Mi Young Do

Western-style diets induce macrophage infiltration and contribute to colitis-associated carcinogenesis.

Background and Aim:  A Western‐style diet (WD) is known to play an important role in inflammatory bowel disease and colon carcinogenesis. The purpose of this study was to understand the role of macrophages in WD‐induced colitis associated with carcinogenesis.

Near-Infrared Fluorescence Imaging Using a Protease-Specific Probe for the Detection of Colon Tumors

BACKGROUND/AIMS Early tumor detection is crucial for the prevention of colon cancer. Near-infrared fluorescence (NIRF) imaging using a target-activatable probe may permit earlier disease detection. Matrix metalloproteinases (MMPs) participate in tumorigenesis and tumor growth. The aim of this study was to determine whether NIRF imaging using an MMP-activatable probe can detect colon tumors at early stages. METHODS WE UTILIZED TWO MURINE COLON CANCER MODELS: a sporadic colon cancer model induced by azoxymethane (AOM), and a colitis-associated cancer model induced by a combination of AOM and dextran sodium sulfate (DSS). Colonic lesions were analyzed by histologic examination, Western blotting, immunohistochemical staining, and NIRF imaging using an MMP-activatable probe. RESULTS Multiple variable-sized tumors developed in both models and progressed from adenomas to adenocarcinomas over time. At the early stage of the AOM/DSS model, diffuse inflammation was observed within the tumors. MMP expression increased progressively through normal, inflammation, adenoma, and adenocarcionoma stages. NIRF signal intensities were strongly correlated with each tumor stage from adenoma to adenocarcinoma. NIRF imaging also distinguished tumors from inflamed mucosa. CONCLUSIONS NIRF imaging using a protease-activatable probe may be a useful tool for early tumor detection. This approach could translate to improve the endoscopic detection of colon tumors, especially in patients with inflammatory bowel disease.

Usefulness of Double Balloon Endoscopy in Patients With Surgically Distorted Intestinal Anatomy

Background Double balloon endoscopy (DBE) is a new endoscopic method with the capability for complete observation of whole small bowel. This study evaluated the feasibility and usefulness of DBE for the diagnosis and therapy of small bowel diseases in patients with distorted intestinal anatomy by previous surgeries. Patients and Methods From January 2005 to August 2007, 15 patients with Roux-en-Y anastomosis underwent DBE in Asan Medical Center. Eight were men and the median age was 57 years (range, 40 to 68 y). Indications of DBE were suspected small bowel bleeding, chronic diarrhea, and recurrent acute pancreatitis. The main outcome measurements included completeness of the observation of afferent loop and DBE findings. Results Because 1 patient underwent DBE twice separately owing to recurrent bleeding, a total of 16 cases were analyzed. The observation of afferent loop was complete in 13 (81%) of 16 cases. The overall diagnostic yield of DBE was 69% (11/16). Out of 11 cases in which DBE detected abnormalities, 6 (55%) showed definite lesions and 5 (45%) probable lesions. Of the 11 cases in which abnormalities were found, 7 (64%) showed lesions in afferent loop. Of the 6 cases in which definite lesions were found, 4 (67%) showed lesions in afferent loop. Therapeutic endoscopic procedures were performed in 4 cases, which include argon plasma coagulation, foreign body removal, and endoscopic nasobiliary drainage. Conclusions DBE in patients with distorted intestinal anatomy such as Roux-en-Y anastomosis is a useful tool for the management of small bowel lesions, especially those in the afferent loop.

Seroconversion Rates of Helicobacter pylori Infection in Korean Adults

Studies on seroconversion and its reversion rate in Korean adults with Helicobacter pylori infection are very rare. The purpose of this study was to evaluate the overall seroprevalence, seroconversion rate, and seroreversion rate of H. pylori infection in an adult population.

A Pilot Study About Tolerability to Double Balloon Endoscopy: Comparison to Esophagogastroduodenoscopy and Colonoscopy

Background Although the diagnostic and therapeutic values of double balloon endoscopy (DBE) have been investigated, the subjective tolerability to DBE has not been assessed. We aimed to evaluate patients’ tolerability to DBE. Methods We prospectively enrolled patients who underwent DBE. For the comparison of tolerability to DBE with that to esophagogastroduodenoscopy (EGD) and colonoscopy, those who had not undergone EGD nor colonoscopy were excluded. A total of 52 patients were included. All procedures were performed under conscious sedation with midazolam with or without pethidine. Patients’ tolerability to DBE, EGD, and colonoscopy was assessed through an interview with a questionnaire using a 10-point Likert scale. Results A total of 36 patients underwent both antegrade DBE and EGD under conscious sedation. The level of abdominal pain during procedures, the level of post-procedural abdominal discomfort, and the proportion of patients with persistent abdominal discomfort until the next morning were higher in antegrade DBE. However, when analyzed in 16 patients who had good quality of sedation, the differences in the level of abdominal pain during procedures and the persistent abdominal discomfort until the next morning disappeared. A total of 23 patients underwent both retrograde DBE and colonoscopy under conscious sedation. Tolerability parameters were not different between retrograde DBE and colonoscopy. Serious complications, including hemodynamic instability, did not occur during all procedures. Conclusion Patients tolerated DBE well. DBE may be performed as comfortably as EGD and colonoscopy if the quality of sedation is good enough.

S2021 Clinical and Endoscopic Analysis of Primary T Cell Lymphoma of the Gastrointestinal Tract According to Pathology and EBV Status

Background:Primary gastrointestinal(GI) T-cell lymphomas are rare tumors and mostly reported from the East. The aims of this study were to determine the clinical and endoscopic features of primaryGI T cell lymphoma, with special emphasis on the pathologic classification, and to elucidate the correlation between Estein-Barr virus (EBV)/ T-cell receptor gene rearrangement (TCR) status and prognosis of this disease. Patients and Methods:35 cases of primary GI T cell lymphomas that satisfied Dawsons criteria were enrolled. The mean age at the time of diagnosis was 47.3 years (range 27 70), and the male:female ratio was 24:11. The 38 lesions from 35 patients were analyzed and classified into enteropathy-type (ETCL), NK/T cell (NK/T), peripheral T cell (PTCL), and anaplastic large cell (ALCL). Clinical characteristics, and endoscopic features were analyzed according to these types, and the survival analysis was done according to clinical factors and EBV/TCR status. EBV/TCR was determined by in situ hybridization and PCR. Results:The initial presenting symptoms were abdominal pain (n=18, 35.0%), fever (n=8, 21.0%), gastrointestinal bleeding (n=6, 15.8%), diarrhea (n=4, 10.5%), and soreness (n=2, 5.3%). As for the location, PTCL more commonly involved stomach (7/12, 58.3%) and duodenum (4/12, 33.3%) while ETCL occurred most frequently in small intestine (8/13, 61.5%), NK/T involved small (4/11, 36.4%) and large intestine (5/11, 45.6%) (p<0.05). The stage of disease at diagnosis was less advanced in NK/T than in ETCL and PTCL (p<0.05). Perforation developed more frequently in NK/T (46.2%) and ETCL (46.2%) than in PTCL (0%) (p<0.05). On endoscopy the lesions were ulcerative in 9 (33.4%), ulcerofungative in 7 (25.9%), ulceroinfiltrative in 5 (18.5%), infiltrative in 3 (11.1%), superficial/erosive in 2 (7.4%), and fungating in 1 (3.7%). The distribution was not different according to the pathologic types. The EBV positivity was higher in NK/T than other types (p<0.05). Initial treatment was surgical resection (n=22, 57.9%), chemotherapy (n=15,39.5%), or supportive care (n=1,2.6%). The median survival was 12.1 months. The poor prognosis is associated with more advanced stage, small bowel location, and perforation (p<0.05). Perforation was found to be the only independent predictor for the prognosis by multivariate analysis (p<0.05). Conclusion:Primary GI T cell lymphoma showed characteristic clinical features according to the 4 major pathologic types. The poor prognosis in this disease is associated with more advanced stage, small bowel location, and perforation. EBV is the most prevalent in NK/T cell type and is not affecting the prognosis.