Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

BACKGROUND/AIMS: Rebleeding is associated with mortality in patients with peptic ulcer bleeding (PUB), and risk stratification is important for the management of these patients. The purpose of our study was to examine the risk factors associated with rebleeding in patients with PUB. METHODS: The Korean Peptic Ulcer Bleeding registry is a large prospectively collected database of patients with PUB who were hospitalized between 2014 and 2015 at 28 medical centers in Korea. We examined the basic characteristics and clinical outcomes of patients in this registry. Univariate and multivariate analyses were performed to identify the factors associated with rebleeding. RESULTS: In total, 904 patients with PUB were registered, and 897 patients were analyzed. Rebleeding occurred in 7.1% of the patients (64), and the 30-day mortality was 1.0% (nine patients). According to the multivariate analysis, the risk factors for rebleeding were the presence of co-morbidities, use of multiple drugs, albumin levels, and hematemesis/hematochezia as initial presentations. CONCLUSIONS: The presence of co-morbidities, use of multiple drugs, albumin levels, and initial presentations with hematemesis/hematochezia can be indicators of rebleeding in patients with PUB. The wide use of proton pump inhibitors and prompt endoscopic interventions may explain the low incidence of rebleeding and low mortality rates in Korea.
Hemorrhage* ; Humans ; Incidence ; Korea ; Mortality ; Multivariate Analysis ; Peptic Ulcer Hemorrhage ; Peptic Ulcer* ; Prospective Studies ; Proton Pump Inhibitors ; Risk Factors

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
Advisory Committees ; Consensus ; Counseling ; Drug Therapy ; Glottis ; Humans ; Laryngeal Neoplasms* ; Neck*

BACKGROUND/AIMS: The incidence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study was to evaluate the relationship between GERD symptoms and dietary factors in Korea. METHODS: From January 2007 to April 2008, 162 subjects were enrolled (81 in GERD group and 81 in control group). They were asked to complete the questionnaires about GERD symptoms and dietary habits. The symptom severity score was recorded by visual analogue scale. RESULTS: Subjects with overweight or obesity had an increased risk for GERD (OR, 2.52; 95% CI, 1.18-5.39). Irregular dietary intake was one of the risk factors for GERD (OR, 2.33; 95% CI, 1.11-4.89). Acid regurgitation was the most suffering (2.85 +/- 2.95 by visual analogue scale) and frequent reflux-related symptom (57.5%) in GERD. Noodles (OR, 1.22; 95% CI, 1.12-1.34), spicy foods (OR, 1.09; 95% CI, 1.02-1.16), fatty meals (OR, 1.20; 95% CI, 1.09-1.33), sweets (OR, 1.42; 95% CI, 1.00-2.02), alcohol (OR, 1.16; 95% CI, 1.03-1.31), breads (OR, 1.17; 95% CI, 1.01-1.34), carbonated drinks (OR, 1.69; 95% CI, 1.04-2.74) and caffeinated drinks (OR,1.41; 95% CI, 1.15-1.73) were associated with symptom aggravation in GERD. Among the investigated noodles, ramen (instant noodle) caused reflux-related symptoms most frequently (52.4%). CONCLUSIONS: We found that noodles, spicy foods, fatty meals, sweets, alcohol, breads, carbonated drinks and caffeinated drinks were associated with reflux-related symptoms.
Bread ; Carbonated Beverages ; Diet ; Food Habits ; Gastroesophageal Reflux ; Incidence ; Korea ; Meals ; Obesity ; Overweight ; Surveys and Questionnaires ; Risk Factors ; Stress, Psychological

PURPOSE: A retrorectal developmental cyst (tailgut cyst, epidermoid cyst, dermoid cyst, teratoma, and duplication) is very rare disease, and the symptoms are not characteristic so that sometimes this disease is still misdiagnosed as a supralevator abscess or a complex anal fistula. We would like to present a clinical approach to this disease. METHODS: We retrospectively examined the charts of 15 patients who were treated for retrorectal cysts from January 2001 to November 2009. RESULTS: All 15 patients were female. The average age was 41 years (range, 21 to 60 years). Fourteen patients (93.3%) were symptomatic, and the most common symptom was anal pain or discomfort. Nine patients (60%) had more than one previous operation (range, 1 to 9 times) for a supralevator abscess, an anal fistula, etc. In 12 patients (80%), the diagnosis could be made by using the medical history and physical examination. Thirteen cysts (80%) were excised completely through the posterior approach. The average diameter of the cysts was 4.8 cm (range, 2 to 10 cm). Pathologic diagnoses were 8 tailgut cysts (53.3%), 5 epidermoid cysts (33.3%) and 2 dermoid cysts (13.3%). The average follow-up period was 18.3 months (range, 1 to 64 months). CONCLUSION: In our experience, high suspicion and physical examination are the most important diagnostic methods. If a female patient has a history of multiple perianal operations, a retrorectal bulging soft mass, a posterior anal dimple, and no conventional creamy foul odorous pus in drainage, the possibility of a retrorectal developmental cyst must be considered.
Abscess ; Adult ; Dermoid Cyst ; Drainage ; Epidermal Cyst ; Female ; Follow-Up Studies ; Humans ; Odors ; Physical Examination ; Rare Diseases ; Rectal Fistula ; Retrospective Studies ; Suppuration ; Teratoma

BACKGROUND/AIMS: Only a few reports have examined informed consent for gastrointestinal endoscopy in Korea. The aim of this study was to evaluate the appropriateness of the informed consent procedure in Korea. METHODS: A total of 209 patients who underwent endoscopy were asked to answer a self-administered structured questionnaire on the informed consent procedure for gastrointestinal endoscopy. RESULTS: One hundred thirteen patients completed questionnaires and were enrolled. In the survey, 91.2% answered that they understood the procedure, and the degree of understanding decreased with age; 85.8% were informed of the risks of the procedure, and the proportion was higher for inpatients and for those receiving therapeutic endoscopy or endoscopic retrograde cholangiopancreatography; 60.2% were informed of alternative methods, and the proportion was higher in older patients; 76.1% had the opportunity to ask questions during the informed consent procedure, and the proportion was higher in inpatients. The understanding of the risks of the endoscopic procedure was better in the younger and more highly educated groups. About 80% had sedation before endoscopy, and only 56% were informed of the risks of sedation during endoscopy. CONCLUSIONS: The current informed consent process may be reasonably acceptable and understandable to the patients. However, the understanding of the risks of endoscopy was insufficient especially in the cases of older, poorly educated patients and outpatients. The information about alternatives, the opportunity to ask for additional information, and the information about the risks of sedation during endoscopy were also insufficient in the current consent process.
Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Conscious Sedation ; *Endoscopy, Gastrointestinal ; Female ; Humans ; Informed Consent/*psychology/*standards ; Male ; Middle Aged ; Multivariate Analysis ; Patient Education as Topic/*standards ; *Patient Satisfaction ; Questionnaires ; Republic of Korea ; Risk Factors

An esophageal foreign body has clinical significance because it may cause serious complications such as esophageal perforation, mediastinitis and/or aorto-esophageal fistula. A prompt attempt to remove an esophageal foreign body via flexible endoscopy should be made when the shape of the foreign body is especially sharp and long as it can easily lead to esophageal perforation. We report here on a case of endoscopic removal of an impacted esophageal foreign body, a fishhook, that hade been present in the esophagus for two months, and there were no serious complications from the procedure.
Endoscopy ; Epoxy Compounds ; Esophageal Perforation ; Esophagus ; Fistula ; Foreign Bodies ; Hydroxybenzoate Ethers ; Mediastinitis

Bezoars are the most common foreign bodies in the stomach as seen endoscopically with a frequency of approximately 0.4%. They consist of persistent concretions or hard accumulations of non-digestible vegetable matter, hair or more unusual materials. Gastric bezoars develop in patients with previous gastric surgery, gastric outlet obstruction, or poor gastric emptying such as gastroparesis due to hypothyroidism, diabetes mellitus or mixed connective tissue disease. The clinical presentations of gastric bezoars include epigastric pain, a palpable mass, a gastrointestinal obstruction and peptic ulceration. The treatment options include surgery, enzymatic dissolution or endoscopic mechanical fragmentation and/or removal. Recently, the efficacy of the administration or lavage of 'Coca-Cola' for the effective dissolution of gastric bezoars has been reported. We report a case of a 27-year-old woman with a large gastric bezoar that was successfully removed by the direct endoscopic injection of a carbonated beverage ('Coca-Cola light', a sugar free product; Coca cola Co., Seoul, South Korea) into the bezoar, which led to fragmentatio
Adult ; Bezoars* ; Carbonated Beverages ; Coca ; Cola ; Diabetes Mellitus ; Endoscopy ; Female ; Foreign Bodies ; Gastric Emptying ; Gastric Outlet Obstruction ; Gastroparesis ; Hair ; Humans ; Hypothyroidism ; Mixed Connective Tissue Disease ; Peptic Ulcer ; Seoul ; Stomach ; Therapeutic Irrigation ; Vegetables

BACKGROUND: To determine the benefits of laparoscopic surgery compared with exploration, the clinical outcomes of open and laparoscopic distal pancreatectomy were compared. METHOD: From March 2005 to June2007, we studied 95 patients at Asan Medical Center. These patients had benign pancreatic disease in the distal pancreas, e.g. a cystic neoplasm. These patients underwent a distal pancreatectomy with or without spleen-preservation using laparoscopic or exploration surgery. We divided these patients into two groups i.e. laparoscopy (n=60) and exploration (n=35), and compared the outcomes of the two groups retrospectively. RESULT: There was no difference in demographic features between the two groups. Laparoscopic resection required a median time of 208 mins, compared with 190 mins for the open resection. (p>0.05) The laparoscopic patients started a liquiddiet on postoperative day three, and required a median hospital stay of 11 days, compared with 4.5 days and 16 days for the open resection surgery, respectively. (p<0.001) The overall postoperative complication rate was 28.3% for the laparoscopic group compared with 22.9% for the open group. (p>0.05) The pancreatic fistula rate was lower in the laparoscopic patient group than in the open group. (8.3% vs. 14.3%) (p>0.05) The rate of spleen-preservation was higher in the laparoscopy group than the open group. (25% vs. 5.7%), (p>0.05) CONCLUSION: The results of this study showed that the laparoscopic distal pancreatectomy had a similar surgical time, an early start of the diet, a shorter hospital stay, and a higher spleensaving rate, compared to exploration surgery. Therefore, considering the benefits of laparoscopic surgery, it appears to be the preferred approach, with or without spleen-preservation, for treating benign distal pancreatic disease.
Chungcheongnam-do ; Diet ; Humans ; Laparoscopy* ; Length of Stay ; Operative Time ; Pancreas ; Pancreatectomy* ; Pancreatic Diseases ; Pancreatic Fistula ; Postoperative Complications ; Retrospective Studies

BACKGROUND/AIMS: A diagnosis of gastroesophageal reflux disease (GERD) is based on the typical symptoms, such as acid regurgitation and heartburn. However, there is a very high inter-observer variation in the evaluation of GERD patients. METHODS: The endoscopic images of forty-two cases with reflux symptoms (2 still images and 15-second video images per case) were analyzed by 18 experienced endoscopists and 22 trainees. The findings were classified into the following: (1) 6 groups (modified LA classification: 4 LA groups, minimal, and normal), (2) erosinve and non-erosive, and (3) confluent erosive and others. The level of inter-observer variation is expressed as a kappa value. RESULTS: The level of inter-observer agreement of the 18 experienced endoscopists for classifying the patients into 6 groups was fairly low (kappa=0.364). However, when the findings were classified into the 2 groups suggested in the Genval workshop (NERD, A, or B versus C or D), the level of inter- observer agreement increased substantially (kappa=0.710). The kappa value of the 22 trainees for classifying the patients into 6 groups was 0.402. CONCLUSIONS: Modified LA classification with minimal change lesions showed a fairly low level of agreement. The problem caused by inter-observer variations decreased significantly when the findings were classified into two groups.
Classification ; Diagnosis* ; Education ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Observer Variation*