Background/Aims: Distinguishing gastric ectopic pancreas (GEP) from malignant tumors is relatively difficult. This study evaluated the endosonography findings of pathologically proven GEP. Methods: Thirty-one patients diagnosed with GEP based on a histopathological analysis from January 2004 to July 2018 were enrolled in this study. All patients underwent EUS and an endoscopic resection. Results: Seventeen patients were female, and the median age was 41.1 years (range, 14-74). The lesions were localized most commonly in the antrum. The mean size of the GEP was 10.6 mm (range, 7-15). Superficial type lesions, lesions with heterogeneous echogenicity, mixed pattern lesions, and lesions with indistinct borders were commonly observed on EUS. Calcification, anechoic duct-like structures, and thickening of the muscularis propria were observed in some patients. Endoscopic mucosal resection (41.9%) and endoscopic submucosal dissection (58.1%) were performed. The mean procedure time was 22.5 minutes. Complete resection was achieved for 71% of patients. No statistically significant results between the endosonography findings and complete resection rates were obtained. The mean follow-up esophagogastroduodenoscopy duration was 4.5 months. None of the patients presented with residual lesions on subsequent endoscopy. Conclusions EUS can help identify the features of GEP. Careful observations of the EUS findings can avoid unnecessary removal of GEP.

BACKGROUND/AIMS: This study aimed to identify the demographic and clinical factors associated with positive breath-test results and to assess the relationship between hydrogen and methane production in patients with suspected irritable bowel syndrome (IBS).METHODS: The demographic and clinical factors of 268 patients with suspected IBS, who had undergone a lactulose breath test, were analyzed.RESULTS: Of 268 patients included in this study, 143 (53.4%) were females. The median age and BMI of the patients was 58.0 years (range, 18.0–80.0 years) and 22.5 kg/m² (range, 14.4–34.3 kg/m²), respectively. A weak positive correlation was observed between the BMI and baseline hydrogen level (rho=0.134, p=0.031). Women were significantly more likely to show a ≥20 ppm increase in hydrogen within 90 min (early hydrogen increase, p=0.049), a ≥10 ppm increase in methane within 90 min (early methane increase, p=0.001), and a ≥10 ppm increase in methane between 90 min and 180 min (late methane increase, p=0.002) compared to men. The baseline hydrogen level was related to the baseline methane level (rho=0.592, p<0.001) and the maximal hydrogen level within 90 min was related to maximal methane level within 90 min (rho=0.721, p<0.001). Patients with an early hydrogen increase (43.8%) were more likely to show a positive result for an early methane increase compared to patients without an early increase in hydrogen (0%, p<0.001).CONCLUSIONS: Women were associated with high rates of positive lactulose breath-test results. In addition, methane production was correlated with hydrogen production.
Breath Tests ; Female ; Humans ; Hydrogen ; Irritable Bowel Syndrome ; Lactulose ; Male ; Methane ; Sex Characteristics

BACKGROUND/AIMS: To evaluate the long-term efficacy and safety of endoscopic injection of N-butyl-2-cyanoacrylate (NBC; Histoacryl) for treatment of bleeding gastric varices. METHODS: We retrospectively analyzed the records of 455 patients with gastric variceal hemorrhage (GVH) who were consecutively treated with NBC from January 2004 to July 2013, with a mean follow-up period of 582 days. The patients' endoscopic findings, initial hemostasis, complications, rebleeding rates, and bleeding-related death rates were reviewed. RESULTS: Hemostasis was achieved initially in 96.9% (441/455) of patients; rebleeding occurred in 35.2% (160/455), and the bleeding-related death rate was 6.8% (31/455) during follow-up. Complications included fever (6.8%), abdominal pain (3.7%), diarrhea (1.3%), spontaneous bacterial peritonitis (0.7%), bacteremia (0.4%), and embolism (0.2%). A red-color sign on concomitant esophageal varices (EVs) (p = 0.002) and previous history of variceal bleeding (p < 0.001) were significant risk factors for rebleeding within 1 year. The Child-Pugh score (p < 0.001), presence of hepatocellular carcinoma (p = 0.001), and failure of initial hemostasis (p < 0.001) were the risk factors most closely associated with bleeding-related death. CONCLUSIONS: This study provides a comprehensive overview of the outcomes and prognostic factors of patients with GVH. The results may help in the selection of effective treatment strategies for patients with GVH.
Adult ; Aged ; Aged, 80 and over ; Enbucrilate/adverse effects/*therapeutic use ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/complications/diagnosis/mortality/*therapy ; Female ; Gastrointestinal Hemorrhage/diagnosis/etiology/mortality/*therapy ; *Hemostatic Techniques/adverse effects/mortality ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Young Adult

BACKGROUND: Bortezomib administration leads to a transient decrease in CD4+ T cells, increasing the susceptibility to opportunistic infections. The activation and proliferation of CD4+ T cells are particularly important in the host's defense against tuberculosis infection. The aim of this study was to determine the incidence and clinical significance of tuberculosis infection in patients with multiple myeloma (MM) treated with a bortezomib-containing regimen. METHODS: We retrospectively investigated the incidence of Mycobacterium tuberculosis in 115 patients with MM who were given a bortezomib-containing regimen and studied the disease prognosis. RESULTS: All patients received chemotherapy prior to bortezomib administration, and the median duration from diagnosis to bortezomib administration was 12.4 months (range, 0.2-230). We diagnosed tuberculosis in 8 patients (8/115, 7%): 7 patients had a pulmonary granulomatous lesion prior to chemotherapy and 1 developed reactivation of tuberculosis, but none of them died of uncontrolled tuberculosis infection. In 50% of patients with tuberculosis, bortezomib-containing therapy was interrupted. This resulted in significantly lower response rates to the bortezomib-containing therapy (P<0.05) and significantly shorter overall survival times amongst tuberculosis vs. non-tuberculosis patients (P=0.017). CONCLUSION: Tuberculosis infection was not uncommon among the patients with MM who were treated with bortezomib-containing therapy, and tuberculosis infection in these patients resulted in an interruption of bortezomib administration, which significantly affected patient outcomes. Therefore, early diagnosis and treatment of tuberculosis infection are critical to avoid worsening outcomes in such patients.
Boronic Acids ; Early Diagnosis ; Humans ; Incidence ; Multiple Myeloma ; Mycobacterium ; Mycobacterium tuberculosis ; Opportunistic Infections ; Pyrazines ; Retrospective Studies ; T-Lymphocytes ; Tuberculosis ; Bortezomib

BACKGROUND: Bortezomib administration leads to a transient decrease in CD4+ T cells, increasing the susceptibility to opportunistic infections. The activation and proliferation of CD4+ T cells are particularly important in the host's defense against tuberculosis infection. The aim of this study was to determine the incidence and clinical significance of tuberculosis infection in patients with multiple myeloma (MM) treated with a bortezomib-containing regimen. METHODS: We retrospectively investigated the incidence of Mycobacterium tuberculosis in 115 patients with MM who were given a bortezomib-containing regimen and studied the disease prognosis. RESULTS: All patients received chemotherapy prior to bortezomib administration, and the median duration from diagnosis to bortezomib administration was 12.4 months (range, 0.2-230). We diagnosed tuberculosis in 8 patients (8/115, 7%): 7 patients had a pulmonary granulomatous lesion prior to chemotherapy and 1 developed reactivation of tuberculosis, but none of them died of uncontrolled tuberculosis infection. In 50% of patients with tuberculosis, bortezomib-containing therapy was interrupted. This resulted in significantly lower response rates to the bortezomib-containing therapy (P<0.05) and significantly shorter overall survival times amongst tuberculosis vs. non-tuberculosis patients (P=0.017). CONCLUSION: Tuberculosis infection was not uncommon among the patients with MM who were treated with bortezomib-containing therapy, and tuberculosis infection in these patients resulted in an interruption of bortezomib administration, which significantly affected patient outcomes. Therefore, early diagnosis and treatment of tuberculosis infection are critical to avoid worsening outcomes in such patients.
Boronic Acids ; Early Diagnosis ; Humans ; Incidence ; Multiple Myeloma ; Mycobacterium ; Mycobacterium tuberculosis ; Opportunistic Infections ; Pyrazines ; Retrospective Studies ; T-Lymphocytes ; Tuberculosis ; Bortezomib

Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease is a rare disorder characterized by proliferation of distinctive histiocytes within lymph node sinuses and lymphatics, sometimes involving extranodal sites. However, clinical suspicion is difficult and there is also a lack of useful diagnostic markers for this disorder prior to histological confirmation. High elevation of serum ferritin is known to be a useful diagnostic marker for various hematologic diseases, including hemophagocytic lymphohistiocytosis and lymphoma. Here, we report a case of fever of unknown origin that presented along with highly elevated serum ferritin (5,780 ng/mL), and was finally diagnosed as Rosai-Dorfman disease by lymph node biopsy.
Adult ; C-Reactive Protein/analysis ; Female ; Ferritins/*blood ; Histiocytosis, Sinus/blood/*diagnosis/pathology ; Humans ; L-Lactate Dehydrogenase/blood ; Lymph Nodes/pathology ; Positron-Emission Tomography and Computed Tomography

Although arteriovenous malformations (AVM) occur frequently in digestive organs, pancreatic AVM is rare. The clinical symptoms of pancreatic AVM are variable and include gastrointestinal bleeding, abdominal pain, jaundice, portal hypertension, pancreatitis, and duodenal ulcer. However, choledochoduodenal or pancreaticoduodenal fistulas complicated with ascending infection and pancreatitis is extremely rare. Herein, we report a case of pancreaticoduodenal fistula associated with a pancreatic AVM that induced recurrent anemia and ascending infection.
Abdominal Pain ; Anemia ; Arteriovenous Malformations ; Duodenal Ulcer ; Fistula ; Hemorrhage ; Hypertension, Portal ; Jaundice ; Pancreatitis

BACKGROUND/AIMS: Although triple combination therapy containing a proton pump inhibitor (PPI) and two antibiotics is considered as a standard regimen for the first-line anti-Helicobacter pylori treatment, the recent trend of eradication rates following this therapy has been declined in the last few years. The purpose of this study was to investigate the trend of H. pylori eradication rates over the last 9 years and to evaluate are clinical factors affecting eradication rates. METHODS: From January 2001 to June 2009, H. pylori eradication rates in 709 patients with documented H. pylori infection who received triple combination therapy for 7 days were retrospectively evaluated according to years and various clinical factors. H. pylori status was evaluated by (13)C urea breath test 4-6 weeks after completion of treatment. RESULTS: The overall H. pylori eradication rate was 77.0%. The annual eradication rates from year 2001 to 2009 were 78.9%, 72.5%, 81.0%, 75.0%, 79.1%, 77.1%, 77.8%, 77.8%, and 75.0% by per-protocol analysis. There was no decreasing tendency of the eradiation rate over 9 years (p=0.974). There was no statistical difference in the eradication rates according to age, sex, smoking, alcohol, NSAIDs, underlying diseases, endoscopic diagnosis, and PPI. However, the eradication rate was lower in patients who took aspirin (OR=0.509, 95% CI=0.292-0.887, p=0.001) and antibiotics within 6 months (OR=0.347, 95% CI=0.183-0.658, p=0.001). CONCLUSIONS: The H. pylori eradication rate has not changed at Gwangju-Chonnam province in Korea for recent 9 years. Lower eradication rate in aspirin and antibiotics users warrants further attention.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Aspirin/therapeutic use ; Child ; Drug Therapy, Combination ; Female ; Helicobacter Infections/diagnosis/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Proton Pump Inhibitors/therapeutic use ; Retrospective Studies ; Risk Factors ; Treatment Outcome

Arterio-enteric fistula is a very rare cause of massive lower gastrointestinal hemorrhage. We report here on a case of massive hematochezia caused by iliac arterio-colic fistula in a 60-year-old woman who had a recent history of spinal surgery for herniated nucleus pulposus. Abdomen computed tomography showed the extravasation of radiocontrast media from right iliac artery encased by an intraabdominal abscess into the adjacent dilatated colon. Also, diagnostic angiography revealed the active extravasation of radiocontrast media via a fistula between right iliac artery and colon. Although successful endovascular exclusion of the fistula with stent graft and coils was performed, disseminated intravascular coagulation and multi-organ failure were developed.
Colonic Diseases/complications/*diagnosis ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Iliac Artery/*radiography ; Intestinal Fistula/complications/*diagnosis ; Middle Aged ; Stents ; Tomography, X-Ray Computed ; Vascular Fistula/complications/*diagnosis

BACKGROUND/AIMS: While endoscopic resection could be considered as the best choice for the treatment of small rectal carcinoid, the colonoscopic biopsies performed at the time of detection may lead to scar and ulcer formation and cause unpredicted difficulty in the endoscopic resection. This study was evaluated to analyze the relationship between the post-biopsy scar and the limitation of submucosal elevation for the endoscopic resection of rectal carcinoids. METHODS: Twenty two cases of rectal carcinoid which received prior biopsies before the endoscopic resection were retrospectively compared with 20 non-biopsied cases. All two groups were treated by endoscopic resection from January 2000 to December 2007. There was no difference in the clinical characteristics and endoscopic findings such as size and location between the two groups. RESULTS: The limited submucosal elevation was experienced in 17 cases (77%) in the biopsy group, significantly more frequent than 9 cases (45%) in the non-biopsy group (p=0.03). The colonoscopic findings which contribute to difficult submucosal elevation were the depressive scar formation after biopsy, the size less than 5 mm in the biopsy group, active ulcer formation after biopsy. Regarding the resection method, endoscopic submucosal dissection was frequently adopted (23% vs. 5%) in the biopsy group. The frequency of endoscopic piecemeal resection in biopsy group was higher than non-biopsy group (23% vs 10%), and all cases were subsequently resected by other endoscopic methods. CONCLUSIONS: The post-biopsy scar can interfere with successful submucosal elevation for endoscopic resection of rectal carcinoids. The number of forcep biopsy should be minimized in the diagnostic colonoscopy when endoscopic resection is planned rectal carcinoids.
Adult ; Aged ; Biopsy ; Carcinoid Tumor/*pathology/surgery ; Cicatrix/pathology ; Colonoscopy ; Female ; Humans ; Intestinal Mucosa/surgery ; Male ; Middle Aged ; Rectal Neoplasms/*pathology/surgery ; Risk Factors