Acute pancreatitis with diaphragmatic hernia is rare, and furthermore, very few were reported in the case without incarceration. The suggested mechanism of acute pancreatitis with diaphragmatic hernia is that herniation of pancreas itself. The other possible mechanism is pancreatic ischemia due to traction after aggravation of hernia or acute distention of stomach. We report a case of acute pancreatitis due to diaphragmatic hernia with no evidence of herniation of pancreas. A 78-year-old male was administered for epigastric pain and dyspnea. The radiologic and laboratory result demonstrated an acute pancreatitis with diaphragmatic hernia without any evidence of herniation of pancreas. The patient was managed conservatively to reduce the hernia and to treat pancreatitis.
Adult* ; Aged ; Dyspnea ; Hernia ; Hernia, Diaphragmatic* ; Humans ; Ischemia ; Male ; Pancreas ; Pancreatitis* ; Stomach ; Traction

Duodenal carcinoid tumors are rare, and they are increasingly recognized with the more widespread use of upper gastrointestinal endoscopy. In the clinical practice, duodenal carcinoid tumors smaller than 1 cm in diameter and confined to the submucosa can be managed with endoscopic removal. For the tumors 2 cm in diameter or larger, operative excision and regional lymphadenectomy should be performed. For the tumors 1 to 2 cm in diameter, there was no consensus in the selection of treatment modality. A healthy 54 year old man was admitted due to an incidentally detected duodenal polyp during regular health screening. The polyp was 1.3 cm sized semi-pedunculated type and the overlying mucosa was relatively intact. It was removed endoscopically with the snare. The final diagnosis was duodenal carcinoid tumor and there was no recurrence for the subsequent 6 years. For the extremely rare appearance with polyp, we reported this case with a brief review of literatures.
Carcinoid Tumor ; Consensus ; Duodenum ; Endoscopy, Gastrointestinal ; Lymph Node Excision ; Mass Screening ; Mucous Membrane ; Polyps ; Recurrence ; SNARE Proteins

Endoscopic quality indicators can be classified into three categories, namely facilities and equipment, endoscopic procedures, and outcome measures. In 2019, the Korean Society of Gastrointestinal Endoscopy updated the accreditation of qualified endoscopy unit assessment items for these quality indicators to establish competence and define areas of continuous quality improvement. Here, we presented the updated program guidelines on the facilities, procedures, and performance of the accredited endoscopy unit. Many of these items have not yet been validated. However, the updated program will help in establishing competence and defining areas of continuous quality improvement in Korean endoscopic practice.
Accreditation ; Endoscopy ; Endoscopy, Gastrointestinal ; Mental Competency ; Outcome Assessment (Health Care) ; Quality Improvement

A case of acute pancreatitis associated with hypercalcemia resulting from a newly diagnosed multiple myeloma is reported. There have been several prior reports of hypercalcemia-induced pancreatitis in patients with multiple myeloma, but very few showed the following two aspects: pancreatitis as the first manifestation of hematologic malignancy and recovery after serum calcium levels fell into normal range. When clinicians encounter a patient with hypercalcemic status and acute pancreatitis without any known etiology of pancreatitis, multiple myeloma as a root cause of pancreatitis should be considered.

Acute pancreatitis caused by acute hepatitis A is extremely rare, with only a small number of cases in young adults having been reported. This paper presents a 74-year-old female patient with an acute abdomen, which proved to be acute pancreatitis with acute hepatitis A. A survey of acute viral hepatitis A as a root cause of pancreatitis should be considered when clinicians encounter patients with acute pancreatitis without any known etiology of pancreatitis.

BACKGROUNDFew studies have used body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (WC) at the same time to investigate the association between obesity and colorectal adenoma. This study examined the strength of association between colorectal adenoma and obesity using not only BMI, but also WHR and WC.

METHODSSubjects of this study included 1322 asymptomatic patients who underwent colonoscopy for cancer screening from January 2006 to June 2008. Anthropometric measurements, blood test results, and a self-administered questionnaire from each subject were analyzed.

RESULTSFour hundred and fourteen adenoma cases were identified in 1322 subjects. Using univariate analysis, the prevalence of adenoma was associated with BMI and WHR and was higher among the abdominal obesity group using WC guidelines of the Korean Society for the Study of Obesity, but not using WC guidelines of the International Diabetes Federation. In multiple Logistic regression analysis, general obesity (BMI ≥ 25 kg/m(2)) increased the risk of colorectal adenoma (odds ratio (OR), 1.43; 95% confidence interval (CI), 1.05 - 1.94). Also, abdominal obesity by the WC cutoffs and the highest WHR percentile group (WHR ≥ 0.95) were significantly associated with adenoma. Among three measures of obesity, however, only BMI had a persistent association with adenoma after adjusting reciprocally for BMI, WC, and WHR (OR, 1.30; 95%CI, 1.02 - 1.80; and 1.49; 1.06 - 2.10, adjusted for WC and WHR, respectively).

CONCLUSIONThe data suggest that general obesity is associated with an increased risk of colorectal adenoma.

Adult ; Body Mass Index ; Colorectal Neoplasms ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Obesity ; epidemiology ; Waist Circumference ; physiology ; Waist-Hip Ratio

An endoscopic retrograde cholangiopancreatography (ERCP) is endoscopically complicated procedure which carries a higher risk of serious adverse events, and it is more challenging compared with general endoscopy. On a national basis, the accepted standards of practice in ERCP are needed to be outlined to ensure consistent clinical standards in patient management. Certificated system for general endoscopy has been implemented since 2006 in Korea. However, an established system for certification of ERCP does not exist, which requires longer training than general endoscopy. Recently, much has been reported about the need to measure and improve the quality of endoscopy services, but still the variability exists in standards used by hospitals for credentialing physicians to ERCP in Korea. There is an urgent need to settle the credentialing process to enhance practice and to protect patients, which suits our society. This article investigated the system of ERCP certification in overseas, and should be helpful to establish the standard certification system of ERCP in Korea.
Certification ; Cholangiopancreatography, Endoscopic Retrograde ; Credentialing ; Endoscopy ; Humans ; Korea

Borrmann type 4 gastric is a malignant disease that shows enlarged gastric folds, and this is easily mistaken as a mucosal flare or as inflammation because a third of these patients show normal mucosa without mucosal defects and the lesion diffusively infiltrates into the submucosal area. Endoscopic ultrasonography is an effective tool for making the differential diagnosis of gastric subepithelial lesion and hypertrophic gastric fold when endoscopy is not suitable to use. Eosinophilic gastritis is a benign lesion with enlarged gastric folds and it shows pathologic eosinophil infiltration in the walls of the stomach. We report here on a case that was suspected to be Borrmann type 4 advanced gastric cancer according to the endoscopic ultrasonography and this was confirmed by abdominal operation. Otherwise, this condition would have been mistaken for eosinophilic gastritis.
Diagnosis, Differential ; Endoscopy ; Endosonography ; Enteritis ; Eosinophilia ; Eosinophils ; Gastritis ; Humans ; Inflammation ; Mucous Membrane ; Stomach ; Stomach Neoplasms

Boerhaave's syndrome is difficult to diagnosis because of the esophageal rupture, which is caused by nausea and vomiting, and Boerhaave's syndrome is known to have a high mortality rate. The mortality increases with a delayed diagnosis; therefore, an early diagnosis and surgical treatment are critical for a good prognosis. Yet some recent cases have shown that non-surgical treatments are successful in some classified patient groups. These groups should be considered according to their symptoms and their laboratory and radiological findings. Sepsis and multi-organ failure should be continuously checked for to see if they occurred and/or progressed. We report here on a 51 year old woman who had Boerhaave's syndrome, and this was caused by heavy drinking, nausea and vomiting, and she improved with just non-surgical treatment such as fasting, antibiotics and endoscopic clipping.
Anti-Bacterial Agents ; Drinking ; Early Diagnosis ; Esophageal Perforation ; Fasting ; Female ; Humans ; Mediastinal Diseases ; Nausea ; Prognosis ; Rupture ; Sepsis ; Vomiting