BACKGROUND/AIMS: Caustic ingestion can cause severe injury to upper gastrointestinal tract. There were few studies about clinical characteristics and treatments of caustic injury in Korea. We investigated the changes in clinical features of caustic injury over the past 20 years including pattern of endoscopic mucosal injury and treatment modality. METHODS: This study was a retrospective review of medical records from patients with caustic injury from September 1993 through December 2012. Patients were classified into two groups based on the year when caustic ingestion occurred: patients who visited the hospital from 1993 to 2002 (early group) and patients who visited the hospital from 2003 to 2012 (late group). RESULTS: A total 140 patients were included (early group [n=50] vs. late group [n=90]). Annual number of caustic ingestions did not show decreasing tendency over the past 20 years. Alkali ingestion increased (20.0% vs. 65.6%, p<0.001) and cases with more than grade 2b of esophageal mucosal injury decreased (41.3% vs. 20.7%, p=0.012) in late group. There were no differences between two groups in sex, age, proportion of accidental ingestion, and systemic/gastrointestinal complications. Use of gastric lavage (p<0.01) and broad spectrum antibiotics (p=0.03) decreased in late group. However, there was no difference in use of steroid between two groups. CONCLUSIONS: In this study, overall caustic ingestion did not decrease and ingestion of alkali agents increased over the past 20 years. Tighter legislation on caustic agents is required and we need to be alert to the best management of caustic injury.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Caustics/*toxicity ; Endoscopy, Digestive System ; Esophageal Diseases/chemically induced/complications/*pathology ; Esophageal Stenosis/complications ; Female ; Gastric Lavage ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies ; Severity of Illness Index ; Tertiary Care Centers ; Young Adult

The prevalence of hospital malnutrition is still high in patients with digestive diseases, especially for those suffering from cancer and bowel diseases which cause malabsorption. It is well known that malnutrition is associated with delayed wound healing, impaired immunity, infection, increased complication, and poor convalenscence. Recently, nutrition screening and assessment by nutrition support team has become essential for nutrition management, and gastroenterologists comprise a dominant member of the nutrition support team. In critically ill patients and older people with chronic disease, nutritional support with enteral feeding and early feeding contributes to recovery and rehabilitation of patients. Securing enteral feeding routes, such as feeding tube insertion and placement of percutaneous endoscopic gastrostomy/jejunostomy, is an essential part of nutrition care that should be accomplished by gastroenterologists without much difficulty. It will also be necessary to recommend nutrition care as one of the clinical routines in gastrointestinal clinical practices. Therefore, education on nutrition care is strongly required as a part of gastroenterologist's training.
Critical Illness ; Digestive System Diseases/*pathology ; Enteral Nutrition ; Humans ; Malnutrition/*prevention & control ; *Nutritional Support

High mobility group box 1 protein (HMGB1), a damage-associated molecular pattern, exists ubiquitously in the cells of mammals. It contributes to maintaining the structure of nucleosome and modulating transcription of gene in nuclei. Extracellular HMGB1 plays two-way roles in promoting inflammatory and tissue repair. Released actively as well as passively following cytokine stimulation during cell death, HMGB1 may act as a late inflammatory factor and an endogenous damage-associated molecular pattern recognized by its receptors. And it may mediate the occurrence, development and outcome of the inflammatory injury of digestive system diseases, such as gastric mucosal injury, inflammatory bowel-disease, liver injury, pancreatitis, and so on. This review mainly concerns the research progresses of HMGB1 in the inflammatory injury of digestive system diseases. At the same time, HMGB1 itself, or as a therapeutic target, can promote tissue repair.
Animals ; Digestive System Diseases ; pathology ; HMGB1 Protein ; metabolism ; Humans ; Inflammation ; pathology

A 53-year-old woman was admitted with epigastric discomfort and weakness. Laboratory examination at admission showed mild anemia and proteinuria. Esophagogastroduodenoscopy revealed marked mucosal atrophy, diffuse nodularity and granular appearance with mucosal friability. Biopsy was performed on the antrum and body of the stomach. On the next day, the patient began to complain of severe dyspnea, and hypoxia was present on pulse oximetry. Therefore, emergency echocardiography was conducted and it showed restrictive cardiomyopathy along with thrombus in the left atrium. With time, heart failure was aggravated despite intensive management. The result of gastric biopsy revealed amyloid deposits which stained positively with Congo red. On immunohistochemistry study, kappa and lambda chain were present. In addition, kappa chain was significantly elevated in urine and serum on electrophoresis. Although the patient was finally diagnosed as having primary gastric amyloidosis with restrictive cardiomyopathy, her general condition rapidly deteriorated and died at 12th hospital day. When obscure gastric lesion is encountered, performing gastric biopsy is strongly recommended since it be primary gastric amyloidosis. Herein, we present an unusual case of primary gastric amyloidosis.
Amyloidosis/complications/*diagnosis/pathology ; Endoscopy, Digestive System ; Female ; Heart Atria/diagnostic imaging ; Heart Failure/complications/*diagnosis ; Humans ; Immunoglobulin kappa-Chains/blood/urine ; Immunoglobulin lambda-Chains/blood/urine ; Immunohistochemistry ; Magnetic Resonance Imaging ; Middle Aged ; Stomach Diseases/complications/*diagnosis/pathology ; Thrombosis/diagnosis/diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography

No abstract available.
Aged ; Biopsy ; Endoscopy, Digestive System ; Female ; Humans ; Hypertension, Portal/*complications ; Polyps/*etiology/pathology ; Stomach Diseases/*etiology/pathology

OBJECTIVE: To assess the safety and efficacy of gastrointestinal anastomosis with nickel titanium shape memory alloy compression anastomosis clip. METHODS: We randomized 51 patients to undergo gastrointestinal anastomosis with stapler (n=25) and nickel titanium compression anastomosis clip (n=26) respectively. The following parameters were recorded to evaluate the safety and efficacy: mean hospitalization time, anastomotic complication, first post-operation flatus and bowel movement, and extrusion of the clip. RESULTS: Anastomotic complications such as leakage, stenosis and obstruction were not observed in both groups. There were no significant differences in the first post-operation flatus time and bowel movement time between the 2 groups (P>0.05). The clip was expelled with stool within 9-15 d. CONCLUSION Compression anastomosis clip is safe and effective.
Anastomosis, Surgical ; instrumentation ; methods ; Anastomotic Leak ; prevention & control ; Digestive System Surgical Procedures ; methods ; Female ; Gastroenterostomy ; instrumentation ; methods ; Gastrointestinal Diseases ; pathology ; surgery ; Humans ; Male ; Nickel ; Surgical Staplers ; Titanium

Behcet's disease (BD) has been recognized as multi-systemic chronic vasculitic disorder of recurrent inflammation, characterized by the involvement of multiple organs and resulting in orogenital ulcers, uveitis, and skin lesions. Involvement of the central nervous system, vessels, and intestines in BD often leads to a poor prognosis. Digestive manifestations in BD have been reported in up to 1-60% of cases, although the rate varies in different countries. The most frequent extra-oral sites of gastrointestinal involvement are the ileocecal region and the colon. Gastric or esophageal involvement is reported to be very rare. Moreover, there have been no reports on the simultaneous involvement of the esophagus, stomach, ileum, and colon. Here, we present a 55-year-old Korean man with intestinal BD and multiple ileal and colonic ulcerations complicated by perforation, gastric ulcer with bleeding followed by perforation, and esophageal ulcers with bleeding.
Behcet Syndrome/complications/*diagnosis/pathology ; Cecal Diseases/complications/pathology ; Diagnosis, Differential ; Endoscopy, Digestive System ; Gastrointestinal Diseases/complications/*diagnosis ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Perforation/*diagnosis/etiology/pathology ; Male ; Middle Aged ; Peptic Ulcer Perforation/pathology ; Stomach Ulcer/complications/pathology

Complications associated with an intramural hematoma of the bowel, is a relatively unusual condition. Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary. Here we describe internal incision and drainage by endoscopy for the treatment of an intramural hematoma of the duodenum. A 63-yr-old woman was admitted to the hospital with hematemesis. The esophagogastroduodenoscopy (EGD) showed active ulcer bleeding at the distal portion of duodenal bulb. A total of 10 mL of 0.2% epinephrine and 2 mL of fibrin glue were injected locally. The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10X5 cm in diameter. Follow-up EGD was performed showing complete luminal obstruction at the second portion of the duodenum caused by an intramural hematoma. The patient's condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife. Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies.
Drainage ; Duodenal Diseases/*diagnosis/pathology/surgery ; Endoscopy, Digestive System ; Female ; Gastrointestinal Hemorrhage/*etiology/therapy ; Hematoma/*diagnosis/pathology/surgery ; Humans ; Intestinal Obstruction/*etiology/therapy ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo establish "an integrative therapy" of drainage and debridement on peripancreatic necrotizing infection (PPNI) with minimally invasive technique, and to detect its clinical effects.

METHODSThere were 17 patients who accepted ultrasound-guided percutaneous tube drainage combined with directly-viewed debridement with cholangioscopy from March 2006 to January 2008. Percutaneous puncture and catheter (6 - 8 F) drainage were adopted on the patients suffering from PPNI with B-us guidance, then the drainage sinus was expanded progressively from 8 F to 24 F in diameter with Cook fascia dilator by degrees, and the 22 F or 24 F tube was easily placed into the interior of PPNI instead of the prior catheter. So a better drainage effect was achieved. One week later, the necrotizing tissue of PPNI could be observed and debrided with choledochoscope under a directly-viewed way through the enlarged new sinus. Thus, with the continuous tube drainage and repeated debridement, the focus was absorbed and covered gradually.

RESULTSSeventeen cases accepted the mini-invasive therapy, 15 cases were saved finally with cure rate of 88.2%, and 2 cases conversion to laparotomy because of some technical reasons. The mean healing time was 73 days, and the mean hospitalization time was 57 days. Bleeding was occurred in 2 cases localized in sinus and the inside of PPNI, digestive tract fistula was detected in 2 cases, and these patients with the complications were cured under nonoperative management. All the patients were still alive with following-up, neither remains nor recurrence of the PPNI was found in our group.

CONCLUSIONSUltrasound-guided percutaneous tube drainage combined with directly-viewed debridement with cholangioscopy, as a mini-invasive therapy, could complete the goal-directed therapy of PPNI, meanwhile, realize the modern surgery ideal of damage control.

Adult ; Aged ; Debridement ; methods ; Drainage ; methods ; Endoscopy, Digestive System ; Female ; Humans ; Infection ; etiology ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Necrosis ; etiology ; surgery ; Pancreatic Diseases ; etiology ; pathology ; surgery ; Pancreatitis, Acute Necrotizing ; complications ; surgery

The diagnostic accuracy of percutaneous transhepatic cholangioscopy (PTCS) was compared to that of three radiologic modalities in distal common bile duct (CBD) strictures for the evaluation of clinical application. Ninety-five patients who underwent PTCS for the evaluation of distal CBD strictures (35 malignant and 60 benign) whose masses were not obvious from radiologic imagings were included. Confirmative diagnosis could not be reached by endoscopic retrograde cholangiopancreatography (ERCP) or radiologic findings in all cases. Specific findings on the computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and direct cholangiography were analyzed among 68 (25 malignant and 43 benign) out of the 95 patients in order to determine the sensitivity and specificity of three radiologic studies for the diagnosis of malignant distal CBD strictures, and to compare those results with those by a combination of PTCS-guided biopsy and tumor vessel observation on cholangioscopy. The sensitivity/specificity of CT, MRCP and direct cholangiography including ERCP in diagnosing malignant distal CBD strictures were 42.9%/65.8%, 53.3%/58.3%, and 70.8%/47.6% respectively, while it was 96%/100% for the combination of PTCS-guided biopsy and tumor vessel. PTCS is a useful method for differential diagnosis of distal CBD strictures, particularly when it is difficult to distinguish benign from malignant strictures by radiologic studies and when peroral approach is not feasible.
Aged ; Biopsy ; Cholangiopancreatography, Magnetic Resonance ; Common Bile Duct Diseases/*diagnosis/pathology ; Common Bile Duct Neoplasms/*diagnosis/pathology ; Constriction, Pathologic ; Endoscopy, Digestive System/*methods ; Endosonography ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity