Subglottic stenosis (SGS) and tracheal stenosis (TS) are rare conditions that can cause significant breathing difficulties and, if not properly managed, may lead to life-threatening complications. Despite their clinical importance, debate continues regarding the optimal management of adult SGS and TS, and no comprehensive guidelines have been established to date. The Korean Bronchoesophagological Society appointed a task force to develop clinical practice guidelines with the goal of providing evidence-based recommendations for managing SGS and TS in adults. The task force conducted a systematic review of the relevant literature by searching PubMed, Embase, and the Cochrane Library using predefined search terms aligned with key clinical questions. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, which also informed the formulation and reporting of the recommendations. The strength of each recommendation reflects the guideline panel’s confidence that the benefits of an intervention outweigh its risks for eligible patients. After drafting the guidelines, feedback was obtained through Delphi questionnaires completed by members of the Korean Bronchoesophagological Society. Ultimately, the committee developed 17 evidence-based recommendations across four categories: initial evaluation, medical management, surgical treatment, and postoperative management and rehabilitation. These guidelines aim to support clinicians in delivering optimal care to adult patients with SGS and TS.

BACKGROUND/AIMS: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. METHODS: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. RESULTS: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group's compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. CONCLUSIONS: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method.
Administration, Oral ; Adult ; Aged ; Colonic Diseases/diagnosis ; Colonoscopy/*methods ; Humans ; Male ; Middle Aged ; Patient Compliance ; Phosphates/*administration & dosage ; Polyethylene Glycols/*administration & dosage ; Questionnaires ; Solutions ; Therapeutic Irrigation

PURPOSE: The diagnosis of hypertrophic pyloric stenosis(HPS) can be made by clinical manifestations and upper gastrointestinal(UGI) series in most cases. Recently, the ultrasonogram(US) is a more accurate and reliable method for the diagnosis of HPS in early stage. METHODS: We retrospectively studied 27 HPS patients confirmed surgically from January 1999 to March 2000. We reviewed clinical histories and physical and laboratory findings. Among these patients, ultrasonograms were carried out in 23 cases preoperatively. Therefore, we analyzed pyloric muscle thickness(PT), pyloric diameters(PD), and pyloric canal lengths(PL), and calculated pyloric volume(PV) by the equation of 'PV=pie(1/2PV)2xPL'. RESULTS: The mean age on admission was 39.0+/-20.4 days and 70.4% of the patients were under 6 weeks of age. The mean age at onset was 26.9+/-20.4 days and the duration of symptoms was 12.7+/-11.6 days. On physical examination, the pyloric tumors were palpated in 14 cases(51.9%) and the gastric peristalses were noted in 8 cases(29.6%). UGI series were carried out in 21 cases, and all of them had the characteristic findings of HPS. The mean PT was 5.23+/-1.05mm, the mean PD wase 13.56+/-2.25mm, the mean PL was 21.42+/-3.85mm, and the calculated PV was 3.23+/-1.35 mL. According to the criteria by Stunden, et al., PT(>=4mm), PD(>=12mm) and PL(>=15mm) were satisfied in 91.3, 73.9 and 91.3% respectively. The PV(>=1.4mL) was satisfied in 95.7% according to the criterion by Westra, et al. CONCLUSION: The US in the diagnosis of HPS is safe and useful. With measurements of PV parameter, the diagnosis by US will be more reliable and more accurate.
Diagnosis ; Humans ; Peristalsis ; Physical Examination ; Pyloric Stenosis, Hypertrophic* ; Retrospective Studies ; Ultrasonography