Seung Bae Yoon

Effect of Helicobacter pylori eradication on metachronous gastric cancer after endoscopic resection of gastric tumors: a meta-analysis.

Although endoscopic resection is widely accepted as the curative treatment modality for early gastric cancer, secondary metachronous cancer may subsequently develop in the residual gastric mucosa. The preventive effect of Helicobacter pylori eradication on the development of metachronous gastric cancer in such cases remains controversial. The aim of this study was to determine the effect of H. pylori eradication on the development of metachronous gastric cancer after endoscopic resection of gastric neoplasm by a meta‐analysis of all relevant studies.

Long-term pretreatment with proton pump inhibitor and Helicobacter pylori eradication rates

AIM To investigate whether proton pump inhibitor (PPI) pretreatment influences Helicobacter pylori eradication rate. METHODS We retrospectively reviewed H. pylori-infected patients who were treated with a standard triple regimen (PPI, amoxicillin 1 g, and clarithromycin 500 mg, all twice daily for 7 d). The diagnosis of H. pylori infection and its eradication was assessed with the rapid urease test, histological examination by silver staining, or the ¹³C-urea breath test. We divided the patients into two groups: one received the standard eradication regimen without PPI pretreatment (Group A), and the other received PPI pretreatment (Group B). The patients in Group B were reclassified into three groups based on the duration of PPI pretreatment: Group B-I (3-14 d), Group B-II (15-55 d), and Group B-III (≥ 56 d). RESULTS A total of 1090 patients were analyzed and the overall eradication rate was 80.9%. The cure rate in Group B (81.2%, 420/517) was not significantly different from that in Group A (79.2%, 454/573). The eradication rates in Group B-I, B-II and B-III were 80.1% (117/146), 81.8% (224/274) and 81.4% (79/97), respectively. CONCLUSION PPI pretreatment did not affect H. pylori eradication rate, regardless of the medication period.

Impact of body fat and muscle distribution on severity of acute pancreatitis

BACKGROUND/OBJECTIVES Obesity is a well-established risk factor for severe acute pancreatitis (AP); however, the impact of visceral obesity or sarcopenic obesity on severity of AP has not been well studied. We compared the relationship between severity of AP and various body parameters including body weight, body mass index (BMI), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and visceral fat-to-muscle ratio (VMR). METHODS We analyzed the data of patients who were diagnosed with AP from 2009 to 2015. Image analysis software program (Aquarius Workstation software) was used to calculate individual VAT, SAT, and skeletal muscle areas from abdominal computed tomography scans at L3 vertebral levels. Revised Atlanta Classification was adopted to define severity of AP. Receiver operating characteristics (ROC) curves were constructed to determine the optimal threshold for predicting the severity. RESULTS Among 203 patients, 13 (6.4%) patients had severe AP and 62 (30.5%) patients had moderately severe cases. VMR demonstrated the highest area under the ROC curve [0.757, (95% confidence interval: 0.689-0.825)] in predicting moderately severe or severe AP. The optimal threshold of VMR for predicting severity was 1. The prevalence of various local complications and persistent organ failure were higher in patients with VMR over 1. CONCLUSIONS High visceral fat with low skeletal muscle volume was strongly correlated with AP severity. VMR had a stronger correlation with AP severity than body weight or BMI. This simple grading system would be useful if incorporated into future predictive scoring models.

The Effect of Exenatide and Erythromycin on Postprandial Symptoms and Their Relation to Gastric Functions

Background: The relationship between abnormal gastric motor function and postprandial abdominal symptoms has not been fully clarified. The aim of the study was to investigate this relationship in response to mediators that affect gastric function. Methods: Ten healthy volunteers participated in a 3-way cross-over study of treatment with placebo, exenatide and erythromycin. The studies were performed at 1-week intervals. Each subject underwent 3-dimensional single photon emission computed tomography to measure fasting and postprandial gastric volumes. A combined nutrient drink test and cutaneous electrogastrography (EGG) were performed on the next day. Results: Erythromycin reduced postprandial symptoms compared with placebo. The postprandial gastric volume after exenatide was greater than after placebo and erythromycin treatment. Exenatide did not aggravate postprandial symptoms compared with placebo. The ratio of postprandial over fasting gastric volume was inversely correlated with the total postprandial symptom score after placebo, exenatide and erythromycin treatment. The postprandial symptom score of the normal EGG group was significantly lower than that of the abnormal group, considering overall treatments. Conclusions: Erythromycin reduced postprandial symptoms, whereas exenatide did not aggravate postprandial symptoms, possibly due to its enhancement of gastric accommodation. An abnormal EGG rhythm was associated with postprandial symptoms.

Esophagogastric Junction Contractile Integral and Morphology: Two High-Resolution Manometry Metrics of the Anti-Reflux Barrier

We evaluated associations of esophagogastric junction (EGJ) metrics as an anti‐reflux barrier with impedance–pH, endoscopic esophagitis, and lower esophageal sphincter (LES) metrics.

A Case of Advanced Gastric Cancer Presenting as Multiple Colonic Lymphoid Hyperplasia

Gastric cancer frequently disseminates to the liver, lung, and bone via hematogeneous, lymphatic, or peritoneal routes. However, gastric adenocarcinoma that metastasize to the colon and that shows typical linea platisca pattern on colonofiberscopy has rarely been reported. Recently, the authors experience a case of advanced gastric cancer with colonic metastases in a 55-year-old female patient. Multiple colonic lymphoid hyperplasias were detected on colonofiberscopy and biopsy revealed metastatic gastric cancer to the colonic wall. She was treated with mFOLFOX (5-FU, oxaliplatin, leucovorin) and has achieved stable disease status without disease progression. Herein, we report a rare case of signet ring-cell gastric cancer which metastasized to the colon in the form of multiple colonic lymphoid hyperplasias.

Metal versus plastic stents for drainage of pancreatic fluid collection: A meta-analysis

Background Although metal stents are increasingly being used for endoscopic transmural drainage of pancreatic fluid collection (PFC), the advantages of metal stents in comparison with plastic stents are not clear. Objective The aim of this study is to compare the clinical outcomes and adverse events between patients receiving endoscopic transmural drainage of PFCs through metal or plastic stents. Methods We performed a systematic literature search to identify all published manuscripts comparing metal and plastic stents for PFC drainage. The primary outcome was clinical success, and the secondary outcomes were technical success, procedure time, overall cost, adverse events, and recurrence. Results Seven studies were considered to be appropriate for this meta-analysis. Metal stents showed a higher clinical success rate (odds ratio (OR) 3.39, 95% confidence interval (CI) 2.05–5.60) and a lower overall adverse event rate (OR 0.37, 95% CI 0.21–0.66) than plastic stents. In subgroup analyses, metal stents showed higher clinical success rates than plastic stents both for pseudocyst (OR 5.35, 95% CI 1.35–21.19) and walled-off necrosis (OR 3.37, 95% CI 1.89–5.99). Conclusions Metal stents are superior to plastic stents for endoscopic transmural drainage of PFC because they have a higher clinical success rate and lower rate of adverse events.

Preoperative sarcopenia and post‐operative accelerated muscle loss negatively impact survival after resection of pancreatic cancer

Sarcopenia and post‐operative accelerated muscle loss leading to cachexia are commonly observed in patients with pancreatic cancer. This study aimed to assess the influence of body compositions and post‐operative muscle change on survival of patients with surgically treated pancreatic cancer.

Treatment of Pancreatic Fluid Collections

Pancreatic Fluid Collection (PFC) develops as a result of acute pancreatitis, chronic pancreatitis, trauma, and postoperation. Although percutaneous drainage, surgery and Endoscopic Retrograde Panceatogram are used as conventional treatments in complicated PFC, the clinical course of PFC is unsatisfactory due to its clinical success rate and the risk of procedure-related complications. Endoscopic ultrasonography-guided transmural drainage of PFC is a safe and effective modality for the management of PFC, particularly in patients with pancreas necrosis. A range of techniques and stents have been introduced and a newly designed metal stent is now available.

More Frequent Follow-up CT Scans in Postsurgical Resection Patients Than in Postendoscopic Resection Patients of Early Gastric Cancers: Impracticality of CTs for Mucosal Cancer

RATIONALE AND OBJECTIVES The aim of this study was to compare the utility and timing of computed tomography (CT) in the detection of recurrent tumors between patients after surgical and endoscopic resections for early gastric cancer (EGC). MATERIALS AND METHODS A total of 670 patients after surgical (n = 535) and endoscopic (n = 135) resections for EGC between 2007 and 2009 were enrolled. The mean numbers of CT and endoscopy between both treatment groups were compared. The mean and cumulative dose length products of CT examinations were calculated. The modality that detected recurrence was compared between the two groups using the Pearson chi-square test. RESULTS The mean interval of CT was significantly shorter and the mean number of CTs was significantly larger in the surgical resection group than in the endoscopic resection group. All 34 gastric recurrences were diagnosed by endoscopy. All seven extragastric recurrences occurred in patients treated for EGC with submucosal invasion. Six extragastric recurrences were detected by CT out of a total of 5417 CT scans. The average cumulative dose length product was significantly higher in the surgical group than in the endoscopic resection group (P = 0.004). CONCLUSION Follow-up CTs were performed more frequently in patients after surgical resection than in patients after endoscopic resection of EGCs. However, CT scans were not effective in detecting recurrent tumors after either treatment methods, especially for patients treated for mucosal gastric cancer.