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대한간학회> Gut and Liver> Metabolically Healthy Obesity Is Associated with an Increased Risk of Colorectal Adenoma Occurrence Diagnosed by Surveillance Colonoscopy

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Metabolically Healthy Obesity Is Associated with an Increased Risk of Colorectal Adenoma Occurrence Diagnosed by Surveillance Colonoscopy

Hyunbeom Chae , Hyo-joon Yang , Soo-kyung Park , Yoon Suk Jung , Jung Ho Park , Dong Il Park , Chong Il Sohn
  • : 대한간학회
  • : Gut and Liver 15권3호
  • : 연속간행물
  • : 2021년 05월
  • : 383-390(8pages)
Gut and Liver

DOI


목차

INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
CONFLICTS OF INTEREST
AUTHOR CONTRIBUTIONS
ORCID
REFERENCES

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Background/Aims: The risk of recurrence of colorectal adenoma among obese individuals without metabolic abnormalities or in those with metabolically healthy obesity is largely unexplored. Therefore, we longitudinally investigated the risk of adenoma occurrence in individuals undergoing surveillance colonoscopy according to metabolic status and obesity.
Methods: This retrospective cohort study included 16,872 Korean adults who underwent their first screening colonoscopy between 2003 and 2012 and who then underwent follow-up colonoscopy until 2017. Participants were categorized into a metabolically healthy nonobese group (reference group), a metabolically healthy obese group, a metabolically abnormal nonobese group, and a metabolically abnormal obese group. Hazard ratios (HRs) for adenoma recurrence compared to the reference group were calculated in each group.
Results: During a median follow-up duration of 47.3 months (interquartile range, 35.6 to 58.9 months), 3,673 (21.8%) and 292 (1.73%) participants developed adenoma and advanced adenoma, respectively. When age, sex, smoking, alcohol consumption, family history of colorectal cancer, and baseline adenoma risk were adjusted, the risk of adenoma recurrence was increased in metabolically healthy obese individuals (HR, 1.33; 95% confidence interval [CI], 1.12 to 1.57) and metabolically abnormal obese individuals (HR, 1.18; 95% CI, 1.08 to 1.30) but not in metabolically abnormal nonobese individuals (HR, 1.03; 95% CI, 0.94 to 1.13).
Conclusions: In this study, metabolically healthy obese individuals and metabolically abnormal obese individuals exhibited increased risks of occurrence of colorectal adenoma diagnosed by surveillance colonoscopy. This finding implies that obesity itself, even without metabolic abnormalities, is associated with an increased risk of adenoma recurrence. (Gut Liver 2021;15:383- 390)

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  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCI
  • : 격월
  • : 1976-2283
  • : 2005-1212
  • : 학술지
  • : 연속간행물
  • : 2007-2021
  • : 1371


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1Benefits of a Molecular-Based Method for the Detection of Clarithromycin-Resistant Helicobacter pylori

저자 : Batsaikhan Saruuljavkhlan , Yoshio Yamaoka

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 487-489 (3 pages)

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2Direct Hyperbilirubinemia as a Predictor of Mortality in Patients with Liver Cirrhosis

저자 : Chang Hun Lee , In Hee Kim

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 490-491 (2 pages)

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3Current Status of Mucosal Imaging with Narrow-Band Imaging in the Esophagus

저자 : Keng Hoong Chiam , Seon Ho Shin , Kun Cheong Choi , Florencia Leiria , Mariana Militz , Rajvinder Singh

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 492-499 (8 pages)

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Recent advances in endoscopic imaging of the esophagus have revolutionized the diagnostic capability for detecting premalignant changes and early esophageal malignancy. In this article, we review the practical application of narrow-band imaging focusing on diseases of the esophagus, including Barrett's esophagus, adenocarcinoma, and squamous cell carcinoma. (Gut Liver 2021;15:492-499)

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4Tumor-Associated Macrophages in Hepatocellular Carcinoma: Friend or Foe?

저자 : Dexi Zhou , Jiajie Luan , Cheng Huang , Jun Li

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 500-516 (17 pages)

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Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, and it has diverse etiologies with multiple mechanisms. The diagnosis of HCC typically occurs at advanced stages when there are limited therapeutic options. Hepatocarcinogenesis is considered a multistep process, and hepatic macrophages play a critical role in the inflammatory process leading to HCC. Emerging evidence has shown that tumor-associated macrophages (TAMs) are crucial components defining the HCC immune microenvironment and represent an appealing option for disrupting the formation and development of HCC. In this review, we summarize the current knowledge of the polarization and function of TAMs in the pathogenesis of HCC, as well as the mechanisms underlying TAM-related anti-HCC therapies. Eventually, novel insights into these important aspects of TAMs and their roles in the HCC microenvironment might lead to promising TAM-focused therapeutic strategies for HCC. (Gut Liver 2021;15:500-516)

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5Management of Gallstones and Acute Cholecystitis in Patients with Liver Cirrhosis: What Should We Consider When Performing Surgery?

저자 : Shang Yu Wang , Chun Nan Yeh , Yi Yin Jan , Miin Fu Chen

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 517-527 (11 pages)

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Acute cholecystitis and several gallbladder stone-related conditions, such as impacted common bile duct stones, cholangitis, and biliary pancreatitis, are common medical conditions in daily practice. An early cholecystectomy or drainage procedure with delayed cholecystectomy is the current standard of treatment based on published clinical guidelines. Cirrhosis is not only a condition of chronically impaired hepatic function but also has systemic effects in patients. In cirrhotic individuals, several predisposing factors, including changes in the bile acid composition, increased nucleation of bile, and decreased motility of the gallbladder, contribute to the formation of biliary stones and the possibility of symptomatic cholelithiasis, which is an indication for surgical treatment. In addition to these predisposing factors for cholelithiasis, systemic effects and local anatomic consequences related to cirrhosis lead to anesthesiologic risks and perioperative complications in cirrhotic patients. Therefore, the treatment of the aforementioned biliary conditions in cirrhotic patients has become a challenging issue. In this review, we focus on cholecystectomy for cirrhotic patients and summarize the surgical indications, risk stratification, surgical procedures, and surgical outcomes specific to cirrhotic patients with symptomatic cholelithiasis. (Gut Liver 2021;15:517-527)

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6Types of 23S Ribosomal RNA Point Mutations and Therapeutic Outcomes for Helicobacter pylori

저자 : Sang Yoon Kim , Jae Myung Park , Chul-hyun Lim , Hye Ah Lee , Ga-yeong Shin , Younghee Choe , Yu Kyung Cho , Myung-gyu Choi

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 528-536 (9 pages)

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Background/Aims: Point mutations in the 23S ribosomal RNA gene have been associated with Helicobacter pylori clarithromycin resistance. This study aimed to detect the prevalence of these point mutations and to investigate the role of different point mutations in the success of eradication therapy.
Methods: We retrospectively investigated a total of 464 consecutive patients who underwent an endoscopic examination and dual-priming oligonucleotide-based multiplex polymerase chain reaction for H. pylori between June 2014 and October 2019. For 289 patients with negative point mutations, standard triple therapy was used in 287 patients, and the bismuth-quadruple regimen was used in two patients. For 175 patients with positive point mutations (A2142G, A2143G, and both mutations), standard triple and bismuth-quadruple therapies were used in 37 patients and 138 patients, respectively.
Results: The eradication rates of standard triple and bismuth-quadruple therapies showed no significant difference in mutation-negative patients or those with the A2142G point mutation. However, the eradication rate with bismuth-quadruple therapy was significantly higher than that with standard triple therapy in the group with the A2143G mutation or with the double mutation. The eradication rates for standard triple and bismuth-quadruple therapies, respectively, were 25.8% and 92.1% in the per-protocol group (p<0.001) and 24.2% and 85.2% in the intention-to-treat analysis (p<0.001).
Conclusions: The A2143G point mutation is the most prevalent cause of clarithromycin resistance. Bismuth-quadruple therapy is superior to standard triple therapy in patients with the A2143G or double point mutation. (Gut Liver 2021;15:528-536)

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7A Nationwide Cohort Study Shows a Sex-Dependent Change in the Trend of Peptic Ulcer Bleeding Incidence in Korea between 2006 and 2015

저자 : Yong Sung Kim , Joonki Lee , Aesun Shin , Jung Min Lee , Jong Heon Park , Hwoon-yong Jung

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 537-545 (9 pages)

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Background/Aims: The incidence of peptic ulcer disease has decreased in past decades; however, the trends in peptic ulcer bleeding (PUB) are inconsistent among regions. This study aimed to investigate the trends in PUB incidence and the effect of risk factors on PUB in Korea.
Methods: The records of patients hospitalized with PUB from 2006 to 2015 were retrieved from the Korean National Health Insurance Service Database. Standardized incidences of PUB were calculated, and the clinical characteristics such as age, sex, Helicobacter pylori infection, drug exposure, comorbidities, and mortality were obtained.
Results: In total, 151,507 hospitalizations with PUB were identified. The overall annual hospitalization rate was 34.98 per 100,000 person-years. The incidence of PUB showed no significant change from 2006 to 2008 and decreased from 2008 to 2015, with an annual change of -2.7% (p<0.05); however, this change was only significant in men. The incidence of PUB was higher in men than in women between 40 and 70 years old and higher in women than in men older than 80 years. From 2006 to 2015, the H. pylori infection rate increased significantly in patients with PUB; however, there was no significant change in exposure to nonsteroidal anti-inflammatory drugs or other drugs that increase the risk of PUB.
Conclusions: Over the past decade, the incidence of PUB has decreased in a sex-specific manner. There has been a decreasing trend in the H. pylori infection rate and no change in exposure to drugs that increase the risk of PUB in Korea. (Gut Liver 2021;15:537-545)

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8The Usefulness of the Measurement of Esophagogastric Junction Distensibility by EndoFLIP in the Diagnosis of Gastroesophageal Reflux Disease

저자 : Jung Min Lee , In Kyung Yoo , Eunju Kim , Sung Pyo Hong , Joo Young Cho

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 546-552 (7 pages)

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Background/Aims: Increased esophagogastric junction (EGJ) relaxation is the most important mechanism involved in gastroesophageal reflux disease (GERD). An endoscopic functional luminal imaging probe (EndoFLIPⓇ) is a device used to quantify EGJ distensibility in routine endoscopy. The aim of the current study was to assess the usefulness of EndoFLIPⓇ for the diagnosis of GERD compared to normal controls.
Methods: We analyzed EndoFLIPⓇ data from 204 patients with erosive reflux disease (ERD), 310 patients with nonerosive reflux disease (NERD), and 277 normal subjects. EndoFLIPⓇ uses impedance planimetry to measure 16 cross-sectional areas (CSAs) in conjunction with the corresponding intrabag pressure within a 4.6 cm cylindrical segment of a fluid-filled bag. The EGJ distensibility was assessed using 40 mL volume-controlled distensions.
Results: The mean distensibility index values were 13.98 ㎟/mm Hg in ERD patients, 11.42 ㎟/mm Hg in NERD patients, and 9.1 ㎟/mm Hg in normal subjects. There were significant differences in EGJ distensibility among the three groups (p<0.001). In addition, the CSAs were significantly higher in the ERD (291.03±160.77 ㎟) and NERD groups (285.87±155.47 ㎟) than in the control group (249.78±144.76 ㎟, p=0.004). We determined the distensibility index cutoff value of EGJ as 10.95 for the diagnosis of GERD by receiver operating characteristic curve analysis.
Conclusions: The EGJ distensibilities of GERD patients were higher than those of normal subjects, regardless of the presence of reflux esophagitis. Thus, the measurement of EGJ distensibility using the EndoFLIPⓇ system could be useful in the diagnosis of GERD. (Gut Liver 2021;15:546-552)

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9Clinical Significance of TWIST-Positive Circulating Tumor Cells in Patients with Esophageal Squamous Cell Carcinoma

저자 : Hyun Jung Lee , Gwang Ha Kim , Su Jin Park , Chae Hwa Kwon , Moon Won Lee , Bong Eun Lee , Dong Hoon Baek , Hoseok I

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 553-561 (9 pages)

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Background/Aims: Unlike other gastrointestinal tract cancers, there are relatively few reports on the clinical significance of circulating tumor cells (CTCs) and TWIST, a marker of epithelial-mesenchymal transition, in patients with esophageal squamous cell carcinoma (ESCC). This study aimed to evaluate the clinical significance of TWIST expression in CTCs in patients with ESCC.
Methods: Peripheral blood samples for CTC analyses were prospectively obtained from 52 patients with ESCC prior to treatment between September 2017 and September 2019. CTCs were detected using a centrifugal microfluidic system based on a fluid-assisted separation technique, and CTCs positive for TWIST on immunostaining were defined as TWIST (+) CTCs.
Results: Of the 52 patients with ESCC, CTCs and TWIST (+) CTCs were detected in 44 patients (84.6%) and 39 patients (75.0%), respectively. The CTC and TWIST (+) CTC counts were significantly higher in patients aged >65 years and those who had a large tumor (>3 cm) than in those aged ≤65 years and those who had a small tumor (≤3 cm), respectively. There were no differences in CTC and TWIST (+) CTC counts according to tumor location, histologic grade, or TNM stage. TWIST (+) CTCs were significantly associated with histologic grade; a proportion of TWIST (+) CTCs ≥0.5 was significantly associated with advanced histologic grade. Other clinicopathologic characteristics such as sex, age, tumor location, tumor size, and TNM stages were not significantly associated with TWIST (+) CTCs.
Conclusions: Our study showed that TWIST (+) CTCs were frequently detected in patients with ESCC, and a high proportion of TWIST (+) CTCs was associated with poor differentiation. (Gut Liver 2021;15:553-561)

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10Pain Intensity at Injection Site during Esophagogastroduodenoscopy Using Long- and Medium-Chain versus Long-Chain Triglyceride Propofol: A Randomized Controlled Double-Blind Study

저자 : Joon Seop Lee , Eun Soo Kim , Kwang Bum Cho , Kyung Sik Park , Yoo Jin Lee , Ju Yup Lee

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 562-568 (7 pages)

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Background/Aims: The intensities of injection pain resulting from the use of long- and medium-chain triglyceride (LCT/MCT) propofol and conventional LCT propofol during esophagogastroduodenoscopy (EGD) have yet to be compared. We aimed to determine the pain intensity caused by different formulations of propofol and to evaluate the formulation that would be preferred by patients as a sedative agent during their next procedure.
Methods: This study was a single-center, randomized, controlled, and double-blind trial. Pain intensity was estimated 30 seconds after propofol injection by an examiner who was blinded to the group assignment using a numeric (0-10) pain rating scale (NPRS). After 1 week, the patients were asked whether they could recall the pain and were willing to receive the same agent for their next EGD.
Results: One hundred twenty-nine patients were randomly assigned to LCT/MCT or LCT group. Although there was no significant difference in pain incidence between the LCT/MCT and LCT groups (52.9% vs 65.6%, p=0.156), the pain intensity was significantly lower in the LCT/MCT group (NPRS median [interquartile range]; 1 (0-2) vs 2 (0-5), p=0.005). After 1 week, fewer patients in the LCT/MCT group recalled the pain (19.1% vs 63.9%, p<0.001) and more patients in the LCT/MCT group were more willing to use the same agent for their next procedure (86.8% vs 72.1%, p=0.048) than in the LCT group.
Conclusions: LCT/MCT propofol significantly reduced injection pain intensity compared to LCT propofol during EGD and preferred by patients as a sedative agent during their next EGD. (Gut Liver 2021;15:562-568)

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1Is Paradigm for the Role of Balloon-Assisted Enteroscopy Changing in Crohn's Disease?

저자 : Yoo Jin Lee

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 3호 발행 연도 : 2021 페이지 : pp. 325-326 (2 pages)

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2Direct-Acting Antiviral Therapy and Risk of Hepatocellular Carcinoma Recurrence in Patients with Chronic Hepatitis C

저자 : Chang Hun Lee , In Hee Kim

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3Image-Enhanced Endoscopy and Its Corresponding Histopathology in the Stomach

저자 : Hisashi Doyama , Hiroyoshi Nakanishi , Kenshi Yao

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 3호 발행 연도 : 2021 페이지 : pp. 329-337 (9 pages)

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In recent years, the technological innovation and progress of endoscopic equipment have been remarkable, and various endoscopic observation techniques have been developed. Among them, representative techniques are magnified observation and narrow-band imaging. Magnifying endoscopy with narrow-band imaging (M-NBI) can visualize superficial microanatomies in the stomach. The normal morphology of the microanatomy visualized using M-NBI differs according to the part of the stomach. The vessel plus surface (VS) classification system has been developed as a diagnostic criterion for early gastric cancer using M-NBI, and its usefulness has been proven. Based on the VS classification system, a magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G), a simplified algorithm used for early gastric cancer diagnosis, was created. We aimed to describe the anatomic structure of the stomach that can be viewed using M-NBI and outline the principles and clinical application of the VS classification system and MESDA-G. (Gut Liver 2021;15:329-337)

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4Characteristics and Early Diagnosis of Gastric Cancer Discovered after Helicobacter pylori Eradication

저자 : Masanori Ito , Shinji Tanaka , Kazuaki Chayama

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 3호 발행 연도 : 2021 페이지 : pp. 338-345 (8 pages)

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The prevalence of gastric cancer after eradication (GCAE) is increasing dramatically in Japan. GCAE has characteristic features, and we must understand these features in endoscopic examinations. Differentiated cancer types were frequently found after eradication and included characteristic endoscopic features such as reddish depression (RD). However, benign RD can be difficult to distinguish from gastric cancer because of histological alterations in the surface structures (nonneoplastic epithelium or epithelium with low-grade atypia [ELA]) as well as multiple appearances of RD. Recently, we clarified similar alterations in genetic mutations between ELA and gastric cancer, suggesting that ELA is derived from gastric cancer. Clinically, submucosal invasive cancer was frequently found in patients after eradication therapy even if they received annual endoscopic surveillance. We can improve the diagnostic ability using image-enhanced endoscopy with magnified observation. (Gut Liver 2021;15:338-345)

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5Application of Artificial Intelligence in the Detection and Characterization of Colorectal Neoplasm

저자 : Kyeong Ok Kim , Eun Young Kim

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 3호 발행 연도 : 2021 페이지 : pp. 346-353 (8 pages)

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Endoscpists always have tried to pursue a perfect colonoscopy, and application of artificial intelligence (AI) using deep-learning algorithms is one of the promising supportive options for detection and characterization of colorectal polyps during colonoscopy. Many retrospective studies conducted with real-time application of AI using convolutional neural networks have shown improved colorectal polyp detection. Moreover, a recent randomized clinical trial reported additional polyp detection with shorter analysis time. Studies conducted regarding polyp characterization provided additional promising results. Application of AI with narrow band imaging in real-time prediction of the pathology of diminutive polyps resulted in high diagnostic accuracy. In addition, application of AI with endocytoscopy or confocal laser endomicroscopy was investigated for realtime cellular diagnosis, and the diagnostic accuracy of some studies was comparable to that of pathologists. With AI technology, we can expect a higher polyp detection rate with reduced time and cost by avoiding unnecessary procedures, resulting in enhanced colonoscopy efficiency. However, for AI application in actual daily clinical practice, more prospective studies with minimized selection bias, consensus on standardized utilization, and regulatory approval are needed. (Gut Liver 2021;15:346-353)

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6Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE)

저자 : Moon Jae Chung , Se Woo Park , Seong-hun Kim , Chang Min Cho , Jun-ho Choi , Eun Kwang Choi , Tae Hoon Lee , Eunae Cho , Jun Kyu Lee , Tae Jun Song , Jae Min Lee , Jun Hyuk Son , Jin Suk Park , Chi Hyuk

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 3호 발행 연도 : 2021 페이지 : pp. 354-374 (21 pages)

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Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a task force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice. (Gut Liver 2021;15:354-374)

KCI등재SCI

7Enteroscopy in Crohn's Disease: Are There Any Changes in Role or Outcomes Over Time? A KASID Multicenter Study

저자 : Seong Ran Jeon , Jin-oh Kim , Jeong-sik Byeon , Dong-hoon Yang , Bong Min Ko , Hyeon Jeong Goong , Hyun Joo Jang , Soo Jung Park , Eun Ran Kim , Sung Noh Hong , Jong Pil Im , Seong-eun Kim , Ja Seol Koo ,

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 3호 발행 연도 : 2021 페이지 : pp. 375-382 (8 pages)

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Background/Aims: Although balloon-assisted enteroscopy (BAE) enables endoscopic visualization of small bowel (SB) involvement in Crohn's disease (CD), there is no data on the changes in outcomes over time. We therefore investigated the changes in BAE use on CD patients over different time periods in terms of its role and clinical outcomes.
Methods: We used a multicenter enteroscopy database to identify CD patients with SB involvement who underwent BAE (131 procedures, 116 patients). We compared BAE-related factors and outcomes between the first period (70 procedures, 60 patients) and the second period (61 procedures, 56 patients). The specific cutoff point for dividing the two periods was 2007, when BAE guidelines were introduced.
Results: Initial diagnosis of SB involvement in CD was the most common indication for BAE during each period (50.0% vs 31.1%, p=0.034). The largest change was in the number of BAE uses for stricture evaluation and/or treatment, which increased significantly in the latter period (2.9% vs 21.3%, p=0.002). The diagnostic yield in patients with suspected CD was 90.7% in the first period and 95.0% in the second (p=0.695). More endoscopic interventions were performed in the second period than in the first (5.1% vs 17.6%, p=0.041). Enteroscopic success rates were high throughout (100% in the first period vs 80.0% in the second period, p>0.999). In the first and second periods, therapeutic plans were adjusted in 62.7% and 61.4% of patients, respectively.
Conclusions: The overall clinical indications, outcomes, and effectiveness of BAE were constant over time in CD patients with SB involvement, with the exception that the frequency of enteroscopic intervention increased remarkably. (Gut Liver 2021;15:375-382)

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8Metabolically Healthy Obesity Is Associated with an Increased Risk of Colorectal Adenoma Occurrence Diagnosed by Surveillance Colonoscopy

저자 : Hyunbeom Chae , Hyo-joon Yang , Soo-kyung Park , Yoon Suk Jung , Jung Ho Park , Dong Il Park , Chong Il Sohn

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 3호 발행 연도 : 2021 페이지 : pp. 383-390 (8 pages)

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Background/Aims: The risk of recurrence of colorectal adenoma among obese individuals without metabolic abnormalities or in those with metabolically healthy obesity is largely unexplored. Therefore, we longitudinally investigated the risk of adenoma occurrence in individuals undergoing surveillance colonoscopy according to metabolic status and obesity.
Methods: This retrospective cohort study included 16,872 Korean adults who underwent their first screening colonoscopy between 2003 and 2012 and who then underwent follow-up colonoscopy until 2017. Participants were categorized into a metabolically healthy nonobese group (reference group), a metabolically healthy obese group, a metabolically abnormal nonobese group, and a metabolically abnormal obese group. Hazard ratios (HRs) for adenoma recurrence compared to the reference group were calculated in each group.
Results: During a median follow-up duration of 47.3 months (interquartile range, 35.6 to 58.9 months), 3,673 (21.8%) and 292 (1.73%) participants developed adenoma and advanced adenoma, respectively. When age, sex, smoking, alcohol consumption, family history of colorectal cancer, and baseline adenoma risk were adjusted, the risk of adenoma recurrence was increased in metabolically healthy obese individuals (HR, 1.33; 95% confidence interval [CI], 1.12 to 1.57) and metabolically abnormal obese individuals (HR, 1.18; 95% CI, 1.08 to 1.30) but not in metabolically abnormal nonobese individuals (HR, 1.03; 95% CI, 0.94 to 1.13).
Conclusions: In this study, metabolically healthy obese individuals and metabolically abnormal obese individuals exhibited increased risks of occurrence of colorectal adenoma diagnosed by surveillance colonoscopy. This finding implies that obesity itself, even without metabolic abnormalities, is associated with an increased risk of adenoma recurrence. (Gut Liver 2021;15:383- 390)

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9Colonoscopic Polypectomy Preferences of Asian Endoscopists: Results of a Survey-Based Study

저자 : Dong-hoon Yang , Bayasgalan Luvsandagva , Quang Trung Tran , Achmad Fauzi , Panida Piyachaturawat , Thida Soe , Zhiqin Wong , Jeong-sik Byeon

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 3호 발행 연도 : 2021 페이지 : pp. 391-400 (10 pages)

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Background/Aims: The clinical practice pattern of polypectomy is not well-investigated in Asian countries. We aimed to survey Asian endoscopists about their preferred polypectomy techniques for given conditions and images of polyps.
Methods: A survey was performed using questionnaires composed of two parts: a scenariobased questionnaire using scenarios of polyps, which were adopted from the European Society of Gastrointestinal Endoscopy guidelines, and an image-based questionnaire using provided endoscopic images of polyps.
Results: A total of 154 endoscopists participated in this survey. The most preferred resection techniques for diminutive (≤5 mm), small (6-9 mm), and benign-looking intermediate (10-19 mm) nonpedunculated polyps were cold forceps polypectomy, hot snare polypectomy, and endoscopic mucosal resection (EMR), respectively, in both the scenario- and image-based questionnaires. For benign-looking large (≥20 mm) nonpedunculated polyps, EMR and endoscopic submucosal dissection (ESD) were preferred in the scenario- and image-based surveys, respectively. In case of malignant nonpedunculated polyps, EMR and ESD were preferred for intermediate-sized and large lesions, respectively, according to the scenario-based survey. However, ESD was preferred in both intermediate-sized and large malignant nonpedunculated polyps according to the imagebased survey. Trainee endoscopists, endoscopists working in referral centers, and endoscopists in the colorectal cancer-prevalent countries were independently associated with preference of cold snare polypectomy for removing small polyps.
Conclusions: The polypectomy practice patterns of Asian endoscopists vary, and cold snare polypectomy was not the most preferred resection method for polyps <10 mm in size, in contrast to recent guidelines. (Gut Liver 2021;15:391-400)

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10Clinical Significance of Residual Nonrectal Inflammation in Ulcerative Colitis Patients in Clinical Remission

저자 : Jongbeom Shin , Sung Min Kong , Tae Jun Kim , Eun Ran Kim , Sung Noh Hong , Dong Kyung Chang , Young-ho Kim

발행기관 : 대한간학회 간행물 : Gut and Liver 15권 3호 발행 연도 : 2021 페이지 : pp. 401-409 (9 pages)

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Background/Aims: The treatment goal of ulcerative colitis (UC) has been changed to achieve endoscopic remission (ER). However, there is insufficient clinical evidence to determine whether a step-up treatment should be performed to achieve ER in clinical remission (CR) without ER, and there are inadequate data on the need to consider the distribution and severity of residual inflammation. This retrospective study aimed to evaluate the prognostic significance of the distribution and severity of residual inflammation in UC patients in CR.
Methods: A total of 131 UC patients in CR who underwent endoscopic evaluation for more than three times between January 2000 and December 2018 were reviewed. The patients were allocated by the endoscopic healing state and the distribution of inflammation to ER (n=31, 23.7%), residual nonrectal inflammation with patchy distribution (NRI) (n=17, 13.0%) or residual rectal involvement with continuous or patchy distribution (RI) (n=83, 63.3%) groups. We reviewed clinical characteristics, endoscopic findings, and factors associated with poor outcome-free survival (PFS).
Results: In UC patients in CR, PFS was significantly higher in the ER and NRI groups than in the RI group (p=0.003). Patients in the ER and NRI groups had similar PFS (p=0.647). Cox proportional hazard model showed only RI (hazard ratio, 5.76; p=0.027) was associated with a higher risk of poor outcome.
Conclusions: We suggest that escalation of treatment modalities may be selectively performed in consideration of the residual mucosal inflammation pattern, even if ER has not been achieved, in UC patients with CR. (Gut Liver 2021;15:401-409)

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