Clinical Endoscopy

Systematic Review and Meta-analysis

Cold snare polypectomy versus cold endoscopic mucosal resection for small colorectal polyps: a meta-analysis of randomized controlled trials: Vishali Moond, Priyadarshini Loganathan, Sheza Malik, Dushyant Singh Dahiya, Babu P. Mohan, Daryl Ramai, Michele McGinnis, Deepak Madhu, Mohammad Bilal, Aasma Shaukat, Saurabh Chandan; Clin Endosc 2024;57(6):747-758. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.081 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Cold snare polypectomy (CSP) is routinely performed for small colorectal polyps (≤10 mm). However, challenges include insufficient resection depth and immediate bleeding, hindering precise pathological evaluation. We aimed to compare the outcomes of cold endoscopic mucosal resection (CEMR) with that of CSP for colorectal polyps ≤10 mm, using data from randomized controlled trials (RCTs).
Methods
Multiple databases were searched in December 2023 for RCTs reporting outcomes of CSP versus CEMR for colorectal polyps ≤10 mm in size. Our primary outcomes were rates of complete and en-bloc resections, while our secondary outcomes were total resection time (seconds) and adverse events, including immediate bleeding, delayed bleeding, and perforation.
Results
The complete resection rates did not significantly differ (CSP, 91.8% vs. CEMR 94.6%), nor did the rates of en-bloc resection (CSP, 98.9% vs. CEMR, 98.3%) or incomplete resection (CSP, 6.7% vs. CEMR, 4.8%). Adverse event rates were similarly insignificant in variance. However, CEMR had a notably longer mean resection time (133.51 vs. 91.30 seconds).
Conclusions
Our meta-analysis of seven RCTs showed that while both CSP and CEMR are equally safe and effective for resecting small (≤10 mm) colorectal polyps, the latter is associated with a longer resection time.

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Original Article

Assessing the potential of artificial intelligence to enhance colonoscopy adenoma detection in clinical practice: a prospective observational trial: Søren Nicolaj Rønborg, Suresh Ujjal, Rasmus Kroijer, Magnus Ploug; Clin Endosc 2024;57(6):783-789. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.038

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: This study aimed to evaluate the effectiveness of the GI Genius (Medtronic) module in clinical practice, focusing on the adenoma detection rate (ADR) during colonoscopy. Computer-aided polyp detection (CADe) systems using artificial intelligence have been shown to improve adenoma detection in controlled trials. However, the effectiveness of these systems in clinical practice has recently been questioned.
Methods
This single-center prospective observational study was conducted at the University Hospital of Southern Denmark and included all individuals referred for colonoscopy between November 2020 and January 2021. The primary outcome was ADR, comparing patients examined with CADe to those examined without it. The selection of patients to be examined with the CADe module was completely random.
Results
A total of 502 patients were analyzed (318 in the control group and 184 in the CADe group). The overall ADR was 32.1% with a slight increase in the CADe group (34.7% vs. 30.5%). Multivariable analysis showed a very modest and statistically insignificant increase in ADR (risk ratio, 1.12; 95% confidence interval, 0.88–1.43).
Conclusions
The use of CADe in clinical practice did not increase ADR with statistical significance when compared to colonoscopy without CADe. These findings suggest that the impact of CADe systems in everyday clinical practice are modest.

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Review

Use of artificial intelligence in the management of T1 colorectal cancer: a new tool in the arsenal or is deep learning out of its depth?: James Weiquan Li, Lai Mun Wang, Katsuro Ichimasa, Kenneth Weicong Lin, James Chi-Yong Ngu, Tiing Leong Ang; Clin Endosc 2024;57(1):24-35. Published online September 25, 2023; DOI: https://doi.org/10.5946/ce.2023.036

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The field of artificial intelligence is rapidly evolving, and there has been an interest in its use to predict the risk of lymph node metastasis in T1 colorectal cancer. Accurately predicting lymph node invasion may result in fewer patients undergoing unnecessary surgeries; conversely, inadequate assessments will result in suboptimal oncological outcomes. This narrative review aims to summarize the current literature on deep learning for predicting the probability of lymph node metastasis in T1 colorectal cancer, highlighting areas of potential application and barriers that may limit its generalizability and clinical utility.

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Prediction of Lymph Node Metastasis in T1 Colorectal Cancer Using Artificial Intelligence with Hematoxylin and Eosin-Stained Whole-Slide-Images of Endoscopic and Surgical Resection Specimens
Joo Hye Song, Eun Ran Kim, Yiyu Hong, Insuk Sohn, Soomin Ahn, Seok-Hyung Kim, Kee-Taek Jang
Cancers.2024; 16(10): 1900. CrossRef
Approaches and considerations in the endoscopic treatment of T1 colorectal cancer
Yunho Jung
The Korean Journal of Internal Medicine.2024; 39(4): 563. CrossRef

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Original Article

Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases: Hayato Yamaguchi, Masakatsu Fukuzawa, Takashi Kawai, Takahiro Muramatsu, Taisuke Matsumoto, Kumiko Uchida, Yohei Koyama, Akira Madarame, Takashi Morise, Shin Kono, Sakiko Naito, Naoyoshi Nagata, Mitsushige Sugimoto, Takao Itoi; Clin Endosc 2023;56(6):778-789. Published online July 26, 2023; DOI: https://doi.org/10.5946/ce.2022.268

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD).
Methods
We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes.
Results
Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]).
Conclusions
RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

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Planned Hybrid Endoscopic Submucosal Dissection as Alternative for Colorectal Neoplasms: A Propensity Score-Matched Study
Yu-xin Zhang, Xun Liu, Fang Gu, Shi-gang Ding
Digestive Diseases and Sciences.2024; 69(3): 949. CrossRef
Understanding hybrid endoscopic submucosal dissection subtleties
João Paulo de Souza Pontual, Alexandre Moraes Bestetti, Diogo Turiani Hourneaux de Moura
Clinical Endoscopy.2023; 56(6): 738. CrossRef

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Review

Korean guidelines for postpolypectomy colonoscopic surveillance: 2022 revised edition: Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo Young Cho, Moon Sung Lee, Oh Young Lee, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases; Clin Endosc 2022;55(6):703-725. Published online October 13, 2022; DOI: https://doi.org/10.5946/ce.2022.136

Abstract PDF Supplementary Material PubReader ePub

Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for the management of advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: (1) adenoma ≥10 mm in size; (2) 3 to 5 (or more) adenomas; (3) tubulovillous or villous adenoma; (4) adenoma containing high-grade dysplasia; (5) traditional serrated adenoma; (6) sessile serrated lesion (SSL) containing any grade of dysplasia; (7) serrated polyp of at least 10 mm in size; and (8) 3 to 5 (or more) SSLs. More studies are needed to fully comprehend the patients most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

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Association between Atherosclerosis and High-Risk Colorectal Adenomas based on Cardio-Ankle Vascular Index and Ankle-Brachial Index
Jung Ho Lee, Hyunseok Cho, Sang Hoon Lee, Sung Joon Lee, Chang Don Kang, Dae Hee Choi, Jin Myung Park, Seung-Joo Nam, Tae Suk Kim, Ji Hyun Kim, Sung Chul Park
The Korean Journal of Gastroenterology.2024; 83(4): 143. CrossRef
A survey of current practices in post-polypectomy surveillance in Korea
Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Eun Ran Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoo
Intestinal Research.2024; 22(2): 186. CrossRef
Approaches and considerations in the endoscopic treatment of T1 colorectal cancer
Yunho Jung
The Korean Journal of Internal Medicine.2024; 39(4): 563. CrossRef
Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revision
Su Young Kim
The Korean Journal of Medicine.2023; 98(3): 102. CrossRef
Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
Clinical Endoscopy.2023; 56(5): 553. CrossRef
Understanding colorectal polyps to prevent colorectal cancer
Dong-Hoon Yang
Journal of the Korean Medical Association.2023; 66(11): 626. CrossRef
Classification and endoscopic diagnosis of colorectal polyps
Ji Hyun Kim, Sung Chul Park
Journal of the Korean Medical Association.2023; 66(11): 633. CrossRef
Endoscopic treatment of colorectal polyps and early colorectal cancer
Yunho Jung
Journal of the Korean Medical Association.2023; 66(11): 642. CrossRef
Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
Yong Soo Kwon, Su Young Kim
Journal of the Korean Medical Association.2023; 66(11): 652. CrossRef

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Original Article

Endoscopic submucosal dissection in colorectal neoplasia performed with a waterjet system-assisted knife: higher en-bloc resection rate than conventional technique: Paolo Cecinato, Matteo Lucarini, Francesco Azzolini, Mariachiara Campanale, Fabio Bassi, Annalisa Cippitelli, Romano Sassatelli; Clin Endosc 2022;55(6):775-783. Published online October 6, 2022; DOI: https://doi.org/10.5946/ce.2022.099

Abstract PDF PubReader ePub

Background
/Aims: Colorectal endoscopic submucosal dissection (ESD) is burdened by its associated high risk of adverse events and long procedure time. Recently, a waterjet-assisted knife was introduced to simplify and speed up the procedure. The aim of this study was to evaluate the efficacy and safety of waterjet-assisted ESD (WESD) compared to that of the conventional ESD (CESD) technique.
Methods
The charts of 254 consecutive patients who underwent colorectal ESD between January 2014 and February 2021 for colorectal neoplasms were analyzed. The primary outcome was the en-bloc resection rate. Secondary outcomes were complete and curative resection rates, the need to switch to a hybrid ESD, procedure speed, the adverse event rates, and the recurrence rates.
Results
Approximately 174 neoplasias were considered, of which, 123 were removed by WESD and 51 by CESD. The en-bloc resection rate was higher in the WESD group (94.3% vs. 84.3%). Complete resection rates and curative resection rates were similar. The need to switch to a hybrid ESD was greater during CESD (39.2% vs. 13.8%). Procedure speed and adverse event rates were similar. During follow-up, one recurrence occurred after a WESD.
Conclusions
WESD allows a high rate of en-bloc resections and less frequently requires a rescue switch to the hybrid ESD compared to CESD.

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Is there a best choice of equipment for colorectal endoscopic submucosal dissection?
Francesco Cocomazzi, Sonia Carparelli, Nunzia Labarile, Antonio Capogreco, Marco Gentile, Roberta Maselli, Jahnvi Dhar, Jayanta Samanta, Alessandro Repici, Cesare Hassan, Francesco Perri, Antonio Facciorusso
Expert Review of Medical Devices.2024; 21(7): 561. CrossRef
Colorectal Endoscopic Submucosal Dissection: Performance of a Novel Hybrid-Technology Knife in an Animal Trial
Jérémie Jacques, Horst Neuhaus, Markus D. Enderle, Ulrich Biber, Walter Linzenbold, Martin Schenk, Kareem Khalaf, Alessandro Repici
Diagnostics.2023; 13(21): 3347. CrossRef

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Reviews

Post-polypectomy surveillance: the present and the future: Masau Sekiguchi, Takahisa Matsuda, Kinichi Hotta, Yutaka Saito; Clin Endosc 2022;55(4):489-495. Published online July 11, 2022; DOI: https://doi.org/10.5946/ce.2022.097

Abstract PDF PubReader ePub

An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polypectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.

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Protocolo diagnóstico del seguimiento de pólipos colónicos
S. Redondo Evangelista, M. Sierra Morales, I. Bartolomé Oterino, P. García Centeno, A. Santos Rodríguez
Medicine - Programa de Formación Médica Continuada Acreditado.2024; 14(4): 219. CrossRef
Approaches and considerations in the endoscopic treatment of T1 colorectal cancer
Yunho Jung
The Korean Journal of Internal Medicine.2024; 39(4): 563. CrossRef
Efficacy of Oral Sulfate Tablet and 2 L-Polyethylene Glycol with Ascorbic Acid for Bowel Preparation: A Prospective Randomized KASID Multicenter Trial
Yunho Jung, Hyun Gun Kim, Dong-Hoon Yang, Hyoun Woo Kang, Jae Jun Park, Dong Hoon Baek, Jaeyoung Chun, Tae-Geun Gweon, Hyeon Jeong Goong, Min Seob Kwak, Hyun Jung Lee, Soo-Kyung Park, Jong Hoon Lee
Journal of Korean Medical Science.2024;[Epub] CrossRef
Metabolic‐associated fatty liver disease is associated with colorectal adenomas in young and older Korean adults
Jiwon Chang, Yoosoo Chang, Yoosun Cho, Hyun‐Suk Jung, Dong‐Il Park, Soo‐Kyung Park, Soo‐Youn Ham, Sarah H. Wild, Christopher D. Byrne, Seungho Ryu
Liver International.2023; 43(11): 2548. CrossRef
Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
Clinical Endoscopy.2023; 56(5): 553. CrossRef
Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
Yong Soo Kwon, Su Young Kim
Journal of the Korean Medical Association.2023; 66(11): 652. CrossRef
Endoscopic treatment of colorectal polyps and early colorectal cancer
Yunho Jung
Journal of the Korean Medical Association.2023; 66(11): 642. CrossRef
Understanding colorectal polyps to prevent colorectal cancer
Dong-Hoon Yang
Journal of the Korean Medical Association.2023; 66(11): 626. CrossRef

4,267 View
274 Download
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8 Crossref

Can Computed Tomography Colonography Replace Optical Colonoscopy in Detecting Colorectal Lesions?: State of the Art: Alessia Chini, Michele Manigrasso, Grazia Cantore, Rosa Maione, Marco Milone, Francesco Maione, Giovanni Domenico De Palma; Clin Endosc 2022;55(2):183-190. Published online February 24, 2022; DOI: https://doi.org/10.5946/ce.2021.254

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Colorectal cancer is an important cause of morbidity and mortality worldwide. Optical colonoscopy (OC) is widely accepted as the reference standard for the screening of colorectal polyps and cancers, and computed tomography colonography (CTC) is a valid alternative to OC. The purpose of this review was to assess the diagnostic accuracy of OC and CTC for colorectal lesions. A literature search was performed in PubMed, Embase, and Cochrane Library, and 18 articles were included. CTC has emerged in recent years as a potential screening examination with high accuracy for the detection of colorectal lesions. However, the clinical application of CTC as a screening technique is limited because it is highly dependent on the size of the lesions and has poor performance in detecting individual lesions <5 mm or flat lesions, which, although rarely, can have a malignant potential.

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Multi-view orientational attention network combining point-based affinity for polyp segmentation
Yan Liu, Yan Yang, Yongquan Jiang, Zhuyang Xie
Expert Systems with Applications.2024; 249: 123663. CrossRef
The Influence of Mechanical Bowel Preparation on Volatile Organic Compounds for the Detection of Gastrointestinal Disease—A Systematic Review
Ashwin Krishnamoorthy, Subashini Chandrapalan, Sofie Bosch, Ayman Bannaga, Nanne K.H. De Boer, Tim G.J. De Meij, Marcis Leja, George B. Hanna, Nicoletta De Vietro, Donato Altomare, Ramesh P. Arasaradnam
Sensors.2023; 23(3): 1377. CrossRef
The Detection of Colorectal Cancer through Machine Learning-Based Breath Sensor Analysis
Inese Poļaka, Linda Mežmale, Linda Anarkulova, Elīna Kononova, Ilona Vilkoite, Viktors Veliks, Anna Marija Ļeščinska, Ilmārs Stonāns, Andrejs Pčolkins, Ivars Tolmanis, Gidi Shani, Hossam Haick, Jan Mitrovics, Johannes Glöckler, Boris Mizaikoff, Mārcis Lej
Diagnostics.2023; 13(21): 3355. CrossRef

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Case Report

Development of colon cancer in a patient with longstanding colonic diffuse ganglioneuromatosis: a case report: Jin Sun Oh, Seung Wook Hong, Jin Hee Noh, Jiyoung Yoon, Hyo Jeong Kang, Young Soo Park, Dong-Hoon Yang, Jeong-Sik Byeon; Clin Endosc 2022;55(3):452-457. Published online March 4, 2021; DOI: https://doi.org/10.5946/ce.2021.013

Abstract PDF PubReader ePub

Colonic diffuse ganglioneuromatosis is an extremely rare disease in which multiple tumors derived from the ganglion cells, nerve fibers, and supporting cells are distributed in the colon. It is generally considered to be a benign neoplastic condition and is occasionally associated with rare hereditary conditions such as neurofibromatosis type I or multiple endocrine neoplasia type 2B. Here, we report a case of a patient in whom colon cancer developed 12 years after the initial diagnosis of colonic diffuse ganglioneuromatosis, which suggests a possible association between colonic diffuse ganglioneuromatosis and colorectal cancer.

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A Case Series of Pediatric Intestinal Ganglioneuromatosis With Novel Phenotypic and Genotypic Profile
Yuan Fang, Ye Zhang, Rui Dong, Yi-zhen Wang, Lian Chen, Gong Chen
Frontiers in Medicine.2022;[Epub] CrossRef

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Reviews

Trends of Colorectal Cancer Prevalence in Kazakhstan Related to Screening: Alma Zhylkaidarova, Dilyara Kaidarova, Kanat Batyrbekov, Oxana Shatkovskaya, Dinara Begimbetova; Clin Endosc 2021;54(1):32-37. Published online May 25, 2020; DOI: https://doi.org/10.5946/ce.2019.198

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We carried out an analysis of the total incidence of colon cancer throughout Kazakhstan. Retrospectively, according to the regional reports on endoscopic screening, the study showed an increase in the age-related incidence of colorectal cancer (CRC) cases from 2004–2008 to 2009–2014. The peak of morbidity in both periods was noted in the age category of >70 years. The indicators of the territorial distribution of CRC incidence make it possible to divide the regions into areas with low or high rates of CRC. Specific indicators showed newly diagnosed cases of CRC stages I, II, III, and IV in 2004–2018. The incidence rates of stages I and II showed a two-fold increase (35%–67.4%) and the incidence of stage IV showed a decline from 19.3% to 13.1% and of stage III from 45.7% to 19.5% from 2004 to 2018, respectively. An analysis of CRC incidence throughout Kazakhstan showed an increase in the overall incidence. Since population-based CRC screening was introduced in 2011, the morbidity was found to increase for stages I and II.

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Colorectal cancer’s burden attributable to a diet high in processed meat in the Belt and Road Initiative countries
Gu Liu, Chang-Min Li, Fei Xie, Qi-Lai Li, Liang-Yan Liao, Wen-Jun Jiang, Xiao-Pan Li, Guan-Ming Lu
World Journal of Gastrointestinal Oncology.2024; 16(1): 182. CrossRef
Serum Interleukins 8, 17, and 33 as Potential Biomarkers of Colon Cancer
Constantin-Dan Tâlvan, Liviuța Budișan, Elena-Teodora Tâlvan, Valentin Grecu, Oana Zănoagă, Cosmin Mihalache, Victor Cristea, Ioana Berindan-Neagoe, Călin Ilie Mohor
Cancers.2024; 16(4): 745. CrossRef
Kazakh version of the beck depression inventory: Validation study in female cancer patients
Indira Karibayeva, Botagoz Turdaliyeva, Nor Zuraida Zainal, Fatima Bagiyarova, Dinara Kussainova
Heliyon.2023; 9(7): e18146. CrossRef
Colorectal Cancer Screening with Computed Tomography Colonography: Single Region Experience in Kazakhstan
Jandos Amankulov, Dilyara Kaidarova, Zhamilya Zholdybay, Marianna Zagurovskaya, Nurlan Baltabekov, Madina Gabdullina, Akmaral Ainakulova, Dias Toleshbayev, Alexandra Panina, Elvira Satbayeva, Zhansaya Kalieva
Clinical Endoscopy.2022; 55(1): 101. CrossRef
Association of four genetic variants with colorectal cancer in Kazakhstan population
Yevgeniya Kolesnikova, Dmitriy Babenko, Irina Kadyrova, Svetlana Kolesnichenko, Lyudmila Akhmaltdinova, Ilya Korshukov, Naylya Kabildina, Valentina Sirota, Vera Zhumaliyeva, Dana Taizhanova, Dmitriy Vazenmiller, Anar Turmukhambetova
Oncotarget.2021; 12(21): 2215. CrossRef

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Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer: Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong Yeul Lee, Jeong-Sik Byeon, Chan Guk Park, Joo Young Cho, Soo Teik Lee, Hoon Jai Chun; Clin Endosc 2020;53(2):142-166. Published online March 30, 2020; DOI: https://doi.org/10.5946/ce.2020.032

Abstract PDF Supplementary Material PubReader ePub

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

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Helicobacter pylori Treatment and Gastric Cancer Risk After Endoscopic Resection of Dysplasia: A Nationwide Cohort Study
Hae Won Yoo, Su Jin Hong, Shin Hee Kim
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A Modified eCura System to Stratify the Risk of Lymph Node Metastasis in Undifferentiated-Type Early Gastric Cancer After Endoscopic Resection
Hyo-Joon Yang, Hyuk Lee, Tae Jun Kim, Da Hyun Jung, Kee Don Choi, Ji Yong Ahn, Wan Sik Lee, Seong Woo Jeon, Jie-Hyun Kim, Gwang Ha Kim, Jae Myung Park, Sang Gyun Kim, Woon Geon Shin, Young-Il Kim, Il Ju Choi
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Management after non-curative endoscopic resection of T1 rectal cancer
Hao Dang, Daan A. Verhoeven, Jurjen J. Boonstra, Monique E. van Leerdam
Best Practice & Research Clinical Gastroenterology.2024; 68: 101895. CrossRef
Tumor size discrepancy between endoscopic and pathological evaluations in colorectal endoscopic submucosal dissection
Takeshi Onda, Osamu Goto, Toshiaki Otsuka, Yoshiaki Hayasaka, Shun Nakagome, Tsugumi Habu, Yumiko Ishikawa, Kumiko Kirita, Eriko Koizumi, Hiroto Noda, Kazutoshi Higuchi, Jun Omori, Naohiko Akimoto, Katsuhiko Iwakiri
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Nomograms and prognosis for superficial esophageal squamous cell carcinoma
Hong Tao Lin, Ahmed Abdelbaki, Somashekar G Krishna
World Journal of Gastroenterology.2024; 30(10): 1291. CrossRef
A new clinical model for predicting lymph node metastasis in T1 colorectal cancer
Kai Wang, Hui He, Yanyun Lin, Yanhong Zhang, Junguo Chen, Jiancong Hu, Xiaosheng He
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Ilker Ozgur, Fevzi Cengiz
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Rare primary colonic T cell lymphoma with curative resection by endoscopic submucosal dissection: A case report
Yu-Hui Sun, Shuang-Shuang Lu, Ying Fang, Zhe Xiong, Qiu-Yue Sun, Jin Huang
World Journal of Clinical Cases.2024; 12(22): 5229. CrossRef
Approaches and considerations in the endoscopic treatment of T1 colorectal cancer
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Optimal Surveillance of Metachronous Gastric Lesion after Endoscopic Resection of Early Gastric Cancer
Dong Chan Joo, Gwang Ha Kim
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Jae Yong Park
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Bing Yue, Mei Jia, Rui Xu, Guang-yong Chen, Mu-lan Jin
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Focused Review Series: The Roles of Endoscopy in the Management of Colonic Obstruction and Perforation

Endoscopic Management of Malignant Colonic Obstruction: Seung Young Seo, Sang Wook Kim; Clin Endosc 2020;53(1):9-17. Published online January 7, 2020; DOI: https://doi.org/10.5946/ce.2019.051

Abstract PDF PubReader ePub

Advanced colorectal cancer can cause acute colonic obstruction, which is a life-threatening condition that requires emergency bowel decompression. Malignant colonic obstruction has traditionally been treated using emergency surgery, including primary resection or stoma formation. However, relatively high rates of complications, such as anastomosis site leakage, have been considered as major concerns for emergency surgery. Endoscopic management of malignant colonic obstruction using a self-expandable metal stent (SEMS) was introduced 20 years ago and it has been used as a first-line palliative treatment. However, endoscopic treatment of malignant colonic obstruction using SEMSs as a bridge to surgery remains controversial owing to short-term complications and longterm oncological outcomes. In this review, the current status of and recommendations for endoscopic management using SEMSs for malignant colonic obstruction will be discussed.

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Original Article

Utility of Forward-View Echoendoscopy for Transcolonic Fine-Needle Aspiration of Extracolonic Lesions: An Institutional Experience: Nithi Thinrungroj, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno; Clin Endosc 2020;53(1):60-64. Published online September 5, 2019; DOI: https://doi.org/10.5946/ce.2019.081

Abstract PDF PubReader ePub

Background
/Aims: Non-invasive tissue sampling from the lower intra-abdominal and pelvic cavity is challenging. The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in this situation is not well-established because of the limitations of the curved linear-array echoendoscopy-EUS for colonic insertion. The aim of this study was to report our institutional experience of transcolonic EUS-FNA using forward-viewing therapeutic linear echoendoscopy-EUS (FV-EUS) in combination with fluoroscopic guidance.
Methods
Medical records of 13 patients who underwent transcolonic EUS-FNA of extracolonic lesions using FV-EUS in combination with fluoroscopic guidance at Aichi Cancer Center Hospital, Nagoya, Japan from June 2015 to November 2018 were retrospectively reviewed.
Results
Using FV-EUS under fluoroscopic guidance, the FNA procedure could be performed successfully in all patients (100% technical success), with a median procedure time of 31 minutes. The sensitivity, specificity, and accuracy of EUS-FNA for detecting malignant lesions in this study were 91%, 100%, and 92%, respectively. There were no adverse events associated with the EUS-FNA procedure.
Conclusions
FV-EUS in combination with fluoroscopic guidance is an easy, safe, and effective technique for FNA of extracolonic lesions in the lower abdomen.

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Review

Clinical and Biological Features of Interval Colorectal Cancer: Yu Mi Lee, Kyu Chan Huh; Clin Endosc 2017;50(3):254-260. Published online March 21, 2017; DOI: https://doi.org/10.5946/ce.2016.115

Abstract PDF PubReader ePub

Interval colorectal cancer (I-CRC) is defined as a CRC diagnosed within 60 months after a negative colonoscopy, taking into account that 5 years is the “mean sojourn time.” It is important to prevent the development of interval cancer. The development of interval colon cancer is associated with female sex, old age, family history of CRC, comorbidities, diverticulosis, and the skill of the endoscopist. During carcinogenesis, sessile serrated adenomas/polyps (SSA/Ps) share many genomic and colonic site characteristics with I-CRCs. The clinical and biological features of I-CRC should be elucidated to prevent the development of interval colon cancer.

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Case Report

A Case of Colonic Mucinous Adenocarcinoma in 19-year-old Male Patient: Mi Yeon Chung, Young Sook Park, Sang Ryul Ryu, Sang Bong Ahn, Seong Hwan Kim, Yun Ju Jo, Jun Kil Han, Jong Eun Joo; Clin Endosc 2012;45(1):103-107. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.103

Abstract PDF PubReader ePub

Colorectal cancer is rare in teenagers, especially without known risk factors. Colon cancer in young age is more likely to be diagnosed at advanced-stage, to present unfavorable tumor histology such as mucinous carcinoma, and poor outcome. We report a case of sporadic mucinous adenocarcinoma of the colon in a 19-year-old male patient without any risk factors. He complained of severe left abdominal pain that developed 1 month ago. He had a distended abdomen with severe tenderness on the left lower quadrant. A distal descending colon mass causing mechanical obstruction was observed on abdominal computed tomography. Emergency colonoscopy showed a large, fungating mass obstructing the lumen at 40 cm from the anal verge. Biopsy of the colonic mass suggested a mucinous adenocarcinoma. After decompression by colonic stent, the patient was transferred to the general surgery department for left hemicolectomy. The lesion was confirmed to be a mucinous adenocarcinoma (7.0×4.5 cm). For hereditary nonpolyposis colorectal cancer evaluation, immunohistochemical staining for MLH1 and MSH2 was normal. Reverse transcription polymerase chain reaction analysis did not detect microinstability in any of the markers tested. The patient had no familial history of cancer. Mucinous adenocarcinoma has high frequencies of poor differentiation, advanced tumor stage, loss of mismatch repair gene expression, and increased MUC2 expression. A mucinous histology is considerably more frequent in children and adolescent than in adults. Adequate invasive study is also necessary for young age patients.

Citations

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Clinicopathological features and prognosis analysis of proximal colonic mucinous adenocarcinoma
Fei Han, Yue Xu, Xiangyu Li, Zhaoxiang Song, Jinlin Xie, Jianning Yao
Scientific Reports.2024;[Epub] CrossRef
NICD3 regulates the expression of MUC5AC and MUC2 by recruiting SMARCA4 and is involved in the differentiation of mucinous colorectal adenocarcinoma
Xiaodong Yan, Yuan Cheng, Xia Zhang, Yi Hu, Haixia Huang, Jie Ren, Boye Wen, Yuhui Yang, Keyuan Xiao, Wenqing Hu, Wei Wang
Molecular Oncology.2022; 16(19): 3509. CrossRef
Biopsy sampling during self-expandable metallic stent placement in acute malignant colorectal obstruction: a narrative review
Sigrid Skov Bennedsgaard, Lene Hjerrild Iversen
World Journal of Surgical Oncology.2021;[Epub] CrossRef
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Cong Luo, Shuyi Cen, Guojun Ding, Wei Wu
Cancer Communications.2019; 39(1): 1. CrossRef
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Cong Luo, Shuyi Cen, Jieer Ying, Xiaohong Wang, Zhixuan Fu, Peng Liu, Wei Wu, Guojun Ding
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Adarsh Pratap Singh, Amit Kumar, Anita Dhar, Shipra Agarwal, Sudhir Bhimaniya
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Marco Colangeli, Carlotta Calamelli, Marco Manfrini, Tommaso Frisoni, Davide Maria Donati
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Musa Ibrahim, Adamu Ladan Mu'azu, Kabir Ibrahim Getso, Binta Jibir Wudil, Mohammad Aminu Mohammad, Ali Bala Umar, Umar Shehu Abdullahi, Kefas John Bwala, Nurlan Nurkenovich Akhparov, Aipov R. Rassulbek
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Colon carcinoma in childhood: review of the literature with four case reports
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Anupam Das, Lalmalsawma Ralte, A. S. Chawla, S. V. Arya, Anil Kumar, Ravi Saroha, Dheer Singh Kalwaniya
Case Reports in Surgery.2013; 2013: 1. CrossRef

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De Novo Submucosal Colorectal Cancer in a 3 mm Sessile Polyp: So My Koo, M.D., Jin Oh Kim, M.D., Hyun Gun Kim, M.D., Tae Hee Lee, M.D., Seong Ran Jeon, M.D., So Young Jin, M.D., and Joon Seong Lee, M.D.; Korean J Gastrointest Endosc 2011;42(2):109-112. Published online February 28, 2011

Abstract PDF: The majority of colorectal carcinomas (95∼100%) are thought to arise from adenomas. Yet colorectal carcinomas may rarely arise de novo. The popular definition of de novo carcinoma is that the lesion should consist exclusively of a carcinoma histologically and contain no adenomatous elements. Without an adenoma-carcinoma sequence, de novo carcinomas have a much higher rate of submucosal invasion, despite their small size. Their speed of growth is thought to be rapid. Some studies have shown that de novo carcinomas might arise as a macroscopically flat or depressed lesion, rather than a protruded one. However, the typical macroscopic findings of de novo carcinomas have not been established. They might be variable macroscopically and include a protruded type. We report a case of de novo colorectal carcinoma that invaded the submucosal layer involving a minute sessile polyp only 3 mm in diameter, which was removed by endoscopic mucosal resection. (Korean J Gastrointest Endosc 2011;42:109-112)

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Colonic Stent Insertion Through a Colostomy in a Patient with Recurred Malignant Obstruction: Nam Chul Jin, M.D., Dae Hyun Kim, M.D., Young A Song, M.D., Ho Seong Ryu, M.D., Sung Bum Cho, M.D., Wan Sik Lee, M.D., Hyun Soo Kim, M.D. and Young Eun Joo, M.D.; Korean J Gastrointest Endosc 2010;41(6):378-381. Published online December 30, 2010

Abstract PDF: Colorectal self-expanding metal stents have been used for palliation or preoperative decompression as a bridge-to-surgery in patients with malignant obstruction due to primary or recurred colorectal cancer. The usual attempt to implant of the stent is through the anus under endoscopic guidance, but that is difficult or impossible in patient who have undergone laparoscopic abdominoperineal resection (APR) and who have a colostomy. Especially, to advance and position the stent in the target lesion through the colostomy is very difficult because of the tortuosity and anatomical alteration of the proximal bowel caused by surgery. We herein report on a case of recurred malignant colonic obstruction with stent placement through a preformed colostomy. To date, this approach through a colostomy for the deployment of a stent has not been described in the Korean literature. (Korean J Gastrointest Endosc 2010;41:378-381)

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Young Aged Colorectal Cancer Patients: Do They Have a Bad Prognosis?: Young Taek Kim, M.D., Hang Rak Lee, M.D., Oh Young Lee, M.D., Byung Chul Yoon, M.D., Ho Soon Choi, M.D., Joon Soo Hahm, M.D., You Hern Ahn, M.D., Dong Chan Kim, M.D., Hyung Tae Kim, M.D., Ji Yiung Yoon, M.D., Sa Il Kim, M.D., Seung Sam Bak, M.D.* and Jin; Korean J Gastrointest Endosc 2010;40(2):84-89. Published online February 27, 2010

Abstract PDF: Background
/Aims: Many previously published articles have reported poor outcomes for young patients with colorectal cancer as compared to that of older patients with colorectal cancer. However, these studies have tended to be small and have various biases. This study was retrospectively designed to determine the clinical course and survival rate of young patient with colorectal cancer.
Methods
All the patients who underwent surgery for colorectal cancer at Hanyang University Hospital between 1995 and 2001 were identified. These patients were assigned to two age groups: the 45 years old and below 45 years old group (123 patients) and the group over the age of 45 (421 patients).
Results
The size of the tumor mass was significantly larger in the young group. There were no significant differences between the two groups for the stage at the time of diagnosis, the differentiation, the degree of lymph node involvement, the cancer location and the gross finding. The median cancer specific survival time was worse for the old group as compared with that of the young group. Age, differentiation, lymph node involvement and the Duke stage were the significant prognostic factors on univariate analysis. Age and the Duke stage were the independent prognostic factors that were significantly correlated with survival on the multivariate analysis using the Cox proportional hazard model.
Conclusions
Contrary to prior reports, younger patients with colorectal cancer appear to have a better survival rate than that of older patients with colorectal cancer. (Korean J Gastrointest Endosc 2010;40:84-89)

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Minute-depressed Type of Submucosal Colon Cancer: Yeon Soo Kim, M.D., Soon Woo Nam, M.D., Jeong Ok Kim, M.D.*, Young Hwa Ki, M.D., Chun Young Song, M.D., Seung Woo Lee, M.D., Sang Bum Kang, M.D. and Dong Soo Lee, M.D.; Korean J Gastrointest Endosc 2008;36(1):40-43. Published online January 30, 2008

Abstract PDF: The development of colorectal cancer has been known as the adenoma-carcinoma sequence. Yet another route for cancer development has recently been proposed, which is call the de novo pathway based on the reports of the depressed-type early colorectal cancers. Early colorectal cancer is defined as invasive tumor limited to the colorectal mucosa or submucosa, regardless of the presence or absence of lymph node metastasis. Especially, depressed type colorectal cancers have a much higher rate of submucosal invasion and rapid progression despite of their relatively small sizes. Our case displayed a depressed type tumor that was only 5mm in diameter and it had invaded the deep submucosal layer (SM3); this was resected by operation with no predictive endoscopic finding. So, the depressed type tumor can show deep invasion or lymph node metastasis despite of its small size. (Korean J Gastrointest Endosc 2008;36:40-43)

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A Comparison of the Use of Self-Expanding Metallic Stent Insertion with Emergency Surgery as an Initial Treatment for Obstructive Colorectal Cancer: Jung Pil Suh, M.D., Sang Woo Kim, M.D., Chang Nyol Paik, M.D., Jae Myung Park, M.D.,Yu Kyung Cho, M.D., In Seok Lee, M.D., Myung Gyu Choi, M.D., Kyu Yong Choi, M.D.,In Sik Chung, M.D., Won Kyung Kang, M.D.* and Seong Taek Oh M.D.*; Korean J Gastrointest Endosc 2007;35(5):321-327. Published online November 30, 2007

Abstract PDF: Background
/Aims: Emergency surgery for obstructive colorectal cancer is associated with a high rate of postoperative complications. The objective of this study is to investigate the clinical difference between the use of elective surgery after stent insertion, and the performance of emergency surgery as an initial treatment for colorectal cancer with an intestinal obstruction. Methods: For patients that were admitted from February 2004 to June 2006 for obstructive colorectal cancer, a retrospective analysis on the clinical outcome was performed for a group of patients that received a stent as an initial treatment (stent group) and a group of patients that received emergency surgery as an initial treatment (emergency operation group). Results: Postoperative complications in the stent group included pneumonia and wound infection (9.5%). For the emergency operation group, postoperative complications included sepsis, deep vein thrombosis, wound infection, anastomosis leakage and postoperative bleeding (38.9%). The number of postoperative complications were significantly less in patients in the stent group than for patients in the emergency operation group (p=0.032). The number of a one-staged operation was significantly higher in the stent group compared with the emergency operation group (85.7% vs 55.6%; p=0.039). The number of a stoma created at least once was significantly lower in the stent group (14.3% vs 50%; p=0.017) than in the emergency operation group. Conclusions: As an initial treatment for an obstructive colorectal cancer, the use of stent insertion for primary management should be considered since it can reduce the degree of postoperative complications and the necessity for multi-staged operations. (Korean J Gastrointest Endosc 2007;35:321-327)

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Characteristics of Colorectal Cancer in Elderly Patients in Comparision with Younger Patients: Hyung Suk Lee, M.D.*, Seokyoung Lee, M.D., Ji-Hyun Seo, M.D., Kyeng Kunn Kwack, M.D., Su Jin Chung, M.D., Kwang Hyuck Lee, M.D., Young-Soo Park, M.D., Jin-Hyeok Hwang, M.D., Jin-Wook Kim, M.D., Sook Hyang Jung, M.D., Nayoung Kim, M.D., Dong Ho Lee, M.D.,; Korean J Gastrointest Endosc 2007;34(2):76-82. Published online March 2, 2007

Abstract PDF: Background
/Aims: Considering the increasing age of the general population and the incidence of colorectal cancer (CRC), this study examined the characteristics of CRC in the aged, by comparing the clinical, endoscopic and histologic findings of CRC of younger and old patients. Methods: The records of 232 patients diagnosed with CRC from March 2003 to September 2004 were reviewed retrospectively. Two cohorts based on age, under and over 65 years, were compared for the patient and tumor characteristics. Results: The bowel habit change was significant (p=0.018) and there was a high prevalence of hematochezia in the older patients. The rate of cancer detection via a routine checkup was higher in the younger patients (p=0.015). The incidence of right colon cancer increased with age, and substantially higher in females. More older patients had Dukes stage C disease (p=0.007), while more younger patients had stage D (p=0.022). The incidence of metastasis was high in those with right colon cancer (p=0.009), and significantly higher in female. In females, high-risk tumor such as mucinous or signet-ring was more common in the older patients. The older patients had significantly low CEA levels in the advanced stage. Synchronous CRC was more common in the older patients (8.1% vs. 3.4%) and was located within the adjacent segment. Conclusions: CRC must be considered when older patients present with changes in their bowel habits or hematochezia. The right colon must be examined closely in older patients, particularly in females. A metastasis should be checked in right colon cancer, particularly in females. In older patients, advanced disease should be considered even in those with a low CEA level, and synchronous CRC must be searched for in the same or adjacent segment to that of the primary cancer.

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Clinical Outcomes of Self-Expanding Metal Stent Insertion for Obstructive Left-Sided Colorectal Cancer: Comparison with Emergency Operation: Do Young Kim, M.D., Tae Il Kim, M.D., Kyu Won Kim, M.D., Kyung Kyu Kim, M.D., Byung Chang Kim, M.D., Sung Jae Shin, M.D., Seung Woo Park, M.D., Yong Chan Lee, M.D., Si Young Song, M.D., Won Ho Kim, M.D., Kang Young Lee, M.D.* and Nam Kyu Kim, M.D.*; Korean J Gastrointest Endosc 2006;32(4):253-259. Published online April 30, 2006

Abstract PDF: Background
/Aims: The aim of this study was to compare the outcome of colorectal stenting with that of performing emergency operation for the patients with malignant left-sided colon obstruction. Methods: The patients with obstructing left-sided colorectal cancer were treated with 'bridge to surgery stenting' and this was followed by operation (group A, n=20), emergency operation (group B, n=21), palliative stenting (group C, n=16), and emergency palliative operation (group D, n=15). Results: The primary anastomosis rate was significantly higher for group A than for group B (65.0 vs. 33.3%, respectively, p＜0.05). None of the patients in group A required intensive care and 3 patients in group B required intensive care. Post-operative complications occurred in 2 and 3 patients in group A and B, respectively. The mean hospital stay showed the tendency to be shorter for group A than for group B (24 vs. 31 days, respectively, p＞0.05). In regard to palliative treatment, the stoma creation rate was 86.7% for group D, and 2 patients in group D needed intensive care. The mean hospital stay was significantly shorter for group C than for group D (9.3 vs. 20.7 days, respectively, p＜0.05). Conclusions: Stent placement is a useful alternative to emergency surgery for the management of malignant colorectal obstruction. (Korean J Gastrointest Endosc 2006;32:253⁣259)

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대장 점막하 침윤암의 림프절 전이의 위험인자 : 심달도 분류를 중심으로 ( Risk Factors of Lymph Node Metastasis in Submucosally Invasive Colorectal Carcinoma : with Special Reference to the Depth of Invasion ): Korean J Gastrointest Endosc 2001;22(6):411-418. Published online November 30, 2000

Abstract PDF: Background
/Aims: It has been reported that lymph node (LN) metastasis occurs in approximately 10 percent of patients with submucosally invasive colorectal carcinoma. The present study was performed to determine the clinical significance of absolute and relative depth of submucosal invasion and to find the associated pathological risk factors of LN metastasis in submucosally invasive colorectal carcinoma. Methods: From June, 1989 to May, 1999, 2,580 patients were pathologically confirmed as having colorectal carcinoma, Of these patients, a total of 61 subjects with submucosally invasive carcinoma could be reviewed pathologically and were included in this retrospective analysis. The relative depth of submucosal invasion was evaluated by Kudo (sm1, 2, 3) and modified Haggitt (L1, 2, 3) classifications, and the absolute depth was measured, Results: The absolute depth of submucosal invasion was significantly correlated with the relative depth evaluated by both Kudo and modified Haggitt classifications (p<0.01). Of 51 patients in whom the status of LN metastasis could be evaluated, six (11.8%) showed LN metastasis, Among the patients with LN metastasis, there was no one with sm1or L1in the relative depth and 500 ㎛or less in the absolute depth. The risk of LN metastasis was related to the gross type, and lymphatic or vessel invasion (p <0.05). Conclusions: The risk factors for LN metastasis in submucosally invasive colorectal carcinoma were the gross type and lymphatic or vessel invasion, The results also suggest that the absolute depth of submucosal invasion might be a useful parameter to select the patients for the endoscopic treatment, (Korean J Gastrointest Endosc 2001;22:411- 418)

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방사선 직장염과 동반된 직장선암 1 예 ( A Case of Rectal Adenocarcinoma with Radiation Colitis ): Korean J Gastrointest Endosc 2000;21(5):873-876. Published online November 30, 1999

Abstract PDF: Radiotherapy induced colorectal adenocarcinoma with radiation colitis after radiotherapy has been reported as a rare case. A patient with rectal adenocarcinoma as a late complication of pelvic irradiation for gynecological malignancy is reported. A 55-year-old woman with bloody diarrhea for 6 months was admitted. She received radiation therapy for carcinoma of cervix 21 years ago. Colonoscopic findings revealed a polypoid mass on rectosigmoid colon. Histopathologic examination of the polypectomy specimen disclosed adenocarcinoma. We reported herein a case of rectal adenocarcinoma with radiation colitis. The patient who had received pelvic irradiation should have close follow-up with colonoscopic study for the early detection of colorectal cancer.

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융기형 조기 대장암의 육안적 분류와 조직병리학적 고찰 ( Macroscopic Classification and Histo-Pathologic Evaluation of Early Colorectal Cancer with Elevated Type ): Korean J Gastrointest Endosc 2000;21(5):849-854. Published online November 30, 1999

Abstract PDF: Background
s/Aims: Early colorectal cancer is defined as carcinoma with invasion to mucosa or submucosa irrespective of involvement of lymph node. Gross morphology is divided into elevated and depressed type according to growth pattern. Until now, carcinomas with elevated type have been found more frequently than depressed type in Korea. It is necessary to classify the macroscopy of morphology and evaluate histo-pathologic findings of early colorectal cancers. Methods: 33 patients (35 foci) with early colorectal cancers were analyzed, macroscopically and pathologically. Early colorectal carcinoma with mucosal invasion is 25 cases, and with submucosal invasion, 10. Results: Macroscopic classification; Ip 12, Isp 6, Is 9, IIa 1, IIa+IIc 4, Isp+IIc1, LST 2. Among them, Ip (34%) is most. Among cancers with mucosal invasion, Ip (36%) is common, and with submucosal invasion, Is (40%) is common. Most of early colorectal cancers with elevated type were accompanied with surrounding adenoma. It's ratio is 100% in early colorectal cancer with mucosal invasion, and 50% with submucosal invasion. Conclusions: Pedunculated type (Ip) is common in early colorectal cancer with elevated type. Surrounding adenoma was usually (85%) accompanied with those. It is suggestl that early colorectal cancer with elevated type would be originated from adenoma.

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대장암 및 충수돌기 주위 농양으로 오인된 복부 방선균증 ( Abdominal Actinomycosis Initially Diagnosed As a Colorectal Cancer or Periappendiceal Abscess ): Korean J Gastrointest Endosc 2000;21(3):717-722. Published online November 30, 1999

Abstract PDF: Background
/Aims: Colonic actinomycosis is a rare disease with clinical and radiographic findings that overlap those of other inflammatory and neoplastic conditions. We performed this study to analyze clinical manifestation, characteristic radiologic findings of 5 cases of abdominal actinomycosis, which was initially diagnosed as a colorectal cancer or periappendiceal abscess. Methods: We analyzed chief complaint, predisposing factor, presence of leukocytosis and sulfur granule, involved site, presence of LN involvement and abdominal CT findings, retrospectively. Results: The most common clinical manifestation was abdominal pain. In 3 cases, predisposing factors were identifiable, which were intrauterine contraceptive device (IUD), previous appendectomy, and diabetes mellitus (DM) respectively. Leukocytosis was noted in 4 cases (80%) and sulfur granule in all 5 cases. Sigmoid colon was the most common involved site (4 cases) followed by appendix and rectum. On computed tomography, inhomogeneous mass or severe inflammation along the bowel wall or serosa was noted. Explorations were performed in 4 cases. Preoperative diagnosis was a colorectal cancer in 3 cases and periappendiceal abscess in 1 case. Conclusions: Actinomycosis should be born in mind in the differential diagnosis of patients with IUD, previous appendectomy and DM, presenting leukocytosis and CT finding of inhomogeneous mass and relatively uncommon LN involvement to eliminate unnecessary exnlorations.

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원발성 미만성 침윤성 대장암 1예 ( A Case of Diffusely Infiltrating Primary Colon Cancer ): Korean J Gastrointest Endosc 2000;21(2):658-661. Published online November 30, 1999

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혈변을 주소로 내원한 하부위장관출혈 환자에 대한 임상적 고찰 ( Clinical Characteristics of Lower Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1999;19(6):911-917. Published online November 30, 1998

Abstract PDF: Backgroud/Aims: The frequency of different etiologies of lower gastrointestinal bleeding varies by a number of factors including patient age, the severity of bleeding evaluated, the diagnostic method, and the institution. There were few reports on the clinical analysis of lower gastrointestinal bleeding in Korea. Therefore, this study was conducted to evaluate the frequency of various etiologies, diagnostic methods, and the management of patients with lower gastrointestinal bleeding. Methods: 474 patients with lower gastrointestinal bleeding who were admitted to Samsung Medical Center from September 1994 to April 1998 were reviewed. The inclusion criteria were as follows: 1) age at least 15 years, and 2) patients whose bleeding was attributed to a lesion distal to the ligament of Treitz. The age and sex distribution, etiology, diagnostic methods, treatment, and transfusion were checked. Results: 474 patients (261 males and 213 females) met the inclusion criteria. The average age of the patients was 51 years old. The etiologies of bleeding were as follows: colorectal cancer, 43%; anorectal disease, 32%; inflammatory bowel disease, 6.6%; ischemic colitis, 5%; miscellaneous, 6%; and unknown, 7.4%. Colonoscopy was the most commonly employed diagnostic modality and was used in 245 (52%) patients of the study group. Other tests included sigmoidoscopy in 136 (29%), barium enema in 90 (19%), small bowel radiography in 24, radionuclide bleeding scans in 8, and mesenteric angiography in 7. Patients who improved with conservative and medical treatment were 29%, and 71% required surgery. Patients who required a transfusion were 37%. 139 patients (68.8%) with diagnosed malignant neoplasm received a transfusion. Conclusions: The incidence of lower gastrointestinal bleeding was high in old age. Colorectal cancer was the most common cause and required surgery. Colonoscopy was a valuable diagnostic tool for the evaluation of lower gastrointestinal bleeding. (Korean J Gastrointest Endosc 19: 911∼917, 1999)

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N함몰형 대장 종양에 대한 인식과 대책 ( Depressed-Type Early Colorectal Cancer ): Korean J Gastrointest Endosc 1999;19(3):361-367. Published online November 30, 1998

Abstract PDF: Background
/Aim: While detection and removal of polyps on the basis of the adenoma- carcinoma sequence has been a principal procedure for endoscopists, a new type of early colorectal cancer has been recognized and has become a hot issue. This new ailment is a depressed-type early colorectal cancer, which has the characteristics of rapid growth and early invasion of the submucosa. Though once considered to be mere conjecture, many researchers claim that this cancer is a de novo carcinoma despite of its rare occurrence. Recently, 4 depressed-type neoplastic lesions were presented, which signifies the importance of recognizing that this type of cancer exists and is characterized by rapid growth and early invasion of the submucosa. Methods: The 4 recently experienced depressed neoplastic lesions were reviewed and analyzed with respect to their endoscopic and clinicopathologic characteristics. The sizes of the lesions were measured in the fully inflated state of the bowel by using an endoscopic ruler. Results: The sites of predilection were the descending and sigmoid colon. All of the lesions were under 10 mm, with 75% being below 5 mm. The largest lesion was an 8-mm, well-differentiated mucosal carcinoma. The overall malignancy rate was 25%. Light redness was observed in all patients. Distortion with air transformation of the mucosal fold was also recognized in all the patients. The main treatment was endoscopic mucosal resection, which amounted to 50%. Conclusions: Depressed colorectal neoplasms are real. They can be determined by their characteristic endoscopic features, such as light redness and distortion with air transformation of the mucosal fold. Because of their characteristics of rapid growth and early invasion of the submucosa, it is important to detect and manage them in an early stage, when their sizes are below 10 mm. (Korean J Gastrointest Endosc 19: 361∼367, 1999)

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원저 : 식도 위장관 ; 연령과 성별에 따른 대장 및 직장암의 분포 변화에 대한 관찰 ( Original Articles : Esophagus , Stomach & Intestine ; A Study for The Changing Subsite Distribution of Colorectal Cancer with Age and Sex ): Korean J Gastrointest Endosc 1997;17(6):771-777. Published online November 30, 1996

Abstract PDF: Background
/Aims: Changes in subsite distribution of colorectal cancer have been shown in recent years. The carcinoma tend to shift to more proximal colon and this proximal shift is influenced by age and sex. This study was designed to delineate the relationship of age to subsite incidence of colorectal cancer and to define the role of gender in this difference. Method: We have analyzed the data by patients with colorectal cancer from 1985 to 1995 for elucidate the relationships between age, sex and prinmry location of colorectal cancer. 749 patients(male 454, female 295) were diagnosed of colorectal cancer performed by colonoscopy and/or sigmoidoeopy were divided into three groups by their location of cancer (Right colon: appendix, ascending colon, hepatic flexure, T-colon proximal 2/3 Left colon: T-colon distal 1/3, splenic flexure, descending colon, sigmoid colon Rectum: rectum). (Korean J Gastrointest Endosc 17: 771-777, 1997) (continue)

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