• Journal of Digestive Cancer Research
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• 제11권3호
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• pp.130-140
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• 2023

Gastric cancer (GC) is one of the most common malignant tumors worldwide, with a 5-year survival rate of < 40%. The diagnosis and treatment decisions of GC rely on human experts' judgments on medical images; therefore, the accuracy can be hindered by image condition, objective criterion, limited experience, and interobserver discrepancy. In recent years, several applications of artificial intelligence (AI) have emerged in the GC field based on improvement of computational power and deep learning algorithms. AI can support various clinical practices in endoscopic examination, pathologic confirmation, radiologic staging, and prognosis prediction. This review has systematically summarized the current status of AI applications after a comprehensive literature search. Although the current approaches are challenged by data scarcity and poor interpretability, future directions of this field are likely to overcome the risk and enhance their accuracy and applicability in clinical practice.

• Clinical Endoscopy
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• 제57권3호
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• pp.402-406
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• 2024

Cronkhite-Canada syndrome is a rare gastrointestinal polyposis syndrome with distinctive clinical features and endoscopic findings. Diagnosis can be challenging without suspicion, and the disease carries high mortality due to complications such as infection, gastrointestinal bleeding, and malignancies. This paper presents two cases of Cronkhite-Canada syndrome occurring after coronavirus disease 2019 (COVID-19) mRNA vaccination. Both cases exhibited typical clinical findings, including hypogeusia, onychodystrophy, alopecia, and weight loss. Typical polyposis in the gastrointestinal tract was confirmed through endoscopies. As symptomatic treatment did not improve the symptoms, corticosteroids were administered, and symptoms and laboratory test results improved immediately. The patients improved upon corticosteroids tapering. These cases illustrate typical presentations of Cronkhite-Canada syndrome and the course of the disease following corticosteroid treatment. Additionally, they suggest the possibility that Cronkhite-Canada syndrome may be triggered by COVID-19 mRNA vaccination.

• 한국간담췌외과학회지
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• 제26권4호
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• pp.298-307
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• 2022

Portal cavernoma cholangiopathy is defined as an obstruction of the biliary system due to distended veins surrounding bile ducts that mainly occur in patients with extrahepatic portal venous obstruction. The periductal venous plexuses encircling the ducts can cause morphological changes which may or may not become symptomatic. Currently, non-invasive techniques such as ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and dynamic contrast enhanced magnetic resonance images are being used to diagnose this disorder. Only a few patients who have symptoms of biliary obstruction require drainage which might be accomplished using endoscopic stenting, decompression of the portal venous system usually via a lienorenal shunt, a difficult direct hepaticojejunostomy, and rarely a liver transplant.

• Asian Pacific Journal of Cancer Prevention
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• 제16권5호
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• pp.1747-1749
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• 2015

Background: Esophageal cancer is one of the major health concerns in Southeast Asian countries, including Thailand. However, only a limited number of studies have been reported from this region. This study was designed to evaluate the prevalence, clinical characteristics and survival rate of esophageal cancer in Thailand. Materials and Methods: Clinical information, histological features and endoscopic findings were collected from a tertiary care center in central region of Thailand between September 2011- November 2014 and reviewed. Results: A total of 64 esophageal cancer patients including 58 men and 6 women with mean age of 62.6 years were enrolled. Common presenting symptoms were dysphagia (74%), dyspepsia (10%) and hematemesis (8%). Mean duration of symptoms prior to diagnosis was 72 days. Esophageal stenosis with contact bleeding was the most common endoscopic finding (55.6%). The location of cancer was found in proximal (16%), middle (50%) and distal (34%) esophagus. Squamous cell carcinoma was far more common histology than adenocarcinoma (84.2% vs 10.5%). However, esophageal adenocarcinoma was significantly more common than squamous cell carcinoma in distal area of esophagus (100% vs 22.9%; p=0.0001, OR=1.6, 95%CI=1.1-2.2). Esophageal cancer stages 3 and 4 accounted for 35.2% and 59.3% respectively. Overall 2-year survival rate was 20% and only 16% in metastatic patients. Conclusions: Most esophageal cancer patients in Thailand have squamous cell carcinoma and nearly all present at advanced stage with a grave prognosis. Screening of high risk individuals and early detection might be important keys to improve the survival rate and treatment outcome in Thailand.

• Tuberculosis and Respiratory Diseases
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• 제72권2호
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• pp.228-231
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• 2012

Bronchobiliary fistula (BBF), defined as an abnormal communication between the biliary duct and bronchial trees, is a very rare condition. Bilioptysis is a pathognomonic finding for BBF. We studied a 58-year-old man, who had a BBF complicated by liver biloma that occurred after radiofrequency ablation. The diagnosis was confirmed by the presence of bile-stained sputum and an Endoscopic Retrograde Cholangio-Pancreatography. BBF was treated successfully by endoscopic sphincterotomy and biliary drainage with insertion of a double pig-tail plastic stent into the biloma. We suggest that the optimal choice of treatment modality for BBF depends on the natural course of the underlying disease, and the status of the biliary stricture.

• Journal of Gastric Cancer
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• 제4권3호
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• pp.186-191
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• 2004

Primary small-cell carcinomas of the stomach are rare and aggressive malignancies with poor survival rates. Preoperative diagnosis is difficult and a standard treatment is not yet established. We have recently experienced two cases of a primary small-cell carcinoma of the stomach. The first case was a 65-year-old man with epigastric soreness. Endoscopic biopsy showed an adenocarcinoma. He underwent a radical subtotal gastrectomy with D2 lymph-node dissection. Pathology revealed a collision tumor of a smallcell carcinoma and an adenocarcinoma with submucosal invasion and with metastasis in 20 out of 48 lymph nodes (T1N3M0). The second case was a 64-year-old man with epigastric soreness. Endoscopic biopsy revealed a small-cell carcinoma. There was no evidence of a primary tumor in the lung. A radical subtotal gastrectomy with D2 lymph-node dissection was performed. Pathology showed a pure smallcell carcinoma with proper muscle invasion and with metastasis in 1 out of 36 lymph nodes (T2aN1M0).

• Journal of Gastric Cancer
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• 제18권1호
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• pp.82-89
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• 2018

Purpose: Early detection of gastric cancer is important to improve prognosis. Early detection enables local treatment, such as endoscopic submucosal dissection (ESD). Therefore, we investigated whether early detection of gastric cancer could reduce healthcare costs by comparison according to stage and treatment modalities. Materials and Methods: Medical care costs were investigated according to tumor stage and initial treatment modality in 1,188 patients newly diagnosed with gastric cancer at 7 medical institutions from December 2011 to June 2012. Total medical care costs during the first-year after diagnosis (total first-year costs) were examined, including the costs of initial treatment, post-initial treatment, and inpatient and outpatient visits. Results: Stage I (75.3%) was the most common cancer stage. ESD was the second most common treatment following surgery. Total first-year costs increased significantly from stages I to IV. The costs of initial treatment and post-initial treatment were lowest in patients with stage I cancer. Among patients with stage I cancer, total first-year costs were significantly lower when treated by ESD; in particular, initial ESD treatment costs were much lower than others. Conclusions: The cost of healthcare has increased significantly with increasing cancer stages. ESD can greatly reduce medical care costs of gastric cancer. Thus, early detection of gastric cancer is important to reduce healthcare costs.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권4호
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• pp.319-328
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• 2020

Purpose: To examine the prevalence and clinical manifestations of eosinophilic esophagitis (EoE) in Korea children. Methods: The study was designed as a 1:2 matching case-control study. Using information from the endoscopic database of a tertiary center, we retrospectively reviewed the medical records of patients aged 18 years or younger who underwent upper gastrointestinal endoscopy between January 2014 and December 2017. A total of 21 patients were diagnosed with EoE based on current diagnostic criteria. In addition, 42 controls with normal esophageal biopsy findings matched to each EoE case by sex, age (±1 months), and season were randomly selected during the study period. Results: The mean age of EoE diagnosis was 12.1±4.0 years and the male-to-female ratio was 2:1. The proportion of allergic diseases in patients with EoE (28.6%) was higher than that in the controls (6.8%) (p=0.04). Most EoE patients tested for allergy were positive for at least one antigen, which was significantly different to the controls (88.2% vs. 47.4%, p=0.01). Characteristic endoscopic findings of EoE were noted in 19 patients (90.5%), but 2 patients (9.5%) showed normal esophageal mucosa. The clinical symptoms of EoE were improved by a proton-pump inhibitor in 10 patients (50.0%), and by an H₂ blocker in 9 patients (45.0%). Only one patient (5.0%) required inhaled steroids. Conclusion: While EoE is rare in the Korean pediatric population, the results of this study will improve our understanding of the clinical manifestations of the disease.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권3호
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• pp.273-278
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• 2021

Purpose: Percutaneous endoscopic gastrostomy (PEG) is a safe method to feed patients with feeding difficulty. This study aimed to compare the outcomes of conventional PEG and laparoscopic-assisted PEG (L-PEG) placement in high-risk pediatric patients. Methods: In our tertiary pediatric department, 90 PEG insertions were performed between 2014 and 2019. Children with severe thoracoabdominal deformity (TAD), previous abdominal surgery, ventriculoperitoneal (VP) shunt, and abdominal tumors were considered as high-risk patients. Age, sex, diagnosis, operative time, complications, and mortality were compared among patients who underwent conventional PEG placement (first group) and those who underwent L-PEG placement (second group). Results: We analyzed the outcomes of conventional PEG placement (first group, n=15; patients with severe TAD [n=7], abdominal tumor [n=6], and VP shunts [n=2]) and L-PEG placement (second group, n=10; patients with VP shunts [n=5], previous abdominal surgery [n=4], and severe TAD [n=1]). Regarding minor complications, 1 (6.6%) patient in the first group underwent unplanned PEG removal and 1 (10%) patient in the second group had peristomal granuloma. We observed three major complications: colon perforation (6.6%) in a patient with VP shunt, gastrocolic fistula (6.6%) in a patient with Fallot-tetralogy and severe TAD, and pneumoperitoneum (6.6%) caused by early tube dislodgement in an autistic patient with severe TAD. All the three complications occurred in the first group (20%). No major complications occurred in the second group. Conclusion: In high-risk patients, L-PEG may be safer than conventional PEG. Thus, L-PEG is recommended for high-risk patients.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권1호
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• pp.100-108
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• 2021

Purpose: Percutaneous endoscopic gastrostomy (PEG) tube placements are commonly performed pediatric endoscopic procedures. Because of underlying disease, these patients are at increased risk for airway-related complications. This study compares patient characteristics and complications following initial PEG insertion with general endotracheal anesthesia (GETA) vs. anesthesia-directed deep sedation with a natural airway (ADDS). Methods: All patients 6 months to 18 years undergoing initial PEG insertion within the endoscopy suite were considered for inclusion in this retrospective cohort study. Selection of GETA vs. ADDS was made by the anesthesia attending after discussion with the gastroenterologist. Results: This study included 168 patients (GETA n=38, ADDS n=130). Cohorts had similar characteristics with respect to sex, race, and weight. Compared to ADDS, GETA patients were younger (1.5 years vs. 2.9 years, p=0.04), had higher rates of severe American Society of Anesthesiologists (ASA) disease severity scores (ASA 4-5) (21% vs. 3%, p<0.001), and higher rates of cardiac comorbidities (39.5% vs. 18.5%, p=0.02). Significant associations were not observed between GETA/ADDS status and airway support, 30-day readmission, fever, or pain medication in unadjusted or adjusted models. GETA patients had significantly increased length of stay (eβ=1.55, 95% confidence interval [CI]=1.11-2.18) after adjusting for ASA class, room time, anesthesia time, fever, and cardiac diagnosis. GETA patients also had increased room time (eβ=1.20, 95% CI=1.08-1.33) and anesthesia time (eβ=1.50, 95% CI=1.30-1.74) in adjusted models. Conclusion: Study results indicate that younger and higher risk patients are more likely to undergo GETA. Children selected for GETA experienced longer room times, anesthesia times, and hospital length of stay.