There has been a sharp increase in the number of obese people worldwide thanks to modern prosperity in accordance with rapid industrialization and economic development. Recently, bariatric surgery has been applied actively to extremely obese patients (BMI>35 kg/m2) and presented as an alternative solution to provide not only weight loss but also a treatment for metabolic diseases such as diabetes mellitus, hypertension, and hyperlipidemia. Gastroesophageal reflux disease (GERD) is one of the most important diseases in morbidly obese patients, and many patients suffer from symptoms like epigastric pain, regurgitation, and dry cough. However, such symptoms are easy to be overlooked and studies on GERD are scarce in relation to bariatric surgery. In morbidly obese patients, high abdominal pressure leads to a pressure gradient between esophagus and stomach. This induces a hiatal hernia causing a greater likelihood of GERD. Many studies in regards to GERD were made after bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass, and gastric band), and various results have been presented. Studies should be carried out on pre-operative diagnosis of GERD, choice of operative method, and improvement of symptoms after the operation. Research is also needed upon bariatric operation in patients with uncontrolled GERD.
Bariatric Surgery ; Cough ; Diabetes Mellitus ; Diagnosis ; Economic Development ; Esophagus ; Gastrectomy ; Gastric Bypass ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Hyperlipidemias ; Hypertension ; Metabolic Diseases ; Methods ; Obesity, Morbid* ; Stomach ; Weight Loss

Ruptured pheochromocytoma is a rare disease. Its mortality rate is up to 31%–50%. Proper management of ruptured pheochromocytoma remains unclear. A 44-year-old male patient visited our Emergency Department and presented with abrupt onset of left flank pain. His blood pressure was 190/140 mmHg with purse rate of 130 beats/min. CT scan showed 8.1 × 5.6-cm-sized heterogeneously mass with rupture on the left retroperitoneal space and active bleeding. His symptom of abdominal pain was aggravated. Follow-up laboratory analysis revealed elevated WBC count and decreased hemoglobin 2 hours after admission. Emergency laparotomy was performed. We resected the ruptured left retroperitoneal mass and hemostasis. Pathologic exams revealed adrenal pheochromocytoma with rupture. Although our patient was alive, according to literature review, mortality rate of emergency operation without medical management is higher than elective operation after blood pressure control with either medical or interventional methods such as transcatheter arterial embolization.
Abdominal Pain ; Adult ; Blood Pressure ; Emergencies ; Emergency Service, Hospital ; Flank Pain ; Follow-Up Studies ; Hemorrhage ; Hemostasis ; Humans ; Laparotomy ; Male ; Mortality ; Pheochromocytoma* ; Rare Diseases ; Retroperitoneal Space ; Rupture ; Rupture, Spontaneous ; Tomography, X-Ray Computed

Inflammation is closely related to the progression of cancer as well as tumorigenesis. Here, we investigated the effect of prostaglandin E2 (PGE2) and interleukin-1beta (IL-1beta) on E-cadherin expression in SNU719 gastric cancer cells. E-cadherin expression decreased as the dose or exposure time of PGE2 and IL-1beta increased, whereas Snail expression increased with dose or time of PGE2 and IL-1beta. E-cadherin expression reduced by PGE2 treatment increased after the transfection of Snail siRNA. Neutralization of IL-1beta using anti-IL-1beta antibody blocked the expression pattern of E-cadherin and Snail occurred by IL-1beta treatment. However, there was no synergic effect of IL-1beta and PGE2 on the expression pattern of E-cadherin and Snail. In conclusion, inflammatory mediators reduced E-cadherin expression by enhancing Snail expression in gastric cancer cells. Inflammation-induced transcriptional regulation of E-cadherin in gastric cancer has implications for targeted chemoprevention and therapy.
Antibodies/immunology ; Antineoplastic Agents/pharmacology ; Cadherins/*metabolism ; Cell Line, Tumor ; Dinoprostone/*pharmacology ; Gene Expression Regulation/*drug effects ; Humans ; Interleukin-1beta/immunology/*pharmacology ; RNA Interference ; RNA, Small Interfering/metabolism ; Stomach Neoplasms/metabolism/pathology ; Transcription Factors/antagonists & inhibitors/genetics/*metabolism

PURPOSE: Peptic ulcer disease (PUD) remains one of the most prevalent gastrointestinal diseases and an important target for surgical treatment. Laparoscopy applies to most surgical procedures; however its use in elective peptic ulcer surgery, particularly in cases of pyloric stenosis, has not been popular. The aim of this study was to describe the role of laparoscopic surgery and an easily performed procedure for pyloric stenosis. We accordingly performed laparoscopic truncal vagotomy with gastrojejunostomy in 10 consecutive patients with pyloric stenosis. METHODS: Data were collected prospectively from all patients who underwent laparoscopic truncal vagotomy with gastrojejunostomy from August 2009 to May 2014 and reviewed retrospectively. RESULTS: A total of 10 patients underwent laparoscopic trucal vagotomy with gastrojejunostomy for peptic ulcer obstruction from August 2009 to May 2014 in oo university hospital. The mean age was 62.6 (+/-16.4) years old and mean BMI was 19.3 (+/-2.5) kg/m2. There were no conversions to open surgery and no occurrence of intra-operative complications. The mean operation time was 107 (90~130) minutes and blood loss was < 20 ml. Oral feeding was permitted for most patients on day 3 post operatively after upper gastrointestinal series to confirm no leakage or passage disturbance. The mean hospital stay was 7.3 days, the mean follow up duration was 19.8 (+/-17.2) months, and there was no mortality related to the operation. CONCLUSION: Laparoscopic truncal vagotomy and gastrojejunostomy was a good, easily performed surgical choice for patients with duodenal ulcer stricture.
Constriction, Pathologic ; Duodenal Ulcer ; Follow-Up Studies ; Gastric Bypass ; Gastroenterostomy ; Gastrointestinal Diseases ; Humans ; Laparoscopy ; Length of Stay ; Mortality ; Peptic Ulcer ; Prospective Studies ; Pyloric Stenosis* ; Retrospective Studies ; Vagotomy ; Vagotomy, Truncal*

PURPOSE: Recently, the number of laparoscopic gastric surgeries increased in Korea. But since many patients prefer to attend larger hospitals, most operations have been performed in high volume center by experienced surgeons, and also most reported studies on laparoscopic gastric surgery have been performed in these hospitals. For better health service and increased access of local residents, district hospitals that have a smaller number of surgical cases also need to perform this surgery safely. METHODS: We retrospectively analyzed 58 patients who underwent laparoscopic assisted distal gastrectomy (LADG) from April 2009 to January 2012 in Dankook University Hospital. We compared our data with the retrospective data of the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) group because we thought the KLASS study was a representative study of LADG. RESULTS: A total of 58 patients underwent LADG during a period of 32 months. The male to female ratio, mean age and body mass index were 34:19, 62.4 years and 23.0 kg/m2, respectively. More than D1 + beta lymph node was dissected in all patients and the mean number of harvested lymph nodes was 31.4. Mean operation time, estimated blood loss and mean hospital stays were 235 minutes, 176 mL and 7.4 days respectively. During the operation, there were no complication and no conversions to open surgery. After the operation, there were 2 cases of wound complication and 1 case of intra-abdominal abscess which improved with conservative treatment and there was no mortality. These data were not different to the data of high volume centers, especially KLASS. CONCLUSION: We report first experience with LADG and concluded that LADG could be performed safely in smaller scale hospitals.
Abdominal Abscess ; Body Mass Index ; Female ; Gastrectomy ; Health Services ; Hospitals, District ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Male ; Retrospective Studies ; Stomach Neoplasms

Gastrojejunocolic fistula is a rare condition after gastrojejunostomy. It is severe complications of gastrojejunostomy, which results an inadequate resection or incomplete vagotomy during peptic ulcer surgery. The symptoms are diarrhea, upper abdominal pain, bleeding, vomiting and weight loss. A 55-year-old man with chronic diarrhea and weight loss for 6 months visited Dankook University Hospital. The patient had received a truncal vagotomy and gastrojejunostomy for duodenal ulcer obstruction 15 years previously. The patient underwent gastroscopy and upper gastrointestinal series evaluations, which detected the gastrojejunocolic fistula. After improving of malnutrition, an exploratory laparotomy was undertaken, which revealed that the gastrojejunostomy site and the T-colon formed adhesion and fistula. En block resection of the distal stomach and T-colon included the gastrojejunocolic fistula, and Roux-en-Y gastrojejunostomy was performed. Recovery was uneventful and the patient remained well at the follow-up. We report a gastrojejunocolic fistula, which is a rare case after gastrojejunostomy.
Abdominal Pain ; Diarrhea ; Duodenal Ulcer ; Fistula ; Follow-Up Studies ; Gastric Bypass ; Gastroscopy ; Hemorrhage ; Humans ; Laparotomy ; Malnutrition ; Peptic Ulcer ; Stomach ; Vagotomy ; Vagotomy, Truncal ; Vomiting ; Weight Loss

Purpose: This study aimed to compare treatment options and outcomes based on peritoneal cancer index (PCI) among patients with peritoneal metastasis (PM) of advanced gastric cancer (AGC). Methods: Between January 2016 and July 2019, clinicopathological data of patients with AGC diagnosed with PM were reviewed. Different treatment methods were performed according to the PCI score: (1) group A (PCI ≤ 13) received cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with postoperative intraperitoneal (IP) and systemic chemotherapy (n = 29), while (2) group B (PCI > 13) received IP chemotherapy with systemic chemotherapy (n = 22). Results: Clinical outcomes of 51 patients at the Dankook University Hospital were reviewed. Group A had a significantly lower mean PCI score (9.8 ± 6.9 vs. 32.6 ± 7.1, P < 0.01) than group B, with 25 patients (86.2%) achieving complete cytoreduction. Complications occurred in 16 patients (31.4%), none of who suffered mortality (group A: 11 patients, 37.9% vs. group B: 5 patients, 22.7%; P = 0.25). Among the morbidity, 5 cases (17.2%) and 2 cases (9.1%) exhibited a Clavien-Dindo grade greater than III in groups A and B, respectively (P = 0.04). Groups A and B had an overall median survival time of 34.0 and 16.0 months, respectively (P = 0.03). Conclusion Patients with PM of AGC received different treatments according to their PCI score. When accompanied with careful patient selection, our approach may be considered an acceptable option for the treatment of PM of AGC.

Purpose: This study aimed to compare treatment options and outcomes based on peritoneal cancer index (PCI) among patients with peritoneal metastasis (PM) of advanced gastric cancer (AGC). Methods: Between January 2016 and July 2019, clinicopathological data of patients with AGC diagnosed with PM were reviewed. Different treatment methods were performed according to the PCI score: (1) group A (PCI ≤ 13) received cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with postoperative intraperitoneal (IP) and systemic chemotherapy (n = 29), while (2) group B (PCI > 13) received IP chemotherapy with systemic chemotherapy (n = 22). Results: Clinical outcomes of 51 patients at the Dankook University Hospital were reviewed. Group A had a significantly lower mean PCI score (9.8 ± 6.9 vs. 32.6 ± 7.1, P < 0.01) than group B, with 25 patients (86.2%) achieving complete cytoreduction. Complications occurred in 16 patients (31.4%), none of who suffered mortality (group A: 11 patients, 37.9% vs. group B: 5 patients, 22.7%; P = 0.25). Among the morbidity, 5 cases (17.2%) and 2 cases (9.1%) exhibited a Clavien-Dindo grade greater than III in groups A and B, respectively (P = 0.04). Groups A and B had an overall median survival time of 34.0 and 16.0 months, respectively (P = 0.03). Conclusion Patients with PM of AGC received different treatments according to their PCI score. When accompanied with careful patient selection, our approach may be considered an acceptable option for the treatment of PM of AGC.

The nutritional support of acutely ill patients is very important and early enteral nutrition is recommended. Feeding via the nasogastric route is used widely for its ease of access if the patient cannot maintain volitional food intake. If the position of the tip or side holes of the nasogastric tube (NGT) is above the gastroesophageal junction, there is the possibility of retention and solidification of the administered enteral feeding formula in the esophagus. Therefore, the tip of the NGT should be checked carefully; a chest radiograph to confirm its position can be considered, especially in patients with a higher risk of aspiration and gastroesophageal reflux. In addition, careful consideration of the risk factors that can trigger esophageal obstruction is required when feeding patients in the intensive care unit. This paper describes two unusual cases of esophageal obstruction caused by the solidification of residue of an enteral feeding formula.
Eating ; Enteral Nutrition* ; Esophagogastric Junction ; Esophagus ; Gastroesophageal Reflux ; Humans ; Intensive Care Units ; Nutritional Support ; Radiography, Thoracic ; Risk Factors

A case report described a 72-year-old man with a history of a deceased-donor liver transplantation (due to hepatitis B-associated end-stage liver cirrhosis) performed in 1994. The patient was diagnosed with renal cell carcinoma and pulmonary metastasis in 1997 and was successfully treated with radiofrequency ablation and thoracoscopic superior segmentectomy. There was no evidence of newly diagnosed metastatic lesions or recurrence until the 19th post-operative month. Gastric cancer was identified by endoscopy during a routine follow-up examination; the pre-pyloric antral lesion measured 1.5 cm in size and was histologically well-differentiated and confined to the submucosal layers on endoscopic ultrasound. Laparoscopic gastrectomy and lymph node dissection (D1 + beta) was successfully performed in March 2009, and the patient was discharged on the 5th post-operative day without complications. This suggests that laparoscopic surgery is one of the feasible methods for resection of gastric cancer in liver transplant patients.
Aged ; Carbamates ; Carcinoma, Renal Cell ; Endoscopy ; Follow-Up Studies ; Gastrectomy ; Hepatitis ; Humans ; Laparoscopy ; Liver ; Liver Transplantation ; Lymph Node Excision ; Mastectomy, Segmental ; Neoplasm Metastasis ; Organometallic Compounds ; Recurrence ; Stomach Neoplasms ; Transplants