WCIM 2014 SEOUL KOREA 515
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0777 Upper GI Tract
Clinical Usefulness of Scoring Systems of Nonvariceal Upper Gastrointestinal Hemorrhage in Korea: The First Korean Multicenter Prospective Study
Hae Min Yang1, Seong Woo Jeon1, Jin Tae Jung2, Dong Wook Lee3, Chang Yoon Ha4, Kyung Sik Park5, Si Hyung Lee6, Chang Heon Yang7, Youn Sun Park8
Department of Internal Medicine, Kyungpook National University Hospital, Korea1, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Korea2, Department of Internal Medicine, Daegu Fatima Hospital, Korea3, Department of Internal Medicine, Gyeongsang National University Hos- pital, Korea4, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Korea5, Department of Internal Medicine, Yeungnam University College of Medicine, Korea6, Department of Internal Medicine, Dongguk University College of Medicine, Korea7, Department of Internal Medicine, Soonchunhyang University Hospital, Korea8
Background: The Glasgow Blatchford score (GBS) and Rockall scores (RS) are widely used to assess patients with upper gastrointestinal hemorrhage (UGIH). We aimed to compare both scoring systems, and evaluate the clinical usefulness of scoring systems in Korea.
Methods: Between February 2011 and December 2013, 1584 patients with nonvar- iceal UGIH were entered in the study. A prospective study was performed to compare the performance of the GBS, pre-RS, full RS in predicting the need for hospital-based intervention (blood transfusion, endoscopic treatment, angioembolization, or surgery), rebleeding and death. We compared the ability of these scores by using receiver-op- erating characteristic (ROC) curves. We also assessed the usefulness of GBS of 0 in identifying low-risk patients.
Results: For prediction of the need for hospital-based intervention, the GBS was similar to the full RS (AUROC 0.705 vs 0.727; p =0.282) and superior to the pre-RS (AUROC 0.705 vs 0.601; p<0.0001). In predicting death, the full RS was superior to the GBS (AUROC 0.758 vs 0.644; p=0.0006) and similar to the pre-RS (AUROC 0.758 vs 0.754; p=0.869). In predicting rebleeding, the full RS was superior to both GBS (AUROC 0.642 vs 0.585; p=0.031) and pre-RS (AUROC 0.642 vs 0.593; p=0.0003).
However none of the systems accurately predicted rebleeding with low AUROC. Of 1584 patients, we identifi ed only 13 patients (0.8%) who scored 0 on the GBS. And one patient with GBS score of 0 required endoscopic treatment.
Conclusions: The GBS is more useful than Pre-RS for predicting the need for hospi- tal-based intervention. However cut-off value of 0 for low risk who might be suitable for outpatient management is not useful. The full RS is helpful in predicting death.
None of the systems accurately predict rebleeding. (Clinical trial: KCT0000514)
PS 0778 Upper GI Tract
Risk Factors of Gastric Cancer and Dysplasia Focusing on ABO Genotype Adjusted with Demographic Factors and Helicobactor pylori Infection
Sooyeon Oh1, Nayoung Kim2, Ji Hyun Park1, Bo Kyung Kim1, Chul Min Shin2, Dong Ho Lee2, Joo Sung Kim1, Hyun Chae Jung1
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medi- cine, Korea1, Department of Internal Medicine and Seoul National University Bundang Hospital, Korea2 Background: ABO blood type has long been assumed to be related to development of gastric cancer. Until recently the results were inconsistent to each other, which could be attributed to the fact that most of the previous studies took ABO phenotype into analyses.
Methods: A case group of 1057 patients of either gastric cancer or gastric dysplasia were compared to a control group of 923 subjects. Controls were those confi rmed, in gastric endoscopic exam, to have either normal mucosa or benign gastric lesions such as chronic gastritis, atrophic gastritis, intestinal metaplasia, duodenal ulcer, benign gastric ulcer and esophageal refl ux with or without erosion. All subjects were geno- typed of their ABO blood type, tested for Helicobacter pylori (H. pylori) infection, and inquired about demographic data through questionnaire.
Results: In multivariate logistic regression analysis adjusted with demographic data and H. pylori infection, B allele was found to be inversely associated with gastric cancer or dysplasia (P = 0.003). Compared to ones who didn’t have any B allele, sub- jects who have one B allele had OR of 0.727(95% CI 0.584~0.905) of having gastric cancer or dysplasia and two B alleles, OR of 0.573(95% CI 0.362~0.909). In addition, age, family history of gastric cancer, childhood residency, smoking, alcohol intake, and infection of H. pylori were also identifi ed to have signifi cant association (Table 1). In- teraction between B allele and H. pylori was tested, which revealed no interaction.
Conclusions: B allele was identifi ed to be inversely associated with gastric cancer or dysplasia. H. pylori and ABO blood group seem to affect gastric carcinogenesis inde- pendently.
PS 0779 Upper GI Tract
Is New Criteria for Mixed Histology is Necessary for Endoscopic Resection in Early Gastric Cancer?
Hong Jin Yoon1, Yong Hoon Kim1, Jie-Hyun Kim1, Yong Chan Lee2, HyunKi Kim3, Hoguen Kim3, Jae Jun Park1, Young Hoon Youn1, Hyojin Park1, Sung Hoon Noh4, Seung Ho Choi5
Gangnam Severance Hospital Department of Internal Medicine, Korea1, Severance Hospital Department of Internal Medicine, Korea2, Severance Hospital Department of Pathology, Korea3, Severance Hospital Department of Surgery, Korea4, Gangnam Severance Hospital Department of Surgery, Korea5 Background: Mixed histology has been reported to show more aggressive behavior than other histologies in early gastric cancer (EGC). We also reported that signet ring cell (SRC) mixed histology showed more submucosal invasion and higher lymph node metastasis (LNM) than others. However, there are no individual criteria for endoscopic resection (ER) in mixed histology. The aim of study was to investigate whether new criteria for mixed histology is necessary for ER in EGC.
Methods: From January 2005 to December 2012, 3,419 patients with EGC underwent surgery. Lesions were classifi ed into three histological classifi cations: Japanese classi- fi cation, WHO classifi cation including SRC mixed histology, and Lauren classifi cation.
Mixed type in Lauren classifi cation was reclassifi ed into four types according to the proportion of differentiated and undifferentiated components. Clinicopathologic char- acteristics were compared according to histological classifi cations, special reference to ER criteria.
Results: 179 (5.2%) lesions were classified as mixed type in Lauren classification.
Among them, 54 (30.2%) lesions were differentiated-predominant mixed type. 361 (10.6%) lesions were classifi ed as SRC mixed histology. Mixed type lesions in Lauren classifi cation and SRC mixed lesions were signifi cantly associated with larger size and higher LNM than others. Among the lesions meeting ER criteria, 20 and 55 lesions were categorized into mixed type in Lauren classifi cation and SRC mixed histology, respective- ly. However, there was no LNM among the lesions recategorized into mixed histology.
Conclusions: Mixed histology in EGC showed higher LNM than other histologies.
However, there was no LNM among the lesions meeting the present ER criteria.
