WCIM 2014 SEOUL KOREA 537
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0855 Upper GI Tract
Effi cacy and Safety of Endoscopic Submucosal Dissection for Synchronous Gastric Lesions on a Single Day
Ki Woo Seo1, Young-Il Kim1, Soo-Jeong Cho1, Jong Yeul Lee1, Chan Gyoo Kim1, Myeong-Cherl Kook1, Il Ju Choi1
National Cancer Center, Korea1
Background: Endoscopic submucosal dissection (ESD) is considered as primary treat- ment for early gastric cancer (EGC) with little risk of lymph node metastasis in Korea.
We aimed to evaluate the outcomes and safety of single day ESD for synchronous double lesions in stomach.
Methods: From January 2005 to December 2013, 1,397 EGCs and 531 low or high- grade dysplasia lesions from 1,711 patients treated by ESD were enrolled in our data- base. We retrospectively evaluated 1,474 single lesions from 1,474 patients treated by single ESD (single lesion group) and 128 double lesions from 64 patients treated by ESD on the same day simultaneously (double lesion group). And we also checked separately performed ESD cases for synchronous lesion. (20 double lesions from 10 patients)
Results: The en-bloc resection rates (96.9% vs. 95.3%, p=0.337), complete resection rates (92.3% vs. 92.2%, p=0.943), and curative resection rates (89.6% vs. 91.4%, p=0.508) were comparable between single lesion group and double lesion group. No perforation developed in the simultaneous ESD group, but 16 (1.1%) perforations were noted in single lesion group. Also there was no signifi cant difference in bleeding rates 3.5% in single lesion group, and 3.1% in double lesion group (p = 0.843). Additional surgery was not needed in any of complication cases. Duration of hospital stay for endoscopic resection showed no difference between the two groups. (p = 0.715) In comparison between simultaneous ESD and separate ESD for synchronous lesion, there was no signifi cant difference about their characteristics, effi cacy and safety. However, hospital day was different between two groups. (4.3 ± 3.3 vs. 7.8 ± 4.0, p=0.004) Conclusions: The simultaneous ESD on a single session for double lesions can be an effective and safe treatment strategy in EGCs and gastric adenomas.
PS 0856 Lower GI Tract
Infl uence of Age at Diagnosis on Clinical Characteristics and Prognosis of Crohn’s Disease in Korea: Results from the Connect Study
Sung Wook Hwang1, Jaeyoung Chun1, Jong Pil Im1, Jae Hee Cheon2, Byong Duk Ye3, Ji Won Kim4, You Sun Kim5, Joo Sung Kim1
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Korea1, Department of Internal Medicine, Yonsei University College of Medicine, Korea2, Department of Internal Medicine, University of Ulsan College of Medicine, Korea3, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Korea4, Department of Internal Medicine, Inje University College of Medicine, Korea5
Background: Age at diagnosis is known to infl uence the clinical course and prognosis of patients with Crohn’s disease (CD). However, the infl uence has not been established yet in Korea. The aim of the present study was to describe the clinical characteristics and prognosis of CD patients according to age at diagnosis in Korea.
Methods: We retrospectively analyzed 1338 patients with CD who were enrolled into CrOhn’s Disease cliNical Network and CohorT (CONNECT) Study. Age at diagnosis was categorized as < 16, 17-40, 41-59 and > 60 years old. The location and behavior were classifi ed according to the Montreal classifi cation. The baseline characteristics and clinical outcomes were analyzed according to age at diagnosis.
Results: The proportion of each age group in total CD patients was 11.6%, 75.5%, 10.1%, and 2.8%, respectively. As the age at diagnosis increased, ratio of male and presence of perianal fi stula signifi cantly decreased (P < 0.001). Old age at diagnosis group showed a higher frequency of ileal location, whereas young group showed a higher frequency of ileocolonic location (P < 0.001). In old age at diagnosis group, the frequency of penetrating behavior was lower than that in young group (P = 0.049). As age at diagnosis increased, the frequency of antibiotics, corticosteroid, immunomodu- lators and anti-TNF use decreased (P < 0.001). The cumulative probability of anti-TNF use in age < 0.05). However, the cumulative probabilities of intestinal resection and all CD-related surgery did not signifi cantly differ between age groups.
Conclusions: In Korean CD patients, younger age at diagnosis may be associated with more severe clinical course and prognosis, compared with older age at diagnosis.
PS 0857 Lower GI Tract
Atractylodes Macrocephala, Taraxacum Spp Extracts Protected Against Dextran Sulfate Sodium-induced Injury in Colitis in Mouse; Effi cacy and Mechanisms
Sung Hun Kwon1 CHA Hospital, Korea1
Background & Aims: In recent years there has been an increasing interest in naturally occurring substances in plant origin that may be used as potential chemopreventive and chemotherapeutic agents to prevent such as antitumor, anti-infl ammatroy and antioxidant. In this study, we aimed at examining the anti infl ammatory activity of Atractylodes macrocephala(AM), Taraxacum spp(TS) administration on experimentally induced injury colitis.
Methods: RT-PCR and Western blot was performed to check anti-infl ammatory action.
AM or TS was pretreated 20h before LPS-induced on IEC-6 cells. Acute colitis was in- duced with 5% dextran sulfate sodium (DSS) for a week in male C57BL/6 mice. Some mice were given AM,TS or sulfasalazine for 2 weeks before the DSS administration.
After killing, in addition to gross and pathologic evaluations, the expressions of infl am- matory enzymes or cytokines were analyzed by Western blot analysis. H&E and F4/80 staining were also performed to observe tissue damages induced by DSS
Results: Oral administration of AM and TS protected against mouse colitis induced by dextran sulfate sodium (DSS). Under the same experimental conditions, AM or TS administration signifi cantly inhibited the activation of nuclear factor-kappa B (NF-κ B) and signal transducer and activator of transcription (STAT)3 and expression of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS) in mouse colon. Fur- thermore, AM or TS inhibited F4/80, CD3 initiated and DSS-promoted adenoma for- mation in mouse colon. Total number of intestinal polyposis was counted and immu- nohistochemical staining with F4/80 and CD3 was done. In vitro studies demonstrated that AM or TS treatment reduced lipopolysaccharide (LPS)-induced inflammatory cytokines,in murine intestinal epithelial IEC-6 cells.
Conclusion: AM or TS is effective in protecting against DSS-induced mouse colitis, suggesting that these AM or TS may have a potential from DSS-induced mouse colitis injury through bioregulation.
PS 0858 Lower GI Tract
The Withdrawal Time for Adequate Adenoma Detection Rate for Colonoscopy Trainee
Jae Hyun Kim1, Hong Jun Park1, Hyun-Soo Kim1, Jae Woo Kim1, Hyun Sik Kim1, Ji Hun Na1, Hee Man Kim1, Kyong Joo Lee1
Wonju Christian Hospital, Korea1
Background: The adenoma detection rate (ADR) is a critical quality indicator in successful colonoscopy, therefore it is important to improve ADR in learning colonoscopy for trainees.
The aim of this study was to evaluate the proper withdrawal time (WT) for trainees to detect adenomas more than 20% or 35% before and after technical competency Methods: In this retrospective study, from March 2011 to February 2013, six fi rst- year GI fellows performed 500 colonoscopies respectively were enrolled. Each fellow fulfi lled the “colonoscopy learning protocol” which includes all of colonoscopy related parameters until 500th colonoscopy. We defi ned a competency of colonoscopy as the successful rate of cecal intubation over 90 percent that is achieved after about 150 cases of colonoscopy. We analyzed optimal withdrawal time for ADR more than 20%
(recommended withdrawal time) and 35% (ADR previous reported in Korea) before and after colonoscopy competency
Results: Among a total of 3,000 colonoscopy procedures, 1272 cases of fi rst-time screening colonoscopies performed by six trainees were analyzed. With 50th cases interval, WTs were signifi cant decreased (p<0.001), however, the ADRs and numbers of adenomas were not changed so much (p=0.347 and p=0.395, respectively). So, the numbers of adenomas per minute were signifi cant increased due to decreased with- drawal time (p=0.011). Before competency (n=406) and after competency (n=866), there was positive correlation between ADR and WT respectively (P<0.001). In ROC curve analysis, trainees should inspect more than 8 minutes for over 20% of ADR and more than 10 minutes for over 35% of ADR before competency (AUROC=0.696). After competency, 6.5 minutes of WT was required for over 20% of ADR and 7.5 minutes of WT for over 35% of ADR (AUROC=0.720)
Conclusions: Therefore, a different WT should be recommended according to training period to improve quality of colonoscopy
