BACKGROUND: Malnutrition is associated with many adverse clinical outcomes. The present study aimed to identify the prevalence of malnutrition in hospitalized patients in Korea, evaluate the association between malnutrition and clinical outcomes, and ascertain the risk factors of malnutrition. METHODS: A multicenter cross-sectional study was performed with 300 patients recruited from among the patients admitted in 25 hospitals on January 6, 2014. Nutritional status was assessed by using the Subjective Global Assessment (SGA). Demographic characteristics and underlying diseases were compared according to nutritional status. Logistic regression analysis was performed to identify the risk factors of malnutrition. Clinical outcomes such as rate of admission in intensive care units, length of hospital stay, and survival rate were evaluated. RESULTS: The prevalence of malnutrition in the hospitalized patients was 22.0%. Old age (≥ 70 years), admission for medical treatment or diagnostic work-up, and underlying pulmonary or oncological disease were associated with malnutrition. Old age and admission for medical treatment or diagnostic work-up were identified to be risk factors of malnutrition in the multivariate analysis. Patients with malnutrition had longer hospital stay (SGA A = 7.63 ± 6.03 days, B = 9.02 ± 9.96 days, and C = 12.18 ± 7.24 days, P = 0.018) and lower 90-day survival rate (SGA A = 97.9%, B = 90.7%, and C = 58.3%, P < 0.001). CONCLUSION: Malnutrition was common in hospitalized patients, and resulted in longer hospitalization and associated lower survival rate. The rate of malnutrition tended to be higher when the patient was older than 70 years old or hospitalized for medical treatment or diagnostic work-up compared to elective surgery.
Cross-Sectional Studies ; Hospitalization ; Humans ; Intensive Care Units ; Korea ; Length of Stay ; Logistic Models ; Malnutrition ; Multivariate Analysis ; Nutrition Assessment ; Nutritional Status ; Prevalence ; Risk Factors ; Survival Rate

BACKGROUND/AIMS: Determining the depth of tumor invasion and the presence of regional lymph node metastasis is important in deciding therapeutic strategies. We aimed to evaluate the diagnostic accuracy of EUS in detecting the depth of tumor invasion and regional lymph node metastasis. MATERIALS AND METHODS: A total of 141 consecutive patients underwent preoperative evaluation using EUS, CT, and PET CT from November 2005 to June 2009 in Pusan National University Hospital. We reviewed the patients' medical records and compared EUS and pathologic findings. RESULTS: A total of 59 patients were included in the final analysis. The overall accuracy of EUS in predicting the correct T stage was 79.7% (95% CI, 66.8~88.6%). EUS accurately predicted T stage in 93.2% (95% CI, 82.7~97.8%) of T1 tumors, 79.7% (95% CI, 66.8~88.6%) of T2 tumors, and 86.4% (95% CI, 74.5~93.6%) of T3 tumors. Overall, EUS accurately predicted N stage in 83.1% of cases. EUS correctly predicted N stage in 91.4% of N0 tumors and 70.8% of N1 tumors. CONCLUSIONS: Overall accuracy of EUS for the T and N staging of esophageal cancer was high. Thus, EUS is a useful diagnostic modality in determining the initial stage of esophageal cancer.
Busan ; Diagnosis ; Endosonography* ; Esophageal Neoplasms* ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis

BACKGROUND/AIMS: Knowledge of the risk factors associated with adverse outcomes after percutaneous endoscopic gastrostomy (PEG) may be helpful for developing PEG recommendations. The purpose of this study was to identify the clinical risk factors associated with adverse clinical outcomes after PEG, especially regarding the use of proton pump inhibitors (PPIs). METHODS: We retrospectively reviewed the data from PEG patients at seven university hospitals between June 2006 and January 2012. All patients were followed up through February 2012 after PEG, and the clinical risk factors for adverse clinical outcomes after PEG were analyzed. RESULTS: Data from 1,021 PEG patients were analyzed. PPI users were more frequently included in the complication group than the noncomplication group (p=0.040). PEG-related complications (p=0.040) and mortality (p=0.003) were more frequent in the PPI group than in the control group. In the subgroup analysis of complicated PEG cases, infectious complications were more frequently found in the PPI group than in the control group (35.8% vs 27.8%). After adjustment for multiple possible confounding factors, PPI users (odds ratio, 1.531; 95% confidence interval, 1.017 to 2.305) and diabetic patients had increased mortality after PEG. CONCLUSIONS: PPI use may be associated with adverse outcomes in patients with PEG; however, further prospective studies investigating this issue are warranted.
Aged ; Case-Control Studies ; Enteral Nutrition/adverse effects/mortality ; Female ; Gastroscopy/*adverse effects/mortality ; Gastrostomy/*adverse effects/mortality ; Humans ; Male ; Prognosis ; Proton Pump Inhibitors/*adverse effects ; Republic of Korea ; Retrospective Studies ; Risk Factors

Gastric hepatoid adenocarcinoma is a special type of gastric carcinoma, which produces AFP. We report a case of an metastatic gastric hepatoid adenocarcinoma mistaken for primary hepatocellular carcinoma (HCC). A 72 year-old woman was transferred to our hospital for treatment of the hepatic mass. She underwent subtotal gastrectomy for gastric cancer 2 years ago. A year ago, she was diagnosed with hepatic mass and treated with transhepatic chemoembolization under the suspicion of primary HCC in other hospital. The hepatic mass looked like primary HCC on CT, and serum AFP was elevated to 18,735 IU/mL. We did the transhepatic mass biopsy and compared it to the histology of the previous gastric cancer. The results of immunohistochemical staining between them was coincident, and so it was diagnosed as a hepatic metastasis of gastric hepatoid adenocarcinoma.
Adenocarcinoma/*diagnosis/pathology/surgery ; Aged ; Carcinoma, Hepatocellular/*diagnosis/therapy ; Embolization, Therapeutic ; Endoscopy, Gastrointestinal ; Homeodomain Proteins/metabolism ; Humans ; Keratin-20/metabolism ; Keratin-7/metabolism ; Liver Neoplasms/diagnosis/*secondary/therapy ; Male ; Stomach Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed ; alpha-Fetoproteins/analysis

Gastric hepatoid adenocarcinoma is a special type of gastric carcinoma, which produces AFP. We report a case of an metastatic gastric hepatoid adenocarcinoma mistaken for primary hepatocellular carcinoma (HCC). A 72 year-old woman was transferred to our hospital for treatment of the hepatic mass. She underwent subtotal gastrectomy for gastric cancer 2 years ago. A year ago, she was diagnosed with hepatic mass and treated with transhepatic chemoembolization under the suspicion of primary HCC in other hospital. The hepatic mass looked like primary HCC on CT, and serum AFP was elevated to 18,735 IU/mL. We did the transhepatic mass biopsy and compared it to the histology of the previous gastric cancer. The results of immunohistochemical staining between them was coincident, and so it was diagnosed as a hepatic metastasis of gastric hepatoid adenocarcinoma.
Adenocarcinoma/*diagnosis/pathology/surgery ; Aged ; Carcinoma, Hepatocellular/*diagnosis/therapy ; Embolization, Therapeutic ; Endoscopy, Gastrointestinal ; Homeodomain Proteins/metabolism ; Humans ; Keratin-20/metabolism ; Keratin-7/metabolism ; Liver Neoplasms/diagnosis/*secondary/therapy ; Male ; Stomach Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed ; alpha-Fetoproteins/analysis

Menetrier's disease is a rare entity characterized by large, tortuous gastric mucosal folds. The mucosal folds in Menetrier's disease are often most prominent in the body and fundus. Histologically, massive foveolar hyperplasia (hyperplasia of surface and glandular mucous cells) is noted, which replaces most of the chief and parietal cells. Profuse mucus is usually observed during the endoscopy but there have been few cases that show interesting endoscopic findings such as mucus bridge or water pearl. Herein, we report a case of Menetrier's disease showing mucus bridge by excessive mucus observed during the endoscopy.
2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Clarithromycin/therapeutic use ; Drug Therapy, Combination ; Gastric Mucosa/*pathology/secretion ; Gastritis, Hypertrophic/*diagnosis/pathology ; Gastroscopy ; Helicobacter Infections/diagnosis/drug therapy ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Mucus/secretion ; Proton Pump Inhibitors/therapeutic use ; Tomography, X-Ray Computed

A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstructive bowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient's known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals.
Abdominal Pain/radiography ; Colonoscopy ; Female ; Gallstones/*diagnosis/therapy ; Humans ; Ileus/*diagnosis/therapy ; Intestinal Obstruction/diagnosis/therapy ; Lithotripsy/*methods ; Middle Aged ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Laryngopharyngeal symptoms of gastroesophageal reflux disease (GERD) such as globus sensation, hoarseness and chronic cough are becoming increasingly recognized. This study was aimed to investigate the diagnostic usefulness of combined dual channel multichannel intraluminal impedance (MII)/pH-metry in 'off-proton pump inhibitor (PPI)' patients with suspected laryngopharyngeal reflux. METHODS: Ninety-eight patients with laryngopharyngeal symptoms of GERD were included. All patients were 'off-PPI' state for at least 2 weeks prior to the study, and underwent endoscopy and dual channel combined MII/pH-metry. RESULTS: The mean age of the patients was 49.8 +/- 10.9 years and there were 44 males (44.9%). Fifty-three patients (54.1%) showed pathologic gastroesophageal reflux (GER). Combined dual channel MII/pH-metry achieved highest diagnostic yield of 49.0% and diagnostic yield of single channel combined MII/pH-metry was 37.8%. Addition of MII to standard pH-metry increased twofold of the diagnostic yield for detecting GER. Among 37 patients (37.8%) who had pathologic GER being detected by MII/pH-metry, 19 patients (19.4%) had nonacid GER (nonacid GER group) while 18 patients (18.4%) had acid GER (acid GER group). Pathologic GER group, as classified by MII/pH-metry showed more frequent globus sensation than nonpathologic GER group. Acid GER group had more proximal reflux than nonacid GER group, especially in the upright position. CONCLUSIONS: In this study, combined dual channel MII/pH-metry showed the highest diagnostic yield for detecting GER. This technique can be performed primarily to accurately diagnose laryngopharyngeal reflux disease and exclude other causes of laryngopharyngeal symptoms.
Cough ; Electric Impedance ; Endoscopy ; Gastroesophageal Reflux ; Hoarseness ; Humans ; Laryngopharyngeal Reflux ; Male ; Sensation

BACKGROUND/AIMS: Laterally spreading tumors (LSTs) are similar in color to the adjacent mucosa, so they are difficult to recognize. This study aimed to investigate the features of LSTs by morphologic classification and find effective diagnoses and treatments. METHODS: This retrospective study was done between March 2006 and August 2008. We reviewed patients' medical records, endoscopic findings, and histological findings. RESULTS: A total of 151 patients met criteria for LSTs. Eighty-seven lesions (57.6%) were of the granular type. The most frequent location was ascending colon (37.1%), followed by rectum and sigmoid colon (36.4%). The cecum is a common site in the granular type, but the transverse colon is common in the nongranular type. The overall malignancy rate was 21.2%, and the malignant rate increased in proportion to size. Malignant rates were higher for the mixed nodular type (25.9%) and pseudo-depressed type (41.2%) than for the homogeneous granular type (3.0%) or flat elevated type (10.0%). CONCLUSIONS: LSTs showed different clinicopathologic characteristics according to their morphologic classification. The homogenous type has a lower malignant potential. Piecemeal resection for those with a large diameter is possible, while the pseudo-depressed and mixed nodular types have a higher malignant potential and should receive en-bloc resection as soon as possible.
Cecum ; Colon, Ascending ; Colon, Sigmoid ; Colon, Transverse ; Colorectal Neoplasms ; Humans ; Medical Records ; Mucous Membrane ; Rectum ; Retrospective Studies

Hemobilia occurs when injury or disease causes communication between intrahepatic blood vessels and the intrahepatic or extrahepatic biliary system. The causes of hemobilia include trauma, gallstone disease, vascular malformation, inflammation, and biliary or hepatic tumors. Hemobilia could be diagnosed by endoscopy, hepatic angiography, computed tomography, and ultrasonogram. Patients with hemobilia may present with biliary colic, obstructive jaundice and gastrointestinal bleeding. Extrahepatic cholangiocarcinoma usually presents with obstructive jaundice and is one of the unusual cause of hemobilia. We, herein, report a case of hemobilia caused by cholangiocarcinoma in a 69-year-old woman. She had the past history of lung cancer and choledochoduodenostomy due to gallstone. Esophagogastroduodenoscopy revealed a blood clot protruding from the choledochoduodenostomy site and the ulcerative mass in the common bile duct. Pathologic examination of the ulcerative mass was compatible with those of cholangiocarcinoma.
Aged ; Bile Duct Neoplasms/*diagnosis/pathology ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*diagnosis/pathology ; Cholangiopancreatography, Magnetic Resonance ; Choledochostomy ; Endoscopy, Gastrointestinal ; Female ; Hemobilia/*diagnosis ; Humans