PURPOSE: Endoscopic submucosal dissection (ESD) in early gastric cancer causes an artificial gastric ulcer and local inflammation that has a negative intraprocedural impact on additional laparoscopic gastrectomy in patients with noncurative ESD. In this study, we analyzed the effect of ESD on short-term surgical outcomes and evaluated the risk factors. MATERIALS AND METHODS: From January 2003 to January 2013, 1,704 patients of the National Cancer Center underwent laparoscopic gastrectomy with lymph node dissection because of preoperative stage Ia or Ib gastric cancer. They were divided into 2 groups: (1) with preoperative ESD or (2) without preoperative ESD. Clinicopathologic factors and short-term surgical outcomes were retrospectively evaluated along with risk factors such as preoperative ESD. RESULTS: Several characteristics differed between patients who underwent ESD-surgery (n=199) or surgery alone (n=1,505). The mean interval from the ESD procedure to the operation was 43.03 days. Estimated blood loss, open conversion rate, mean operation time, and length of hospital stay were not different between the 2 groups. Postoperative complications occurred in 23 patients (11.56%) in the ESD-surgery group and in 189 patients (12.56%) in the surgery-only group, and 3 deaths occurred among patients with complications (1 patient [ESD-surgery group] vs. 2 patients [surgery-only group]; P=0.688). A history of ESD was not significantly associated with postoperative complications (P=0.688). Multivariate analysis showed that male sex (P=0.008) and laparoscopic total or proximal gastrectomy (P=0.000) were independently associated with postoperative complications. CONCLUSIONS: ESD did not affect short-term surgical outcomes during and after an additional laparoscopic gastrectomy.
Gastrectomy* ; Humans ; Inflammation ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Male ; Multivariate Analysis ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms* ; Stomach Ulcer

PURPOSE: Open adhesiolysis has been the favored approach regarding surgical management of intestinal obstruction. Following the development of laparoscopic devices and necessary surgical techniques, laparoscopic treatment of intestinal obstruction and adhesion has been tried in highly selected cases. Our study was designed to investigate laparoscopic adhesiolysis to treat intestinal obstruction. METHODS: The clinicopathologic data and surgical outcomes of 14 patients who underwent emergency laparoscopy between January 2007 and April 2015 were retrospectively reviewed. RESULTS: Five patients had a history of abdominal surgery, and twelve patients had adhesive intestinal obstruction. The causes of adhesive intestinal obstruction included tuberculous peritonitis, periappendiceal abscess, serosal fibrosis and chronic inflammation of intestine, gastric volvulus by fibrotic band. Two patients had non-adhesive intestinal obstruction, caused by intussusception and small bowel ulcer with stricture. The mean surgical time was 98.5 minutes, with mean blood loss of 35 ml. One case was converted to open surgery (7.1%). The mean postoperative hospital stay was 6.5 days. The mean time to oral intake was 3.4 days. There were no postoperative complications or deaths. CONCLUSION: When the patients are selected carefully in accordance with the guidelines, in our experience laparoscopic adhesiolysis is safe and feasible.
Abscess ; Adhesives ; Constriction, Pathologic ; Emergencies ; Fibrosis ; Humans ; Inflammation ; Intestinal Obstruction* ; Intestines ; Intussusception ; Laparoscopy ; Length of Stay ; Operative Time ; Peritonitis, Tuberculous ; Postoperative Complications ; Retrospective Studies ; Stomach Volvulus ; Ulcer

BACKGROUND/AIMS: Endoscopic hemoclip application is an effective and safe method of endoscopic hemostasis. We conducted a multicenter retrospective study on hemoclip and hemoclip combination therapy based on prospective cohort database in terms of hemostatic efficacy not in clinical trial but in real clinical practice. METHODS: Data on endoscopic hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB) were prospectively collected from February 2011 to December 2013. Among 1,584 patients with NVUGIB, 186 patients treated with hemoclip were enrolled in this study. Subjects were divided into three groups: Group 1 (n=62), hemoclipping only; group 2 (n=88), hemoclipping plus epinephrine injection; and group 3 (n=36), hemocliping and epinephrine injection plus other endoscopic hemostatic modalities. Primary outcomes included rebleeding, other therapeutic management, hospitalization period, fasting period and mortality. Secondary outcomes were bleeding associated mortality and overall mortality. RESULTS: Active bleeding and peptic ulcer bleeding were more common in group 3 than in group 1 and in group 2 (p<0.001). However, primary outcomes (rebleeding, other management, morbidity, hospitalization period, fasting period and mortality) and secondary outcomes (bleeding associated mortality and total mortality) were not different among groups. CONCLUSIONS: Combination therapy of epinephrine injection and other modalities with hemoclips did not show advantage over hemoclipping alone in this prospective cohort study. However, there is a tendency to perform combination therapy in active bleeding which resulted in equivalent hemostatic success rate, and this reflects the role of combination therapy in clinical practice.
Adult ; Aged ; Angiography ; Cohort Studies ; Combined Modality Therapy ; Databases, Factual ; Epinephrine/therapeutic use ; Female ; Gastrointestinal Hemorrhage/etiology/*therapy ; *Hemostasis, Endoscopic ; Humans ; Male ; Middle Aged ; Prospective Studies ; Proton Pump Inhibitors/therapeutic use ; Retrospective Studies ; Stomach Ulcer/complications/drug therapy/pathology ; Surgical Instruments ; Treatment Outcome

Helicobacter pylori can cause variety of upper gastrointestinal disorders such as peptic ulcer, mucosa associated lymphoid tissue (MALT)-lymphoma, and gastric cancer. The prevalence of H. pylori infection has significantly decreased in Korea since 1998 owing to active eradication of H. pylori. Along with its decrease, the prevalence of peptic ulcer has also decreased. However, the mean age of gastric ulcer increased and this is considered to be due to increase in NSAID prescription. Gastric cancer is one of the leading causes of cancer deaths in Korea and Japan, and IARC/WHO has classified H. pylori as class one carcinogen of gastric cancer. Despite the decreasing prevalence of H. pylori infection, the total number of gastric cancer in Korea has continuously increased from 2006 to 2011. Nevertheless, the 5 year survival rate of gastric cancer patients significantly increased from 42.8% in 1993 to 67% in 2010. This increase in survival rate seems to be mainly due to early detection of gastric cancer and endoscopic mucosal dissection treatment. Based on these findings, the prevalence of peptic ulcer is expected to decrease even more with H. pylori eradication therapy and NSAID will become the main cause of peptic ulcer. Although the prevalence of gastric cancer has not changed along with decreased the prevalence of H. pylori, gastric cancer is expected to decrease in the long run with the help of eradication therapy and endoscopic treatment of precancerous lesions.
Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Gastrointestinal Diseases/complications/*epidemiology ; Helicobacter Infections/complications/drug therapy/epidemiology ; Humans ; Lymphoma, B-Cell, Marginal Zone/epidemiology ; Peptic Ulcer/epidemiology/etiology ; Prevalence ; Stomach Neoplasms/etiology/mortality/pathology

PURPOSETo compare the therapeutic effects of different doses of intravenous esomeprazole on treating trauma patients with stress ulcer bleeding.

METHODSA total of 102 trauma patients with stress ulcer bleeding were randomly divided into 2 groups: 52 patients were assigned to the high-dose group who received 80 mg intravenous esomeprazole, and then 8 mg/h continuous infusion for 3 days; 50 patients were assigned to the conventional dose group who received 40 mg intravenous esomeprazole sodium once every 12 h for 72 h.

RESULTSCompared with the conventional dose group, the total efficiency of the high-dose group and conventional dose group was 98.08% and 86.00%, respectively (p < 0.05), the hemostatic time was 22.10 h ± 5.18 h and 28.27 h ± 5.96 h, respectively (p < 0.05).

CONCLUSIONBoth doses of intravenous esomeprazole have good hemostatic effects on stress ulcer bleeding in trauma patients. The high-dose esomeprazole is better for hemostasis.

Adolescent ; Adult ; Aged ; Anti-Ulcer Agents ; therapeutic use ; Dose-Response Relationship, Drug ; Esomeprazole ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Peptic Ulcer Hemorrhage ; drug therapy ; Stomach Ulcer ; complications ; Stress, Psychological ; complications ; Wounds and Injuries ; complications

BACKGROUND/AIMS: Retreatment after initial treatment failure for Helicobacter pylori is very challenging. The purpose of this study was to evaluate the efficacies of moxifloxacin-containing triple and bismuth-containing quadruple therapy. METHODS: A total of 151 patients, who failed initial H. pylori treatment, were included in this retrospective cohort study. The initial regimens were standard triple, sequential, or concomitant therapy, and the efficacies of the two following second-line treatments were evaluated: 7-day moxifloxacin-containing triple therapy (rabeprazole 20 mg twice a day, amoxicillin 1,000 mg twice a day, and moxifloxacin 400 mg once daily) and 7-day bismuth-containing quadruple therapy (rabeprazole 20 mg twice a day, tetracycline 500 mg 4 times a day, metronidazole 500 mg 3 times a day, and tripotassium dicitrate bismuthate 300 mg 4 times a day). RESULTS: The overall eradication rates after moxifloxacin-containing triple therapy and bismuth-containing quadruple therapy were 69/110 (62.7%) and 32/41 (78%), respectively. Comparison of the two regimens was performed in the patients who failed standard triple therapy, and the results revealed eradication rates of 14/28 (50%) and 32/41 (78%), respectively (p=0.015). The frequency of noncompliance was not different between the two groups, and there were fewer adverse effects in the moxifloxacin-containing triple therapy group (2.8% vs 7.3%, p=0.204 and 25.7% vs 43.9%, p=0.031, respectively). CONCLUSIONS: Moxifloxacin-containing triple therapy, a recommended second-line treatment for initial concomitant or sequential therapy failure, had insufficient efficacy.
Aged ; Amoxicillin/*therapeutic use ; Anti-Bacterial Agents/*therapeutic use ; Anti-Ulcer Agents/*therapeutic use ; Breath Tests ; Cohort Studies ; Drug Therapy, Combination ; Female ; Fluoroquinolones/*therapeutic use ; Gastroesophageal Reflux/complications ; Helicobacter Infections/complications/*drug therapy/pathology ; Helicobacter pylori ; Humans ; Male ; Metronidazole/*therapeutic use ; Middle Aged ; Organometallic Compounds/*therapeutic use ; Peptic Ulcer/complications ; Rabeprazole/*therapeutic use ; Republic of Korea ; Retrospective Studies ; Salvage Therapy ; Stomach/pathology ; Tetracycline/*therapeutic use ; Treatment Failure ; Treatment Outcome ; Urea/analysis

Median arcuate ligament syndrome is an anatomic and clinical entity characterized by dynamic compression of the proximal celiac artery by the median arcuate ligament, which leads to postprandial epigastric pain, vomiting, and weight loss. These symptoms are usually nonspecific and are easily misdiagnosed as functional dyspepsia, peptic ulcer disease, or gastropathy. In this report, we presented a 72-year-old male patient with celiac artery compression syndrome causing recurrent abdominal pain associated with gastric ulcer and iron deficiency anemia. This association is relatively uncommon and therefore not well determined. In addition, we reported the CT angiography findings and three-dimensional reconstructions of this rare case.
Abdominal Pain/*etiology ; Aged ; Anemia, Iron-Deficiency/*etiology ; Angiography/methods ; Arterial Occlusive Diseases/radiography ; Celiac Artery/*abnormalities/radiography ; Constriction, Pathologic/complications/*radiography ; Diaphragm ; Humans ; Male ; Recurrence ; Stomach Ulcer/complications/*radiography ; Syndrome ; Tomography, X-Ray Computed ; Weight Loss

A 11-year-old child diagnosed as chronic tonsillitis and adenoid hypertrophy underwent adeno-tonsillectomy under general anesthesia. After surgery, patient complained with abdominal discomfort, paleness and vomiting, which presented as the old black contents. Complete blood count showed: 45.2 g/L, hemoglobin of red blood cells 2.57 x 10(12)/L, An emergency gastroscopy confirmed gastric ulcer with hemorrage. Hemorrage was controlled and complete blood count results restored to normal after supportive therapy. Gastric ulcer completely recovered two weeks after discharge.
Adenoidectomy ; Child ; Humans ; Male ; Peptic Ulcer Hemorrhage ; etiology ; Postoperative Complications ; Stomach Ulcer ; etiology ; Tonsillectomy

Since the Korean College of Helicobacter and Upper Gastrointestinal Research has first developed the guideline for the diagnosis and treatment of Helicobacter pylori infection in 1998, the revised guideline was proposed in 2009 by the same group. Although the revised guideline was made by comprehensive review of previous articles and consensus of authoritative expert opinions, the evidence-based developmental process was not applied in the revision of the guideline. This new guideline has been revised especially in terms of changes in the indication and treatment of H. pylori infection in Korea, and developed by the adaptation process as evidence-based method; 6 guidelines were retrieved by systematic review and the Appraisal of Guidelines for Research and Evaluation (AGREE) II process, 21 statements were made with grading system and revised by modified Delphi method. After revision, 11 statements for the indication of test and treatment, 4 statements for the diagnosis and 4 statements for the treatment have been developed, respectively. The revised guideline has been reviewed by external experts before the official endorsement, and will be disseminated for usual clinical practice in Korea. Also, the scheduled update and revision of the guideline will be made periodically.
Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Aspirin/therapeutic use ; Bismuth/therapeutic use ; Breath Tests ; Clarithromycin/therapeutic use ; Gastroesophageal Reflux/etiology ; Gastroscopy ; Helicobacter Infections/complications/*diagnosis/drug therapy ; *Helicobacter pylori ; Humans ; Lymphoma, B-Cell, Marginal Zone/complications ; Metaplasia/complications ; Metronidazole/therapeutic use ; Peptic Ulcer/complications/drug therapy ; Proton Pump Inhibitors/therapeutic use ; Republic of Korea ; Stomach Neoplasms/complications/surgery ; Tetracycline/therapeutic use

A 47-year-old man was referred to Seoul National University Bundang Hospital with an ulcerative lesion in the midbody of the stomach. Computed tomography revealed that he was a situs inversus totalis (SIT) patient. Robot-assisted distal gastrectomy with D1+beta lymph node dissection and Billroth II anastomosis were performed. With the aid of robotic surgery, the surgeon didn't need to change his position and could perform the surgery without any confusion resulting from the patient's reversed anatomy. The operation took 300 minutes, with no intraoperative complications. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. The final pathologic report was pT3N3a by American Joint Committee on Cancer 7th tumor-node-metastasis staging. We successfully performed robot-assisted distal gastrectomy for gastric cancer in a SIT patient. We believe that this is the first case of robotic surgery reported in a SIT patient with gastric cancer.
Gastrectomy ; Gastroenterostomy ; Humans ; Intraoperative Complications ; Joints ; Lymph Node Excision ; Middle Aged ; Situs Inversus ; Stomach ; Stomach Neoplasms ; Ulcer