Use of colorectal stents has increased dramatically over the last decades. Colorectal stents offer an alternative way to relieve fatal intestinal obstruction and can take place of emergency surgery, which associated with significant morbidity and mortality and a high incidence of stoma creation, to elective resection. Although there remain a few concerns regarding the use of stents as a bridge to surgical resection, use of self-expandable metallic stents for palliation in patients with unresectable disease has come to be generally accepted. Advantages of colorectal stents include acute restoration of luminal patency and allowance of time for proper staging and surgical optimization, and the well-known disadvantages are procedure-related complications including perforation, migration, and stent failure. General indications, procedures, and clinical outcomes as well as recent evidences regarding the use of colorectal stents will be discussed in this review.
Colorectal Neoplasms ; Emergencies ; Humans ; Incidence ; Intestinal Obstruction ; Mortality ; Phenobarbital ; Stents*

Over the past century, since the introduction of non steroidal anti-inflammatory drugs (NSAID), antacid, histamine H2-receptor antagonists (H2RA), proton pump inhibitors (PPI), and discovery of Helicobacter pylori infection, the paradigm of peptic ulcer disease has changed with marked decrease in morbidity and mortality. However, peptic ulcer disease still occupies a position as a major health problem with increase of aged population and NSAIDs usage. In daily general practice, the management of peptic ulcer disease is directed according to the presence of bleeding or not. For non-bleeding peptic ulcer disease, proper acid suppression and the correction of underlying causes such as Helicobacter pylori infection and NSAID use is the main stay of treatment. Though a complete understanding of pathophysiology and a perfect treatment strategy are still a challenge, this guideline aims to provide practical recommendations based on evidences or consensus of experts through in-depth literature review and expert meeting.
Antacids/toxicity ; Anti-Inflammatory Agents, Non-Steroidal/toxicity ; Anti-Ulcer Agents/therapeutic use ; Bismuth/therapeutic use ; Helicobacter Infections/diagnosis/drug therapy ; Helicobacter pylori ; Histamine Antagonists/therapeutic use ; Humans ; Peptic Ulcer/*drug therapy ; Proton Pump Inhibitors/therapeutic use

Intimal hyperplasia is the universal response to endothelial denudation and occur after a variety of vascular procedures. In a proportion of cases the smooth muscle cell proliferation may lead to stenosis of the blood vessels. The precise pathophysiologic pathways leading to the development of intimal hyperplasia have not been characterized. This study was undertaken to examine the effect of drugs on the development of proliferative intimal lesion after experimental arterial injury in a rat model. Aortic denudation was performed by balloon catheter in 20 rats. The rats were divided into three group: 1) control group, normal feeding, 2) heparin group, heparin 1200 U/kg/day subcutaneously, 3) ACE inhibitor group, ramipril 10 mg/kg/day subcutaneously. The rat were sacrificed and aortas were perfused and fixed at 21 days after denudation. Microscopic findings were observed and cross sectional intima-to-media ratio were calculated. To evaluate the effects of various drugs on gene expression of aortic smooth muscle cell, semiquantitative reverse transcription polymerase chain reaction(RT-PCR) was done. After reverse transcription, PCR was done to evaluate the change of gene expression in platelet-derived growth factor(PDGF-B), transforming growth factor-beta(TGF-beta). The results were as follows: 1) Normal aorta with intima to media ratio was 0.38+/-0.06. 2) Marked intimal thickening with a mean I-M ratio of 1.35+/-0.45 in the control group. 3) In contrast, the I-M ratio in the heparin group was 0.54+/-0.23, ramipril group was 0.71+/-0.27(P<0.05). 4) mRNA expression of PDGF-B did show significantly increased in control group compared to normal group(0.97+/-0.34 vs 1.60+/-0.21), treatment with heparin and ACE inhibitor shows a tendency to downregulation of mRNA expression to control group(1.04+/-0.31 in heparin group, 1.23+/-0.41 in ACE inhibitor treated group). 5) mRNA expression of TGF-beta was decreased in control group compared to normal group(2.80+/-0.74 vs 1.97+/ 0.24), treatment with heparin and ACE inhibitor shows a tendency to downregulation of mRNA expression to control group(1.36+/-0.40 in heparin group, 1.65+/- 0.45 in ACE inhibitor treated group). In summary, this study shows that repair in even the simplest model of vascular injury is an exceedingly complex, including upregulation of PDGF gene expression. Treatment with heparin and ACE inhibitor revealed a downregulation of each mRAN expression to control group. There results suggest that dysregulation of there gene expression may be involved in the pathogenesis of intimal hyperplasia after endothelial injury.
Animals ; Aorta ; Blood Vessels ; Catheters ; Constriction, Pathologic ; Down-Regulation ; Gene Expression ; Heparin ; Hyperplasia ; Models, Animal ; Myocytes, Smooth Muscle ; Polymerase Chain Reaction ; Ramipril ; Rats ; Reverse Transcription ; RNA, Messenger ; Transforming Growth Factor beta ; Up-Regulation ; Vascular System Injuries

Marginal zone B-cell lymphoma of the gastrointestinal tract most commonly affects the stomach. Endoscopic findings of primary gastrointestinal lymphoma are various and heterogeneous. Lesions may appear as ulcers, erosions, or erythemas. Gastrointestinal lymphomas presenting as multiple polyps on endoscopy are rare. No case of marginal zone B-cell lymphoma manifesting as multiple polyps has been reported on the stomach, although a few cases have been reported in the colon. We present a rare case of a 77-year-old female patient diagnosed as primary gastric marginal zone B-cell lymphoma presenting as multiple polyps. She was fully treated by combination chemotherapy.
Aged ; Colon ; Drug Therapy, Combination ; Endoscopy ; Erythema ; Female ; Gastrointestinal Tract ; Humans ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone ; Polyps ; Stomach ; Ulcer

BACKGROUND: The purpose of this study was to evaluate the association of physical distress and mental health characteristics with the willingness to repeat an esophagogastroduodenoscopic (EGD) examination. METHODS: A questionnaire survey was conducted on 137 patients who had an EGD procedure. The mental health status was evaluated with the Checklist-90-Revision tool, which is based on the Multidimensional Self Report Symptom Inventory. RESULTS: The results were as follows. 1) The elderly and those patients with two or more procedures had a significantly higher willingness to repeat the EGD examination. Those who were willing to repeat the examination had more EGD examinations than those who did not (p<0.05). 2) As for the mental health characteristics, persons with a willingness to repeat the EGD examination showed significantly lower scores on the interpersonal, sensitivity, depression, anxiety, hostility, and paranoid ideation than did those without a willingness. 3) As for the degree of physical distress during the EGD examination, persons with a willingness to repeat the EGD examination had significantly lower scores on the total symptom score and global discomfort score than those without a willingness (p<0.05). 4) The younger patients, under 30, had a significantly lower willingness to repeat the EGD examination than did the elderly patients over 60 (OR=86.03, 95% CI 2.11-999). According to patient occupations, homemakers showed a significantly higher willingness than did others (OR=16.24, 95% CI 1.69-156.23). CONCLUSIONS: The results of this study suggested that a willingness to repeat the EGD examination was closely associated with the mental health characteristics of the patients.
Aged ; Anxiety ; Depression ; Endoscopy, Digestive System ; Hostility ; Humans ; Mental Health ; Occupations ; Self Report ; Surveys and Questionnaires

A 55 year-old man was admitted with epigastric pain of one-month duration. We performed an esophagogastroduodenoscopy that showed the presence of a 3 cm sized polypoid mass at the lesser curvature side of the antrum. A biopsy demonstrated the presence of a neuroendocrine carcinoma of the stomach. A subtotal gastrectomy with D2 lymph node dissection was performed and the microscopic features of the resected specimen confirmed the diagnosis of a composite large cell neuroendocrine carcinoma with an adenocarcinoma of the stomach. A gastric neuroendocrine carcinoma is extremely rare and a composite neuroendocrine carcinoma with an adenocarcinoma of the stomach has been rarely reported. We report a case of a gastric composite tumor with an adenocarcinoma and a large cell neuroendocrine carcinoma.
Adenocarcinoma ; Biopsy ; Carcinoma, Neuroendocrine ; Endoscopy, Digestive System ; Gastrectomy ; Lymph Node Excision ; Stomach

A lipoma, one of the most commonly encountered submucosal tumors in the gastrointestinal tract, usually presents as one or a few lesions. Lipomatous polyposis, which is defined as the presence of multiple lipomas in the intestinal wall, is rare. Here, we report a case of colonic lipomatous polyposis that involved not only the colon, but also the omentum and skeletal muscle. The patient presented with right lower quadrant abdominal pain and was diagnosed using colonoscopy and computed tomography (CT). The abdominal pain caused by omental torsion due to an omental lipoma resolved after conservative treatment without surgical intervention.
Abdominal Pain ; Colon ; Colonoscopy ; Gastrointestinal Tract ; Humans ; Lipoma ; Lipomatosis ; Muscle, Skeletal ; Omentum

Photodynamic therapy is a promising modality for the palliation of advanced upper gastrointestinal cancer and for the eradication of early neoplastic and pre-neoplastic lesions. It is based on the combination of a photosensitizer that is selectively localized in the target tissue and illumination of the lesion with visible light, resulting in photodamage and subsequent cell death. For early esophageal cancer, esophagectomy has been a standard modality of curative intent. However, accumulated data supports the possibility of PDT replacing surgery as a curative modality. We experienced a case of early esophageal cancer that recurred after esophagectomy. The patient was successfully treated with photodynamic therapy using porfimer sodium as a photosensitizer.
Endoscopy, Gastrointestinal ; Esophageal Neoplasms/*drug therapy/pathology/surgery ; *Esophagectomy ; Humans ; Male ; Middle Aged ; *Photochemotherapy ; Photosensitizing Agents/administration & dosage/*therapeutic use

Gastrointestinal melanosis is observed most frequently in the colon it also can develop in the ileum, duodenum and esophagus very rarely. Melanosis ilei was thought that causative materials such as aluminum, magnesium, silicate, titanium and other compounds entered the body through the ingestion of agents. We experienced a case of melanosis in the terminal ileum that a 65-year-old female patient ingested 10 g edible charcoal everyday for 3 years to address symptoms of chronic abdominal pain. In Korea, edible charcoal has been considered to be an effective folk remedy for patients with diarrhea or chronic abdominal pain. In our case, a follow up colonoscopy was performed 3.5 years after the termination of the ingestion of edible charcoal, at which point pigmentation was faded color intensity. In conclusion, it is thought that melanosis ilei is a rare disease by ingestion of causative materials and is discontinuous, local and reversible disease.
Abdominal Pain ; Aged ; Aluminum ; Capsule Endoscopy ; Charcoal ; Colon ; Colonoscopy ; Diarrhea ; Duodenum ; Eating ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Ileum ; Korea ; Magnesium ; Medicine, Traditional ; Melanosis ; Microscopy, Electron ; Pigmentation ; Rare Diseases ; Silicates ; Titanium

PURPOSE: Pancreatic cancer is a devastating disease and the complete resection is difficult due to its the aggressive histologic behavior. Among the possible treatments for the unresectable pancreatic cancer, intraoperative radiation therapy (IORT) has the several advantages. But the impacts of the IORT on survival and local control are not clear. We analyzed the effects of the IORT on pain control, survival duration and local control in patients with unresectable pancreatic cancer. METHODS: We reviewed 6 years of the medical records of 94 patients who had undergone operations involving the pancreatic adenocarcinoma (33 patient IORTs, 39 palliative surgerys only and 22 curative resections involving a curative resection). The clinicopathologic factors and outcomes of the 33 patients treated with the IORT were compared with those of the palliative surgery groups. RESULTS: The age and sex distribution and tumor stage were same for the two groups. The average tumor size in the IORT group was larger than those of the palliative surgery group. The preoperative serum CA19-9 level in the IORT group was higher than the other group. The most common reason for unresectability in the IORT group was local invasion to the adjacent organs including of the great vessels. On the contrary, distant metastasis was a more common cause unresectability in the palliative surgery group. The postoperative complications and operative times were similar in both groups. Pain relief after treatment was observed in 12 cases of the 26 patients in the IORT group, and 5 of 29 patients in the palliative surgery group (P<0.05). The cases of minor and partial remission were more common in the IORT group than the palliative surgery group. However, the survival rate of the IORT group was no better than the palliative surgery group. CONCLUSION: This study suggests that IORT may have an important palliative role especially in ameliorating visceral pain in patients with unresectable pancreatic cancer. However, IORT appears to have no significant effect on overall survival.
Adenocarcinoma ; Humans ; Medical Records ; Neoplasm Metastasis ; Operative Time ; Palliative Care ; Pancreatic Neoplasms* ; Postoperative Complications ; Sex Distribution ; Survival Rate ; Visceral Pain