Intestinal metaplasia (IM) is recognized as a precancerous condition for intestinal type gastric cancer. Therefore, endoscopic diagnosis of IM is valuable for patients undergoing surveillance endoscopy. However, there are no standard endoscopic findings that distinguish it from the normal mucosa. Thus, biopsy is normally required to confirm the diagnosis of IM. Recently, the development of high-resolution image technique and some advanced endoscopic technologies such as chromoendoscopy, magnifying endoscopy with narrow band image and confocal laser endomicroscopy has significantly improved the ability to observe mucosal surface and identify IM. Although chromoendoscopy is time consuming, it is a useful method for diagnosis of IM. Narrow band imaging may enhance the accuracy of endoscopic surveillance of IM and dysplasia. Confocal laser endomicroscopy could provide in the real-time identification and classification of IM. Herein, we reviewed the clinical usefulness of white light endoscopy and several new endoscopic methods for the diagnosis of gastric intestinal metaplasia. Also, we will discuss appropriate follow-up period according to IM type and extension.
Biopsy ; Endoscopy ; Follow-Up Studies ; Humans ; Light ; Metaplasia ; Methylene Blue ; Microscopy, Confocal ; Mucous Membrane ; Narrow Band Imaging ; Precancerous Conditions ; Stomach Neoplasms

Belching is the audible escape of air from the esophagus into the pharynx. It is considered a disorder when the symptom is very frequent and causes significant distress to the patients. Excessive belching can be divided according to excessive supragastric and gastric belching. Gastric belching is usually physiological. In contrast, supragastric belching can be considered learned behavior. In addition, many psychiatric conditions, including anxiety, have been described in patients with supragastric belching and some patients have reported that their symptoms increased during stressful events. We report on a case of supragastric belching in a depressive patient and discuss its management through psychiatric approaches.
Anxiety ; Cognitive Therapy ; Depressive Disorder, Major ; Eructation* ; Esophagus ; Humans ; Life Change Events ; Pharynx ; United Nations

Belching is the audible escape of air from the esophagus into the pharynx. It is considered a disorder when the symptom is very frequent and causes significant distress to the patients. Excessive belching can be divided according to excessive supragastric and gastric belching. Gastric belching is usually physiological. In contrast, supragastric belching can be considered learned behavior. In addition, many psychiatric conditions, including anxiety, have been described in patients with supragastric belching and some patients have reported that their symptoms increased during stressful events. We report on a case of supragastric belching in a depressive patient and discuss its management through psychiatric approaches.
Anxiety ; Cognitive Therapy ; Depressive Disorder, Major ; Eructation* ; Esophagus ; Humans ; Life Change Events ; Pharynx ; United Nations

No abstract available.
Common Bile Duct ; Surgical Instruments

No abstract available.
Aged ; Biopsy ; Esophageal Neoplasms/*diagnosis/pathology ; Esophagoscopy ; Esophagus/*pathology ; Humans ; Male ; Mucous Membrane/pathology ; Papilloma/*diagnosis/pathology

A primary adenosquamous carcinoma of the liver is a rare subtype of a cholangiocarcinoma. Adenosquamous carcinoma is known to have an aggressive biologic behavior and is associated with a poor prognosis. Recently, we experienced a case of a primary adenosquamous carcinoma of the liver. A 69-year-old man was subjected to a right hemicolectomy five months ago due to an ascending colon cancer. At a periodic check-up, abdominal ultrasonography and magnetic resonance imaging showed a ~1.1 cm-sized hepatic mass which was highly suspicious of being a hepatic metastasis from the ascending colon cancer. A hepatic segmentectomy was performed. The tumor was microscopically composed of an adenocarcinoma and a squamous cell carcinoma, and it was different from the previous colon cancer as determined by immunohistochemistry. Three months after the hepatic segmentectomy, multiple hepatic metastasis was found and the patient has been treated as an outpatient with capecitabine.
Adenocarcinoma* ; Aged ; Carcinoma, Adenosquamous* ; Carcinoma, Squamous Cell ; Cholangiocarcinoma ; Colon* ; Colon, Ascending ; Colonic Neoplasms ; Humans ; Immunohistochemistry ; Liver* ; Magnetic Resonance Imaging ; Mastectomy, Segmental ; Neoplasm Metastasis ; Outpatients ; Prognosis ; Ultrasonography ; Capecitabine

Toothpicks are not uncommonly swallowed, and subsequently, may be impacted into gastrointestinal wall and cause morbidities, and even mortality. Therefore, the early diagnosis and immediate retrieval of an ingested toothpick is important. In many cases, endoscopic removal is attempted initially, but if this fails or a complication is encountered, surgery should be considered. The authors experienced a case of ingested toothpick penetrating the gastric wall. A 51-year-old woman visited our hospital with epigastric pain of one-week duration. Upper endoscopy revealed that the sharp end of a toothpick had been impacted into the distal antrum. Endoscopic removal using an alligator jaw forceps failed because the toothpick broke during removal and our continued attempts to extract the remnant resulted in it becoming more embedded in the stomach wall. In such circumstances, surgical treatment should be considered. However, we incised the mucosa to expose the remnant toothpick, and fortunately, we were then able to grasp and remove the toothpick using an alligator jaw forceps. We report this unusual case of a toothpick impacted in the gastric wall that was resolved endoscopically by mucosal incision.
Alligators and Crocodiles ; Early Diagnosis ; Endoscopy ; Female ; Foreign Bodies ; Hand Strength ; Humans ; Jaw ; Middle Aged ; Mucous Membrane ; Stomach ; Surgical Instruments

Toothpicks are not uncommonly swallowed, and subsequently, may be impacted into gastrointestinal wall and cause morbidities, and even mortality. Therefore, the early diagnosis and immediate retrieval of an ingested toothpick is important. In many cases, endoscopic removal is attempted initially, but if this fails or a complication is encountered, surgery should be considered. The authors experienced a case of ingested toothpick penetrating the gastric wall. A 51-year-old woman visited our hospital with epigastric pain of one-week duration. Upper endoscopy revealed that the sharp end of a toothpick had been impacted into the distal antrum. Endoscopic removal using an alligator jaw forceps failed because the toothpick broke during removal and our continued attempts to extract the remnant resulted in it becoming more embedded in the stomach wall. In such circumstances, surgical treatment should be considered. However, we incised the mucosa to expose the remnant toothpick, and fortunately, we were then able to grasp and remove the toothpick using an alligator jaw forceps. We report this unusual case of a toothpick impacted in the gastric wall that was resolved endoscopically by mucosal incision.
Alligators and Crocodiles ; Early Diagnosis ; Endoscopy ; Female ; Foreign Bodies ; Hand Strength ; Humans ; Jaw ; Middle Aged ; Mucous Membrane ; Stomach ; Surgical Instruments

Although metastasis from cutaneous malignant melanoma to the small intestine is not uncommon, primary small bowel melanoma (SBM) is extremely rare. This case report describes a rare case of primary SBM, diagnosed by single-balloon enteroscopy. A 74-year-old man presented with recurrent melena. Upper endoscopy and colonoscopy were unremarkable. Abdominal computed tomography (CT) revealed an ileal mass with ileo-ileal intussusception. Subsequent single-balloon enteroscopy identified an ileal tumor, which was histologically diagnosed as melanoma. Extensive clinical examination did not reveal any primary cutaneous lesions. To the best of our knowledge, this is the first case of primary SBM in South Korea.
Aged ; Colonoscopy ; Endoscopy ; Humans ; Intestine, Small ; Intussusception ; Korea ; Melanoma* ; Melena ; Neoplasm Metastasis

BACKGROUND/AIMS: Laparoscopic Heller myotomy with antireflux procedure is considered to be a standard treatment for achalasia. Recently, peroral endoscopic myotomy (POEM) was developed and performed on patients with achalasia. However, there is no report on POEM use in South Korea. The aim of this study was to evaluate the technical feasibility of POEM in a porcine model. METHODS: POEM was performed on two mini pigs. We performed upper endoscopy under general anesthesia. A submucosal tunnel was created and the circular muscle layer was incised using several knives. The mucosal entry was closed using resolution clips. We performed a follow-up endoscopy and sacrificed the pigs 2 weeks after the POEM. The myotomy site was evaluated grossly and histologically. RESULTS: POEM was successfully performed on the two mini pigs. No injuries to any abdominal or mediastinal structures occurred. Two weeks after the POEM, the esophageal mucosa healed without any endoscopic evidence of complications. Necropsy revealed that the circular muscle layer was completely lost and replaced with fibrotic tissue. CONCLUSIONS: We found that POEM is a technically feasible method which can be performed on an animal model. However, to ensure safe use on patients with achalasia, further studies on technical methods and long-term follow-up examinations are required.
Anesthesia, General ; Animals ; Dietary Sucrose ; Endoscopy ; Esophageal Achalasia ; Esophagus ; Feasibility Studies ; Follow-Up Studies ; Humans ; Models, Animal ; Mucous Membrane ; Muscles ; Republic of Korea ; Swine