As colonoscopy is widely used as a diagnostic tool in Korea, it produces many complications such as colonic bleeding and perforation. These are considered to be an usual event, not as a concept of complication. Therefore, the adverse events are given the term of incidental events, not as the complications in the recent days. Medical treatment may be offered as an alternative to surgical method for immediate management of these complications. Colonic perforation usually results in fatal and emergent condition requiring surgical intervention. Others described the application of endoclip as a therapeutic endoscopic maneuver twenty years ago, and in 1997, Yoshikane et al. used clips to close a colonic perforation after performing the endoscopic mucosal resection of an early cancer. Since then, endoscopic repairs of iatrogenic perforation have frequently been used in many cases. We report a 69 year-old man who was successfully treated by endoscopic clipping of iatrogenic colonic perforation site during polypectomy without complications.
Eosinophilic gastroenteritis (EG) is characterized by eosinophilic infiltration of the bowel wall and variable gastrointestinal manifestations.Clinicians should have a high index of suspicion for EG when faced with gastrointestinal symptoms and peripheral eosinophilia to avoid incorrect diagnosis and inappropriate treatments.A 24-year-old woman was admitted to our hospital complaining of acute right lower quadrant abdominal pain and a laparoscopic appendectomy performed for a presumed diagnosis of an acute appendicitis.However, the procedure revealed bowel edema and a moderate amount of ascites without evidence of a suppurative appendicitis.Postoperatively, she showed persistent and progressive eosinophilia, exudative eosinophilic ascites, eosinophilic infiltration of the resected appendix wall, and eosinophilic infiltration of gastroduodenal mucosa.A punch biopsy of the abdominal skin also revealed inflammation with marked eosinophilic infiltration of the skin.She recovered after the treatment with a low dose of steroid for the EG with eosinophilic dermatitis.EG with eosinophilic dermatitis has not been reported yet and is considered fortuitous in this case.
Cytomegalovirus (CMV) infection can cause organ-specific damage or severe complications such as bowel perforation in immunocompromised patients. 1On the other hand, CMV infection in an immunocompetent individual is very rare, and only anecdotal reports have described CMV-associated bowel perforation in these patients. 2,3In the present report, we describe a healthy human immunodeficiency virus (HIV)-negative elderly man with CMV enteritis resulting in ileal perforation, and have reviewed the relevant English literature with specific reference to different ages at diagnosis.An 88-year-old healthy man was admitted with six days history of diarrhea with diffuse abdominal pain.He had no noteworthy past history or any conditions of immunosuppression, including diabetes.He denied any weight loss or fever at admission.His physical examination revealed mild distension and tenderness in the right lower abdomen without rebound tenderness.Laboratory investigation showed leukocytosis of 14.3×10 6 /µL (normal range, 4.0-10.0)and elevated Creactive protein of 26 mg/dL (normal range, 0.0-5.0).Electrolyte disturbances and azotemia were attributed to dehydration and were easily corrected after rehydration.Blood and stool cultures were negative, and Clostridium difficile toxin was not detected.Widal test and HIV serology were also negative.Colonoscopy revealed no specific lesions from the rectum to the cecum, but intubation into the
To develop and validate a risk stratification-based screening model for predicting colorectal advanced neoplasia in Korea.Colorectal advanced neoplasia is the relevant finding of screening colonoscopy. Risk estimation for advanced neoplasia may be helpful to improve compliance and to develop more cost-effective approaches toward screening.We developed Korean Colorectal Screening (KCS) score by optimizing and adjusting Asia-Pacific Colorectal Screening (APCS) score to predict advanced neoplasia in an asymptomatic Korean population who received screening colonoscopies from September 2006 to September 2009. Moreover, we validated the KCS score in another Korean cohort who received screening colonoscopies from October 2009 to February 2011. We also assessed the predictive power and diagnostic performance of both KCS and APCS scores.There were 3561 subjects in the derivation cohort and 1316 subjects in the validation cohort, with a prevalence of advanced neoplasia of 4.7% and 4.3%, respectively. After a multivariate analysis, KCS was developed as 0 to 8 points comprising of age, sex, body mass index, smoking, and family history of CRC. Using KCS scores to stratify the validation cohort, the prevalences of advanced neoplasia in the 3 risk tiers (average, moderate, and high) were 2.0%, 3.7%, and 10.9%, respectively. Moderate-risk and high-risk tiers showed 2.1- and 6.5-fold increased prevalences, respectively, of advanced neoplasia compared with average risk tier. In addition, KCS score showed relatively good discriminative power (ROC=0.681) and higher sensitivity compared with APCS score for the high-risk tier.KCS score may be clinically simple and useful for assessing advanced neoplasia risk in Korea. However, racial disparity should be considered in risk stratification-based screening in each country.
Background/Aims Little is known for the capacity and quality of colonoscopy, and adherence to colonoscopy surveillance guidelines in Korea. This study aimed to investigate the present and potential colonoscopic capacity, colonoscopic quality, and adherence to colonoscopy surveillance guidelines in Korea. Methods We surveyed representative endoscopists of 72 endoscopy units from June to August 2015, using a 36-item questionnaire regarding colonoscopic capacity, quality, and adherence to colonoscopy surveillance guidelines of each hospitals. Results Among the 62 respondents who answered the questionnaire, 51 respondents were analyzed after exclusion of 11 incomplete answers. Only 1 of 3 of endoscopy units can afford to perform additional colonoscopies in addition to current practice, and the potential maximum number of colonoscopies per week was only 42. The quality of colonoscopy was variable as reporting of quality indicators of colonoscopy were considerably variable (29.4%-94.1%) between endoscopy units. Furthermore, there are substantial gaps in the adherence to colonoscopy surveillance guidelines, as concordance rate for guideline recommendation was less than 50% in most scenarios. Conclusions The potential capacity and quality of colonoscopy in Korea was suboptimal. Considering suboptimal reporting of colonoscopic quality indicators and low adherence rate for colonoscopy surveillance guidelines, quality improvement of colonoscopy should be underlined in Korea. Keywords: Colonoscopy; Colorectal neoplasms; Quality; Surveys and questionnaires; Guideline
A leukemoid reaction is defined as reactive leukocytosis exceeding 50,000/mm3, with a significant increase in early neutrophil precursors, and can be a paraneoplastic manifestation of various malignant tumors. A 71-year-old male patient complained of decreased appetite, fatigue, and abdominal fullness. He had a palpable, firm liver, and laboratory investigations suggested leukemoid reaction. Liver dynamic computed tomography revealed a hypervascular mass, and an ultrasound-guided fine-needle aspiration of the mass confirmed hepatocellular carcinoma (HCC) with a sarcomatoid component. The leukocyte count of the patient had increased to 147,800/mm3, and he died 10 days after admission. This is a rare case of leukemoid reaction in a patient with sarcomatous HCC. Keywords: Leukemoid reaction; Paraneoplastic; Hepatocellular carcinoma
Background/Aims: Knowledge regarding the quality metrics of fecal immunochemical test (FIT)-based colorectal cancer screening programs is limited.The aim of this study was to investigate the performance and quality metrics of a FITbased screening program.Methods: In our screening program, asymptomatic subjects aged ≥50 years underwent an annual FIT, and subjects with positive FIT results underwent a subsequent colonoscopy.The performance of the FIT and colonoscopy was analyzed in individuals with a positive FIT who completed the program between 2009 and 2015 at a university hospital.Results: Among the 51,439 screened participants, 75.1% completed the FIT.The positive rate was 1.1%, and the colonoscopy completion rate in these patients was 68.6%.The positive predictive values of cancer and advanced neoplasia were 5.5% and 19.1%, respectively.The adenoma detection rate in the patients who underwent colonoscopy after a positive FIT was 48.2% (60.0% for men and 33.6% for women).The group with the highest tertile quantitative FIT level showed a significantly higher detection rate of advanced neoplasia than the group with the lowest tertile (odds ratio, 2.6; 95% confidence interval, 1.4 to 5.1; p<0.001).Conclusions: The quality metrics used in the United States and Europe may be directly introduced to other countries, including Korea.However, the optimal quality metrics should be established in each country.(
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