The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 473
Slide Session
S-LG-04 Lower GI Tract
Probe-Based Confocal Laser Endomicroscopy for Evaluating the Submucosal Invasion of Colorectal Neoplasms: A Feasibility Study
Bun Kim1, Soo Jung Park1, Jae Hee Cheon1, Tae Il Kim1, Won Ho Kim1, Sung Pil Hong1 Severance Hospital, Korea1
Background: Probe-based confocal laser endomicroscopy (pCLE) is a novel method that provides in-vivo histology of colorectal neoplasms. However, there has been no study to evaluate in-vivo histology in colorectal submucosa. The aim of this study was to assess the feasibility and safety of pCLE in evaluating colorectal submucosa layer and suggest diagnostic criteria of cancer infi ltration in submucosa.
Methods: This was a prospective, single-center pilot study. From March 2014 to June 2014, 20 patients who underwent scheduled colonoscopic procedures were enrolled.
All procedures were performed by a single expert colonoscopist. The pCLE videos of each lesion were acquired and biopsies were taken for histopathology.
Results: Thirty submucosal layers of twenty patients were analyzed. Among 30 le- sions, real-time video sequences were obtained in all lesions with mosaic images. Most of the images were adequate for evaluation of cellular morphology and structure of the submucosal layers. We classifi ed submucosa into normal, fi brosis, and cancer infi ltration with representative images. In the layer which was dissected into the deep submucosa, muscles that were just below were shown as longitudinal structure of single myofi brils of a cylindrical shape with bright stained capillaries (fi gure 1(A)). In superfi cial submucosa, small and round cells were scattered singly (fi gure 1(B)). Bright linear shape structures were woven irregularly without cellular structure in submu- cosal fi brosis without carcinoma infi ltrations (fi gure 1(C)). Dark and irregular cell nests which were contained irregular cell architecture with little or no mucin were shown at submucosa with invasion of adenocarcinoma (fi gure 2). No adverse events occurred during the procedures.
Conclusions: Submucosal assessment of pCLE during colonoscopy is feasible and safe.
Prospective large scale studies are mandatory for further evaluation of the clinical impact of this technology during endoscopic procedure.
S-LG-05 Lower GI Tract
Clinical Predictors at Diagnosis for Disabling Crohn’s Disease in Korea : Results from the Connect Study
Jae Jun Park1, Yoomi Park1, You Sun Kim2, Joo Sung Kim3
Department of Internal Medicine, Yonsei University College of Medicine, Korea1, Department of Internal Medicine, Inje University College of Medicine, Korea2, Department of Internal Medicine, Seoul National University College of Medicine, Korea3
Background: Identifi cation of Crohn’s disease (CD) at high risk of disabling disease would be invaluable guidance for clinicians in making initial therapeutic strategy. The aim of this study was to identify at diagnosis factors predictive for subsequent 5-year disabling course and to validate previously proposed clinical predictors in Korea pa- tients with CD.
Methods: Among the 1,382 CD patients who comprise the retrospective cohort from 32 hospitals in Korea, we excluded patients underwent abdominal surgery within 1 month after diagnosis, received immunosuppressant or biologics therapy within 6 months of diagnosis, and those with limited follow-up duration. A total of 843 patients with a follow-up of longer than 5 years were enrolled. The defi nition of dis- abling CD, which was modifi ed from ¹Saint-Antoine defi nition, included at least one of the following criteria: further hospitalization for fl are-up or complications, need for immunosuppressant or biologics, intestinal resection or perianal surgery.
Results: The rate of disabling CD during subsequent 5-years after diagnosis was 89.4%. An age below 40 years (Odd ratio [OR]:5.3, 95% confi dence interval [CI]:3.232- 8.751), the initial requirement for corticosteroids use (OR:2.3, 95% CI:1.116-4.797), and jejunal involvement (OR: 2.4, 95% CI:1.113-5.169) were independently associated with disabling CD. Meanwhile, presence of perianal disease, which was signifi cant predictor in previous study, was not related with disabling CD. Based on those three predictors, the positive predictive value of the risk factors for disabling disease was 0.62 (zero risk factor), 0.90 (one risk factor), 0.96 (two risk factors), and 1.00 (three risk factors).
Conclusions: Predictors for subsequent 5-year disabling course are an age below 40 years, the initial requirement for corticosteroids, and jejunal involvement in Korean patients with CD. Further prospective validation of these parameters is warranted.
¹Beaugerie et al, Gastroenterololgy, 2006; 130: 650-656
S-LG-06 Lower GI Tract
Long-Term Clinical Outcomes of Urban Versus Rural Environment in Korean Patients with Crohn’s Disease:
Results from the Connect Study
Yoon Suk Jung1, Dong Il Park1, ByongDuk Ye2, Jae Hee Cheon3, You Sun Kim4, Young Ho Kim5, Joo Sung Kim6, Hiun Suk Chae7, Kwang Ho Baik8, Dong Soo Han9 Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea1, Asan Medical Cen- ter, University of Ulsan College of Medicine, Korea2, Yonsei University College of Medicine, Korea3, Seoul Paik Hospital, Inje University College of Medicine, Korea4, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea5, Seoul National University College of Medicine, Korea6, Uijeongbu St Mary’s Hospital, College of Medicine, Catholic University of Korea, Korea7, ChunCheon Sacred Heart Hospital, Hallym University College of Medicine, Korea8, Hanyang University College of Medicine, Korea9 Background: Environmental factors and genetic predisposition are thought to play an important role in the pathogenesis of Crohn’s disease (CD). Although numerous studies have reported the positive association between urban environment and CD devel- opment, few studies have compared the clinical outcomes between urban and rural environments. Therefore, this study aimed to compare the clinical characteristics and long-term prognosis between urban and rural populations of patients with CD.
Methods: This retrospective multicenter cohort study included 1002 Korean patients with CD (743 urban residents and 259 rural residents) from 32 medical centers.
The clinical outcomes of urban versus rural populations were compared using the Kaplan-Meier method and log-rank test.
Results: Disease distribution and behavior of the urban population did not differ from those of the rural population. There were no signifi cant differences in the cumulative prob- abilities of perianal fi stula (P=0.086) and intestinal complications such as stricture (P=0.109), fi stula (P=0.952), abscess (P=0.227), and perforation (P=0.382) between the two groups.
In addition, no signifi cant differences were observed between the two groups with regard to the cumulative probabilities of immunosuppressant use (P=0.527) and biological agent use (P=0.731). However, the cumulative probability of surgery in the urban population was signifi cantly higher than that in the rural population (19.2%, 25.8%, and 35.8% vs. 13.6%, 20.4%, and 29.8% at 1 year, 5 years, and 10 years, respectively; P=0.040).
Conclusions: The urban population required surgical treatment more frequently than the rural population, although there were no significant differences in cumulative probabilities of immunosuppressant and biological agent use. Our results suggest that factors associated with an urban lifestyle may infl uence poor prognosis of CD.
S-LG-07 Lower GI Tract
Assessment of Satisfaction with Healthcare in Patients with Infl ammatory Bowel Disease: An Online Korean Association for the Study of Intestinal Disease (KASID) Survey
Young Sun Kim1, Sung-Ae Jung2, Kang Moon Lee3, Soo Jung Park4, Tae Oh Kim5, Chang-Hwan Choi6, Hyun Gun Kim7, Won Moon8, Chang Mo Moon2, Hye Kyoung Song2, Soo-Young Na9, Suk-Kyun Yang10
Seoul National University Hospital Healthcare System Gangnam Center, Korea1, Ewha University School of Medicine, Korea2, The Catholic University College of Medicine, Korea3, Yonsei University College of Medicine, Korea4, Haeundae Paik Hospital, Inje University College of Medicine, Korea5, Chung-Ang University College of Medicine, Korea6, Soonchunhyang University College of Medicine, Korea7, Kosin University College of Medicine, Korea8, Jeju National University School of Medicine, Korea9, Ulsan Uni- versity College of Medicine, Korea10
Background: Patient satisfaction with healthcare services provided for Infl ammatory bowel diseases (IBD) is essential to improve treatment adherence, producing improve- ments in disease outcomes. The aim of the present study was to assess patient’s satis- faction with healthcare as well as treatment and patient–physician communication.
Methods: Self-administered, computer-aided internet-based questionnaires were dis- tributed to members of Korean patients’organization for IBD from March to April 2014 by Korean Association for the Study of Intestinal Disease (KASID).
Results: Surveys were completed by 502 patients with IBD [Crohn’s disease(CD): 276;
ulcerative colitis(UC): 226]. Most (78%) of respondents received a final diagnosis within a year from noticing fi rst symptoms. However, for 22%, it took longer than a year, for 4% longer than fi ve years. With regard to treatment, 51% of all respondents reported that they were very or somewhat satisfi ed with their current treatment, and 57% of the respondents reported that the doctors provide the best range of options for patients to get in touch. Considering accessibility to the hospital, 35% of patients have easily adequate access to a physician. As for communicating with physicians, 33% of the respondents felt that they were not able to tell their physician something potentially important about their illness. Furthermore, 75.3% of the respondents felt
