Purpose:The prevalence and incidence of eosinophilic esophagitis (EoE) are increasing worldwide.Despite increased understanding of inflammatory pathogenesis, changes in endoscopic features after treatment of EoE have not been clearly described.We aimed to investigate the reversibility of endoscopic features of EoE after treatment.Materials and Methods: Out of 58 adult subjects who were diagnosed with EoE at the Yonsei University Health System from July 2006 to August 2019, we recruited 33 subjects (30 males; mean age: 42 years) whose pre-treatment and post-treatment endoscopic images were available.Endoscopic features included both inflammatory and fibrostenotic features.Exudate, edema, furrow, and crepe paper-like mucosa were classified as inflammatory features.Ring and stricture were classified as fibrostenotic features.We compared changes in endoscopic features after treatment for EoE.Results: After treatment, clinical symptoms improved in all patients.The following endoscopic features were observed before treatment: furrow (81.8%), edema (90.9%), exudate (42.4%), ring (27.3%), crepe paper-like mucosa (15.2%), and stricture (3.0%).Endoscopic remission was achieved in 21 patients (63.6%).Inflammatory features were reversible (72.7%, p<0.001), whereas fibrostenotic features were not (10%, p=0.160).Exudate had resolved in 92.9% of patients, edema in 70% and furrow in 88.9%.Ring and stricture persisted in almost all of the patients (9/10) who had these endoscopic features before treatment. Conclusion:We outlined the reversibility of endoscopic inflammatory features of EoE.Fibrostenotic features were irreversible after esophageal remodeling in patients with EoE.However, further validation studies with long-term follow-up are needed.
Wireless capsule endoscopes (CEs) have become a useful diagnostic tool for small bowel diseases, but they may fail to examine the entire small bowel. We analyzed the clinical experience of the MiRo CE in patients with suspected small bowel disease to assess whether longer operation time could increase the complete examination rate of the small bowel and diagnostic yield.A total of 96 patients with suspected small bowel disease received CE examination at 4 tertiary hospitals in Korea. The recorded information was uploaded to a computer and analyzed by the physicians responsible for each patient.The average total capsule operation time was 11 hours and 39 minutes (range: 5 hours 18 minutes approximately 12 hours). In 87 (90.6%) out of 96 cases, the CE was able to explore the entire small bowel. In 32 cases (33.3%), it took more than 8 hours to reach the cecum. Capsule retention occurred in 2 cases (2.1%). The CE found meaningful small bowel lesions in 62 (64.6%) out of 96 total cases.A CE with a long operation time had more chance to explore the entire small bowel even in patients with suspected small bowel disease.
Background: Immune-mediated inflammatory diseases (IMIDs) are associated with chronic inflammation that may increase fracture risk; however, their impact within specific populations, such as those with type 2 diabetes mellitus (T2DM), remains unclear. This study aimed to evaluate the association between IMIDs and fracture risk, leveraging a large, high-quality population-based cohort of patients with T2DM. Methods: A total of 2,120,900 patients with T2DM without a previous history of fractures were enrolled from the nationwide health check-up database provided by the Korean National Health Insurance Service. The outcomes were overall, osteoporotic, non-osteoporotic, vertebral and hip fractures. Multivariable Cox proportional hazard regression analysis was performed to estimate the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) according to the presence of IMIDs. Results: The presence of ulcerative colitis (aHR: 1.31), rheumatoid arthritis (aHR: 1.19), ankylosing spondylitis (aHR: 1.32), and psoriasis (aHR: 1.14) were significantly associated with the risk of overall fractures. Compared with controls, patients with a single IMID (aHR: 1.18) and at least two IMIDs (aHR: 1.29) had a significantly increased risk of overall fractures, showing a dose–response relationship. Similar results were observed for osteoporotic, vertebral, and hip fractures. Conclusions: The presence of IMIDs in patients with T2DM was associated with an increased risk of fractures, particularly osteoporotic, vertebral, and hip fractures. This study highlights the significant impact of IMIDs on fracture risk within a diabetic population, emphasizing the need for careful monitoring and tailored management strategies.
Abstract Background Peritoneal carcinomatosis can influence clinical outcomes of patients receiving self-expandable metal stents (SEMS) for malignant colorectal obstruction, but data regarding this issue are sparse. We analyzed the clinical outcomes of post-SEMS insertion for malignant colorectal obstruction based on carcinomatosis status. Methods Stent- and patient-related clinical outcomes were compared for carcinomatosis status in a retrospective review involving 323 consecutive patients (colorectal cancer 198 patients; extracolonic malignancy 125 patients) who underwent palliative SEMS placement for malignant colorectal obstruction from January 2005 to March 2012. Severity of carcinomatosis was classified as mild, moderate, or severe. Results Carcinomatosis was observed in 190 patients (58.8 %). The rates of technical (84.7 vs. 94.7 %; P = 0.005) and clinical (73.2 vs. 83.5 %; P = 0.03) success were lower in patients with vs. without carcinomatosis. Rates of early (2.1 % vs. 3.0 %; P = 0.72) and delayed (1.6 % vs. 6.0 %; P = 0.08) perforation and stent failure (27.9 % vs. 26.3 %; P = 0.75) showed no difference. Technical and clinical success rates were significantly different based on the severity of carcinomatosis (technical success rate: mild 90.7 %, moderate 97.4 %, severe 76.3 %, P = 0.003; clinical success rate: mild 83.3 %, moderate 82.1 %, severe 63.9 %, P = 0.01). In multivariate analysis, severe carcinomatosis was identified as an independent factor related to technical (odds ratio [OR] 0.18, 95 % confidence interval [CI] 0.06 – 0.56) and clinical (OR 0.33, 95 %CI 0.15 – 0.74) success. Conclusions Peritoneal carcinomatosis was associated with decreased technical and clinical success rates in patients receiving SEMS for malignant colorectal obstruction. Moreover, the presence of severe carcinomatosis was an independent factor determining these clinical outcomes.
Endoscopic papillary large balloon dilatation (EPLBD) after endoscopic sphincterotomy (EST) has recently become widely used for common bile duct (CBD) stone removal, but many clinicians remain concerned about post-procedural pancreatitis with increasing the balloon size to over 15 mm. We aimed to evaluate the safety and efficacy of EPLBD with a relatively large balloon (15–20 mm) after EST and to evaluate the factors related to post-EPLBD pancreatitis. A retrospective review was undertaken of the endoscopic database of 101 patients with CBD stones who underwent EPLBD using a larger balloon size of over 15 mm (15–20 mm). Clinical parameters, endoscopic data, and outcomes were analyzed. The mean age of the subjects was 69 years. All patients had a dilated CBD of over 11 mm (mean = 22.6 mm). The mean size of balloon used in EPLBD was 17.1 ± 1.9 mm (range 15–20 mm). Mechanical lithotripsy was required in seven patients (6.9%). The rate of complete stone removal in the first session was 92.1%. Post-procedural pancreatitis developed in five cases (5.4%), but none were graded as severe. The smaller dilatation of the CBD, longer cannulation time, and longer time for stone removal were associated with post-procedural pancreatitis, but larger size of balloon did not affect the development of post-EPLBD pancreatitis. EPLBD with a large balloon of over 15 mm with EST is an effective and safe procedure with a very low probability of severe post-procedural pancreatitis. Post-EPLBD pancreatitis was not associated with larger balloon size, but was associated with longer procedure time and smaller dilatation of the CBD.
The importance of Helicobacter pylori eradication after endoscopic resection (ER) of gastric neoplasms remains controversial. In this study, we clarified the importance of H. pylori eradication for metachronous lesions after ER.This study included 3,882 patients with gastric neoplasms who underwent ER. We included patients infected with H. pylori who received eradication therapy. Among them, 34 patients with metachronous lesions after ER and 102 age- and sex-matched patients (nonmetachronous group) were enrolled. Background mucosal pathologies such as atrophy and intestinal metaplasia (IM) were evaluated endoscopically. The expression levels of CDX1, CDX2, Sonic hedgehog (SHH), and SOX2 were evaluated based on H. pylori eradication and the development of metachronous lesions.The eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.036). Open-type atrophy (P=0.003) and moderate-to-severe IM (P=0.001) occurred more frequently in the metachronous group. In patients with an initial diagnosis of dysplasia, the eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.002). In addition, open-type atrophy was more frequent in the metachronous group (P=0.047). In patients with an initial diagnosis of carcinoma, moderate-to-severe IM occurred more frequently in the metachronous group (P=0.003); however, the eradication failure rate was not significantly different between the two groups. SHH and SOX2 expression was increased, and CDX2 expression was decreased in the nonmetachronous group after eradication (P<0.05).Open-type atrophy, moderate-to-severe IM, and H. pylori eradication failure were significantly associated with metachronous lesions. However, eradication failure was significantly associated with dysplasia, but not carcinoma, in the metachronous group. Thus, H. pylori eradication may play an important role in preventing metachronous lesions after ER for precancerous lesions before carcinomatous transformation.
Cytomegalovirus (CMV) colitis is common among immunocompromised patients, and often diagnosed by pathologic confirmation because it is associated with a diverse spectrum of clinical and endoscopic features. However, Crohn's disease has no definitive diagnostic criteria, but longitudinal ulcers and cobble stone appearance are accepted as typical endoscopic features of Crohn's disease. An 83 year-old male with a history of radiotherapy for hypopharyngeal cancer visited our hospital with a complaint of melena for 1 week. His colonoscopic exam showed multiple longitudinal ulcers along the entire colon. Most of the ulcers were longer than 4 cm, these endoscopic findings were suspected as typical endoscopic features of Crohn's disease. Pathologic reports revealed multiple inclusion bodies with CMV on immunohistochemistry. He was finally diagnosed as having CMV colitis, and received a 3 week-course of intravenous ganciclovir. A colonoscopic follow-up showed complete healing of the multiple longitudinal ulcers, and he is doing well now without further treatment.
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