Hoon Jai Chun

Esophageal subepithelial tumor: why tunneling?

Subepithepial tumors (SETs) in esophagus are mostly benign and causes no specific symptoms, however, resection should be considered in case of large tumors leading to troublesome symptoms such as dysphagia or rapidly growing tumor. Endoscopioc submucosal dissection (ESD) has been performed for therapeutic resection of esophageal epithepial lesions or even SETs, however, post-procedureal stricture is a major concern. Recently, a novel endoscopic approach using submucosal space, namely submucosal tunneling, is considered as a good alternative option for endoscopic resection of esophageal lesions. This approach can preserve mucosal integrity and use it as a coverage flap, which prevents serious late complications such as stricture in esophagus. Here, we report two cases of large esophageal SETswhich were endoscopically resected by two different approaches: the first one by conventional ESD, and the second one by submucosal tunneling approach. The former eventually resulted in significant stricture at esophagus, thus repeatitive balloon dilation was needed. However, the latter had no serious late complications including stricture. This case report clealy provides the advantage of submucosal tunneling over conventional ESD in the treatment of esophageal SETs, and the promising therapeutic value of this new approach is expected.

CHAPTER 29:l-Carnosine and Zinc in Gastric Protection

The incidence of gastric mucosal injury has been increasing rapidly because nonsteroidal anti-inflammatory drugs (NSAIDs) and antithrombotic agents are being increasingly prescribed, especially to elderly patients. Several approaches for gastric mucosa defense have been adopted for the prevention and cure of gastropathy, including gastric ulcers. Zinc l-carnosine is used for the treatment of gastric mucosal damage disease. Zinc l-carnosine (or polaprezinc) is a chelated compound that consists of l-carnosine and zinc. Zinc l-carnosine protects the mucosa against aggressive injury factors and has been found to prevent gastric mucosal injury in diverse experimental models through anti-inflammatory action, antioxidant action, growth factors, and cytoprotective factors such heat-shock proteins. Zinc l-carnosine is effective in treating Helicobacter pylori infection, NSAID-induced gastric injury, ethanol-induced gastropathy, and acetic acid-gastric damage. In conclusion, zinc l-carnosine is a valuable mucosal protective agent with multiple targets that can be used in gastric mucosal damage healing.