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| 1 | Combination could be another tool for bowel preparation?显示文摘Optimal bowel preparation increases the cecal intubation rate and detection of neoplastic lesions while decreasing the procedural time and procedural-related complications. Although high-volume polyethylene glycol(PEG) solution is the most frequently used preparation for bowel cleansing, patients are often unwilling to take PEG solution due to its large volume, poor palatability, and high incidence of adverse events, such as abdominal bloating and nausea. Other purgatives include osmotic agents(e.g., sodium phosphate, magnesium citrate, and sodium sulfate), stimulant agents(e.g., senna, bisacodyl, and sodium picosulfate), and prokinetic agents(e.g., cisapride, mosapride, and itopride). A combination of PEG with an osmotic, stimulant, or prokinetic agent could effectively reduce the PEG solution volume and increase patients' adherence. Some such solutions have been found in several published studies to not be inferior to PEG alone in terms of bowel cleansing quality. Although combination methods showed similar efficacy and safety, the value of these studies is limited by shortcomings in study design. New effective and well-tolerated combination preparations are required, in addition to rigorous new validated studies. | Jae Seung Soh Kyung-Jo Kim | 2016 | World Journal of Gastroenterology2016，22，10： | 7 |
| 2 | Treatment for gastric ‘indefinite for neoplasm/dysplasia' lesions based on predictive factors显示文摘BACKGROUND Gastric ‘indefinite for neoplasm/dysplasia'(IFND) is a borderline lesion that is difficult to diagnose as either regenerative or neoplastic. There is a need for guidance in the identification of a subset of patients, who have an IFND lesion with a higher risk of malignant potential, to enable risk stratification and optimal management.AIM To determine the clinical and pathologic factors for the accurate diagnosis of gastric IFND lesions.METHODS In total, 461 gastric lesions diagnosed via biopsy as IFND lesions were retrospectively evaluated. Endoscopic resection(n = 134), surgery(n = 22), and follow-up endoscopic biopsy(n = 305) were performed to confirm the diagnosis.The time interval from initial biopsy to cancer diagnosis was measured, and diagnostic delays were categorized as > 2 wk, > 2 mo, > 6 mo, and > 1 year. The IFND lesions presenting as regenerating atypia(60%) or atypical epithelia(40%)at initial biopsy were adenocarcinomas in 22.6%, adenomas in 8.9%, and gastritis in 68.5% of the cases.RESULTS Four clinical factors [age ≥ 60 years(2.445, 95%CI: 1.305-4.580, P = 0.005),endoscopic size ≥ 10 mm(3.519, 95%CI: 1.891-6.548, P < 0.001), single lesion(5.702, 95%CI: 2.212-14.696, P < 0.001), and spontaneous bleeding(4.056, 95%CI:1.792-9.180, P = 0.001)], and two pathologic factors [atypical epithelium(25.575,95%CI: 11.537-56.695, P < 0.001], and repeated IFND diagnosis [6.022, 95%CI:1.822-19.909, P = 0.003)] were independent risk factors for gastric cancer. With two or more clinical factors, the sensitivity and specificity for carcinoma were91.3% and 54.9%, respectively. Ten undifferentiated carcinomas were initially diagnosed as IFND. In the subgroup analysis, fold change(5.594, 95%CI: 1.458-21.462, P = 0.012) predicted undifferentiated or invasive carcinoma in the submucosal layers or deeper. Diagnostic delays shorter than 1 year were not associated with worse prognoses. Extremely well-differentiated adenocarcinomas accounted for half of the repeated IFND cases and resulted in low diagnostic accuracy even on retrospective blinded review.CONCLUSION More than two clinical and pathologic factors each had significant cut-off values for gastric carcinoma diagnosis; in such cases, endoscopic resection should be considered. | Mi Jung Kwon Ho Suk Kang Hyeon Tae Kim Jin Woo Choo Bo Hyun Lee Sung Eun Hong Kun Ha Park Dong Min Jung Hyun Lim Jae Seung Soh Sung Hoon Moon Jong Hyeok Kim Hye-Rim Park Soo Kee Min Jin won Seo Ji-Young Choe | 2019 | World Journal of Gastroenterology2019，25，4： | 4 |
| 3 | Does the discrepancy in histologic differentiation between a forceps biopsy and an endoscopic specimen necessitate additional surgery in early gastric cancer?显示文摘AIM To investigate the clinicopathological variables in early gastric cancer(EGC) patients in relation to differentiation discrepancy.METHODS The data of 265 specimens from 240 patients with EGC, who had undergone radical operation at Hallym University Sacred Heart Hospital from 2010 to 2015, were retrospectively analyzed. We evaluated clinical, endoscopic, and histopathological data according to histological discrepancy.RESULTS Clinically significant discrepancy rate showed the difference in differentiated type(well and moderately differentiated) and undifferentiated type(poorly differentiated and signet ring cell) between endoscopic biopsies and postoperative specimens was 9.4%(25/265). There were no differences in tumor location, size, gross pattern, and number of biopsies. Specimens having histological discrepancy showed more submucosal invasion(72.0% vs 49.6%, P = 0.033) and lymph node involvement(24.0% vs 7.9%, P = 0.009) than specimens having non-discrepancy. The rate of a positive epidermal growth factor receptor status was higher in specimens having discrepancy than in specimens having non-discrepancy(81.0% vs 55.4%, P = 0.035).CONCLUSION The discordance of histologic differentiation is associated with higher submucosal invasion and lymph node metastases in EGC. Patients have histological discrepancy may require additional surgical treatments. | Jae Seung Soh Hyun Lim Ho Suk Kang Jong Hyeok Kim Kab Choong Kim | 2017 | World Journal of Gastrointestinal Oncology2017，9，8： | 4 |
| 4 | Temporal trends in the misdiagnosis rates between Crohn's disease and intestinal tuberculosis显示文摘AIM To investigate the temporal trends in the misdiagnosis rate between Crohn's disease(CD) and intestinal tuberculosis(ITB) in South Korea. METHODS We retrospectively reviewed the medical records of patients managed for CD or ITB at Asan Medical Center, a tertiary referral hospital, Seoul, Korea between 1996 and 2014. The temporal trends in the misdiagnosis rates between the two diseases were analyzed. The demographic and clinical characteristics were compared between CD patients who were initially misdiagnosed as ITB(final CD group) and vice versa(final ITB group). Final diagnostic criteria for ITB and medication for CD before definite diagnosis of TB were also analyzed in final ITB group.RESULTS In total, 2760 patients were managed for CD and 772 patients for ITB between 1996 and 2014. As well, 494 of the 2760 CD patients(17.9%) were initially misdiagnosed as ITB and 83 of the 772 ITB patients(10.8%) as CD. The temporal trend in misdiagnosing CD as ITB showed a decrease(OR = 0.89, 95%CI: 0.87-0.91, P < 0.001), whereas the temporal trend in misdiagnosing ITB as CD showed an increase(OR = 1.06, 95%CI: 1.01-1.11, P = 0.013). Age at diagnosis, presenting symptoms, and proportion of patients with active/past perianal fistula and active/inactive pulmonary tuberculosis(TB) were significantly different between final CD group and final ITB group. Forty patients(48.2%) in final ITB group were diagnosed by favorable response to empirical anti-TB treatment. Seventeen patients(20.5%) in final ITB group had inappropriately received corticosteroids and/or thiopurines due to misdiagnosis as CD. However, there were no mortalities in both groups. CONCLUSION Cases of CD misdiagnosed as ITB have been decreasing, whereas cases of ITB misdiagnosed as CD have been increasing over the past two decades. | Hyungil Seo Seohyun Lee Hoonsub So Donghoi Kim Seon-Ok Kim Jae Seung Soh Jung Ho Bae Sun-Ho Lee Sung Wook Hwang Sang Hyoung Park Dong-Hoon Yang Kyung-Jo Kim Jeong-Sik Byeon Seung-Jae Myung Suk-Kyun Yang Byong Duk Ye | 2017 | World Journal of Gastroenterology2017，23，34： | 3 |
| 5 | Lymphovascular invasion in more than one-quarter of small rectal neuroendocrine tumors显示文摘AIM To identify the frequency, clinicopathological risk factors, and prognostic significance of lymphovascular invasion(LVI) in endoscopically resected small rectal neuroendocrine tumors(NETs).METHODS Between June 2005 and December 2015, 104 cases of endoscopically resected small(≤ 1 cm) rectal NET specimens at Hallym University Sacred Heart Hospital in Korea were retrospectively evaluated. We compared the detected rate of LVI in small rectal NET specimens by two methods: hematoxylin and eosin(H&E) and ancillary immunohistochemical staining(D2-40 and Elastica van Gieson); in addition, LVI detection ratedifference between endoscopic procedures were also evaluated. Patient characteristics, prognosis and endoscopic resection results were reviewed by medical charts.RESULTS We observed LVI rates of 25.0% and 27.9% through H&E and ancillary immunohistochemical staining. The concordance rate between H&E and ancillary studies was 81.7% for detection of LVI, which showed statistically strong agreement between two methods(κ = 0.531, P < 0.001). Two endoscopic methods were studied, including endoscopic submucosal resection with a ligation device and endoscopic submucosal dissection, and no statistically significant difference in the LVI detection rate was detected between the two(26.3% and 26.8%, P = 0.955). LVI was associated with large tumor size(> 5 mm, P = 0.007), tumor grade 2(P = 0.006). Among those factors, tumor grade 2 was the only independent predictive factor for the presence of LVI(HR = 4.195, 95%CI: 1.321-12.692, P = 0.015). No recurrence was observed over 28.8 mo regardless of the presence of LVI.CONCLUSION LVI may be present in a high percentage of small rectal NETs, which may not be associated with short-term prognosis. | Mi Jung Kwon Ho Suk Kang Jae Seung Soh Hyun Lim Jong Hyeok Kim Choong Kee Park Hye-Rim Park Eun Sook Nam | 2016 | World Journal of Gastroenterology2016，22，42： | 0 |
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