th KJSGE IDEN 2013 / 12 54 Poster Presentation Abstracts PUG-01 - - PDF document

54

IDEN 2013 / 12

th KJSGE

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 391 PUG-01

End Endosc scopi

• pic Surveillanc

llance Can I e Can Incr crease ease the Chanc the Chance

• f
• f R

Resectabilit sectability and End and Endosc scop

• pic T

ic Treat eatment in ent in Gas Gastric C Canc ncer

Ji Yong Ahn, Hwoon-yong Jung, Ji Young Choi, Jeong Hoon Lee, Kwi-sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee and Jin-ho Kim

Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea

Backg Background

• und /

/ aim aims: : Little is known about the effects of periodic endoscopic screening before detection of pri- mary gastric cancer on clinical outcomes in endoscopi- cally resected patients. We therefore compared clinical

• utcomes in patients who did and did not undergo en-

doscopy before diagnosis. Methods: thods: Between January 2009 and November 2011, 769 patients (507 men, mean age 60.1±11.7 years) were referred to Asan Medical Center after diagnosis of gas- tric cancer at another hospital. Clinical outcomes were compared in patients who had (n=512) and had not (n=257) undergone endoscopic screening before diag- nosis of gastric cancer. Factors affecting tumor resect- ability and the possibility of endoscopic resection were analyzed. Re Results: In the non-examined group, 225 patients (87.5%) had resectable gastric cancers and were treated surgically (n=151, 67.1%) or by endoscopic resection (n=74, 32.9%). In the examined group, 493 patients (96.3%) had resectable tumors and were resected surgi- cally (n=243, 49.3%) or endoscopically (n=250, 50.7%). Multivariate analysis showed that initial symptoms, lack of endoscopic screening, and lower serum albumin concentration were independently associated with tu- mor unresectability. Of the 718 patients with resectable tumors, 394 underwent surgery and 324 underwent en- doscopic resection. Multivariate analysis showed that

• lder age, lack of initial symptoms, ≤1 year interval be-

tween endoscopy and tumor detection, and higher se- rum albumin were independently associated with en- doscopic resection. Conc nclusi sions:

• ns: Previous endoscopy, especially in asymp-

tomatic patients with proper nutritional status, can in- crease gastric cancer resectability. Moreover, a ≤1 year interval from endoscopic examination can increase the likelihood of less invasive endoscopic resection. Keyw ywor

• rds:

ds: Endoscopy, gastric cancer, surveillance PUG-02

Ser Serum P m Pepsinogen L psinogen Levels and ls and the Statu the Status o

• f

Heli licobact bacter Pylori Pylori Infect ction in ion in Predi edicting the ng the Cell T ll Types pes of

• f Gas

Gastric N Neop

• plasm

lasm

Hong Seok Choi, Sun-young Lee, Jeong Hwan Kim, In-kyung Sung, Hyung Seok Park, Chan Sup Shim, Choon Jo Jin and Yong Hwang

Internal Medicine, Konkuk University School of Medicine, Seoul, Korea

Backg Background

• und /

/ aim aims: : A combination of serum PG levels and Helicobacter pylori serology are used as a bio- marker strategy for detection of individuals at increased risk of gastric neoplasm based on Correa’s hypothesis. We aimed to uncover whether this combination meth-

• d could predict the risk and cell type of gastric

neoplasm. Me Methods: This study was based on the data of 2428 asymp- tomatic Korean adults who underwent serum PG tests,

• H. pylori serology, and esophagogastroduodenoscopy

(EGD) on the same day at our center. Subjects who had gastric surgery, with extragastric malignancy were ex- cluded from the analysis (n=337). Definite diagnosis for gastric corpus atrophy was given when PG I/II ratio was less than 3, PG I level was less than 70 ng/ml, and the EGD finding showed chronic atrophic gastritis. Re Results: Of 2031 subjects, 11 subjects were diagnosed as gastric neoplasm incidentally (Table 1). Of 792 atro- phy(-)/H. pylori(-) subjects, 1 poorly cohesive carcino- ma and 2 adenomas with high-grade dysplasia were found (0.379%). Of 1016 atrophy(-)/H. pylori(+) sub- jects, 2 adenocarcinoma and 2 adenomas with low-grade dysplasia were found (0.393%). Of 210 atro- phy(+)/H. pylori(+) subjects, 1 adenocarcinoma and 2 adenomas with low-grade dysplasia were found (1.429%). Of 13 atrophy(+)/H. pylori(-) subjects, 1 ad- enoma with low-grade dysplasia was found (7.692%). Conc nclusi sions:

• ns: Incidental gastric neoplasm is most com-

mon in atrophy(+)/H. pylori(-) group followed by atro- phy(+)/H. pylori(+), atrophy(-)/H. pylori(+), and atro

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392 IDEN 2013 / 12th KJSGE

Table 1. Incidentally found gastric neoplasms according to the status of H. pylori infection and atrophic gastritis

phy(-)/H. pylori(-) groups. Although atrophy(-)/H. py- lori(-) group shows the lowest incidence, it shows most advanced histology such as poorly cohesive carcinoma and adenoma with high-grade dysplasia suggesting a rapid progression of gastric neoplasm. Keyw ywor

• rds:

ds: Serum pepsinogen, helicobacter pylori, gas- tric cancer PUG-03

Endosc Endoscopi

• pic Finding

Findings S Suggest ggesting ng Adenocar enocarcino cinoma ma

• f
• f Gas

Gastric Lesions I Lesions Init itial ially Diag Diagno nosed A sed As Ad Adenomas by Fo Forc rceps B Biopsy

Jae Un Lee, Jin Woong Cho, Wang Guk Oh, So Hee Yun, Moon Sik Park, Shang Hoon Han, Young Jae Lee, Gum Mo Jung, Yong Keun Cho and Ji Woong Kim

Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea

Backg Background

• und /

/ aims: aims: Endoscopic resections are widely implemented for the management of gastric neoplasia. But, histologic results between the forcep biopsy sam- ples and post-endoscopic resection specimens may be

• different. The aim of this study was to evaluate endo-

scopic findings of gastric adenocarcinoma that are ini- tially diagnosed as adenomas by forceps biopsy. Methods: thods: We retrospectively reviewed 494 lesions diag- nosed as gastric adenomas by forceps biopsy from January 2008 to June 2012. The endoscopic findings were reviewed for location, size, gross appearance, ul- ceration and surface color. All patients underwent en- doscopic resection and we compared the difference be- tween the biopsy results before and after endoscopic submucosal dissection(ESD). Re Results: After endoscopic resection, 434 lesions were di- agnosed as adenomas, and 60 lesions were diagnosed as

• adenocarcinoma. The diameter of the lesions was

21.29±8.7mm in the adenoma group and 23.53±10.1mm in the adenocarcinoma group. On post-resection tissue biopsies, adenocarcinomas were diagnosed more fre- quently among depressed adenomas(20.9%) than non- depressed adenomas.(9.0%) (p<0.001, OR=2.663) Similarly, adenocarcinoma were diagnosed more frequently among adenomas with ulceration(31.2%) than without ulcer- ation (10.8%) (p=0.002, OR=3.745). In the multivariate analysis, combined high-grade dysplasia, red discoloration were significant variables associated with carcinomas. Conc nclusi sions:

• ns: Gastric adenomatous lesions with endo-

scopic findings such as a depressed type, red discoloration, mucosal ulceration, and high-grade dysplasia should be considered for endoscopic resection. Keyw ywor

• rds:

ds: Gastric adenoma; Gastric adenocarcinoma; Endoscopic submucosal dissection; Endoscopic findings PUG-04

End Endosc scopi

• pic Charact

aracteristic ics A s Assoc ssociat ated w ed with t the e Oc Occu currenc ence o

• f Miss

ssed S ed Sync nchr hronou

• us G

s Gast stric c Neopl

• plasms

sms

Moon Sik Park, Jin Woong Cho, Wang Guk Oh, Jae Un Lee, So Hee Yun, Shang Hoon Han, Young Jae Lee, Gum Mo Jung, Ji Woong Kim and Yong Keun Cho

Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea

Backg Background

• und / aim

/ aims: : A few studies have been published

• n missed synchronous lesions (MSLs) after endo-

scopic submucosal dissection (ESD), but the data of en- doscopic characteristics of MSLs are lacking. The aims

• f our study were to define differences between missed

synchronous gastric neoplasms and unmissed gastric neoplasms, and to determine the endoscopic character- istics of MSLs after ESD. Methods: thods: From January 2008 to June 2012, 586 patients with early gastric cancers (EGCs) or gastric adenomas who had undergone ESD were included. We compared clinicopathologic factors and endoscopic character- istics between patients with MSLs group and patients

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 393 with unmissed synchronous lesions group(USLs group). Re Results: Out of 586 patients, 60 patients (10.2%) had synchronous lesions, and 17 patients (2.9%) among them had MSLs. The MSLs were found at 6.82 months (mean) after ESD. Univariate analysis of endoscopic factors showed that MSLs were correlated to the loca- tion of lesions and tumor numbers at the time of ESD, which were a significant predictive factor for presence

• f MSLs by multivariate logistic regression analysis.

MSLs were more frequently observed when the primary main lesions were multiple than single at the time of

• ESD. Furthermore, the risk of MSLs increased 4.8-fold

in the multiple lesions group at the time of ESD com- pared to the single lesion group (29.4% vs 8.1%; p = 0.003; OR=4.801; 95% CI=1.729-13.333).

• Table1. Comparison of Caracteristics of Main Lesion

Between Patients With and Without MSLs. Table 2. Multivariate Logistic Regression Analysis for Predictive Factors Associated With the Presence of Missed Synchronous Lesions

Conc nclusi sions:

• ns: Tumor numbers at the time of ESD could

be predictive factor for the presence of MSLs after ESD. The entire stomach should be examined with particular care during esophagogastroduodenoscopy, especially when ESD of multiple gastric lesions is to be performed. Keyw ywor

• rds:

ds: Gastric neoplasms, Endoscopic surgical pro- cedures PUG-05

Mali lignant P ant Potent ntial of ial of Regene nerat rative Atypic ical al Epit ithel helium um of

• f B

Biopsi sied G ed Gast stric c Spec Specime imen fr from Scr Screening ing End Endosc scopy

• py

Changhyun Lee1, Seon Hee Lim1, Su Jin Chung1, Min Jung Park1, Min A Kim2, Woo Ho Kim2, Jong Pil Im3, Sang Gyun Kim3, Joo Sung Kim3 and Hyun Chae Jung3

1Department of Internal Medicine and Healthcare Research Institute,

Healthcare System Gangnam Center, Seoul National University Hospital, Seoul,

2Department of Pathology, Seoul National University Hospital, Seoul, 3Department of Internal Medicine and Liver Research Institute, Seoul National

University College of Medicine, Seoul, Korea

Bac Background / aims:

• und / aims: Regenerative atypical epithelium on

biopsied gastric specimen (category 2 of Vienna classi- fication; indefinite for neoplasia/dysplasia) was some- times found in screening upper endoscopy. The aim of this study was to evaluate clinical significance and ma- lignant potential of regenerative atypical epithelium. Methods: thods: We retrospectively reviewed 466 cases proven regenerative atypical epithelium on initial histology of endoscopic biopsy during health checkups at Seoul National University Hospital Healthcare System Gangnam Center between October 2003 and March 2013. Of those, 282 (60.5%) had a subsequent endoscopy and enrolled the analysis. Re Results: Among 282 cases, 11 cases (3.9%) were finally diagnosed as gastric dysplasia (GD); gastric cancer (n=9, 81.8%) or adenoma (n=2, 18.2%). The other 271 cases were enrolled control group. The mean age (years; 60.4±9.2 versus 51.5±10.4; p = 0.006) and the mean of smoking history (pack-year; 25.4±23.2 versus 15.9±14.8; p = 0.016) were significantly different between GD group and control group. In the multivariate analysis, age≥59 years (OR 3.85, 95% CI 1.06-13.96; p = 0.040) and smoking history≥25 pack-year (OR 3.65, 95% CI 1.02-13.12; p = 0.047) significantly increased the risk of dysplastic lesion. Distribution of sex, familial history of gastric cancer, drinking, endoscopic impression, num- ber of taken biopsy, status of H. pylori infection were not different between two groups. Conc nclusi sions:

• ns: Among the cases of regenerative atypical

epithelium on initial biopsy, the rate of dysplasia was 3.9% on subsequent biopsy and the risk of dysplasia was increased with age and smoking history. Subsequent en-

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doscopy with biopsies is highly recommended, partic- ularly in old age and long-standing smoker. Ke Keywords: Stomach neoplasm, Aged, Smoking, Gastro- intestinal Endoscopy, Regenerative Atypical Epithelium PUG-06

Efficacy a and Safe fety of

• f Endo

doscop

• pic S

Submu bmucosal Dissection ion for Sup for Superfic icia ial Sq Squa uamous Esop

• phage

geal Neoplasia:

• plasia: a

a Meta-analysis ta-analysis

Byung-wook Kim and Joon Sung Kim

Internal Medicine, Incheon St Mary's Hospital, the Catholic University of Korea, Incheon, Korea

Backg Background

• und /

/ aims: aims: Although, ESD has grown popular in resecting lesions in the stomach, the application of ESD to the esophagus has been limited by greater tech- nical difficulty. An increasing number of series have re- cently reported the application of ESD to esophageal

• lesions. However, data on the efficacy and safety of

esophageal ESD are still controversial. The aim of the present systemic review and meta-analysis was to evaluate the efficacy and safety of ESD for esophageal lesions. Me Methods: Comprehensive literature searches (1999-2012) were performed on studies that reported ESD for the re- moval of esophageal neoplasia. Primary outcome meas- ures were pooled estimates of complete resection rate and en bloc resection rate. Secondary outcome meas- ures were pooled estimates of complication rates. Re Results: A total of 17 studies (15 Asian, 2 European) provided data on 865 ESD-treated lesions. The pooled estimate of complete resection rate was 89.7 % (95 % CI 85 %-93 %). The pooled estimate of en bloc re- section was 96 % (95 % CI 93 %-98 %). The pooled es- timates of complications of ESD such as bleeding, per- foration and stenosis were 2 %, 5 %, 12 %, each. Conc nclusi sions:

• ns: ESD appeared to be an extremely effective

technique to achieve complete resection of esophageal

• neoplasia. The very low rate of complications also

shows the potential safety of this approach. Ke Keywords: Endoscopic submucosal dissection; Esophageal neoplasia; Meta-analysis PUG-07

Cli Clinical F ical Featu atures es and Ou and Outcomes es of

• f End

Endosc scopi

• pic

Hemost mostasi asis f for Gas Gastroduod duodenal nal U Ulcer B r Bleed eeding ing in in the Elderly the Elderly

Itaru Yamamoto1, Hiroki Tanaka2, Keisuke Ishigami1, Ayako Ito1, Masanao Nasuno2, Suguru Nakagaki1, Shuji Satho1, Haruo Shimizu1 and Hiroyuki Kaneto1

1Department of Gastroenterology, Muroran City General Hospital, Muroran,

Hokkaido, 2Inflammatory Bowel Disease Center, Sapporo Kosei General Hospital, Sapporo, Hokkaido, Japan

Backg Background

• und / aims:

/ aims: With an increasingly aging society, the frequency of gastroduodenal ulcer bleeding in eld- erly individuals has been increasing. Here we compared the clinical features of endoscopic hemostasis between elderly and younger patients. Methods: thods: A total of 151 patients who underwent emer- gency endoscopy for gastroduodenal ulcer bleeding from January 2006 to December 2011 were examined. They were divided into an elderly group (90 patients; age, ≥70 years) and a younger group (61 patients; age, Re Results: The proportion of females was significantly higher in the elderly group than in the younger group (55.6% vs. 16.4%, p < 0.01), as was the proportion of pa- tients who received nonsteroidal anti-inflammatory drugs, anticoagulant agents, and antiplatelet agents (55.2% vs. 31.1%, p = 0.01). On the other hand, the rate

• f H. pylori infection was lower in the elderly group than

in the younger group (28% vs. 65%, p < 0.01). There were no significant differences in gastroduodenal ulcer loca- tion, hemostatic method, rebleeding rate, blood trans- fusion requirement, and fasting period between the two groups. Conc nclusi sions:

• ns: The treatment outcome of endoscopic

hemostasis was similar between the elderly and younger

• groups. If the general condition of a patient is good, we

recommend urgent endoscopic hemostasis as the first choice of treatment for gastroduodenal ulcer bleeding in both elderly and younger individuals. Keyw ywor

• rds:

ds: Gastroduodenal ulcer bleeding; Endoscopic hemostasis

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 395 PUG-08

Do the Do the Risk F Risk Fact ctor

• rs f

s for R Rebleeding bleeding Di Diffe ffer r According t g to the U the Use e of

• f A

Antithr thromb mbot

• tics?

ics?

Mi Jin Hong, Sun- Young Lee, Jeong Hwan Kim, In- Kyung Sung, Hyung Seok Park, Chan Sup Shim and Choon Jo Jin

Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea

Backg Background

• und / aims:

/ aims: Background/Aims: Endoscopic he- mostasis is the first-line treatment for upper gastro- intestinal bleeding (UGIB). Although several risk fac- tors for rebleeding have been reported, little is known in patients taking antithrombotics. The aim of this study was to uncover whether the risk factors for rebleeding differ according to the use of antithrombotics. Methods: thods: Methods: UGIB patients who were success- fully controlled by endoscopic hemostasis between August 2005 and September 2012 were included. Rebleeding was diagnosed when the lesion bled again within one month of the initial endoscopic hemostasis. Medical history including current medications was recorded. Emergency endoscopy was defined when the endo- scopic hemostasis was performed beyond the routine work hours (8:30 am - 6:00 pm). Resul sults: s: Of 614 UGIB patients, 138 patients (22.5%) were taking antithrombotics including 16 subjects taking du- al antithrombotics. Rebleeding rate was significantly higher in patients with antithrombotics (23.9%) than without antithrombotics (16.8%, p = 0.040). In pa- tients with antithrombotics, risk factor for rebleeding was longer procedural time for endoscopic hemostasis

Figure 1. Flow chart of upper gastrointestinal bleeding (UGIB) patients who were successfully controlled by en- doscopic hemostasis.

(p = 0.004). In patients without antithrombotics, emer- gency endoscopy (p = 0.027) was related to rebleeding in addition to longer procedural time (p = 0.015). Conc nclusi sions:

• ns: Conclusions: The risk of rebleeding is

higher in patients taking antithrombotics and those with longer procedural time. Need for emergency en- doscopy is an additional risk factor for rebleeding in pa- tients without antithrombotics (ClinicalTrials.gov ID: KCT0000640). Keyw ywor

• rds:

ds: Antithrombotics, Endoscopic hemostasis, Rebleeding, Risk factor, Upper gastrointestinal bleeding PUG-09

Usefulness o efulness of Pret etreat atment in ment in Transnasal ansnasal Endosc Endoscopy U

• py Using Rhinosc

ing Rhinoscope

Kamigaki Masahiko, Sinji Watanabe, Hideki Komatu, Yoshinori Fujimoto, Ikuo Nakazawa, Yasutaka Kumei and Norio Hayashi

Internal Medicine, Fukagawa Daiichi Hospital, Hokkaido, Japan

Backg Background

• und /

/ aims: aims: Although transnasal endoscopy has spread rapidly as an upper gastrointestinal tract exami- nation technique because of the reduced burden on the subjects, its pretreatment is rather more complicated than that in transoral endoscopy. Therefore we in- tended to improve the pretreatment of transnasal en- doscopy with respect to simplicity and efficiency. Methods: thods: We used a rhinoscope to select the nasal cav- ity for inserting the endoscope and then to anesthetize the selected nasal cavity by spraying 6 times(about 1.5mL) by means of Jackson type spray with 0.05% naphazoline nitrate, followed by 4% lidocaine hydro- chloride (corresponding to about 0.75mg and about 60mg, respectively). It took about 2 min to finish the pretreatment, and then after about 5 min, or 8 min when the selected nasal cavity seems to be slightly nar- row, endoscopic examination was set about on the left side. Re Results: The insertion of an endoscope into the selected nasal cavity was performed in 133 subjects who had un- dergone transoral endoscopy before (mean age, 65.3), and 125 subjects (94%) tolerated it safely. The re- sponses to a questionnaire administered to the subjects

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396 IDEN 2013 / 12th KJSGE

about the use of a rhinoscope, the procedure of anes- thesia and nasal pain during endoscopic examination showed high rates of satisfaction. Out of 125 subjects who underwent transnasal endoscopy, 115 subjects (92%) said they preferred transnasal endoscopy at the next endoscopic examination because of less distress during endoscopic examination compared to transoral endoscopy. Conc nclusi sions:

• ns: This pretreatment method of transnasal

endoscopy is considered to be a simple, but efficient and safe, method. Ke Keywords: Transnasal endoscopy, Rhinoscope, Pretreatment PUG-10

Cli Clinical Ou ical Outcomes es of

• f End

Endosc scopi

• pic and S

and Surg rgical ical Management f nagement for r Post stop

• per

erat ative U e Upper r Gast Gastroint intest stinal L inal Leakage akage

Seohyun Lee1, Hwoon-yong Jung1, Ji Yong Ahn1, Jeong Hoon Lee1, Kwi-sook Choi1, Do Hoon Kim1, Kee Don Choi1, Ho June Song1, Gin Hyug Lee1, Jin-ho Kim1, Beom Su Kim2, Jeong Hwan Yook2, Sung Tae Oh2, Byung Sik Kim2 and Seungbong Han3

1Gastroenterology, University of Ulsan College of Medicine, Asan Medical

Center, Asan Digestive Disease Research Institute, Seoul, 2Surgery, University of Ulsan College of Medicine, Asan Medical Center, Asan Digestive Disease Research Institute, Seoul, 3Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Backg Background

• und /

/ aims: aims: The aim of this study was to eval- uate the safety and efficacy of endoscopic therapy, an al- ternative and less invasive modality for the manage- ment of leakage after gastrectomy. Methods: thods: An electronic database of 35 patients with anastomotic leaks after surgery for stomach cancer that were treated with either an endoscopic procedure or surgery between January, 2004, and March, 2012, was

• reviewed. The success rates and safety of both modal-

ities was evaluated. Re Results: Endoscopic treatment was performed in 20 pa- tients and surgical treatment in 15 patients. The median time interval between the primary surgery and diag- nosis of leakage was 8.0 days (interquartile range, 5.0?14.0 days). Of the 20 patients with endoscopic treatment, technical success was achieved in 19 patients (95%) with resulting clinical success achieved in all of these 19 patients (100%). One patient with failed endo- scopic management went on to receive surgery. There were no cases of leakage-related deaths after endoscopic

• treatment. Of the 15 patients with surgical treatment,

five died due to sepsis, bleeding, or hospital-acquired

• pneumonia. For diagnosis of leakage, 17 patients from

the endoscopy group underwent computed tomog- raphy (CT) scanning, which revealed leakages in three patients (17.6%) and occult leakages were subsequently defined at fluoroscopy in all 20 patients. Seven of twelve patients (58.3%) from the surgical group had leakages diagnosed by CT scan. Conc nclusi sions:

• ns: Endoscopic treatment can be considered a

valuable option for the management of postoperative anastomotic leakage with a high degree of technical fea- sibility and safety, particularly for leakages that are not excessively large. Keyw ywor

• rds:

ds: Anastomotic leak, Endoscopy, Gastrectomy PUG-11

Usefulness o efulness of Introd

• duc

ucer M er Method thod of

• f P

Percutaneous utaneous End Endosc scopi

• pic Gast

Gastrost stom

• my U

y Using U g Ultrat athin hin Transnasal End ansnasal Endosc scopy

Chul-hyun Lim1, Hong-seok Lee1, Han Hee Lee1, Yoonbum Lee1, Soon-wook Lee1, Hyo Jun Ahn1, Na Young Kim1, Fisseha Tekle2, Tae-geun Kwon1, Jong Yul Lee1, Myong-ki Baeg1, Jin Su Kim1, Yu Kyung Cho1, Jae Myung Park1, In Seok Lee1, Sang Woo Kim1, Myung-gyu Choi1 and Kyu Yong Choi1

1Internal Medicine, The Catholic University of Korea College of Medicine, Seoul,

Korea, 2Internal Medicine, Myungsung Christian Medical Center, Addis Abeba, Ethiopia

Backg Background

• und /

/ aims: aims: The introducer method of percuta- neous endoscopic gastrostomy (PEG) minimizes pro- cedure-related peristomal infection. Ultrathin trans- nasal endoscopy (UTE) allows the comfortable endo- scopic examination of patients, with fewer adverse ef- fects, and the endoscope can pass through a narrow esophagus or oropharynx. The aim of this study was to investigate the clinical outcomes of the introducer method of PEG with UTE. Methods: thods: Patients who underwent introducer-method PEG with UTE between March 2009 and May 2012 were analyzed. The outcomes and complications of the

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 397 patients within 180 days of gastrostomy placement were investigated. Re Results: Ninety-two patients (31.9% male, 67.7 ± 16.6 years old) underwent introducer-method PEG with UTE during the study period. The major indications for PEG insertion were stroke (40.4%), esophageal cancer

• r head and neck cancer (27.1%), and neurological dis-
• rder (14.9%). Esophageal stenosis was identified by

endoscopy or imaging in 14 patients before PEG. UTE was successfully introduced through the nasal cavity in all patients. PEG was successfully inserted in 90 of the 92 patients (97.8%). Insertion of the endoscope to the stomach was impossible in two patients because head and neck cancer caused severe narrowing of the upper

• esophagus. There was no procedure-related peristomal

infection, gastric contents leakage, or bleeding within 30 days of gastrostomy placement. Catheter displace- ment occurred within 30 days in eight (8.7%) patients. Catheter displacement occurred in 44 (47.8%) patients and gastric contents leakage in eight (9%) patients within 30?180 days of gastrostomy placement. Conc nclusi sions:

• ns: Introducer PEG with UTE is a useful

method for gastrostomy placement, with a high success rate. Keyw ywor

• rds:

ds: Ultrathin endoscopy, Transnasal endoscopy, Percutaneous endoscopic gastrostomy, Introducer method PUG-12 Prepr eprocedur dural R l Rabepr bepraz azole T

• le Treatment bef

t before Gast stric c Endo Endosc scopic R ic Resect ction ion

Myong Ki Baeg, Myung-gyu Choi, Myong Ki Baeg, Seong Jin Moon, Chul-hyun Lim, Jin Soo Kim, Yu Kyung Cho, Jae Myung Park, In Seok Lee, Sang Woo Kim and Kyu Yong Choi

Division of Gastroenterology, Seoul St Mary's Hospital, Seoul, Korea

Backg Background

• und /

/ aims: aims: The time for the full effect of pro- ton pump inhibitors(PPI) to take place are reported to be 5 days. Our aim was to evaluate the benefit of start- ing oral PPI treatment 5 days before endoscopic sub- mucosal dissection(ESD) to prevent bleeding. Methods: thods: This was a prospective randomized con- trolled trial. 120 patients who underwent ESD were randomly assigned to the PPI/placebo group. Patients were given either oral rabeprazole 20mg or placebo b.i.d for 5 days before ESD. On the morning of ESD and date after, pantoprazole 40mg was intravenously administered. Afterwards, oral rabeprazole 20mg was administered

• nce daily. Follow-up endoscopy was performed on

days 1 and 28. Intragastric pH was measured in 25 pa- tients consenting to 48-hour pH measurement. The primary endpoint was major bleeding. The secondary endpoints were the number of exposed vessels/ulcer area and ulcer healing rate on endoscopy and intra- gastric pH. Re Results: Data for 98 patients who underwent ESD(PPI group: n=45; placebo group: n=53) were analyzed. Mean age of PPI and placebo group were 59±8.9 and 58±10 years. Major bleeding occurred in four from PPI and three from placebo group. The number of exposed ulcer vessels/ulcer area on day 1 were 0.20±0.27 in PPI and 0.36±0.41 in placebo group (p = 0.03). There were no significant differences in the ulcer healing rate. Intragastric pH over 4, 5 and 6 were 84.44%±19.32, 80.55%±22.21 and 73.8%±25.44 in PPI and 86.55%± 25.85, 85.18%±26.37 and 82.79%±27.14 in placebo group. Conc nclusi sions:

• ns: Preprocedural administration of rabepra-

zole offers no additional benefit in preventing major bleeding after gastric ESD. Keyw ywor

• rds:

ds: Gastric neoplasm, Endoscopic submucosal dissection, Proton pump inhibitor PUG-13

The The The Therape apeutic P c Potent ntial o ial of Irreversi rsible le Elec Electropor

• porat

atio ion n in St in Stomac

• mach:

h: Exp Experimental Study mental Study in R in Rat t

Hyuk Soon Choi, Bora Keum, Jae Min Lee, Jong Soo Lee, Seung Han Kim, Seoung Joo Nam, Eun Sun Kim , Yeonseok Seo, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Soon Ho Um, Chang Duck Kim and Ho Sang Ryu

Internal Medicine University College of Medicine, Seoul, Korea

Backg Background

• und /

/ aim aims: : Irreversible electroporation (IRE) is a novel, non-thermal method of tissue ablation using short pulses of high-voltage pulse current. IRE induces the breakdown of cell homeostasis and thereby cell

• death. The aim of this study was to evaluate the ther-

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398 IDEN 2013 / 12th KJSGE

apeutic potential of IRE in rat gastric tissue according to different electric energy. Methods: thods: A 3-cm midline abdominal incision in Sprague-Dawley rats was made, exposing the stomach. Small incision was done on greater curvature of stom- ach, a set of needle electrodes were gently applies on both side of the stomach. All samples for histologic analysis and tunnel assay were got at 0hours, 10 hours, 24 hours and 48 hours after IRE application. Re Results: H-E staining of tissue showed extensive areas and severe cell death, which were proved by a pyknotic nucleus and eosinophilic cytoplasm near absence of cell at 10 hours after IRE ablation. Positive results of TUNEL assay were found in the ablated zone at gross assessment, indicating involvement of apoptotic cell

• death. After 24 and 48 hours, mucosa becomes much

thinner by shedding of dead cells in the mucosa. And this result shows a morphologically intact endothelium

• f vessel on submucosal layer after IRE irrespective of

time, indicating sparing of connective tissue. Conc nclusi sions:

• ns: This study showed that IRE ablated stom-

ach tissue very effectively through the induction of cel- lular apoptosis. And apoptotic area was increased ac- cording to amplified IRE electric energy without dam- age to adjacent structure. This study suggests the po- tentiality of IRE application in the treatment of gastric cancer without metastasis. Keyw ywor

• rds:

ds: Irreversible electroporation, gastric cancer PUG-14

Esophageal Esophageal Fi Fibr brovascu ascular P lar Poly lyp I p Inducing cing As Asphyxia

Jin-seok Park, Seok Jeong, Byoung Wook Bang, Don Haeng Lee, Hyung Gil Kim, Kye Sook Kwon, Jin-woo Lee, Yong Woon Shin and Young Soo Kim

Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea

Con Conten ents ts: Fibrovascular polyps (FVPs) are benign but rare tumors of the upper digestive tract, and their course is usually indolent until reaching enormous

• proportions. The most common complaints include

dysphagia and foreign body sensation when the polyp

• regurgitates. And the asphyxia and laryngeal ob-

struction by the polyp regurgitation may cause sudden death which is the most feared complication. We de- scribe a 51-year-old male patient with an asphyxia oc- curred when he had been sleeping. The patient was ex- amined with Endoscopy and an FVP of the esophagus was notified. After diagnosing, we removed the polyp endoscopically using a polypectomy snare. After polyp excision, the patient was doing well at the 3-month fol- low-up without asphyxia or sleep disturbance. Ke Keywords: Esophageal neoplasm, asphyxia, polyps, treatment

Figure 1. The fibrovascular polyp went through vocal cord and obstructed air way. Figure 2. Histopathological examination revealed that the polypoid lesion contained vascularized loose fibrous shafts covered by squamous epithelium with acanthosis, indicative of a fibrovascular polyp

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 399 PLG-01

Meta-anal ta-analysis: s: P Predic edictive Cl Clinic inicopatho

• patholo

logic Fact ctors

• rs f

for r Lymp mph N h Node M de Metast stasi asis i in P Patient ents with E Early C Colore rectal C Carc rcinoma

Ju Young Choi1, Sung-ae Jung1, Ki-nam Shim1, Bora Keum2, Jeong-sik Byeon3, Kyu Chan Huh4, Byung Ik Jang5, Dong Kyung Chang6 and Hwoon-yong Jung3

1Department of Internal Medicine, Ewha Medical Research Institute, Ewha

Womans University School of Medicine, Seoul, 2Department of Internal Medicine University College of Medicine, Seoul, 3Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,

4Department of Internal Medicine, Konyang University College of Medicine,

Daejeon, 5Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, 6Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Backg Background

• und /

/ aims: aims: In order to reduce the number of unnecessary additional surgical resections, more rigid criteria for radical resections or additional resections following polypectomy are required. The objective of this study is to conduct a meta-analysis to determine risk factors that may facilitate patient selection for colectomy. Methods: thods: Eligible articles were identified by searches of PUBMED, Cochrane Library and Korean Medical Database using the terms (early colorectal carcinoma, LN metastasis, colectomy, endoscopic resection). Re Results: Thirteen cohort studies of 7,066 ECC patients who only underwent radical surgery have been analysed. There was a significant risk of LN metastasis when they had submucosal invasion(≥SM2 or ≥1000 μm)(OR3.00, 95%CI1.36-6.62, p=0.007). LN metastasis was noted in 12.9% with SM2 or ≥1000 μm submucosal invasion and 4.7% with SM1 or <1000 μm submucosal invasion. Moreover, it has been found that vascular invasion (2.70, 1.95-3.74, p<0.001), lymphatic invasion (6.91, 5.40-8.85, p<0.001), poorly differentiated tumours (8.27, 4.67- 14.66, p<0.001) and tumour budding (4.59, 3.44-6.13, p<0.001) were significantly associated with LN metastasis. Furthermore, another analysis was carried out on eight cohort studies of 310 patients who underwent additional surgeries following polypectomy. The major factors iden- tified in these studies include lymphovascular invasion

• n polypectomy specimens (5.47, 2.46-12.17, p<0.001)

and poorly or moderately differentiated tumours (4.07, 1.08-15.33, p=0.04). Conc nclusi sions:

• ns: For ECC patients with ≥SM2 or ≥1000

μm submucosal invasion, vascular invasion, lymphatic invasion or tumour budding, it is deemed that a more extensive resection accompanied by a LN dissection is

• necessary. An additional surgical resection should be

considered in patients with poorly or moderately differ- entiated tumours or lymphovascular invasion . Keyw ywor

• rds:

ds: Early colorectal carcinoma; Lymph node metastasis; Endoscopic resection; Surgical resection PLG-02

The The Relat lationshi

• nship betw

betwee een Gl n Gluc ucose T

• se Transpo

ansporter-1 r-1 (g (glut-1) Expr t-1) Expression and 18f-f ession and 18f-fdg U dg Uptak take in in Co Colore rectal C Cancer

Joung-ho Han

Division of Gastroenterology, Department of Internal Medicine, Chungbuk National University College of Medicine, 410 Sungbong-ro Heungdeok-gu, Cheongju-si Chungbuk, Korea

Backg Background

• und /

/ aim aims: : We assessed the ability of 18F-fluo- rodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to diagnose lymph node and distant metastases in colorectal cancer with GLUT-1 and Vascular endothelial growth factor expression. Methods: thods: We investigated 169 patients with the diag- nosis of colorectal cancer underwent 18F-FDG PET/CT before surgical treatment. Immunohistochemistry was performed using postoperative histopathological speci- mens and classified core and peripheral specimens. The estimation of immunohistochemistry was conducted using scoring analysis. We investigated the relationships between maximum standardized uptake value of pri- mary tumor (p-SUVmax) and lymph nodes (LN- SUVmax) and GLUT-1 expressions/pathologic T (p-T) stage/pathologic N (p-N) stage/pathologic tumor size/ WHO classification/tumor differenciation/American Joint Committee on Cancer TNM stage (AJCC TNM stage). We analyzed the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 18F-FDG PET/CT and CT for detect- ing lymph node metastases. Resu sults: s: SUVmax significantly correlated with GLUT-1

IDEN 2013 / 12th KJSGE

400 IDEN 2013 / 12th KJSGE

expressions and p-tumor length (GLUT-1: r _ 0.475, P _ 0.001; p-tumor length: r =0.475, P _ 0.001). SUVmax of the primary tumor had a significant relationship with p-T stage, p-N stage, and VEGF expression (p-T stage: P <0.001; p-N stage: P =0.037; VEGF expression: p= 0.009). There was a statistically significant difference between GLUT-1 expression and p-T stage/VEGF expression, but not p-N stage (pp-T stage: p=0.012; VEGF expression: P =0.01; p-N stage:P =0.572). VEGF expression had a sig- nificant relationship with p-T stage, but not with p-N stage (p-T stage:P_0.032; p-N stage:P_0.763). Conc nclusi sions:

• ns: 18F-FDG uptake can be determined by

GLUT-1 and VEGF.SUVmax would have a connection with the tumor progression and lymph node metastasis. Ke Keywords: Colorectal cancer, 18F-FDG uptake, PET/CT, GLUT-1 PLG-03

Color lorectal A ctal Adeno enomat atou

• us P

s Poly lyps ps and Lif and Life St Style e Re Related D Diseases

Kensuke Takuma1, Ryoichi Wada2, Toru Mitushima2 and Yoshinori Igarashi1

1Diveision of Gastroenterology and Hepatology, Department of Internal

Medicine, Oho University Omori Medical Center, Tokyo, 2Department of Digestive Organs, Kameda Medical Center Makuhari, Chiba, Japan

Backg Background

• und /

/ aim aims: : Recently, colorectal tumors have in- creased in Japan, and some reports have investigated an association of life style. In this study, we evaluated the association between colorectal adenoma and examina- tion outcomes of life style related diseases, and differ- ences of risk factors between genders. Methods: thods: A total of 2970 healthy subjects(2077 males and 893 females , mean age 51.8 years) had undergone initial colonoscopy for health examination at Kameda Medical Center Makuhari from April 2007 to March

• 2012. We divided them into two groups, such as 691

subjects with a pathological diagnosis of colorectal ad- enoma and 1812 subjects with normal colon, and eval- uated association with the prevalence of colorectal ad- enoma by gender according to age, physical findings {abdominal girth, body mass index (BMI), systolic and diastolic blood pressure}, biochemical examination {fasting blood glucose level, hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol, high-density lip-

• protein cholesterol, triglyceride, urinary acid}, ab-

dominal ultrasonography (fatty liver, gallbladder stone). All data were analyzed using Mann-Whitney-U test and multiple logistic regression analysis. Re Results: The prevalence of colorectal adenoma was 33.1% in males and 15.7% in females (p<0.001). In males, age {odds rate (OR) =2.925}, abdominal girth (OR=1.527), systolic blood pressure (OR=1.583), HbA1c (OR=1.336) were significant association with colorectal

• adenoma. In females, abdominal girth (OR=9.687), BMI

(OR=3.084), HbA1c (OR=4.399), fatty liver (OR=3.333) were significant association. Conc nclusi sions:

• ns: Abdominal girth and glucose intolerance

were associated the risk for colorectal adenoma in both genders, but age was not statistically significant in

• females. Dietary pattern will be confirmed by addi-

tional study. Keyw ywor

• rds:

ds: Colorectal adenoma; Life style related dis- ease PLG-04

A Ra Randomi

• mized Pros
• spectiv

ive T Tria ial Comp Comparin ing Differ Different R nt Regimens mens of

• f Or

Oral al Pic Picosulphat sulphate and and Poly lyeth ethyle lene Gl ne Glycol

• l-bas
• based L

ed Lavag vage in the in the Prep epar arat ation ion of

• f P

Patients f ents for r Colo Colonosc noscop

• py

Seung-joo Nam, Hoon Jai Chun, Yoon Tae Jeen, Jong Soo Lee, Eun Sun Kim, Bora Keum, Hong Sik Lee, Soon Ho Um, Chang Duck Kim and Ho Sang Ryu

Department of Internal Medicine University College of Medicine, Seoul, Korea

Backg Background

• und /

/ aim aims: : Adequate bowel cleansing is essen- tial for a high-quality, effective, and safe colonoscopy. There are rare reports that compare directly conventional polyethylene glycol (PEG) intake and picosulphate. The aim of this study is to compare the efficacy, safety, and tolerability of different regimens of oral picosulphate and PEG. Methods: thods: This study involved 200 adult patients under- going elective colonoscopy and was single-blinded pro- spective randomized design in tertiary-care institutions

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 401

• f South Korea. Patients were randomized into four

groups with endoscopist was blinded to the regimen. Group A: PEG 4L at 4-6 hours before procedure on the day of the colonoscopy. Group B: PEG 2L at 6:00 PM the day before and 4-6 hours before procedure. Group C: One of 2 sachets of sodium picosulphate at 6:00 PM the day before and 4 hours before procedure. Group D: One of 3 sachets of sodium picosulphate given at 6:00 and 09:00 PM the day before and at 4 hours before procedure. Re Results: PEG 4L group (both split and non-split dos- age) and 3 sachets of picosulphate produced better mu- cosal cleansing than 2 sachets of picosulphate. Side ef- fects were more frequent in PEG 4L than picosulphate. Patients’ preferences were most high in picosulphate than other goups. Conc nclusi sions:

• ns: Picosulphate is as effective as high-vol-

ume PEG-electrolyte solution but has superior tolerance. It has fewer adverse events and is preferred by patients. Ke Keywords: Picosulphate, Polyethylene glycol, Colonoscopy PLG-05

Addit dition o

• n of Peg

g or

• r Re-e
• exam w

m with Bisac th Bisacody dyl for l for Bo Bowel l Prepar eparat ation F n Failure: e: a a Prosp

• spect

ctive Study e Study

Jong Wook Kim1, Jeong-sik Byeon2, Sun-jin Boo3, Ock Bae Ko2, Jung-hye Han2, Soo-kyung Park2, Sang Hyoung Park2, Dong-hoon Yang2, Kee Wook Jung2, Kyung-jo Kim2, Byong Duk Ye2, Seung-jae Myung2, Suk-kyun Yang2 and Jin-ho Kim2

1Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, 2Department of Gastroenterology, Asan Medical Center, University of Ulsan

College of Medicine, Seoul, 3Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea

Backg Background

• und /

/ aims: aims: We aimed to compare bowel prepa- ration methods after failed initial bowel preparation (BP). Methods: thods: Patients who had BP failure for colonoscopy after routine 4L ingestion of polyethylene glycol (PEG) were prospectively enrolled from March 2008 to March

• 2012. Second colonoscopy was performed either on the

same day after additional ingestion of 2L of PEG (group A), or a week later with routine PEG (4L) and oral bisa- codyl 20 mg (group B). Multivariable analysis for poor BP on second colonoscopy was performed using logis- tic regression. Patients who had undergone prior major abdominal surgery or colon cancer were excluded. Re Results: Among the 85 patients enrolled, there were 20 cases (23.5%) of poor BP on second colonoscopy. The adequacy of PEG ingestion during the first colonoscopy among the groups A and B were similar (64.3% vs. 53.5%; p = 0.312). Multivariable adjusted odds ratio (OR) for poor BP on second colonoscopy with group B compared to group A was 0.47 (95% confidence inter- val [CI], 0.16-1.37). Adequately ingested PEG during the initial colonoscopy was associated with poorer BP

• n second colonoscopy (OR, 3.45; 95% CI, 1.03-11.57).

The rates of patient discomfort during the second BP were similar among the groups. Conc nclusi sions:

• ns: Immediate addition of 2L of PEG with

second colonoscopy on the same day after failed initial BP was not superior to re-examination after one week with additional bisacodyl to 4L of PEG ingestion. Stricter low fiber intake in group B could have con- tributed to lower rate of poor BP in group B. Keyw ywor

• rds:

ds: Colonoscopy; Bowel cleansing, Preparation regimen; Polyethylene glycol PLG-06

Inter tervent ention of

• n of Cap-

Cap-as assis sisted Chr ed Chromoendo endosc scopy

• py

aft after Colo r Colonosc noscop

• py Co

y Compet mpetency I cy Impr proves the es the Adeno enoma Det a Detect ctio ion R n Rates i s in the T the Trainees ainees

Hong Jun Park, Hyun-soo Kim, Bo Ra Kim, So Yeon Park, Jin Heon Hong, Ki Won Jo, Ho Yoel Ryu, Il Young Lee and Yong Kwan Lee

Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Backg Background

• und /

/ aim aims: : It is important to improve ADR in learning colonoscopy. Previously we reported that tech- nological assistance of cap-assisted panchromoendo- scopy (CAP-ACE) can increased the ADR. The aim of this study was to assess whether CAP-ACE intervention after technical competency increased ADR in the colo- noscopy trainees. Methods: thods: In this prospective study, from March 2011 to February 2013, six first-year GI fellows performed 500 colonoscopies respectively. Each fellow performed standard colonoscopy (SC) in the first 150 cases, then, 6

IDEN 2013 / 12th KJSGE

402 IDEN 2013 / 12th KJSGE

Figure 1. In the pre-intervention period, CAP-ACE group has a tendency of high adenoma detection rate. However, ADR was significantly different after intervention. In addi- tion, CAP-ACE group has found more adenomas after intervention. Figure 2. CAP-ACE intervention has strikingly increased the ability to find the small and flat adenomas.

fellows were divided into 2 groups, which were CAP-ACE group and SC group. The 3 fellows in CAP-ACE group performed 30 procedures from the 150st case using a CAP-ACE with indigocarmine, and then, the rest 3 fellows performed additional 350 SCs. Six GI fellows made and fulfilled the “colonoscopy learn- ing protocol” which includes all related parameters. Re Results: Six first-year GI fellows participated and a total

• f 3,000 colonoscopy procedures were analyzed. There

were no significant differences in gender, indications between the two groups. Mean withdrawal time were

• nly 1 minute longer in CAP-ACE group. In the first

150 cases, ADR, advanced ADR, number of patients with more than 3 adenomas (NMT3As) and mean number of adenomas per patient (MNAPP) were

• similar. However, in the latter 350 cases, ADR, NMT3As

and MNAPP were significantly increased in CAP-ACE

• group. On per adenoma analysis, more flat and smaller ad-

enomas were detected in CAP-ACE group than SC group. Conc nclusi sions:

• ns: After technical competency of colono-

scopy, the introduction of CAP-ACE could be helpful for quality improvement in the colonoscopy training programs. Keyw ywor

• rds:

ds: Trainee, Cap assisted, Chromoendoscopy PLG-07

Metac tachronous C nous Colon lon Neoplasm aft lasm after r Poly lypect pectom

• my: a

a Co Compar mpariso ison betw between een One-stag One-staged ed and T and Two-staged

• -staged Poly

lypecto ctomy y

Soo-kyung Park, Jeong-sik Byeon, Sang Hyoung Park, Jong Wook Kim, Hyo Jeong Lee, Ho-su Lee, Ji Beom Kim, Dong-hoon Yang, Kee Wook Jung, Kyung Jo Kim, Byong Duk Ye, Seung-jae Myung, Suk-kyun Yang and Jin-ho Kim and Jeong-sik Byeon

Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Backg Background

• und /

/ aims: aims: The impact of one-stage (removal

• f all neoplasms during diagnostic colonoscopy) vs.

two-stage polypectomy (removal of all neoplasms dur- ing therapeutic colonoscopy following the initial diag- nostic colonoscopy) on developing metachronous neo- plasm is poorly understood. We aimed to compare

• ne-staged and two-staged polypectomy on developing

metachronous neoplasm. Methods: thods: We reviewed the patients with colon neo- plasms for whom one-stage polypectomy was done and followed by at least 1 colonoscopy (case group). The de- velopment of any metachronous neoplasm and ad- vanced metachronous neoplasm were compared with age and sex matched (1:2) two-staged polypectomy group (control group). Re Results: A total of 249 patients underwent one-stage

• polypectomy. At the initial colonoscopy, the number of

neoplasms ≥3 (46.6% vs. 27.3%, p<0.001) was more common in control group, and there was no difference in advanced neoplasm (36.1% vs. 30.5%, p=0.13) between two groups. During the follow up (mean 26.3±13.1 months in case group vs. 23.9±12.5 months in control group, p=0.02), 347 (46.5%) patients had any metachro- nous neoplasm and 33 (4.4%) patients had advanced metachronous neoplasm. In multivariate analyses, ≥3

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 403 neoplasms compared with those with <3 neoplasm was the significant risk factor in the development of any metachronous neoplasms (hazard ratio, 1.72; 95% con- fidence interval, 1.38-2.14, p<0.001) and advanced neo- plasm was the significant risk factor in the development

• f any advanced metachronous neoplasms (hazard ratio,

2.33; 95% confidence interval, 1.17-4.66, p=0.01). One-staged vs. two-staged polypectomy did not affect the development of either any or advanced metachronous neoplasms. Conc nclusi sions:

• ns: One-staged polypectomy showed a sim-

ilar cumulative incidency of metachronous neoplasms compared with two-staged polypectomy. Keyw ywor

• rds:

ds: Polypectomy, colon, neoplasms PLG-08

Di Diffic fficult lt F Fact ctors of s of End Endosc scopi

• pic S

Submuc ucos

• sal

al Di Dissect ssection f n for C Colorect ctal al N Neopl

• plasms

sms

Naoki Hirano, Yoshinori Igarashi and Yasukiyo Sumino

Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan

Backg Background

• und / aims:

/ aims: Endoscopic submucosal dissection (ESD) for colorectal neoplasms have been able to resect the whole lesion in one piece and to provide histologic

• information. However, this technique has disadvantages

such as a long intervention time, complexity of the pro- cedure, and higher rate complications.Factors correlat- ing with the technical difficulty of colorectal ESD are still unclear. We defined difficult colorectal ESD case as more than 60min procedure time. The present retro- spective study aimed to clarify important factor related to difficult colorectal ESD. Methods: thods: From May 2009 to December 2012 ESD was performed on consecutive 81 lesions (45 men, 36 wom- en; mean age 68.6 years) of colorectal neoplasm, less than 60 min procedure time (44 lesions, Group A) or more than 60min procedure time (37 lesions, Group B ) and their clinical outcomes were compared. Results: sults: The mean procedure time of Group A was 31.7±12.9min. Group B was 121.5±69.5min. Multivariate logistic regression analysis confirmed significant, in- dependent factors: The mean tumor size was larger group B (42.9±15.9mm, ±SD) than group A (32.0±8.4) (p<0.05). Tumor location was not significant difference between group A (Right 18/ Left 26 ) and group B (Right 9/ Left 28). Tumor depth was not significant difference between group A (M 40, SM 4) and group B (M 32, SM 5). The complication such as bleeding (Group A, 0/44, 0%, Group B 0/37, 0%), perforation (Group A, 2/44, 4.5%, Group B 2/37, 5.4%) were not different between group A and group B. Conc nclusi sions:

• ns: Tumor size was difficult factor to proce-

dure colorectal ESD. In case of large size tumor, more caution is needed during submucosal dissection. Keyw ywor

• rds:

ds: Colorectal ESD PLG-09

Comp mpar aris ison o

• n of End

Endosc scopic ic T Treat eatment f for S Small all Rect ctal al C Carcinoi inoid T d Tumo mor: End Endosc scopic ic S Submuc ucosal

• sal

Di Dissect ssection V n Vers rsus S Simpli lified fied End Endosc scopic ic Sub Submuco ucosal D Dissection

• n

Seung Hye Jung, Young Seok Cho, Hyung Keun Kim, Sung Soo Kim and Hiun Suk Chae

Internal Medicine, Uijeongbu St Mary's Hospital, the Catholic University of Korea, Uijeongbu, Korea

Backg Background

• und / aims:

/ aims: Endoscopic submucosal dissection (ESD) has been used for the resection of rectal carci- noid tumor. ESD may cause longer resection time, more severe complications. The aim of this study was compare ESD with simplified ESD for the endoscopic treatment of small rectal carcinoid tumor. Methods: thods: Between January 2010 and February 2013, we enrolled consecutive patients with rectal carcinoid tu- mor 10 mm or less in diameter. We compared ther- apeutic outcomes of the ESD group and the simplified ESD group. Simplified ESD involved initially perform- ing ESD and used snaring as the final step of resection. Re Results: Thirty three lesions in 30 patients were enrolled (17 ESD cases and 16 simplified ESD cases). Both groups had similar mean tumor diameters (ESD 7.53 ± 1.94 vs. simplified ESD 6.63 ± 1.99 mm; p = 0.197). Resection time was longer in the ESD group than in the simplified

IDEN 2013 / 12th KJSGE

404 IDEN 2013 / 12th KJSGE

ESD group (20.12 ± 12.60 vs. 9.69 ± 3.61 min; p = 0.004). Histologically complete resection rate was 88.2% (15 of 17) in the ESD group and 81.2% (13 of 16) in the sim- plified ESD group (p = 0.592). Suspected perforation

• ccurred in 1 ESD patient (5.9%) and in 1 simplified

ESD patient (6.3%), and both patients were successfully managed using clips. There were no delayed perforation

• r delayed bleeding in either group. All patients with in-

complete pathologic resection showed no local re- currence or distant metastasis during the follow-up period. Conc nclusi sions:

• ns: Simplified ESD is a simple and effective

endoscopic treatment that compares favorably to ESD for small rectal carcinoid. Keyw ywor

• rds:

ds: Rectal carcinoid tumor; Endoscopic sub- mucosal dissection PLG-10

Long-t ng-ter erm Onc m Oncologic Out c Outcom

• mes

es of

• f St

Stent enting A ng As a a Br Bridge idge to to Surger rgery for M y for Malignant ant Col Colonic nic Obst struct ction: ion: Compariso mparison w with Em Emer ergenc ncy y Sur Surgery

Ji Min Choi, Jong Pil Im, Yoo Min Han, Min Jong Lee, Young Hoon Choi, Jeehye Kwon, Dong Kee Jang, Changhyun Lee, Sang Gyun Kim, Joo Sung Kim and Hyun Chae Jung

Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

Ba Backgroun

• und /aims: Self-expandable metallic stents (SEMS)

are now regarded as an effective and safe intervention for malignant colorectal obstruction (MCO). However, stent-related overt or silent perforations might lead to the spillage of tumor cells and result in distant metastases. We aimed to compare the long-term oncologic out- comes of SEMS insertion as a bridge to surgery with those of emergency surgery for MCO. Methods: thods: Between June 2005 and December 2011, 60 patients who underwent elective curative resection after SEMS insertion were included in the ‘SEMS group’. The ‘SEMS group’ was matched to 180 patients who underwent emergency curative surgery for MCO dur- ing the same period (‘Emergency surgery [ES] group’). The clinicopathologic characteristics, recurrence-free survival (RFS), and overall survival (OS) were com- pared between the two groups. Re Results: There were no significant differences in demo- graphics, tumor stage, location, and histology between the ‘SEMS group’ and the ‘ES group’. The Median fol- low-up times were 30.0 months (range 3.7~70.5 months) for the ‘SEMS group’ and 37.4 months (range 0.3~85.8 months) for the ‘ES group’. The proportions

• f patients who received postoperative adjuvant che-

motherapy were comparable (SEMS Group vs. ES group, 68.3% vs. 77.8%; p = 0.21). The long-term prog- nosis did not significantly differ between SEMS Group and ES group in either the 5-year RFS rate (76.3% vs. 69.5%; p = 0.352) or the 5-year OS rate (97.9% vs. 95.3%; p = 0.524). Conc nclusi sions:

• ns: Long-term oncologic outcomes of SEMS

insertion as a bridge to surgery were comparable to those of primary curative surgery. Keyw ywor

• rds:

ds: Stents, Emergencies, Intestinal obstruction, Colorectal neoplasms, Survival rate PLG-11

Palli lliat ative St e Stent ent fo for M r Malig lignant C ant Colonic lonic Obst struct ction ion by Ext by Extrac acolonic M

• lonic Malig

lignancy ancy: a a Co Comparison w with Co Colorectal C Cancer er

Sung Jin Moon, Sangwoo Kim, Bo-in Lee, Chul-hyun Lim, Jin Soo Kim, Yu Kyung Cho, Jae Myung Park, In Seok Lee, Myung-gyu Choi and Kyu Yong Choi

Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea

Backg Background

• und / aim

/ aims: : Palliative self-expandable metal stent (SEMS) placements for colonic obstruction aris- ing from an extracolonic malignancy (ECM) might be as useful as those for colorectal cancer (CRC), but data are limited. The purpose of this study were to inves- tigate the success and complication rates of SEMS placement in patients with ECM and to compare the long-term clinical outcomes of ECM group with those

• f CRC group

Methods: thods: We reviewed the short- and long-term out- come parameters of patients treated with palliative stents for colonic obstruction by ECM (n=44) or un- resectable CRC (n=53) from January 2006 to March 2011.

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 405 Re Results: Neither the technical success rates for SEMS placement in the ECM and CRC groups (93.2% vs. 98.1%, respectively, p = 0.326) nor the clinical success rates in the two groups differed significantly (77.3% vs. 84.9%, respectively, p = 0.433). The complications of SEMS placement also differed only slightly in the two groups (perforation: 4.8% [two cases] vs. 0%, re- spectively; migration: 4.8% vs. 5.8%, respectively, p = 0.343). In the aspect of long-term outcomes, although stent patency was shorter in the ECM group (p = 0.015), because the overall survival of this group was also shorter (p = 0.018), it was sufficient for palliative purposes. Conc nclusi sions:

• ns: Palliative stent placement was equally ef-

fective and safe for the treatment of colonic obstruction arising from ECM and from unresectable CRC. Even in cases of colonic obstruction arising from ECM, SEMS placement should be considered as a primary palliative therapy. Keyw ywor

• rds:

ds: Extracolonic malignancy, stent, colorectal cancer, stent patency, survival PLG-12

Repor port o

• n C

Clinic ical U al Use e of

• f C

Caps psule E e Endoscop

• py

y in in Korea f a for 10 Y r 10 Years ars

Yun Jeong Lim2, Oh Young Lee2, Yoon Tae Jeen2, Seong Ran Jeon2, Dae Young Cheung2, Jae Hee Cheon2, Byong Duk Ye2, Ji Hyun Kim2, Hyun Joo Song2, Jin Su Kim2, Cheol Hee Park2, Jae Hyuk Do2, Jeong Seop Moon2, Ki-nam Shim2, Dong Kyung Chang2, Jin-oh Kim2, Hoon Jai Chun2 and Myung Gyu Choi2

1Internal Medicine, Dongguk University Ilsan Hospital, Goyang, 2Korean Gut

Images Study Group,n Society of Gastrointestinal Endoscopy, Seoul, 3Internal Medicine,, Hanyang University College of Medicine, Seoul, Korea

Backg Background

• und / aim

/ aims: : Capsule endoscopy (CE) is firstline method to evaluate the small bowel since it was initiated about 10 years ago.To maximize the diagnostic yield, the entire small bowel needs to be visualized. Adequate bowel preparation is important because CE has the problem that lumen visualization is impaired by bub- bles, bile etc. Capsule retention is complication. This study is aimed at the overall evaluation of indication, endoscopic findings, diagnosis, completion rate and re- tention through nationwide multicenter study. Methods: thods: The twenty nine hundreds fourteen cases from twenty four hospitals had been registered in Korean capsule endoscopy registry for 10 years (October, 2002~September, 2012). Re Results: Mean age is 53.0 ± 17.6 years and male is pre- dominant (61%). The most common cause of reason for CE is obscure GI bleeding (59%). On the CE find- ing, normal finding occupied 34% and ulcers (20%), erosions (11%), angiodysplasia (9%) are common

• findings. Most common CE diagnosis is small bowel tu-

mor (9.6%) and vascular lesions (9.3%). Incomplete rate is 33%. Completion rate is significantly increasing in better bowel preparation. The quality of bowel prep- aration for CE was not statistically different according to various methods of preparation. Capsule retention is 3% (90/2914) and is high in small bowel tumor (5.7%) and Crohn’s disease (3.4%). Children under 10 years should be cautioned because retention is very high (8.3%). Poor bowel preparation are significantly asso- ciated with retention. Conc nclusi sions:

• ns: CE is valuable in the elucidating small

bowel disease but, retention and incomplete rate is rela- tively high as compared with previous reports. Keyw ywor

• rds:

ds: Capsule endoscopy, Small bowel disease, Bowel preparation, Retention PLG-13

Comp mpar arison o ison of Capsule End Capsule Endosc scopy R

• py Reading

ading Mode: de: Conc ncer ern ab n about Efficiency

• ut Efficiency and

and Time Sa me Saving ng

Jae Min Lee, Yoon Tae Jeen, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Hong Sik Lee, Hoon Jai Chun, Soon Ho Um, Chang Duck Kim and Ho Sang Ryu

Gastroenterology University Anam Medical Center, Seoul, Korea

Backg Background

• und / aims:

/ aims: Capsule endoscopy is a useful test for evaluation of the small bowel. However, capsule en- doscopy is needed the substantial time for capsule

• reading. The aim of this study was to investigate evalua-

tion times and false negative rates in three different reading modes to find the most appropriate mode for evaluation of capsule endoscopy. Methods: thods: Three trainee endoscopists reviewed capsule endoscopy studies performed at our institution from

IDEN 2013 / 12th KJSGE

406 IDEN 2013 / 12th KJSGE

5/2007 to 6/2012. Each trainee endoscopist read a total

• f 30 capsule endoscopy videos. Three endoscopists

compared three different capsule endoscopic software modes: automatic view at a speed of 20 frames per sec-

• nd (fps) and automatic quadview at a speed of 20 fps,

quickview at a speed of 4 fps. Re Results: The mean evaluation time using quickview was significantly shorter than with automatic view (automatic single view: 18 min 48 sec, quadview: 19 min, quick- view: 2 min 7 sec). The false negative rates of ulcers, erosions were higher when reading in quickview com- pared with reading in automatic view. However, the de- tection rate of bleeding was similar when reading in quickview compared with automatic view. A theoretical advantage of quadview is a longer single frame exposure time compared with singleview. Conc nclusi sions:

• ns: Quickview can be used confidently in

small bowel bleeding and can be performed in a short

• time. However, quickview mode has a high false neg-

ative rate for the other lesions, such as ulcers or

• erosions. Selection among time-saving methods should

be made on the basis of the clinical indication for the capsule endoscopy. Ke Keywords: Capsule endoscopy, reading mode, Detection rate, Evaluation time PLG-14

Cli Clinical and ical and End Endosc scopi

• pic Featur

atures of es of P Patients w ents with th Ulcera rati tive C Coliti tis i in a J Japanese L Local C Core Ho Hospital

Ayako Ito1, Hiroki Tanaka2, Keisuke Ishigami1, Itaru Yamamoto1, Masanao Nasuno2, Suguru Nakagaki1, Shuji Satoh1, Haruo Shimizu1 and Hiroyuki Kaneto1

1Department of Gastroenterology, Muroran City General Hospital, Muroran,

Hokkaido, 2Inflammatory Bowel Disease Center, Sapporo Kosei General Hospital, Sapporo, Hokkaido, Japan

Backg Background

• und / aims:

/ aims: In Japan, the prevalence of ulcer- ative colitis (UC) is increasing rapidly, resulting in in- creased opportunities for diagnosis and medical treat- ment of UC patients in local core hospitals. However, details of Japanese UC patients visiting local core hospi- tals are unknown because of the small number of cases. We characterized the clinical and endoscopic features of patients with UC in a Japanese local core hospital. Methods: thods: Retrospective data for 35 patients with UC visiting the Department of Gastroenterology, Muroran City General Hospital were collected. We compared the clinical and endoscopic features of UC patients diag- nosed before 2002 with those of patients diagnosed af- ter 2003. Re Results: A total 35 UC cases were treated, of which 18 were female. Their mean age at the time of publishing the study and at the time of diagnosis were 45.5 and 36.9 years, respectively. The mean duration of disease was 16.4 years. Sixteen had total colitis, 10 had left-sid- ed colitis, and 9 had proctitis-type colitis. Although the clinical and endoscopic features were similar between UC cases diagnosed before 2002 (n = 14) and after 2003 (n = 21), the mean age at the time of diagnosis among UC cases diagnosed before 2002 (31.8 ± 14.2 years) than those diagnosed after 2003 (40.3 ± 20.3 years). Conc nclusi sions:

• ns: The characteristic clinical and endoscopic

features of UC cases in a Japanese local core hospital re- sembled those previously reported in Japan, and most showed no remarkable changes in comparison with ten years previously. However, the age at onset of UC may be increasing. Keyw ywor

• rds:

ds: Ulcerative colitis; Characteristic clinical and endoscopic features; Japanese local core hospital PLG-15

The The Usefu efulness of ness of T Tacr crolim

• limus in

us in Ulcerative Coli Colitis

Shinji Sato, Hiroshi Morita, Naoki Hirano, Ken Ito, Hidenori Kurakata, Hidenari Nagai, Yasukiyo Sumino and Yoshinori Igarashi Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan

Backg Background

• und /

/ aims: aims: Ulcerative colitis (UC) is an idio- pathic inflammatory bowel disease characterized by a chronic relapsing/intermittent clinical course.Tacrolimus has been shown to be safe and effective therapy for ste- roid refractory/resistant UC.Since differences in the on- set of action between various agents are thought to in- fluence the achievement and maintenance of disease re-

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 407 mission, accelerated stepup therapy with tacrolimus may be useful. The aim of this study is to identify the short term benefit of one month tacrolimus admin- istration for the treatment of moderate to severe UC. Methods: thods: Eight patients(male 6, female2 age 40.2±8.2) with active phase, moderate to severe UC were treated with oral tacrolimus at a dose of 0.1 mg/kg body weight

• daily. The dosages were adapted to maintain trough

whole-blood levels of 10 to 15 ng/mL to induce re- mission and 5 to 10 ng/mL to maintain remission. Laboratory data,activity index and endoscopic featuers were assessed to evaluate in short-term outcomes. Re Results: At four weeks after the initiation of tacrolimus therapy, clinical remissions were observed for three pa- tients (37.5%) and clinical response were achieved for three patients (37.5%) and the response rate was 75%. Harf of the patients got into mucosal healing in end- scopic features, and almost patients were successed to induce high trouph phase within 7 days after the ini- tiation oftacrolimus therapy and there was no severe complications in entire period of using tacrolimus. Conc nclusi sions:

• ns: Tacrolimus is a safe and effective therapy

for the treatment of moderate to severe UC,although still more longer follow-up of patients and compilation

• f further clinical data will be necessary.

Keyw ywor

• rds:

ds: Tacrolimus,ulcerative colitis PLG-16 Mucosal sal H Heal alin ing R g Rate in J in Japanese P nese Patients w ents with C th Croh

• hn’

n’s s Diseas ase Trea eate ted w with Inf th Infliximab

Hiroki Tanaka, Masaki Yamashita, Masanao Nasuno, Manabu Ishii, Satoshi Motoya and Akimichi Imamura

Inflammatory Bowel Disease Center, Sapporo Kosei General Hospital, Sapporo, Hokkaido, Japan

Backg Background

• und /

/ aims: aims: Mucosal healing is considered an important benefit of treatment with anti-tumor ne- crosis factor alpha for Crohn’s disease (CD). However, the details of mucosal healing in Japanese patients with CD treated with infliximab remain unclear. We ana- lyzed the mucosal healing rate in Japanese patients with CD treated with infliximab. Methods: thods: We investigated patients who were treated with infliximab for CD between January 2003 and November 2010 at the IBD Center, Sapporo Kosei General Hospital. The inclusion criteria were as follows: 1) patients who received infliximab for at least 6 months; 2) those who underwent baseline ileocolono- scopy and who had mucosal ulcerations in the terminal ileum, cecum, colon or rectum; and 3) those with base- line mucosal ulceration and who underwent follow-up ileocolonoscopy 7-30 months prior to receiving dose intensification of infliximab. Mucosal healing was de- fined as absence of mucosal ulceration at baseline. Re Results: A total of 56 patients were selected for this ret- rospective study. Of these, 17 were female. The mean patient age was 27.3 ± 9.6 years, and mean disease dura- tion was 4.4 ± 5.7 years. Thirty-five patients had ileoco- litis, 12 had ileitis, and 7 had colitis. Concomitant treat- ment with azathioprine or 6-mercaptopurine, 5-ami- nosalicylic acid, elemental diet therapy, and pre- dnisolone was administered in 41, 45, 41 and 46 pa- tients, respectively. Seven patients underwent surgery for CD. Mucosal healing was observed in 77.8% pa- tients Conc nclusi sions:

• ns: Satisfactory mucosal healing rate was ach-

ieved in patients with CD who did not require dose in- tensification of infliximab. Ke Keywords: Crohn’s disease; Infliximab; Mucosal healing PLG-17

Effi Efficac cacy of

• f A

Adali alimumab ab in P in Patients w ts with C th Crohn’

• hn’s

s Di Disease sease

Manabu Ishii, Ken-ichi Tarumi, Tomoari Kamada, Hiroshi Matsumoto, Minoru Fujita, Yoshiyuki Yamanaka, Takahisa Murao, Motoyasu Osawa, Asami Hayashida, Nobunori Hirai, Shinya Fukushima, Yoshiki Kimura, Rui Nakato, Akiko Shiotani and Ken Haruma

Gastroenterology Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan

Backg Background

• und /

/ aim aims: : In this study, we aimed to inves- tigate the efficacy of adalimumab in Japanese patients with Crohn’s disease (CD). Methods: thods: From February 2011 to November 2011, ret-

IDEN 2013 / 12th KJSGE

408 IDEN 2013 / 12th KJSGE

rospective data were collected from patients with active CD (Harvey-Bradshaw index [HBI] scores, ≥7) who received adalimumab. A total of 10 patients with active CD were included. Each patient received adalimumab 160/80 mg at weeks 0/2, and then 40 mg adalimumab every other week. The efficacy of adalimumab was eval- uated based on reduction in HBI scores. Clinical re- mission was defined as an HBI score of ≤4. In patients who underwent colonoscopy before and within 6 months of more than 3 months after the initiation of adalimumab therapy, the efficacy of adalimumab was evaluated based on reduction in Simple Endoscopic Score for Crohn’s Disease (SES-CD). Re Results: At any observational point before 24 weeks af- ter the initiation of adalimumab therapy, HBI scores were lower than those before the start of treatment. The remission rates at 4, 10, and 24 weeks after the start of adalimumab therapy were 50%, 40%, and 70%,

• respectively. Among 6 patients who underwent colono-

scopy, 2 showed decreased SES-CD, while 2 others showed increased SES-CD; the SES-CD of the remain- ing 2 patients did not change. Conc nclusi sions:

• ns: Adalimumab was effective for the in-

duction and maintenance of clinical remission in pa- tients with active CD. In particular, the remission rate at 24 weeks after the initiation of adalimumab therapy was higher than that immediately after the initiation of therapy. Keyw ywor

• rds:

ds: Adalimumab, Crohn’s Disease PLG-18

Peritoni nitis s Accompani mpanied w d with S th Small all Bo Bowel l Perforat ation ion Caused b Caused by Fish B Fish Bone in ne in Normal al Pe Person

Yong Hoon Choi1, Gyu Won Kim1, Jung Seok Kim1, Ha Ram Lee1 and Chan Sup Shim2

1Internal Medicine, Sahm Yook Medical Center, Seoul, 2Global Digestive Disease

Center, Konkuk University Medical Center, Seoul, Korea

Con Conten ents ts: Perforation of the GI tract by ingested for- eign bodies is rare, and less than 1% of ingested foreign bodies perforate the bowel. Perforation of the GI tract has a wide spectrum of clinical presentations, including acute or chronic abdominal pain, gastrointestional hemorrhage, bowel obstruction, and even bizarre clin- ical manifestations such as ureteric colic. So foreign body perforation represent a challenging clinical scenario. Foreign body perforations could occur in all segments of the GI tract, but tend to occur in regions of acute angu- lation, such as the ileocecal and rectosigmoid junctions. But perforation occurred in small bowel with negative pathologic findings has been rarely reported. So we re- port a case of small bowel perforation caused by fish bone, with negative surgical and pathologic findings.

Figure 1. Computed tomography findings, showing small amount of free air with mesenteric perforation Figure 2. Operative findings of small bowel perforation by fish bone, without definite obstruction or stricture.

Keyw ywor

• rds:

ds: Peritonitis; Small bowel perforation; Foreign body ingestion; Fish bone

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 409 PLG-19

Reso solution of

• n of Col

Colonic L nic Lymphang mphangiomatos iomatosis aft after r Po Polypectomy: a a Case R Report

Young Soo Lee1, Kyu Won Kim1, Dong Keun Kim1, Yong Hoon Choi1, Dong Ju Kim1, Hye Jae Cho2 and Chan Sup Shim3

1Internal Medicine, Sahm Yook Medical Center, Seoul, 2Pathology, Sahm Yook

Medical Center, Seoul, 3Global Digestive Disease Center, Konkuk University Medical Center, Seoul, Korea

Con Conten ents ts: Lymphangioma is an uncommon malforma- tion of the lymphatic system that involves a benign pro- liferation of the lymphatics. Cystic mass in lymphangio- ma is caused by obstruction or agenesis of lymphatic

• vessel. Lymphangioma is recognized as a benign tumor,

but the proper method of its treatment has remained

• unsettled. As it is thought to be produced by the obstruction
• f lymphatic flow, one can expect it to be resolved by mak-

ing a new channel or conduit to it. We have a case of co- lonic lymphangiomatosis that was completely resolved

Figure 1. Colonoscopic view of colonic lymphangiomatosis. Figure 2. Resolved colonic lymphangiomatosis after polypectomy.

by a single polypectomy and several incisions. Therefore, we propose that making conduits for lymphatic drainage may be an alternative, and perhaps the optimal, method

• f treatment for lymphangioma.

Ke Keywords: Lymphangioma; Lymphangio- matosis; Colon; Resolution; Polypectomy PLG-20

A Cas Case of

• f Skul

Skull M Metas tastasis asis fr from

• m Col

Colon n Canc Cancer er

Dong Woo Shin, Yun Jin Chung, Hyunsoo Kim, Chang Keun Park, Dae Jin Kim, Hyang Eun Seo, Jae Kwon Jung and Dong Wook Lee

Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea

Con Conten ents ts: The incidence of colon cancer in many Asian countries has been rising steadily and that is associated with increased mortality. The common sites of meta- stasis from colon cancer are liver, peritoneum and lung. However, metastasis to the skull is extremely rare.A 63-year-old man presented with subcutaneous bulging mass on the left scalp without focal neurologic deficit. He was already diagnosed with adenocarcinoma of the colon with multiple liver metastasis 26 months ago and received chemotherapy. Brain MRI showed a convex mass in left parieto-temporal skull that was slightly

Figure 1. MR image of skull metastasis

IDEN 2013 / 12th KJSGE

410 IDEN 2013 / 12th KJSGE

Figure 2. Histologic findings on skull metastasis

decreased signal intensity on axial T1- and T2-weighted images with heterogenous enhancement by gadolinium. The mass destructed bony structures and expanded

• utward to the scalp and inward to the dura not involv-

ing brain parenchyme or adjacent leptomeninges. PET-CT revealed a hypermetabolic focus suggesting distant metastasis. Needle biopsy was performed of the mass and histological examination demonstrated a mod- erately differentiated adenocarcinoma. Immunohisto- chemical stain was positive for cytokeratin 20 and CDX2 that are specific markers for metastatic adenocarcinoma. The final diagnosis is the skull metastasis from colon cancer and the patient was transferred to the depart- ment of the radiation oncology for palliative radiotherapy. We report a case of skull metastasis in a patient with co- lon cancer. Keyw ywor

• rds:

ds: Skull Metastasis, Colon Cancer PPB-01

Chang Changes s in Cau in Causat ative P e Pathog thogens of ens of A Acut ute e Cholang Cholangitis s and Their Ant and Their Antimicr microbial

• bial

Susc scept eptibi bilit lity o

• ver a

er a Period

• d of
• f 6 Y

6 Years ars

Dae Young Yun, Ho Gak Kim, Jeong Seok Kwon, Hyun Hee Kim, Hyun Sik Hwang, Jun Hyeok Choi, Jang Seok Oh, Hee Sang Jang, Jimin Han, Jin Tae Jung, Joong Goo Kwon and Eun Young Kim

Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea

Backg Background

• und / aims:

/ aims: We evaluated changes of bacteria cultured from bile and blood and their antimicrobial susceptibility over six years at our institution. Methods: thods: From Aug. 2006 to Aug. 2012, medical re- cords of patients with acute cholangitis who received biliary drainage were retrospectively reviewed. Acute cholangitis was diagnosed when one or more of the fol- lowings were present: purulent bile, WBC in bile≥ 50/HPF, positive bile culture. Total of 1,589 cases were

• included. Cases were divided according to time period:

group A (Aug.2006-Dec.2008) and group B (Jan.2009- Aug.2012). Cases were also divided into community- acquired cholangitis (CAC) (n=201, 12.6%) and hospi- tal-acquired cholangitis (HAC) (n=1,388, 87.4%). Re Results: Of 1,589 cases with bile culture, growth of bac- terium was detected in 1,513 cases (95.2%). Gram-neg- ative bacteria were isolated in 1,422 cases (94%). Most frequently isolated Gram-negative bacteria were ex- tended beta-lactamase (ESBL)-producing Escherichia coli (E. coli) (n=482, 33.9%), E. coli (n=211, 14.8%), Citrobacter freundii (n=110, 7.7%), Klebsiella pneu- moniae (K. pneumoniae) (n=99, 7.0%), and ESBL- producing K. pneumoniae (n=90, 6.3%). In HAC group, prevalence of ESBL-producing E. coli and Citrobacter freundii was higher than in CAC (52.1 vs. 31.4%, p = 0.00; 13.5 vs. 6.9%, p = 0.002). Prevalence

• f Citrobacter freundii was higher group B (p = 0.000)

and HAC (p = 0.001) and prevalence of ESBL-produc- ing E. coli was higher in HAC (p = 0.000). Antimicrobial agents with high susceptibility were as follows: imipenem (95.7%), amikacin (85.3%), cefote- tan (77.7%), piperacillin-tazobactam (70.3%). Conc nclusi sions:

• ns: ESBL-producing E. coli is the most com-

mon pathogen in cholangitis over 6 year period. In

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 411 HAC, prevalence of ESBL-producing E. coli and Citrobacter freundii is higher than in CAC. Keyw ywor

• rds:

ds: Acute cholangitis, bile culture, antimicrobial susceptibility, antimicrobial resistance PPB-02

Percutaneou aneous P Papillar pillary Lar Large Balloo e Balloon Di Dilat lation f for r Treat eatment of t of Lar Large B e Bile-duct le-duct St Stones:

• nes: a F

a Feasi asibili ility y Stu Study

Gyung Eun Kim, Seok Jeong, Jee Young Han, Don Haeng Lee, Byoung Wook Bang, Jin-woo Lee, Kye Sook Kwon, Hyung Gil Kim, Yong Woon Shin and Young Soo Kim

Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea

Backg Background

• und /

/ aims: aims: When the access to major duodenal papilla or endoscopic retrograde cholangiopancreatog- raphy (ERCP) is failed, percutaneous transhepatic chol- angioscopic lithotripsy (PTCS-L) may be useful to re- move common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) performed during PTCS-L for the removal of large CBD stones, is not established yet. The aim of this study was to inves- tigate the safety and efficacy of PPLBD for the treat- ment of large CBD stones. Methods: thods: Eleven patients with large CBD stones in whom the access to major papilla or ERCP had failed in a tertiary referral center between September 2011 and August 2012 were enrolled prospectively. Papillary dila- tion using large-bored (12-20 mm) balloon dilation catheter was performed through the percutaneous transhepatic route. We analyzed the efficacy of the stone retrieval and post-procedure complications after the procedure. Re Results: The success rate for the complete duct clearance was 100%. There was no patient who needs use of basket to remove the stone after PPLBD. Electrohydraulic litho- tripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8

• minutes. There was no any complications occurred af-

ter PPLBD. Asymptomatic hyperamylasemia did not

• ccur in all patients.

Conc nclusi sions:

• ns: The current data suggested that PPLBD is

safe and effective for removal of large CBD stones. Keyw ywor

• rds:

ds: Balloon Dilation,Choledocholithiasis PPB-03

Dev Development of lopment of a a Swine Benig ine Benign Biliar Biliary St Strict ctrure Mode del U Using Endobi g Endobiliar ary R y Radi diofre

• frequenc

quency A Ablation

• n

Seok Jeong and Don Haeng Lee

Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea

Backg Background

• und /

/ aims: aims: An established and reproducible animal model of benign biliary stricture (BBS) has been indispensable to develop new devices or methods for endoscopic treatment of biliary stricture. We studied how to make a porcine BBS model using endobiliary ra- diofrequency ablation (RFA). Methods: thods: 14-month-old, female mini pigs (Sus scrofa), each approximately 30 kg, were used. Endoscopic retro- grade cholangiography (ERC) was performed in 12

• swine. The animals were allocated to three groups (100

W, 80 W, and 60 W) according to the electrical power level of RFA electrode. Endobiliary RFA was applied to the common bile duct for 60 seconds using by RFA probe which could be endoscopically inserted. ERC was repeated two and four weeks respectively after the RFA to identify BBS. After the strictures were identified, the animals were euthanized and bile duct samples were achieved to evaluate the pathologic findings. Re Results: BBS were verified in all animals. Cholangitis were detected on endoscopic findings of day 14 in all the animals of 3 groups, but not significant. Bile duct perforations occurred in 1 swine (n=1, 100%) for 100 W group, and 1 swine (n=7, 14.3%) for 80 W group. There was no major complication (n=4, 0%) in 60 W

• group. All benign strictures were proven pathologically.

The pathologic findings resembled BBS in human. Conc nclusi sions:

• ns: The application of endobiliary RFA with

60 W-electrical power resulted in a safe and reprodu- cible swine model of BBS. Ke Keywords: Catheter ablation, radiofrequency; Common bile duct; Constriction, pathologic

IDEN 2013 / 12th KJSGE

412 IDEN 2013 / 12th KJSGE

PPB-04

Treatment S ent Strategy for for A Adenom enomyomato tosis sis of

• f th

the Gallb Gallbladde dder r According ing t to 3 Di 3 Diffe fferent T nt Types pes

Eun-ji Lee, Young Soo Moon, Tae Oh Kim, Seung Ha Park, Jong Ha Park, Nae-yun Heo, Hyung Jun Kim, Soon Il Lee and Gi Jung Jeon

Department of Internal Medicine, Haeundae Paik Hospital,inje University College of Medicine, Busan, Korea

Backg Background

• und / aims:

/ aims: Adenomyomatosis of gallbladder (GB) is relatively rare, benign hyperplastic condition. Correct diagnosis is sometimes difficult because over- lapping features of imaging. We investigated final diag- noses in patients with different types of gallbladder ad- enomyomatosis by multimodality evaluation, including US, CT and EUS. Methods: thods: A retrospective review of 16 consecutive pa- tients with abnormal radiologic findings (focal or dif- fuse GB wall thickening) were included. Re Results: Among 16 patients, US, CT, EUS and histo- logic diagnosis were made. Ten patients of 16 whom ad- enomyomatosis was suspected underwent surgical

• resection. Three of them were confirmed by surgical
• pathology. Two patients of them had localized type ad-

enomyomatosis and one had segmental. In one patient that was diagnosed as adenocarcinoma revealed diffuse type by surgery. Other 6 patients showed chronic

• cholecystitis. Their EUS findings were equivocal, 4 of

them were accompanied with sludge or stone. Six pa- tients without symptoms have only regular follow-up. Three morphological types of adenomyomatosis are described, and some patients were treated with

• peration. Localized type, especially adenomyoma is

indication of surgery because imaging could not differ- entiate malignancy. Segmental type is reported to be oc- casionally associated with cancer risk. If patient have symptoms or gallstone, we consider surgical treatment primarily. Conc nclusi sions:

• ns: Adenomyomatosis is an uncommon, be-

nign gallbladder disease, and sometimes accurate diag- nosis is difficult because of overlapping features with

• ther conditions. Surgical resection may be indicated in

symptomatic cases or an unclear diagnosis, but judi- cious decision making through meticulous examina- tion is necessary. Here, we recommend treatment strat- egy for the management of GB adenomyomatosis. Ke Keywords: Adenomyomatosis of gallbladder, EUS, Surgical pathology PPB-05

Effic Efficacy of cy of Endo Endosc scopic P

• pic Pancr

ncreat atic ic St Stent enting for ng for the the Panc ncreatic D ic Duct ct S Strictu cture fr e from C Chronic P c Panc ncreatit itis is

Ken Ito, Takahiko Mimura, Seiichi Hara, Kensuke Takuma, Yui Kishimoto and Yoshinori Igarashi

Division of Gastroenterology and Hepatorolo, Toho University, Omori Medical Center, Tokyo, Japan

Backg Background

• und / aims:

/ aims: We carried out a retrospective study to evaluate the efficacy of the endoscopic treatment of pancreatic duct strictures from chronic pancreatitis. Methods: thods: The indications for this study are the follow- ings :a) presence of abdominal symptoms, and b) asso- ciation with the pancreatic duct stricture and upstream MPD dilatation detected by diagnostic imaging. The relative indications are the followings, a) asymptomatic cases, and the presence of lithiasis in the Santorini duct

• r Wirsung duct with MPD dilatation. Panceratic

sphincterotomy was routinely performed. After gradual dilatation, 10Fr. plastic pancreatic stent was finally

• inserted. The stents were replaced every 3 months, and

removed if the stricture was considered to be dilated af- ter stenting. Re Results: Over an eight-year period (May 2005 to December 2010), 59 patients (alcoholic in 49 patients, idiopathic in 3 patients, and others in 7 patients) were treated by

• EPS. Endoscopic stenting was successfully completed in

46 of 59 patients (77.9%) without any complication. Pain relief was obtained in 53 of 59 patients (89.8%). In the 13 failed cases of pancreatic stenting, 10 patients were asymptomatic, but 3 patients required surgical drainage because no improvement of pain relief. Six of 46 patients (13%) had recurrence of MPD stricture ( al- cohol abuse in 2 patients, no alcohol abuse in 4 pa- tients), and required re-stenting. Conc nclusi sions:

• ns: EPS is an effective and useful procedure

and useful for prevention of re-stricture in patients with

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 413 benign pancreatic duct strictures from chronic pancreatitis. However, surgical drainage should be considered in EPS failed cases. Keyw ywor

• rds:

ds: Endoscopic pancreatic stenting chronic pan- creatitis PPB-06

Abdomi dominal C nal Compar mpartment S ent Syndr ndrome me in Se in Severe Acute P e Pancr ncreat atit itis T is Treat eated d with th Percutaneous utaneous Cathet eter Dec Decompr mpressi ssion

• n

Seung Ho Lee, Seon Mee Park, Joung-ho Han, Soon Man Yoon, Hee Bok Chae and Sei Jin Youn

Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea

Con Conten ents ts: Acute pancreatitis is one of the main causes

• f intra-abdominal hypertension (IAH). IAH contrib-

utes to multiple physiologic alterations and leads to the development of abdominal compartment syndrome (ACS) that induce multi-organ failure. We report the case of ACS in severe acute pancreatitis. A 44-year-old man who was admitted in a drunken state was diag- nosed with severe acute pancreatitis. During manage- ment with excessive fluid resuscitation in an intensive care unit, drowsy mentality, respiratory acidosis, shock requiring inotrope, and oliguria developed in the con- dition of tensely distended abdomen. Under pre- sumptive diagnosis of ACS, abdominal decompression via percutaneous catheter was performed immediately.

Figure 1. After a percutaneous drainage catheter was in- serted, the patient’s intra-abdominal pressure (IAP) was

• decreased. Consequently, respiratory acidosis, oliguria

and confused mental status resolved.

High abdominal pressure was detected via percuta- neous drainage catheters. After abdominal decom- pression, multi-organ failure was reversed. We present a case of ACS managed successfully with percutaneous catheter decompression. Keyw ywor

• rds:

ds: Severe acute pancreatitis, Intra-abdominal hypertension, Abdominal compartment syndrome, Percutaneous catheter decompression PPB-07

The The Eff Effect of ct of S Sustai stained U ned Use e of

• f Plat

Platelet elet Aggreg egat ation I n Inhibi hibito tors rs on P

• n Post-endosc

st-endoscopic pic Sp Sphinct hincteroto tomy Bleeding Bleeding

Sang Hyub Lee1, Min Geun Lee2, Seung June Lee3, Yoon Suk Lee3, Jin Hyeok Hwang3, Jaihwan Kim4, Ban Seok Lee5 and Byung Hyo Cha5

1Internal Medicine, Seoul National University Hospital, Seoul, 2Internal

Medicine, Hanmaeum Hospital, Jeju, 3Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 4Internal Medicine, Kangwon National University School of Medicine, Chuncheon, 5Internal Medicine, Cheju Halla General Hospital, Jeju, Korea

Backg Background

• und / aim

/ aims: : The effect of platelet aggregation inhibitors (PAI) on post-endoscopic sphincterotomy (EST) bleeding in patients who cannot discontinue PAI for sufficient time has not been identified.To evaluate the effect of PAI on post-EST bleeding,this study was performed. Methods: thods: In a single, tertiary-care referral center, this retrospective analysis for the incidence, type, and se- verity of post-EST bleeding according to the sustained use of PAI was performed. A total of 132 patients who had sustained PAI therapy until EST or had it inter- rupted for less than 7 days prior to EST was analyzed (Figure 1). Re Results: Among 132 patients with continued use of PAI, 49 patients were sustained users of PAI until EST due to the high risk of thromboembolism (n=21), acute septic cholangitis (n=20), or combined problems (n=8). The clinical characteristics were not different according to the sustained use of PAI. There was no significant dif- ference regarding the bleeding rate and severity accord- ing to sustained or non-sustained use (p = .071 and p = .086, respectively). However, the type of post-EST

IDEN 2013 / 12th KJSGE

414 IDEN 2013 / 12th KJSGE

bleeding differed among the groups (p = .038). Post- EST delayed bleeding more frequent in sustained PAI users than in non-sustained PAI users (7/49, 14.3% vs. 2/83, 2.4%, p = .013). Furthermore, multivariate anal- ysis showed that post-EST delayed bleeding was sig- nificantly associated with the sustained use of PAI (OR 6.750; 95% CI, 1.342-33.940; p = .020) in continuation group.

Figure 1. Among a total of 762 patients undergoing EST, 132 patients were analyzed.

Conc nclusi sions:

• ns: Sustained use of PAI until EST might in-

crease the risk of delayed bleeding. Ke Keywords: Platelet aggregation inhibitors, Gastrointestinal hemorrahge, Endoscopic sphincterotomy PPB-08

Value e of

• f C

Comp mput uted ed T Tomog mograp aphy f for r End Endosc scopic ic Retrog

• grade Cholang

de Cholangiopancr

• pancreat

eaticograph aphy End Endosc scopi

• pists t

to Identify fy the T e Type of pe of Anast astomosi mosis s in P in Patients ents w with P th Prev evious ious Subt btotal al Gast Gastrectom

• my

Jung Sun An1, Sung-hoon Moon1, Seung Yeon Chun1, Jong Hyeok Kim1, Dong Hee Koh2 and Jae Hoon Yoon3

1Department of Internal Medicine, Hallym University Sacred Heart Hospital,

Anyang, 2Department of Internal Medicine, Dongtan University Sacred Heart Hospital, Dongtan, 3Department of Internal Medicine, Chuncheon University Sacred Heart Hospital, Chuncheon, Korea

Backg Background

• und / aims:

/ aims: In patients who had previous Billroth II gastrectomy, the success rate of endoscopic retrograde cholangiopancreaticography (ERCP) is low and complication rate is high. It may be important for ERCP endoscopists to identify the type of gastroenteric anastomosis in patients with previous subtotal gas- trectomy before the start of the ERCP, particularly in biliary emergencies. The aim of this study was to eval- uate whether ERCP endoscopists can distinguish the type of gastroenteric anastomosis in patients with pre- vious subtotal gastrectomy based on CT findings. Methods: thods: A total of 70 abdominal CT scans from pa- tients who had undergone subtotal gastrectomy (n=36, Billroth I; n=34, Billroth II) were selected for the study. Images were reviewed by 3 ERCP endoscopists blinded to clinical data. The endoscopists were asked to provide the most probable type of anastomosis. The sensitivity and specificity were analyzed for identifying Billroth II gastrectomy. Re Results: The sensitivity, specificity and interobserver agreement of CT findings to identify the type of anasto- mosis by ERCP endoscopists were 100%, 97% and 0.971, respectively. The key CT features of distinguish- ing Billroth II gastrectomy from Billroth I gastrectomy were 1) loss of continuity between the remnant stom- ach and duodenum; 2) less distended duodenal bulb; 3) the presence of closed duodenal stump with surgical staples and 4) presence of continuity between the rem- nant stomach and jejunum. Conc nclusi sions:

• ns: ERCP endoscopists had the ability of dis-

tinguishing the type of anastomosis in patients with previous gastrectomy based on CT findings. Careful evaluation of abdominal CT before emergency proce- dure may identify the type of anastomosis. Keyw ywor

• rds:

ds: Subtotal gastrectomy; Endoscopic retro- grade cholangiopancreaticography; Computed tomog- raphy

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 415 POT-01

Feasibi ibilit ity of

• f Endos

doscop

• pic S

Submu bmucos

• sal D

Dissection ion for for T Type I I Ga Gastric Ca Carcin inoi

• ids

ds Comp Compared with th End Endosc scopi

• pic S

Submuc ucos

• sal

al Resect sectio ion

Hyung Hun Kim1, Ji Hyung Kim2, Gwang Ha Kim3 and Myung-kyu Choi1

1Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, 2Internal Medicine, Inje University College of Medicine, Busan, 3Internal

Medicine, Pusan National University School of Medicine, Bsuan, Korea

Backg Background

• und /

/ aims: aims: Conventional endoscopic sub- mucosal resection (EMR) of carcinoid tumors is often associated with involvement of the resection margin, which necessitates further intervention. Endoscopic submucosal dissection (ESD) is a novel technique for the removal of carcinoid tumors. The aim of the present study was to compare the clinical usefulness of ESD with that of EMR for the complete resection of gastric carcinoid tumors. Methods: thods: Between January 2001 and October 2010, a total of 41 patients with 54 type I gastric carcinoid tu- mors that were estimated to be 10 mm or less in diame- ter and that were resected either using ESD or EMR were investigated for this study. The complete resection rate and complications associated with these two proce- dures were analyzed. Re Results: Among the 54 lesions, 36 were resected using EMR, and 18 lesions were resected using ESD. There were no significant differences between the EMR and ESD groups in terms of the location or the size of the

• tumors. The overall ESD complete resection rate was

higher than that of EMR (88.9% vs. 75.0%, respectively, p = 0.301). A lower vertical margin involvement rate was obtained when ESD was performed compared to that when EMR was performed (5.6% vs. 16.7%, re- spectively, p = 0.403). However, there was no statistical

• difference. The complication rate was not significantly

different between the two groups. Conc nclusi sions:

• ns: ESD showed higher complete resection

rate, especially in vertical margin despite lack of stat- istical significance. Keyw ywor

• rds:

ds: Carcinoid tumor; Endoscopic submucosal resection; Ligation device POT-02

Gener Generation

• n of
• f P

Pain aft in after r Endosc Endoscopic S ic Subm bmuc ucosal

• sal

Di Dissect ssection f n for Early G Early Gast stric c Neoplas lasms

Da Hyun Jung, Hyojin Park, Jie-hyun Kim and Young Hoon Youn

Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Backg Background

• und /

/ aims: aims: ESD has been widely used as cur- able local treatment for EGC. However, there is rare da- ta about pain which might lower compliance. Thus, we investigated incidence and risk factors associated with pain after ESD. Methods: thods: This was a prospective, randomized control

• study. Between 2011 and 2012, 78 patients were diag-

nosed as EGC and underwent ESD at Gangnam Severance Hospital. Among them, 20 patients were re- ceived test with 150 mL of 0.1 mol/L hydrochloric acid-infusion for investigating mechanisms of pain af- ter ESD. The severity of symptoms were assessed by a 10 cm visual analogue scale at 3 hours and day after ESD and during acid-infusion. To investigate effect of acid suppression on pain after ESD, subjects were random- ized to receive PPI before or after ESD. Re Results: The incidence of pain after ESD was 50.4 %. The male, older age, lower location, larger size and lon- ger time tended to be associated with pain after ESD. Among 20 patients who were received acid-infusion, subjects developing dyspeptic symptoms was 50 %. The subjects experiencing pain after ESD was significantly greater in patients with dyspeptic symptoms than with-

• ut by acid infusion. The patients who were generated

pain were significantly more in group which was re- ceived PPI after ESD than before ESD. Conc nclusi sions:

• ns: The pain after ESD was significantly

greater in patients who were developed dyspeptic symptoms by acid-infusion. The subjects with pain af- ter ESD were significantly lower when gastric acid was suppressed, suggesting that hypersensitivity to acid is

• ne of the important mechanisms of pain in ESD

patients. Keyw ywor

• rds:

ds: Pain, Early Gastric Cancer, Endoscopic Submucosal Dissection

IDEN 2013 / 12th KJSGE

416 IDEN 2013 / 12th KJSGE

POT-03

Three Cases of ee Cases of Dela Delayed P d Perfor

• rat

atio ion aft n after r End Endosc scopi

• pic S

Submuc ucos

• sal

al Diss ssect ection

• n

Takafumi Yano1, Satoshi Tanabe2, Masao Araki1, Kenji Ishido2, Mizutomo Azuma2, Toru Sasaki2, Katsuhiko Higuchi2, Wasaburo Koizumi2 and Tetsuo Mikami3

1Department of Gastroenterology, Sagamihara Kyodo Hospital, Sagamihara

City, 2Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara City, 3Department of Pathology, Kitasato University School of Medicine, Sagamihara City, Japan

Con Conten ents ts: Background: The incidence of delayed perfo- ration after endoscopic submucosal dissection (ESD) is low, but this procedural accident requires extreme cau- tion and surgical intervention. As of March 2011, de- layed perforation occurred in 3 (0.2%) of 1321 patients who underwent ESD for gastric tumors in our hospital. We report the clinical characteristics of these patients. Case patients: Patient 1 was an 89-year-old man with a superficial and slightly depressed type (0-IIc) lesion measuring 70 mm in diameter, arising in the gastric

• angle. An area measuring 100 mm was resected using an

insulation-tipped (IT) knife. In the early morning of day 2 after ESD, free air was detected on abdominal computed tomography (CT). An emergency lapa- rotomy was performed on the same day. Patient 2 was a 74-year-old man with two adjacent 0-IIc lesions arising in the anterior and posterior walls of the greater curva- ture of the gastric angle. ESD was performed with an IT knife-2. Areas measuring 47 mm and 43 mm were

• resected. The cut surfaces were fused together, creating
• ne ulcer-like surface. Free air was detected on abdomi-

nal CT on the day after ESD. An emergency laparotomy was performed on the same day. Patient 3 was a 63-year-old man who had undergone distal gas- trectomy with Billroth I reconstruction. A 0-IIa lesion was found in the posterior wall of the greater curvature

• f the residual stomach. An area measuring 30 mm × 24

mm was resected with an IT knife-2. Nausea developed during the night of the day of ESD. In the early morning

• f the day after ESD, abdominal CT revealed free air,

and an emergency laparotomy was performed on the same day. A perforation was found at the site of

• treatment. Conclusions: Patients should be carefully

followed up after ESD, even if there is no evidence of perforation during or immediately after the procedure. Keyw ywor

• rds:

ds: Delayed Perforation POT-04

Hyal alur uroni

• nic Acid

id Sol Solution I Inject jectio ion t n to Co Cont ntrol l Bleeding fr eeding from a a Scler Sclerotic Ulc c Ulcer r Base o Base or Canc Cancer er

Hyung Hun Kim, Chul-hyun Lim, Jae Myung Park and Myung-gyu Choi

Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea

Backg Background

• und /

/ aims: aims: Conventional techniques to control bleeding from sclerotic tissue, such as endoscopic clip- pings, are not always successful. Hyaluronic acid sol- ution injection can be an additional endoscopic modal- ity for controlling difficult cases when other techniques

• failed. We evaluated the feasibility of hyaluronic acid sol-

ution injection in various bleeding cases retrospectively. Me Methods: W e evaluated 12 cases which we used Hyaluronic acid solution injection for stop bleeding. Hyaluronic acid solution injection was performed as follows: (1) generation of 20 cc of a 0.2% hyaluronic acid solution by mixing hyaluronic acid and saline; (2) precise identi- fication of the bleeding focus; (3) injection of 5 cc of hy- aluronic acid solution into each point surrounding the bleeding focus; and (4) the lesion was washed and checked for further bleeding. Cessation of bleeding was measured based on clinical findings or endoscopic examination. Re Results: Immediately following Hyaluronic acid sol- ution injection, bleeding was controlled in 11 out of 12

• cases. There was no evidence of renewed bleeding and

proved complete healing was found in 11 cases, al- though we were unable to do follow-up endoscopy in all cases. Conc nclusi sions:

• ns: : Hyaluronic acid solution injection is a

simple and efficient method for controlling bleeding at the site of a sclerotic ulcer base, so it needs to be consid- ered as a next step before deciding radiologic inter- vention or surgery. Ke Keywords: Hyaluronic acid; Hemorrhage; Ulcer; Neoplasms

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 417 POT-05

Tumor Lo r Loca calization

• n U

Usin ing M Magnetic M Markin ing Cl Clip ip duri ring L Laparoscopic S Surgery for G Gastri ric Submu bmucosal

• sal Tumor

mor : a P a Pilot Study lot Study

Jong Soo Lee, Hoon Jai Chun, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen, Hong Sik Lee, Chang Duck Kim, Seung Han Kim, Jae Min Lee, Sun Young Yim, Seok Bae Yoon and Tae Jung Yun

Division of Gastroenterology and Hepatology University College of Medicine, Seoul, Korea

Backg Background

• und /

/ aims: aims: It is difficult to locate a tumor sim- ply and correctly during laparoscopic surgery for sub- mucosal tumor (SMT). Various methods such as intra-

• perative sonography, intraoperative endoscopy, etc,

are performed in localization gastrointestinal tumor for laparoscopic surgery. However there are limitations of methods, such as discomfort for surgeon, complexity. To overcome these limitation, we devised a simple marking clip with magnet to locate a tumor. Methods: thods: This study enrolled 11 patients undergoing laparoscopic wedge resection for SMT. We devised 10mm sized ring type magnet (outdiameter:D10mm, indiameter:4mm, thickness:3mm, maximal magnetic force:2660G), which was coated with silicon and fixed to endoclip using 3‐0 nylon. A magnetic marking clip was applied on the center of lesion during preoperative

• esophagogastroduodenoscopy. During surgery, mag-

netic body hanged with long thread which was inserted through laparoscopic trocar, was used to find intra- gastric lesion which marked by magnetic clip. We ana- lized tumor detection rate, detection time, proximal & distal margin from lesion and complication. Re Results: Magnetic marking clips were successfully de- tected in all 11 patients. The time required for detection ranged from 20 to 85 sec. The resected margin from le- sion ranged from 5 to 30 mm. 8/12 of pathology was confirmed GIST, 3/12 was leiomyoma, 1/12 was

• schwanoma. None of our patients experienced compli-

cation s from this marking technique. Conc nclusi sions:

• ns: Magnetic marking clip method was sim-

ple and convenient for surgeon, and showed good re- sults for accuracy of tumor localization, and detection

• rate. Therefore the magnetic marking clip method may

be useful for tumor site detection during laparoscopic SMT wedge resection. Keyw ywor

• rds:

ds: Endoclip; Magnet; Laparoscopic surgery POT-06

Dela Delayed Flu Flumazenil I azenil Inject jectio ion aft n after r End Endosc scopic ic Sedati tion Increases P Pati tient S Sati tisfacti tion C Compared to Immedi mediat ate Fl e Flumaz umazeni enil I Inject jection

Chun Ho Shin, Byoung Wook Bang, Hyung Gil Kim, Kye Sook Kwon, Yong Woon Shin and Hyun Jung Chung

Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea

Backg Background

• und / aims:

/ aims: Flumazenil was administered after the completion of endoscopy under sedation to reduce recovery time and increase patient safety. We evaluated patient satisfaction after endoscopy with sedation accord- ing to the timing of post-procedural flumazenil injection. Methods: thods: Two hundred subjects undergoing con- current colonoscopy and upper endoscopy while se- dated with midazolam and meperidine were enrolled in

• ur investigation. We randomly administered 0.3 mg

flumazenil either immediately or 15 minutes after the endoscopic procedure. Post-procedural questionnaire and next-day telephone interview were conducted to assess patient satisfaction. Re Results: Flumazenil injection timing did not affect the duration of time spent in the recovery room when com- paring the two groups of patients. However, subjects in the 15-minute injection group were more satisfied with undergoing endoscopy under sedation than patients in the immediate injection group according to the post-proce- dural survey (p = 0.019). However, no difference in overall satisfaction, memory, or willingness to undergo future en- doscopy was observed between the two groups when the telephone survey was conducted the following day. Conc nclusi sions:

• ns: This study showed that delayed flumaze-

nil injection after endoscopic sedation increased patient satisfaction without prolonging recovery times even though the benefit of delayed flumazenil injection did not persist into the following day. Keyw ywor

• rds:

ds: Colonoscopy; Flumazenil; Midazolam; Patient satisfaction

IDEN 2013 / 12th KJSGE

418 IDEN 2013 / 12th KJSGE

POT-07

Endos doscop

• pic

ic M Magnetic ic M Markin ing Tech chnique for for Lap Laparosc scop

• pic C

ic Colon T lon Tumo mor Op r Oper erat atio ion : n : a a Pilot Pilot Stu Study

Seung Han Kim, Hoon Jai Chun, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen, Hong Sik Lee, Chang Duck Kim, Jae Min Lee, Seung Joo Nam, Jong Soo Lee, Sun Young Yim, Seok Bae Yoon and Tae Jung Yun

Division of Gastroenterology and Hepatology, University College of Medicine, Seoul, Korea

Background /

• und / aim

aims: It is difficult to locate correctly and safely a colorectal tumor for laparoscopic surgery. Tattooing is simple, so generally used for localization of colorectal tu- mor during laparoscopic surgery. However there are limi- tations, such as incorrect tumor localization due to spread

• f ink, risk of bowel perforation. To overcome these limi-

tations, we devised a simple magnetic marking technique. Methods: thods: This study enrolled 12 patients undergoing laparoscopic surgery for early colorectal cancer. We de- vised 10mm sized ring type magnet (outdiameter:10mm, indiameter:4mm, thickness:3mm, maximal magnetic force:2660G) which was coated with silicon, and we tied loop using 3-0 nylon. We inserted the marking magnet near lesion with biopsy forcep, and then clipped magnet

• n target through loop of magnet. A magnetic marking

clip was applied on the distal side of lesion during pre-

• perative colonoscopy. During surgery, another mag-

netic body hanged with long thread which was inserted through laparoscopic trocar, was used to find out the le- sion that was marked by magnetic clipping. We ana- lyzed detection rate, detection time, resection margin length from lesion and complication. Re Results: Magnetic marking clips were successfully de- tected in all 12 patients. The time required for detection ranged from 10 to 35 sec. The resection margin from le- sion ranged from 40 to 50mm. None of our patients ex- perienced complication s from this marking technique. Conc nclusi sions:

• ns: Magnetic marking technique was simole

and showed good result for accuracy of tumor local- ization without complication. Therefore, the magnetic marking clip method may be useful for colorectal tu- mor detection during laparoscopic surgery. Keyw ywor

• rds:

ds: Endoclip; Magnet; Laparoscopic surgery POT-08

Clinic ical Effic al Efficacy of

• f V

Variou

• us Diag

s Diagnost nostic ic T Test sts in t s in the e Small Bo all Bowel T l Tumors and mors and Cli Clinical F ical Featu atures es of

• f

Miss Missed Smal ed Small l Bowel wel T Tumors mors by Capsule Capsule End Endosc scopy

• py

Jung Wan Han1, Hyun Joo Jang1, Sung Noh Hong2, Seong Ran Jeon3, Hwang Choi4, Soo Jung Park5, Dong Kyung Chang2, Small Intestine Research (SIR) Group of the Korean Association for the Study of Intestinal Diseases

1Dongtan Sacred Heart Hospital, Hallym University College of Medicine,

Hwaseong, 2Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 3Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Seoul, Korea, 4Incheon St. Mary’s Hospital, Catholic University School of Medicine, Incheon, 5YonSei University College of Medicine, Seoul, Korea

Backg Background

• und / aims:

/ aims: Primary small bowel neoplasms are rare but increasing in prevalence and are associated with significant morbidity. Capsule endoscopy (CE) is widely accepted as the preferred diagnostic test in the evaluation of small bowel diseases. However, small bowel tumors (SBT) are sometimes missed by CE. The purpose of this study is to evaluate the diagnostic yields

• f various diagnostic tools such as CT, small bowel fol-

low through (SBFT), and CE and to evaluate the clinical features of missed SBT by CE. Methods: thods: This study is a multicenter, retrospective study of KASID SIR group with the 79 patients of SBTs diagnosed by surgery and enteroscopy with biopsies be- tween March 2004 and December 2012. Demographic characteristics, clinical presentation, results of diag- nostic tests and characteristics of tumors were evaluated for each patient. Re Results: The most common symptoms of SBTs were bleeding (43%, 29 overt and 5 occult bleeding) and ab- dominal pain (13.9%). Diagnostic yields of various di- agnostic tests were as follow: CT detected 55.8%(38/68)

• f definitive SBT, SBFT 46.1%(18/39) of definitive SBT,

CE 83.3%(45/54) of definitive SBT. The sensitivity of diagnostic tests was as follow: CT was 40.4%, SBFT 43.9%, CE 79.6%. Nine patients (16.7%) which were suspicious(2) and negative(7) findings of CE were fi- nally diagnosed as GISTs(4), adenocarcinoma(1), in- flammatory fibroid polyp(1), and small polyps(3), which were located in proximal jejunum(5), mid jeju- num(1), distal jejunum(1) and proximal ileum (2).

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 419 Conc nclusi sions:

• ns: CE can more effectively detect SBTs than

radiologic diagnostic tests. However CE can miss some significant tumors located mainly in proximal jejunum. Keyw ywor

• rds:

ds: Small bowel tumor, Capsule endoscopy POT-09

Premedicat emedicatio ion of n of Er Erythr hromycin in Impr Improves es End Endosc scopi

• pic Mucosal V

sal Visualizat sualizatio ion in n in Patients ents wi with S Subtotal G Gastrectomy

Byoung Yun Jun1, Myung-gyu Choi1, Fisseha Tekle2, Jong Yul Lee1, Myong-ki Baeg1, Sung Jin Moon1, Chul-hyun Lim1, Jin Su Kim1, Yu Kyung Cho1, In Seok Lee1, Sang Woo Kim1 and Kyu Yong Choi1

1Department of Internal Medicine, The Catholic University of Korea, Seoul,

Korea, 2Department of Internal Medicine, Myungsung Christian Medical Center, Addis Ababa, Ethiopia

Backg Background

• und /

/ aims: aims: Food residues in remnant stomach after subtotal gastrectomy (STG) interfere endoscopic

• bservation. We investigated whether intravenous er-

ythromycin improves gastric mucosa visualization in patients with STG.

Figure 1. The percentage of patients with good visibility in the placebo group and in the erythromycin group

Methods: thods: Design: Double-blinded, placebo-controlled, randomized trial. Setting: Tertiary referral center. Participants: Patients who received STG with complete resection (Stage; T1-2N0M0) were included. Exclusion criteria were DM, neurologic disease, myopathy, recent viral enteritis history, concomitant therapy influencing GI motility and severe co-morbidity. Intervention: Patients were assigned randomly to receive either eryth- romycin (125 mg in normal saline 50 cc) or placebo. Endoscopy was performed 15 min after infusion. Grade

• f residual food was rated as follows; G0 no residual

food, G1 a small amount of residual food, G2 a moder- ate amount of residual food, G3 a moderate amount of residual food which hinders observation of the entire surface even with body rolling, G4 a great amount of re- sidual food for which endoscopic observation is impossible.

Figure 2. The grade of food stasis against the time elapsed after surgery in the placebo group and in the er- ythromycin group.

Re Results: When good visibility was defined as G0+G1, vis- ibility was significantly better in EM group (61%+19%) compared with placebo group (38%+12%, p<0.001). However, this effect was not seen in patients within 6 months after gastrectomy. Risk factor for food stasis in placebo group (N = 58) was food stasis at last endoscopy. Factor predicting EM response in EM group (N = 56) was

• nly elapsed time after surgery. Adverse Effects included

11 (19.7%) nausea and 1 (1.8%) vomiting in EM group

IDEN 2013 / 12th KJSGE

420 IDEN 2013 / 12th KJSGE

and 3 (5.2%) in placebo group. However, they were tran- sient and tolerable. Conc nclusi sions:

• ns: Premedication of erythromycin improves

mucosal visualization during endoscopy in patients with STG. Keyw ywor

• rds:

ds: Gastrectomy; Gastrointestinal motility; Gastroparesis; Premedication; Erythromycin POT-10

An A Adequat equate L Level of l of T Training f aining for r Technical nically Compet mpetent ent End Endosc scopic ic M Mucosal sal R Resect ction ion of

• f

Co Colore rectal P Polyps ps

Sun-jin Boo1, Jeong-sik Byeon2, Seon Ok Kim3, Ji Hoon Jung2, Jae Ho Park2, Soo-young Na1, Kee Wook Jung2, Dong-hoon Yang2, Kyung Jo Kim2, Byong Duk Ye2, Seung-jae Myung2, Suk-kyun Yang2 and Jin-ho Kim2

1Department of Internal Medicine, Jeju National University School of Medicine,

Jeju, 2Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 3Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Backg Background

• und /

/ aims: aims: This study aimed to obtain the baseline data regarding technical competence for endo- scopic mucosal resection (EMR) of colorectal polyps by experienced colonoscopists and to investigate the amount

• f training necessary for acquisition of technical com-

petence for colon EMR in trainees. Methods: thods: Baseline data were obtained from three expe- rienced colonoscopists. Trainees were three gastro- enterology fellows who had experienced more than 150 cases of diagnostic colonoscopy before this study. The success of individual colon EMR procedure by trainees was defined if (1) en bloc resection was obtained and (2) EMR time was within two times of median colon EMR time by experienced colonoscopists. Re Results: Experienced colonoscopists showed median co- lon EMR time of 79 sec. 750 colon EMR procedures in 410 patients were performed by three trainees. The aver- age size of polyps was 7.8 ± 2.5 mm. The median colon EMR time, en bloc resection rate and complication rate were 118 sec, 95.6% and 6.8%, respectively. The colon EMR times by trainees shows a significant EMR time de- crease as the experience accumulated (p<0.001). En bloc resection rate also improved (p=0.011). However, the rate

• f complication did not change significantly in trainees

(p=0.140). The frequency of successful colon EMR had increased steadily and trainees reached the success rate of 81.3% in 200-250 colon EMR procedures (p=0.003). Conc nclusi sions:

• ns: In trainees, colon EMR time decreased

and en bloc resection rate improved steadily till 250

• cases. At least 250 colon EMR experience may be neces-

sary for technical competence of colon EMR after the achievement of technical competence for diagnostic colonoscopy. Ke Keywords: Colorectal polyp; EMR; Technical Competence POT-11

Endos doscop

• pic

ic Ul Ultrasono

• nograph

phy G y Guided Dr Draina nage ge of

• f

Pelvic A ic Absc scess Caused b ess Caused by Cecal P Cecal Perfor

• rat

atio ion aft n after r Colonic Endo lonic Endosc scopic S

• pic Submuc

bmucosal

• sal Dissec

Dissection

Shang Hoon Han, Jin Woong Cho, So Hee Yun, Jae Un Lee, Moon Sik Park, Wang Guk Oh, Young Jae Lee, Ji Woong Kim, Gum Mo Jung and Yong Keun Cho

Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea

Con Conten ents ts: Pelvic abscesses have usually been drained by surgery or radiologic percutaneous drainage. Lately, as the therapeutic role of endoscopic ultrasonography (EUS) is developing, EUS guided drainage of pelvic ab- scesses have been considered as an alternative method.

Figure 1. 7*10 cm sized mature abscess in pelvis.

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 421

Figure 2. perirectal abscess drainage using insertion of pig-tail stent.

We report an interesting case of pelvic abscess with EUS-guided transrectal drainage. A 52-year-old female received surveillance colonoscopy and a 5 cm sized lat- eral spreading tumor (homogenous granular type) was de- tected in the cecum. The colonic endoscopic submucosal dissection (ESD) was performed with flex knife in our

• hospital. After the ESD, she developed colonic perfo-

ration and was managed conservatively. She was dis- charged without symptom in the 12th day. But, 9 days later she presented watery diarrhea. Sigmoidoscopy and abdomino-pelvic computed tomography showed a large pelvic abscess. EUS-guided drainage was per- formed with the insertion of pig-tail stent. In the 27th day, the abscess was improved completely and the stent was removed. So, we could managed pelvic abscess by EUS-guided drainage successfully and reported the case. Ke Keywords: Endosonography; Abscess; Drainage; Colonic Perforation POT-12

Th The C Compar arison

• n of
• f La

Lapar parosc scopi

• pic W

Wedge dge Resection and H Hybrid id Notes in T s in Trea eatment ent of I Intraluminal Growing ing Gast Gastric S c Subepi pithelial T thelial Tumors mors

Mi-young Kim1, Joo Young Cho1, Min Jeong Kim1, Jun-hyung Cho1, Yong Jin Kim2 and So Young Jin3

1Digestive Disease Center, Soon Chun Hyang University Hospital, Seoul, 2Department of Surgery, Soon Chun Hyang University Hospital, Seoul, 3Department of Pathology, Soon Chun Hyang University Hospital, Seoul, Korea

Backg Background

• und /

/ aims: aims: The laparoscopic wedge resection (LWR) has been applied for resection of the sub- epithelial tumor (SET) less than proper muscle layer. Hybrid NOTES is a combined endoscopic and laparo- scopic procedure to remove the SET. Methods: thods: This is a retrospective analysis using pro- spectively collected data at a single tertiary referral

• center. From January 2008 to December 2012, 35 pa-

tients with intraluminal growing SET originated in proper muscle layer were included. Twenty-two were treated with the LWR and 13 were conducted by hybrid NOTES. Re Results: In LWR group, there were 12 of gastrointestinal stromal tumor (GIST), 4 of leiomyoma, 3 of schwanno- ma, and 3 of ectopic pancreas. In hybrid NOTES group, there were 11 of GIST including 1 malignancy, 1 leio- myoma, and 1 schwannoma. Mean tumor sizes of LWR and hybrid NOTES groups were 25.2 mm and 19.8 mm, respectively (p = 0.124). Mean treatment duration

• f LWR and hybrid NOTES groups was 77 min and 84

min, respectively (p = 0.618). All tumors were com- pletely resected without intraoperative or postoperative adverse events. In hybrid NOTES group, mean re- section size was significantly small compared with lapa- roscopic wedge resection group (33.4 mm vs. 45.5 mm, p = 0.031). There was no significant difference in safety margin. Conc nclusi sions:

• ns: Hybrid NOTES is a feasible minimally in-

vasive procedure that can achieve smaller resection size, similar treatment duration, and en-bloc tumor re- section compared with the laparoscopic wedge resection. Ke Keywords: NOTES, Subepithelial tumor, Stomach, W edge resection POT-13

Rar Rare Case Case of

• f Sar

Sarcomat

• matoid R
• id Renal Cell Car

nal Cell Carcino inoma a with C th Conc ncom

• mitant

itant Gas Gastric and c and Colo Colonic M nic Metas tastas ases es

Ki Yung Boo, Yoo-kyung Cho, Seung Uk Jeong, Sun Jin Boo, Soo Young Na, Hyun Joo Song, Jung Mi Kwon, Eun Kwang Choi and Byung Cheol Song

Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea

Con Conten ents ts: BackgroundSarcomatoid renal cell carcino- ma is a rare subtype of kidney malignancy and meta-

IDEN 2013 / 12th KJSGE

422 IDEN 2013 / 12th KJSGE

stasis to gastrointestinal tract is uncommon. We report a case of sarcomatoid renal cell carcinoma with multi- ple metastases including stomach and colon. Case reportA 65-year-old man presented with right upper abdominal pain for 3 days. Laboratory findings on ad- mission showed leukocytosis (11,900/㎕), elevated se- rum creatinine (2.0 mg/dl), elevated hs-crp (5.77 mg/dl) and elevated procalcitonin (12 ng/ml). No hematuria was noted. Abdominal ultrasound revealed a 4cm sized right renal mass and a 2cm sized hepatic mass sugges- tive of renal and hepatic abscess. After antibiotic treat- ment for 5 days, serum creatinine was normalized and constrast-enhanced abdominal CT was performed. An enhanced ascending colon polyp, a 3.6cm sized pleu- ral-based mass on left lower lung field and lumbar spi- nal osteolytic lesions were first recognized in addition to known renal and hepatic mass. Under the impression

• f metastatic malignancy, gastroduodenoscopy and colono-

scopy were performed to find origin. Gastroduodenoscopy revealed multiple hemorrhagic polypoid lesions on the body and the fundus. Colonoscopy revealed a 1.2cm sized hemorrhagic cecal polyp. Pathologic findings from stomach and colon didn’t show adenocarcinoma, but sarcomatoid carcinoma. Renal mass biopsy revealed sarcomatoid renal cell carcinoma and finally diagnosed as sarcomatoid renal cell carcinoma with gastric, colon- ic and hepatic metastases. He was planned to receive chemotherapy and transferred to other hospital as he

• wanted. ConclusionsMultiple hyperemic, hemorrhagic

polypoid lesions of the stomach and the colon should

Figure 1. Abdominal CT showed (A) renal mass (B) hep- atic mass (C) right colon polyp and (D) pleural mass. Figure 2. Endoscopic examination showed multiple hy- peremic hemorrhagic polyps on (A) lower body, (B) mid- body, (C) fundus on the stomach and (D) cecum.

be ruled out metastatic carcinoma and pathologic con- firmation is very important for differential diagnosis. Keyw ywor

• rds:

ds: Sarcomatoid renal cell carcinoma; Gastric metastasis; Colonic metastasis POT-14

Mesoc socolon lon Lac Laceration F

• n Follo

llowing C ng Colonosc lonoscopy

Jin-seok Park, Seok Jeong, Byoung Wook Bang, Don Haeng Lee, Hyung Gil Kim, Yong Woon Shin, Kye Sook Kwon, Jin-woo Lee and Young Soo Kim

Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea

Co Contents: Colonoscopy is a safe procedure, but sometimes unexpected complications can be occurred. Bleeding and perforation of the colon were reported as the most com- mon complications. Hemoperitoneum after colonoscopy is an unusual complication of colonoscopy, but it may be catastrophic. We report a 20-years-old man who pre- sented with left low quadrant pain following colonoscopy. Hemoperitoneum was diagnosed by abdominal CT. Laparoscopic exploration was urgently performed. Laparoscopic examination revealed laceration of the mesocolon of descending colon. The bleeding of the in- jured site could be controlled without complication. The patient recovered fully without signs of recurrent

• bleeding. This report implicates that if the patient has

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 423

Figure 1. Contrast enhanced CT scans show hyper-atte- nuated fluid collections0 in the anterior aspect of sigmoid colon of pelvic cavity, both paracolic gutters and right sub- hepatic space, suggesting intraperitoneal hemorrhage. Figure 2. Laparoscopic finding. Moderate amount of blood is noticed in pelvic cavity.

persistent abdominal pain after receiving colonoscopy, we should consider hemoperitoneum as one of the causes. To

• ur knowledge, there was no reported case of isolated lac-

eration of the mesocolon of descending colon developed after colonoscopy up to now Ke Keywords: Mesocolon, Colonoscopy, Hemoperitoneum POT-15

A Case A Case of I Idiop iopathic thic Sc Scler lerosing Encapsulat sing Encapsulating ing Pe Peritonitis

Hyun Sik Hwang1, Joong Goo Kwon1, Jin Tae Jung1, Eun Young Kim1, Jimin Han1, Ho Gak Kim1, Chang Ho Cho2 and Hyun Dong Chae3

1Department of Internal Medicine, Catholic University of Daegu School of

Medicine, Daegu, 2Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, 3Department of General Surgery, Catholic University

• f Daegu School of Medicine, Daegu, Korea

Con Conten ents ts: Sclerosing encapsulated peritonitis (SEP) is a rare form of peritoneal inflammation that results in an intestinal obstruction due to total or partial encapsula- tion of small bowel by peritoneal fibrosis and adhesion. It is reported to occur as an idiopathic form or secon- dary form in association with peritoneal dialysis, sur- gery, and recurrent peritonitis. We experienced one case

• f idiopathic SEP presented as small bowel obstruction.

A 74 year-old man presented with an acute onset ab- dominal distension, palpable abdominal mass and

• vomiting. There was no medical history of peritoneal

dialysis, infection, or abdominal surgeries. An abdomi- nal examination revealed a firm immovable round mass in the upper abdomen, without tenderness and bowel sounds were decreased. Upper gastrointestinal endos- copy showed distended stomach and duodenum. Abdominal computed tomography (CT) showed small bowel loops congregated to the center of abdomen en- cased by a thick enhanced peritoneum. Double balloon enteroscopic examination showed no luminal ob- struction up to mid-jejunum. He failed to respond to conservative treatment, thus an exploration laparotomy was performed. Surgery revealed an entire small bowel encased in a thick and whitish fibrotic tissue capsule, simulating a cocoon. After a dissection of the fibrotic capsule from the visceral surface, small bowel was com- pletely released. Pathological findings showed intensive fibrosis, which was compatible with the diagnosis of sclerosing peritonitis. Abdominal distention recurred 10 days after operation and follow-up abdominal CT showed similar findings of preoperative state. His symptoms did not respond to conservative treatment. Ke Keywords: Sclerosing encapsulated peritonitis; Intestinal

• bstruction; Peritoneal fibrosis

IDEN 2013 / 12th KJSGE

424 IDEN 2013 / 12th KJSGE

POT-16

A Case of A Case of C Cronkhit

• nkhite-Canada S

e-Canada Syndr ndrome Impr me Improved ed by Lo Long-t ng-ter erm Intak m Intake of

• f Rabepr

praz azole.

• le.

Kayoung Kim1, Hiunsuk Chae1, Hyungkeun Kim1, Youngsuk Cho1, Sunyoung Ko1, Seunghye Jung1 and Kyungjin Seo2

1Department of Internal Medicine, Uijeongbu St Mary’s Hospital, Catholic

University of Medical College, Uijeongbu, 2Department of Pathology, Uijeongbu St Mary’s Hospital, Catholic University of Medical College, Uijeongbu, Korea

Con Conten ents ts: Cronkhite-Canada syndrome is a rare, un- known etiologic and non-familial syndrome presenting numerous hamartomatous polyps throughout the GI tract sparing the esophagus. The common symptoms of the disease are diarrhea, weight loss, nausea, vomiting, hypogeusia, anorexia. The unique ectodermal abnor- malities are accompanied with alopecia, cutaneous hy- perpigmentation, and dystrophic changes of nails. The diagnosis is based on history and physical examination, imaging and endoscopic findings with histopathology. Many complications, including GI bleeding, intussusception, prolapse and infection have been reported. Despite therapy, including treatment with steroids and anti- biotics, the affected patients still display poor prognosis

Figure 1. Initial endoscopic findings of the patient’s stom- ach (A), duodenum (B), and colon (C): observed immeas- urable polyps; and histopathology (HE staining) of biopsy from the polyp in the stomach (D): the polyps contained an expanded, edematous lamina propria. Figure 2. Follow-up endoscopic findings after rabepra- zole treatment for 1 year: stomach(A), duodenum(B), and colon (C): few polypoid lesions were observed.

with high mortality rate (60%) and substantial occur- ence of GI malignancy (10%). We herein report a case

• f Cronkhite-Canada syndrome improved by chronic

use of rabeprazole.A 52-year-old man visited for lower abdominal pain, diarrhea and weight loss for a month. He had no familial and previous medical history. On physical examination, brittle and friable nail changes with alopecia were observed. Laboratory investigations showed no abnormalities. Esophagogastroduodenal endoscopy and colonoscopy showed immeasurable polyps of whole mucosa (more than 100 polyps) in stomach, duodenum and colon (Fig 1). Biopsies were

• btained and their histopathology revealed hyperplastic
• polyps. Based on clinical features and biopsy findings,

the diagnosis of Cronkhite-Canada syndrome was

• made. The patient was given 20mg of rabeprazole daily

and all of clinical symptoms improved after 1 year. Follow-up of esophagogastroduodenal and colono- scopy were performed and they revealed near-complete disapperance of mulitple polyposis (Fig 2). Keyw ywor

• rds:

ds: Cronkhite-Canada syndrome, Hyperplastic polyp, Rabeprazole POT-17

BRTO f for Ga Gastri stric V Vari rices i s in a an I Infant,report o

• f a

Cas Case

Kazunori Hijikata, Yoshinori Igarashi, Ken Ito and Aya Sato

Hepatorogy and Gastoroentrogy, Toho Univ,medicalcenter Oomori Hospital, Tokyo, Japan

Con Conten ents ts: This case concerns a 14-year-old female pa- tient with a low height and weight, but who otherwise had no history of attending hospital. While away from home she vomited blood and was brought into the

Poster Presentation Abstracts

IDEN 2013 / 12th KJSGE 425 emergency room. An emergency endoscopy showed clotting, together with nodular varicose veins in the gas- tric fundus, leading to a diagnosis of gastric varicose

• rupture. After admission to the hospital, the patient was

subjected to various examinations and the underlying condition was diagnosed to be IPH. Contrast enhanced CT showed short gastric veins, from which shortening

• f gastric varices in the renal venous system could be

extrapolated, and BRTO was therefore selected as the treatment method. Subsequent to the operation, no worsening was noted in either fluid in the abdomen or esophageal varices, and no complications were re- corded in regard to unexpected side-effects. Within the scope of our research, only one case has so far been re- corded of the use of BRTO in the treatment of gastric varices in an infant, and this is considered to be an in- teresting example of this condition. Keyw ywor

• rds:

ds: BRTO for infant