therapy might be a risk factor for recurrent biliary events.

Background and Aim Although a few studies have reported that sarcopenia is associated with alcoholic liver disease (ALD), no studies have investigated this association in a large sample representative of the elderly Korean population. Methods This was a cross-sectional study that used data from the Fourth and Fifth Korean National Health and Nutrition Examination Surveys (KNHANES) on subjects aged 65 years and older. Sarcopenia was defined as a skeletal muscle index (SMI) more than 1 SD below the gender-specific mean for young adults; SMI was calculated as the appendicular muscle mass divided by height squared (ASM/Ht2). Heavy alcohol consumption was defined as consuming at least 210 g/week, and elevated liver enzymes were defined as alanine aminotransferase levels of at least 32 U/L or aspartate aminotransferase levels of at least 34 U/L. ALD was defined as heavy alcohol consumption and elevated liver enzymes. Results The mean age of the 1,151 elderly males was 71.6 ± 0.2 years, and the prevalence of heavy alcohol consumption was 11.8% (136 subjects). SMI did not differ between the non-heavy and heavy alcohol consumer groups (7.1 ± 0.0 kg/m2 vs. 7.3 ± 0.1 kg/m2, respectively, P = 0.145). However, after stratifying by the presence of liver disease and heavy alcohol consumption and adjusting for other confounders in the multivariate logistic regression, SMI was significantly lower among heavy alcohol consumers with ALD (all P < 0.05). Additionally, two-way ANOVA showed a significant interaction between heavy alcohol consumption and liver disease (P = 0.011). Conclusion Sarcopenia was accelerated in the elderly male ALD group, with a significant interaction between alcohol consumption and liver disease.

The frequency of esophageal cancer is globally on the increase. Esophageal cancer is a relatively rare type of cancer in Korea: its incidence and prevalence rates are 3.1 and 6.4, respectively, out of 100,000 persons. Esophageal squamous cell carcinoma (ESCC) has been regarded as a type of cancer with a poor survival rate and is characterized by the ninth highest mortality rate among all the types of cancer. As the early diagnosis using esophagogastroduodenoscopy and technological development, which involves image enhancement and endoscopy using iodine dye, make a larger number of esophageal cancer patients diagnosed early and as the development of therapeutic protocols improves the long-term survival rate, the prevalence of esophageal cancer is on the increase. As a result, secondary primary malignancy (SPM) in esophageal cancer patients has attracted attention and a few relevant studies were conducted.1–3 Esophageal cancer patients may often have SPM in the head and neck, stomach and rarely have it in the colon, the lungs, the kidneys, and the female breasts.1 SPM, which accompanies esophageal cancer, shares risk factors with the cancer. Risk factors for ESCC usually include smoking (ESCC, 3 to 7 fold; adenocarcinoma, 2 fold risk), excessive alcohol intake (≥3 drinks/day), diet, achalasia, and low socioeconomic status; of these, the first two seem to be significant risk factors.4 It is widely known that head and neck cancer, a typical type of SPM, shares major risk factors with ESCC and frequently accompanies it.5 Esophageal cancer and colorectal neoplasm (CRN) also share some risk factors and colorectal cancer reportedly forms approximately 7% to 16% of all the types of SPM for esophageal cancer.2,6 While a few researchers have reported that Barrett’s metaplasia or esophageal adenocarcinoma patients are at higher risk of CRN, there are relatively fewer studies on the correlation between ESCC and CRN. The meta-analysis performed by Andrici et al.7 showed that Barrett’s metaplasia almost doubled the risk of colon polyp and colorectal cancer. Bollschweiler et al.,8 who conducted a case-control study in a total of 171 esophageal cancer patients (78 adenocarcinoma and 93 ESCC), found that ESCC was relatively less correlated with CRN than adenocarcinoma: the ESCC and adenocarcinoma groups showed approximately 2-fold and 4.35-fold higher prevalence of CRN, respectively, than the control group. In contrast, colonoscopic evaluation in ESCC patients, which was restrictively conducted, obtained conflicting results.8–11 Recently, Baeg et al.12 performed retrospective analysis to determine correlation between ESCC and CRN. He compared 60 patients, who were recently diagnosed with ESCC and received colonoscopy within a year after the diagnosis, with 180 persons in the control group with age, gender, and body mass index matched. As a result, a significantly higher percentage of the ESCC group had CRNs (odds ratio [OR], 2.311; 95% confidence interval [CI], 1.265 to 4.220) or advanced CRNs (OR, 2.317; 95% CI, 1.185 to 4.530). Multivariate analysis showed that the significant risk factors for CRN and advanced CRN were ESCC (OR, 2.157; 95% CI, 1.106 to 4.070; p=0.024) and older age (OR, 1.068; 95% CI, 1.032 to 1.106; p40% in the control group; CRNs could have been overestimated in the former group since the adenoma detection rate is generally about 20% to 25%. It is therefore necessary to conduct multicenter, prospective research in a larger number of patients. Despite these limitations, colonoscopy is expected to be applicable right after diagnosis of esophageal cancer in clinical practice, as recommended on the basis of these results. Taking unfavorable prognoses of esophageal cancer into account, however, it is necessary to conduct a well-designed, randomized prospective study to see if this will improve prognoses for esophageal cancer patients in the long term and care should be taken to determine a specific group of patients and a specific clinical stage in which colonoscopic screening is useful.

Background/Aims: Clarithromycin resistance is one of the main predictors of eradication treatment failures in Helicobacter pylori infections. The aim of this study was to investigate the ideal eradication rate of more than 90% of tailored therapies using a polymerase chain reaction (PCR)-based test for clarithromycin resistance in patients with peptic ulcer disease. In addition, we evaluated the possibility of sequential therapies for infections due to clarithromycin-resistant strains. Materials and Methods: We prospectively enrolled patients referred to the gastroenterology unit for the evaluation and management of peptic ulcer from January 2012 to January 2014. Histology, a rapid urease test, and a dual-priming oligonucleotide-based multiplex (DPO)-PCR test were performed on gastric biopsy specimens. In the absence of 23S rRNA point mutations in H. pylori, the patients were treated with standard triple therapy, while in the presence of 23S rRNA point mutations, they were treated with sequential therapies. Results: A total of 93 patients had peptic ulcer disease that was associated with H. pylori infections. These patients received eradication therapies, and 78 patients completed the therapies. The total eradication rate was 91% per protocol analysis, whereas it was 78.3% in patients treated with sequential therapies. Conclusions: The eradication rate of H. pylori with tailored therapies using the DPO-PCR test was acceptable. However, sequential therapies were not effective in patients who did not respond to clarithromycin.