Background: and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear. Methods: Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death. Results: Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis. Conclusion In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.

Background: and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear. Methods: Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death. Results: Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis. Conclusion In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.

Background: and Purpose The Treat Stroke to Target (TST) was a randomized clinical trial involving French and Korean patients demonstrating that a lower low-density lipoprotein cholesterol (LDL-C, <70 mg/dL) target group (LT) experienced fewer cerebro-cardiovascular events than a higher target (90–110 mg/dL) group (HT). However, whether these results can be applied to Asian patients with different ischemic stroke subtypes remains unclear. Methods: Patients from 14 South Korean centers were analyzed separately. Patients with ischemic stroke or transient ischemic attack with evidence of atherosclerosis were randomized into LT and HT groups. The primary endpoint was a composite of ischemic stroke, myocardial infarction, coronary or cerebral revascularization, and cardiovascular death. Results: Among 712 enrolled patients, the mean LDL-C level was 71.0 mg/dL in 357 LT patients and 86.1 mg/dL in 355 HT patients. The primary endpoint occurred in 24 (6.7%) of LT and in 31 (8.7%) of HT group patients (adjusted hazard ratio [HR]=0.78; 95% confidence interval [CI]=0.45–1.33, P=0.353). Cardiovascular events alone occurred significantly less frequently in the LT than in the HT group (HR 0.26, 95% CI 0.09–0.80, P=0.019), whereas there were no significant differences in ischemic stroke events (HR 1.12, 95% CI 0.60–2.10, P=0.712). The benefit of LT was less apparent in patients with small vessel disease and intracranial atherosclerosis than in those with extracranial atherosclerosis. Conclusion In contrast to the French TST, the outcomes in Korean patients were neutral. Although LT was more effective in preventing cardiovascular diseases, it was not so in stroke prevention, probably attributed to the differences in stroke subtypes. Further studies are needed to elucidate the efficacy of statins and appropriate LDL-C targets in Asian patients with stroke.

Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

With an aging population, the number of patients with difficulty swallowing due to medical conditions is gradually increasing. In such cases, enteral nutrition is administered through a temporary nasogastric tube. Long-term use of a nasogastric tube leads to various complications and a decreased quality of life. Percutaneous endoscopic gastrostomy (PEG) is the percutaneous placement of a tube into the stomach, aided endoscopically, which may be an alternative to a nasogastric tube when enteral nutritional is required for 4 weeks or more. This paper is the first Korean clinical guideline for PEG. It was developed jointly by the Korean College of Helicobacter and Upper Gastrointestinal Research and led by the Korean Society of Gastrointestinal Endoscopy. These guidelines aimed to provide physicians, including endoscopists, with the indications, use of prophylactic antibiotics, timing of enteric nutrition, tube placement methods, complications, replacement, and tubes removal for PEG based on the currently available clinical evidence.

Purpose: To analyze adenoma detection rate (ADR) and related quality indicators of colonoscopy among trainees and make recommendations for appropriate colonoscopy training. Methods: ADR and related indicators of colonoscopies performed by 3 trainees and 5 colonoscopy experts between March and November 2022 were analyzed. These indicators were analyzed in both the entire patients and the screening/surveillance group. In addition, the training period of the 3 trainees was divided into 3 sections, and the changes in these indicators were examined. Results: The mean ADR of the 3 trainees was 50.6%. In the screening/surveillance group, the mean ADR of the 3 trainees was 51.8%, showing no significant difference from the experts' ADR (53.4%). When the training period was divided into 3 sections and analyzed in the screening/surveillance group, the mean ADR of the trainees gradually increased to 49.4%, 52.6%, and 53.6%, respectively; however, the difference was insignificant. Analyzing each trainee’s ADR, there was a significant difference among the 3 trainees (58.5% vs. 44.7% vs. 50.2%, P=0.008). However, in the third section of the training period, the 3 trainees’ ADRs were 53.0%, 49.2%, and 57.3%, respectively, showing no significant difference (P=0.606). Conclusion In the early stages of training, the ADR was higher than recommended; however, there were variances in ADR between individuals. As the training period passed, the ADR became similar at the expert level, whereas the difference in ADR between trainees decreased. Therefore, efforts to increase ADR should be made actively from the beginning of training and continued during the training period.

Purpose: To analyze adenoma detection rate (ADR) and related quality indicators of colonoscopy among trainees and make recommendations for appropriate colonoscopy training. Methods: ADR and related indicators of colonoscopies performed by 3 trainees and 5 colonoscopy experts between March and November 2022 were analyzed. These indicators were analyzed in both the entire patients and the screening/surveillance group. In addition, the training period of the 3 trainees was divided into 3 sections, and the changes in these indicators were examined. Results: The mean ADR of the 3 trainees was 50.6%. In the screening/surveillance group, the mean ADR of the 3 trainees was 51.8%, showing no significant difference from the experts' ADR (53.4%). When the training period was divided into 3 sections and analyzed in the screening/surveillance group, the mean ADR of the trainees gradually increased to 49.4%, 52.6%, and 53.6%, respectively; however, the difference was insignificant. Analyzing each trainee’s ADR, there was a significant difference among the 3 trainees (58.5% vs. 44.7% vs. 50.2%, P=0.008). However, in the third section of the training period, the 3 trainees’ ADRs were 53.0%, 49.2%, and 57.3%, respectively, showing no significant difference (P=0.606). Conclusion In the early stages of training, the ADR was higher than recommended; however, there were variances in ADR between individuals. As the training period passed, the ADR became similar at the expert level, whereas the difference in ADR between trainees decreased. Therefore, efforts to increase ADR should be made actively from the beginning of training and continued during the training period.

Purpose: To analyze adenoma detection rate (ADR) and related quality indicators of colonoscopy among trainees and make recommendations for appropriate colonoscopy training. Methods: ADR and related indicators of colonoscopies performed by 3 trainees and 5 colonoscopy experts between March and November 2022 were analyzed. These indicators were analyzed in both the entire patients and the screening/surveillance group. In addition, the training period of the 3 trainees was divided into 3 sections, and the changes in these indicators were examined. Results: The mean ADR of the 3 trainees was 50.6%. In the screening/surveillance group, the mean ADR of the 3 trainees was 51.8%, showing no significant difference from the experts' ADR (53.4%). When the training period was divided into 3 sections and analyzed in the screening/surveillance group, the mean ADR of the trainees gradually increased to 49.4%, 52.6%, and 53.6%, respectively; however, the difference was insignificant. Analyzing each trainee’s ADR, there was a significant difference among the 3 trainees (58.5% vs. 44.7% vs. 50.2%, P=0.008). However, in the third section of the training period, the 3 trainees’ ADRs were 53.0%, 49.2%, and 57.3%, respectively, showing no significant difference (P=0.606). Conclusion In the early stages of training, the ADR was higher than recommended; however, there were variances in ADR between individuals. As the training period passed, the ADR became similar at the expert level, whereas the difference in ADR between trainees decreased. Therefore, efforts to increase ADR should be made actively from the beginning of training and continued during the training period.

Purpose: To analyze adenoma detection rate (ADR) and related quality indicators of colonoscopy among trainees and make recommendations for appropriate colonoscopy training. Methods: ADR and related indicators of colonoscopies performed by 3 trainees and 5 colonoscopy experts between March and November 2022 were analyzed. These indicators were analyzed in both the entire patients and the screening/surveillance group. In addition, the training period of the 3 trainees was divided into 3 sections, and the changes in these indicators were examined. Results: The mean ADR of the 3 trainees was 50.6%. In the screening/surveillance group, the mean ADR of the 3 trainees was 51.8%, showing no significant difference from the experts' ADR (53.4%). When the training period was divided into 3 sections and analyzed in the screening/surveillance group, the mean ADR of the trainees gradually increased to 49.4%, 52.6%, and 53.6%, respectively; however, the difference was insignificant. Analyzing each trainee’s ADR, there was a significant difference among the 3 trainees (58.5% vs. 44.7% vs. 50.2%, P=0.008). However, in the third section of the training period, the 3 trainees’ ADRs were 53.0%, 49.2%, and 57.3%, respectively, showing no significant difference (P=0.606). Conclusion In the early stages of training, the ADR was higher than recommended; however, there were variances in ADR between individuals. As the training period passed, the ADR became similar at the expert level, whereas the difference in ADR between trainees decreased. Therefore, efforts to increase ADR should be made actively from the beginning of training and continued during the training period.

Purpose: To analyze adenoma detection rate (ADR) and related quality indicators of colonoscopy among trainees and make recommendations for appropriate colonoscopy training. Methods: ADR and related indicators of colonoscopies performed by 3 trainees and 5 colonoscopy experts between March and November 2022 were analyzed. These indicators were analyzed in both the entire patients and the screening/surveillance group. In addition, the training period of the 3 trainees was divided into 3 sections, and the changes in these indicators were examined. Results: The mean ADR of the 3 trainees was 50.6%. In the screening/surveillance group, the mean ADR of the 3 trainees was 51.8%, showing no significant difference from the experts' ADR (53.4%). When the training period was divided into 3 sections and analyzed in the screening/surveillance group, the mean ADR of the trainees gradually increased to 49.4%, 52.6%, and 53.6%, respectively; however, the difference was insignificant. Analyzing each trainee’s ADR, there was a significant difference among the 3 trainees (58.5% vs. 44.7% vs. 50.2%, P=0.008). However, in the third section of the training period, the 3 trainees’ ADRs were 53.0%, 49.2%, and 57.3%, respectively, showing no significant difference (P=0.606). Conclusion In the early stages of training, the ADR was higher than recommended; however, there were variances in ADR between individuals. As the training period passed, the ADR became similar at the expert level, whereas the difference in ADR between trainees decreased. Therefore, efforts to increase ADR should be made actively from the beginning of training and continued during the training period.