Purpose: Endoscopic submucosal dissection (ESD) has become a standard minimally invasive treatment for selected patients with early gastric cancer (EGC). This study presents the first nationwide survey of patients with EGC treated with ESD in 2023, conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research. Materials and Methods: Data were retrospectively collected from participating referral centers across Korea using a standardized case report form covering patient characteristics, tumor features, procedural details, histopathological findings, and clinical outcomes.Descriptive and comparative analyses were conducted to summarize nationwide ESD practice patterns and outcomes. Results: Data from 5,460 ESD cases from 5,250 patients across 27 institutions were analyzed. The mean age was 67.4 years, with 74.1% males. Multiple synchronous lesions were identified in 3.7%. Most lesions were located in the lower third of the stomach (64.0%), and differentiated-type adenocarcinomas accounted for 87.8%. The en bloc and complete resection rates were 99.2% and 91.4%, respectively. Curative resection was achieved in 80.5%, whereas local non-curative resection (L-NCR) and surgical non-curative resection (S-NCR) were identified in 2.8% and 16.7%, respectively. Additional surgery was performed more frequently in patients with S-NCR than in those with L-NCR (59.3% vs. 24.7%). The bleeding and perforation rates were 3.6% and 0.9%, respectively, and were mostly managed conservatively or endoscopically. The median length of hospitalization was 4.0 days. Conclusions This first nationwide survey provides a comprehensive overview of the current practice of EGC treatment using ESD in Korea, demonstrating high technical success and safety, and establishing a baseline dataset for future longitudinal research.

Objectives: Endoscopic submucosal dissection (ESD) has become a standard minimally invasive treatment for selected patients with early gastric cancer (EGC). This study presents the first nationwide survey of patients with EGC treated with ESD in 2023, conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research. Methods: Data were retrospectively collected from participating referral centers across Korea using a standardized case report form covering patient characteristics, tumor features, procedural details, histopathological findings, and clinical outcomes. Descriptive and comparative analyses were conducted to summarize nationwide ESD practice patterns and outcomes. Results: Data from 5460 ESD cases from 5250 patients across 27 institutions were analyzed. The mean age was 67.4 years, with 74.1% males. Multiple synchronous lesions were identified in 3.7%. Most lesions were located in the lower third of the stomach (64.0%), and differentiated-type adenocarcinomas accounted for 87.8%. The en bloc and complete resection rates were 99.2% and 91.4%, respectively. Curative resection was achieved in 80.5%, whereas local non-curative resection (L-NCR) and surgical non-curative resection (S-NCR) were identified in 2.8% and 16.7%, respectively. Additional surgery was performed more frequently in patients with S-NCR than in those with L-NCR (59.3% vs. 24.7%). The bleeding and perforation rates were 3.6% and 0.9%, respectively, and were mostly managed conservatively or endoscopically. The median length of hospitalization was 4.0 days. Conclusions This first nationwide survey provides a comprehensive overview of the current practice of EGC treatment using ESD in Korea, demonstrating high technical success and safety, and establishing a baseline dataset for future longitudinal research.

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hypo-osmotic hyponatremia. There are several etiologies of SIADH including neuroendocrine tumor, pulmonary disease, infection, trauma, and medications. Here, we report a case of SIADH associated with a schwannoma involving the mediastinum in a 75-year-old woman who presented with nausea, vomiting, and general weakness. Laboratory testing showed hypo-osmolar hyponatremia, with a serum sodium level of 102mmol/L, serum osmolality of 221mOsm/kg, urine osmolality of 382mOsm/kg, urine sodium of 55 mmol/L, and plasma antidiuretic hormone (ADH) of 4.40 pg/mL. Chest computed tomography identified a 1.5-cm-sized solid enhancing nodule in the right lower paratracheal area. A biopsy specimen was obtained by video-assisted thoracoscopic surgery, which was diagnosed on pathology as a schwannoma. The hyponatremia was completely resolved after schwannoma resection and plasma ADH level decreased from 4.40 pg/mL to 0.86 pg/mL. This case highlights the importance of suspecting and identifying the underlying cause of SIADH when faced with refractory or recurrent hyponatremia, and that on possibility is mediastinal schwannoma
Aged ; Biopsy ; Female ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Lung Diseases ; Mediastinum ; Nausea ; Neurilemmoma* ; Neuroendocrine Tumors ; Osmolar Concentration ; Pathology ; Plasma ; Sodium ; Thoracic Surgery, Video-Assisted ; Thorax ; Vomiting

BACKGROUND: Many epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI) can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT). Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition. METHODS: We conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT. RESULTS: Patients were categorized into three groups according to tertiles of body mass index (BMI). During ≥30 days after the initiation of CRRT, 39 patients (57.4%) in the highest tertile died, as compared with 58 patients (78.4%) in the lowest tertile (P = 0.02). In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37–0.87; P = 0.01). This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43–0.94; P = 0.03) and 90-day mortality (HR, 0.66; 95% CI, 0.44–0.97; P = 0.03). CONCLUSION: This study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.
Acute Kidney Injury* ; Body Mass Index* ; Epidemiologic Studies ; Humans ; Mortality* ; Obesity ; Observational Study ; Renal Replacement Therapy*

BACKGROUND/AIMS: Treatment of gastric neuroendocrine tumors is determined by type and size of the lesion. This study aimed to compare the long-term efficacy of observation and endoscopic resection for type 1 gastric neuroendocrine tumors without metastasis. MATERIALS AND METHODS: Among the 223 cases of gastric neuroendocrine tumors diagnosed between January 1996 and December 2011, 104 cases were type 1 gastric neuroendocrine tumors. Sixty-seven patients were treated endoscopically and 27 patients were observed without treatment. Endoscopic mucosal resection, endoscopic submucosal dissection, and polypectomy were the methods used for endoscopic treatment. Therapeutic efficacy and rates of complication and recurrence were evaluated retrospectively. RESULTS: In the endoscopic resection group, complete resection was observed in 53 patients (79.1%), and recurrence was observed in 14 patients (20.9%). On analysis of the observation group, no change was observed in 19 patients (70.4%), and tumor progression was observed in 8 patients (29.6%). Median follow-up duration was 49 months (31~210 months). No mortality was reported in either group during follow-up. CONCLUSIONS: Observation of type 1 gastric neuroendocrine tumors without metastasis yields results similar to those produced by endoscopic resection. Observation alone may be a safe treatment.
Endoscopy ; Follow-Up Studies* ; Humans ; Mortality ; Neoplasm Metastasis ; Neuroendocrine Tumors* ; Recurrence ; Retrospective Studies* ; Stomach

OBJECTIVECheongseoikki-tang (CIT, Korean), also called Qingshu Yiqi decoction () and Seisho-ekki-to (Japanese), is well known as an effective traditional combination of herbs for treating cardiovascular diseases. This study was to research its effects on bone marrow-derived mast cell (BMMC)-mediated allergy and inflammation mechanisms.

METHODSIn this study, the biological effect of Cheongseoikki-tang ethanol extract (CITE) was evaluated, focusing on its effects on the production of allergic mediators by phorbol 12-myristate 13-acetate (PMA) plus calcium ionophore A23187 (A23187)-stimulated BMMCs. These allergic mediators included interleukin-6 (IL-6), prostaglandin D2 (PGD2), leukotriene C4 (LTC4), and β-hexosaminidase (β-hex).

RESULTSOur data revealed that CITE inhibited the production of IL-6, PGD2, LTC4, and β-hex induced by PMA plus A23187 (P<0.05).

CONCLUSIONThese findings indicate that CITE has the potential for use in the treatment of allergy.

Animals ; Anti-Inflammatory Agents ; pharmacology ; therapeutic use ; Bone Marrow Cells ; pathology ; Calcimycin ; pharmacology ; Cell Degranulation ; drug effects ; Cell Survival ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Hypersensitivity ; drug therapy ; pathology ; Interleukin-6 ; secretion ; Leukotriene C4 ; pharmacology ; Male ; Mast Cells ; drug effects ; pathology ; physiology ; Mice ; Mice, Inbred BALB C ; Prostaglandin D2 ; biosynthesis ; Tetradecanoylphorbol Acetate ; pharmacology ; beta-N-Acetylhexosaminidases ; metabolism

A duodenal diverticulum is common and usually originates in the second portion of the duodenum. The majority of diverticula are asymptomatic; however, they may sometimes present with symptoms such as obstruction, hemorrhage, perforation, jaundice and pancreatitis. Active bleeding from a duodenal diverticulum is rare, and moreover, Dieulafoy's lesion as a cause is quite rare with very few cases reported so far. The use of endoscopic methods instead of surgery in achieving hemostasis has been on the increase with the widespread use and improvement in endoscope instrumentation and accessories. Of these methods, the use of endoscopic hemoclipping for Dieulafoy's lesion is considered more effective and safe than the use of other methods, such as injection and thermal methods. We report here a case of a bleeding Dieulafoy's lesion in a duodenal diverticulum treated by endoscopic hemoclipping.
Diverticulum* ; Duodenum ; Endoscopes ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Jaundice ; Pancreatitis

The gastric carcinoma displays various macroscopic appearances ranging from well defined protuberant to diffuse infiltrating tumors but its histological diagnosis is usually simple when performing an endoscopic biopsy. A few gastric cancinomas resemble submucosal tumors (SMT). A gastric carcinoma with a SMT-like appearance is extremely rare, and reportedly accounts for 0.1% to 0.63% of all resected gastric carcinomas in Japan. A histological diagnosis of a SMT-like gastric carcinoma by repeated endoscopic biopsies is often difficult as the tumors are almost entirely covered with normal mucosa. When one sees the lesions in an upper gastrointestinal endoscopy, one should be careful about the location of depression, redness and coating that deviates from the top of the tumor. Here we report two cases of SMT-like gastric carcinomas, diagnosed by the usual endoscopic biopsy method and treated with surgery, with an accompanying review of the recent literature.
Adenocarcinoma* ; Biopsy ; Depression ; Diagnosis ; Endoscopy, Gastrointestinal ; Japan ; Mucous Membrane