Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat.It is a commonly encountered clinical condition that is usually long-lasting,difficult to treat,and has a tendency t...Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat.It is a commonly encountered clinical condition that is usually long-lasting,difficult to treat,and has a tendency to recur.Furthermore,due to the uncertain etiology of globus,it remains difficult to establish standard investigation and treatment strategies for affected patients. As a first step for managing globus,careful history taking and nasolaryngoscopy are essential.Given the benign nature of the condition and the recent notion that gastroesophageal reflux disease is a major cause of globus,empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical globus.If patients are nonresponsive to this therapy, definitive assessments such as endoscopy,multichannel intraluminal impedance/pH monitoring,and ma-nometry should be considered.Speech and language therapy,anti-depressants,and cognitive-behavioral therapy can be helpful in patients whose symptoms persist despite negative investigations.展开更多
To assess the accuracy of a new magnifying endoscopy (ME) classification for predicting depth of invasion of superficial esophageal squamous cell carcinoma (SESCC). METHODSThis study included a total of 70 lesions in ...To assess the accuracy of a new magnifying endoscopy (ME) classification for predicting depth of invasion of superficial esophageal squamous cell carcinoma (SESCC). METHODSThis study included a total of 70 lesions in 69 patients with SESCC who underwent ME with narrow-band imaging (ME-NBI) before resection from August 2010 to July 2016. Accuracy of ME-NBI for predicting depth of invasion of SESCC was analyzed by using a new ME classification proposed by the Japan Esophageal Society (JES), and interobserver agreement was assessed. RESULTSOverall accuracy of ME-NBI for estimating depth of invasion of SESCC was 78.6%. Sensitivity and specificity of type B1 for tumors limited to the epithelial layer (m1) or invading into the lamina propria (m2) were 71.4% and 100%, respectively. Sensitivity and specificity of type B2 for tumors invading into the muscularis mucosa (m3) or superficial submucosa (≤ 200 μm, sm1) were 94.4% and 73.1%, respectively, while those of type B3 for tumors invading into the deep submucosa (> 200 μm, sm2) were 75.0% and 97.8%, respectively. Interobserver agreement was excellent (κ = 0.86, 95%CI: 0.76-0.95). CONCLUSIONThe recently developed JES ME classification is useful for predicting depth of invasion of SESCC, with reliable interobserver agreement.展开更多
AIM: To identify clinicopathologic factors influencing the accuracy of a high-frequency catheter probe endoscopic ultrasonography (EUS) for superficial esophageal carcinomas (SECs).
AIM: To examine the association between obesity and gastropharyngeal reflux disease (GPRD) as well as gastroesophageal reflux disease (GERD) METHODS: We conducted a cross-sectional study of consecutive patients underg...AIM: To examine the association between obesity and gastropharyngeal reflux disease (GPRD) as well as gastroesophageal reflux disease (GERD) METHODS: We conducted a cross-sectional study of consecutive patients undergoing ambulatory 24-h dual-probe pH monitoring from July 2003 to December 2006. The association between body mass index (BMI) and parameters about gastroesophageal or gastropharyngeal reflux was examined in univariate and multivariate analyses.RESULTS: A total of 769 patients (307 men and 462 women; mean age 50.7 years) were finally enrolled. Most variables showing gastroesophageal reflux was higher in the obese patients than the patients with normal BMI. There was no difference in all the variables showing gastropharyngeal reflux according to the BMI. After adjustment for age, sex, alcohol intake and smoking, obese patients demonstrated an about 2-fold increase in risk of GERD compared with patients with normal BMI (OR, 1.9; 95 CI, 1.3-2.9), but overweight patients did not demonstrate increased risk of GERD (OR, 1.2; 95 CI, 0.8-1.7). Both obese patients and overweight patients did not demonstrated increased risk of GPRD compared with patients with normal BMI (OR, 1.1; 95 CI, 0.8-1.7; and OR, 0.9; 95 CI, 0.6-1.3, respectively).CONCLUSION: Obesity is not associated with GPRD reflux while it is associated with GERD.展开更多
AIM: To investigate the difference in magnifying endoscopic findings of gastric epithelial dysplasias (GEDs) according to the morphologic characteristics.
We experienced a case of intussusception caused by cystic lymphangioma of the colon in a 32 years old female who was admitted to our hospital for the chief complaint of bloody stool. In the colonoscopic examination, c...We experienced a case of intussusception caused by cystic lymphangioma of the colon in a 32 years old female who was admitted to our hospital for the chief complaint of bloody stool. In the colonoscopic examination, cystic mass with stalk which had smooth mucosal surface was noted at the descending colon. Abdominal ultrasonography and computed tomography revealed left colon intussusception with a multilocular cystic tumor as a leading point. Emergent operation was performed. On the histopathologic examination, the cystically dilated spaces lined by endothelium and septated by fibrous septa were present. The pathological diagnosis was cystic lymphangioma of the colon. Although intussusception due to lymphangioma in an adult are rare, it should be taken into consideration that it is possible diagnosis.展开更多
AIM:To investigate the nature and origin of cardiac mucosa(CM).METHODS:Biopsy samples from sixty-one individuals were included in this study. The specimens were taken "at","just below",or "jus...AIM:To investigate the nature and origin of cardiac mucosa(CM).METHODS:Biopsy samples from sixty-one individuals were included in this study. The specimens were taken "at","just below",or "just above" the gastroesophageal junction,including the histologic squamocolumnar junction. Clinical data were obtained by reviewing electronic medical records for each patient. Patients with a history of stomach adenoma or carcinoma and esophageal carcinoma were excluded,and cases that were endoscopically suspicious of Barrett's esophagus or a polyp were also ruled out. Histologic and endoscopic reviews were performed blinded to the patient's clinical data. Histologic evaluation wasconducted by two pathologists,and endoscopic review was performed by a endoscopist with wide experience in the field. Histologically,the columnar epithelium of squamocolumnar junction,presence and severity of acute and chronic inflammation,atrophy,intestinal metaplasia,and presence of carditis were evaluated. Endoscopically,reflux esophagitis was evaluated by Los Angeles(LA) classification,hiatal hernias were classified by Hill grade,and gastroesophageal flap valves were assessed. RESULTS:Fifty-nine of the 61(96.7%) patients were Korean; 65.6%(40/61) of the patients underwent endoscopy according to the schedule of the National Health Insurance Program as a screening inspection. Of these,only 20.0%(8/40) of cases had reflux s y m p t o m s. C M w a s p r e s e n t i n 4 1 / 6 1( 6 7. 2 %) individuals,and its presence was associated with older age compared to oxyntocardiac mucosa/oxyntic mucosa(60.59 ± 2.02 years vs 51.55 ± 3.35 years; P = 0.018). The presence of CM was associated with endoscopic diagnosis of esophagitis according to the LA classification(P = 0.022). CM was associated with mononuclear cell infiltration and neutrophilic infiltration,which were statistically significant(P = 0.001,and P = 0.004,respectively). The inflammation of CM,"carditis",showed a statistically significant association with endoscopic diagnosis of reflux esophagitis according to the LA classification(P = 0.008). CONCLUSION:CM at the gastroesophageal junction is a common histologic finding in biopsy specimens,though not always present,and associated with gastroesophageal reflux disease and carditis severity.展开更多
AIM： TO evaluate the association between IEM and gastropharyngeal reflux disease （GPRD） in patients who underwent ambulatory 24-h dual-probe pH monitoring for the evaluation of supraesophageal symptoms. METHODS： A...AIM： TO evaluate the association between IEM and gastropharyngeal reflux disease （GPRD） in patients who underwent ambulatory 24-h dual-probe pH monitoring for the evaluation of supraesophageal symptoms. METHODS： A total of 632 patients who underwent endoscopy, esophageal manometry and ambulatory 24-h dual-pH monitoring due to supraesophageal symptoms （e.g. globus, hoarseness, or cough） were enrolled. Of them, we selected the patients who had normal esophageal motility and IEM. The endoscopy and ambulatory pH monitoring findings were compared between the two groups. RESULTS;： A total of 264 patients with normal esophageal motility and 195 patients with the diagnosis of IEM were included in this study. There was no difference in the frequency of reflux esophagitis and hiatal hernia between the two groups. All the variables showing gastroesophageal reflux and gastropharyngeal reflux were not different between the two groups. The frequency of GERD and GPRD, as defined by ambulatory pH monitoring, was not different between the two groups. CONCLUSION： There was no association between IEM and GPRD as well as between IEM and GERD. IEM alone cannot be considered as a definitive marker for reflux disease.展开更多
BACKGROUND Fexuprazan,a novel potassium-competitive acid blocker,reversibly suppresses the K+/H+-ATPase enzyme in proton pumps within gastric parietal cells.Fexuprazan’s suppression of gastric acid was maintained in ...BACKGROUND Fexuprazan,a novel potassium-competitive acid blocker,reversibly suppresses the K+/H+-ATPase enzyme in proton pumps within gastric parietal cells.Fexuprazan’s suppression of gastric acid was maintained in healthy individuals for 24 h in a dose-dependent manner.AIM To compare fexuprazan to esomeprazole and establish its efficacy and safety in patients with erosive esophagitis(EE).METHODS Korean adult patients with endoscopically confirmed EE were randomized 1:1 to receive fexuprazan 40 mg or esomeprazole 40 mg once daily for eight weeks.The primary endpoint was the proportion of patients with healed EE confirmed by endoscopy at week 8.The secondary endpoints included the healing rate of EE at week 4,symptom response,and quality of life assessment.Safety profiles and serum gastrin levels were compared between the groups.RESULTS Of the 263 randomized,218 completed the study per protocol(fexuprazan 40 mg,n=107;esomeprazole 40 mg,n=111).Fexuprazan was non-inferior to esomeprazole regarding the healing rate at week 8[99.1%(106/107)vs 99.1%(110/111)].There were no between-group differences in the EE healing rate at week 4[90.3%(93/103)vs 88.5%(92/104)],symptom responses,and quality of life assessments.Additionally,serum gastrin levels at weeks 4 and 8 and drug-related side effects did not significantly differ between the groups.CONCLUSION Fexuprazan 40 mg is non-inferior to esomeprazole 40 mg in EE healing at week 8.We suggest that fexuprazan is an alternative promising treatment option to PPIs for patients with EE.展开更多
BACKGROUND Gastritis is one of the most frequently diagnosed diseases requiring medical treatment in South Korea.Fexuprazan,a novel potassium-competitive acid blocker,has been approved for treating gastritis and erosi...BACKGROUND Gastritis is one of the most frequently diagnosed diseases requiring medical treatment in South Korea.Fexuprazan,a novel potassium-competitive acid blocker,has been approved for treating gastritis and erosive esophagitis.Meanwhile,rebamipide is the most commonly used mucoprotective agent for acute and chronic gastritis in real-world settings in South Korea.However,there have been no studies comparing the efficacy of these two drugs yet.AIM To compare the efficacy of fexuprazan with that of rebamipide for acute and chronic gastritis.METHODS This was a matching-adjusted indirect comparison.Individual patient data from a phase III study of fexuprazan(10 mg BID)were compared with cumulative data from two matching studies of rebamipide(100 mg TID).Erosion improvement and healing rates were compared between two weeks of fexurapan,two weeks of rebamipide,and four weeks of rebamipide.The two main outcome variables were presented as percentages,and the risk differences(RD)and 95%confidence intervals(CI)were calculated for the relative treatment effects.RESULTS In the primary analysis,the erosion improvement and healing rates after a twoweek treatment with fexuprazan were 64.5%and 53.2%,respectively,while a twoweek treatment with rebamipide resulted in erosion improvement and healing rates of 43.6%(RD:21.0%;95%CI:9.6-32.3;P<0.01)and 35.6%(RD:17.6%;95%CI:6.1-29.2;P=0.003),respectively.In the additional analysis,the erosion improvement and healing rates for the two-week fexuprazan treatment(64.2%and 51.2%,respectively)were similar to those obtained during a four-week treatment with rebamipide(60.6%;RD:3.6%;95%CI:-9.8,17.0;P=0.600 and 53.5%;RD:-2.3%;95%CI:-16.1,11.5;P=0.744,respectively).CONCLUSION The two-week fexuprazan treatment was superior to the two-week rebamipide treatment and similar to the fourweek rebamipide treatment for patients with gastritis.展开更多
AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endos...AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endoscopic ultrasonography before endoscopic resection.Endo-scopic resection was performed by two methods:endo-scopic mucosal resection(EMR)by the injection-and-cut technique or endoscopic mucosal dissection(ESD).RESULTS:We planned to perform EMR in all eight cases but EMR was successful in only four cases.In the other four cases,saline spread into surrounding normal tissues and the lesions becameattened,which made it impossible to remove them by EMR.Inthose four cases,we performed ESD and removed the lesions without any complications.CONCLUSION:If conventional EMR is difficult to remove gastric ectopic pancreas,ESD is a feasible alternative method for successful removal.展开更多
AIM:To clarify the short and long-term results and to prove the usefulness of endoscopic resection in type 3gastric neuroendocrine tumors(NETs).METHODS:Of the 119 type 3 gastric NETs diagnosed from January 1996 to Sep...AIM:To clarify the short and long-term results and to prove the usefulness of endoscopic resection in type 3gastric neuroendocrine tumors(NETs).METHODS:Of the 119 type 3 gastric NETs diagnosed from January 1996 to September 2011,50 patients treated with endoscopic resection were enrolled in this study.For endoscopic resection,endoscopic mucosal resection(EMR)or endoscopic submucosal dissection(ESD)was used.Therapeutic efficacy,complications,and follow-up results were evaluated retrospectively.RESULTS:EMR was performed in 41 cases and ESD in 9 cases.Pathologically complete resection was performed in 40 cases(80.0%)and incomplete resection specimens were observed in 10 cases(7 vs 3 patients in the EMR vs ESD group,P=0.249).Upon analysis of the incomplete resection group,lateral or vertical margin invasion was found in six cases(14.6%)in the EMR group and in one case in the ESD group(11.1%).Lymphovascular invasions were observed in two cases(22.2%)in the ESD group and in one case(2.4%)in the EMR group(P=0.080).During the follow-up period(43.73;13-60 mo),there was no evidence of tumor recurrence in either the pathologically complete resection group or the incomplete resection group.No recurrence was reported during follow-up.In addition,no mortality was reported in either the complete resection group or the incomplete resection group for the duration of the follow-up period.CONCLUSION:Less than 2 cm sized confined submucosal layer type 3 gastric NET with no evidence of lymphovascular invasion,endoscopic treatment could be considered at initial treatment.展开更多
AIM： To investigate prevalence of C/onorchis sinensis in patients with gastrointestinal symptoms, and the relation of the infection to hepatobiliary diseases in 26 hospitals in Korea. METHODS： Consecutive patients w...AIM： To investigate prevalence of C/onorchis sinensis in patients with gastrointestinal symptoms, and the relation of the infection to hepatobiliary diseases in 26 hospitals in Korea. METHODS： Consecutive patients who had been admitted to the Division of Gastroenterology with gastrointestinal symptoms were enrolled from March to April 2005. Of those who had been diagnosed with clonorchiasis, epidemiology and correlation between infection and hepatobiliary diseases were surveyed by questionnaire. RESULTS： Of 3080 patients with gastrointestinal diseases, 396 （12.9%） had clonorchiasis and 1140 patients （37.2%） had a history of eating raw freshwater fish. Of those with a history of raw freshwater fish ingestion, 238 （20.9%） patients had clonorchiasis. Cholangiocarcinoma was more prevalent in C. sinensis-infected patients than nonnfected patients [34/396 （8.6%） vs 145/2684 （5.4%）, P = 0.015]. Cholangiocarcinoma and clonorchiasis showed statistically significant positive cross-relation （P = 0.008）. Choledocholithiasis, cholecystolithiasis, cholangitis, hepatocellular carcinoma, and biliary pancreatitis did not correlate with clonorchiasis. CONCLUSION： Infection rate of clonorchiasis was still high in patients with gastrointestinal diseases in Korea, and has not decreased very much during the last two decades. Cholangiocarcinoma was related to clonorchiasis, which suggested an etiological role for the parasite.展开更多
AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying endoscopy.METHODS:The study was of a blinded,randomized,prospective design.Patients were a...AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying endoscopy.METHODS:The study was of a blinded,randomized,prospective design.Patients were assigned to groups administered oral premedication of either pronase and simethicone(Group A)or simethicone alone(Group B).First,the gastric mucosal visibility grade(1-4)was determined during conventional endoscopy,and then a magnifying endoscopic examination was conducted.The quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from1 to 3,with a lower score indicating better visibility.The endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic views.The main study outcomes were the visibility scores during magnifying endoscopy and the number of water flushes.RESULTS:A total of 144 patients were enrolled,and data from 143 patients(M:F=90:53,mean age 57.5 years)were analyzed.The visibility score was significantly higher in the stomach following premedication with pronase(73%with a score of 1 in Group A vs 49%in Group B,P<0.05),but there was no difference in the esophagus visibility scores(67%with a score of 1in Group A vs 58%in Group B).Fewer water flushes[mean 0.7±0.9 times(range:0-3 times)in Group A vs 1.9±1.5 times(range:0-6 times)in Group B,P<0.05]in the pronase premedication group did not affect the endoscopic procedure times[mean 766 s(range:647-866 s)for Group A vs 760 s(range:678-854 s)for Group B,P=0.88].The total gastric mucosal visibility score was also lower in Group A(4.9±1.5 vs 8.3±1.8in Group B,P<0.01).CONCLUSION:The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes.展开更多
AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective databas...AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective database in a tertiary care university hospital.From October 2006 to October 2008,we enrolled 101 patients with NVUGIB that had a high-risk stigma on endoscopy.Within 24 h of hospital admission,all patients underwent endoscopic therapy.After successful endoscopic hemostasis,all patients received an 80-mg bolus of pantoprazole followed by continuous intravenous infusion(8 mg/h for 72 h).The somatostatin adjunct group(n=49)also received a 250-μg bolus of somatostatin,followed by continuous infusion (250μg/h for 72 h).Early rebleeding rates,disappearance of endoscopic stigma and risk factors associated with early rebleeding were examined.RESULTS:Early rebleeding rates were not significantly different between treatment groups(12.2%vs 14.3%,P=0.766).Disappearance of endoscopic stigma on the second endoscopy was not significantly different between treatment groups(94.2%vs 95.9%,P=0.696).Multivariate analysis showed that the complete Rockall score was a significant risk factor for early rebleeding(P =0.044,OR:9.080,95%CI:1.062-77.595).CONCLUSION:The adjunctive use of somatostatin was not superior to pantoprazole monotherapy after successful endoscopic hemostasis in patients with NVUGIB.展开更多
AIM: To predict the rate of lymph node(LN) metastasis in diffuse- and mixed-type early gastric cancers(EGC) for guidelines of the treatment.METHODS: We reviewed 550 cases of EGC withdiffuse- and mixed-type histology. ...AIM: To predict the rate of lymph node(LN) metastasis in diffuse- and mixed-type early gastric cancers(EGC) for guidelines of the treatment.METHODS: We reviewed 550 cases of EGC withdiffuse- and mixed-type histology. We investigated the clinicopathological factors and histopathological components that influence the probability of LN metastasis, including sex, age, site, gross type, presence of ulceration, tumour size, depth of invasion, perineural invasion, lymphovascular invasion, and LN metastasis status. We reviewed all slides and estimated the proportions of each tumour component; pure diffuse type, mixed-predominantly diffuse type(diffuse > intestinal type), mixed-predominantly intestinal type(intestinal > diffuse type), and mixed diffuse = intestinal type. We calculated the extents of the respective components.RESULTS: LN metastasis was observed in 12.9%(71/550) of early gastric cancers cases [15/288 mucosal EGCs(5.2%) and 56/262 submucosal EGCs(21.4%)]. Of 550 cases, 302 were diffuse-type and 248 were mixed-type EGCs. Of 248 mixed-type EGCs, 163 were mixed-predominantly diffuse type, 82 were mixed-predominantly intestinal type, and 3 were mixed diffuse = intestinal type. Mixed-type cases with predominantly diffuse type histology showed a higher frequency of LN metastasis(20.2%) than cases of pure diffuse type(9.3%) and predominantly intestinal type(12.2%) histology. We measured the dimensions of each component(intestinal and diffuse type) to determine the association of the extent of each component with LN metastasis in mixed-type gastric carcinoma. The total tumour size and the extent of poorly differentiated components was associated with LN metastasis, while that of signet ring cell components was not.CONCLUSION: We recommend careful identification and quantitative evaluation of mixed-type early gastric cancer components after endoscopic resection to determine the intensity of the treatment.展开更多
With respect to gastric cancer treatment,improvements in endoscopic techniques and novel therapeutic modalities[such as endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)]have been developed.Cu...With respect to gastric cancer treatment,improvements in endoscopic techniques and novel therapeutic modalities[such as endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)]have been developed.Currently,EMR/ESD procedures are widely accepted treatment modalities for early gastric cancer(EGC).These procedures are most widely accepted in Asia,including in Korea and Japan.In the present era of endoscopic resection,accurate prediction of lymph node(LN)metastasis is a critical component of selecting suitable patients for EMR/ESD.Generally,indications for EMR/ESD are based on large Japanese datasets,which indicate that there is almost no risk of LN metastasis in the subgroup of EGC cases.However,there is some controversy among investigators regarding the validity of these criteria.Further,there are currently no accurate methods to predict LN metastasis in gastric cancer(for example,radiologic methods or methods based on molecular biomarkers).We recommend the use of a 2-step method for the management of early gastric cancer using endoscopic resection.The first step is the selection of suitable patients for endoscopic resection,based on endoscopic and histopathologic findings.After endoscopic resection,additional surgical intervention could be determined on the basis of a comprehensive review of the endoscopic mucosal resection/endoscopic submucosal dissection specimen,including lymphovascular tumor emboli,tumor size,histologic type,and depth of invasion.However,evaluation of clinical application data is essential for validating this recommendation.Moreover,gastroenterologists,surgeons,and pathologists should closely collaborate and communicate during these decisionmaking processes.展开更多
Diffusion-weighted magnetic resonance imaging(DWI)is a well established method for the evaluation of intracranial diseases,such as acute stroke.DWI for extracranial application is more difficult due to physiological m...Diffusion-weighted magnetic resonance imaging(DWI)is a well established method for the evaluation of intracranial diseases,such as acute stroke.DWI for extracranial application is more difficult due to physiological motion artifacts and the heterogeneous composition of the organs.However,thanks to the newer technical development of DWI,DWI has become increasingly used over the past few years in extracranial organs including the abdomen and pelvis.Most previous studies of DWI have been limited to the evaluation of diffuse parenchymal abnormalities and focal lesions in abdominal organs,whereas there are few studies about DWI for the evaluation of the biliopancreatic tract.Although further studies are needed to determine its performance in evaluating bile duct,gallbladder and pancreas diseases,DWI has potential in the assessment of the functional information on the biliopancreatic tract concerning the status of tissue cellularity,because increased cellularity is associated with impeded diffusion,as indicated by a reduction in the apparent diffusion coefficient.The detection of malignant lesions and their differentiation from benign tumor-like lesions in the biliopancreatic tract could be improved using DWI in conjunction with findings obtained with conventional magnetic resonance cholagiopancreatography.Additionally,DWI can be useful for the assessment of the biliopancreatic tract in patients with renal impairment because contrast-enhanced computed tomography or magnetic resonance scans should be avoided in these patients.展开更多
AIM: To investigate whether adding ecabet sodium to the standard triple therapy for H pylori infection improve eradication rate. METHODS: Two hundred and fifty-seven H pylori-infected patients were randomly assigned t...AIM: To investigate whether adding ecabet sodium to the standard triple therapy for H pylori infection improve eradication rate. METHODS: Two hundred and fifty-seven H pylori-infected patients were randomly assigned to standard triple therapy (group A, n = 129) or triple therapy plus ecabet sodium (group B, n = 128). Successful eradication was defined as a negative 13C-urea breath test 6-8 wk after completion of treatment. RESULTS: After completion of therapy, 194/257 patients showed negative 13C-urea breath test results. According to intention-to-treat analysis, the infection was eradicated in 93/129 (72.1%) patients in group A and 101/128 (78.9%) in group B (P = 0.204). Per-protocol analysis showed successful eradication in 93/118 (78.8%) patients from group A and 101/114 (88.6%) from group B (P = 0.044). There were no significant differences in the side effects experienced by the patients in the two treatment groups. CONCLUSION: Our results suggest that the addition of ecabet sodium improves the efficacy of the standard triple therapy for H pylori.展开更多
AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review...AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.展开更多
基金Supported by A Pusan National University Hospital Clinical Research Grant(2011)a grant from the National R and D Program for Cancer Control,Ministry for Health,Welfare and Family Affairs,Republic of Korea,No.0920050
文摘Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat.It is a commonly encountered clinical condition that is usually long-lasting,difficult to treat,and has a tendency to recur.Furthermore,due to the uncertain etiology of globus,it remains difficult to establish standard investigation and treatment strategies for affected patients. As a first step for managing globus,careful history taking and nasolaryngoscopy are essential.Given the benign nature of the condition and the recent notion that gastroesophageal reflux disease is a major cause of globus,empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical globus.If patients are nonresponsive to this therapy, definitive assessments such as endoscopy,multichannel intraluminal impedance/pH monitoring,and ma-nometry should be considered.Speech and language therapy,anti-depressants,and cognitive-behavioral therapy can be helpful in patients whose symptoms persist despite negative investigations.
基金Supported by the National R&D Program for Cancer Control,Ministry for Health,Welfare and Family Affairs,South Korea,No.0920050the Medical Research Center Program through the National Research Foundation of Korea grant funded by the Korea government,No.NRF-2015R1A5A2009656
文摘To assess the accuracy of a new magnifying endoscopy (ME) classification for predicting depth of invasion of superficial esophageal squamous cell carcinoma (SESCC). METHODSThis study included a total of 70 lesions in 69 patients with SESCC who underwent ME with narrow-band imaging (ME-NBI) before resection from August 2010 to July 2016. Accuracy of ME-NBI for predicting depth of invasion of SESCC was analyzed by using a new ME classification proposed by the Japan Esophageal Society (JES), and interobserver agreement was assessed. RESULTSOverall accuracy of ME-NBI for estimating depth of invasion of SESCC was 78.6%. Sensitivity and specificity of type B1 for tumors limited to the epithelial layer (m1) or invading into the lamina propria (m2) were 71.4% and 100%, respectively. Sensitivity and specificity of type B2 for tumors invading into the muscularis mucosa (m3) or superficial submucosa (≤ 200 μm, sm1) were 94.4% and 73.1%, respectively, while those of type B3 for tumors invading into the deep submucosa (> 200 μm, sm2) were 75.0% and 97.8%, respectively. Interobserver agreement was excellent (κ = 0.86, 95%CI: 0.76-0.95). CONCLUSIONThe recently developed JES ME classification is useful for predicting depth of invasion of SESCC, with reliable interobserver agreement.
基金Supported by A grant of the Korea Healthcare Technology R and D Project,Ministry of Health and Welfare,Republic of Ko-rea,No.A121994
文摘AIM: To identify clinicopathologic factors influencing the accuracy of a high-frequency catheter probe endoscopic ultrasonography (EUS) for superficial esophageal carcinomas (SECs).
文摘AIM: To examine the association between obesity and gastropharyngeal reflux disease (GPRD) as well as gastroesophageal reflux disease (GERD) METHODS: We conducted a cross-sectional study of consecutive patients undergoing ambulatory 24-h dual-probe pH monitoring from July 2003 to December 2006. The association between body mass index (BMI) and parameters about gastroesophageal or gastropharyngeal reflux was examined in univariate and multivariate analyses.RESULTS: A total of 769 patients (307 men and 462 women; mean age 50.7 years) were finally enrolled. Most variables showing gastroesophageal reflux was higher in the obese patients than the patients with normal BMI. There was no difference in all the variables showing gastropharyngeal reflux according to the BMI. After adjustment for age, sex, alcohol intake and smoking, obese patients demonstrated an about 2-fold increase in risk of GERD compared with patients with normal BMI (OR, 1.9; 95 CI, 1.3-2.9), but overweight patients did not demonstrate increased risk of GERD (OR, 1.2; 95 CI, 0.8-1.7). Both obese patients and overweight patients did not demonstrated increased risk of GPRD compared with patients with normal BMI (OR, 1.1; 95 CI, 0.8-1.7; and OR, 0.9; 95 CI, 0.6-1.3, respectively).CONCLUSION: Obesity is not associated with GPRD reflux while it is associated with GERD.
基金Supported by Grant from the Korea Healthcare technology R&D Project,Ministry of Health and Welfare,South Korea,No.A121994
文摘AIM: To investigate the difference in magnifying endoscopic findings of gastric epithelial dysplasias (GEDs) according to the morphologic characteristics.
文摘We experienced a case of intussusception caused by cystic lymphangioma of the colon in a 32 years old female who was admitted to our hospital for the chief complaint of bloody stool. In the colonoscopic examination, cystic mass with stalk which had smooth mucosal surface was noted at the descending colon. Abdominal ultrasonography and computed tomography revealed left colon intussusception with a multilocular cystic tumor as a leading point. Emergent operation was performed. On the histopathologic examination, the cystically dilated spaces lined by endothelium and septated by fibrous septa were present. The pathological diagnosis was cystic lymphangioma of the colon. Although intussusception due to lymphangioma in an adult are rare, it should be taken into consideration that it is possible diagnosis.
基金Supported by A grant from the National R and D Program for Cancer Control,Ministry for Health,Welfare,and Family affairs,South Korea,No.0920050
文摘AIM:To investigate the nature and origin of cardiac mucosa(CM).METHODS:Biopsy samples from sixty-one individuals were included in this study. The specimens were taken "at","just below",or "just above" the gastroesophageal junction,including the histologic squamocolumnar junction. Clinical data were obtained by reviewing electronic medical records for each patient. Patients with a history of stomach adenoma or carcinoma and esophageal carcinoma were excluded,and cases that were endoscopically suspicious of Barrett's esophagus or a polyp were also ruled out. Histologic and endoscopic reviews were performed blinded to the patient's clinical data. Histologic evaluation wasconducted by two pathologists,and endoscopic review was performed by a endoscopist with wide experience in the field. Histologically,the columnar epithelium of squamocolumnar junction,presence and severity of acute and chronic inflammation,atrophy,intestinal metaplasia,and presence of carditis were evaluated. Endoscopically,reflux esophagitis was evaluated by Los Angeles(LA) classification,hiatal hernias were classified by Hill grade,and gastroesophageal flap valves were assessed. RESULTS:Fifty-nine of the 61(96.7%) patients were Korean; 65.6%(40/61) of the patients underwent endoscopy according to the schedule of the National Health Insurance Program as a screening inspection. Of these,only 20.0%(8/40) of cases had reflux s y m p t o m s. C M w a s p r e s e n t i n 4 1 / 6 1( 6 7. 2 %) individuals,and its presence was associated with older age compared to oxyntocardiac mucosa/oxyntic mucosa(60.59 ± 2.02 years vs 51.55 ± 3.35 years; P = 0.018). The presence of CM was associated with endoscopic diagnosis of esophagitis according to the LA classification(P = 0.022). CM was associated with mononuclear cell infiltration and neutrophilic infiltration,which were statistically significant(P = 0.001,and P = 0.004,respectively). The inflammation of CM,"carditis",showed a statistically significant association with endoscopic diagnosis of reflux esophagitis according to the LA classification(P = 0.008). CONCLUSION:CM at the gastroesophageal junction is a common histologic finding in biopsy specimens,though not always present,and associated with gastroesophageal reflux disease and carditis severity.
文摘AIM： TO evaluate the association between IEM and gastropharyngeal reflux disease （GPRD） in patients who underwent ambulatory 24-h dual-probe pH monitoring for the evaluation of supraesophageal symptoms. METHODS： A total of 632 patients who underwent endoscopy, esophageal manometry and ambulatory 24-h dual-pH monitoring due to supraesophageal symptoms （e.g. globus, hoarseness, or cough） were enrolled. Of them, we selected the patients who had normal esophageal motility and IEM. The endoscopy and ambulatory pH monitoring findings were compared between the two groups. RESULTS;： A total of 264 patients with normal esophageal motility and 195 patients with the diagnosis of IEM were included in this study. There was no difference in the frequency of reflux esophagitis and hiatal hernia between the two groups. All the variables showing gastroesophageal reflux and gastropharyngeal reflux were not different between the two groups. The frequency of GERD and GPRD, as defined by ambulatory pH monitoring, was not different between the two groups. CONCLUSION： There was no association between IEM and GPRD as well as between IEM and GERD. IEM alone cannot be considered as a definitive marker for reflux disease.
基金This study is registered at ClinicalTrials.gov.The registration identification number is NCT03736369。
文摘BACKGROUND Fexuprazan,a novel potassium-competitive acid blocker,reversibly suppresses the K+/H+-ATPase enzyme in proton pumps within gastric parietal cells.Fexuprazan’s suppression of gastric acid was maintained in healthy individuals for 24 h in a dose-dependent manner.AIM To compare fexuprazan to esomeprazole and establish its efficacy and safety in patients with erosive esophagitis(EE).METHODS Korean adult patients with endoscopically confirmed EE were randomized 1:1 to receive fexuprazan 40 mg or esomeprazole 40 mg once daily for eight weeks.The primary endpoint was the proportion of patients with healed EE confirmed by endoscopy at week 8.The secondary endpoints included the healing rate of EE at week 4,symptom response,and quality of life assessment.Safety profiles and serum gastrin levels were compared between the groups.RESULTS Of the 263 randomized,218 completed the study per protocol(fexuprazan 40 mg,n=107;esomeprazole 40 mg,n=111).Fexuprazan was non-inferior to esomeprazole regarding the healing rate at week 8[99.1%(106/107)vs 99.1%(110/111)].There were no between-group differences in the EE healing rate at week 4[90.3%(93/103)vs 88.5%(92/104)],symptom responses,and quality of life assessments.Additionally,serum gastrin levels at weeks 4 and 8 and drug-related side effects did not significantly differ between the groups.CONCLUSION Fexuprazan 40 mg is non-inferior to esomeprazole 40 mg in EE healing at week 8.We suggest that fexuprazan is an alternative promising treatment option to PPIs for patients with EE.
文摘BACKGROUND Gastritis is one of the most frequently diagnosed diseases requiring medical treatment in South Korea.Fexuprazan,a novel potassium-competitive acid blocker,has been approved for treating gastritis and erosive esophagitis.Meanwhile,rebamipide is the most commonly used mucoprotective agent for acute and chronic gastritis in real-world settings in South Korea.However,there have been no studies comparing the efficacy of these two drugs yet.AIM To compare the efficacy of fexuprazan with that of rebamipide for acute and chronic gastritis.METHODS This was a matching-adjusted indirect comparison.Individual patient data from a phase III study of fexuprazan(10 mg BID)were compared with cumulative data from two matching studies of rebamipide(100 mg TID).Erosion improvement and healing rates were compared between two weeks of fexurapan,two weeks of rebamipide,and four weeks of rebamipide.The two main outcome variables were presented as percentages,and the risk differences(RD)and 95%confidence intervals(CI)were calculated for the relative treatment effects.RESULTS In the primary analysis,the erosion improvement and healing rates after a twoweek treatment with fexuprazan were 64.5%and 53.2%,respectively,while a twoweek treatment with rebamipide resulted in erosion improvement and healing rates of 43.6%(RD:21.0%;95%CI:9.6-32.3;P<0.01)and 35.6%(RD:17.6%;95%CI:6.1-29.2;P=0.003),respectively.In the additional analysis,the erosion improvement and healing rates for the two-week fexuprazan treatment(64.2%and 51.2%,respectively)were similar to those obtained during a four-week treatment with rebamipide(60.6%;RD:3.6%;95%CI:-9.8,17.0;P=0.600 and 53.5%;RD:-2.3%;95%CI:-16.1,11.5;P=0.744,respectively).CONCLUSION The two-week fexuprazan treatment was superior to the two-week rebamipide treatment and similar to the fourweek rebamipide treatment for patients with gastritis.
基金Supported by Pusan National University Research Grant for two years
文摘AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endoscopic ultrasonography before endoscopic resection.Endo-scopic resection was performed by two methods:endo-scopic mucosal resection(EMR)by the injection-and-cut technique or endoscopic mucosal dissection(ESD).RESULTS:We planned to perform EMR in all eight cases but EMR was successful in only four cases.In the other four cases,saline spread into surrounding normal tissues and the lesions becameattened,which made it impossible to remove them by EMR.Inthose four cases,we performed ESD and removed the lesions without any complications.CONCLUSION:If conventional EMR is difficult to remove gastric ectopic pancreas,ESD is a feasible alternative method for successful removal.
文摘AIM:To clarify the short and long-term results and to prove the usefulness of endoscopic resection in type 3gastric neuroendocrine tumors(NETs).METHODS:Of the 119 type 3 gastric NETs diagnosed from January 1996 to September 2011,50 patients treated with endoscopic resection were enrolled in this study.For endoscopic resection,endoscopic mucosal resection(EMR)or endoscopic submucosal dissection(ESD)was used.Therapeutic efficacy,complications,and follow-up results were evaluated retrospectively.RESULTS:EMR was performed in 41 cases and ESD in 9 cases.Pathologically complete resection was performed in 40 cases(80.0%)and incomplete resection specimens were observed in 10 cases(7 vs 3 patients in the EMR vs ESD group,P=0.249).Upon analysis of the incomplete resection group,lateral or vertical margin invasion was found in six cases(14.6%)in the EMR group and in one case in the ESD group(11.1%).Lymphovascular invasions were observed in two cases(22.2%)in the ESD group and in one case(2.4%)in the EMR group(P=0.080).During the follow-up period(43.73;13-60 mo),there was no evidence of tumor recurrence in either the pathologically complete resection group or the incomplete resection group.No recurrence was reported during follow-up.In addition,no mortality was reported in either the complete resection group or the incomplete resection group for the duration of the follow-up period.CONCLUSION:Less than 2 cm sized confined submucosal layer type 3 gastric NET with no evidence of lymphovascular invasion,endoscopic treatment could be considered at initial treatment.
基金Supported by The Korean Society of Gastroenterology Research Fund, No. 2005-1
文摘AIM： To investigate prevalence of C/onorchis sinensis in patients with gastrointestinal symptoms, and the relation of the infection to hepatobiliary diseases in 26 hospitals in Korea. METHODS： Consecutive patients who had been admitted to the Division of Gastroenterology with gastrointestinal symptoms were enrolled from March to April 2005. Of those who had been diagnosed with clonorchiasis, epidemiology and correlation between infection and hepatobiliary diseases were surveyed by questionnaire. RESULTS： Of 3080 patients with gastrointestinal diseases, 396 （12.9%） had clonorchiasis and 1140 patients （37.2%） had a history of eating raw freshwater fish. Of those with a history of raw freshwater fish ingestion, 238 （20.9%） patients had clonorchiasis. Cholangiocarcinoma was more prevalent in C. sinensis-infected patients than nonnfected patients [34/396 （8.6%） vs 145/2684 （5.4%）, P = 0.015]. Cholangiocarcinoma and clonorchiasis showed statistically significant positive cross-relation （P = 0.008）. Choledocholithiasis, cholecystolithiasis, cholangitis, hepatocellular carcinoma, and biliary pancreatitis did not correlate with clonorchiasis. CONCLUSION： Infection rate of clonorchiasis was still high in patients with gastrointestinal diseases in Korea, and has not decreased very much during the last two decades. Cholangiocarcinoma was related to clonorchiasis, which suggested an etiological role for the parasite.
基金Supported by Research grant from Pharmbio Korea,Co.Ltd.,Seoul,South Korea
文摘AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying endoscopy.METHODS:The study was of a blinded,randomized,prospective design.Patients were assigned to groups administered oral premedication of either pronase and simethicone(Group A)or simethicone alone(Group B).First,the gastric mucosal visibility grade(1-4)was determined during conventional endoscopy,and then a magnifying endoscopic examination was conducted.The quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from1 to 3,with a lower score indicating better visibility.The endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic views.The main study outcomes were the visibility scores during magnifying endoscopy and the number of water flushes.RESULTS:A total of 144 patients were enrolled,and data from 143 patients(M:F=90:53,mean age 57.5 years)were analyzed.The visibility score was significantly higher in the stomach following premedication with pronase(73%with a score of 1 in Group A vs 49%in Group B,P<0.05),but there was no difference in the esophagus visibility scores(67%with a score of 1in Group A vs 58%in Group B).Fewer water flushes[mean 0.7±0.9 times(range:0-3 times)in Group A vs 1.9±1.5 times(range:0-6 times)in Group B,P<0.05]in the pronase premedication group did not affect the endoscopic procedure times[mean 766 s(range:647-866 s)for Group A vs 760 s(range:678-854 s)for Group B,P=0.88].The total gastric mucosal visibility score was also lower in Group A(4.9±1.5 vs 8.3±1.8in Group B,P<0.01).CONCLUSION:The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes.
基金Supported by A grant of the Korea Healthcare technology R&D Project,Ministry for Health,Welfare&Family Affairs,Republic of Korea NO.A091047 Medical Research Institute Grant (2009-1),Pusan National University
文摘AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective database in a tertiary care university hospital.From October 2006 to October 2008,we enrolled 101 patients with NVUGIB that had a high-risk stigma on endoscopy.Within 24 h of hospital admission,all patients underwent endoscopic therapy.After successful endoscopic hemostasis,all patients received an 80-mg bolus of pantoprazole followed by continuous intravenous infusion(8 mg/h for 72 h).The somatostatin adjunct group(n=49)also received a 250-μg bolus of somatostatin,followed by continuous infusion (250μg/h for 72 h).Early rebleeding rates,disappearance of endoscopic stigma and risk factors associated with early rebleeding were examined.RESULTS:Early rebleeding rates were not significantly different between treatment groups(12.2%vs 14.3%,P=0.766).Disappearance of endoscopic stigma on the second endoscopy was not significantly different between treatment groups(94.2%vs 95.9%,P=0.696).Multivariate analysis showed that the complete Rockall score was a significant risk factor for early rebleeding(P =0.044,OR:9.080,95%CI:1.062-77.595).CONCLUSION:The adjunctive use of somatostatin was not superior to pantoprazole monotherapy after successful endoscopic hemostasis in patients with NVUGIB.
基金Supported by A grant from the National R&D Program for Cancer Control,Ministry for Health,Welfare,and Family Affairs,South Korea,No.0920050
文摘AIM: To predict the rate of lymph node(LN) metastasis in diffuse- and mixed-type early gastric cancers(EGC) for guidelines of the treatment.METHODS: We reviewed 550 cases of EGC withdiffuse- and mixed-type histology. We investigated the clinicopathological factors and histopathological components that influence the probability of LN metastasis, including sex, age, site, gross type, presence of ulceration, tumour size, depth of invasion, perineural invasion, lymphovascular invasion, and LN metastasis status. We reviewed all slides and estimated the proportions of each tumour component; pure diffuse type, mixed-predominantly diffuse type(diffuse > intestinal type), mixed-predominantly intestinal type(intestinal > diffuse type), and mixed diffuse = intestinal type. We calculated the extents of the respective components.RESULTS: LN metastasis was observed in 12.9%(71/550) of early gastric cancers cases [15/288 mucosal EGCs(5.2%) and 56/262 submucosal EGCs(21.4%)]. Of 550 cases, 302 were diffuse-type and 248 were mixed-type EGCs. Of 248 mixed-type EGCs, 163 were mixed-predominantly diffuse type, 82 were mixed-predominantly intestinal type, and 3 were mixed diffuse = intestinal type. Mixed-type cases with predominantly diffuse type histology showed a higher frequency of LN metastasis(20.2%) than cases of pure diffuse type(9.3%) and predominantly intestinal type(12.2%) histology. We measured the dimensions of each component(intestinal and diffuse type) to determine the association of the extent of each component with LN metastasis in mixed-type gastric carcinoma. The total tumour size and the extent of poorly differentiated components was associated with LN metastasis, while that of signet ring cell components was not.CONCLUSION: We recommend careful identification and quantitative evaluation of mixed-type early gastric cancer components after endoscopic resection to determine the intensity of the treatment.
基金Supported by A 2-Year Research Grant of Pusan National University
文摘With respect to gastric cancer treatment,improvements in endoscopic techniques and novel therapeutic modalities[such as endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)]have been developed.Currently,EMR/ESD procedures are widely accepted treatment modalities for early gastric cancer(EGC).These procedures are most widely accepted in Asia,including in Korea and Japan.In the present era of endoscopic resection,accurate prediction of lymph node(LN)metastasis is a critical component of selecting suitable patients for EMR/ESD.Generally,indications for EMR/ESD are based on large Japanese datasets,which indicate that there is almost no risk of LN metastasis in the subgroup of EGC cases.However,there is some controversy among investigators regarding the validity of these criteria.Further,there are currently no accurate methods to predict LN metastasis in gastric cancer(for example,radiologic methods or methods based on molecular biomarkers).We recommend the use of a 2-step method for the management of early gastric cancer using endoscopic resection.The first step is the selection of suitable patients for endoscopic resection,based on endoscopic and histopathologic findings.After endoscopic resection,additional surgical intervention could be determined on the basis of a comprehensive review of the endoscopic mucosal resection/endoscopic submucosal dissection specimen,including lymphovascular tumor emboli,tumor size,histologic type,and depth of invasion.However,evaluation of clinical application data is essential for validating this recommendation.Moreover,gastroenterologists,surgeons,and pathologists should closely collaborate and communicate during these decisionmaking processes.
基金Supported by Clinical research grant from Pusan National University Hospital
文摘Diffusion-weighted magnetic resonance imaging(DWI)is a well established method for the evaluation of intracranial diseases,such as acute stroke.DWI for extracranial application is more difficult due to physiological motion artifacts and the heterogeneous composition of the organs.However,thanks to the newer technical development of DWI,DWI has become increasingly used over the past few years in extracranial organs including the abdomen and pelvis.Most previous studies of DWI have been limited to the evaluation of diffuse parenchymal abnormalities and focal lesions in abdominal organs,whereas there are few studies about DWI for the evaluation of the biliopancreatic tract.Although further studies are needed to determine its performance in evaluating bile duct,gallbladder and pancreas diseases,DWI has potential in the assessment of the functional information on the biliopancreatic tract concerning the status of tissue cellularity,because increased cellularity is associated with impeded diffusion,as indicated by a reduction in the apparent diffusion coefficient.The detection of malignant lesions and their differentiation from benign tumor-like lesions in the biliopancreatic tract could be improved using DWI in conjunction with findings obtained with conventional magnetic resonance cholagiopancreatography.Additionally,DWI can be useful for the assessment of the biliopancreatic tract in patients with renal impairment because contrast-enhanced computed tomography or magnetic resonance scans should be avoided in these patients.
基金An unrestricted grant by JEIL Pharm.Co.,Ltd.,Korea
文摘AIM: To investigate whether adding ecabet sodium to the standard triple therapy for H pylori infection improve eradication rate. METHODS: Two hundred and fifty-seven H pylori-infected patients were randomly assigned to standard triple therapy (group A, n = 129) or triple therapy plus ecabet sodium (group B, n = 128). Successful eradication was defined as a negative 13C-urea breath test 6-8 wk after completion of treatment. RESULTS: After completion of therapy, 194/257 patients showed negative 13C-urea breath test results. According to intention-to-treat analysis, the infection was eradicated in 93/129 (72.1%) patients in group A and 101/128 (78.9%) in group B (P = 0.204). Per-protocol analysis showed successful eradication in 93/118 (78.8%) patients from group A and 101/114 (88.6%) from group B (P = 0.044). There were no significant differences in the side effects experienced by the patients in the two treatment groups. CONCLUSION: Our results suggest that the addition of ecabet sodium improves the efficacy of the standard triple therapy for H pylori.
文摘AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.
