Indefinite-for-neoplasia is an expression used to describe lesions in which carcinoma or dysplasia cannot be clearly and conclusively established via biopsy. Gastric indefinite-for-neoplasia may represent a reactive change secondary to inflammation in some patients; however, some lesions are eventually diagnosed as dysplasia or carcinoma. Follow-up endoscopic biopsy is commonly performed in patients with gastric indefinite-for-neoplasia lesions. Nonetheless, patients may undergo resection based on a high index of clinical suspicion for dysplasia or carcinoma based on endoscopic findings. Accurate target biopsies of the lesion and effective communication with pathologists are required to improve diagnostic accuracy and avoid unnecessary re-examinations. It is important to establish endoscopic findings useful in differentiating lesions that require resection. In this review, we describe the approach for the management of indefinite-for-neoplasia lesions detected on gastric mucosal biopsy and the characteristics of lesions that require resection.

Purpose: Total hip arthroplasty (THA) using dual mobility components (DMC) is a reasonable surgical option for displaced femoral neck fractures in elderly patients, resulting in lower dislocation rates and improved stability. The purpose of this study was to investigate the clinical outcomes and risk factors responsible for mortality in elderly patients who were diagnosed with a displaced femoral neck fracture and had undergone DMC-THA. Materials and Methods: Out of 147 cases of THA from December 2018 to June 2020, a total of 79 cases were enrolled in this study, with the following characteristics: (1) Garden stage III or IV, (2) over 75 years of age, and (3) over 1 year of follow-up. All the patients received DMC-THA surgery using the anterolateral approach. Results: The mean follow-up period was 15.0±8.43 months and a total of one dislocation case was observed. The mortality rate was 17.7% (14/79), and it was especially higher in patients with a past medical history of malignancy (odds ratio [OR]=7.18, p=0.03) or a cognitive disorder such as dementia (OR=5.48, p=0.03). Preoperative low initial hemoglobin levels (OR=0.65, p=0.04) and low UCLA (Uni-versity of California at Los Angeles) score (OR=0.47, p=0.02) were also associated with mortality. Conclusion When considering THA as a treatment approach in elderly patients with a displaced femoral neck fracture, a high mortality rate is expected in patients with low preoperative hemoglobin levels or a history of malignancy or cognitive disorders. Hence, thorough monitoring and management should be undertaken before and after surgery.

Bisphosphonate is used widely for osteoporosis management. On the other hand, some studies have reported that prolonged use of bisphosphonate without a proper resting period can cause insufficiency fracture and, in rare cases, fractures on the femur neck. This paper reports a case of an elderly patient who suffered bilateral femur neck insufficiency fractures induced by non-stopped long-term bisphosphonate therapy. The patient complained of pain in her buttocks at the first visit. During the admission period, inguinal area pain newly developed. Both a femur neck insufficiency fracture was observed on the hip radiographic image. Hip pinning and postoperative parathyroid hormone treatment were performed. The patient was discharged without specific complications and reported improvement in symptoms on the last follow-up. Several authors have reported one-sided femoral neck insufficiency fractures due to bisphosphonate use, but the present case is uncommon in that it occurred simultaneously in both femur necks. In addition, in the case of bilateral femur fractures, the walking ability after surgery is lower than that of one-sided fracture cases, so active rehabilitation is necessary.

Purpose: This study was performed to compare the clinical results and radiological follow-up differences between intertrochanteric fractures treated with the U-blade Gamma3 nail or the Zimmer natural nail (ZNN). Materials and Methods: The medical records of 129 cases diagnosed with an intertrochanteric frac-ture (90 cases of U-blade Gamma3 nail, 39 cases of ZNN) from July 2015 to December 2018 were reviewed. Patients were assigned to a U-blade Gamma3 nail (n=39) or a ZNN (n=39) group. To reduce selective bias, groups were subjected to Propensity score matching by age, body mass index, bone mineral density, and fracture type. Patients that met the following criteria were excluded; age <65 years, non-ambulatory, high energy or pathologic fracture, and a follow-up of <6 months. Operation times, estimated blood losses, preoperative and postoperative Koval grades, Harris hip score and radiological lag screw positions in the femoral head, reduction quality, cut-out, tip-apex distance (TAD), lag screw sliding distances, and times to union were compared. Results: Clinical results were similar in the two groups, but lag screw TAD was significantly greater in Ublade Gamma3 nail group (23.4 mm vs. 21.0 mm) (p=0.042). One case of cut-out occurred in the Ublade Gamma3 nail group, but no other nail-related postoperative complication was noted. Conclusion No significant difference was observed between the outcomes of U-blade Gamma3 nail or ZNN treatments of intertrochanteric fractures. We conclude that the U-blade confers no specific advan-tage.

Purpose: This study was performed to compare the clinical results and radiological follow-up differences between intertrochanteric fractures treated with the U-blade Gamma3 nail or the Zimmer natural nail (ZNN). Materials and Methods: The medical records of 129 cases diagnosed with an intertrochanteric frac-ture (90 cases of U-blade Gamma3 nail, 39 cases of ZNN) from July 2015 to December 2018 were reviewed. Patients were assigned to a U-blade Gamma3 nail (n=39) or a ZNN (n=39) group. To reduce selective bias, groups were subjected to Propensity score matching by age, body mass index, bone mineral density, and fracture type. Patients that met the following criteria were excluded; age <65 years, non-ambulatory, high energy or pathologic fracture, and a follow-up of <6 months. Operation times, estimated blood losses, preoperative and postoperative Koval grades, Harris hip score and radiological lag screw positions in the femoral head, reduction quality, cut-out, tip-apex distance (TAD), lag screw sliding distances, and times to union were compared. Results: Clinical results were similar in the two groups, but lag screw TAD was significantly greater in Ublade Gamma3 nail group (23.4 mm vs. 21.0 mm) (p=0.042). One case of cut-out occurred in the Ublade Gamma3 nail group, but no other nail-related postoperative complication was noted. Conclusion No significant difference was observed between the outcomes of U-blade Gamma3 nail or ZNN treatments of intertrochanteric fractures. We conclude that the U-blade confers no specific advan-tage.

Conventional endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been reported to be effective therapeutic options in sporadic non-ampullary duodenal tumors, but the rate of perforation is higher than that of other gastrointestinal lesions. Underwater EMR (UW EMR) has been reported to be a safe alternative to conventional EMR and ESD for superficial non-ampullary duodenal adenomas. We reviewed the medical chart and endoscopic report of patients who underwent endoscopic resection between August 2018 and February 2020. A total of 12 duodenal tumors were resected by UW EMR. The mean specimen and lesion sizes were 6.7 mm (2~16 mm) and 5.3 mm (2~10 mm), respectively. Of the 12 lesions, nine (75.0%) were located in the 2nd portion, and three (25.0%) were in the bulb. The mean procedural time was 7.8 minutes (3.2~18.7 minutes). Histologic results showed 10 dysplasia (nine low-grade, one high-grade) and two neuroendocrine tumors. UW EMR showed favorable efficacy and safety within small dysplastic lesions compared to previous studies’ results. Furthermore, it might be considered a treatment option with caution in patients with the duodenal subepithelial tumor within the third layer.

Esophageal abscess caused by acute phlegmonous esophagitis is rare but life-threatening. Rapid abscess drainage is an important part of the treatment, and endoscope-assisted intra-luminal abscess drainage is frequently performed. Although endoscopic drainage is less invasive than surgery, it has the potential to cause esophageal stricture as a complication. We present a rare case of esophageal stricture as a complication of intra-luminal drainage and evaluate a method to minimize the incidence of esophageal stricture complications.

A type III choledochal cyst, known as a choledochocele, is rare. It is defined as cystic dilatation of the distal common bile duct, protruding into the duodenal lumen. Surgical treatment of a choledochocele remains controversial because it has a low incidence for malignancy compared with other choledochal cysts. While there have been few reported cases of choledochocele with malignancy, here we report our experience of a choledochocele with high-grade dysplasia and provide a literature review of the field.
Choledochal Cyst* ; Common Bile Duct ; Dilatation ; Incidence

Hemosuccus pancreaticus is an unusual gastrointestinal hemorrhage through the main pancreatic duct. We report a rare case of hemosuccus pancreaticus due to a simple mucinous cyst of the pancreas. A 52-year-old man who had been followed-up for a suspected branch duct intraductal papillary mucinous neoplasm (IPMN) visited the emergency room due to hematochezia. Endoscopy showed active bleeding from the ampulla. Computed tomography revealed hemorrhage in a 2.0-cm cystic mass in the pancreatic body. The patient was diagnosed with hemosuccus pancreaticus caused by bleeding into the main pancreatic duct from suspected IPMN. Elective laparoscopic distal pancreatectomy was performed. The histopathological diagnosis was a simple mucinous cyst with squamous metaplasia based upon the pathological finding involving the absence of ovarian-type stroma. In conclusion, it should be recognized that a pancreatic cyst including simple mucinous cyst may cause hemosuccus pancreaticus, and these cysts should be viewed as neoplastic and approached similarly as other mucinous pancreatic neoplasms.
Diagnosis ; Emergency Service, Hospital ; Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Metaplasia ; Middle Aged ; Mucins* ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Pancreatic Ducts ; Pancreatic Neoplasms