Clinical Endoscopy

Original Article

Prognosis of Korean patients with familial adenomatous polyposis who did not undergo colectomy: a retrospective study: Min Kwan Kwon, Jin Hee Noh, Ji Yong Ahn, Woochang Lee, Seok-Byung Lim, Yong Sang Hong, Seung Wook Hong, Sung Wook Hwang, Sang Hyoung Park, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Dong-Hoon Yang; Received June 18, 2025 Accepted August 23, 2025 Published online December 31, 2025; DOI: https://doi.org/10.5946/ce.2025.191 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: The International Society for Gastrointestinal Hereditary Tumors polyposis scoring system (IPSS) categorizes familial adenomatous polyposis (FAP) according to the burden of colorectal polyps and histology. However, the prognosis of patients with uncolectomized FAP has not been established.
Methods
Medical records of patients diagnosed with FAP between 1991 and 2021 were reviewed, and the IPSS stage was determined. The cumulative upstaging rate and risk factors for IPSS upstaging during surveillance were analyzed in patients without colectomies.
Results
Among 237 patients, 35 (28.9%) with IPSS stages 0–2 did not undergo colectomy. The cumulative risk of upstaging was 0%, 31%, 54%, and 73% at 1, 3, 7, and 10 years after FAP diagnosis, respectively. In univariate analysis, age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01–1.08; p=0.014) and having an ampulla of Vater adenoma (HR, 3.95; 95% CI, 1.17–13.30; p=0.027) were associated with upstaging. Multivariate analysis revealed that each 1-year increase in age was an independent risk factor of upstaging (adjusted HR, 1.04; 95% CI, 1.01–1.09; p=0.027).
Conclusions
In our analysis, patients with uncolectomized FAP and IPSS stages 0–2 at diagnosis showed a time-dependent progression in the IPSS stage.

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Review

Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events: Min Kyu Kim, Sung Wook Hwang; Clin Endosc 2024;57(6):725-734. Published online August 29, 2024; DOI: https://doi.org/10.5946/ce.2024.003

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The use of immune checkpoint inhibitors (ICIs) for the treatment of various malignancies is increasing. Immune-related adverse events can occur after ICI administration, with gastrointestinal adverse events constituting a significant proportion of these events. When ICI-related diarrhea/colitis is suspected, endoscopic evaluation is recommended to differentiate it from other etiologies and assess the severity of colitis. The distribution of intestinal inflammation in ICI-related colitis demonstrates a high frequency of extensive colitis (23–86%). However, isolated right-sided colitis (3–8%) and ileitis (2–16%) are less prevalent. Endoscopic findings vary and predominantly encompass features indicative of inflammatory bowel disease, including aphthae, ulcers, diffuse or patchy erythema, mucosal edema, loss of vascular pattern, and friability. The presence of ulcers and extensive intestinal inflammation are associated with a reduced response to treatment. Microscopic inflammation can be observed even in endoscopically normal mucosa, underscoring the need for biopsies of seemingly normal mucosa. Histological findings present with acute/chronic inflammation and occasionally exhibit characteristics observed in inflammatory bowel disease, microscopic colitis, or ischemic colitis. The first-line therapeutic choice for ICI-related diarrhea/colitis with a common terminology criteria for adverse events grade of 2 or above is corticosteroids, whereas infliximab and vedolizumab are recommended for refractory cases.

Citations

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Clinical, Endoscopic, and Histological Characteristics of Severe Immune Checkpoint Inhibitor-Induced Colitis
Diego Casas Deza, Cristina Polo Cuadro, Marta Gascón Ruiz, Manuel Barreiro-de Acosta, Míriam Mañosa, Francisco Rodríguez-Moranta, Yamile Zabana, Elena Céspedes Martínez, Ingrid Ordás, José Miranda Bautista, María José García, Irene García de la Filia Moli
Journal of Clinical Medicine.2026; 15(1): 353. CrossRef
Enteropathogenic Escherichia coli and Bacterial Overgrowth Co-infection Exacerbating Immune Checkpoint Inhibitor-Induced Colitis
Ermias A Kibru, Abdul-Rahaman A Ottun, John G Dusek, Eunice Hama, Bezawit M Fikadu
Cureus.2026;[Epub] CrossRef
Who is at risk for immune checkpoint inhibitor-induced colitis among Korean patients?
Ji Hyun Kim, Sung Chul Park
The Korean Journal of Internal Medicine.2025; 40(1): 3. CrossRef
A Case Report of Metastatic Melanoma in the Transverse Colon
Sophia Bee Ting Tan, Michael Lamparelli
Cureus.2025;[Epub] CrossRef
Immune checkpoint inhibitor-related colitis in a patient with non-small cell lung cancer co-infected with HBV and EBV: a case report
Chao Han, Sujuan Xi, Te Shi, Haiyan Yue
Immunotherapy.2025; 17(9): 631. CrossRef
Endoscopic insights into digestive-related adverse effects of immune checkpoint inhibitors: A narrative review
Grigorios Petrousis, Sylwester Szczegielniak, Haider Sabhan, Peter Elbe, Gülden Bilican, Hans Strid, Francesca Bresso, Charlotte Hedin, Stephan L Haas
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Risk factors for steroid-refractory in immune checkpoint inhibitor-induced colitis: a retrospective cohort study
Ke Meng, Jing Chen, Junzhe Chen, Shengjie Sun, Hui Li, Guanzhou Zhou, Fei Pan
Frontiers in Immunology.2025;[Epub] CrossRef
CD8+ cell dominance in immune checkpoint inhibitor-induced colitis and its heterogeneity across endoscopic features
Min Kyu Kim, Hye-Nam Son, Seung Wook Hong, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Shinkyo Yoon, Sung Wook Hwang
Therapeutic Advances in Gastroenterology.2024;[Epub] CrossRef

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Original Article

Efficacy of Precut Endoscopic Mucosal Resection for Treatment of Rectal Neuroendocrine Tumors: Hoonsub So, Su Hyun Yoo, Seungbong Han, Gwang-un Kim, Myeongsook Seo, Sung Wook Hwang, Dong-Hoon Yang, Jeong-Sik Byeon; Clin Endosc 2017;50(6):585-591. Published online October 12, 2017; DOI: https://doi.org/10.5946/ce.2017.039

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Background
/Aims: Endoscopic resection is the first-line treatment for rectal neuroendocrine tumors (NETs) measuring <1 cm and those between 1 and 2 cm in size. However, conventional endoscopic resection cannot achieve complete resection in all cases. We aimed to analyze clinical outcomes of precut endoscopic mucosal resection (EMR-P) used for the management of rectal NET.
Methods
EMR-P was used to treat rectal NET in 72 patients at a single tertiary center between 2011 and 2015. Both, circumferential precutting and EMR were performed with the same snare device in all patients. Demographics, procedural details, and histopathological features were reviewed for all cases.
Results
Mean size of the tumor measured endoscopically was 6.8±2.8 mm. En bloc and complete resection was achieved in 71 (98.6%) and 67 patients (93.1%), respectively. The mean time required for resection was 9.0±5.6 min. Immediate and delayed bleeding developed in six (8.3%) and 4 patients (5.6%), respectively. Immediate bleeding observed during EMR-P was associated with the risk of delayed bleeding.
Conclusions
Both, the en bloc and complete resection rates of EMR-P in the treatment of rectal NETs using the same snare for precutting and EMR were noted to be high. The procedure was short and safe. EMR-P may be a good treatment choice for the management of rectal NETs.

Citations

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Digestive and Liver Disease.2025; 57(7): 1473. CrossRef
Submucosal saline injection and mini-probe endoscopic ultrasound to assess endoscopic resectability of colorectal subepithelial tumors
Jung-Bin Park, Ji Eun Baek, June Hwa Bae, Seung Wook Hong, Sung Wook Hwang, Sang Hyoung Park, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Dong-Hoon Yang
The Korean Journal of Internal Medicine.2025; 40(4): 592. CrossRef
Precut mucosectomy versus endoscopic resection techniques for colorectal lesions sized 10–30 mm: meta-analysis and systematic review
Miriam Chinzon, Mateus Bond Boghossian, Matheus de Oliveira Veras, Evellin Souza Valentim dos Santos, Daryl Ramai, Larissa Mercadante de Assis, Vitor Hernandes Lopes, Nelson Miyajima, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Surgical Endoscopy.2025; 39(9): 5506. CrossRef
Safety and Efficacy of Simplified EMR Versus ESD for Rectal Neuroendocrine Tumors ≤ 10 Mm: A Retrospective Cohort Study
Linfeng Zou, Long Zou, Yingyun Yang, Weixun Zhou, Xi Wu, Tao Guo, Qingwei Jiang, Yunlu Feng, Shengyu Zhang, Qiang Wang, Aiming Yang
Journal of Clinical Medicine.2025; 14(17): 6125. CrossRef
Endoscopic mucosal resection using anchored snare Tip-in versus precut technique for small rectal neuroendocrine tumors
Seung Wook Hong, Dong-Hoon Yang, Yoo Jin Lee, Dong Hoon Baek, Jaeyoung Chun, Hyun Gun Kim, Sung Joo Kim, Seung-Mo Hong, Dae-Seong Myung
The Korean Journal of Internal Medicine.2024; 39(2): 238. CrossRef
Risk Factors for Lymph Node Metastasis and Oncologic Outcomes in Small Rectal Neuroendocrine Tumors with Lymphovascular Invasion
Seung-Joo Nam, Byung Chang Kim, Hee Jin Chang, Han Ho Jeon, Junho Kim, Su Young Kim
Gut and Liver.2022; 16(2): 228. CrossRef
EMR-P for small rectal neuroendocrine tumors: is it a preferred treatment?
Zhaohui Liu, Chunsi Zheng, Shihua Ding, Chong Chen, Jingbo Yang, Ruinuan Wu, Dayong Sun
Scandinavian Journal of Gastroenterology.2022; 57(12): 1503. CrossRef
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Sukit Pattarajierapan, Supakij Khomvilai
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Giuseppe Iabichino, Milena Di Leo, Monica Arena, Giovanni Giuseppe Rubis Passoni, Elisabetta Morandi, Francesca Turpini, Paolo Viaggi, Carmelo Luigiano, Luca De Luca
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Hee Sung Lee, Hee Seok Moon, In Sun Kwon, Jae Ho Park, Ju Seok Kim, Sun Hyung Kang, Eaum Seok Lee, Seok Hyun Kim, Jae Kyu Sung, Byung Seok Lee, Hyun Yong Jeong
Surgical Endoscopy.2021; 35(11): 6055. CrossRef
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Francesco Maione, Alessia Chini, Marco Milone, Nicola Gennarelli, Michele Manigrasso, Rosa Maione, Gianluca Cassese, Gianluca Pagano, Francesca Paola Tropeano, Gaetano Luglio, Giovanni Domenico De Palma
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Chung‐Ying Lee, Ming‐Yao Chen, Hwai‐Jeng Lin, Hsi‐Yuan Chien
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Case Report

Multiple Polypoid Angiodysplasia with Obscure Overt Bleeding: Jooyoung Lee, Sung Wook Hwang, Jihye Kim, Jinwoo Kang, Gyeong Hoon Kang, Kyu Joo Park, Jong Pil Im, Joo Sung Kim; Clin Endosc 2016;49(1):91-96. Published online January 28, 2016; DOI: https://doi.org/10.5946/ce.2016.49.1.91

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Angiodysplasia (AD) is increasingly being recognized as a major cause of gastrointestinal bleeding. Morphologically flat lesions are common types of AD, whereas the polypoid types are rare. We report a case of multiple polypoid AD in the small bowel causing severe anemia and requiring surgical treatment. A 60-year-old male patient visited our hospital with dyspnea and hematochezia. He had a history of myocardial infarction and was taking both aspirin and clopidogrel. Capsule endoscopy, enteroscopy, computed tomography, and angiography revealed multifocal vascular lesions with a polypoid shape in the jejunum. Surgical resection was performed because endoscopic treatment was considered impossible with the number and the location of lesions. The risk of recurrent bleeding related to the use of antiplatelet agents also contributed to the decision to perform surgery. AD was histologically diagnosed from the surgical specimen. He resumed taking both aspirin and clopidogrel after surgery. He fully recovered and has been doing well during the several months of follow-up.

Citations

Citations to this article as recorded by

Intraoperative Endoscopic-Guided Bowel Resection for Persistent Gastrointestinal Bleeding Caused by Angiodysplasia: A Case Report and Literature Review
Emily Fellows, Joy Harris, Tania Kibble, Nicholas M. McDonald, Nabeel Azeem, James V. Harmon
The Surgery Journal.2023; 09(04): e112. CrossRef
Ileal angiodysplasia presentation as a bowel obstruction: A case report
Ons Ghdes, Ali Gaja, Ahlem Blel, Hichem Jarraya, Najla Mnif
International Journal of Surgery Case Reports.2017; 39: 301. CrossRef
Solitary Polypoid Angiodysplastic Lesion Mimicking a Tumor in the Jejunum
Abhishek D. Polavarapu, Mayurathan Kesavan, Vivek V. Gumaste, Monika Wrzolek, Elias Purow
ACG Case Reports Journal.2017; 4(1): e83. CrossRef

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